Genital and Subjective Sexual Response in Women After Restorative Proctocolectomy with Ileal Pouch Anal Anastomosis—A Prospective Clinical Trial


Willem Bemelman, MD, PhD, Department of Surgery, Academic Medical Center, PO Box 22660, 1100 DD, Amsterdam, The Netherlands. Tel: 0031205666818; Fax: 0031206915462; E-mail:


Introduction.  Sexual dysfunction after ileo pouch anal anastomosis (IPAA) is common. The most systematic physical reaction to sexual stimulation is an increase in vaginal vasocongestion. Genital response can be assessed by vaginal pulse amplitude (VPA) using vaginal photoplethysmography.

Aim.  To assess whether restorative proctocolectomy with IPAA is associated with autonomic pelvic nerve damage and changes in subjective indices of sexual function in women.

Methods.  Female patients undergoing IPAA between April 2004 and January 2006 were included. During sexual stimulation (visual and vibrotactile) changes in vaginal vasocongestion were measured by vaginal photoplethysmography. Concurrently, quality of life (SF-36) and sexual functioning (FSFI, FSDS) were assessed using validated questionnaires.

Main Outcome Measures.  Primary endpoint was difference in VPA pre- and postoperatively. Secondary endpoints were differences in feelings of sexual arousal and estimated lubrication pre- and postoperatively and difference in psychological and sexual functioning pre-and postoperatively.

Results.  Eleven patients were included. For eight patients (median age 37 [22–49 years]) pre- and postoperative data were collected. VPA analysis showed a significant reduction in vaginal vasocongestion during sexual stimulation postoperatively, P = 0.012. Subjective sexual arousal and estimated lubrication during the experiment, reported psychological and sexual functioning pre- and postoperative were not different.

Conclusions.  Vaginal vasocongestion after IPAA was significantly reduced in this small study; indicating that IPAA in women might possibly be associated with autonomic pelvic nerve damage or partial devascularization of the vagina. Subjectively reported sexual arousal, estimated lubrication, psychological and sexual functioning were not diminished. Future research should focus on the possible advantage of a full close rectal dissection in these patients. Vlug MS, Laan ET, van Lunsen RHW, van Koperen PJ, Polle SW, and Bemelman WA. Genital and subjective sexual response in women after restorative proctocolectomy with ileal pouch anal anastomosis—A prospective clinical trial. J Sex Med 2010;7:2509–2520.