Sexual dysfunction is highly prevalent in patients with active perianal fistulizing Crohn's disease: Outcomes from a large national prospective cohort study.

BACKGROUND: Sexual function is one of the determinants of quality of life (QoL) and is prevalent in approximately half of the patients with inflammatory bowel disease. However, the sexual function in patients with perianal fistulizing Crohn's disease (pCD) needs to be further elucidated. This study aimed to evaluate the sexual function, the correlation with health-related QoL (HR-QoL), and to identify risk factors for sexual dysfunction (SD) in patients with active pCD. METHODS: Patients with active pCD were identified from a prospective multicentre cohort study in 41 Dutch hospitals. Respondents to sexual function (FSFI for females or IIEF-5 for males) and HR-QoL questionnaires were included in this study. The primary outcome was the prevalence of SD (FSFI <26.55, IIEF-5 <22). Potential risk factors for SD were identified using multivariable logistic regression. RESULTS: 211 patients were included (52% females, median age 37 years, median pCD duration 4 years). Overall, SD was reported by 69% (females 75%, males 63%, p = 0.046). A weak correlation of SD was observed with the CAF-QoL scale (r = 0.25) and the sIBDQ (r = -0.24). Older age (aOR 1.0; 95% CI 1.0-1.1), a longer pCD duration (aOR 0.9; 95% CI 0.8-0.9) and a decreased pCD-related QoL (aOR 1.0; 95% CI 1.0-1.1) were independently associated with SD. In subgroup analysis of patients with a known partner status (66.1%), having a partner (aOR 0.3; 95% CI 0.1-0.9) was identified as a protective factor. CONCLUSION: Sexual dysfunction is common in both male and female patients with active pCD. A weak correlation between HR-QoL and sexual dysfunction suggests that these questionnaires do not fully assess sexual function, highlighting the need for separate evaluation. Factors such as age, reduced pCD-related QoL, longer pCD duration and having a partner were associated with sexual dysfunction. Given its prevalence, routine sexual function assessment by the treating team is recommended, with referral to a sexologist or other expert when needed.