Ileal J-pouch--anal anastomosis, sexual dysfunction, and fertility

Our aim was to establish what kind of changes take place in sexual functions after restorative proctocolectomy and ileoanal anastomosis with J-pouch (IAA) and whether the operation alters fertility.

One hundred and ten consecutive patients who underwent IAA operation for ulcerative colitis at our institute were sent a questionnaire after at least 2 years' follow-up with special emphasis on sexual functions. Analysis was made by an independent researcher.

Ninety-five patients (86.7%) responded to the questionnaire. The mean follow-up of the patients was 71.5 months (range, 30-128 months). The median age of the 51 women in this study was 39.0 years (range, 23-74 years). Dyspareunia increased after the operation, but sexual satisfaction improved. The operation seems to reduce fertility slightly in women, and the rate of spontaneous abortion may be higher than in the normal population. The median age of the men was 43.0 (25-69) years. One (2.3%) case of retrograde ejaculation and six (14.6%) cases of erectile function problems were reported after the operation. The fear of leakage during coitus were reduced.

Sexual satisfaction is improved after operation, mainly due to improved general health, despite minor disturbances in sexual function. There may be a risk of decreased fertility after restorative proctocolectomy.