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Crohn’s disease and intimacy

By Kevin Ashby, MD, told to Michele Jordan

I became a doctor because I knew it would be intellectually stimulating and I wanted to help people. I truly believe in treating my patients like family. As a board-certified gastroenterologist, I treat people with a variety of digestive issues, some mild and some more serious. I see many patients with Crohn’s disease, which is an inflammatory bowel condition that affects the digestive system. It can cause a number of symptoms, ranging from abdominal pain and frequent diarrhea to swelling and fatigue.

I’ve been in this field for many years, and I’ve heard of a variety of issues that come with disease. Most people tell me about the physical impacts, but Crohn’s disease can also impact many areas of a person’s personal life.

It’s a sensitive subject

One area that Crohn’s disease can impact is a person’s sex life. Many patients are not comfortable talking about intimacy and how Crohn’s disease can interfere with their social life. Because of this, they often don’t get the help they need. On the other hand, some patients are comfortable talking about the impact of their disease on their intimate life. As physicians, we understand this is a sensitive topic for some and are here to help. People with Crohn’s disease are able to be emotionally and physically intimate. There are just a few things to consider to ensure a certain level of comfort.

Whenever there is a gastro problem that requires the patient to go to the bathroom regularly (as with Crohn’s disease), it can have an impact on sex and dating. Some patients worry about a flare-up occurring and the challenges it could bring to their social life.

People sometimes forget that Crohn’s disease is a systemic disease, which means it can affect the whole body, not just the digestive system. People with Crohn’s disease may experience lethargy (or fatigue), weakness, swelling, rectal bleeding, and it can affect the skin, eyes, and other organs in the body. Crohn’s disease can also impact the urinary tract. Certain symptoms can cause changes in hormone levels or other symptoms that can affect sex drive.

Women with Crohn’s disease may have what is called dyspareunia, which is when intercourse is painful.

The impact of Crohn’s disease on energy levels is also a factor. It’s hard to have the motivation to date or have an active sex life when you’re not feeling well. My patients talk about how it can keep them from going out to dinner with friends or other activities that can help sustain a long-term relationship.

The emotional side

The physical impact of Crohn’s disease on intimacy is one thing, but I also see emotional effects. There may be negative opinions about body image, embarrassment about the urgency or frequency of using the toilet and, in the most extreme cases, some depression. It can be emotionally draining not feeling ready to go out and socialize or build a relationship.

Crohn’s disease can affect your daily life, and for some, coping with it can be very difficult. It can be life changing and unpredictable. The fear of having to go to the bathroom unexpectedly can weigh heavily on some people. Dealing with symptoms while trying to maintain an intimate life can be incredibly stressful.

Make adjustments

Because Crohn’s symptoms – particularly the urgency to go to the bathroom – can be unpredictable, some patients have had to get creative with their love life and intimacy. I’ve had patients say they prefer to go to restaurants that don’t have spicy food, so they don’t have to go to the bathroom. Some of my patients say they’d rather not do anything food related and may suggest a walk in the park or something instead of meeting at a restaurant. Many Crohn’s disease patients may not go to the person they are dating and instead suggest meeting at their home with access to their own bathrooms and privacy.

In general, sex is safe for people with Crohn’s disease, and I don’t often suggest that patients abstain from sex unless it’s painful. Anal sex can be painful after some surgeries for Crohn’s disease. Pushing with swelling can make certain positions uncomfortable. Although I don’t hear it that often, it can happen. When this happens, I recommend that my patients stop having sex until the problem causing this pain can be resolved. This is the only time I suggest people don’t have sex with Crohn’s disease – when it hurts. Pain can be their guide in this case.

There is hope

Some people shared some concerns about how the treatments might impact intimacy. I didn’t see much. The main concern for new drugs is the risk of infection, but I have not seen this impact on the private lives of my patients.

Over the past 10 years or so, many new drugs have come out for Crohn’s disease. These drugs have revolutionized the lives of many people with Crohn’s disease and their management of the disease. These drugs have allowed many patients to see an improvement in their symptoms and a much better quality of life. Some of these new drugs have helped reduce the frequency of toilet use, abdominal pain, and energy levels. They have helped many of my patients feel better overall. I am happy to see how the treatments have enabled patients who suffered regularly to do things that they may have stopped doing before.

Talk to your doctor about your options. Your medical support team can help you with physical issues that may affect your intimacy.

Some other tips that I suggest to my patients if they are having difficulty in their sexual, intimate or romantic life with Crohn’s disease:

  • Talk to your partner. You might be surprised that some things you care about don’t matter much to them. I haven’t had any partners come to complain, which can say a lot! This does not mean that these problems are not there, but they may not be as important as the person affected. Crohns may think they are.
  • Sex should not impact your stoma/pouch if you have one, but patients should consider changing it before sex so there is no potential damage. There are many products on the market that hold pouches in place and garments that can discreetly cover your stoma and pouch.
  • Talk to your doctor about whether you can take anti-diarrheal medicine before sex or before dating. This could save you time if your bowel movements are unpredictable, as they can be with Crohns.
  • Think of different ways to be intimate beyond sex. For some reason, traditional sex might not be an option for you at this time, but talk to your partner about other ways to show your affection to each other.
  • Consider getting additional help. In addition to talking to your gastroenterologist, talk to a sex therapist or counselor if what you’ve tried so far isn’t working. Some doctors specializing in Crohns disease may also be able to offer additional solutions.

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