Gynaecological problems related to anatomical changes after conventional proctocolectomy and ileostomy.

I recently took on a 37 year old female patient who has been unsuccessful to conceive her fifth child. All her western tests came back fine. Her cycle is regular and she suffers no PMS complaints. The only major change since the birth of her now 4 year old child was that she needed to have an ileostomy put in because of her lacking a large bowel due to crohn's disease. From searching Pub Med I came across the following study showing a 50% reduction in pregnancy rates following this procedure.

Has anyone seen this before and/ or worked with it. I would be interested to see how you approached it.

Department of Obstetrics and Gynecology, Sahlgrens' Hospital, University of Göteborg, Sweden.

Seventy-one women who had a proctocolectomy for ulcerative colitis (n = 41) or Crohn's disease (n = 30) were interviewed in the follow-up clinic about gynaecological problems and fertility. All women were examined by an independent gynaecologist and abnormalities of the internal genital tract were registered. Forty-nine per cent (35/71) of the women had a distressing vaginal discharge after proctocolectomy, compared with 9% (6/71) before surgery. At the gynaecological examination 45% (32/71) had a heavy vaginal secretion with- out any signs of an acute vaginal infection. In 68% (30/44) fluid retention in the vagina was associated with a caudally firmly fixed and dilated posterior vaginal fornix. Twelve per cent (8/66) of the women reported dyspareunia before surgery. After surgery, 27% (18/66) complained of this symptom. Fertility was significantly reduced after surgery since only 37% (10/27) of the women who attempted to become pregnant succeeded within 5 years follow-up. The corresponding figure before surgery was 72% (39/54). Those who conceived went through pregnancy and parturition without any incident, 6 of 21 delivered by caesarean incision. In conclusion, conventional proctocolectomy in women will result in distressing vaginal discharge, and dyspareunia in a considerable proportion of the patients. The operation also seems to decrease their chances of becoming pregnant.