Sex therapy for GI patients: UChicago Medicine program is the first of its kind in the U.S.

People with chronic gastrointestinal (GI) diseases sometimes have sexual problems related to their health, but they may suffer in silence.

“Patients are often afraid to bring up their sexual issues to their GI providers — and the providers usually don’t ask,” said Alyse Bedell, PhD, a University of Chicago Medicine clinical health psychologist and certified sex therapist who specializes in working with people with GI conditions.

These patients, especially those with inflammatory bowel diseases (IBD) such as Crohn’s and ulcerative colitis, or who may have had ostomy surgery, have unique sexual health concerns. It’s why sex therapy is now part of the spectrum of services available at UChicago Medicine’s IBD Center.

No question is taboo for Bedell. In 2021, she began offering sex therapy to patients, making UChicago Medicine the only hospital system in the country to have this specialized care.

Bedell spoke more about her work.

What are some of the most common sexual problems GI patients face?

For women, it’s low desire and difficulty reaching orgasm. For men, it’s erectile dysfunction and low desire.

The reasons why are largely the same across genders: Fatigue and pain can play a large role in reducing desire for sexual activity, but body image concerns can also contribute.

A major surgery or ongoing GI issues might cause embarrassment and make it hard for a person to see themselves as attractive, sexual beings. So, we talk about things they can do to cultivate desire.

How do you help GI patients with sexual health issues?

I start by reviewing a patient’s chart and talking to their GI team to see if there’s something going on medically that could impact their sexual function — like medications, unmanaged chronic diseases, or less commonly, hormonal or neurological issues.

Sometimes, patients need additional evaluation with a sexual medicine specialist, like a gynecologist or urologist. My expertise is talking to the patient and figuring out what psychological, social and interpersonal factors might be at play.

We work together to identify the source of the problem, and I help patients learn cognitive and behavioral strategies to address it. This might include how to discuss sexual concerns with their partner, managing anxiety around sexual activity and learning how to relax the mind and body.

A sex therapist can open a dialogue about the person’s current interest in sexual activity. For patients in committed relationships, it is often helpful to have their partner attend some sessions.

What are some of the strategies you offer?

People with active GI symptoms, or who are living with long-term anatomical changes like an ostomy, may still have interest in sexual activity and can benefit from modifications that help them feel more comfortable.

This might be achieved by allowing time before sexual activity to “freshen up,” or letting their partner know they might need breaks. Some people may prefer keeping on certain items of clothing. For example, you can purchase belts or lingerie to wear over an ostomy pouch.

Modifications could also involve a more comfortable sex position or prioritizing sexual activity during the day, since many people with chronic illness don’t have good energy at night.

When a disease is active, it’s normal to have low desire. We can help patients normalize this, so they feel OK telling their partner that penetrative intercourse or other sexual activity is off the menu for now. However, we can encourage continued engagement in other activity, including nonsexual physical intimacy like massages, kissing, hugging or cuddling.

What is the “sitting apart on the couch” phenomenon?

This happens when a person with a GI condition is in pain, tired, is struggling sexually or isn’t interested in sexual activity.

Even in a nonsexual context, like sitting and watching TV together, they change their behavior and might sit farther apart from their partner on the couch, as if to subtly say “stay away from me.” They fear being close might imply that they want to do something sexual.

But then, when they feel better, they continue to sit apart. They’re no longer physically affectionate with their partner, which can lead to bigger issues.

In these cases, people can really benefit from working with a sex therapist. They can talk through what puts the brakes on their sexual drive and learn cognitive and behavioral skills to increase their sexual desire.

What made you decide to offer sex therapy for GI patients at UChicago Medicine?

I spent six months working with UChicago Medicine oncology psychologist and sex therapist Amy K. Siston, PhD, learning how to do sex therapy with cancer patients and survivors. At the time, I already had extensive training working with patients who had GI conditions and didn’t see this service being offered in a GI setting.

It became a lightbulb moment for me. I trained for several years to become an AASECT-certified sex therapist.

I now train clinical psychology externs, interns and postdocs to also do sexual health work. We also have another GI psychologist at UChicago Medicine, Jennifer Schmaus, PhD, who helps patients with other issues related to their IBD.

To make an appointment with a UChicago Medicine GI psychologist or sex therapist, ask your GI provider for a referral to the psychogastroenterology service.