Living with Ostomy

Intimacy With An Ostomy

Sex and intimacy are important to our physical and emotional well-being. We all seek to feel desirable and loved, which does not change after ostomy surgery. Ostomates face the same relationship challenges as those without ostomies, including feelings of insecurity and how we feel about our bodies (also known as body image).  

If you have had an ostomy, you may have thoughts such as:  

• How will the ostomy affect my sex life? 
• How will wearing a pouch impact sexual activity? 
• Will my partner reject me?   

It's easy to hide a stoma under clothing and go on with your normal life. But, the thought of removing clothing during an intimate encounter can be daunting and can challenge your self-confidence. It's important to remember that those with stomas can lead normal, happy, and fulfilling lives and relationships after surgery. 

Most of us, with or without a stoma, have body insecurities and experience sexual difficulties at some point in our lives. It's important to remember you are the same person inside your heart and mind as you were before surgery. Your body is just a little different.   

Discuss Your Concerns With Your Partner

If you have had a partner throughout your illness and ostomy surgery, talk to them about your concerns before resuming intimacy. Most likely, they have fears too.

If you are single probably wondering how to bring up the topic of having a stoma if you meet someone. If your relationship is serious, discussing the stoma before becoming physical is best. I know it sounds easy to do, but it can cause anxiety. Talk about the seriousness of your illness and the need for ostomy surgery. Give them time to absorb and be grateful that you are alive and well.   

To strengthen your intimate relationship, talking with your partner is a must. Most people do not understand what a stoma or ostomy is, let alone know how it can affect your sexual function.

Educating your partner about the ostomy will help ease any fears that they may hurt or damage the stoma.

Here are a few topics to discuss with your partner:  

• Physical limitations (difficulty with erection or vaginal dryness)  
• Pain with intercourse  
• Fears (of rejection, leakage, odor, removing clothing, can I perform)  
• Expectations (yours and your partner's)  
• Sexual activity (likes and dislikes)  
• Emotions that interfere with sexual desire (guilt, resentment, anger, loss of libido)  

Talking about these issues is a giant step toward meeting your intimacy needs.  

Give Your Body Time To Recover

Recovering from serious surgery takes time, and there is no set time to resume sexual activity afterward. If you are physically tired or still having pain, you are most likely not thinking about sex.

Take care of your body and learn how to manage the ostomy before planning intimate encounters.

Tips for Enjoying Intimacy With An Ostomy

Once you are ready to participate in sexual activity, here are a few tips:  

• Conventional positions are most often possible (type of surgery may affect this)  
• Start slow and gentle (loving, kissing, touching, and tenderness add to the pleasure of sex) 
• Empty your pouch before becoming physical  
• Consider a pouch deodorant   
• If wearing a transparent pouch, a pouch cover will offer more self-confidence.  
• Wear a wrap around your pouch to keep it close to your body.  
• Those with colostomies can often use a stoma cap rather than a full-sized pouch.  
• Never use the stoma for penetration.  

Remember that your first intimate encounter after surgery may not be perfect. Surgery in the pelvis can cause temporary and permanent changes. The reason for needing ostomy surgery (such as rectal cancer, bladder cancer, Crohn's disease) and the type of stoma you have (ileostomy, colostomy, or urostomy) can all be factors of what kind of physical changes you experience. For example, surgery such as an abdominoperineal resection for rectal cancer requires the removal of more tissue in the lower pelvis, which can cause damage to nerves and blood vessels that control aspects of sexual activity.

Whereas surgery for Crohn's disease or ulcerative colitis (UC) requires less tissue to be excised, leaving nerve tissue and blood supply intact and free of damage.    

Changes for Women After an Ostomy

Some surgeries can cause changes in the pelvis that affect sexual function. Surgery in or around the rectum can take a long time to heal. For women, removing all or part of the colon can cause the uterus to shift, causing pain during intercourse. Nerve pathways may be impaired during surgery, leading to decreased sensation and ability to climax. Referral to a physical therapist for pelvic floor strengthening can help.  

Vaginal dryness can result from surgery, certain medications you may be taking, or the aging process. A lubricating agent is helpful. If radiation was part of your treatment plan, vaginal scarring could cause tightness. Vaginal dilators can help and are available in kits with progressive sizes or purchased individually. 

Contraception   

For those with ileostomies, taking birth control pills may not be effective because they may travel through the GI system too fast to be absorbed properly. Some types of surgery may alter the anatomy of the vagina and uterus, making using IUDs, diaphragms, and cervical caps difficult. Other types of hormonal birth control that are more appropriate after surgery include hormone injections or birth control patches. Condoms are effective for birth control and protect against sexually transmitted diseases (STDs).    

If you are considering starting a family, having a stoma should not be an issue. Normal vaginal delivery is possible if the reproductive organs are not damaged during surgery.   

Changes for Men After An Ostomy 

There is a risk of damage to the nerves that stimulate erection and ejaculation during rectal surgery. The nerve pathways run close to the rectum. Some men can have difficulty getting and keeping an erection. The inability to get or sustain an erection long enough to climax is called impotence. Healing takes a long time, and it may be unclear if impotence is temporary or permanent, as nerve regeneration takes up to 1 year. Temporary impotence is not uncommon after ostomy surgery. Specialized surgical treatment is available for those struggling with impotence, whether related to ostomy surgery or not. Make an appointment with a urologist for evaluation and to discuss treatment options.   

The changes after ostomy surgery that affect your sex life can be frustrating, even upsetting. Always remember that you are special, and sexuality is only one part of who you are.   

 

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