What’s the Connection Between Ulcerative Colitis and Erectile Dysfunction?

Ulcerative colitis (UC) can take a toll on your sexual health. “Erectile dysfunction is relatively common in men with ulcerative colitis,” says Robert Valenzuela, MD, a prosthetic and general urologist at Mount Sinai in New York City.

Unfortunately, he says, “Sexual health is rarely a primary topic during medical appointments unless the patient brings it up.”

Erectile dysfunction (ED) seems to be more common in men with ulcerative colitis.

Several factors contribute to erectile dysfunction in men with UC.

Greater Disease Activity and Worse Symptoms

• Inflammation Substances that your body releases when inflammation occurs can inhibit the production of testosterone and are linked to ED.

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• Pain You’re less likely to be able to achieve or maintain an erection when you’re experiencing pain or discomfort. One study found that men with anal or rectal pain were more than twice as likely to have erectile dysfunction.

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• Fatigue UC flares can sap your energy and interest in intimacy, says Dr. Valenzuela.
• Bowel Movements Having more frequent or urgent bowel movements can distract from arousal and interrupt sexual activity. “Fear of having an incontinent episode during intercourse [often] makes the idea of having pleasurable intercourse worrisome to patients with IBD,” says Lisa Fasone, a certified physician assistant in urology at Northwestern Medicine in Illinois.
• Nutrition Deficiencies Some nutrient deficiencies linked to IBD, such as zinc deficiency, can reduce testosterone production and affect sexual function.

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Effects of Treatment

Physical challenges may persist long after recovery. “For men who have undergone surgery, nerve damage or structural changes from colectomy, J-pouch, or ostomy procedures can lead to altered erectile function,” says Valenzuela.

Psychological Factors

Psychological issues are a major contributor to erectile dysfunction in men with UC. “Men with IBD are at an increased risk for having anxiety and depression, which may impact erectile health,” says Fanone. What’s more, you may not feel good about the way your body looks or functions, which can harm your sexual confidence and contribute to erectile dysfunction.

The first step in getting help for erectile dysfunction is talking about it. That can start you on the path to getting the right treatment.

Taking to Your Doctor

Many healthcare providers don’t ask men with ulcerative colitis about erectile dysfunction or other sexual issues. “Sexual health is an important aspect of overall health and wellness, and we need to get better about talking about it,” says Fasone.

“Despite its prevalence, many men are reluctant to discuss ED with their doctors or partners due to feelings of embarrassment, stigma, or the misconception that it is a separate issue unrelated to UC,” says Valenzuela. “Concerns about masculinity and the fear of being judged often prevent men from seeking help.”

You may be wondering how to talk to your doctor, about this sensitive issue, and the key is to be open and honest. Valenzuela says that urologists are often more comfortable discussing ED treatments than other healthcare providers, so don’t be afraid to ask for a referral to a urologist if this interests you. You should also feel free to raise any concerns with your gastroenterologist or primary care doctor.

Medications and Other Treatments

Both medications and devices can help treat erectile dysfunction, depending on your health situation and treatment goals and preferences.

• avanafil (Stendra)
• sildenafil (Viagra)
• tadalafil (Cialis)
• vardenafil (Levitra)

It takes between 15 and 60 minutes for PDE5 inhibitors to start working, depending on which drug you take. They don’t automatically cause an erection, so you’ll still need to become aroused for them to work.

It’s common for your self-image, including your body image, to take a hit from ulcerative colitis symptoms or complications. But there are ways to fight back and rebuild your self-image, which might help with your sexual confidence and function:

• Shift your focus from flaws to strengths. “Instead of dwelling on physical changes caused by UC, such as weight fluctuations or surgical scars, men can emphasize what their bodies can still achieve,” says Valenzuela.
• Get regular exercise. Both aerobic and resistance training can help boost feelings of self-efficacy and well-being. Exercise can also boost testosterone levels, which can help with ED, says Valenzuela.

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• Consider counseling. Seeing a counselor or therapist, such as a psychologist or sex therapist, may be beneficial for some men with UC, says Fasone. You can also look into IBD support groups in your area or online, which may help you connect with other men and share your experiences and concerns.

If you’re experiencing erectile dysfunction or other issues with intimacy because of your ulcerative colitis, you may benefit from certain adjustments to your sex life. Often that means letting go of past expectations for how you should perform sexually or what a successful sexual experience looks like.

Making sure that your UC is well managed and flares are limited can be key to improving your sexual health, Fasone says. But aside from that, here are some suggestions that may help improve your sex life with UC:

• Plan intimacy around your energy level. If you’re less fatigued in the morning or after resting, these times may be better for intimacy than just before your bedtime.
• Try different positions. Lying on your side, or spooning, can reduce strain on your abdomen or joints, Valenzuela says.
• Use heat therapy for comfort. A warm bath or heating pad can help your pelvic and abdominal muscles relax, which may reduce pain and discomfort during sex.
• Have a routine for bowel urgency. Avoid any trigger foods and go to the bathroom before intimacy, and keep supplies like wipes or towels nearby in case you need them.
• Use wraps to feel comfortable. If you have an ostomy bag or sensitive surgical scars, a specialized wrap can cover the area or keep your bag secure.
• Set the mood. Dim lighting, soft bedding or blankets, scented candles, or music can help make you feel sexy and comfortable.
• Broaden your sexual horizons. Sex can mean many different things, including nonpenetrative and sensual activities like giving massages, as well as oral or manual genital stimulation. You can also experiment with different kinds of lubricants.

Above all, “open communication with a partner is essential, helping to ease concerns, strengthen emotional intimacy, and address body image insecurities,” says Valenzuela. Talk with your partner ahead of a sexual encounter about what both of you can do to make the experience as fulfilling as possible.

• UC can cause erectile dysfunction through inflammation, pain, fatigue, worries about incontinence, aftereffects of surgery, or body image difficulties.
• Options for ED treatment include medications, erectile aid devices, counseling, and adaptations to make sexual activity more comfortable and pleasurable.
• Talking openly about sexual difficulties with your healthcare provider and your partner can help you find the right solutions.