[Sexual dysfunctions after conventional proctocolectomy]

Abstract

Seventy-one women who had a proctocolectomy for ulcerative colitis (n = 41) or Crohn's disease (n = 30) were interviewed in the follow-up clinic about gynaecological problems and fertility. 49% (35/71) of the women had a distressing vaginal discharge after proctocolectomy, compared with 9% before surgery. At the gynaecological examination 45% (32/71) had a heavy vaginal secretion without any signs of an acute vaginal infection. In 68% (30/44) fluid retention in the vagina was associated with a caudally firmly fixed and dilated posterior vaginal fornix. Twelve per cent (8/66) of the women reported dyspareunia before surgery. After surgery, 27% (18/66) complained of this symptom. Fertility was significantly reduced after surgery since only 37% (10/27) of the women who attempted to become pregnant succeeded within five years follow-up. The corresponding figure before surgery was 72% (39/54). Those who conceived went through pregnancy and parturition without any incident, 6 of 24 delivered by caesarean section. 57 men who had a proctocolectomy for ulcerative colitis (n = 41) or Crohn's disease (n = 30) were interviewed in the follow-up clinic about the presence of sexual disturbances and their incidence was studied, 57% of elderly patients (above 40 years old) complained a reduced libido and sexual satisfaction. In younger patients (below 40 years old) 33% complained an impaired quality of sexual ife and 22% complained an impaired sexual satisfaction. However, despite some sexual dysfunction, 56% reported improved sexual life and 67% improved sexual satisfaction. This may be explained by improved general health and increased libido after removal of diseased bowel. The incidence of patients with ejaculatory disfunction (retention or retrograde ejaculation) is 9%. The increased awareness of uro-genital disfunction and therefore their prevention can contribute to the improvement of quality of life and to the rehabilitation of patients with benign diseases.