After any ostomy, colostomy, ileostomy or ureterostomy procedure, it takes a few weeks of patience to fully return to your daily life. After recovery, there is nothing pathological that prevents your sexual activity since it is extremely rare for these procedures to cause any damage to the nerves of the sexual system.
However, resuming sexual activity after surgery can be an emotional and difficult time for both you and your partner. Problems arise during adjustment to the new reality, but most focus and worry about self-perception and how the change in the abdominal area may affect attractiveness.
As you will discover below, it is usually all in the mind and there are all the solutions to make sex life with an ostomy as enjoyable for you and your partner as before . All it takes is more information, a lot of communication and a little willingness and patience to adapt.
Fear & sexual problems caused by stoma
I recently found this question, published in the Canadian GI Society.
My wife recently had a temporary ileostomy. We are both afraid to have sex again. Are there things we can do to make it easier?
At first you'll probably be worried about everything from how to lie down to which side. These are common questions not only about sex but even about sleep.
Remember, you've had major surgery, so it's normal to be concerned about your partner's reactions to your stoma. It will take time for both of you to adjust to the changes and for your bodies to recover.
Physically, you may not be able to relax and enjoy an intimate relationship for some time. This time varies depending on:
- How long you were sick before the surgery
- The extent of the ostomy surgery itself
- The need for other treatments after surgery
Although decreased sexual desire is completely normal , it can lead to stress for both of you, so it's vital to talk to each other to avoid misunderstandings.
If you are still in this phase, you need to work on regaining your confidence so that sex will no longer be synonymous with fear and anxiety, but a moment of intimacy and pleasure .
Changing body image
The main fear and essential obstacle to returning to previous sexual activity stems from the change in body image after stoma creation surgery.
Although every person deals with it differently, the substantial challenge of accepting and connecting with a changed body often destroys sexual self-confidence, while the situation is compounded by the insecurity that arises as one is unsure whether one's sexual partner is able to adapt to the new reality.
This bad psychology, however, arises from the person's completely wrong perceptions and poor information about sex and stoma. Do not prejudge situations and do not create a negative atmosphere.
Face the physical change with determination and optimism. You are fighters, thirsty for life and you should face sex in exactly the same way. The stoma is not an obstacle but the solution to all the everyday problems you faced before .
Especially for women
An ostomy can have an impact on women but it is not something that cannot be overcome.
Quite often, dryness is observed but can be resolved very easily with some lubricant, suppositories, lubricated condoms or even saliva.
In extremely rare cases, surgery can alter the sensitivity of the clitoris or vagina due to changes in the nerve pathways. There is no reason to worry, it will just take a little experimentation by you and your partner to remap these erogenous zones.
Sometimes, the body develops scar tissue, which can in turn affect the elasticity of the vagina. And there is absolutely no problem here, you just need to spend a little more time relaxing the vaginal area.
Finally, in the case of a total rectal removal, you may experience discomfort with some positions because the rectum supports the vagina during sex, but again, this is not a problem since there are countless positions that you just have to try. Those that do not weigh down the stoma area are usually preferred.
Especially for men
There may be some problems with erection after ostomy surgery, but they are temporary . The problem may be caused by changes in blood supply and, more rarely, nerve endings in the penis. Although some men will experience erection problems for up to 2 years after surgery, there are many treatments that can help, including:
- Medications (Viagra, penile injections, etc.)
- Implants
- Mechanical erection devices
- Vacuum pumps
Most of the time, of course, the problem is purely psychological and it would be a good idea to talk to your doctor or a specialist before turning to other solutions.
Although extremely rare as the nerves that control sexual function are located near the gut, there is a very small risk of impotence or infertility, especially in cases such as pelvic tilt surgery where the bladder is removed. Discuss with your doctor whether it would be a good idea to store sperm before such a procedure.
Especially for same-sex couples
Of course, the same applies here, but the stoma certainly poses an additional challenge for people who use their rectum for sex. It would be a good idea to talk to your doctor as there is an increased risk of injury and bleeding so that you can continue to enjoy your sex life safely. Unfortunately, in the case of a total removal of the rectum, anal sex is not possible .
If you had sex before the stoma
Everything is easier when we have someone to lean on. Having a partner before an ostomy operation is valuable since you have already faced an illness together that led to this.
You may be scared or sad at first and have dozens of questions about what's changing, but you'll learn everything and adapt together. It would be a big mistake to exclude your partner from this process. Communication is vital to restoring your sexual relationship.
The time you spend together after illness, surgery, and recovery is filled with emotion. Discuss these feelings and responses to the changes that have occurred. Some people find it difficult to see themselves naked because of their stoma , and at the same time, they think this feeling will be even greater for their partner.
There will undoubtedly be fears about whether you remain sexy, but you have nothing to lose by asking what your significant other thinks about you. You will most likely hear that their feelings for you have not changed and they desire you just as much as before. That alone is enough to restore your self-confidence.
But even if the stoma makes him/her uncomfortable, explore it together. What you accomplish as a couple will also be a way to come even closer than before.
Of course, some relationships may end after ostomy surgery. Sex is only one part, albeit an important one, of a healthy relationship. If your ex claimed that this was the reason for the breakup, then you are definitely better off without him.
Looking for a partner
So if you haven't been in a relationship or have broken up, then the time will inevitably come when you will start dating.The big question is when to tell a potential partner about your stoma, and it's definitely not a good idea to leave it for a while before the clothes come off.
Of course it all depends on what you are looking for. If you just want sex, a one night stand as they say in Greek, then it would be better to let me know right away. But if you are looking for something serious then you will definitely find the right time.
Besides, by going on a few dates with the same person, you will also give him/her time to see that your stoma does not affect your daily life . You can go out and have fun like everyone else. At some point, you will talk to him/her about the illness that led you to have an ostomy operation and then you will be able to inform him/her about what he/she needs to know.
What changes in sex when you have a stoma?
Waiting for full penetrative sex immediately after stoma surgery may not be realistic. Generally, surgeons recommend waiting about 3 weeks, but this varies from person to person. Initially, spontaneity may be lost as you learn to manage the pouch and stoma during sexual activity .
A gradual approach to sexual activity that you had before can help you and your partner feel more comfortable and confident.
First of all, penetrative sex is not the only way to get close, and this applies to everyone, regardless of sexual orientation. If this idea scares you, remember that satisfaction comes from a caress, a hug, a kiss, or just holding someone's hand.
Reach out to each other, touch each other, give yourself the time you need to regain your confidence and revitalize your relationship after a difficult surgery. Find room for humor, as the stoma makes unexpected noises. Try to avoid schedules and specific expectations about resuming sexual activity.
Above all , you should be honest with yourself and take the time to discuss your feelings with your partner. Clarify whether the problems really stem from the illness you are facing and the stoma or whether they predate previous relationships.
Anyway, our primary sexual organ is the brain. Sexual problems usually stem from anxiety and insecurity and not from any pathology. If you do not solve any problem that arises with your partner, you should be ready to discuss it with your doctor as his advice may concern various issues.
It may involve a practical solution, such as changing your position during sex, or using lubricant if the problem is dryness or discomfort. There are also many other medical specialties to refer you to if you feel you would benefit from their advice, such as a sexologist or psychosexual counselor at a similar clinic.
The secret is hidden in the ostomy bag
We all prepare ourselves properly for sex, from a simple shower, shaving or wearing sexy lingerie to soft lights, champagne or music for the more romantic ones. Of course, nothing changes for people with an ostomy, but the right bag and the right preparation will help you feel more comfortable in the bedroom .
- Make sure you are clean. Take a shower or better yet, get in the tub or shower with your partner, using the bath as a safe opportunity to start touching and caressing each other again.
- If you wear an ostomy belt, make sure it is clean too
- Side positions may work better on the stoma side since the bag won't come between you and your partner.
- Focus on the pleasure, not the bag. If you're worried it'll come undone, reinforce it with tape around the edges.
- If you are concerned about the appearance of the pouch, use a cover and of course, opt for opaque pouches. There are special lacy garments that cover only the belly and hide the pouch in a discreet pocket. There are ostomy underwear that provide enough support while remaining sexy, while there are many who take a needle and thread to make their own custom underwear for bed.
- The secret is in the bag. Use a "passion bag" during sex. These are much smaller bags (mini) that will make a big difference in your sex life.
Smaller, more discreet pouches are the best choice, whether they are disposable self-adhesive pouches or two-piece systems. While they have a limited capacity, this is a minor issue for you since you will be using them for a very specific purpose. Just remember to return to your regular ostomy pouch after sex.
The ostomy bag is the most important tool and is essentially a part of your body. Modern bags are made of such materials so that you have a constant feeling of cleanliness. As for those who are afraid of possible odors that may emerge during sexual intercourse, there is absolutely no danger since thanks to the development of technology there are now appropriate filters that repel all unpleasant odors.
Of course, there are similar solutions for the case of enemas.
What should I know about contraception, pregnancy and childbirth?
Regarding contraception, you may need to change the type of contraception you were using before surgery, as in the case of birth control pills, for example, your body may no longer be able to absorb the full dose of the medication. You should ask your doctor about contraception after surgery.
A ureterostomy does not prevent a woman from becoming pregnant or giving birth . Many women have had successful and uncomplicated pregnancies after their surgery. In fact, in many cases, they have had multiple children after having ostomy surgery.
However, it is usually recommended to wait about a year after surgery to start a family, as this gives you time to heal and allows you to recover psychologically. If you have any concerns, please contact the Traumacare nursing staff.