Sexual dysfunction in patients with irritable bowel syndrome and non-ulcer dyspepsia

Pleasurable and problematic receptive anal intercourse and diseases of the colon, rectum and anus

The ability to experience pleasurable sexual activity is important for human health. Receptive anal intercourse (RAI) is a common, though frequently stigmatized, pleasurable sexual activity. Little is known about how diseases of the colon, rectum, and anus and their treatments affect RAI. Engaging in RAI with gastrointestinal disease can be difficult due to the unpredictability of symptoms and treatment-related toxic effects. Patients might experience sphincter hypertonicity, gastrointestinal symptom-specific anxiety, altered pelvic blood flow from structural disorders, decreased sensation from cancer-directed therapies or body image issues from stoma creation. These can result in problematic RAI - encompassing anodyspareunia (painful RAI), arousal dysfunction, orgasm dysfunction and decreased sexual desire. Therapeutic strategies for problematic RAI in patients living with gastrointestinal diseases and/or treatment-related dysfunction include pelvic floor muscle strengthening and stretching, psychological interventions, and restorative devices. Providing health-care professionals with a framework to discuss pleasurable RAI and diagnose problematic RAI can help improve patient outcomes. Normalizing RAI, affirming pleasure from RAI and acknowledging that the gastrointestinal system is involved in sexual pleasure, sexual function and sexual health will help transform the scientific paradigm of sexual health to one that is more just and equitable.

Prospective Evaluation of Sexual Dysfunction in Men With Chronic Pancreatitis: A Pilot Study

OBJECTIVE

Our study aimed to determine the prevalence of sexual dysfunction (SD) and its association with quality of life (QOL) in men with chronic pancreatitis (CP).

MATERIALS AND METHODS

Male patients with CP were prospectively enrolled in our pancreas center and completed the following 4 validated questionnaires: International Index of Erectile Function 5, Erectile Hardness Score, Pancreatitis Quality of Life Instrument, and Short Form Survey. Patients were classified as having mild, moderate, or severe SD based on review of questionnaires.

RESULTS

Thirty patients were enrolled in the study, of which 18 patients had SD (mild in 9, moderate in 1, and severe in 8 patients). No significant differences were seen demographic or clinical characteristics in patients with and without SD. Patients with SD had more abdominal pain compared with those without SD (94.4% vs 83.3%, P = 0.001). No significant differences were noted in QOL metrics between the 2 groups.

CONCLUSIONS

This pilot study shows that SD is present in 60% males with CP. No difference was noted in the QOL of patients with and without SD, albeit limited by our small sample size. Physicians caring for CP patients should routinely inquire for symptoms of SD and offer a urology referral if indicated.

Psychiatric Symptoms, Aggression, and Sexual Dysfunction Among Patients With Benign Anal Conditions

INTRODUCTION

The aim of this study was to investigate the incidence of general psychiatric symptoms, aggression levels, and sexual dysfunction in patients with benign anorectal diseases and compare the results with those of healthy control subjects.

METHODS

We prospectively enrolled consecutive adult patients who presented for treatment of benign perianal diseases and healthy control subjects between June 2017 and December 2018. All patients had either grade 3 or 4 hemorrhoidal disease or perianal fistula with active discharge who had not undergone previous anorectal surgery. We also included a control group with benign subcutaneous lumps presenting for minor surgery. We used the Symptom Checklist-90-Revised Form to evaluate general psychiatric symptoms, the Buss-Perry Aggression Questionnaire (BPAQ) to evaluate aggression levels, and the Arizona Sexual Experiences Scale to evaluate sexual dysfunction.

RESULTS

A total of 563 patients were assessed for eligibility; after exclusions, 94 with anal fistula, 89 with hemorrhoids, and 59 healthy control subjects were enrolled. The groups were similar with regard to age, gender, and educational level. Physical and verbal aggression, anger, and total BPAQ score were significantly higher in patients with perianal fistula than in those with hemorrhoidal disease and healthy control subjects (P < .001).

CONCLUSION

This study suggests that patients with perianal fistula have higher levels of aggression than healthy control subjects and those with hemorrhoidal disease. One must bear this in mind during preoperative patient evaluations and obtaining informed consent. Further studies are needed to investigate the reason for this association and potential causality.

Sexual dysfunction worsens both the general and specific quality of life of women with irritable bowel syndrome. A cross-sectional study

Background

Irritable bowel syndrome (IBS) and sexual dysfunction (SxD) lowers quality of life (QOL) separately, but the effect of their overlap in unselected populations has not been studied.

Objective

To evaluate the QOL of IBS women with and without SxD and compare it with controls.

Methods

In this cross-sectional assessment, we studied 51 IBS women (Rome IV criteria) and 54 controls. SxD was determined using the female sexual function index questionnaire. QOL was evaluated by the Short Form 36 (SF-36) and IBS-QOL questionnaires.

Results

SxD prevalence was similar between IBS women (39.22%) and controls (38.89%). Compared with other groups, IBS patients with SxD showed lower scores in all domains as well as in the physical, mental summaries of the SF-36 and almost all domains (except for body image, food avoidance, and social reaction compared with IBS patients without SxD) and the total score of IBS-QOL.

Conclusions

These findings show that SxD worsens both general and specific QOL of women with IBS. The consideration of SxD in patients with IBS will allow us to make a more effective diagnostic and therapeutic approach. Clinical trial registry in Mexico City General Hospital: DI/19/107/03/080. Clinical trials registration: NCT04716738.

Long-Term Proton Pump Inhibitor Therapy and its Effect on Endocrine Hormones in Selected Patient Population

Proton pump inhibitors (PPI) are commonly prescribed medications for a variety of gastrointestinal disorders around the globe. Long-term utilization of proton pump inhibitors is linked with different adverse events. Although, short-term therapy has been demonstrated to have little or no impact on endocrine hormones in men, yet its safety with long-term use has poorly been studied. We aimed to evaluate the impacts of long-term utilization of proton pump inhibitors on male reproductive hormones and its clinical outcomes. A cross-sectional study was performed in two out-patients gastroenterology clinics in Khyber Pakhtunkhwa province. Male patients who were using PPIs regularly for≥3 months were enrolled in this study. Among 65 enrolled participants, patients with sexual complaints have significant variations in mean serum levels of prolactin (p<0.001), sex hormone binding globulins (p=0.043), total testosterone (p<0.001) and progesterone (p=0.001) as compared to patients without sexual complaints. Significantly high values of prolactin mean ranks were observed in patient with sexual complaints (p<0.001). There were statistically significant correlations of serum levels of sex hormone binding globulins (p=0.003), total testosterone (p=0.008) and progesterone (p<0.001) with serum prolactin levels. Similarly, statistically significant variation was observed for decreased libido (p=0.001), erectile dysfunction (p=0.001) and decreased semen mass ((p<0.001) between normal and hyperprolactinemic PPI users. Highly significant differences were observed in serum sex hormone binding globulins (p<0.001), total testosterone (p<0.001) and progesterone (p<0.001) values in normal and hyperprolactinemic groups. In conclusion, long-term utilization of PPI may induce endocrine hormone disruption with subsequent sexual complications.

Management of Sexual Dysfunction in Gastrointestinal Disorders

Patients with gastrointestinal (GI) disorders are at increased risk of sexual dysfunction (SD) due to a combination of biomedical, psychological, social, and interpersonal factors. While most patients desire information on the impact of their GI disorder on sexual function, few providers initiate this conversation. GI providers should routinely assess their patients for SD, validate these concerns, and provide brief education and a referral for evaluation and/or treatment. Treatment of sexual concerns is often multidisciplinary and may involve a sexual medicine physician, pelvic floor physical therapists, and sex therapists.

Irritable bowel syndrome: Factors of importance for disease-specific quality of life

BACKGROUND

Irritable bowel syndrome patients report reduced disease-specific quality of life (IBSQOL). Factors of potential relevance for QOL include gastrointestinal (GI), psychological, and somatic symptoms, demographics, and GI motor and sensory abnormalities.

OBJECTIVE

The aim of our study was to evaluate the relative importance of these factors on the different IBSQOL dimensions.

METHODS

We included irritable bowel syndrome (IBS) patients who completed validated questionnaires to assess QOL, stool form and frequency, GI symptom severity, psychological distress, GI-specific anxiety, sense of coherence, and overall somatic symptom severity. Patients also underwent tests for oroanal transit time and rectal sensitivity. The nine dimensions of IBSQOL and their average (overall IBSQOL) were used as outcome variables, and factors associated with these were assessed using general linear models.

RESULTS

We included 314 IBS patients (74% female, mean age 36.3 ± 12.2 years). Higher stool frequency, GI and overall somatic symptom severity, psychological distress, and GI-specific anxiety were independently associated with reduced overall IBSQOL, with the model explaining 60% of the variance (p < 0.001). In models using each of the nine dimensions as outcomes, different association of demographic factors, GI symptoms, overall somatic symptom severity, psychological factors and sense of coherence were associated with reduced IBSQOL, explaining 20%-60% of the variance, with GI-specific anxiety being the factor that contributed most frequently. Rectal sensitivity or oroanal transit time were not independently associated with any of the dimensions.

CONCLUSION

Different combinations of demographic factors, GI and somatic symptoms, and psychological factors are of importance for the nine IBSQOL dimensions. Gastrointestinal-specific anxiety was the most important factor contributing to the majority of those dimensions in patients with IBS.

Review article: Physical and psychological comorbidities associated with irritable bowel syndrome

Irritable bowel syndrome (IBS) is one of the most common gastrointestinal disorders encountered by physicians in primary and secondary care. Patients with IBS commonly present with various extraintestinal complaints, which account for a substantial clinical and economic burden. The common extraintestinal comorbidities associated with IBS include anxiety, depression, somatisation, fibromyalgia, chronic fatigue syndrome, chronic pelvic pain, interstitial cystitis, sexual dysfunction and sleep disturbance. The presence of comorbidity in IBS poses a diagnostic and therapeutic challenge with patients frequently undergoing unnecessary investigations and interventions, including surgery. This review discusses the different physical and psychological comorbidities associated with IBS, the shared pathophysiological mechanisms and potential management strategies.

Sexual Dysfunction in Patients With Chronic Gastrointestinal and Liver Diseases: A neglected Issue

INTRODUCTION

Normal sexual activity is an important determinant of quality of life. Unfortunately, several chronic health disorders are associated with an impaired sexual function.

OBJECTIVE

To provide coverage of the current literature on prevalence and pathophysiology of sexual dysfunction in patients with gastrointestinal and liver disorders METHODS: A Comprehensive review of the literature on the prevalence of sexual dysfunction in chronic gastrointestinal and liver disorders, assessing the underlying mechanism (s) was performed.

RESULTS

Many gastrointestinal disorders, either functional or organic, are associated with some degree of sexual dysfunction. The main pathogenic mechanisms are: (i) the disease itself causing fatigue, anxiety or depression with a potential alteration of self-esteem; (ii) worry of transmitting a potential infectious agent through sexual activity; (iii) alteration of the endocrine mechanisms which are necessary for normal sexual functioning; (iv) chronic pro- inflammatory conditions which may cause endothelial dysfunction and abnormal vascular responses; (v) iatrogenic.

CONCLUSION

Based on this review, a thorough evaluation of sexual function through validated questionnaires and/or psychological interviews with patients with chronic gastrointestinal disorders should be part of the clinical assessment in order to timely diagnose and possibly treat sexual dysfunction in this clinical setting. L Romano, L Granata, F Fusco, et al. Sexual Dysfunction in Patients With Chronic Gastrointestinal and Liver Diseases: A neglected Issue. Sex Med Rev 2021;XX:XXX-XXX.

Sexual Dysfunction in Inflammatory Bowel Disease: What the Specialist Should Know and Ask

Inflammatory bowel disease (IBD) is a chronic condition that globally affects the health of people who suffer from it, deteriorating their quality of life (QoL). An aspect rarely explored by healthcare providers is the influence of the disease on the sexual functioning of individuals. This discretion is mainly due to an unconscious resistance when asking our patients about their sexual functioning because of a lack of knowledge and skills to tackle this topic or disinterest on the part of professionals, and fear or shame on the part of patients. Sexual function is a constant concern in IBD patients that has been reflected in several studies, especially if we consider that the prevalence of sexual dysfunction (SD) in IBD is higher than that reported in the general population. The etiology of SD in patients with IBD remains unclear but is likely to be multifactorial, where biological, psychosocial, and disease-specific factors are involved. Currently, there are no formal recommendations in the IBD clinical guidelines on how to manage SD in these patients. The use of validated clinical scales could improve the detection of SD and allow the treatment of the underlying causes in order to improve the QoL of patients with IBD. This review aims to illustrate the different aspects involved in SD in IBD patients and the importance of the participation of a multidisciplinary team in the early detection and treatment of SD at different stages of the disease.

Sex- and Gender-Related Differences in Common Functional Gastroenterologic Disorders

Functional gastrointestinal (GI) disorders (FGIDs) result from central and peripheral mechanisms, cause chronic remitting-relapsing symptoms, and are associated with comorbid conditions and impaired quality of life. This article reviews sex- and gender-based differences in the prevalence, pathophysiologic factors, clinical characteristics, and management of functional dyspepsia (FD) and irritable bowel syndrome (IBS) that together affect approximately 1 in 4 people in the United States. These conditions are more common in women. Among patients with IBS, women are more likely to have severe symptoms and coexistent anxiety or depression; constipation or bloating and diarrhea are more common in women and men, respectively, perhaps partly because defecatory disorders, which cause constipation, are more common in women. Current concepts suggest that biological disturbances (eg, persistent mucosal inflammation after acute gastroenteritis) interact with other environmental factors (eg, abuse) and psychological stressors, which influence the brain and gut to alter GI tract motility or sensation, thereby causing symptoms. By comparison to a considerable understanding of sex-based differences in the pathogenesis of visceral hypersensitivity in animal models, we know less about the contribution of these differences to FGID in humans. Slow gastric emptying and colon transit are more common in healthy women than in men, but effects of gonadal hormones on colon transit are less important than in rodents. Although increased visceral sensation partly explains symptoms, the effects of sex on visceral sensation, colonic permeability, and the gut microbiome are less prominent in humans than rodents. Whether sex or gender affects response to medications or behavioral therapy in FD or IBS is unclear because most patients in these studies are women.

Effects of Irritable Bowel Syndrome on Daily Activities Vary Among Subtypes Based on Results From the IBS in America Survey

BACKGROUND & AIMS

Irritable bowel syndrome (IBS) is associated with significant disease burden and decreased quality of life (QOL). We investigated the effects of IBS on different areas of daily function and compared these among disease subtypes.

METHODS

The Life with IBS survey was conducted by Gfk Public Affairs & Corporate Communications from September through October 2015. Respondents met Rome III criteria for constipation-predominant or diarrhea-predominant IBS (IBS-C and IBS-D, respectively). Data were collected from 3254 individuals (mean age, 47 years; 81% female; and 90% Caucasian) who met IBS criteria.

RESULTS

Respondents who were employed or in school (n = 1885) reported that IBS symptoms affected their productivity an average of 8.0 days out of the month and they missed approximately 1.5 days of work/school per month because of IBS. More than half the individuals reported that their symptoms were very bothersome. Individuals with IBS-C were more likely than with IBS-D to report avoiding sex, difficulty concentrating, and feeling self-conscious. Individuals with IBS-D reported more avoidance of places without bathrooms, difficulty making plans, avoiding leaving the house, and reluctance to travel. These differences remained when controlling for symptom bothersomeness, age, sex, and employment status. In exchange for 1 month of relief from IBS, more than half of the sample reported they would be willing to give up caffeine or alcohol, 40% would give up sex, 24.5% would give up cell phones, and 21.5% would give up the internet for 1 month.

CONCLUSIONS

Although the perceived effects of IBS symptoms on productivity are similar among its subtypes, patients with IBS-C and IBS-D report differences in specific areas of daily function.

The Incidence of Sexual Dysfunction in Patients With Irritable Bowel Syndrome

Introduction

Several studies have suggested that patients with irritable bowel syndrome (IBS) frequently have symptoms of sexual dysfunction.

Aim

The current study aims to map the current knowledge about the burden of sexual dysfunction in patients with IBS.

Methods

A literature review was conducted on PubMed and EMBASE using the following search terms or combinations thereof: irritable bowel syndrome; functional colonic disease; sexual function; sexual health; sexual behavior; sexual dysfunction; dyspareunia; erectile dysfunction; quality of life; and questionnaire.

Main Outcome Measure

Sexual dysfunction.

Results

1,273 texts were found, 331 duplicates were removed, and 844 texts were excluded because they did not meet the inclusion criteria, leaving 98 full text articles. These were examined and it was found that 41 fulfilled the criteria. 4 questionnaires were found; Irritable Bowel Syndrome Quality of Life (IBS-QOL) questionnaire, the Irritable Bowel Syndrome – Quality of Life (IBSQOL) questionnaire, the Irritable Bowel Syndrome-36 question (IBS-36) questionnaire, and the Arizona Sexual Experience Scale. Subscores for sexual relations in IBS-QOL ranged from 37.7−100 (11.9) for patients with IBS and 82.2−100 (6.6) for controls. The IBSQOL and IBS-36 subscores for sexual relations ranged from 49.7−90.5 (9) to 3.9−5.4 (0.8) with no healthy controls for comparison. After interventions were implemented, there was an improvement in subscores (the IBS-QOL mean changed to 10.5%, IBSQOL mean changed to 3.8%, and the IBS-36 mean changed to 40%). The study using Arizona Sexual Experience Scale showed that 51% of patients with IBS had sexual dysfunction and also scored lower on the IBSQOL questionnaire.

Conclusion

The information about sexual dysfunction in patients with IBS is sparse and emerges primarily from quality of life questionnaires. It seems as though patients with IBS have more sexual problems compared to controls, but further investigation regarding the extent and type of sexual dysfunction is needed.

Sørensen J, Schantz Laursen B, Drewes AM, et al. The Incidence of Sexual Dysfunction in Patients With Irritable Bowel Syndrome. Sex Med 2019;7:371–383.

Deep Dyspareunia: Review of Pathophysiology and Proposed Future Research Priorities

INTRODUCTION

Dyspareunia has been traditionally divided into superficial (introital) dyspareunia and deep dyspareunia (pain with deep penetration). While deep dyspareunia can coexist with a variety of conditions, recent work in endometriosis has demonstrated that coexistence does not necessarily imply causation. Therefore, a reconsideration of the literature is required to clarify the pathophysiology of deep dyspareunia.

AIMS

To review the pathophysiology of deep dyspareunia, and to propose future research priorities.

METHODS

A narrative review after appraisal of published frameworks and literature search with the terms (dyspareunia AND endometriosis), (dyspareunia AND deep), (dyspareunia AND (pathophysiology OR etiology)).

MAIN OUTCOME VARIABLE

Deep dyspareunia (present/absent or along a pain severity scale).

RESULTS

The narrative review demonstrates potential etiologies for deep dyspareunia, including gynecologic-, urologic-, gastrointestinal-, nervous system-, psychological-, and musculoskeletal system-related disorders. These etiologies can be classified according to anatomic mechanism, such as contact with a tender pouch of Douglas, uterus-cervix, bladder, or pelvic floor, with deep penetration. Etiologies of deep dyspareunia can also be stratified into 4 categories, as previously proposed for endometriosis specifically, to personalize management: type I (primarily gynecologic), type II (nongynecologic comorbid conditions), type III (central sensitization and genito-pelvic pain/penetration disorder), and type IV (mixed). We also identified gaps in the literature, such as lack of a validated patient-reported questionnaire or an objective measurement tool for deep dyspareunia and clinical trials not powered for sexual outcomes.

CONCLUSION

We propose the following research priorities for deep dyspareunia: deep dyspareunia measurement tools, inclusion of the population avoiding intercourse due to deep dyspareunia, nongynecologic conditions in the generation of deep dyspareunia, exploration of sociocultural factors, clinical trials with adequate power for deep dyspareunia outcomes, partner variables, female sexual response, pathways between psychological factors and deep dyspareunia, and personalized approaches to deep dyspareunia. Orr N, Wahl K, Joannou A, et al. Deep Dyspareunia: Review of Pathophysiology and Proposed Future Research Priorities. Sex Med Rev 2020;8:3-17.

The Role of Physical Therapy in Sexual Health in Men and Women: Evaluation and Treatment

INTRODUCTION

Many conditions of pelvic and sexual dysfunction can be addressed successfully through pelvic floor physical therapy (PFPT) through various manual therapy techniques, neuromuscular reeducation, and behavioral modifications. The field of pelvic rehabilitation, including sexual health, continues to advance to modify these techniques according to a biopsychosocial model.

AIM

To provide an update on peer-reviewed literature on the role of PFPT in the evaluation and treatment of pelvic and sexual dysfunctions in men and women owing to the overactive and the underactive pelvic floor.

METHODS

A literature review to provide an update on the advances of a neuromusculoskeletal approach to PFPT evaluation and treatment.

MAIN OUTCOME MEASURE

The use and advancement of PFPT methods can help in successfully treating pelvic and sexual disorders.

RESULTS

PFPT for pelvic muscle overactivity and underactivity has been proven to be a successful option for pelvic and sexual dysfunction. Understanding the role of the organs, nerves, fascia, and musculoskeletal system in the abdomino-pelvic and lumbo-sacro-hip region and how pelvic floor physical therapists can effectively evaluate and treat pelvic and sexual health. It is important for the treating practitioner to know when to refer to PFPT.

CONCLUSION

Neuromusculoskeletal causes of pelvic floor disorders affect a substantial proportion of men, women, and children and PFPT is a successful and non-invasive option. Pelvic floor examination by healthcare practitioners is essential in identifying when to refer to PFPT. Use of a biopsychosocial model is important for the overall well-being of each patient. Further research is needed. Stein A, Sauder SK, Reale J. The role of physical therapy in sexual health in men and women: Evaluation and treatment. Sex Med Rev 2019;7:46-56.

Gene Expression Profiling and Assessment of Vitamin D and Serotonin Pathway Variations in Patients With Irritable Bowel Syndrome

BACKGROUND/AIMS

Irritable bowel syndrome (IBS) is a multifaceted disorder that afflicts millions of individuals worldwide. IBS is currently diagnosed based on the presence/duration of symptoms and systematic exclusion of other conditions. A more direct manner to identify IBS is needed to reduce healthcare costs and the time required for accurate diagnosis. The overarching objective of this work is to identify gene expression-based biological signatures and biomarkers of IBS.

METHODS

Gene transcripts from 24 tissue biopsy samples were hybridized to microarrays for gene expression profiling. A combination of multiple statistical analyses was utilized to narrow the raw microarray data to the top 200 differentially expressed genes between IBS versus control subjects. In addition, quantitative polymerase chain reaction was employed for validation of the DNA microarray data. Gene ontology/pathway enrichment analysis was performed to investigate gene expression patterns in biochemical pathways. Finally, since vitamin D has been shown to modulate serotonin production in some models, the relationship between serum vitamin D and IBS was investigated via 25-hydroxyvitamin D (25[OH]D) chemiluminescence immunoassay.

RESULTS

A total of 858 genetic features were identified with differential expression levels between IBS and asymptomatic populations. Gene ontology enrichment analysis revealed the serotonergic pathway as most prevalent among the differentially expressed genes. Further analysis via real-time polymerase chain reaction suggested that IBS patient-derived RNA exhibited lower levels of tryptophan hydroxylase-1 expression, the enzyme that catalyzes the rate-limiting step in serotonin biosynthesis. Finally, mean values for 25(OH)D were lower in IBS patients relative to non-IBS controls.

CONCLUSIONS

Values for serum 25(OH)D concentrations exhibited a trend towards lower vitamin D levels within the IBS cohort. In addition, the expression of select IBS genetic biomarkers, including tryptophan hydroxylase 1, was modulated by vitamin D. Strikingly, the direction of gene regulation elicited by vitamin D in colonic cells is "opposite" to the gene expression profile observed in IBS patients, suggesting that vitamin D may help "reverse" the pathological direction of biomarker gene expression in IBS. Thus, our results intimate that IBS pathogenesis and pathophysiology may involve dysregulated serotonin production and/or vitamin D insufficiency.

Mega-Cecum: An Unrecognized Cause of Symptoms in Some Female Patients with Uro-Gynecological Symptoms and Severe Slow Transit Constipation

BACKGROUND

A subset of female patients with severe constipation report overlapping uro-gynecological symptoms which have been attributed to visceral hypersensitivity.

AIMS

To study colon morphology and motor function in female patients with medically refractory chronic constipation with or without uro-gynecological symptoms and to assess clinical outcomes following laparoscopic ileo-proctostomy.

METHODS

Colon anatomy and cecal emptying time were assessed with plain films and fluoroscopy following a standardized test meal mixed with barium. Transit time was determined with radiopaque markers. IBS-QOL and urinary incontinence questionnaires were employed to assess post-colectomy clinical response.

RESULTS

In 21 consecutive patients, mean colon transit time (h) was 211.1 ± 11.3, which was significantly greater than 58.9 ± 5.1 of 10 normal subjects (P < 0.001). Mega-cecum was found in 15 (Group 1) with mean cecal volume of 587 ± 27.9 cm³, significantly greater (P < 0.001) than 169.5 ± 10.4 cm³ of six without mega-cecum (Group 2). Mean cecal empting time (days) of barium-mixed feces in Group 1, 4.0 ± 0.6 was significantly greater than 1.33 ± 0.21 in Group 2 (P < 0.001). Eighteen patients (Groups 1 and 2) who had laparoscopic ileo-proctostomy experienced significantly improved quality of life (P < 0.001). In particular, Group 1 patients benefited significantly from improved uro-gynecological symptoms.

CONCLUSIONS

Hitherto an unrecognized mega-cecum with markedly impaired emptying function was found in patients with severe slow transit constipation and uro-gynecological symptoms. Subtotal colectomy relieved constipation and improved significantly uro-gynecological symptoms, suggesting strongly that mega-cecum is causally related to these symptoms.

Association Between Colonic Diverticulosis and Erectile Dysfunction: A Nationwide Population-Based Study

We investigated whether colonic diverticulosis (CD) is associated with an increased risk of the subsequent development of erectile dysfunction (ED).We identified 2879 patients, diagnosed with CD between 1998 and 2011 from the Taiwan National Health Insurance Research Database as the study cohort. Patients in a comparison cohort were frequency-matched with those in the CD cohort at a ratio of 1:4, frequency matched according to age (in 5-year bands) and year of CD diagnosis. The patients were followed-up until ED development, withdrawal from the National Health Insurance system, or the end of 2011. For both cohorts, the overall and age-specific incidence density rates of ED (per 1000 person-years) were calculated. The effects of age, CD, and other comorbidities on the risk of ED development were examined using Cox proportional hazards regression models.The average follow-up durations were 4.76 years and 4.97 years for the CD patients and comparison cohorts, respectively. The overall incidence of ED was 1.70-fold higher in the CD cohort than in the comparison cohort (2.92 and 1.71 per 1000 person-years, respectively). Colonic diverticulosis was an independent risk factor for subsequent ED development (adjusted HR [aHR] = 1.56, 95% confidence interval = 1.07-2.28) in a multivariate Cox proportional hazards regression model.In this large retrospective cohort study, CD was associated with future ED development. Additional studies are required for validating our results.

Getting personal: a review of sexual functioning, body image, and their impact on quality of life in patients with inflammatory bowel disease

BACKGROUND

Inflammatory bowel disease (IBD), which includes Crohn's disease and ulcerative colitis, is a chronic relapsing disorder associated with distressing physical and psychological symptoms. Many patients with IBD have impaired quality of life. Sexual functioning and body image are rated high among concerns of patients with IBD and may impact quality of life. A better understanding of the roles of sexual functioning and body image in quality of life for patients with IBD is needed because improvement in quality of life is a primary therapeutic goal. The aim of this review was to summarize the current literature on sexual functioning and body image in patients with IBD, emphasizing their impact on quality of life.

METHODS

An electronic search of the literature was conducted using the PubMed, PsycINFO, and Cochrane databases. Key phrases included: "Ulcerative Colitis/Crohn's disease/Inflammatory Bowel Disease and sexual function," and "Ulcerative Colitis/Crohn's disease/Inflammatory Bowel Disease and body image." The search produced 1284 citations. We identified 56 studies, which were conducted from 1990 through April 2014, written in English, and included at least 10 adults with IBD.

CONCLUSIONS

Few studies have tested directly the association between quality of life and sexual functioning and body image among patients with IBD. Results preliminarily suggest a positive relationship between quality of life and sexual functioning and body image postoperatively among patients with IBD. Future studies comprised of patients who have not had surgery are necessary to better understand the relationship between sexual functioning, body image, and quality of life in patients with active and inactive IBD.

Sexual dysfunction in inflammatory bowel disease

Sexual health is a broad term that encompasses a variety of functions including sexual thoughts, desire, arousal, intercourse, orgasm, and the impact of body image. Sexual dysfunction in individuals with inflammatory bowel disease is multifactorial including the impact of psychosocial factors, disease activity, medical therapies, surgical interventions, body image perceptions and changes, hypogonadism, and pelvic floor disorders. Providers caring for patients with inflammatory bowel disease should be cognizant of these concerns and develop management plans and techniques for earlier diagnosis and treatment.

Increased subsequent risk of erectile dysfunction in patients with irritable bowel syndrome: a nationwide population-based cohort study

This retrospective population-based study aimed to investigate associations between erectile dysfunction (ED) and the irritable bowel syndrome (IBS) using a Taiwanese cohort. We identified 17 608 male patients who were newly diagnosed with IBS from 1997 to 2010. The date that the diagnosis of IBS had been made was the index date. IBS patients with a history of ED before the index date or with incomplete demographic information were excluded. 70 432 age-matched subjects without IBS were selected as comparison cohort. Both cohorts were followed until the end of 2010 or censored. Cox proportional hazard regression model was used to estimate the effects of IBS on ED risks. The incidence rate ratio of ED in the IBS cohort was 2.92 times higher than that in the non-IBS cohort (29.5 vs. 10.1 per 10 000 person-years), with an adjusted hazard ratio (aHR) of 2.58 (95% confidence interval [CI]: 2.24-2.98). The risk of ED increased with increasing age and number of comorbidities. Patients with depression were at a higher risk of ED (aHR: 1.97; 95% CI: 1.49-2.63) compared with the subjects without depression. IBS patients had a higher risk of developing ED compared with non-IBS subjects. Ageing and comorbidities including diabetes, cardiovascular disease, chronic kidney disease and depression were associated with the risk of ED.

Patient satisfaction after gut-directed hypnotherapy in irritable bowel syndrome

BACKGROUND

Gut-directed hypnotherapy is an effective treatment option for irritable bowel syndrome (IBS). However, clinical observations suggest that patient satisfaction with hypnotherapy is not always associated with improvement in IBS symptoms.

METHODS

We evaluated 83 patients with IBS treated with gut-directed hypnotherapy (1 h week(-1), 12 weeks). After the treatment period, patients reported their satisfaction with the treatment (ranging from 1 = not at all satisfied, to 5 = very satisfied) and completed questionnaires to assess IBS symptom severity, quality of life, cognitive function, sense of coherence, depression, and anxiety before and after treatment.

KEY RESULTS

After hypnotherapy improved IBS symptom severity, quality of life, cognitive function, and anxiety were seen. Thirty patients (36%) were very satisfied with the treatment and 57 (69%) patients scored 4 or 5 on the patient satisfaction scale. Patient satisfaction was associated with less severe IBS symptoms and better quality of life after the treatment. In a multiple linear regression analysis, only the quality of life domain sexual relations was independently associated with patient satisfaction after hypnotherapy, explaining 22% of the variance. Using 25% reduction of IBS symptom severity to define an IBS symptom responder, 52% of the responders were very satisfied with hypnotherapy, but this was also true for 31% in the non-responder group.

CONCLUSIONS & INFERENCES

Patient satisfaction with gut-directed hypnotherapy in IBS is associated with improvement of quality of life and gastrointestinal (GI) symptoms. However, other factors unrelated to GI symptoms also seems to be of importance for patient satisfaction, as a substantial proportion of patients without GI symptom improvement were also very satisfied with this treatment option.

Prevalence of disturbed bowel functions and its association with disturbed bladder and sexual functions in the male population

BACKGROUND AND AIM

Chronic constipation is usually associated with young women, and urinary and sexual dysfunction has been reported as co-morbidity. Elderly men also appear to suffer from chronic constipation, as well as lower urinary tract symptoms and erectile dysfunction, but their association as co-morbidity has not been studied in the community. The aim of the present study was to determine the prevalence of bowel symptoms in our community with particular reference to the association with urinary and sexual dysfunction in the male population.

METHODS

A population-based cross-sectional survey involving 2276 subjects (1143 male, 1133 female) representative of the Singapore population demographics was conducted to evaluate the prevalence of chronic bowel disturbances, lower urinary tract symptoms (LUTS), and erectile dysfunction (ED).

RESULTS

The prevalence of chronic constipation was 25.1% overall, with the highest in men aged ≥ 70 years (35.8%) followed by women aged 20-29 years (30.5%). The commonest symptoms reported in chronic constipation were hard stool (95.1%), straining (90.9%) and incomplete evacuation (53.8%). Bloating was often experienced by 25.5% of the community, among whom 61.1% had some form of bowel disturbance. In men aged ≥ 30 years, LUTS (7.8% v 3.1%) and ED (60.5% v 48.6%) were more common in men with than without chronic constipation; constipation was an independent predictor of ED.

CONCLUSIONS

In this Asian urban community, chronic constipation was more common than previously suspected, and urinary and erectile dysfunction were found to be co-morbidity in men.

Comprehensive self-management reduces the negative impact of irritable bowel syndrome symptoms on sexual functioning

BACKGROUND

Women with irritable bowel syndrome (IBS) report sexual dysfunction. Comprehensive self-management (CSM) intervention has been shown to reduce gastrointestinal, psychological, and somatic symptoms in IBS women. Whether this intervention also reduces sexual dysfunction is not known.

AIMS

We sought to compare demographic and clinical factors in IBS women with and without sexual dysfunction as defined by the Arizona sexual experiences scale (ASEX) and to test the effects of CSM treatment on sexual dysfunction scores and on the sexual relations subscale of an IBS quality of life (IBSQOL) scale which measures the effect of IBS on sexual QOL.

METHODS

IBS (Rome II) women enrolled in a randomized clinical trial of CSM treatment were characterized as having sexual dysfunction (N = 89) or not (N = 86) at baseline based on ASEX criteria. Baseline characteristics and symptoms were compared between the two groups. Post-intervention changes were compared between the CSM and the usual care arms of the randomized trial.

RESULTS

Women meeting ASEX criteria for sexual dysfunction were older, had higher lifetime depression and antidepressant use, more primary care/MD visits, fewer mental healthcare visits, and greater sleep disturbance than those without sexual dysfunction. No significant group differences in gastrointestinal or somatic symptoms were observed. Compared with usual care treatment, CSM increased sexual QOL scores and had a weaker effect on ASEX scores.

CONCLUSIONS

Severity of IBS symptoms at baseline did not differ between IBS women with or without sexual dysfunction. The CSM intervention can reduce the effect of IBS on sexual QOL.

What level of IBS symptoms drives impairment in health-related quality of life in community subjects with irritable bowel syndrome? Are current IBS symptom thresholds clinically meaningful?

BACKGROUND

Quality of life is impaired in some people with IBS, but the level of symptoms that may drive this impairment is unclear.

AIMS

We aimed to identify whether current frequency and severity cut-offs for IBS-type symptoms are associated with a clinically meaningful impairment of quality of life in the community.

METHODS

People who met modified Rome III criteria for IBS (n = 201) and controls (n = 1,904) were assessed. Frequency of IBS symptoms was grouped a priori into 'less frequent' (not at all and sometimes) and 'more' frequent (often, very often and almost always). Severity of abdominal pain was grouped into 'mild' (very mild and mild) and severe (moderate, severe and very severe). Mental and physical functioning was measured using the valid SF-12, with 'normal' functioning (defined as a score of >43 and >48) and 'impaired' functioning (defined as a score of ≤43 and ≤48), respectively. Psychological variables were assessed via valid self-report.

RESULTS

Having 'more' versus 'less' severe abdominal pain (OR = 9.41; 95% CI 1.17-75.43, P = 0.03) and 'more' versus 'less' frequent diarrhoea (OR = 2.19; 95% CI 1.13-4.26, P = 0.02) along with increasing age (OR = 1.03; 95% CI 1.01-1.05, P = 0.003) were significant independent predictors of having impairment in physical functioning. In terms of psychological factors, having higher levels of depression (OR = 1.61; 95% CI 1.36-1.91) and somatic distress (OR = 1.17; 95% CI 1.09-1.27) were independently associated with mental and physical impairment, respectively.

CONCLUSION

The current frequency and severity threshold cut-offs for IBS symptoms in the Rome III criteria are associated with a clinically meaningful impairment of quality of life in community subjects with IBS.

Irritable bowel syndrome and chronic pelvic pain: a population-based study

BACKGROUND

Women with irritable bowel syndrome (IBS) frequently report chronic pelvic pain, however, it is still unanswered whether these are truly separate entities. IBS negatively impacts on quality of life, but the impact of IBS on sexual function is not clear.

GOALS

We aimed to (1) describe the impact of IBS on sexual function, and (2) evaluate the association between pelvic pain and IBS, and in particular identify if there are unique characteristics of the overlap group.

STUDY

The Talley Bowel Disease Questionnaire was mailed to an age- and gender-stratified random sample of 1031 Olmsted County, Minnesota residents aged 30 to 64 years. Manning (at least 2 of 6 positive) and Rome criteria (Rome I and modified Rome III) were used to identify IBS. Pelvic pain was assessed by a single item. Somatization was assessed by the valid somatic symptom checklist.

RESULTS

Overall 648 (69%) of 935 eligible participants responded (mean age 52 years, 52% female). Self-reported sexual dysfunction was rare (0.9%; 95% CI 0.3-2.0%). Among women, 20% (95% CI 16-24%) reported pain in the pelvic region; 40% of those with pelvic pain met IBS by Manning, or Rome criteria. IBS and pelvic pain occurred together more commonly than expected by chance (P<0.01). The overall somatization score (and specifically the depression and dizziness item scores) predicted IBS-pelvic pain overlap versus either IBS alone or pelvic pain alone.

CONCLUSION

In a subset with pelvic pain, there is likely to be a common underlying psychologic process (somatization) that explains the link to IBS.

Sexual dysfunction among Ghanaian men presenting with various medical conditions

BACKGROUND

Several medical conditions can affect and disrupt human sexuality. The alteration of sexuality in these medical conditions often hinder effective communication and empathy between the patients and their sexual partners because of cultural attitudes, social norms and negative feelings such as anxiety and guilt. Validated and standardized sexual inventories might therefore help resolve this problem. The objective of this cross-sectional study was to obtain data on the prevalence of male sexual dysfunction (SD) among Ghanaians with various medical conditions residing in Kumasi.

METHODS

The Golombok Rust Inventory of Sexual Satisfaction (GRISS) was administered to 150 Ghanaian men with various medical conditions between 19 and 66 years old (mean ± standard deviation: 40.01 ± 12.32 years) domiciled in the Kumasi metropolis.

RESULTS

Out of the total 150 questionnaires administered, 105 (70.0%) men returned the questionnaires. Questionnaires from 3 men were incomplete, leaving 102 complete and evaluable questionnaires, indicating a 68.0% response rate. Of the remaining 102 men, 88.2% were married, 70.6% had attained higher education, 88.2% were non-smokers. Whereas 54.9% were engaged in exercise, 61.8% indulged in alcoholic beverages. The prevalence of the various medical conditions include: diabetes (18%), hypertension (24.5%), migraine (11.8%), ulcer (7.8%), surgery (6.9%), STD (3.9) and others (26.5%). The prevalence of SD among the respondents in the study was 59.8%. The highest prevalence of SD was seen among ulcer patients (100%), followed by patients who have undergone surgery (75%), diabetes (70%), hypertension (50%), STD (50%) and the lowest was seen among migraine patients (41.7%).

CONCLUSIONS

SD rate is high among Ghanaian men with medical conditions (about 60%) and vary according to the condition and age.

Irritable Bowel Syndrome and Co-morbid Gastrointestinal and Extra-gastrointestinal Functional Syndromes

The irritable bowel syndrome (IBS) is the best known of the functional gastrointestinal tract disorders. Many IBS patients have at least one co-morbid somatic complaint and many meet diagnostic criteria for other functional disorders. Patients with IBS and another functional disorder, in comparison with patients with IBS only, have more severe IBS symptoms, a higher rate of psychopathology, greater impairment of quality of life, and more illness-related work absenteeism. Estimates of the prevalence of IBS in patients with fibromyalgia range from 30-35% to as high as 70%. Studies of IBS among patients with chronic fatigue syndrome have reported a prevalence ranging from 35-92%. The prevalence of IBS among patients with chronic fatigue syndrome is reported to be 14%. IBS patients with other co-morbid functional disorders appear to manifest a greater degree of somatization. It has been suggested that the presence of multiple co-morbid disorders may be a marker for psychological influences on etiology. This raises the question of whether the functional syndromes represent the same pathophysiological process, i.e., are the same entity that has been separated into different clinical entities because of medical sub-specialization, or are indeed separate disorders. While the answer to this question awaits further research, it would appear that most functional patients who meet formal diagnostic criteria for more than one functional disorder manifest one disorder clinically more that the others and seek consultation differentially for that set of symptoms.

Pelvic floor disorders and quality of life in women with self-reported irritable bowel syndrome

BACKGROUND

Quality of life among women with irritable bowel syndrome may be affected by pelvic floor disorders.

AIM

To assess the association of self-reported irritable bowel syndrome with urinary incontinence, pelvic organ prolapse, sexual function and quality of life.

METHODS

We analysed data from the Reproductive Risks for Incontinence Study at Kaiser Permanente, a random population-based study of 2109 racially diverse women (mean age = 56). Multivariate analyses assessed the association of irritable bowel syndrome with pelvic floor disorders and quality of life.

RESULTS

The prevalence of irritable bowel syndrome was 9.7% (n = 204). Women with irritable bowel had higher adjusted odds of reporting symptomatic pelvic organ prolapse (OR 2.4; 95% CI, 1.4-4.1) and urinary urgency (OR 1.4; 95% CI, 1.0-1.9); greater bother from pelvic organ prolapse (OR 4.3; 95% CI, 1.5-11.9) and faecal incontinence (OR 2.0; 95% CI, 1.3-3.2); greater lifestyle impact from urinary incontinence (OR 2.2; 95% CI, 1.3-3.8); and worse quality of life (P < 0.01). Women with irritable bowel reported more inability to relax and enjoy sexual activity (OR 1.8; 95% CI, 1.3-2.6) and lower ratings for sexual satisfaction (OR 1.8; 95% CI, 1.3-2.5), but no difference in sexual frequency, interest or ability to have an orgasm.

CONCLUSIONS

Women with irritable bowel are more likely to report symptomatic pelvic organ prolapse and sexual dysfunction, and report lower quality of life.

Healthcare resource utilization and expenditures of women diagnosed with hypoactive sexual desire disorder

OBJECTIVE

To describe healthcare utilization and costs among commercially insured women with a diagnosis of hypoactive sexual desire disorder (HSDD) in the US and to compare them with an age-matched control cohort.

METHODS

The Thomson Reuters MarketScan * Commercial Database was used to identify women aged 18-64 with an ICD-9-CM coded diagnosis of HSDD from 1/1/1998 to 9/30/2006. A control group of women with no diagnosis of any sexual dysfunction was matched 3:1 to cases based on age, health plan, and enrolment period. Healthcare utilization and costs were examined in the year prior to (pre-period) and following (post-period) index. Multivariate analyses were used to determine the adjusted difference in cost between women with and without HSDD in the post-period.

RESULTS

In both the pre- and post-periods, women with HSDD had more outpatient office visits, radiology services, prescription medication use, and medical visits (e.g., laboratory and outpatient surgeries) relative to controls. In the 12-month post-period, women with HSDD had significantly higher total costs relative to controls ($5,504 ± 11,132 vs. $4,606 ± 12,601, p < 0.001). After adjusting for clinical characteristics, women with HSDD had total healthcare expenditures that were 16.8% higher than controls (p < 0.001).

LIMITATIONS

There is a potential for selection bias among the women who actually received a diagnosis of HSDD from a clinician. Women who received a diagnosis may be different from women without a diagnosis in ways that cannot be measured in this study. Additionally, it is possible that some women in the control group had HSDD but were undiagnosed. To the extent that the control group included women who did have HSDD, the study estimates of differences between the two groups would be underestimated.

CONCLUSIONS

Women diagnosed with HSDD use significantly more healthcare services than women without diagnosed sexual dysfunction. These higher costs are driven by a greater use of outpatient services and prescription medications.

Somatic comorbidities of irritable bowel syndrome: a systematic analysis

OBJECTIVE

A large number of irritable bowel syndrome (IBS) patients are additionally afflicted with other somatic intestinal and/or extraintestinal comorbidities. The occurrence of one or more comorbidities is correlated with enhanced medical help seeking, worse prognosis, and higher rates of anxiety and depression-all resulting in a reduced quality of life. The aims of this study were, firstly, to review the literature on comorbidities of IBS and to assess gastrointestinal and extraintestinal comorbidities, and, secondly, to evaluate explanatory hypotheses and possible common pathophysiological mechanisms.

METHODS

We systematically reviewed the scientific literature in the past 25 years, as cited in MEDLINE.

RESULTS

IBS patients present with a twofold increase in somatic comorbidities compared to controls, possibly caused by common pathophysiological mechanisms. Nevertheless, to date, there has been no convincing evidence for a consolidated underlying pathophysiology or somatization. Gastrointestinal disorders, such as functional dyspepsia, gastroesophageal reflux disease, functional constipation, and anal incontinence, occur in almost half of the patients. In a broad variety of extraintestinal comorbidities, fibromyalgia, chronic fatigue syndrome, and chronic pelvic pain are best documented and appear in up to 65%.

CONCLUSION

The knowledge and structured assessment of comorbid somatic symptoms might allow to identify subgroups of IBS patients with special characteristics and lead to adaptation of the therapeutic concept.

Irritable bowel syndrome and chronic pelvic pain: a singular or two different clinical syndrome?

Irritable bowel syndrome (IBS) and chronic pelvic pain (CPP) are both somatoform disorders with a high prevalence within the population in general. The objective was to compare both entities, to find the differences and the similarities related to epidemiology and psychosocial aspects like stressful life events, physical and sexual abuse, illness behaviour and comorbidity. The technical literature was reviewed systematically from 1971 to 2006 and compared. According to literature, IBS and CPP seem to be one rather than two different entities with the same localisation of pain. Both syndromes also are similar concerning prevalence, the coexistence of mental and somatoform disorders, the common history of sexual and physical abuse in the past and their health care utilization. It could be shown that there were many similarities between IBS and CPP. Nevertheless both are traded as different clinical pictures as far. Therefore it seems to be reasonable and necessary to generate a common diagnosis algorithm and to bring gynaecologists and gastroenterologists into dialogue.

Is functional dyspepsia of particular concern in women? A review of gender differences in epidemiology, pathophysiologic mechanisms, clinical presentation, and management

Dyspepsia is a remarkably common symptom in the general population. Although multiple definitions have been used to describe the symptom, the most common explanation is that of chronic or recurrent pain or discomfort (a subjective negative feeling that may be associated with early satiety, fullness, bloating, or nausea) centered in the upper abdomen. When a thorough evaluation of a dyspeptic patient fails to identify a cause for her symptoms, the label of nonulcer or functional dyspepsia is applied. Functional dyspepsia is a heterogeneous disorder characterized by relapsing and remitting symptoms. Treatment strategies should focus on alleviating the most bothersome symptom and can be based on the proposed underlying pathophysiology. The effect of gender on mechanisms of disease, symptom presentation, and treatment response is an area of increasing interest and study. As with other functional gastrointestinal disorders, there appear to be some gender-specific features of functional dyspepsia. Specifically, gender-related differences have been observed in some studies of both the prevalence of individual dyspepsia symptoms, and in gastric emptying and proximal gastric motor function. There also appear to be gender differences in the psychosocial realm, with dyspeptic women experiencing a lesser sense of well-being than dyspeptic men, as well as an association of an abuse history with functional dyspepsia. This review will highlight specific gender differences related to the symptom presentation, pathophysiology, and approach to treatment of functional dyspepsia, while noting where differences have not been found and where further investigation is warranted.

Cues resulting in desire for sexual activity in women

INTRODUCTION

A number of questionnaires have been created to assess levels of sexual desire in women, but to our knowledge, there are currently no validated measures for assessing cues that result in sexual desire. A questionnaire of this nature could be useful for both clinicians and researchers, because it considers the contextual nature of sexual desire and it draws attention to individual differences in factors that can contribute to sexual desire.

AIM

The aim of the present study was to create a multidimensional assessment tool of cues for sexual desire in women that is validated in women with and without hypoactive sexual desire disorder (HSDD).

METHODS

Factor analyses conducted on both an initial sample (N = 874) and a community sample (N = 138) resulted in the Cues for Sexual Desire Scale (CSDS) which included four factors: (i) Emotional Bonding Cues; (ii) Erotic/Explicit Cues; (iii) Visual/Proximity Cues; and (iv) Implicit/Romantic Cues.

MAIN OUTCOME MEASURES

Scale construction of cues associated with sexual desire and differences between women with and without sexual dysfunction.

RESULTS

The CSDS demonstrated good reliability and validity and was able to detect significant differences between women with and without HSDD. Results from regression analyses indicated that both marital status and level of sexual functioning predicted scores on the CSDS. The CSDS provided predictive validity for the Female Sexual Function Index desire and arousal domain scores, and increased cues were related to a higher reported frequency of sexual activity in women.

CONCLUSIONS

The findings from the present study provide valuable information regarding both internal and external triggers that can result in sexual desire for women. We believe that the CSDS could be beneficial in therapeutic settings to help identify cues that do and do not facilitate sexual desire in women with clinically diagnosed desire difficulties.

Increased symptoms in female IBS patients with dysmenorrhea and PMS

Women with irritable bowel syndrome often report premenstrual distress syndrome and dysmenorrhea. A descriptive, four-group comparison design was used to compare the symptoms and psychological distress levels of women with irritable bowel syndrome (age 18-45 years) with and without dysmenorrhea and premenstrual distress syndrome. Data from three studies on women with irritable bowel syndrome (n = 226) collected between 1995 and 2004 were combined. Of these, 38 had self-reported irritable bowel syndrome with dysmenorrhea and premenstrual distress syndrome, 59 had irritable bowel syndrome with premenstrual distress syndrome, 15 had irritable bowel syndrome and dysmenorrhea, and the remaining 114 had irritable bowel syndrome only. Participants completed the Symptom Checklist-90 Revised and a symptom diary. Pain symptoms and computed scales of anxiety, depression, anger, and cognitive difficulties were compared during the luteal phase, menses phase, and for the change from luteal to menses phases. Premenstrual distress syndrome and dysmenorrhea had a strong impact on uterine cramping at menses, and a weaker effect on other pain symptoms at both luteal and menses phases. Premenstrual distress syndrome was associated with higher depression, anger, and cognitive problems at both luteal and menses phases; however, it was not associated with a greater increase from luteal to menses phases for any symptoms other than uterine cramping. The multiple symptoms reported by women with both irritable bowel syndrome and premenstrual distress syndrome suggest that this group may be particularly challenging to treat and may require a multicomponent (e.g., education, diet, relaxation, cognitive restructuring) approach.

Traditional Chinese medicine based subgrouping of irritable bowel syndrome patients

Partly from lack of effective conventional therapeutics, patients with irritable bowel syndrome (IBS) turn to complementary and alternative approaches, including Traditional Chinese Medicine (TCM). Key to TCM's approach to IBS is individualized therapies targeted at subgroups. Subgroups represent distinct patterns of dysregulation (e.g. "excess" or "deficiency") identified by both intestinal and extra-intestinal symptoms. Our objective was to identify operational criteria supporting the existence of TCM-based subgroups in IBS and to assess reliability and validity of these criteria. Using TCM principles, items were selected on face validity from conventional questionnaires. TCM practitioners evaluated items for content and face validity. Symptom items and a set of patient cases with item responses were validated by examining patient's pattern of response to items and assessing the consistency with which practitioners diagnosed patients on the spectrum of an "excess" or "deficiency" syndrome. Standard correlation analysis revealed 33 intestinal and extra-intestinal symptom items. There was high degree of practitioner agreement in assessing individual items to particular patterns. External validation by practitioners of cases showed high internal consistency among practitioners (Cronbach's alpha coefficients of 0.91 and 0.87 for excess and deficiency, respectively) and high correlation of average practitioner rating to original questionnaire generated scores (Pearson correlation coefficients of 0.94 and 0.92 for excess and deficiency, respectively). This pilot study provides preliminary support for a methodology to identify novel subgroups of IBS patients related to the TCM classification, which may differ in underlying pathophysiology and treatment responses.

Sex, gender, and irritable bowel syndrome: making the connections

BACKGROUND

Irritable bowel syndrome (IBS) is a widespread chronic health condition experienced more often by women than by men. The extent to which women outnumber men varies, however, with a narrower sex ratio found in population surveys and the widest in gastroenterology clinics. This suggests that explanations of women's excess risk of this condition likely involve both sex, or biological, differences between men and women as well as gender, or social, differences.

OBJECTIVE

This article reviews research on sex and gender factors in IBS and, in particular, the ways in which these factors affect the risk of IBS, either independently or in synergy.

METHODS

A multidisciplinary literature review of English-language IBS research published between 1966 and 2002 was conducted using a number of electronic databases (ASSIA, MEDLINE, PsycLIT, and SSCI/Web of Knowledge), augmented by manual search of issues not yet entered onto the databases. The key terms sex, gender, women, men, and irritable bowel disease were used to identify articles with potential relevance; titles and abstracts were reviewed and downloaded to a bibliographic referencing system. This approach yielded approximately 450 articles of interest in the subject area.

RESULTS

The literature review highlighted a range of sex- and gender-linked factors in IBS, including hormonal factors, genetic differences, psychosocial factors related to stress, mental well-being, gender roles, and the experience of sexual abuse. In addition, the literature suggests that gender-related factors overlap each other in explanations of IBS among women, and the interactions between these factors and sex-linked biology are not yet fully understood.

CONCLUSION

A complex model is needed-reflecting sex- and gender-linked factors and their interactions-to fully understand how these factors affect variations in risk and outcome between men and women with IBS.

Sex-based differences in gastrointestinal pain

Recent interest has focused on sex-related differences in irritable bowel syndrome (IBS) physiology and treatment responsiveness to novel pharmacologic therapies. Similar to a variety of other chronic pain conditions and certain affective disorders, IBS is more prevalent amongst women, both in population-based studies as well as in clinic-based surveys. Non-painful gastrointestinal symptoms, constipation and somatic discomfort are more commonly reported by female IBS patients. While perceptual differences to rectosigmoid stimulation are only observed following repeated noxious stimulation of the gut, sex-related differences in certain sympathetic nervous system (SNS) responses to rectosigmoid stimulation are consistently seen. Consistent with experimental findings in animals, current evidence is consistent with a pathophysiological model which emphasizes sex-related differences in autonomic and antinociceptive responses to certain visceral stimuli.

Long-term safety and efficacy of alosetron in women with severe diarrhea-predominant irritable bowel syndrome

OBJECTIVES

To assess long-term safety and efficacy of alosetron in women with severe, chronic diarrhea-predominant IBS and in a subset having more frequent urgency (i.e., bowel urgency at least 10 of 14 days during screening).

METHODS

Randomized patients received either alosetron 1 mg (n = 351) or placebo (n = 363) twice daily during a 48-wk, double-blind study. The primary endpoint was the 48-wk average rate of adequate relief of IBS pain and discomfort. Secondary endpoints included 48-wk average satisfactory control rates of urgency, stool frequency, stool consistency, and bloating. Other efficacy endpoints were average monthly adequate relief and urgency control rates and impact of provided rescue medication.

RESULTS

Alosetron-treated patients had significantly greater 48-wk average adequate relief (p= 0.01) and urgency control (p < 0.001) rates, regardless of rescue medication use, compared with placebo. Results in subjects with more frequent urgency were more robust than those in the overall population (p= 0.005). In weeks without rescue medication use, satisfactory control rates for stool frequency and stool consistency were significantly greater in alosetron-treated patients than placebo. Alosetron-treated patients had significantly greater adequate relief than placebo-treated patients (p < 0.05) in 9 of 12 months and significantly greater urgency control (p < 0.001) in all months. Adequate relief and urgency control were maintained throughout the treatment. Adverse events and serious adverse events were similar between treatment groups, except for constipation. Neither ischemic colitis nor serious events related to bowel motor dysfunction was reported.

CONCLUSIONS

Long-term use of alosetron is effective and well-tolerated in women with chronic, diarrhea-predominant IBS, including those with more frequent urgency.

The irritable bowel syndrome

Symptoms of IBS are very prevalent. One quarter of symptomatic individuals present for medical care because of symptom severity and psychologic factors. The pathogenesis of IBS is multifactorial, involving abnormalities in the gut, immune system, enteric sensory and motor nerves, and the CNS. IBS is diagnosed by symptomatology according to the Rome criteria and the absence of alarm findings suggestive of organic disease. Minimal testing is advocated to confirm the diagnosis in patients presenting with typical symptoms. Therapy is based on the dominant symptom (IBS subtype). Therapeutic options include dietary modifications, counseling, medications, and psychologic treatments. Novel therapies are being investigated to correct potentially pathogenetic peripheral and CNS abnormalities in IBS.

Does a preexisting anxiety disorder predict response to paroxetine in irritable bowel syndrome?

Irritable bowel syndrome (IBS) is the most common disorder in patients seen by gastroenterologists. Twenty subjects with IBS diagnosed with the Rome criteria were treated for 12 weeks with 20-40 mg/day of paroxetine (mean dose=31 mg/day). At baseline, 10 patients had a lifetime history of an anxiety disorder, and 10 patients did not have such a history. Both groups had similar improvement in abdominal pain, constipation, diarrhea, incomplete emptying, and bloating/ abdominal distension. Paroxetine was very well tolerated.

Gender differences in irritable bowel syndrome

In the United States and other Western cultures, a greater number of women seek health care services for symptoms of functional pain disorders, including irritable bowel syndrome, than men. Recent clinical trials indicate that gender differences in responsiveness to drug therapy also occur. Several lines of inquiry have focused on explaining this gender-related difference due to the higher prevalence of these disorders in women. Evidence of a physiologic component is based on gender differences in gastrointestinal transit time, visceral sensitivity, central nervous system pain processing, and specific effects of estrogen and progesterone on gut function. Additional factors may play a role, including gender-related differences in neuroendocrine, autonomic nervous system, and stress reactivity, which are related to bowel function and pain. However, the link between these measures and gut motility or sensitivity remains to be clarified. Psychological characteristics, including somatization, depression, and anxiety as well as a history of sexual abuse, may also contribute to gender-related differences in the prevalence of irritable bowel syndrome. Although gender differences in the therapeutic benefit of serotonergic agents have been observed, less is known about potential differences in responsiveness to nondrug therapies for irritable bowel syndrome.