Sexual desire may be reduced by generalised debility or by the presence of perianal or cutaneous fistulas which alter the acceptance of his/her own body image and thus make the patient uncomfortable and embarrassed with his or her partner. More often, the constant presence of symptoms like abdominal pain and diarrhoea are the cause of reduced relational and sexual activity .
Besides these psychological aspects, many women suffer from dyspareunia. This can be secondary to perineal disease, severe proctitis or to the presence of an inflamed segment of bowel in the pouch of Douglas, in direct contact with the posterior fornix of the vagina . In these cases symptoms generally improve after resection of the inflamed bowel [135-137]. Another possible cause of dyspareunia is vaginal candidiasis, which has been frequently noticed in women affected by CD .
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