Month: May 2023

Everyone who lives with inflammatory bowel disease (IBD) knows their illness has a major impact on daily life. Many people are diagnosed in their 20s or 30s, a time when we might hope for few health challenges.

Medications, and sometimes surgery, may be used to treat IBD. If you identify as LGBTQ+, you might wonder how all of this may affect you — your physical health, of course, but also your sexual health and pleasure. Below are a few things to understand and consider.

What is inflammatory bowel disease?

IBD is a condition that causes inflammation along the gastrointestinal (GI) tract. The two main types are Crohn's disease and ulcerative colitis:

• Crohn's disease: inflammation can occur anywhere along the GI tract (from the mouth to the anus)
• Ulcerative colitis: typically affects the large intestine (colon) only.

IBD can cause diarrhea, bloody stool, weight loss, and abdominal pain, and is typically diagnosed with blood and stool tests, imaging, and colonoscopy. A diagnosis of IBD may increase the risk of developing anxiety or depression, and can also have an impact on sexual health. People with IBD may require long-term medical treatment or surgery for their condition.

The starting point: Talking to your doctor

Talking to your medical team about IBD and sexual health may not be easy. This may depend on how comfortable you feel disclosing your LGBTQ+ identity with your health care providers. Ideally, you should feel comfortable discussing sexuality with your medical team, including what types of sexual partners and activities you participate in and how IBD may affect this part of your life.

Be aware that health care providers may not be able to address all LGBTQ+-specific concerns. Optimal care for people with IBD who identify as LGBTQ+ is not fully understood. However, this is an active area of research.

How might medicines for IBD affect sexual health?

Many effective IBD medications subdue the immune system to decrease inflammation. These immunosuppressive medicines may raise your risk for sexually transmitted infections (STIs) such as HIV, chlamydia, syphilis, and gonorrhea.

What you can do: Discuss these concerns with your doctor so you can take appropriate protective measures. This might include:

• ensuring that your vaccinations, such as hepatitis B and HPV, are up to date.
• engaging in sex using barrier protection to prevent STI transmission.
• taking pre-exposure prophylaxis (PrEP). This safe and effective medicine helps prevent the spread of HIV. Ask your primary care doctor or gastroenterologist if PrEP is appropriate for you.

How might surgery for IBD affect sexual health?

For some people with IBD, gut inflammation is severe enough to require surgery to remove part of the intestine. For example:

• Abscesses or fistulas (abnormal connections between two body parts) sometimes form when someone has Crohn's disease around the anus. This may require surgical treatment.
• Active inflammation in the rectum or anus may make sex painful, particularly for people who engage in anal receptive sex.
• We don't yet know whether anal receptive sex is safe for people who have had surgery to remove the colon and create a J-pouch, which is formed from small intestine to create an internal pouch that enables normal bowel movements.

What you can do: Discuss your concerns with your gastroenterologist and colorectal surgeon.

If you engage in anal sex, you may be confused about whether it is safe to do so. While you may feel uncomfortable discussing this concern and others with your doctor, try to be as honest and open as you can. That way, you'll receive the best information on how to engage in safe and enjoyable sex after an IBD diagnosis or surgery.

What else to consider if you are transgender

People with IBD who are transgender may have additional concerns to address.

For example, there may be a risk for sexual side effects from gender-affirming surgery. These procedures may include vaginoplasty (surgical creation of a vagina) for transgender females, or phalloplasty (surgical creation of a penis) for transgender males. The safety of these procedures in people with IBD is not currently well understood.

What you can do: If you identify as transgender, ask your doctor if any gender-affirming surgeries you've had or medicines you take, such as hormones, might affect your IBD, recommended treatments, or sexual health.

If you're considering gender-affirming surgery, discuss your options with your medical team. Be aware that gender-affirming surgery may be more challenging, or may not be advisable, for people with complex or active IBD. It's important to discuss your specific risks with your doctor when pursuing gender-affirming care. Having access to a team of physicians, including a surgeon and a gastroenterologist, may improve outcomes.

The bottom line

Try to talk to your gastroenterologist about how your sexual practices and gender identity may affect — and be affected by — your IBD. A conversation like this may feel uncomfortable, but being candid about your symptoms and concerns will help you receive the best possible care.

Often, a multidisciplinary approach to care is helpful. Your health care providers, including your gastroenterologist and surgeon, may suggest seeing additional specialists.

Much remains unknown about sexual health and practices in LGBTQ+ people with IBD. While more research is needed, open communication on the impact of medications, surgery, and other aspects of living with IBD can do a lot to improve your quality of life.

About the Authors

Andrew Eidelberg, MD, Contributor

Dr. Andrew Eidelberg is a third-year internal medicine resident at Beth Israel Deaconess Medical Center. After graduating from the University of Miami and Weill Cornell Medical College, he decided to pursue a career in gastroenterology, specifically … See Full Bio View all posts by Andrew Eidelberg, MD

Loren Rabinowitz, MD, Contributor

Dr. Loren Rabinowitz is an instructor in medicine Beth Israel Deaconess Medical Center and Harvard Medical School, and an attending physician in the Inflammatory Bowel Disease Center at BIDMC. Her clinical research is focused on the … See Full Bio View all posts by Loren Rabinowitz, MD

At some point in life, everyone experiences denial, a natural response when you’re unable or unwilling to face the facts. Denial is not always a bad thing. But it might be easier to recognize in others than in yourself.

“It’s hard to look at your own life and take a good inventory of what’s going on. It takes a lot of work,” says Jonathan Scholl, a therapist and clinical social worker at Harvard-affiliated McLean Hospital.

Here’s a little insight about denial, how to spot it in yourself and others, and what you might want to do about it.

What is denial?

In psychological terms, denial is a defense mechanism, a skillful tool the mind can employ when things get tough. “I see it as a protective barrier we have that we might or might not be aware of,” Scholl says. “It keeps us safe. It also keeps us from looking at ourselves or addressing something around us and making a change.”

You can be in denial about something you’re not ready to admit or take on, or something that challenges deeply held beliefs.

Common triggers for denial can involve

• abuse (mental, emotional, physical, verbal, sexual, financial, or other types of abuse)
• alcohol in excess or other substance use, or substance use disorder
• lifestyle or family issues
• medical diagnoses
• mental health issues
• politics
• smoking
• unhealthy weight gain.

How does denial help us?

Denial can shield us from difficult emotions. Scholl says that might be helpful in the short term, and provide relief to people who don’t have the bandwidth or ability to face a problem.

For example, maybe someone is unhappy in a relationship, but the thought of being alone is worse than the thought of being together. Or perhaps someone is burned out or overwhelmed, and lacks the energy or emotional capability for accepting what’s happening. “Part of the person feels it’s easier not to think about the situation, and lets it go because it feels like it’s too much to handle right now,” Scholl says.

How can denial hurt us?

In dangerous or unhealthy situations, denial can hurt us.

For example, keeping our eyes shut about the realities of a physical or mental illness can lead to serious health consequences. “We see a lot of teens with depression and substance use disorders, and some parents deny there are problems because they’re afraid of what it means for the child. It comes from a place of worry,” Scholl says. “But denying problems can hurt children and block them from making meaningful change.”

Denial can also hurt when it involves addiction or abuse. Those problems affect everyone in a family, and can lead to unhealthy patterns that get passed down from one generation to the next.

Spotting behavior patterns that suggest denial

People in denial often exhibit certain behaviors. For example, they might

• minimize or justify problems, issues, or unhealthy behaviors
• avoid thinking about problems
• avoid taking responsibility for unhealthy behaviors, or blame them on someone else
• refuse to talk about certain issues, and get defensive when the subjects are brought up.  

Moving from denial toward meaningful change

Dealing with denial means first recognizing that it’s occurring — which can be a challenge for anyone — and then addressing the underlying issue that’s causing it.

If you recognize denial in yourself, Scholl advises that you reach out for help. Talk to someone close to you or get an outside opinion from a therapist, a spiritual counselor, your doctor, or a hotline number, such as the National Domestic Violence Hotline if you’re experiencing intimate partner violence. For addiction problems, make that first call to a substance use disorder hotline or recovery center, or try attending just one meeting of a 12-step program (such as Alcoholics Anonymous). In time, you can learn to face your fears or concerns, and develop a concrete plan to change.

Recognizing denial in others: Tread carefully

If you recognize denial in others and you’d like to point it out, tread very carefully. Seek guidance from experts before taking on a situation that could be dangerous to you or to the other person.

If the situation is not dangerous, be as compassionate as possible. “Have a warm and empathetic conversation in an environment without distractions,” Scholl says. “Express your love and point out what you’re seeing. Talk about how it affects you. And then give it time. You can’t force anyone to change. All you can do is plant a seed.”

About the Author

Heidi Godman, Executive Editor, Harvard Health Letter

Heidi Godman is the executive editor of the Harvard Health Letter. Before coming to the Health Letter, she was an award-winning television news anchor and medical reporter for 25 years. Heidi was named a journalism fellow … See Full Bio View all posts by Heidi Godman

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD