Sexual Health for Ostomates

DO start slowly. Start off with gently and with ease. Take advantage of romance and tenderness. Intimacy also means kissing and touching, making sex pleasurable.

DO dress comfortably. For women, some wear a vest made of silk or cotton that covers the midsection and ostomy bag. There are also different sizes of pouches, smaller ones are especially used for intimate moments.

DO empty your pouch. Take a few minutes before you get intimate to empty your pouch. It will give you a little more confidence and ease your mind.

DON’T let your bag get in the way. There are fabric pouches made special for ostomy bags made of cotton and help conceal the bag. This also helps to stabilize the pouch to help reduce chaffing and rubbing against the skin. This also hides the contents of the pouch if you are using a clear device. There are also accessories that are useful in concealing and stabilizing the pouch: ostomy belts, belly bands, crotchless underware, and cummerbunds.

DON’T change your methods. (however, you may want to and that is okay). How does a person have sex when they have a stoma? The same as how people without stomas have sex. Common sexual positions are usually physically possible. Make sure your are staying within your level of comfort and preferences.

DON’T use your stoma as an entrance for intercourse under any circumstances. The stoma should never be penetrated.

Some common feelings after surgery about sex: depression, shame, embarrassment, anger, and fear. Fear can be of pain, leakage, being naked, and/or rejection. Be open, honest, and trusting when discussing intimacy with your partner. The more you discuss your ostomy, your feelings, and your needs, the bond between you will grow and strengthen.

How you see yourself impacts how others see you. After surgery, dedicate some time to recognize and appreciate the changes in your body and what all you have been through. Do self-checks with your emotional state after surgery. Don't hide those feelings- share them, especially with your partner. It takes time for accepting your body and it's new changes.

Stomas are without nerve endings so they do not have the capacity to transmit pain/sensations. However, there are many blood vessels in a stoma so it does have a possibility of bleeing when it is rubbed or slightly irritated. Experiment with different positions to avoid issues (side-by-side is popular among ostomates because of the way the bag lands to your side, away from your partner) with rubbing/irritation.

Birth control- if you are using oral contraceptives, there is a risk that they will not fully absorb (especially with an ileostomy) due to the shortened small intestine. Make sure to speak with your medical team to discuss the best form of birth control for your body.

One side effect after surgery, can be vaginal dryness. If so, try using a lubricant, or ask your doctor what the best option would be.

Some women experience a decrease in feeling/sensitivity from their clitoris. This may be from surgery- the area where the large intestine was removed sometimes gets impaired by the surgery, effecting the nerves.

The first time having sex after surgery might not bring you to orgasm. This is normal.

Men may encounter symptoms of erectile disfunction: inability to ejaculate or not able to achieve/sustain an erection their first experience with intimacy after surgery. This is common and is no need for panic or worry. It can be from either the surgery itself, or it can be from too much self-concern/worry about being intimate after surgery. If this continues, discuss with surgeon and medical team.

It can be up to two years post-surgery to be clear if you are dealing with permanent impotence, or if the functions of sexual arousal will return. If you are still in active treatment (such as chemo or radiation), it can have an effect on sexual desires and intercourse ability.

There is a risk that the nerves governing erection and ejaculation can be damaged in surgery. Erection happens when stimuli travel along the nerve pathways. These fibers run close to the rectum. If these fibers are damaged in surgery, the ability to have an erection can be wholly or partially lost. Ejaculation is also dependent on the nervous system. These pathways are vulnerable in surgery too. Surgery for bowel cancer is extensive and therefore, can be more damaging.

In the “man on top” position, lean a little toward the pouch-free side of your tummy.

Wearing a cummerbund can help keep the pouch stable.

If you are worried about your pouch showing, try wearing attractive boxers to help with covering.

If problems such as erectile disfunction continue, discuss it with your healthcare provider.