Female reproductive health after ileal pouch anal anastomosis for ulcerative colitis.
Ileal pouch anal anastomosis is the surgical treatment of choice for ulcerative colitis, offering intestinal continuity and fecal continence. IPAA does not seem to affect menstrual function or gynecologic symptoms. Overall sexual satisfaction may be improved with surgery, although ability to experience orgasm and coital frequency remain essentially unchanged. However, dyspareunia seems to increase postoperatively. Fertility is also adversely affected by IPAA, possibly a result of pelvic adhesions. Pregnancy is characterized by a transient increase in day and night stool frequency and incontinence that resolves after delivery. The ideal route of delivery has not been determined, but vaginal delivery seems safe and does not directly cause pouch dysfunction.


BACKGROUND
Obstetricians & Gynecologists, Family Physicians.


OBJECTIVE
After completion of this article, the reader will be able to describe the procedure ileal pouch anal anastomosis, to summarize the effects of IPAA on menstrual function and sexual health, and to outline the association of IPAA and infertility.
Wax
Joseph R
JR
Division of Maternal-Fetal Medicine, Maine Medical Center, Portland, Maine, USA. waxj@mmc.org
Pinette
Michael G
MG
Cartin
Angelina
A
Blackstone
Jacquelyn
J
D000328:Adult; D003093:Colitis, Ulcerative / Q000601:surgery*; D039021:Colonic Pouches; D036861:Delivery, Obstetric; D005260:Female; D005298:Fertility; D006801:Humans; D008598:Menstruation; D009948:Orgasm; D011247:Pregnancy; D011256:Pregnancy Outcome; D012098:Reproduction