P202 - Sexual Distress After Restorative Proctocolectomy for Ulcerative Colitis

Purpose/Background: The reported prevalence of sexual dysfunction in patients with ulcerative colitis is high, especially in those who have previously undergone abdominal and pelvic surgery. However, most studies have focused primarily on physiologic sexual function and have not considered the psychological aspects of bowel function on sexuality. The objective of this study was to determine the proportion of ulcerative colitis patients who are experiencing sexual distress after restorative proctocolectomy, and to explore the effects of social demographics, age, bowel function, anxiety and depression in this patient population.

Methods/Interventions: This was a cross-sectional survey study using validated questionnaires in all patients who had undergone pelvic pouch procedures for ulcerative colitis at a single high-volume colorectal surgery center in Toronto, Canada between 1980-2022. Eligible patients identified via prospective database, were contacted, and invited to complete the survey via online secure link. The survey consisted of several validated questionnaires including the 13-item Sexual Distress Scale (SDS), the Hospital Anxiety and Depression Scale (HADS) and the Colorectal Functional Outcome (COREFO) Questionnaire. The primary outcome was the proportion of patients with sexual distress defined as a score of 11 or greater on the SDS. Regression analysis was used to explore factors that may contribute to sexual distress (i.e., operative details, age, gender, income, education, ethnicity, sexual orientation, relationship status, bowel function, anxiety, and depression scores)

Results/Outcomes: A total of 2420 patients who underwent pelvic pouch procedure for ulcerative colitis from 1980-2022 were identified from our institution. After excluding patients without current contact information, who had undergone pouch excision, or who were decreased, a total of 1910 patients were contacted, of whom 498 responded (26%). A total of 88 patients declined to answer one of more sexual function questions, therefore 410 were included in the analysis. 189 patients (46%) screened positive for sexual distress on the SDS questionnaire. Most patients self-identified as white (n=367 (90.8%), heterosexual (n=387, 94.9%), and in a relationship (n=340, 83.7%). On multivariable analysis, self-identified female gender (OR: 2.71, 95%CI 1.40, 5.24, p = 0.003), higher bowel dysfunction according to total COREFO score (OR: 1.06, 95%CI 1.03, 1.09, p < 0.001), and higher depression scores (OR:1.18, 95%CI 1.02-1.37, p=0.027) were all independently associated with sexual distress.

Conclusion/Discussion: Sexual distress is common among patients following restorative proctocolectomy for ulcerative colitis. Female gender, worse bowel function, and higher depression scores are all associated with sexual distress, but not age, operative technique, income status, level of education, relationship status, or sexual orientation. These factors should be kept in mind when counselling patients prior to surgery. Future research is needed to investigate the reasons for these associations in order to develop effective mitigating strategies.

Predictors of sexual dysfunction in patients with ulcerative colitis with ileoanal pouch