Sexuality after an ostomy

By: Cláudia Silva, Portuguese Association of Stomatherapy Care Nurses

Ostomy is a surgical intervention that allows to create an artificial opening in the body (stoma), with various purposes, ranging from feeding and breathing, to the elimination of feces, gas or urine. After the ostomy is reated, the person lives with the presence and functioning of his stoma,  and it is necessary to develop physical and emotional skills to adapt to  changes in his body, his own image and lifestyle.

Sexuality is one of the areas most affected, both by the organic changes resulting from the surgery itself and the treatments, as well as the difficulty in dealing with a different body, with the presence of a stoma and a device.

Issues related to intimacy and sexual pleasure are often relegated to the background, as individual insecurities regarding the ability to arouse sexual desire are transferred to partners, often resulting in periods of withdrawal between couples and sexual abstinence.

The inability to perform habitual tasks / activities can lead to the loss of the different roles that the person had in the family, professional and social environment, generating feelings of discouragement, low self-esteem, insecurity and dysfunctionality.

There are potential constraints associated with ostomy functioning, such as leaks and smells, or the presence of the device, creating in ostomized people the need to change hygiene, clothing and / or eating habits.

Sexuality is a very important component of quality of life. However, in the case of the person with ostomy, there is now the presence of an “intruder” between partners.

It is necessary that the person has a determined and proactive attitude towards the disease and ostomy, and be accompanied by a Stomatherapy nurse, who helps in the management of body image, the promotion of self-care, training and activity, whether motor, social, cultural or sexual, as well as to the partner, reducing embarrassment, communication difficulties and separation between couples.

Stomatherapy nurses help to work confidence and emotions, encourage the person to talk about what has changed and explore the body, facilitate adaptation and thus the ability to be and be with and with each other.

Practical advice:

1) Maintain the habits of intimacy, affection and complicity existing before surgery.

2) It is essential to continue sleeping in the same bed as the partner. After surgery, many people do not want to sleep in the same bed because they are afraid of getting it dirty or bothering their partner. However, there are numerous devices on the market, with different characteristics, indications and resistances, which allow you to sleep soundly without changing habits. People with ostomy should try them and decide which one is best for them.

3) Before bedtime or possible intimacy, you should always replace the device to feel more comfortable and confident.

4) When you want to expose yourself to others, it is important to know how to disguise or hide what makes you embarrassed. Nowadays, there is a varied supply of garters, girdles and underwear for both women and men to help disguise the existence of the stoma. Trust is essential.

5) In specific situations, it is possible to control the functioning of the bowel. If you have a descending colon bowel ostomy (colostomy), you can have a bowel irrigation that promotes bowel cleansing, allowing you to not emit any kind of content (feces or gas) for 24 to 48 hours. Or use a capsule (a kind of tampon), which seals the passage of content outwards and allows the person to open it to empty the bowel and recap whenever necessary. Not all people with colostomies can use these strategies, so it is important that you seek advice from a stomatherapy nurse.

In this way, it is possible to do daily activities, as well as being in intimacy, without the bowel functioning and without fear of leakage or other constraints.

In addition to the situations presented here, associated with ostomy, there are also changes in the experience of sexuality, resulting from sexual dysfunctions or the penetrative capacity of men or women. It is essential that the person with ostomy talk openly with the stoma nurse about what has changed after surgery and how these changes affect him in his daily life and relationships. There are therapies for this purpose and sexual rehabilitation programs available to which the stoma nurse can refer you.