If you have ulcerative colitis, you might be wondering whether it’s possible to have a satisfying sex life. The short answer is yes. Up to half of women and a quarter of men with inflammatory bowel disease (also known as IBD, which includes ulcerative colitis and Crohn’s disease) experience some sexual problems.
Fortunately, “There’s a lot you can do to address issues that impact your sexuality and ability to be intimate with a partner,” says David Rubin, MD, co-director of the Digestive Diseases Center at the University of Chicago Medicine and lead scientific advisor for the GI Research Foundation (GIRF). Here’s what can help.
Start With Your Doctor
“Don’t ignore problems and wait for them to get better. Talk to your health care team,” Rubin says. Most IBD doctors believe that treatment for it should also address sexual health. But only 14 percent bring up sex to their patients most or all of the time, according to a 2014 study from Rubin and his colleagues.
And another 31 percent only bring it up sometimes. But that’s because most doctors feel crunched for time, not because they don’t care. “You may need to bring it up to your doctor, so they know it’s a priority for you,” Rubin says.
Be clear about how your symptoms impact your ability to be intimate. For example, if urgency issues make you avoid sex, your doctor may be able to adjust your treatment plan. It’s important to remember that feeling good shouldn’t be your only treatment goal, Rubin says. “The goal is deep remission,” he says. “That gives you much more control, which can improve your confidence.”
Being able to be sexually spontaneous is important to most people with IBD. That may be possible once you’re in remission. But if you have active colitis or have had surgery to remove your rectum or colon, sex will require a little planning.
Using the bathroom before you’re intimate can help you feel more confident. Even so, “An inflamed rectum doesn’t give the right signals,” Rubin says. If you have a hard time telling when you really need to use the bathroom or whether it’s just gas, that can be a sign that your treatment plan isn’t fully effective.
If you use a pouch or ostomy bag, empty it right before you plan to be intimate. “If you’re embarrassed about it or if it gets in your way, let your medical team know,” says Amanda McClure, MD, a colon and rectal surgeon at IHA/Saint Joseph Mercy Health System in Ypsilanti, MI. “They can discuss other options that may help, like using a deodorized bag or pouch or placing it in a different area.”
Planning ahead may feel like a downer, but “try to remember that it isn’t unique to ulcerative colitis,” says Jennifer Berman, MD, a urologist specializing in female sexual health. “There are numerous chronic conditions, not to mention other issues that people face, that make advance planning necessary. Do your best to look at planning as something that helps, rather than hurts, your relationship.”
Try Not to Stress About Sex
The more you stress about your sex drive and performance, the less likely you’ll be able to get in the mood. That’s why it’s important to give yourself a break if you’re noticing occasional issues, like being too tired to be intimate with your partner. “That’s normal, especially as we get older,” Berman says.
But if your libido is consistently low or you have issues like vaginal pain or erectile dysfunction, tell your doctor. Some UC medications can impact your sex drive and ability to have sex. A new medication or sexual aid, like lubricant, may improve the way you feel and function. If you have physical problems like a fistula or weak pelvic floor, a specialist should be able to help.
Being open with your partner can also ease anxiety. “If you’re just dating or in a new relationship, you’ll want to establish trust before telling them about your condition,” Berman says. “But once you’re in a committed relationship, it can take pressure off to be up-front about your needs and fears.”
Consider getting your partner involved in your medical care, too, especially if you’re going to have surgery for your UC. “We encourage partners to come to appointments and have an open discussion about this stage of treatment,” McClure says. “It helps make everyone more comfortable and get prepared for what comes next.”
Above all, be gentle on yourself. “Stress makes pain, discomfort, and UC symptoms worse,” Berman says. “Do your best not to focus on what you don’t have or can’t do. The faster you accept your situation for what it is, the better your self-confidence and sex life are likely to be.”