Sex and relationships
Sex is a basic individual, complex human need, and sexual expression and behaviour can be influenced by many factors, including
- Illness and disease
- Psychological make-up
- Culture, religion and belief systems
- Environment and lifestyles
- Disability
- Relationships
- Biology
Preparation for surgery
Invasive surgery can challenge our sexuality, body image and self-esteem, and needs to be discussed with you prior to undergoing stoma surgery. Early discussion can give reassurance, education and encouragement. To aid adjustment and adaptation, the factors to consider are:
The nature of the surgery- Why it is being performed
- Age and lifestyle
- The disease process and prognosis
- If the stoma is temporary or permanent
- If surgery is planned or if it's an emergency
- Present relationships and support systems
- Your work/school and leisure activities
- Sexual orientation
- Body shape and location of the stoma
Post-operative period
Even with good pre-operative support, the immediate post-op period is a time ofmany anxieties and insecurities. Youmay fear being ostracised and rejected. You may experience grief and loss for a body part or function; may feel abnormal, with loss of control; and may be concerned about smells and odours. You may also fear rejection by partners, loved ones or friends and may have fears about your ability to perform sexually. These are entirely natural reactions and your Stoma Care Nurse is there to help and guide you through these concerns.
Remember - you are the same person you were prior to the surgery and, physically, youmay even be stronger. There are many stages to recovery and each person will respond according to their individual circumstances and their own personality.
It is important to feel secure with the safety and reliability of your appliance before you embark on a more active sex life. Be patient with yourself and keep lines of communication open. Allow partners to be involved in stoma care, if you both wish, as this can be a comforting experience. Try to understand how they, too, might be feeling.
In discussing relationships following stoma surgery, it may be useful to consider the most frequently asked questions:
When is it safe to have intercourse after surgery?
Allow time to recover your strength and for you both to feel confident and comfortable. Promote intimacy by touching, holding and kissing. Remember - intimacy need not involve sexual intercourse. Find themost comfortable position and experiment with different positions.
How can I disguise my bag when I am with my partner?
Experiment with smaller, more discreet pouches, if appropriate. Experiment with sexy underwear and with scarves/cummerbunds to support the bag. Be adventurous and innovative. Sexy/satin bag covers are available.Maintain your sense of humour. There are gelling tablets/solidifying agents that can be used if output is watery (ileostomies). Don’t forget the obvious - and empty or change the bag before sexual activity.
Will the appliance be obvious under my clothes?
No. There is usually no need to make major adjustments to clothing. Empty/change bags regularly - and always before going out or going to bed. Most closed and drainable appliances have an integral filter to avoid ballooning. If there is a fear of smells and odours, it can be helped by the use of ostomy deodorants.
When should I tell a prospective partner about my surgery and stoma?
When the time feels right and before you initiate intimacy. Get to know the person first - and don’t rush. Don’t blame a rejection on the fact that you have a stoma. Rejection happens to everyone and is always painful.
What about contraception?
Inform your family planning clinic that you have a stoma. For ileostomists, some contraceptive pills may not give adequate protection. The coil may not be an option. It may be necessary to use a barrier method, especially if output is high (ileostomists) or a tummy upset is present.
Can I get pregnant with a stoma?
Yes, you can have a normal pregnancy with a stoma. It may be necessary to alter the template of your bag as pregnancy progresses.
When should I consider having and internal iloe anal pouch formation?
Female ileostomists considering pouch formation may be advised to have their families first, if appropriate. Discuss timing with your surgeon.
Will surgery affect my sexual function?
This will depend on the type of surgery you have had. Talk to your Stoma Care Nurse to help your understanding of your individual situation. Be patient - try to relax and not get stressed. Should problems arise, they are often temporary. Male patients may experience temporary problems with erection. Females may have vaginal dryness and some discomfort with deep penetration. Lubricating gels may be useful for dryness. Should problems continue, please discuss them with your Stoma Care Nurse or consultant, who may be able to help you or consider referral to a special clinic.
Life with a stoma
Even though stoma surgery can be life enhancing - and often is -most patients will go through periods of self-doubt. If you have worries, seek advice from your Stoma Care Nurse. Join patient support groups. Attend open days and exhibitions to keep yourself updated. Don’t forget - it’s good to talk! You will soon find you are not alone, and problems or anxieties shared are often solved.