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Guideline of the month - Sexual health in patients with IBD

December’s guideline of the month

The guideline

The Faculty of Sexual and Reproductive Healthcare offers advice on sexual and reproductive health issues that commonly arise in patients with inflammatory bowel disease. The guideline includes advice on fertility, pregnancy and contraception in patients with Crohn’s or ulcerative colitis.

Key points for GPs

  • Women with IBD should conceive only when the disease is under control – refer for pre-pregnancy counselling if indicated.
  • If either the man or woman is taking methotrexate, contraception should be used during treatment, and for at least three months after use of the drug has stopped.
  • Consider ectopic pregnancy as a diagnosis in sexually active women with IBD who present with abdominal pain and gastrointestinal symptoms.
  • Inform women that no causal association between combined oral contraception and onset or exacerbation of IBD has been established.
  • When prescribing contraception to women with IBD, consider the impact of associated conditions, such as VTE and osteoporosis.

Practical issues

The guideline calls for pathways to be developed to ensure patients can receive care from different services. Their absence in some areas may make referral difficult.

This applies notably to counselling, which the document recommends should be made available to patients and their partners.

Expert comment

Dr Anne Connolly, a GPSI in gynaecology in Bradford and chair of the Primary Care Women’s Health Forum, says: ‘The new FSRH guideline recognises the need for holistic healthcare for men and women who suffer from IBD.

‘It acknowledges that women with either Crohn’s or ulcerative colitis are at higher risk of thromboembolic disease, osteoporosis and hepatobiliary disease and offers advice about contraceptive options available.’

The guideline

Sexual and Reproductive Health for Individuals with Inflammatory Bowel Disease. London: FSRH; 2016

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