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Master Thesis

Évaluation de la fonction sexuelle chez les patients atteints de lésions ano‐périneales associées à la maladie de Crohn : résultats de l’étude SEPAL

Abstract : Introduction: over the past 10 years, several studies have found a link between Crohn's disease (CD) and sexual dysfunction (SD), especially in the female population. The most commonly associated factor was depressed mood; the perineal disease (PD) did not appear to play a significant role. The main objective of this work was to compare the prevalence of SD between 2 groups: in cases followed for active PD (group 1) compared to controls without active PD (with or without a history of PD) (group 2 ). Methods: french, multicenter (14 centers) cohort study. Cases were included between September 2016 and July 2017. Inclusion criterias were patients followed for active PD associated to CD. An active PD was defined by at least one ulceration (U1, U2 according to the Cardiff classification), symptomatic fistula (F1 or F2 with discharge, pain or induration) or symptomatic stenosis (S1 or S2 with terminal constipation or fecal incontinence). Controls without active PD had been selected from the existing SEXIA cohort. Men completed the International Index of Erectil Function (IIEF) and women the Female the Sexual Function Index (FSFI). Both assessed their perception of the impact of PD on their sexuality. Ano-perineal and luminal CD were evaluated by the Perineal Disease Activity Index and the Harvey-Bradshaw score. The primary endpoint was sexual dysfunction defined by a FSFI <26.55 in women and an IIEF <42.9 in men. Results: 64 women and 33 men were included in the cases, compared with 131 women and 107 men in the controls (46 women and 43 men with a history of PD in remission). A SD was found in 66% of the women and 30% of the men in the group of cases, versus 50% and 16% respectively in the control group. This difference was significant in women (p = 0.04) and not in men (p = 0.06). In men, erectile dysfunction was noted in 46% of cases and in 43% of controls (p = 0.8). In the group with active PD, 62% of women and 51% of men felt that their ano-perineal CD had an impact on their sexuality. In multivariate analysis, the predictive factor associated with SD in women was ano-perineal disease activity (PDAI> 4) (OR = 13.05 [2.32 - 73.44]) and being a smoker (OR = 0.08 [0.01 – 0.58]). In secondary analysis, women with PD in remission had a SD rate of 48%, significantly lower compared to active cases (p = 0.03). Conclusion: women with active PD had an increased prevalence rate of SD compared to controls without active PD. This result is not found in men. In patients in whom anoperineal remission was obtained, the SD rate was significantly lower than in active cases, but was still high (similar to that of a population without prior history of PD).
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-01676738
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Submitted on : Saturday, January 6, 2018 - 10:24:13 AM
Last modification on : Friday, January 19, 2018 - 1:18:05 AM

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Mohamed Réda Boudiaf. Évaluation de la fonction sexuelle chez les patients atteints de lésions ano‐périneales associées à la maladie de Crohn : résultats de l’étude SEPAL . Médecine humaine et pathologie. 2017. ⟨dumas-01676738⟩

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