Tucson AZ, Inc.
Dorothy Vaillancourt, RN, CETN*
Sex is a subject that is on everyone's mind. Do people with ostomies actually have sex? Of course, but as with everything with an ostomy there is some adjustment. Incorporating sexual health in ostomy care is no longer disputed as a legitimate role for ET nurses and other health care professionals today. So many patients receiving ostomy surgery have anxiety as a result of sexual alterations or even loss of sexual function.
Sexuality
Sexuality cannot be destroyed, even though sexual function may be affected. Sexuality is a physiologic and psychologic component of the person that is based on genes, hormones, and life experiences. Sexuality is not as simple as an act of intercourse. It can be expressed physically through touch and acts of sexual intercourse, or it can be shared verbally or emotionally through intimacy and closeness. Sexuality is present throughout all our lives and is constantly undergoing alteration.
Physical Aspects
Physical is the ostomy itself. Many surgical procedures may result in disruption to nerve and vascular supplies, which in turn may lead to loss of sexual function. Medications, radiation therapy, and chemotherapy can also decrease sexual desire. Removal of testicals in men or ovaries in women can decrease sexual desire. Good sexual education either before or during treatment can forewarn patients and spouses that the effect of these treatments could cause less desire, but that it is the treatment not the lack of love that is the cause of not tonight, dear.
Psychological Aspects
The psychological effect of having an ostomy may have an effect on self-image and self-esteem. Sexuality is influenced by feelings of attractiveness and one's desirability as a lovable person. Anxiety about the disease or treatment and their effect on sexual function will often keep one focused on the problems at hand rather than the immediate pleasure of the act.
Anger directed toward the disease, fate or one's sexual partner can interfere with function. Sometimes the "safest" person to direct anger toward may be the one you love. Then the partner turns away and a vicious circle begins. Frustration, resentment, aggression, and tension render lovemaking difficult.
Social Aspects
The social impact of having an ostomy intermingles with the physical, psychological and sexual aspects. Concerns of patients include being able to resume sexual activity, feeling alone, fear of rejection from their sexual partner, or if there is no partner, fear of never finding anyone that will desire him or her as a sexual partner.
How do you sleep with a pouch? Concerns of odor, how the ostomy will effect daily activities, making changes in clothing styles, cleanliness and deciding whom to tell, are some of the many worries that face those with ostomies.
How to be Sexual with an Ostomy
Here are some answers and suggestions on how to be sexual with an ostomy.
1. When do you resume sex after surgery? Mainly it is when the person who had surgery feels he or she is ready. It is necessary to consider any treatments, medication, or lack of physical strength that may limit desire. It should be noted that if the initial try fails, the person should not condemn her/himself. It is most likely just the fact of not being quite ready yet. Sometimes the spirit is willing, but the flesh is weak!
2. Proper hygiene is, of course, essential in successful sexual relationships. Making sure the pouch is empty and securely in place, vaginal lubrication, if appropriate, using an attractive pouch cover, a cummberbund or pretty crotchless panties are good suggestions for sexual activity. One of the best ideas is to use your sense of humor. So what if something goes wrong. Remember, practice makes perfect, and it's all worth while in the end. Sexual activity will not harm the stoma. The side to side position may be more comfortable if the stoma and abdominal incision are only a few weeks old..
3. You may need specific suggestions about communicating with each other. For example, miscommunications may lead a man to move to another bedroom to sleep alone when he is no longer able to have an erection, whereas the woman may be missing the hugging, kissing and snuggling aspects of their shared bed. An open mind, being able to talk with each other, expressing each other's needs and concerns, all go a long way towards a happy recovery.
4. If there are severe problems with sexuality, it may be necessary to consult a sex therapist for help. This may involve brief counseling to help the person to cope with the distractions of the ostomy, or intensive sex therapy, which involves communications training, behavioral treatment or other intensive therapy. Consultation with your physician would be helpful in this case.
5. For men who have erectile dysfunction, there are devises and treatments to assist in rehabilitation in this area. A consult with a urologist would be most valuable if this is a problem for you.
6. Gays and lesbians will find help from the UOA[United Ostomy Association]. The Gay and Lesbian Ostomate Committee (now called GLO) was established in 1982. This committee works to assist gay men and lesbians live more positively with an ostomy. Resources include: a newsletter, a network of gay and lesbian ostomates and supportive others who offer mutual aid and support through telephone or personal contact (US and Canada). It also offers informal discussion and social events for gay and lesbian ostomates at UOA regional and national conferences.
For further information contact: Chairman, GLO, c/o UOA, 19772 MacArthur Blvd., Suite 200, Irvine, CA 92612-2405. Telephone (949)660-8624 or (800)826-0826
7. Females in the child-bearing years have successfully borne children. Pouch modification during the pregnancy is usually necessary.
We are all sexual, and we all may have sexual problems whether or not we've had any surgery. Keeping lines of communication open, seeking help when needed, expressing our concerns to each other, and loving life with our partners.
* Dorothy Vaillancourt, RN, CETN, is retired after 20 years as an ET nurse at the Medical Center of Central Massachusetts.
Reference: Hampthon and Bryant: "Ostomies and Continent Diversions," Nursing Management, Mosby Year Book 1992.
From OA of Boston (MA) OAB Bulletin; via Worchester (MA) OA New Dimensions; Greater Seattle (WA) Chpt. The Ostomist; Regina (SK) Ostomy Chpt. Regina Ostomy Chapter News; Coquitlam (BC) OA The Coquitlam Connection (11/00); The Mission Ostomy Chapter of Tucson (AZ) THE COURIER (11/01). ~
