Intimacy after Ostomy Surgery
   Sex and the Male Ostomate Fact Sheet

Making Love

After surgery, while you are recovering and learning to manage your ostomy, you may not experience any sexual feelings for days, weeks, or even months. On the other hand, you may begin to focus on sexual feelings while still in the hospital. You need to let your partner know what to expect from you about intimacy and sex.

Women recovering from ostomy surgery worry about many things: How they will look to themselves and if they will still be attractive to others, will there be pain, how to manage the pouch before, during and after sex. Remind yourself that your lovableness and self-worth do not depend on a body part.

If the rectum has been removed, the whole position and structure/size of your vagina may feel different. Be aware that for some women it is either uncomfortable and/or painful. Your vagina may feel too small or too tight. You may not come to orgasm the first time if things are too strange and different.

An intimate relationship is one in which it matters how well you can communicate about this intimate experience. Your partner will take the cue from you. But do not forget that your partner's feelings are real, too, and they should not be denied any more than your own.

Potential Problems

The longer you lived with the conditions of disease process, the longer you adjusted your sexual activities to the limitation they placed on you. This will now change with some caring and sharing on both your parts. A helpful task for you now is to sort through these limitations to determine if they were from the illness or "ancient history" experiences.

Pain blocks good sexual feelings. Remember that the rectal-genital area consists of soft tissue that is rich in blood vessels and nerves; tissues like this bruise and swell easily when traumatized. They take time to heal. Another source of pain is lack of lubrication.

Most women who have experienced painful post-operative intercourse say that the pain diminishes with time, hormonal creams or lubricants, relaxation, gentle thrusting, and manual stimulation.

Factors Which Influence Sexual Intimacy

1.Desire. Sometimes you may experience little or no desire for sex. Illness and medical treatments often lower sexual desire as do pain, medication and just plain not feeling well. A change in body image and lowered self-esteem interfere with sexy feelings. Fatigue, depression, anxiety or anger is likely to dampen desire.
2.Loss and Grief. Ostomy surgery means a major change in your body. Even if your surgery has brought an end to years of illness and discomfort, or has been to cure a life-threatening disease, it still represents the loss of a natural body function. Not infrequently, grief is experienced as anger or fear.
3.Body Image. Body image is the way we see ourselves in the mirror and like to imagine our appearance. Although the change seems so great to oneself, most others do not see the ostomy as changing in any major way the person they love. Harmony within oneself precedes harmony in a relationship.
4.Medications. Drugs taken during illness and surgery may affect sexual behavior. Each person reacts individually to medication. Anesthesia can leave a person feeling off center for quite some time.
5.Surgical Procedures. If the rectum has been removed along with the colon, there may be a different sensation in the vagina during intercourse since part of its supporting structure is gone. In some women the angle of the vaginal barrel changes penetration, and orgasm may be harder to achieve. The uterus may change position, leading to difficulties in conception. If radiation therapy has been received, there may be vaginal tenderness and dryness.

Talking About Sex

It is your right to share or not to share information about your body. Sharing information about your ostomy may not be easy. If you find someone with whom you want to share a sexual relationship, then you need to decide when and how much you want to share about your operation.

Many a loving partner of an ostomate has admitted to feeling anger and resentment towards a sick mate. Such feelings are natural. Until they have been expressed and worked out, both of you may feel guilty and unlovable. There is nothing more frustrating and painful than dealing with a partner who refuses to talk about important issues in a relationship such as sex, anger, fear, rejection, or the ostomy. Going together to a professional counselor may be the answer.

Seek Professional Advice

Any sexual difficulty should be addressed by medical professionals, first your surgeon and/or an ET. Referrals may be made to gynecologist, therapist or counselors.
Sex and the Female Ostomate Fact Sheet
So You Have an Ostomy

Individuals with ostomies have proven that they can achieve anything they desire. An ostomy alone is not a deterrent to any activities you are otherwise capable of and that includes your social life.

Whether a person desires companionship, active participation in sex, or a serious romance leading to marriage, how one's surgery will be accepted by a potential partner or friend is a normal concern.

Body image is the way we see ourselves in the mirror and like to imagine our appearance. Although the change seems so great to oneself, most others do not see the ostomy as changing in any major way the person they love. Harmony within oneself precedes harmony in a relationship.

Sharing the News
Whom. You can choose whom you want to tell. Sexual partners will naturally have to be told because, covered or uncovered, the stoma or pouch will be apparent during intimate moments. You should tell a prospective marriage partner, because being open and honest is important to the success of any marriage. In addition, the reaction to your disclosure gives a good indication of the person's feelings about the whole you.

When. You can pick your time to tell but it seems better to tell early in a relationship. This not only relieves your anxiety, but also if there is an adverse reaction the letdown is not as harsh as it might be later. Most people prefer to tell at a time when there is a calm and understanding mood with their partner. Do not wait until "discovery is imminent."

What. When you explain the surgery, do it clearly and confidently, with self-assurance. Start with a simple explanation. You need not be too detailed and technical at this point. Emphasize that this type of surgery was necessary and that managing your ostomy does not interfere with your activities and enjoyment of life.

Rejection. People do not fall in love with, or like, everyone they date. Nearly every would-be lover gets his or her share of romantic rejection. Individuals with ostomies are no exception. When you experience rejection your ostomy may seem to be the only reason for rejection; however, chances are it is really only a convenient excuse. Be sure it is rejection and not misunderstanding. Allow enough time for him, or her, to think it through.
Preparing For Sex

Just as you attend to personal hygiene when anticipating intimacy, ostomy hygiene is also important. Of course, good ostomy hygiene should always be practiced:
The covering for regulated or continent ostomies should always be clean and neat.
The pouch for other ostomies should be clean, neat and fastened securely. The pouch should be odor free and preferably opaque. If transparent, use a pouch cover.
Unless sex is absolutely spontaneous, the pouch should be emptied beforehand.
During intimacies, especially the first encounters after surgery or with a new partner, your partner may have a fear of hurting your stoma or dislodging your pouch or covering. Intercourse will not harm the ostomy nor will most positions disturb the pouch or covering.

Women can accomplish covering the pouch or stoma area by wearing a sexy shorty nightgown or crotch-less panties. Some men wear cummerbund type coverings, which encircles the midsection and the pouch can be tucked up out of the way. A pouch cover can be worn. There are many products available that can be purchased or you can make your own covering.

Physical Sexual Limitations
A physical impairment that affects genital sexual relations can occur with ostomy surgery, but people to whom this happens must realize there are also ways for them to enjoy sex, intimacy and marriage.

Extensive surgery in women may cause a physical impairment resulting in painful intercourse the first few times after surgery to remove the rectum. A decrease in clitoral feeling and possible inorgasm may occur.

Male potency can be affected by ostomy surgery because necessary surgical procedures may interfere with the nerve pathways that control the male's ability to have an erection or to ejaculate. Every male with an ostomy should consider psychological factors before jumping to conclusions that an erectile problem is physically caused.

Any man or woman who has doubts or questions about sexual function after an operation should discuss the matter with a medical professional.
Additional Concerns

Ostomy surgery knows no demographic bounds. It also happens to people who are homosexual. The same concerns and anxieties are present in gay or lesbian relationships. Apply the same principles for coping with telling, rejection, and preparing for sex.

Since the closing of the anus may present a sexual impairment for some individuals with an ileostomy or colostomy, modifications for sexual fulfillment are necessary. The fact that a person is homosexual should be confided to the physician or surgeon if it is at all possible.

Seek Professional Advice

Any sexual difficulty should be addressed by medical professionals, first your family doctor surgeon and/or your ET. Referrals may be made to gynecologist, urologist, therapist or counselor.
Sex and the Single Ostomate Fact Sheet
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    Making Love

                            1.  Ostomy Management
                             Good ostomy management is the key to establish confidence during lovemaking. The pouching
                             system should be free of odor and leakage. Pouches should be emptied prior to lovemaking
                             and  some ostomates may wish to avoid eating or drinking anything that may give trouble.
                             Consider opaque pouches and/or pouch covers to enhance intimacy
                            2.  Positions
                             If the pouch or other stoma covering seems to be in the way during intercourse, experiment  
                             with different positions.

                            3.  Preparation
                             In addition to good ostomy management, preparation for sex is the same as it is for the non-ostomate:    
                             cleanliness, appealing nightclothes, privacy and a loving attractive manner.

      Psychological Problems Following Surgery

     Many sex problems that male ostomates experience after surgery may stem from psychological factors. It is often
difficult to determine the difference between psychological and physical factors. If sexual difficulty should be
experienced, careful consideration of any psychological issues may help resolve the cause. Most of the following
concerns apply primarily to the immediate post-operative period.

                            1. Serious anxiety or fear about one's ability to perform sexually, the attractiveness of his                                                                  
a                              altered body, the possibility of odor, and the security of his pouch or other stoma covering.                                                                                                                                                  
                          2.  Failure because of attempting intercourse before strength returns following the operation.                                  
                         3.  Depression which many patients suffer following major surgery.
                         4.  Medication, sedative or other.

      It is important that the new male ostomate and his partner understand that impotence is not unusual and is
usually temporary because of the foregoing reasons.

     A cooperative partner is one who takes the ostomy for granted with warmth, tenderness, and patience. They
engage in activities that provide both partners with maximum enjoyment. In some cases this may require that
previous sex patterns may need to be changed. Any changes should be pleasing and acceptable to both lovers.

     The presence of a stoma on the abdomen is quite a change in one's anatomy and can make the ostomate self-
conscious and may pose a psychological barrier in sexual relations. There should be some communication with one's
partner that intercourse will not harm it.

     The ostomate should be relaxed and unworried. This may be difficult the first time, but subsequent encounters
are likely to become easier. If the partner expresses concern about hurting the stoma or dislodging the pouch, one
should not misinterpret it as rejection.

     Sexual Difficulty

                               1.It is important that the male and his mate understand that failure to achieve and/or sustain
                                 an erection can happen, but in most cases the condition is temporary and potency will return
                                 in a few months. Be patient, do not panic.

                               2.This does not mean that the couple should avoid making love. There is much more to sex     
                                  than  erections and orgasm. Love play, or pleasuring each other, is delightful.
                               3.There are many ways a man can satisfy his partner sexually up to and including orgasm.                              
i                                    There is is masturbation, manual stimulation, oral-genital sex, stuffing the flaccid penis                   
a                                    into the vagina and moving the pubis without thrusting.
                              4.Uninhibited communication between both partners is the key to finding the best technique.

     Organic Problems Following Surgery

     The nature and extent of ostomy surgery in some instances may cause sexual impairment of a physical or
organic     nature. This is because of the location of the prostate glands and the nerves serving them in the case of
urostomy surgery. When the rectum is removed in ileostomy or colostomy surgery, it is because of the location of
the nerve system serving the genitals.

      The types of sexual impairment that may result from removal of the bladder or the rectum are:
                                 1.Impotence. Inability to achieve and/or sustain an erection.
                                  2.Orgasmic dysfunction. Inability to have an orgasm or the lessening of the quality and                                
o                                   intensity of orgasm.
                                  3.Ejaculatory incompetence. Inability to ejaculate.
                                   4.Sterility. Inability to produce sperm for impregnation of the female.

    Seek Professional Advice

     Medical professionals should address any sexual difficulty, first with your surgeon and/or an ET. Referral may be
made to a urologist, therapist or counselor, and they may recommend new advances in medical and surgical

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