Colorectal Dis. 2025 Oct;27(10):e70246. doi: 10.1111/codi.70246.
ABSTRACT
BACKGROUND AND AIMS: Total proctocolectomy (TPC) with ileal pouch-anal anastomosis (IPAA) is the standard surgical treatment for patients with ulcerative colitis refractory to medical therapy. While its impact on bowel function is well documented, its effects on sexual function remain controversial. This study aimed to evaluate changes in sexual function, psychological outcomes (anxiety, depression and fatigue) and quality of life (QoL) after surgery.
METHODS: This prospective multicentre cohort study included patients undergoing IPAA. Sexual function was assessed using the IIEF-5 (men) and FSFI (women). Psychological status, fatigue and QoL were evaluated using the HADS, FSS and SIBDQ, respectively. Validated patient-reported outcome measures were collected at baseline and 6-12 months postoperatively.
RESULTS: A total of 332 patients were included. Male sexual function remained stable: 50% reported erectile dysfunction (ED) at baseline with no significant change postoperatively. Female sexual function improved significantly, particularly in desire (p = 0.002) and arousal (p = 0.003). Anxiety and depression (HADS) decreased significantly over time (p < 0.001), as did fatigue (FSS ≥4 dropping from 43% to 25%, p = 0.004). QoL improved markedly, with the proportion of patients reporting poor QoL (SIBDQ <45) reduced threefold at 12 months (p < 0.001). Depressive symptoms were strongly associated with ED in men (OR = 14.46, p = 0.021), while disease extent had no significant effect on sexual function.
CONCLUSIONS: IPAA was associated with significant improvement in psychological well-being, fatigue and QoL, with notable improvements in sexual function among women. However, persistent sexual dysfunction-particularly in women and in men with depressive symptoms-underscores the need for tailored psychological support in the perioperative period.
PMID:41036690 | DOI:10.1111/codi.70246
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