Inflammatory bowel diseases (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC), are chronic conditions that significantly impact patients’ physical and psychological well-being [1] . While extensive research has been conducted on IBD in Western populations, data from North Africa, particularly Morocco, remain scarce [2] . Over the past decades, the incidence of IBD has been increasing in newly industrialized countries, including those in the Maghreb region [3] . However, beyond clinical and endoscopic remission, the impact of IBD on patients’ quality of life, particularly in terms of sexual health, remains an overlooked issue [4] .

Sexual dysfunction (SD) is a common but often neglected consequence of IBD, affecting patients through disturbances in sexual desire, arousal, satisfaction, and overall sexual well-being [5] . Studies from Western countries estimate that SD affects between 40% and 66% of female IBD patients and 44% to 53.9% of male patients [6] . Despite the growing recognition of SD in IBD management, no studies have yet addressed this issue in Moroccan patients. Given the sociocultural context in Morocco, where discussions around sexual health remain taboo, SD in IBD patients may be underreported and poorly managed, further exacerbating its impact on quality of life [7] .

The STRIDE II consensus emphasizes that the management of IBD should extend beyond endoscopic and histologic healing to include patient-reported outcomes such as quality of life and functional well-being [8] . In this framework, addressing SD is essential to ensuring a comprehensive approach to IBD care.

This study is the first to investigate SD in Moroccan IBD patients. By assessing its prevalence and associated factors in comparison to healthy controls, we aim to highlight the need for a more holistic, patient-centered approach to IBD management. Raising awareness about this issue is crucial to breaking the silence around SD in IBD, ultimately fostering better clinical care and improving patients’ overall well-being.

A case-control study was conducted in our department, including 100 patients diagnosed with IBD and 100 age- and sex-matched healthy controls. Sexual dysfunction was assessed using the Female Sexual Function Index (FSFI) for women and the International Index of Erectile Function (IIEF) for men.

Data collection was carried out through an anonymous questionnaire consisting of two sections. The first section, completed by the physician, included detailed information on disease type, localization, phenotype, perianal manifestations, previous surgery, stoma presence, current treatment, and disease activity. The second section, completed by the patient, collected demographic and lifestyle information, including age, gender, height, weight, marital status, socioeconomic status, presence of depression, alcohol and tobacco consumption, and the two sexual function scores. Depression was assessed subjectively without the use of a standardized scoring system.

Sexual dysfunction (SD) in patients with inflammatory bowel disease (IBD) is frequently overlooked by healthcare providers, with insufficient attention given to this aspect of patient care. Various factors, including social and religious beliefs, make it challenging to discuss sexual health openly with patients. As a result, SD has become a “blind spot” in the medical field, despite its significant impact on both the physical and mental well-being of patients. In some cases, SD can exacerbate psychosomatic disorders, complicating the management of IBD and severely diminishing the quality of life for many individuals affected by the disease [9] [10] .

Our study revealed that 50 % of female IBD patients and 15 % of male IBD patients experienced sexual dysfunction (SD) and erectile dysfunction (ED), respectively, with both rates being notably higher than those observed in the control groups. These findings suggest that individuals with IBD are more vulnerable to SD compared to healthy individuals. Previous studies have reported SD prevalence ranging from 40% to 71% in female IBD patients and 30% to 55% in male IBD patients [9] - [14] . An interesting observation was the high prevalence of SD among female IBD patients with active disease. While the exact cause remains unclear, we propose that women may be more prone to abdominal pain, diarrhea, and other discomforts associated with active disease, which could contribute to the higher prevalence of SD in this group [12] .

We found no association between IBD subtype and sexual dysfunction (SD). However, patients with active disease were more likely to experience SD compared to those in remission. Additionally, our study showed that IBD had the most significant impact on female sexual desire, arousal, orgasm, and satisfaction. Previous studies have identified IBD disease activity as a risk factor for SD [12] [13] , which aligns with our findings. Increased disease activity often results in reduced libido, particularly in female patients. Active patients tend to experience more lubrication issues and dyspareunia. Concerns about discomfort, such as abdominal pain and diarrhea, can cause pelvic floor muscle tension, potentially leading to painful intercourse and lubrication difficulties due to fear of pain [12] [13] . A key finding in our study was that perianal disease (especially active PD) was an independent risk factor for SD. Moody et al. reported that Crohn’s disease (CD) patients, especially those with anal fistulas, are more likely to experience dyspareunia or even a complete lack of sexual activity [15] . Kappelman et al. observed low sexual desire and satisfaction in patients with active perirectal disease [16] . Horst et al. analyzed perianal disease in IBD patients treated with both medication and surgery, finding that 65% of patients had moderate to severe SD at baseline, with only 11% reporting moderate SD after 48 weeks of treatment. These findings suggest that active perianal disease can impair sexual function in IBD, and that treatment may help alleviate SD [17] .

In male patients, the only parameter that was significantly affected was erection.

Our study also identified anxiety and depression as independent risk factors for sexual dysfunction (SD) in women and erectile dysfunction (ED) in men. Given the physical and psychological distress associated with IBD, anxiety and depressive symptoms are more prevalent in these patients, with anxiety being particularly common among women [11] . Previous research has also linked anxiety [6] [10] and depression [11] - [13] to SD in IBD patients, which aligns with our findings.

Additionally, our study found no correlation between IBD-related surgical history and SD. This lack of association may be attributed to variations in surgical techniques, the expertise of the operating team, and differences in postoperative recovery, all of which can influence the impact of surgery on sexual function. Similarly, we did not find any link between IBD-related medications and SD. A survey conducted in Australia among 347 IBD patients revealed that over 60% of respondents were unconcerned about the potential impact of medications on their libido or sexual activity frequency. However, a small subset of patients (9.7%) reported deliberately avoiding medication due to concerns about its negative effects on sexual function [18] . These findings highlight the importance of patient education regarding medication use to improve adherence and dispel misconceptions.

Similarly, we did not find any link between IBD-related medications and SD. However, the number of patients receiving certain treatments (e.g., corticosteroids: n = 3 females, n = 2 males) was too small to draw meaningful conclusions.

This is the first study conducted in Morocco assessing sexual dysfunction (SD) in women and erectile dysfunction (ED) in men with IBD. Given the potential influence of geographical and cultural factors, we believe this study provides valuable new perspectives in this field.

Sexual dysfunction is more common in patients with IBD than in the general population, affecting nearly one in two women and one in six men. Disease activity, female sex, the presence of stomas, anoperineal manifestations, and anxiety-depressive disorders are independent risk factors for SD in IBD patients. Clinicians should assess the sexual function of IBD patients and provide appropriate treatment to enhance their quality of life. We strongly recommend systematically addressing this topic with patients as part of fostering a better doctor-patient relationship, allowing them to express their concerns and helping to break the longstanding taboo surrounding sexual health.