Barriers to Discussing Sexual Health and Ulcerative Colitis
Talking about sex is often hard, but talking about sex and mood disorders can be especially tough. “Sexual dysfunction can be a consequence of the psychological problems” that come with IBD, says Dr. Keefer. “And both sex and mental health are taboo topics in this country.”
Lanier has experienced this hesitancy to discuss sexual dysfunction firsthand. “It’s a tough topic of conversation,” he says, “and I used to be very reserved about it. Shame and embarrassment were big parts of that.”
While it can be difficult for many people with UC to discuss how the condition is affecting their sexual health, Dr. Friedman says that doctors can also be reluctant to bring up the subject.
When “you ask patients what’s important to them,” Friedman says, the answer is often “lifestyle factors like sex, fertility, and reproduction.” Sometimes, she says, “it’s doctors who are really uncomfortable talking about these things. Patients will gush about it if you prompt them.”
Keefer says that while physical challenges and debilitating thoughts can frustrate people’s sex lives, these problems are not inevitable. “Your sex life doesn’t have to be defined by this diagnosis,” she says.
Many of the UC symptoms that make satisfying sex difficult are treatable, and if side effects from your medication are causing a problem, your doctor may be able to adjust your medication. If you feel burdened by depression or anxiety, your doctor can refer you to therapy if you’re not already going regularly, and a psychiatrist may be able to adjust any medication you’re taking for a mental health condition. But none of that is possible if doctors and patients don’t talk about sex.
“If patients initiate this conversation, they can have a much more normal life than they might have ever thought was possible,” Friedman says. Here are two ways to start a dialogue with your doctor.
- Talk about the symptoms that interfere with your sex life. “Gastroenterologists don’t always think of sex as in their wheelhouse,” Keefer says. But doctors want to hear about any UC symptoms that are interfering with your life, including your sex life.
- Talk about sex as it relates to fertility. Most people with IBD receive a diagnosis before age 30 — a time when many of them are thinking about having children. Even if you have no immediate desire to have kids, bringing up the topic can lead to a conversation about sexual desire, frequency, and satisfaction. Plus, Friedman says, “There are a lot of misconceptions about IBD and reproduction. It’s an opportunity for clinicians to correct them.”
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