ABSTRACT
Chapter 19 describes women’s sexual and reproductive health during and after an eating disorder. On the whole, full recovery should result in women having as good a chance of a satisfying sex life and ability to become pregnant and carry to term as any other women. Data that emerge from population studies and from specialized eating disorder centers represent different eating disorder acuities. Sexual functioning is impacted negatively by eating disorders. Pain during penetrative intercourse (dyspareunia) is common in women with malnutrition. Individuals with active eating disorders have significantly lower fertility rates than healthy controls, and accordingly, they have a much higher rate of having undergone fertility treatment such as in vitro fertilization (IVF) or intrauterine insemination (IUI). Unexpected pregnancy can also occur in someone without regular periods, a reminder of the importance of birth control. Fertility doctors and other obstetrician/gynecologists feel they lack sufficient training in eating disorders. Active eating disorders also influence pregnancy outcomes, from higher rates of induced abortion in those with bulimia nervosa, to higher rates of miscarriage in those with binge eating disorder, to higher incidence of intrauterine growth retardation and premature delivery in those with anorexia nervosa. While eating disorder symptoms may remit during pregnancy, relapse rates are high. Patients are advised to postpone pregnancy until recovery, or to maintain an active treatment team if in their disorder during their pregnancies.
