Feelings and emotions
IBD and its treatments can also have emotional and psychological effects on personal and sexual relationships. Some people with IBD struggle with poor body image (for example, you may be unhappy with your weight). If you have had surgery for IBD, you may feel embarrassed about scars. Or you may still be coming to terms with a stoma. It can be difficult to feel sexy if you are unhappy or dissatisfied with how you look or how your body works. Worrying about how your partner will react can add to these negative feelings and make maintaining your self-confidence even more difficult.
Another anxiety may be about how your partner will react to more day-to-day aspects of IBD. What if you need to rush to the loo in the middle of sex? Or make inappropriate noises or smells? Will they feel frustration or irritation? Even in the strongest relationships, partners can sometimes say or do the ‘wrong thing’, perhaps, at least partly, out of embarrassment. If you are feeling particularly vulnerable this can be hurtful.
Sometimes you may not feel like having sex - either due to your IBD symptoms, or because you don’t feel much desire. This sort of situation is very common and can make people feel stressed and anxious, especially if they then feel guilty about it. It is natural to feel this way – coming to terms with the impact of a long-term condition like IBD is not easy.
If you cannot enjoy your usual sexual practices, this can have an impact on your relationship. Having individual or couple counseling may help you to come to terms with any changes in how you feel about your self-image.
DEPRESSION
Some people with IBD might become depressed, which can affect their interest in sex. Men who are depressed often find it more difficult to get an erection, and both men and women can find that their sexual satisfaction is decreased. Anxiety and depression are common in people with IBD, which is not surprising when you consider the disruption that can be caused by the unpredictable and fluctuating nature of the condition. If you are troubled by depression, or are worried that you might be depressed, speak to your GP or IBD team. Both counseling (see above) and anti-depressant medication can be effective.
However, some anti-depressant medications may decrease sex drive or cause sexual problems, such as difficulty maintaining an erection, or experiencing orgasm. If you develop these or other side effects from anti-depressant medication, contact your GP or our IBD team to see if you can try an alternative medication.
TALKING TO YOUR PARTNER
One of the best ways to deal with these sorts of fears is to talk about them. 
This may not be easy. Many people find it very difficult to talk openly about sexual matters, regardless of whether or not they have an illness such as IBD. But, discussing your fears and worries with your partner can often relieve a lot of anxiety and greatly improve mutual understanding. Also, the more you are able to talk about your concerns to your partner, the more relaxed you are likely to feel. It may help to alleviate their worries, as they might be concerned too, for example, about hurting you. If you shut your partner out from what you are thinking and feeling, they might feel rejected or think they have done something wrong. Sharing your feelings can reassure them and help them to feel a part of what’s going on in both of your lives.
It may be that your preferences and needs have changed because of your IBD symptoms or treatments. Perhaps activities that used to bring you pleasure are now uncomfortable or painful. Talk to your partner about this - and also what you would like to do and what still feels good. Discussing such sensitive issues can be difficult at first, but it will get easier with time and should help you feel more emotionally intimate.
Some couples find that having a sense of humor can be a real help. While it is important to be sensitive and caring, sometimes being able to see the funny side of things, and having a laugh about it, can ease the situation and bring you together.
You (and your partner) may find it useful to discuss some of these issues with a sympathetic member of your IBD team. IBD nurses are often very supportive. If you find it really difficult to talk through your feelings and worries with your partner, you might like to think about seeking help from a specialist relationship counsellor. A counselor with experience of working with people with chronic illnesses may be particularly helpful.
BEING INTIMATE
If you are in a relationship, you can be intimate in many different ways. 
You don’t have to focus on sexual intercourse to give and receive sexual pleasure. You might agree with your partner to avoid the sexual activities you don’t want to engage in, and to explore other ways to be sexually intimate. Find a time that you are not rushed when you could try experimenting. This could be, for instance, with the sense of touch, each letting the other know ‘what turns you on’, and spending more time on these sensations. You could try using aromatic oils to massage each other, creating an intimate atmosphere with music and candles. Another idea is to try bathing together, or even taking it in turns to bathe each other. The key aim is to find activities that will bring you closer together in a way you both enjoy.
