Gastroenterologists play ‘important role’ in addressing sexual dysfunction in patients
Click Here to Manage Email Alerts
Sexual dysfunction is a common problem for patients with gastrointestinal disorders. The sensitive nature of the topic can cause patients and providers to avoid discussing it, resulting in many patients not receiving access to treatment.
Gastroenterologists can help address this problem by asking patients about their sexual functioning and providing recommendations for further evaluation and care.
Types and causes of sexual dysfunction
Sexual problems fall into four domains: problems related to sexual desire, arousal, orgasm and pain associated with sexual activity. It is important to understand that causes of sexual dysfunction may be complex and include biomedical, psychological, sociocultural and interpersonal factors.
In some cases, biomedical factors may be related to overall health, as reduced sexual functioning can result from a variety of medical conditions and is a common side effect of several types of medications. In contrast, biomedical factors may be related to the GI condition itself, such as pain, pelvic floor dysfunction or physiological changes resulting from surgery or active disease.
Mental health conditions, such as depression and anxiety, as well as other psychological factors including sexual performance anxiety can reduce a person’s interest in sexual activity and interrupt the body and mind’s ability to respond sexually. Often, it is challenging to fully characterize a factor as purely biological or purely psychological.
For example, a patient with perianal Crohn’s disease may experience sexual dysfunction resulting from use of a suppository or enema, though not directly. Rather the use of a suppository or enema can indirectly contribute to sexual dysfunction by desexualizing this area of the body, causing self-consciousness or embarrassment in the presence of a partner and interrupting the couple’s usual sexual routine.
Sociocultural factors affecting sexual function may include religious and cultural beliefs (particularly those related to sexual activity), level of sexual knowledge, stress level and environmental factors (such as having sufficient privacy for sexual activity).
Interpersonal factors may include whether the patient is single or partnered, relevant experiences in prior romantic and sexual relationships, and the partner’s response to the GI condition and sexual difficulties.
Role of a gastroenterologist
Gastroenterologists should be aware that sexual dysfunction is common among GI patients and should routinely assess this among their patients. Assessment can be completed in just a few sentences. Consider asking a question such as, “It’s common for people with GI conditions to experience difficulties related to sexual functioning. Have you noticed any changes in your sexual functioning or satisfaction lately?” If the patient endorses a problem, let them know that effective treatments exist.
Consider whether their GI symptoms or treatment may be contributing and address these as necessary. In many cases, the next step may be to recommend that they discuss the sexual problem with a primary care doctor, gynecologist or urologist for evaluation and treatment.
When discussing sexual functioning, it is important to avoid making assumptions related to sexual practices based on age, gender, sexual orientation, religion or other socio-demographic variables. Also, remember to maintain an open definition of sexual activity: It refers to any activity resulting in sexual pleasure such as manual, oral, vaginal and anal stimulation and/or penetration. Be mindful of the ways that a GI condition or its treatments may disrupt any of these activities.
Treating sexual dysfunction
Treatment of sexual dysfunction is multidisciplinary, often including a urologist or gynecologist, a pelvic floor physical therapist and a sex therapist a mental health professional who uses psychotherapy to improve sexual function and satisfaction. A sex therapist works directly with the patient (and often, the patient’s partner) to address the psychosocial, sociocultural and interpersonal factors affecting their sexual functioning. Patients and providers can locate a certified sex therapist at www.AASECT.org.
Sexual dysfunction is common among GI patients and is often closely tied to their GI symptoms and condition. Gastroenterologists play an important role in promoting sexual well-being among their patients by evaluating sexual dysfunction, treating the concern with support and care, and providing recommendations for further evaluation and treatment.
Collapse
Read more about
Click Here to Manage Email Alerts
