Sex with IBD: Overcoming Physical and Emotional Concerns

Inflammatory bowel disease can cause symptoms that interfere with sexual desire and performance. Here’s how I deal with them.

Shortly after I was diagnosed with ulcerative colitis (UC), I discovered that one of my biggest challenges was maintaining a positive sex life with my husband. The pain and discomfort I felt during flares, coupled with my worry about experiencing symptoms, made it difficult for me to relax and be intimate.

Over time, I learned that my reluctance had more to do with mental anxiety than actual physical obstacles, and I discovered ways to overcome my concerns and enjoy a fulfilling intimate life.

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The first step: seeking help

It took me a couple of years following my diagnosis before I finally got the courage to have a conversation with my doctor about my intimacy issues.

I was embarrassed to even talk about it. But my nerves quickly calmed as my doctor reassured me that what I was going through was typical for people with IBD, especially women.

In fact, research suggests that anywhere from 50% to 90% of women with IBD experience sexual issues.

My doctor explained that symptoms like abdominal pain, diarrhea, and anxiety can affect sexual function and desire. There are no specific treatment guidelines to address these problems, but my doctor and I decided that we would include building a positive body image and improving sexual health into my treatment plan.

And to this day, 20 years later, my doctor asks me during regular check-ups about my physical and mental well-being — including how I’m feeling about intimacy.

The physical barriers

In people with inflammatory bowel disease (IBD), a range of physical factors — beyond symptoms — can play a role in sexual function and intimate relationships.

A 2021 study suggests that factors include how long you’ve been living with IBD, how active your disease is, and whether you’ve had surgery for it.

Some people, like me, sometimes have pain during sexual activity. For me, this happens mostly during a flare when I’m already experiencing abdominal pain.

I’ve realized that during these times, it’s OK to tell my husband that I’d prefer to be intimate in other ways. For example, we feel close physically when we kiss, hold hands, and snuggle.

Physical intimacy with IBD requires patience and effort from both partners. I suggest keeping an open mind and being willing to explore other physically intimate experiences together, especially during times when you’re having pain or other symptoms.

I also worried about having an accident or feeling the urge to run to the bathroom in the middle of things. But I’ve since learned that if I empty my bowels prior to sex and stick to positions that don’t put strain on my stomach, I don’t have that sudden urge.

My self-image

For me, the physical hurdles were easier to overcome than the emotional barriers I encountered in maintaining an intimate connection.

I want to feel confident and sexy about engaging in intimacy with my husband. But I had times — especially when I first began struggling with UC in my 20s — that I felt self-conscious.

I felt less attractive and lacked sexual self-esteem. I struggled with a negative body image, which resulted in a lack of desire and ability to enjoy sex.

I’m not alone. The same research that addressed physical concerns also noted that psychological and social factors like depression, anxiety, and body image can decrease sexual interest and performance.

Through a combination of therapy, reading lots of self-help books, and engaging in mindfulness, I learned to love and accept my body as it is. And I became less self-conscious about being intimate.

One thing that made the biggest difference for me was learning how to control my mind. When I stay in the moment and focus on the positive feelings I experience during sex, I’m able to keep my concerns at bay.

I constantly remind myself that my health issues should not stop me from experiencing pleasure, joy, and intimacy.

Mood matters

My mood can be an emotional barrier to intimacy at times. During a flare, I feel frustrated and gloomy. These feelings can make it difficult to get in the mood for physical intimacy.

I’ve found that it helps to do something relaxing or romantic with my husband. Taking a walk together, cuddling up by the fire, or enjoying a special dinner together usually helps improve my mood and feel more connected to my husband.

Feeling tired can also hinder my interest in being sexually active. However, if my husband wants to be intimate, I often try to push past the tiredness — not because I feel like I have to, but because I find that when I do so, I actually feel better.

My mood improves, I feel less stressed, and I have more energy.

Some IBD medications may affect your mood and desire or cause other sexual problems. If you’re experiencing any issues in this area, I recommend talking with your doctor. They may try adjusting doses or changing medications.

Managing intimacy

I’ve learned that taking a few simple steps helps me feel strong and confident in my body.

I always take a shower before showing affection to my husband so I feel clean and refreshed. Also, I occasionally splurge on flattering clothes and lingerie, which help me feel more attractive.

I don’t eat a big meal before being intimate because I feel physically better when my stomach isn’t full. And while I can push through my fatigue and enjoy sex at night after a long day, it’s even better for me in the morning or afternoon when I’m not as tired.

Intimacy can be an uncomfortable or embarrassing topic to discuss. But I encourage you to be honest with your partner. I’ve found that when I share my most vulnerable self with my husband, he understands my feelings and concerns, and we grow even more intimate together, physically and emotionally.

The takeaway

Intimacy is a natural, healthy part of relationships. IBD doesn’t need to impede this part of your life.

Understanding your barriers is the first step to overcoming them. I recommend talking to your partner — and your doctor — about how you can revive intimacy and enjoy a fulfilling relationship.