Sexuality and fertility outcomes following hand-sewn versus stapled ileal pouch anal anastomosis for ulcerative colitis

Abstract : Background: Ileal pouch anal anastomosis (IPAA) may alter sexuality and fertility in women. The laparoscopic approach seems to reduce infertility rates in women after IPAA. However, the impact of hand-sewn versus stapled IPAA on sexuality and fertility has never been assessed in patients with ulcerative colitis (UC). The objective of this study was to analyse the impact of the IPAA technique on sexuality and fertility in UC. Methods: All UC patients who underwent an IPAA between May 1996 and April 2011 were included. The patients answered mailed questionnaires including sexuality validated questionnaires and fertility questionnaires. The risk factors of sexual dysfunction were explored. Results: A total of 135 patients were included. Eighty-eight patients (65%) answered the questionnaires. Their mean age and follow-up were 37.2 ± 13.4 years and 109.7 ± 57.5 months. The rates of female and male sexual dysfunction were 50% and 29%, respectively. Intestinal transit disorders were identified as risk factors in both men and women, and anastomotic stricture in women sexual dysfunction, in univariate analyses. The IPAA technique did not impact sexual function in women but there was a trend for less erectile dysfunction following hand-sewn IPAA (16.7% vs 44.4%). The fertility rate was 47% in women and 75% in men, with a trend for a better fertility in women after hand-sewn IPAA (p=0.07). Conclusion In this preliminary study, the hand-sewn or stapled IPAA technique did not impact the sexuality or fertility outcomes of UC patients, but there was a trend for better female fertility and male erectile function following hand-sewn IPAA. Intestinal transit disorders contributed to male and female sexual dysfunction after IPAA.