Intimacy and Crohn’s Disease

By Kevin Ashby, MD, as told to Michele Jordan 

I became a doctor because I knew it would be intellectually stimulating and I wanted to help people. I truly believe in treating my patients like family. As a board-certified gastroenterologist, I treat people who have a variety of digestive issues – some mild and others more severe. I see many patients with Crohn’s disease, which is an inflammatory bowel condition that impacts the digestive system. It can cause a number of symptoms, from abdominal pain and frequent diarrhea to swelling and fatigue. 

I’ve been in this field for many years, and I’ve heard a variety of issues that come along with the disease. Most people talk to me about the physical impacts, but Crohn’s can impact so many areas of someone’s personal life as well. 

It’s a Sensitive Topic

One area that Crohn’s disease can impact is a person’s sex life. Many patients are not comfortable talking about intimacy and how Crohn’s may get in the way of their social life. Because of that, they often don’t get the help they need. On the other hand, some patients are comfortable talking about how their disease impacts their intimate life. We, as doctors, understand that this is a sensitive topic for some and are here to help. People with Crohn’s disease are capable of being intimate emotionally and physically. There are just some things to consider to ensure some level of comfort. 

Whenever there is a gastro issue that results in the patient needing to use the bathroom regularly (like with Crohn’s disease), it can have an impact on sex and dating. Some patients fear having a flare occur and the challenges that might cause for their social life.

People sometimes forget that Crohn’s is a systemic disease – meaning it can affect the entire body and not just the digestive system. People with Crohn’s may have lethargy (or fatigue), weakness, swelling, some rectal bleeding, and it can affect the skin, eyes, and other organs of the body. Crohn’s can also impact the urinary tract. Some symptoms may cause changes in hormone levels or other symptoms that can affect sex drive. 

Women with Crohn’s may have something called dyspareunia, which is when intercourse is painful. 

Crohn’s disease’s impact on energy levels is also a factor. It’s hard to have the motivation to date or have an active sex life when you’re not feeling well. My patients talk about how it can prevent them from going out to dinner with friends or other activities that may help lead to a long-term relationship.

The Emotional Side

The physical impact of Crohn’s on intimacy is one thing, but I also see some emotional effects. There may be some negative views about body image, embarrassment about the urgency or frequency of needing to use the restroom, and in more extreme cases some depression. It can be emotionally draining to not feel up to going out and socializing or building a relationship. 

Crohn’s disease can affect your daily life, and for some, dealing with that may be very difficult. It can be life-altering and unpredictable. The fear of having to go to the bathroom unexpectedly can take its toll on some people. Managing the symptoms while trying to maintain an intimate life can be incredibly stressful.

Making Adjustments

Because Crohn’s symptoms – particularly urgency in needing to use the bathroom – can be unpredictable, some patients have had to be creative about their dating life and intimacy. I’ve had patients say they prefer to go to restaurants that don’t have spicy foods, so they won’t have to go to the bathroom. Some of my patients say they prefer not to do anything food-related and may suggest a walk in the park or something like that instead of meeting at a restaurant. Many patients with Crohn’s may skip going to the house of the person they’re dating and instead may suggest meeting at their own house with access to their own bathrooms and privacy. 

In general, sex is safe for people with Crohn’s, and I don’t often suggest patients refrain from sexual intercourse unless it is painful. Anal sex may be painful after certain surgeries for Crohn’s. A flare with swelling may make certain positions uncomfortable. While I don’t hear this as often, it can occur. When that happens, I recommend my patients stop having sex until the issue causing that pain can be resolved. That’s the only time I suggest people not have sexual intercourse with Crohn’s – when it’s painful. Pain can be their guide in this case. 

There Is Hope

Some people have shared some concerns about how treatments might impact intimacy. I haven’t seen that much. The main concern for newer medications is the risk of infection, but I haven’t seen this impact my patients’ intimate life. 

Over the last 10 years or so, many new medications have come out for Crohn’s. These medications have revolutionized life with Crohn’s for many people and their management of the disease. These meds have made it possible for many patients to see an improvement in their symptoms and a much better quality of life. Some of these new meds have helped with frequency of needing to use the restroom, abdominal pain, and energy levels. They’ve helped many of my patients just feel better overall. I’m happy to see how the treatments have made it possible for patients who have suffered on a regular basis to do things they may have stopped doing before. 

Do talk to your doctor about options for you. Your medical support team can help you address the physical issues that may be affecting your intimacy. 

A few other tips I suggest to my patients if they are struggling in their sex, intimate, or dating life with Crohn’s disease: 

• Talk to your partner. You may be surprised that some things you’re concerned about aren’t a big deal to them. I haven’t had any partners come in and complain, which may say a lot! It doesn’t mean those issues aren’t there, but they may not be as significant as the person with Crohn’s may think they are.
• Sex shouldn’t impact your stoma/pouch if you have one, but patients should consider changing it before sex so there aren’t any potential messes. There are a lot of products on the market that hold the pouches in place and clothing that can discreetly cover your stoma and pouch.
• Talk to your doctor about whether you can take an anti-diarrheal medication before sex or before going out on a date. It might buy you some time if your bowel movements are unpredictable, as they can be with Crohn’s.
• Think about different ways to be intimate beyond sex. For whatever reason, traditional intercourse may not be an option for you at the time, but talk to your partner about other ways you can demonstrate your affection to each other.
• Consider getting extra help. In addition to talking your gastroenterologist, talk to a sex therapist or counselor if what you’ve been trying so far isn’t working. Some medical doctors who specialize in Crohn’s disease may also be able to offer additional solutions.