Female Sexuality, Fertility, Pregnancy, and Delivery after Ileal Pouch Anal Anastomosis for Ulcerative Colitis

Ileal pouch anal anastomosis (IPAA) may have a significant impact on female sexuality and fertility. While most women report no change or even improved sexual function after IPAA, 9 to 25% of women will experience a decrease in sexual satisfaction as a result of dysparunia, vaginal dryness, and incontinence during intercourse. Fertility is significantly decreased after IPAA and studies suggest that only 36 to 56% of women who try to become pregnant after surgery will be successful. For those women who do become pregnant, pregnancy is safe with no associated increase in maternal or fetal mortality. A transient deterioration in frequency and continence is reported by some women during pregnancy and these problems typically resolve after delivery. Because of the potential for anal sphincter injury with vaginal delivery, there has been considerable debate regarding the preferred method of delivery after IPAA. Studies suggest that there is no difference in pouch function between women who have delivered vaginally and those who have had a planned caesarian section. However, the true rate of sphincter injury associated with vaginal delivery remains unclear and the long-term risk of incontinence after vaginal delivery is unknown.