Impaired Fertility and Sexual Function in Women with Hirschsprung
disease: Results from an international multi-centre cross-sectional
study.
Abstract
Objective: Hirschsprung is a congenital disorder affecting the
gastrointestinal tract. However, pelvic colorectal surgery in infancy
has been hypothesised to impact gynaecological outcomes in later life.
Describe sexual function and fertility outcomes in women with
Hirschsprung disease compared to population controls. Assess factors
associated with poor outcomes (sexual dysfunction and subfertility).
Design: International multicentre cross-sectional cohort study
with population-matched controls Setting: Status post-discharge
from paediatric services Population: Female patients aged
> 20 years Methods: Validated questionnaire based
survey with linkage to patient medical records. Comparison with controls
using Mann-Whitney and Fisher’s Exact tests. Multivariable logistic
regression using outcomes of sexual dysfunction and subfertility.
Main Outcome Measures: Sexual Dysfunction (Female Sexual
Function Index; FSFI ≤ 26), Subfertility at 1 and 2 years.
Results: Sexual dysfunction as per the FSFI was more common in
patients and associated with poor functional outcomes; sexual abstinence
seemed to associate even moreso with poor bowel outcomes. Subfertility
was higher in patients compared to controls (1 year: 21/45 (47%) vs
38/178 (21%), p=0.0008; 2 years: 12/45 (27%) vs 17/178 (10%),
p=0.004). There was an increased proportion of patients who had accessed
fertility services (20/45 (44%) vs 43/178 (24%); p=0.009), however the
proportion of successful pregnancies in patients attempting to conceive
with IVF (11/17 (65%) vs 27/43 (63%); p=1.0) were similar.
Conclusions: This novel data suggests that women with
Hirschsprung disease who have undergone reconstructive surgery may be at
risk for adverse sexual functional and fertility outcomes.