Sexual distress affects 39% of patients following pelvic pouch surgery for ulcerative colitis, significantly more in women (57.8% vs. 26.5% in men).

• Female gender is the only strong preoperative predictor of sexual distress (OR 4.796; p < 0.001).
• Poor bowel function, anxiety, and depression significantly correlate with sexual distress (all p < 0.001).

Surgeons should incorporate psychological evaluation and counseling into pre- and post-operative care for pelvic pouch patients, particularly women, to address these concerns effectively.