Ulcerative Colitis and Erectile Dysfunction: Understanding the Link

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On April 23, 2025

Erectile dysfunction (ED) seems to be more common in men with ulcerative colitis.

In an analysis of 14 studies involving over 32,000 men with inflammatory bowel disease (IBD), including UC, researchers found that 27 percent of participants reported having ED. Those with depression were more than 3 times as likely to have erectile dysfunction, while those with greater disease activity were about twice as likely. Surgery related to IBD raised the risk by about 30 percent.

Other studies found that 34 percent of men with IBD reported having some type of sexual dysfunction, compared with 63 percent of women with IBD.

Several factors contribute to erectile dysfunction in men with UC.

Greater Disease Activity and Worse Symptoms

More severe disease activity, or active UC flares, may cause ED in the following ways:

Inflammation Substances that your body releases when inflammation occurs can inhibit the production of testosterone and are linked to ED.
Pain You’re less likely to be able to achieve or maintain an erection when you’re experiencing pain or discomfort. One study found that men with anal or rectal pain were more than twice as likely to have erectile dysfunction.
Fatigue UC flares can sap your energy and interest in intimacy, says Dr. Valenzuela.
Bowel Movements Having more frequent or urgent bowel movements can distract from arousal and interrupt sexual activity. “Fear of having an incontinent episode during intercourse [often] makes the idea of having pleasurable intercourse worrisome to patients with IBD,” says Lisa Fasone, a certified physician assistant in urology at Northwestern Medicine in Illinois.
Nutrition Deficiencies Some nutrient deficiencies linked to IBD, such as zinc deficiency, can reduce testosterone production and affect sexual function.

Effects of Treatment

Surgery related to your UC, such as procedures for a J-pouch or ostomy, can make sexual activity difficult or impossible as you recover. Even after you’ve adapted physically, you may have body image difficulties related to your surgery. While 51 percent of people with IBD who haven’t had surgery report having an impaired body image, this number rises to 81 percent for those who’ve had surgery.

Physical challenges may persist long after recovery. “For men who have undergone surgery, nerve damage or structural changes from colectomy, J-pouch, or ostomy procedures can lead to altered erectile function,” says Valenzuela.

Fasone says, “Certain treatments for IBD may cause hypogonadism, or low testosterone levels, which can contribute to ED.” Research suggests that up to 4 in 10 people with Crohn’s or colitis have low testosterone levels. This could be because of several possible factors, including steroid medications, opiate medications, inflammation, and stress.

Psychological Factors

Psychological issues are a major contributor to erectile dysfunction in men with UC. “Men with IBD are at an increased risk for having anxiety and depression, which may impact erectile health,” says Fanone. What’s more, you may not feel good about the way your body looks or functions, which can harm your sexual confidence and contribute to erectile dysfunction.

To make things more complicated, some antidepressants can contribute to erectile dysfunction. They may also reduce sexual desire or make it difficult to reach orgasm. Antidepressants most likely to cause these undesired sexual effects include selective serotonin reuptake inhibitors and serotonin and norepinephrine reuptake inhibitors such as venlafaxine (Effexor XR).