Hierarchical correlates of sexual dysfunction in inflammatory bowel disease: Psychological burden outweighs disease...

Sexual dysfunction (SD) is a common but underrecognized complication of inflammatory bowel disease (IBD), arising from a complex interplay of biological, psychological, and social factors. Their relative contributions to SD severity have not been examined within a unified biopsychosocial framework. This study aimed to determine SD prevalence and clarify the independent contributions of demographic, clinical, functional reserve, and psychological factors using a hierarchical approach.

In this cross-sectional study, 219 patients with IBD (105 Crohn's disease, 114 ulcerative colitis) were evaluated. SD was assessed using the Arizona Sexual Experiences Scale (ASEX), sarcopenia-related functional reserve through handgrip strength, muscle mass, and gait speed, and psychological symptoms using the Hospital Anxiety and Depression Scale. Hierarchical multiple linear regression examined the incremental contributions of each domain to ASEX total score.

SD was present in 60.7%, elevated depressive symptoms in 48.4%, elevated anxiety in 37.4%, and probable sarcopenia in 71.7%. ASEX total score correlated positively with age, depressive and anxiety symptom severity, and Harvey-Bradshaw Index, and negatively with gait speed, muscle mass, and handgrip strength. Age and female sex remained significant across all models; the psychological symptom block provided a significant increment in explained variance (ΔR² = 0.065, p < 0.001). The final model explained 46.2% of the variance, with older age, female sex, and greater depressive symptom burden independently associated with SD severity.

SD in IBD is more strongly associated with demographic and psychological factors than disease characteristics or sarcopenia-related indicators, supporting integration of psychosocial assessment into routine IBD follow-up.