title: Female sexual function and fertility after ileal pouch-anal anastomosis.
abstract: OBJECTIVE
  A potential complication in women after ileal pouch-anal anastomosis (IPAA) is sexual impairment and reduced fertility. The aim was to evaluate sexual function and fertility after IPAA.
  
  
  METHODS
  All female patients who underwent an IPAA between 2004 and 2013 were retrospectively included. Sexual function, fertility, and continence were explored by the female sexual function index (FSFI), telephonic interview, and Wexner's score.
  
  
  RESULTS
  Among 127 women included, 93 responded to the questionnaires (73.2%). Seventy five were sexually active, and 48 (64%) had normal sexual function (FSFI > 26). In univariate analysis, there was a significant relationship between ulcerative colitis (p = 0.0161), age > 40 years (p = 0.01311), number of bowel movements (p = 0.0238), nocturnal pouch activity (p = 0.0094), use of loperamide (p = 0.0283), and existence of sexual dysfunction. After multivariate analysis, age and nocturnal pouch activity were associated with a worse sexual function (p = 0.0235, OR = 3.3 (1.2-9.9) and p = 0.0094, OR = 4.1 (1.4-13.5)). Of 16 patients who wished to have children, 10 (63%) became pregnant without recourse to in vitro fertilization, of whom 3 had two or more pregnancies. In total, there were 13 children born after IPAA. The mean time between the first pregnancy and surgery was 24.8 ± 22 months. At 12 and 24 months after cessation of contraception, 57 and 67% had at least one pregnancy.
  
  
  CONCLUSIONS
  While sexual function is impaired in a limited number of patients, the impact of surgery can be regarded as modest. Age and nocturnal pouch activity were some independent factors of worse sexual function. The risk of infertility should not preclude consideration of IPAA as a treatment option.
authors.affiliation: Department of Digestive Surgery, Hôpital Saint Antoine (AP-HP), University Pierre and Marie Curie (Paris VI), 184, rue du Fbg Saint-Antoine, 75012, Paris, France.
authors.forename: Thevy
authors.initials: T
authors.lastname: Hor
authors.affiliation: Department of Digestive Surgery, Hôpital Saint Antoine (AP-HP), University Pierre and Marie Curie (Paris VI), 184, rue du Fbg Saint-Antoine, 75012, Paris, France. jeremie.lefevre@sat.aphp.fr.
authors.forename: Jeremie H
authors.initials: JH
authors.lastname: Lefevre
authors.affiliation: Department of Digestive Surgery, Hôpital Saint Antoine (AP-HP), University Pierre and Marie Curie (Paris VI), 184, rue du Fbg Saint-Antoine, 75012, Paris, France.
authors.forename: Conor
authors.initials: C
authors.lastname: Shields
authors.affiliation: Department of Digestive Surgery, Hôpital Saint Antoine (AP-HP), University Pierre and Marie Curie (Paris VI), 184, rue du Fbg Saint-Antoine, 75012, Paris, France.
authors.forename: Najim
authors.initials: N
authors.lastname: Chafai
authors.affiliation: Department of Digestive Surgery, Hôpital Saint Antoine (AP-HP), University Pierre and Marie Curie (Paris VI), 184, rue du Fbg Saint-Antoine, 75012, Paris, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Tiret
authors.affiliation: Department of Digestive Surgery, Hôpital Saint Antoine (AP-HP), University Pierre and Marie Curie (Paris VI), 184, rue du Fbg Saint-Antoine, 75012, Paris, France.
authors.forename: Yann
authors.initials: Y
authors.lastname: Parc
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D015331:Cohort Studies; D039021:Colonic Pouches / Q000473:pathology*; D005260:Female; D005298:Fertility; D006801:Humans; D053208:Kaplan-Meier Estimate; D015999:Multivariate Analysis; D012735:Sexual Dysfunction, Physiological / Q000503:physiopathology*; D011795:Surveys and Questionnaires
keywords: Familial adenomatous polyposis; Fertility; Ileal pouch-anal anastomosis; Sexual function; Ulcerative colitis; Women