Gynecologic history of women with inflammatory bowel disease

To describe the gynecologic history of women with inflammatory bowel disease.

Questionnaires were sent to the 1000 women age 20-60 who had been hospitalized for inflammatory bowel disease at the Cleveland Clinic Foundation during 1989-1993. There were 692 responses, and those from 662 women who had undergone surgery for inflammatory bowel disease were analyzed. Of the 117 women who had undergone hysterectomy, 85 responded to follow-up questionnaires.

Three hundred sixty women had Crohn disease, 251 had ulcerative colitis, and 51 had inflammatory bowel disease of indeterminate or unknown type. Menstrual abnormalities were reported by 58%. Symptomatic vaginal discharge, reported by 40%, was more likely to occur in those with Crohn disease than with ulcerative colitis (odds ratio [OR] 2.09, 95% confidence interval [CI] 1.47-2.99; P < .001). Infertility was reported by 25% of the women in this series. Abdominal pain with sexual intercourse (50% overall) was more common in women with Crohn disease than in those who had ulcerative colitis (OR 1.64, 95% CI 1.13-2.40; P = .01), but pain with penetration (55% overall) did not differ statistically by type of inflammatory bowel disease. Half of the women reported the loss of pleasure or desire for sex. Ovarian cysts had been diagnosed in 39% of women and resulted in surgical treatment in 57% of these. One hundred seventeen women (18%) had undergone hysterectomy, 52 (44% of total) at age 35 or younger.

Gynecologic conditions are common in women with inflammatory bowel disease, including menstrual abnormalities, vaginal discharge, infertility, and gynecologic surgery. All physicians providing care for women with inflammatory bowel disease should be familiar with the frequency and nature of concurrent gynecologic conditions.