Sexual functioning in patients with inflammatory bowel diseases (IBD) prevalence, predictors, and potential benefits of cognitive behavioral therapy (CBT)

Objectives: Patients with inflammatory bowel diseases (IBD) express concerns about their disease’s effects on intimacy and sexuality. This study assessed sexual dysfunction in IBD patients and indirect beneficial effects of IBD-specific cognitive behavioral therapy (CBT) on improving sexual functioning over time. Materials & Methods: N = 118 patients participated in a multi-center randomized controlled trial (RCT) and were assigned to either an 8-week ‘IBD-specific CBT’ intervention or waitlist-control group. Standardized self-report measures assessed sexual functioning (the sexuality item of the Inflammatory Bowel Disease Questionnaire, IBDQ), symptoms of depression and anxiety (Hospital Anxiety and Depression Scale: HADS), health-related quality of life (HRQoL; MOS Short-Form Health Survey: SF-36), and IBD symptoms/disease activity (Simple Clinical Colitis Activity Index: P-SCCAI, Harvey Bradshaw Index: P-HBI). Data were analyzed cross-sectionally and longitudinally by means of repeated measures and mediation analyses. Results: At baseline, nearly half of patients reported sexual problems, including 21.4% with moderate and 15.5% with (very) severe sexual problems, as well as 10.2% reporting sexual abstinence due to IBD. At baseline, sexual functioning was weakly to moderately associated with symptoms of depression or anxiety (r<-0.4) and physical health complaints (r=.3). Longitudinally, ‘IBD-specific CBT’ had positive effects on sexual functioning which were mediated by improved depressive symptoms (R²=32.9%). Conclusions: Impairments in sexual functioning are common in IBD patients, which appears in part related to depressive symptoms. Addressing sexual problems in clinical care is crucial, and this study provided preliminary evidence that ‘IBD-specific CBT’ directed at mental health outcomes, such as depressive complaints, can parallelly help to alleviate sexual dysfunction.