In particular, Crohn’s disease can cause complications in a woman’s genital area or urinary tract. Because these issues can impact her reproductive and mental health, they require gynecologists and gastroenterologists to work together, according to a study published in October 2013 in the International Journal of Women’s Health. “There’s a huge overlap of symptoms [between Crohn’s and gynecological issues],” says Nirupama N. Bonthala, MD, a gastroenterologist who is part of the Integrated IBD Pregnancy and Fertility Program at Cedars-Sinai in Los Angeles. From painful sex to irregular periods, here are six possible issues that women with Crohn’s can experience.

  1. Irregular periods It’s not uncommon to wonder what’s going on with your menstrual cycle in any given month. (Seriously, where is my period this month?) But there should be some normalcy to your cycle. The American College of Obstetricians and Gynecologists (ACOG) defines a normal menstrual cycle as one that occurs every 24 to 38 days and lasts up to eight days. “The year before women are diagnosed [with Crohn’s], their periods are often different, such as bleeding that’s heavier or lighter than normal,” says Dr. Bonthala. Your periods or the length of your cycle can also get shorter or longer, but your cycle will likely normalize as time goes on. IBD is just one reason for irregular periods; talk with your gynecologist if you suspect anything else is amiss.
  2. Rectovaginal fistula A rectovaginal fistula occurs when an abnormal connection between your rectum and vagina develops, which can cause stool to be rerouted through your vagina. “This can be very scary for women,” says Rajeev Jain, MD, a cochair of the IBD Parenthood Project program and a gastroenterologist at Texas Digestive Disease Consultants in Dallas. One-third of those with Crohn’s disease will develop some type of fistula — any abnormal connection between two body parts — according to a paper published in July 2017 in the journal Clinical and Translational Gastroenterology. A physical exam, along with contrast x-rays or other imaging tests such as a CT scan, can help doctors diagnose a fistula, according to the Mayo Clinic.
  3. Endometriosis Researchers believe that there may be a link between endometriosis, a disorder that occurs when the uterine lining grows on other organs outside your uterus, and certain autoimmune diseases. According to a study published in December 2011 in the journal Gut, women who have endometriosis are also more likely to develop Crohn’s disease. Other symptoms of endometriosis include pelvic pain, painful periods, and pain during sex.
  4. Painful periods Along with an irregular cycle, you might experience painful periods, referred to as dysmenorrhea. A study published in June 2013 in the journal Inflammatory Bowel Diseases found that 40 percent of women with Crohn’s experienced painful periods. Even women who don’t have IBD can experience GI symptoms around their periods — diarrhea is a common one — but for women who have Crohn’s or ulcerative colitis, menstruation also exacerbates this digestive distress. The important thing is recognizing that the two go hand in hand; that way, you can work with your doctors to take steps to ease menstrual pain, which may help control IBD symptoms too.
  5. Pain during sex This is one symptom you may be tempted to brush off. You might think that it’s normal to feel some pain during sex or just assume you need to use lubrication next time, but it’s important to pay attention the occurrence of pain during intimacy, rather than ignoring it or simply hoping it goes away. If you have Crohn’s and sex feels uncomfortable, Bonthala suggests broaching the subject with your GI doc. “It’s a topic that women might only talk to their ob-gyn about, but your GI doctor may want to evaluate you further to make sure nothing else is going on,” she says.
  6. Vulvar lesions Crohn’s can trigger skin problems, and the skin on your vulva — the external part of the genitals — is no exception. While it’s less common, some women can develop ulcers or fissures in the skinfolds of their vulva, as well as vulvar swelling and redness, according to the 2013 study. Your GI doctor can work with you to control your Crohn’s, while your gynecologist can help with the vulvar symptoms.