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Irritable Bowel Syndrome and Sexuality

Irritable bowel syndrome (IBS) is a common chronic disorder that affects the stomach and intestines, also called the gastrointestinal tract. Symptoms include cramping, abdominal pain, bloating, gas, diarrhoea or constipation, or both. Only a small number of people with IBS have severe symptoms. Some people can control their symptoms by managing diet, lifestyle and stress. More severe symptoms can be treated with medication and counselling. The exact cause is unknown, but some factors that might play a role are contractions of the muscle in the intestine, poorly coordinated signals between the brain and the intestines, severe infections, early life stress and changes in bacteria, fungi and viruses, which typically reside in the intestines and play a key role in health. The prevalence varies from ~7.0% in southeast Asian and Middle Eastern studies to 11.8–14.0% in North American, North European and Australasian studies, and to 15.0–21.0% in South European, African and South American studies. 

Sexual dysfunction in IBS remains poorly studied and poorly understood despite its significant impact on health-related quality of life. IBS patients seem to have a higher prevalence of sexual dysfunction than the population who doesn’t suffer from this condition. There are also differences in the type of IBS symptoms and sexual dysfunction: those with constipation prevalent subtype report significantly higher rates of sex avoidance compared with patients with diarrhoea-predominant IBS and this might be due to the increased levels of negative self-esteem and dissatisfaction with body image in patients with constipation due to symptoms of bloating and distention. Other sexual dysfunctions are reduced libido and dyspareunia, especially for females. Neuromodulators for IBS, such as selective serotonin reuptake inhibitors and tricyclic antidepressants are also associated with sexual dysfunction, such as reduced libido, premature ejaculation, erectile dysfunction and dyspareunia. 

Patients often feel embarrassed to discuss bowel symptoms, moreover discussing the correlated sexuality. At the same time, health care providers may feel frustrated by a lack of definitive treatments, and underestimate the impact of IBS on patients’ lives. The Patient-Provider (P-P) relationship is the foundation to assure a good relationship and management of the disease, particularly for the management of chronic illnesses such as Irritable Bowel Syndrome, since it correlates with disease improvement. A significant aspect of fostering the P-P relationship is providing effective patient-centred education about IBS. 

Here’s what physicians should know and do. 

1. Know the patient’s perspective 

Three major themes seem to determine IBS patients’ illness experience: (1) feeling of frustration from the inability to anticipate, prevent, or control the symptoms of IBS; (2) a sense of isolation: discussing bowel habits is seen as a taboo, or at the least socially unacceptable, and therefore embarrassing. Patients may choose to suffer alone without sharing their experiences with family, friends, or sometimes even with their healthcare providers. Concerns about bowel habits, feeling “unclean”, and interference with dating, intimacy and sexuality are very common; (3) dissatisfaction with the available treatments, information received, and the health care system in general. Patients tended to feel they were not taken seriously, labelled as “neurotic”, stigmatized, and let down by their health care providers. Patients need and expect empathy and validation in order to feel better. They consider the relationship quality of medical care as important as the provider’s knowledge.

2. Manage your perspective 

When compared to their patients, providers generally: (1) underestimate the severity of IBS and the negative effects IBS symptoms have on their quality of life; (2) consider the symptoms less serious or important; (3) perceive the role of psychological contribution as a cause of IBS to a greater degree than patients do; and (4) believe patients’ requests to be less reasonable. These differences naturally lead to greater patient dissatisfaction. 

3. Optimize the patient-provider interaction 

Patients need more empathy, in addition to more information that they can understand and apply in their daily lives. The essential elements of communication in medical encounters can be summarized in seven essential skills: (1) build the provider-patient relationship; (2) open the discussion; (3) gather information; (4) understand the patient’s perspective; (5) share information; (6) reach agreement on problems and plans; and (7) provide closure. 

4. Comprehensive Self-Management intervention for sexual problems 

The comprehensive self-management (CSM) intervention can reduce the effect of IBS on sexual quality of life (QoL). The CSM intervention included nine sessions: overview and introduction; diet and review of abdominal breathing; alternative thinking and passive progressive muscle relaxation; cognitive distortions/diet/personalized goals; fibre/ fluids/active progressive relaxation; sleep patterns/sleep hygiene/mini-relaxers; pain management and sexual dysfunction; eating out and travel; and, lastly, evaluation of plan and termination. For what concerns sexual activity, patients are required to address communication with sexual partners and use cognitive strategies (e.g. relaxing expectations), manage diet (e.g. avoiding trigger foods before sexual activity), use relaxation techniques (e.g. abdominal breathing, muscle relaxation exercises), and problem-solving (e.g. planning date and time for intimacy, position changes) strategies. 

REFERENCES 

Halpert A. (2018). Irritable Bowel Syndrome: Patient-Provider Interaction and Patient Education. Journal of Clinical Medicine. 7(1):3. https://doi.org/10.3390/jcm7010003 

Lovell, R. M., Ford, A. C. (2012). Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis. Clin. Gastroenterol. Hepatol. 10, 712–721.e4. 

Eugenio M. D., Jun S., Cain K. C., Jarrett M. E., Heitkemper M. M., (2012). Comprehensive Self-Management Reduces the Negative Impact of Irritable Bowel Syndrome Symptoms on Sexual Functioning, 57(6), 1636–1646. doi:10.1007/s10620-012-2047-1 

Shiha, MG, Aziz, I. (2021). Review article: Physical and psychological comorbidities associated with irritable bowel syndrome. Aliment Pharmacol Ther. 54(Suppl. 1): S12– S23. https://doi.org/10.1111/apt.16589

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