Sex, relationships and inflammatory bowel disease

The physical and emotional impact of IBD is very individual and, as such, people are affected in different ways.^2–4

Whether and how much IBD affects you and your relationships can depend on a combination of factors such as the:⁴

• the severity of your condition
• physical impact it has on you
• the emotional aspects of diagnosis
• which treatment you are receiving

Depression and anxiety (your mental health), fatigue, sleep disturbance and pain are associated with a decreased interest or satisfaction with sex, and physical changes to your body can reduce self-confidence, making intimacy more difficult for some people.^2,5

It may help to talk to your loved one about your condition and how it is making you feel so they can better understand what you are experiencing and how they can support you. Visit our talking about your IBD page for some tips.

Most people with IBD experience fatigue at some point but there are ways you can manage it. Feeling fatigued is a symptom of your ulcerative colitis or Crohn’s disease and you should discuss this with your doctor. Learn more.

Low mood, depression and anxiety are more common in people with a chronic illness like IBD, and these negatively impact both libido (sex drive) and worsen fatigue.⁶

You should speak to your doctor about any changes to your mood which may be impacting your daily living and you can learn more about mental health and IBD here.

Living with IBD can affect your body image and self-esteem. And these in turn can make it difficult to have an intimate relationship with someone.⁴

If you feel this way, know that you are not alone – almost 70% of IBD patients report impaired body image.⁷

Impaired body image is more common in:⁷

• women (75%) vs men (51%)
• those who have had IBD-related surgery (81%) versus non-surgical patients (51%)

You have no reason to feel shame or embarrassment – but this is easier said than done if you are struggling with your body image, a good place to start might be our tips on living well with IBD.

You may also be able to access counselling through NHS sexual health services.⁸

One of the major challenges IBD patients face is not feeling able to be spontaneous when engaging in sex, because it requires a little more planning and communication than before.

Talking to your partner about how your condition impacts you can be overwhelming, but it can help your partner understand how you feel and in turn help you both feel more comfortable.

It can be very difficult to bring up, but someone you trust will be receptive and listen to you. Remember, although it's important to communicate with your partner you can determine the boundaries around conversations and only share what you are comfortable with.

Some aspects of intimacy and sex can be better broached with your doctor. They will be able to signpost you or refer you to a specialist like a psychologist or sex therapist. Remember, you can share as much as you would like.

You can read more about your healthcare team here.

The symptoms and complications of IBD (bloating, wind, diarrhoea, incontinence, fistula, abscess) can be uncomfortable or painful, make the thought of sex unappealing, or cause you to worry or be very nervous about having sex.⁴

There are many things you can do to make you more comfortable and less worried, such as:⁴

• wearing loose fitting clothes
• adjusting your eating times
• going to the toilet or having a shower before sex
• preparing for the possibility of an accident with towels and wet wipes nearby
• talking to your partner about your feelings and worries.

Your healthcare team can give you advice on sexual activity if you are managing a fistula. If you are worried about incontinence, you could try to have sex at times when your gut is less active, and you can ask to be referred to a continence specialist.⁴

You might need to have an ileostomy or colostomy as part of the management of your Crohn’s disease or ulcerative colitis. This might mean you need to have a stoma. Having a stoma does not have to affect your sex life and many people with IBD find that their libido (sex drive) is improved after surgery as they have better control of their condition.

However, some types of surgery can make certain sexual positions painful, especially during the healing period after surgery. With time, this pain should improve. Ask your IBD team and surgical team if there is anything you should know, and they will be able to inform you.⁴

Before surgery, speak to your IBD team about any concerns might have about sexual function or fertility. If you have a partner, you may wish to include them in the conversation. Being as well informed as possible will help you to feel better about your operation.

Your IBD team may advise when they think it’s safe for you to have sex after surgery.⁴ You might want to explore new ways of being intimate when you do resume sexual activity. It’s common to feel less comfortable; research shows 37% of people change their usual sex positions after colorectal surgery.⁹

Sex positions may feel different for several reasons which include:

• having scar tissue which can cause pain
• changes to sensation due to nerve damage
• difficulty getting and maintaining erections.

However, some changes may be temporary and can improve over time. If they don’t, do not hesitate to speak to your IBD team for advice and support as they may be able to help.

There is no right or wrong answer to engaging in anal sex with IBD. However, there are risks associated with anal sex even without IBD as the lining of the bottom and rectum can be easily damaged.⁴

With IBD, the risk of catching and passing on an infection from anal sex is higher if there is an open wound in the area.⁴

To find out more information about what you can do to help lower your risk of damage visit CCUK’s sexual relationships page.