Crohn Disease and the Gynecologic Patient

Abstract

Although Crohn disease (CD) is considered an inflammatory bowel disease, extraintestinal gynecologic manifestations are varied, frequent, and oftentimes difficult to manage. Its predilection for young and reproductive-age women makes it an important disease process for the gynecologist to understand, as its complications can have long-term repercussions on the developmental, sexual, reproductive, and psychological health of affected women. Patients may present with a variety of vulvovaginal, perineal, perianal, and urologic complaints. Perianal involvement from an intestinal fistula is the most common skin manifestation seen in CD. Other gynecologic manifestations include metastatic CD and rectovaginal and urovaginal fistulas. Recognition and accurate diagnosis of extraintestinal gynecologic manifestations, as well as a good understanding of the gynecologic effects of chronic disease, are necessary for optimal management. The article provides an overview of CD and highlights the gynecologic considerations in caring for women affected by this disease.

Imaging and Surgical Management of Anorectal Vaginal Fistulas

“…Early methods used for detection of Crohn disease-related ARVFs included CT, with 60% accuracy; vaginography, with 79% sensitivity; and proctography, with an even lower sensitivity of 35% (22,26,27). MRI has been proven to be the most effective for the diagnosis of ARVFs, with an accuracy approaching 100% (25).…”

Crohn’s disease in women

“…If pregnancy occurs at a time of active disease, two-thirds of patients may have persistent activity during pregnancy and, of these, two-thirds may deteriorate;19 this is known as “the rule of thirds.”6 This statement specifically refers to pregnant women with active CD in comparison with pregnant women with ulcerative colitis (UC) 6,20,21. The primary aim of preconception counseling should be to achieve remission of disease activity for at least 3 months before conception, especially if we keep in mind that the disease state during conception usually tends to remain throughout the pregnancy 22. The first and, so far, only prospective study (by Bortoli et al23) showed that there was no significant difference in pregnancy outcomes between pregnant women with IBD and healthy controls.…”

“…More than half of the registered lesions are presented in the vulvar region 22,60. A variety of clinical manifestations is described in that area such as unilateral edema, erythema, papule and nodule lesions, ulcerations, vulvar pruritus, and pain 61.…”

“…If recognized in time, vulvovaginal disease is treated with systemic therapy for CD, and antibiotics are added in case of secondary infection. Surgery should be considered only in rare cases of failure of medical therapy 22. The treatment of perianal fistulas depends on the symptoms and complexity of fistulas.…”

“…Sides et al22 found that the onset of the disease before or during pregnancy could result with a delayed menarche. In adult women, the main problem seems to be irregular menses; oligomenorrhea is the most common abnormality 80.…”