The Impact of Perianal Disease on Patient's Sex Life

Background and Rationale:

While surgical success in proctology is traditionally measured by healing rates and recurrence, recent literature suggests that the psychosexual impact of perianal disease is a major determinant of overall quality of life. Chronic drainage, pain, and the physical presence of seton drains can lead to "internalized shame," body image disturbance, and avoidance of intimacy. Current surgical counseling often fails to address these sensitive topics, leaving a significant gap in patient care.

Study Design:

This is a prospective, cross-sectional, observational study. No interventional procedures or deviations from standard-of-care treatments will occur.

Participant Flow and Procedures:

Patients presenting to the Proctology Outpatient Clinic of the 3rd Surgical Department, AHEPA University General Hospital of Thessaloniki with chronic perianal disease (anal fistulae, perianal Crohn's, anal fissure, or pilonidal disease) will be screened. Eligible participants who provide informed consent will complete a one-time assessment consisting of:

Demographic and Clinical Data: Age, etiology (e.g. Crohn's vs. Cryptoglandular), duration of disease, and surgical history.

Sexual Function Assessment: The International Index of Erectile Function (IIEF-5) for male participants or the Female Sexual Function Index (FSFI-6) for female participants.

The "Hidden Morbidity" PROM: A 10-item questionnaire utilizing Likert scales and Visual Analog Scales (VAS) to measure body-esteem, anticipatory anxiety related to pain, and the impact of seton drains.

Communication Assessment: Evaluation of whether preoperative counseling included discussions on sexual health and intimacy.

Objectives:

Primary Objective: To correlate the presence of active perianal disease and surgical setons with sexual dysfunction scores (IIEF-5/FSFI-6).

Secondary Objectives: * To evaluate the impact of disease etiology (Crohn's vs. Cryptoglandular) on body image perception.

To assess the specific functional limitations in patients practicing anal intercourse.

To quantify the prevalence of "Unmet Patient Needs" regarding professional psychosexual support.

Statistical Analysis:

A target sample size of 50-80 patients will be enrolled to ensure sufficient power (80%) to detect a medium effect size. Descriptive statistics will summarize demographic data, while t-tests and ANOVA will be used to compare distress scores between subgroups (e.g. Seton vs. No Seton, Crohn's vs. Non-Crohn's). Correlation coefficients (Pearson/Spearman) will analyze the relationship between disease duration and self-esteem scores.

Inclusion criteria

• Diagnosis of chronic perianal disease (fistula-in-ano, pCD, pilonidal).
• Age >18 years.
• Ability to understand and complete the Greek versions of the IIEF-5/FSFI-6 and the study PROM.
• Signed informed consent.

Exclusion criteria

• Active malignancy (colorectal or anal cancer).
• Major pelvic surgery in the last 3 months (unrelated to perianal disease).
• Cognitive impairment preventing survey completion.