When you have a chronic disease like Inflammatory Bowel Disease (IBD), you might be wondering about the possible impact on fertility and sexual health. While there is no clear link between IBD and reduced fertility in men, there are some factors associated with the disease that could impact sexual health and fertility.  

Sexual Function 

IBD can potentially impact sexual function in a variety of ways: 

• One of the hallmarks of IBD are periods where the disease is in remission and periods when the disease “flares,” meaning higher levels of inflammation and increased symptoms. When experiencing an IBD flare, men can experience higher rates of erectile dysfunction (ED). However, when IBD is in remission rates of ED are comparable to the general population. 
• Fatigue is a common symptom of IBD that may also impact sex drive – it’s hard to get into the mood when you are exhausted all the time! 

Some surgeries that are used to treat IBD, especially if the incision site is near the rectum, may potentially affect sexual function in men. Proctocolectomy with ileal pouch-anal anastomosis (IPAA) has shown some association with sexual dysfunction; however, studies show that the risk is low and can be successfully treated if it does occur.  

Fertility 

It has been found that people with IBD generally have fewer children than that of the general population, usually due to “voluntary childlessness.” Those with IBD often have many concerns about having children, such as passing on their disease or effects of medications on pregnancy, and elect to not have children at all.  The good news is that fertility rates among people who have IBD in remission are around the same as people without IBD. It’s also been found that women with IBD can have healthy pregnancies. 

Most medications used for IBD have not been shown to affect fertility, however there are a couple of exceptions – sulfasalazine and methotrexate. Sulfasalazine may be associated with temporary infertility, but this is reversible when the patient is switched to a different medication. Methotrexate is typically associated with birth defects when women are taking it during conception, but does not appear to cause similar issues if the father is on this medication. However, methotrexate may be associated with ED, so the current recommendation is to stop taking the medication if possible 3 to 4 months prior to trying for pregnancy.  

Psychological Impact of IBD on Sexual Health 

People with IBD have higher rates of anxiety and depression, conditions that are both associated with higher risk of developing ED or reducing sex drive. Having IBD, especially for those that have had surgery, may negatively affect body image which in turn can play a role in developing ED.  

Summary 

Having IBD does not mean that you can’t also have a family! Be sure to discuss with your doctor if you are concerned about your fertility or are experiencing sexual dysfunction. There are many options available to you to ensure that you get the treatment that you need while not conflicting with your other aspects of your life. If you are experiencing anxiety or depression, don’t hesitate to bring this up to your Care Team or think about seeking help from a mental health professional! 

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Jedel S, Hood MM, Keshavarzian A. Getting personal: a review of sexual functioning, body image, and their impact on quality of life in patients with inflammatory bowel disease. Inflamm Bowel Dis. 2015;21(4):923-938. doi:10.1097/MIB.0000000000000257 

Shin T, Okada H. Infertility in men with inflammatory bowel disease. World J Gastrointest Pharmacol Ther. 2016;7(3):361-369. doi:10.4292/wjgpt.v7.i3.361