Sexual dysfunction following proctocolectomy for benign disease of the colon and rectum

Standard surgical therapy for the treatment of chronic ulcerative colitis is total extirpation of the colon and rectum. Since ulcerative colitis is primarily a disease of young adults affecting many people at the inception or height of their sexually active years, postoperative sexual dysfunction is an extremely disconcerting complication. Between July 1973 and May 1981, 291 proctectomies for benign disease of the colon and rectum were performed by the authors. This included 135 men and 156 women. Resection of the rectum was performed using an intrasphincteric technique with dissection kept extremely close to the wall of the rectosigmoid, rectum, and anus. Proctectomy was performed in this manner to prevent significant disruption of the nerves carrying stimuli to the genital organs. Of the 135 males undergoing a proctectomy, four (3%) had a permanent deficit in sexual function. Two men, aged 32 and 30, could sustain an erection but had retrograde ejaculation. Two patients, age 19 and 44, have remained impotent for 1 1/2 and two years, respectively. One hundred fifty-two of the 156 females are sexually active and only two (1.3%) have complained of any physical sexual dysfunction. Each had temporary dyspareunia lasting between nine months and one year after operation.