Abstract
Sex (the physical and physiologic effects resulting from having specific combinations of sex chromosomes) and gender (sex-associated behaviours, expectations, identities, and roles) significantly affect the course of inflammatory bowel disease (IBD) and the experience of living with IBD. Sex-influenced physiologic states, like puberty, the menstrual cycle, pregnancy, and andropause/menopause may also impact and be impacted by IBD.
While neither Crohn’s disease nor ulcerative colitis is commonly considered sex-determined illnesses, the relative incidence of Crohn’s disease and ulcerative colitis between males and females varies over the life cycle. In terms of gender, women tend to use healthcare resources at slightly higher rates than men and are more likely to have fragmented care. Women are more commonly prescribed opioid medications and are less likely than men to undergo colectomy. Women tend to report lower quality of life and have higher indirect costs due to higher rates of disability. Women are also more likely to take on caregiver roles for children with IBD. Women with IBD are more commonly burdened with adverse mental health concerns and having poor mental health has a more profound impact on women than men.
Pregnant people with active IBD have higher rates of adverse outcomes in pregnancy, made worse in regions with poor access to IBD specialist care. The majority of individuals with IBD in Canada do not have access to a pregnancy-in-IBD specialist; access to this type of care has been shown to allay fears and increase knowledge among pregnant people with IBD.
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1 Division of Gastroenterology and Hepatology, Mount Sinai Hospital, University of Toronto , Toronto, Ontario , Canada
2 Department of Gastroenterology, Women’s College Hospital , Toronto, Ontario , Canada
3 Departments of Medicine and Community Health Sciences, University of Calgary , Calgary, Alberta , Canada
4 SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children , Toronto, Ontario , Canada
5 Department of Medicine, University of Ottawa , Ottawa, Ontario , Canada
6 Division of Gastroenterology and Hepatology, McGill University Health Centre IBD Centre, McGill University , Montréal, Quebec , Canada
7 Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba , Winnipeg, Manitoba , Canada
8 Departments of Medicine, Clinical Health, and Epidemiology, Dalhousie University , Halifax, Nova Scotia , Canada
9 Crohn’s and Colitis Canada , Toronto, Ontario , Canada
10 Department of Community Health and Epidemiology, University of Saskatchewan , Saskatoon, Saskatchewan , Canada
11 College of Nursing, University of Saskatchewan , Saskatoon, Saskatchewan , Canada
12 Department of Medicine, McMaster University , Hamilton, Ontario , Canada
13 Division of Gastroenterology and Hepatology, University Health Network, University of Toronto , Toronto, Ontario , Canada
14 Department of Gastroenterology, Temerty Faculty of Medicine, University of Toronto , Toronto, Ontario , Canada
15 Department of Medicine, Temerty Faculty of Medicine, University of Toronto , Toronto, Ontario , Canada
16 Department of Internal Medicine, Temerty Faculty of Medicine, University of Toronto , Toronto, Ontario , Canada
17 Department of Medicine, Queen’s University , Kingston, Ontario , Canada
18 Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, University of Toronto , Toronto , Canada
19 Faculty of Law, University of Victoria , Victoria, British Colombia , Canada
20 Michael G. DeGroote School of Medicine, McMaster University , Hamilton, Ontario , Canada
21 Faculty of Medicine and Health Sciences, McGill University , Montreal, Quebec , Canada
22 Department of Obstetrics and Gynecology, Memorial University of Newfoundland , St. John’s, Newfoundland , Canada