Introduction

Irritable bowel syndrome (IBS) is one of several functional gastrointestinal disorders, which are often associated with significant changes in sleep patterns, appetite, body weight, and sexual function; these changes can impact still further the already impaired quality of life in such patients. A study conducted in 1998 examined the prevalence of sexual dysfunction in patients with upper (functional dyspepsia) or lower gastrointestinal tract (IBS) disorders, comparing their findings with those in healthy volunteers. Here's a summary of their report.

Method

The investigators surveyed 683 patients referred to the University of California (Los Angeles) Center for Functional Bowel Disease and Abdominal Pain. They were mostly Caucasian, affluent, and well-educated. An organic cause for their symptoms was excluded by full work-up, and those who met the accepted diagnostic criteria for IBS and non-ulcer dyspepsia (NUD) were included for further analysis.

The normal subjects were healthy volunteers who completed questionnaires about gastrointestinal symptoms. Out of 247 normal volunteers enrolled, there were 42 (17%) who had symptoms signifying IBS who had not sought treatment, and 10 who had NUD symptoms who had also not sought treatment. The 'non-patients' were designated IBS-NP and NUD-NP, respectively.

The sexual function questionnaire asked for reports of any interference with sexual function in the previous 6 months, with characterization of the problem. The types of difficulty included were: decreased sexual drive, pain during intercourse, symptoms directly preventing intercourse, and worsening of sexual problems during worsening of bowel problems.

An additional questionnaire was used to assess psychological symptoms, focusing on anxiety and depression, as these are commonly reported in patients with functional gastrointestinal disorders.

Results

The demographics of the patients and the normal volunteers showed they were fairly well-matched. There were 62% females in the 247 normal volunteers, and 72% in the 683 patients group; the patient population was slightly older than the normal volunteers. These variables were therefore controlled in the analysis.

The prevalence of reported sexual dysfunction was 43% in the patients group and 16% in the normal volunteers (excluding the IBS-NP and NUD-NP). After controlling for differences in age and gender, the odds ratio for patients having sexual dysfunction was highly significant at 4.33 (95% CI 2.69-7.25). The IBS-NP group had a prevalence of 24%.

There was no difference in the prevalence of sexual dysfunction between patients with IBS and NUD. The most frequent cause of dysfunction was decreased sexual drive, in both patients and normal volunteers, followed by dyspareunia. (The latter was more common in female patients). Of the total patients reporting a worsening of sexual function during worsening of their bowel symptoms, 90% of them had IBS or IBS-with-NUD.

A further analysis examined the severity of symptoms from the bowel questionnaire with sexual dysfunction. There was a significant correlation between the severity of gastrointestinal symptoms and frequency of sexual dysfunction. On the other hand, the presence of anxiety or depression was not different between patients with and without sexual dysfunction.

In another analysis, it was found that sexual dysfunction was commoner in constipation-predominant than in diarrhea-predominant IBS - 49% and 28%, respectively.

Comment

This study showed that symptoms of functional gastrointestinal disorders - IBS and NUD - were significantly associated with sexual dysfunction. There were no differences in this finding with respect to the type of disorder (NUD or IBS), except that sexual problems were greater in constipation-predominant IBS, when compared with the diarrhea-predominant type. Nor did the psychological symptoms that were assessed correlate with sexual problems.

It should be noted that the most common type of sexual dysfunction was decreased drive, or libido, regardless of age or gender. This is a feature also seen in other chronic disorders, such as diabetes, arthritis, and Parkinson's disease.

The authors of the study believe that the psychological distress resulting from sexual dysfunction can help maintain the vicious cycle of functional gastrointestinal disorders. It should be noted that loss of sexual drive is often reported in patients with chronic fatigue syndrome, and fibromyalgia.

Since this study was published, effective medications have become available specifically to treat the symptoms of IBS: alosetron for diarrhea-predominant IBS and tegaserod for constipation-predominant IBS. It might be appropriate to study whether such treatments also improve the sexual satisfaction of the patients taking them.