No matter whether you are young, old, married or single, ostomy surgery can have a huge impact on relationships. How your stoma will affect your partner, your ability to participate physically in an intimate relationship, and how much and with whom you should share details about your stoma may all be major concerns.
Who and how much you tell about your stoma will be entirely your choice. It is possible that during your time in hospital or when you first returned home, your partner helped to change your pouch so they may already know what your stoma looks like. If they don’t and subsequently decline an offer to see it, don’t mistake this for rejection.
Initially following your surgery your sexuality may be affected. You have had major surgery and your body will need time to heal so you may not have any sexual feelings for quite some time. Share your feelings with your partner and enjoy cuddling for the time being. You will know when you are ready for deeper intimacy.
When you are ready to participate in sexual activity following your surgery, you may be concerned that your stoma will be hurt or damaged. While intercourse will not harm your stoma, it is recommended that you empty your pouch immediately prior to sex to lessen the chances of any unwanted accidents. Some ostomy product suppliers have smaller pouches which may be suitable for intimate moments.
One of the greatest challenges faced by a person entering a new relationship is when to tell your prospective future partner about your stoma. Ultimately, only you will know when the time is right so trust your own judgement. If you care for each other, then you will probably find that telling will not make any difference to your feelings for each other.
Even though your stoma surgery may have brought an end to years of illness and discomfort, or been done to cure a life-threatening disease, it still represents a change to a natural body function. Some of the emotions you may experience will be a result of this change and may affect the way you see yourself.
Most changes in the way we see ourselves take place gradually over a period of time, as in ageing. Surgery resulting in the formation of a stoma means a sudden major change in your body and in the way you see yourself.
It will take time to get used to this change. It is natural to experience sadness and grief while you adapt to the new, but not really so different, you. Sexual activity is one of our normal functions and having a stoma should not prevent this activity.
Hints and tips
- Share your thoughts and needs with your partner.
- Your sleeping arrangements should stay the same.
- Show that you appreciate a warm and loving relationship.
- Remain intimate and discuss issues openly.
- Touching, caressing, warmth and affection are all important.
If you don’t have a partner at present but are concerned about how to tell a new partner that you have a stoma, there is no right or best time to tell. You need to use your own judgement. However, it may be better to tell them early in the relationship, prior to a first intimacy. This may make things easier and help you relax.
People with stomas have relationships, marry, have children, and lead normal lives. Relationships involving a person with a stoma are just as stable as relationships in general.
Men may experience difficulty with erection and ejaculation, because the nerves and blood supply involved in sexual function lie close together and may be bruised during any pelvic surgery where the anus and rectum have been removed. If you are unable to have or maintain an erection, talk to your surgeon or stoma nurse for advice.
Pain during intercourse and lack of sexual interest may also occur. This is not unusual and, in most cases, temporary, but the experience can be worrying and you may think that your sexual desire and arousal have disappeared. It is important that you and your partner understand these difficulties, so that you will both keep calm and not be unduly worried.
Resuming your sex life after stoma surgery
Initially, you might find that sex is the last thing on your mind after your ostomy surgery, which is totally understandable. Take your time to recover until you are fit and healthy, both physically and emotionally. In some cases, you may have temporary nerve damage or scar tissue, or you may find that your desire for sex deteriorates. These issues usually resolve themselves with time. Once healed, having sex should not be damaging to your stoma, so don’t worry about that. Remember: there are no specific guidelines as to when to start having sex again. Everyone is different and it’s best to be guided by your own feelings.
Hints and tips for making love
When you do feel ready to become intimate again, some of the following tips may help:
- Empty/change the appliance before sexual activity.
- You may like to wear a cover over your appliance to prevent the plastic clinging to your skin.
- Try experimenting with attractive underwear
- Covers can be made in many styles and materials from cotton to sensual satin
- A mini bag or stoma cap can be used if you’d like something a bit more discreet for a relatively short time period – if you’ve not heard about these, talk to your Stoma nurse as they are available
- Sexual activity will not harm the stoma.
- As long as your appliance is secure, whatever positions you choose should not affect the stoma bag, the cover or dislodge the appliance.
- A normal size appliance can be folded and taped into a smaller shape
- Do not mistake your partner’s concern for rejection.
- Any position that is comfortable for both of you is suitable for sexual activity.
- If you have a partner of the same sex, the surgical removal/closing of the anus may cause a problem in a sexual relationship. Intercourse via the stoma can be dangerous and is not advisable.
- Your stoma care nurse can refer you to an appropriate counsellor.
Urostomate males, and those with low deep pelvic surgeries, are more prone to specific sex-related challenges because impotence and other sexual problems often occur in men after bladder surgery. If you have a urostomy, you will have been advised before surgery if impotence is a possibility. Your medical team will counsel you and may refer you to a Urology Specialist Nurse. Younger men having urostomy surgery will probably be offered sperm banking. Don’t despair if you do experience impotence – there are several helpful solutions, such as penile implants, injections, tablets and vacuum pumps. In some cases, after the operation there may be some local nerve damage or scar tissue that causes difficulties. Problems often resolve themselves with time and understanding. If the ability to have an erection after stoma surgery persists, seek advice from your surgeon or Stoma Nurse as there have been many advancements in treatment for erectile problems – sometimes as simple as taking a tablet.
Hints and tips for men
- It has been said that sex is 95 percent mental and 5 percent physical.
- Consider psychological factors that may stop you having an erection. There are a number of different ways to help erectile problems:
- Medication such as Viagra
- Penile injections
- Penile implants
- Mechanical erectile appliances, e.g. vacuum pumps
Vaginal pain, vaginal tenderness or a lack of lubrication may make sexual intercourse painful for women following bowel surgery. This tends to be short term and the tenderness usually disappears as the inflammation and swelling from the surgery subsides. Women who have had their rectum removed during surgery may feel a different sensation in their vagina when having sexual intercourse. There may be pain, vaginal tenderness, dryness or vaginal discharge for some months. It is important that you and your partner understand these difficulties, so that you will both keep calm and not be unduly worried.
Hints and tips for women
- Try using water-soluble lubricant.
- Treatment with a hormone replacement.
- Oestrogen cream.
- Change of position during intercourse.
Having an ostomy usually won’t affect your fertility (although the condition that led to your stoma might), but you should discuss this with your Stoma Nurse or GP if you’re thinking about trying for a baby. An ostomy also shouldn’t prevent you from having a successful pregnancy and birth, although it is wise to wait a while after surgery and seek medical advice before attempting to conceive. Your stoma might protrude more than usual during pregnancy, but they tend to revert to normal size afterwards.
The contraceptive pill may not be ideal for women with ileostomies, as it may be passed through the body before being fully absorbed. Your GP or Stoma Nurse will be able to advise about suitable alternatives.
Several things may make sex more difficult in the immediate postoperative period.
- Anxiety or fear about your ability to perform sexually.
- How you feel about your body.
- The worry of odour and that the stoma bag might leak.
- The worry that the stoma bag might come off.
- Attempting intercourse before your strength and confidence have returned after the operation.
- Depressed mood, which many people experience following major surgery.
- Medication such as blood pressure medication, anti-depressants, etc.
- Chemotherapy and/or radiotherapy.
Understanding, communication and warmth between you and your partner are vital. We cannot read each other’s thoughts, so it is important to ask questions and talk about needs and desires when it comes to what you like best sexually.