Sexual functions in adulthood after restorative proctocolectomy for paediatric onset ulcerative colitis.
OBJECTIVE
Proctocolectomy with straight or J-pouch ileoanal anastomosis is the standard surgical treatment (ST) for ulcerative colitis (UC) also in children. Pelvic dissection may damage structures essential for sexual functions (SF). We compared SF in adults with ST during childhood or adolescence with adults with medical treatment (MT).


METHODS
Sixty-three sexually active patients (ST 25, males 8; MT 38, males 19) median age of 27 years (range 17-41) (ST) and 29 years (20-40) (MT) (P = NS) were included. UC was diagnosed 15 years (5.1-26) (ST) and 7.5 years (2-20) (MT) (P < 0.05) before. Median ages at and follow-up after ST was 13 years (5.0-19) and 13 years (4.4-22), respectively. In ST and MT groups the daily stooling frequency and the incidence of soiling were 6 (2-17) and 2 (1-12), and 13/25 (52%) and 3/38 (8%), respectively (P < 0.05). SF were assessed with a structured form.


RESULTS
In ST and MT groups, 21/25 (84%) and 31/38 (82%) reported satisfactory SF and 17/25 (68%) and 28/38 (74%) enjoyable sex life (P = NS). Urinary and faecal incontinence disturbed SF in both ST and MT groups in 2/25 (8%) and 3/38 (8%) and 13/25 (52%) and 15/38 (39%) (P = NS in each). Faecal incontinence inversely correlated with sexual satisfaction in all patients (R range; 0.36-0.68, P < 0.05). No erectile problems occurred. One patient (MT) reported ejaculatory problems. In females, dysorgasmia and dyspareunia were reported by 1/17 (6%) and 6/17 (35%) (ST) and 1/19 (5%) and 11/19 (58%) (MT) (P = NS). With intention to conceive 2/5 females in ST and 2/3 in MT group became pregnant within 1 year (P = NS). Only 2/25 (8%) (ST) and 7/38 (18%) (MT) had received information of the effect of treatment on SF.


CONCLUSIONS
Compared with adult CU patients with MT, SF in patients with ST for CU in childhood or adolescence were similar. ST at a young age does not seem to affect SF in adulthood. Faecal incontinency disturbed SF in MT and ST groups.
Koivusalo
Antti
A
Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland. antti.koivusalo@hus.fi
Pakarinen
Mikko P
MP
Natunen
Johanna
J
Ashorn
Merja
M
Rintala
Risto J
RJ
Sipponen
Taina
T
Kolho
Kaija-Leena
KL
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003093:Colitis, Ulcerative / Q000601:surgery*; D005242:Fecal Incontinence / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D016737:Proctocolectomy, Restorative / Q000009:adverse effects*; D012735:Sexual Dysfunction, Physiological / Q000209:etiology*; D019529:Sexuality; D014549:Urinary Incontinence / Q000209:etiology*; D055815:Young Adult