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A Guide to Sex with an Ostomy

Before we get started, let’s cut to the chase and let it be known that for most ostomates, a stoma has little effect over the ability to enjoy sex, regardless of sexual preferences or lifestyle before surgery.

Sexuality and ostomy are complex subjects with many facets: the physical, emotional, and psychological pressures are major influences in ones’ life. Let’s break down these issues down to discuss the physical considerations (both after surgery and ongoing) and then the psychological and emotional considerations for sex and ostomy.

Physical (Post-Surgical)

There are many potential physical issues with sex within the first few months after surgery for a new ostomate. Depending on the type of surgeries done, medications administered, and what parts were affected is going to determine the viability of your sex life. But most of the anxieties of post-surgery ostomates about sex are alleviated after a few months and most find they can have sex just the same as before they had their surgery.

Some of the issues faced by post-op ostomates are:

1) Initial anxiety due to physical changes & fear of injury
2) Feelings of loneliness or a sense of rejection
3) Inability to achieve an erection / lubrication / orgasm.

Sex Tips for Post-Op Ostomates

– For a partner of a new Ostomate, being supportive and patient are the best things you can do.
– Be patient, sex drive and the bits-and-pieces will usually rebound to full function again.
– Intercourse can be painful the first couple times after surgery, especially if you haven’t had any for several weeks/months.
– Sex doesn’t have to mean penetration. Oral, petting (foreplay), masturbation, toys, and any number of other sexual activities can be enjoyed.

Physical (Ongoing)

Over time, after a full recovery from surgery and regular sexual function returns, more thoughts & concerns arise about sex. Here are some of the common concerns and some information about them:

1) Fertility / Ability to Have Children – Most women can still conceive after Ostomy surgery without any problem. Most men will remain fertile, even if they cannot achieve an erection for a period after their surgery, so artificial insemination may be an alternative if sexual ability has been limited by surgery affecting the urological system and sexual nerve pathways.

2) Injury to the Stoma – Ensure your partner that having sex will not damage the stoma.

3) Sexual Positions – Most ostomates will find they can still enjoy sex in most positions. But if some positions are uncomfortable or compromise the appliance, try something different until you find the best ones for you.

4) Odor – Many ostomates worry about odor & this can be a psychological factor as well. Before sex: don’t eat foods that create odors/gas, clean the skin around the stoma and wear a fresh pouch or empty and clean a drainable pouch prior to sex.

Sex Tips for Physical Issues and Ostomy

– Communication is key in any sexual relationship. Ostomy and sex is no different. Let your partner know they won’t injure your stoma by having sex and if something is uncomfortable.
– No sex in or around the stoma. No anal sex.
– For odor management, also try DEVROM internal odor control tablets and Hollister’s m9 Drop Deodorizer for pouches. Burn candles and/or incense.
– Empty the pouch beforehand when time allows. Keep everything clean and neat beforehand.
– Check all fasteners and adhesives to ensure they’re secure.

Psychological & Emotional

Ostomy can be hard for both the patient and the healthy partner. In some instances where a patient has had surgery for dibilitating health problems like cancer, the healthy partner helps to take care of the ostomate and “certain” bodily functions. Working through these hard times without sex can take a toll on the sex life, and it can take time for these couples to adjust and recoup to a healthy sexual lifestyle again.

But there are also far more common psychological considerations for ostomates and sexuality. And they mainly have to do with…

– Desirability/Attractiveness: “Will my partner still want to have sex with me?” or “I don’t look like I used to.” The truth is, We put a lot of pressure on ourselves to appear a certain way and become sensitive to our differences when compared to others. A step further is when we feel others judge us the same way we judge ourselves. But imagine if your partner, someone you care about, had the same condition and how you would feel about them. What would you be thinking, or how would you react? Most find their partner has a sensitivity and understanding towards the ostomy.

– Breaking the Ice/Fear of Rejection: At some point, a single Ostomate has to tell a potential partner about their ostomy. But when and how? And what do you say? The best advice would be to tell someone earlier than later. When it comes to one’s health, it’s best to present the facts at face value with confidence and understanding that the person you’re telling may not understand what an ostomy is and how it affects your life. Explain the surgery and how it affects your physical ability for intercourse. Let them ask questions, don’t judge them and be patient. Typically this understanding tone will be returned in full, but even if you are rejected, don’t blame it on your stoma – simply do what all single folks do and go fishing again. :)

Sex Tips for Psychological Issues and Ostomy

Below are some things many ostomates do to increase confidence for intimacy:

1) Wear a small, low-profile pouch such as Convatec’s Mini Pouch or stoma cap before intimacy. These pouches are more discreet, so they’ll be less invasive.
2) Wear a pouch cover such as C&S Pouch Covers or satin My Heart Ties for the ladies.
3) Many ladies also choose to wear a comfortable satin slip or camisole to bed with them. Men may wear a belt or similar support along with a pouch cover.

A Few Last Thoughts…

There are some cases where physical impairment may prevent one from having sex. This can happen sometimes based on previous health and the types of surgery needed. Some types of colorectal cancer can result in removal of the nerve pathways that cause erections. In some cases, colorectal surgery can result in the vagina changing shape and structure. All of these physical changes can limit some types of sexual activities.

Homosexual couples deal with all of the same issues as straight couples. And, due to the surgical implications of the colostomy or ileostomy surgery, it can influence what sexual activities are permissible.

No matter what the sexual preferences and difficulties you’re facing, consult these issue candidly with a health care professional that understands your surgery. They can provide you with advice specific to your personal needs.

Some Resources on Sex and Ostomy:
http://www.o-wm.com/article/5339
http://www.hollister.com/uk/ostomy/resource/love.html
http://www.ostomyok.org/ostomy_care_guides/uoa_facts_sexmale_en.pdf
http://www.outsiders.org.uk/leaflets/sex-and-ostomy
http://www.ostomyinternational.org/Facts/Sex%20and%20the%20Single%20Ostomate.pdf
http://www.colonandrectalsurgery.com/html/patientedu/sub/ped2/disease13.htm

Please feel free to leave your comments with additional tips, suggestions and thoughts!

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