PURPOSE OF REVIEW: This review details the pathophysiologic mechanisms from medical, surgical to psychosocial factors that illustrate how and why sexual health and intimacy are impacted in IBD. RECENT FINDINGS: Recent clinical surveys of practicing gastroenterologists document that clinicians should routinely address sexual health when addressing patient reported outcomes but very few actually make direct inquiry or suggest management into this important aspect of human life. Example 'patter' are suggested to clinicians to demonstrate how to introduce the subject of sexual intimacy and well-being and engender patient trust on this sensitive topic. Once specific symptomatology are elicited, then a review follows on how referral to a cadre of available multidisciplinary specialists can help directly manage the patient's concerns. Specific emphasis on addressing the sexual health in ostomate and sexual and gender minority populations is focused upon as well. Overall, this in depth review highlights a practical clinical approach to understanding how to address sexual wellbeing and human intimacy in IBD patients.