Association Between Vulvovaginal Discomfort and Activity of Inflammatory Bowel Diseases

      Background & Aims

      Inflammatory bowel diseases (IBD) affect 200–400 people per 100,000 in the United States, about half of whom are women. We aimed to define the prevalence of vulvovaginal symptoms and association with IBD activity in a large cohort of women.


      Women more than 18 years old with IBD (1250) completed an online survey querying the presence and severity of vulvar or vaginal itch, burn, or irritation, vaginal discharge or dryness, and vulvovaginal pain. The survey collected information on demographic features and IBD activity (categorized using the Manitoba index). Women with and without symptoms were compared using bivariate analyses. Logistic regression evaluated associations between IBD severity and vulvovaginal symptoms, adjusted for diagnosis, menopause, smoking, depression, and use of medications to treat IBD.


      A total of 512 (41%) women reported at least 1 moderate–severe vulvovaginal symptom. All vulvovaginal symptoms except vaginal dryness were more common in women with active IBD. In a multivariate model controlled for menopause, smoking, t-score from the PROMIS depression instrument, and use of IBD medications, women with constant or frequent active IBD, based on Manitoba index scores, had increased odds for moderate–severe vulvovaginal symptoms (odds ratio, 1.68; 95% CI, 1.22–2.32) compared to women in remission. Vulvovaginal discomfort frequently or always decreased interest in sex (n=336; 28%) or ability to have sex (n=207; 16%).


      In an online survey of 1250 women, we found that women with more active IBD have increased prevalence of vulvovaginal discomfort, compared to women in remission. These symptoms affect sexual health.


      Abbreviations used in this paper:

      BV (bacterial vaginosis), CCFA Partners (Crohn’s and Colitis Foundation online cohort), CD (Crohn’s disease), CI (confidence interval), IBD (inflammatory bowel disease), IC (indeterminate colitis), OR (odds ratio), PROMIS (Patient-Reported Outcomes Measurements Information System), UC (ulcerative colitis)
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        • Ng S.C.
        • Shi H.Y.
        • Hamidi N.
        • et al.
        Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies.
        Lancet. 2017; 390: 2769-2778
        • Devroede G.
        • Schlaeder G.
        • Sanchez G.
        • Haddad H.
        Crohn's disease of the vulva.
        Am J Clin Pathol. 1975; 63: 348-358
        • Foo W.C.
        • Papalas J.A.
        • Robboy S.J.
        • Selim M.A.
        Vulvar manifestations of Crohn's disease.
        Am J Dermatopathol. 2011; 33: 588-593
        • Lipsky M.S.
        • Waters T.
        • Sharp L.K.
        Impact of vaginal antifungal products on utilization of health care services: evidence from physician visits.
        J Am Board Fam Pract. 2000; 13: 178-182
        • Karasz A.
        • Anderson M.
        The vaginitis monologues: women's experiences of vaginal complaints in a primary care setting.
        Soc Sci Med. 2003; 56: 1013-1021
        • Graham D.B.
        • Tishon J.R.
        • Borum M.L.
        An evaluation of vaginal symptoms in women with Crohn's disease.
        Digest Dis Sci. 2008; 53: 765-766
        • Vide J.
        • Osorio F.
        • Costa-Silva M.
        • et al.
        Cutaneous morbidity among inflammatory bowel disease patients: a cohort study.
        J Crohn's Colitis. 2017; 12: 442-451
        • Nyirjesy P.
        • Peyton C.
        • Weitz M.V.
        • Mathew L.
        • Culhane J.F.
        Causes of chronic vaginitis: analysis of a prospective database of affected women.
        Obstet Gynecol. 2006; 108: 1185-1191
        • Bel L.G.
        • Vollebregt A.M.
        • Van der Meulen-de Jong A.E.
        • et al.
        Sexual dysfunctions in men and women with inflammatory bowel disease: the influence of IBD-related clinical factors and depression on sexual function.
        J Sex Med. 2015; 12: 1557-1567
        • Riviere P.
        • Zallot C.
        • Desobry P.
        • et al.
        Frequency of and factors associated with sexual dysfunction in patients with inflammatory bowel disease.
        J Crohns Colitis. 2017; 11: 1347-1352
        • Huppertz-Hauss G.
        • Hoivik M.L.
        • Langholz E.
        • et al.
        Health-related quality of life in inflammatory bowel disease in a European-wide population-based cohort 10 years after diagnosis.
        Inflamm Bowel Dis. 2015; 21: 337-344
        • Eluri S.
        • Cross R.K.
        • Martin C.
        • et al.
        Inflammatory bowel diseases can adversely impact domains of sexual function such as satisfaction with sex life.
        Digest Dis Sci. 2018; 63: 1572-1582
        • Kingsberg S.A.
        • Krychman M.
        • Graham S.
        • Bernick B.
        • Mirkin S.
        The Women's EMPOWER Survey: identifying women's perceptions on vulvar and vaginal atrophy and its treatment.
        J Sex Med. 2017; 14: 413-424
        • Chung A.E.
        • Sandler R.S.
        • Long M.D.
        • et al.
        Harnessing person-generated health data to accelerate patient-centered outcomes research: the Crohn's and Colitis Foundation of America PCORnet Patient Powered Research Network (CCFA Partners).
        J Am Med Inform Assoc. 2016; 23: 485-490
        • Long M.D.
        • Kappelman M.D.
        • Martin C.F.
        • et al.
        Development of an internet-based cohort of patients with inflammatory bowel diseases (CCFA Partners): methodology and initial results.
        Inflamm Bowel Dis. 2012; 18: 2099-2106
        • Clara I.
        • Lix L.M.
        • Walker J.R.
        • et al.
        The Manitoba IBD Index: evidence for a new and simple indicator of IBD activity.
        Am J Gastroenterol. 2009; 104: 1754-1763
        • Walmsley R.S.
        • Ayres R.C.
        • Pounder R.E.
        • Allan R.N.
        A simple clinical colitis activity index.
        Gut. 1998; 43: 29-32
        • Peyrin-Biroulet L.
        • Panes J.
        • Sandborn W.J.
        • et al.
        Defining disease severity in inflammatory bowel diseases: current and future directions.
        Clin Gastroenterol Hepatol. 2016; 14: 348-354.e17
        • Thia K.
        • Faubion Jr., W.A.
        • Loftus Jr., E.V.
        • Persson T.
        • Persson A.
        • Sandborn W.J.
        Short CDAI: development and validation of a shortened and simplified Crohn's disease activity index.
        Inflamm Bowel Dis. 2011; 17: 105-111
        • Jowett S.L.
        • Seal C.J.
        • Barton J.R.
        • Welfare M.R.
        The short inflammatory bowel disease questionnaire is reliable and responsive to clinically important change in ulcerative colitis.
        Am J Gastroenterol. 2001; 96: 2921-2928
        • Health Measures
        Why use PROMIS?.
        (Available at:)
        • Cella D.
        • Riley W.
        • Stone A.
        • et al.
        The Patient-Reported Outcomes Measurement Information System (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005–2008.
        J Clin Epidemiol. 2010; 63: 1179-1194
        • Abdalla M.I.
        • Sandler R.S.
        • Kappelman M.D.
        • et al.
        Prevalence and impact of inflammatory bowel disease-irritable bowel syndrome on patient-reported outcomes in CCFA Partners.
        Inflamm Bowel Dis. 2017; 23: 325-331
        • Mitchell C.M.
        • Reed S.D.
        • Diem S.
        • et al.
        Efficacy of vaginal estradiol or vaginal moisturizer vs placebo for treating postmenopausal vulvovaginal symptoms: a randomized clinical trial.
        JAMA Intern Med. 2018; 178: 681-690
        • Brotman R.M.
        • Shardell M.D.
        • Gajer P.
        • et al.
        Association between the vaginal microbiota, menopause status, and signs of vulvovaginal atrophy.
        Menopause. 2013; 21: 450-458
        • Brotman R.M.
        • He X.
        • Gajer P.
        • et al.
        Association between cigarette smoking and the vaginal microbiota: a pilot study.
        BMC Infect Dis. 2014; 14: 471
        • Mantzouranis G.
        • Fafliora E.
        • Glanztounis G.
        • Christodoulou D.K.
        • Katsanos K.H.
        Inflammatory bowel disease and sexual function in male and female patients: an update on evidence in the past ten years.
        J Crohns Colitis. 2015; 9: 1160-1168
        • Reed B.D.
        • Haefner H.K.
        • Sen A.
        • Gorenflo D.W.
        Vulvodynia incidence and remission rates among adult women: a 2-year follow-up study.
        Obstet Gynecol. 2008; 112: 231-237
        • Reed B.D.
        • Harlow S.D.
        • Sen A.
        • et al.
        Prevalence and demographic characteristics of vulvodynia in a population-based sample.
        Am J Obstet Gynecol. 2012; 206 (e1–9): 170
        • Foxman B.
        • Marsh J.V.
        • Gillespie B.
        • Sobel J.D.
        Frequency and response to vaginal symptoms among white and African American women: results of a random digit dialing survey.
        J Womens Health. 1998; 7: 1167-1174
        • Frank S.M.
        • Ziegler C.
        • Kokot-Kierepa M.
        • Maamari R.
        • Nappi R.E.
        Vaginal Health: Insights, Views & Attitudes (VIVA) survey - Canadian cohort.
        Menopause Int. 2013; 19: 20-27
        • Linhares L.M.
        • Witkin S.S.
        • Miranda S.D.
        • Fonseca A.M.
        • Pinotti J.A.
        • Ledger W.J.
        Differentiation between women with vulvovaginal symptoms who are positive or negative for Candida species by culture.
        Infect Dis Obstet Gynecol. 2001; 9: 221-225
        • Lowe N.K.
        • Neal J.L.
        • Ryan-Wenger N.A.
        Accuracy of the clinical diagnosis of vaginitis compared with a DNA probe laboratory standard.
        Obstet Gynecol. 2009; 113: 89-95
        • Kostic A.D.
        • Xavier R.J.
        • Gevers D.
        The microbiome in inflammatory bowel disease: current status and the future ahead.
        Gastroenterology. 2014; 146: 1489-1499
        • Antonio M.A.
        • Rabe L.K.
        • Hillier S.L.
        Colonization of the rectum by Lactobacillus species and decreased risk of bacterial vaginosis.
        J Infect Dis. 2005; 192: 394-398
        • Schilling J.
        • Loening-Baucke V.
        • Dorffel Y.
        Increased Gardnerella vaginalis urogenital biofilm in inflammatory bowel disease.
        J Crohns Colitis. 2014; 8: 543-549
        • Bielefeldt K.
        • Davis B.
        • Binion D.G.
        Pain and inflammatory bowel disease.
        Inflamm Bowel Dis. 2009; 15: 778-788

      Linked Article

      • Predictors of Dyspareunia Among Female Patients With Inflammatory Bowel Disease
        Clinical Gastroenterology and HepatologyVol. 18Issue 4
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          We read the recent paper published in Clinical Gastroenterology and Hepatology by Ona et al1 with interest. Sexual dysfunction is a well-recognized complication of chronic illness. In inflammatory bowel disease (IBD), such factors as age of diagnosis, increased bowel frequency, abdominal pain, fatigue, incontinence, perianal fistulas, abscesses, or skin tags may lead to an accumulation of physical and psychosocial factors that can impair sexual function. The authors reported that vulvovaginal discomfort was significantly associated with IBD activity, measured using validated symptom-based questionnaires in an online survey of 1250 women in the United States.
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