Intimacy and sexuality with an ostomy

Your operation has changed your body and will take some getting used to, both for yourself and your partner. But it is not your ostomy that decides if you are able to have a satisfying sex life or other meaningful romantic relations. Read our tips below. 

couple happy ostomate Talk about your ostomy By talking through your emotions to do with your ostomy, disease and operation, you will get through this difficult time a little easier. Who to talk to about your ostomy and what to say?
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Talk about your ostomy

References

Annemette Bach, stoma nurse, Denmark; Grethe Hansen, stoma nurse, Denmark; Elisabeth Aveborn, stoma therapist, Sweden; Ina Berndtsson, stoma therapist og sexologist, Sweden.

Losing the desire for sexual intercourse while you are unwell and after an operation is natural. Many might avoid physical contact due to a fear that it might lead to expectations or demands that cannot be fulfilled. However there is generally nothing standing in the way of having a good sex life when you have had an ostomy operation. Talking through your emotions towards your ostomy, disease and operation might help you get through this difficult time.

Talk to your stoma nurse about your intimate life

Talk to your nurse about all of your concerns – including those related to your intimate life. This will help you get a good start. Your stoma care nurse is used to discussing all issues you’re experiencing and will be able to help in many ways, both with advice and with accessory products.

If you practice anal sex, make sure you talk to your nurse about this before surgery so that your options and the risks involved can be assessed.

Talk to your partner about your ostomy

Talk openly and honestly with your partner. Even if doing so makes you feel embarrassed at first, you can be sure that it will only deepen the bond of respect and trust between you.

Although you might be lacking energy and are finding it difficult to re-start your sex life due to tiredness, fear of pain or other mental barriers, it is still important to maintain closeness and physical contact with your partner - without it necessarily leading to sexual intercourse.

How to tell a new partner about your ostomy?

The thought of a prospective intimate relationship might seem daunting to an ostomate without a partner. When would it be appropriate to speak about your ostomy? Early in the relationship, to make sure the partner doesn't feel deceived? Or later on, with the risk of ruining the moment? It can be difficult to open up about the topic.

To make sure you are ready for the situation it can be a good idea to prepare what to say beforehand.

Always remember that you are so much more than an ostomate. By showing this to your partner, you keep the ostomy from ever becoming a problem to the extent that it will affect your relationship.

Colostomy and ileostomy support groups

Ultimately, nothing is more helpful than talking to someone who really understands what you are going through. Your local support group is one way of meeting peers to get handy tips, inspiration and personal support. Talk to your stoma nurse about relevant groups to join. 

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friends having beer talking Coming to terms with your changing body Following ostomy surgery, it’s natural to have concerns about your body’s appearance. Read here about what you can do to come to terms with your new body. Practical tips when living with a stoma
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Practical tips when living with a stoma

References

Annemette Bach, stoma nurse, Denmark; Grethe Hansen, stoma nurse, Denmark; Elisabeth Aveborn, stoma therapist, Sweden; Ina Berndtsson, stoma therapist og sexologist, Sweden.

Following ostomy surgery, it’s natural to have concerns about your body’s appearance. Radical changes to your body, the fear of a serious disease, hospitalisation and the operation itself can all come together with an immense emotional load. It can take time to get used to the physical changes and you may feel less attractive as a result. Although it can be a challenge, you will feel better when you accept it as a part of who you are - the same goes for your partner. You life is not dictated by your ostomy, your needs can still be fulfilled.

Focus on your partner’s needs

It's ok if it takes a little while before your intimate life is what it was before. Avoid putting pressure on yourself and your partner, it is going to take time to adjust, but most people are able to get back to a healthy sex life eventually. Focus also on your partner's needs, not only your own, then many of your concerns will  decrease naturally.

Intimacy is more than sex

Remember that intimacy is much more than intercourse, and can be fulfilling and fun on its own. Take time to enjoy simply touching each other, holding, cuddling and kissing – allow feeling ready for intercourse to come naturally over time.

New relationships

The fear of being rejected is something almost everybody deals with. Remember that non-ostomates also get rejected. The possibility of meeting a person, who, without knowing about your ostomy, will reject you, also exists. This might be a person who is intimidated by something new and different.  Keep in mind how likely it would be that the relationship would not work, even if you were not an ostomate.

What happens with the ostomy bag when you have sex?

If you are thinking about your stoma and bag it might be difficult to relax and give yourself sexually. Keep in mind that both the stoma and the bag can endure sexual intercourse. It is important to remember the sex you had before the operation, to make sure you don’t forget previous problems, and blame the ostomy. 

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Physical changes after ostomy surgery Physical changes after ostomy surgery Intimacy and a normal loving relationship following ostomy surgery can be resumed. How and when depends on the nature of the operation you've had. Read about some changes that may occur after surgery
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Physical changes after ostomy surgery

References

Annemette Bach, stoma nurse, Denmark; Grethe Hansen, stoma nurse, Denmark; Elisabeth Aveborn, stoma therapist, Sweden; Ina Berndtsson, stoma therapist og sexologist, Sweden.

Intimacy and a normal loving relationship following ostomy surgery can be resumed. How and when depends on the nature of the operation you've had. You could feel discomfort if the rectum or bladder were removed, and the uterus may change position. Changes in feeling can occur, and you might feel some level of pain. Each individual experience will be slightly different.

How will the stoma cope?

The stoma is perfectly capable of coping with you resuming your sex life and the operation scar will not break. The disease you have been operated for is not infectious and the risk of it returning is not dependent on your sex life. 

Remember that the stoma will often be most active 1-1½  hours after a meal, so it might be a good idea to cover the air outlet during this time, to keep it from disturbing you. 

What can you do to make your sexual experiences better?

It can help to try different sexual positions that shift weight away from your stoma, supporting yourself with a pillow, or using lubricants.

Some men experience difficulties keeping their erection after their ostomy surgery due to damages to the nerves. If you experience this issue it can be helpful to be in a position where you are less physically active as this can prolong the erection. 

Changes in anatomy after your ostomy operation

The physical changes from an ostomy operation and their impact on your sex life will depend on a few different factors. Some functions may be temporarily or permanently damaged, and not work as they previously did. 

It is important to get sufficient information about your surgery from the hospital. A diagram of the operation might be helpful. If you experience sexual difficulties following the ostomy operation, it is important to determine the cause and correct the problem. 

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Ostomy underwear Ostomy underwear Special underwear that can help you feel attractive while still covering your pouch completely is available from specialist online stores. Read tips for men and women about ostomy underwear
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Ostomy underwear

References

Annemette Bach, stoma nurse, Denmark; Grethe Hansen, stoma nurse, Denmark; Elisabeth Aveborn, stoma therapist, Sweden; Ina Berndtsson, stoma therapist og sexologist, Sweden.

Tips for women

Crotch-less underwear might be an option to provide more support for the stoma. You can also transform a pair of beautiful lace panties yourself by cutting a small opening in the bottom or adapting lace underwear so that it’s worn as a tube around your body covering the pouch. 

Tips for men

Some prefer to wear a t-shirt or a singlet during intercourse to cover the stoma. 

Vanilla Blush – specialising in ostomy underwear

Our friends at Vanilla Blush specialise in making underwear and lingerie for men and women who have had Ostomy surgery. Visit the Vanilla Blush website.

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Ostomy products that may help Ostomy products that may help There are a lot of products available that you can use while having sex in order for you to feel free, relaxed and enjoy those intimate moments. Considerations when choosing your ostomy product
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Ostomy products that can help you

References

Annemette Bach, stoma nurse, Denmark; Grethe Hansen, stoma nurse, Denmark; Elisabeth Aveborn, stoma therapist, Sweden; Ina Berndtsson, stoma therapist og sexologist, Sweden.

In order to feel more free, relaxed and capable of enjoying sex, you can follow some of these useful tips:

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mum daughter birth control Birth control for ostomates Most ostomates can use any type of contraception. However, for some ileostomates there might be some changes. Read about birth control for ostomates here
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Birth control for ostomates

References

Annemette Bach, stoma nurse, Denmark; Grethe Hansen, stoma nurse, Denmark; Elisabeth Aveborn, stoma therapist, Sweden; Ina Berndtsson, stoma therapist og sexologist, Sweden.

Birth control for women with an ostomy

Most ostomates can continue to use contraception as before the surgery, if pregnancy is not a long-term goal.

For some ileostomists the barium swallow is so prompt, that the assimilation of contraceptive pills becomes adverse. Contraceptive pills are therefore not a safe method for some who have an ileostomy.

Please consult your doctor or Stoma Therapy Nurse for further information.

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pregnant ostomate Fertility and pregnancy with an ostomy You can still get pregnant after colostomy, ileostomy or urostomy surgery. Read about how the surgery might have an impact on your fertility and the different stages of your pregnancy. Fertility and pregnancy with an ostomy
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Fertility and pregnancy with an ostomy

References

Annemette Bach, stoma nurse, Denmark; Grethe Hansen, stoma nurse, Denmark; Elisabeth Aveborn, stoma therapist, Sweden; Ina Berndtsson, stoma therapist og sexologist, Sweden.

Fertility after surgery

Women:

  • A comprehensive bladder or intestine operation can result in reduced fertility due to adhesions or if the uterus has reclined.

Men

  • Before any operation with a potential risk of nerve damage, you should consider discussing with your doctor the possibility of having your semen deposited in a sperm bank. This is done in case something was to go wrong that may limit your ability to have children in the future.
  • Stress from the operation and treatment can reduce the amount testosterone produced in the short term.
  • As long as the testicles remain untouched during surgery, there should be no need for hormonal treatment. 

Assistance with getting pregnant

There are many different options for both Ostomates and others having trouble getting pregnant. Contact your doctor regarding your options.

Ostomates can have a normal pregnancy

Having an ostomy does not prevent you from carrying a baby to term and having a normal delivery. As the belly grows, the stoma will typically just follow the changing shape of the abdomen. 

Early stages of pregnancy

It is worth getting in touch with your stomal therapy nurse in the early stages of pregnancy as they will be able to help you with special products that may be necessary. 

Later stages of pregnancy 

In the later stages of pregnancy, you might need to use a mirror when changing your pouch. Delivery usually takes place as normal. 

Will the ostomy affect birth?

You can give birth without any risk to yourself or the baby, the ostomy shouldn't be a hindrance. 

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Anal sex after ostomy surgery Anal sex after ostomy surgery Talk to your surgeon before your operation about the need to preserve the rectum and the associated risks. It is highly advised that you do not substitute the stoma for the rectum for anal sex. Anal sex with an ostomy
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Anal sex after ostomy surgery

References

Annemette Bach, stoma nurse, Denmark; Grethe Hansen, stoma nurse, Denmark; Elisabeth Aveborn, stoma therapist, Sweden; Ina Berndtsson, stoma therapist og sexologist, Sweden.

Before the operation, it is important to consult the surgeon about the need to preserve the rectum and the associated risks. 

It’s unsafe to use the stoma for anal sex as a replacement of the rectum

To substitute the ostomy for the rectum is highly advised against as it can lead to bleeding and cicatrisation that might cause problems and a possibility that you might need further surgery.

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woman smiling ostomate Intimacy related complications for women with an ostomy Read about potential complications for women regarding intimacy and sexuality after ostomy surgery. Potential issues for women following ostomy surgery
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References

Annemette Bach, stoma nurse, Denmark; Grethe Hansen, stoma nurse, Denmark; Elisabeth Aveborn, stoma therapist, Sweden; Ina Berndtsson, stoma therapist og sexologist, Sweden.

Having an ostomy and feeling pain during intercourse

Pain can have an impact on sexual stimulation, and after repeated attempts, the anxiety of pain might compromise the pleasure and spontaneity of your sex life. Thus it is important to find a solution to the pain you experience. Talk to your stoma nurse about the pain and your experiences, there are various analgesic gels you can use and also different exercises that may help.

If the vagina feels too tight

If the vagina feels tight, expansion might help. The simplest way to do this is by inserting a finger into the vagina. After doing so, the expansion can gradually be increased by 2 or 3 fingers. This can be done by yourself or your partner. It is also possible to buy dilatators in different sizes that can help dilate and extend the vagina. If you feel insecure doing this yourself, it is also possible for your doctor or gynaecologist to do this. 

If the vagina feels dry after your ostomy operation

Suppositories, water-based lubricant or spit on a finger, might help relieve vaginal dryness. Lubricating gel can be purchased at the pharmacy. The lubricant, which preferably should be water based and without additives, is applied to the penis and area around the vaginal entry.

Increased vaginal discharge

There are different ways to solve problems with increased discharge – depending on the size of the problem. To some, a panty shield might be enough. To others it is necessary to discuss suppositories or douches. Discuss this with your doctor. It may also help to strengthen your pelvic floor muscles by doing regular exercises. Discuss this with a physical therapist. In rare cases, surgery might be necessary.

Urinary problems after ostomy surgery

If you are experiencing urinary difficulties, it is important to consult your physical therapist about rehabilitation of the pelvic floor muscles through daily exercises. If the problem is more serious, it may also be worth consulting your doctor, urologist or gynaecologist for an examination.

When using the toilet take your time to empty the bladder. It is also important to remember, that the bladder is best emptied during relaxation and not by pushing.

Ostomates experiencing changed sensitivity of the clitoris

The nerve paths to the clitoris might be damaged, and the level of sensitivity might consequently change. It might take some people longer to reach sexual stimulation because of this. On the other hand, the area around the vaginal entry might become too sensitive, which can result in even the gentlest touch being uncomfortable or painful.

To be sexually stimulated or experiencing orgasm from other places besides the clitoris is also an option. If previously unknown, this can be trained or discovered. Try to explore yourself through masturbation.

Side affects of chemotherapy or radiotherapy

Aftercare can occasionally result in side affects that can influence your sex life. Chemotherapy can influence menstruation in such a way that it ends for a short or long period of time. Some medication can affect the desire for sexual intercourse. Radiotherapy can, depending on the radiation field, cause pain and irritation of the vaginal mucosa. Scar formation might occur after radiotherapy, which can lead to the vagina becoming inelastic and it might heal to the surrounding environment. It is important to consult a doctor regarding the extent of the treatment and possible consequences. 

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Intimacy related complications for men with an ostomy Intimacy related complications for men with an ostomy Read about potential complications for men regarding intimacy and sexuality after ostomy surgery. Potential issues with intimacy for men
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References

Annemette Bach, stoma nurse, Denmark; Grethe Hansen, stoma nurse, Denmark; Elisabeth Aveborn, stoma therapist, Sweden; Ina Berndtsson, stoma therapist og sexologist, Sweden.

The most common issues experienced include a defective or lacking erection or problems regarding ejaculation.

Lacking erection

A vacuum pump can help the blood flow inside the penis after which a solid tension ring can be tightened around the root of the penis. A support condom can also be applied.

There are also options available such as medical treatment or surgery which can be more permanent. 

Lack of ejaculation

Nerve damage can either cause ejaculation to terminate or semen may be pushed up into the bladder, where it is emptied with urination. This makes the urine look a little strange but is quite harmless. However if this is the case, you will no longer be fully fertile. Most men don't experience any difference in the feeling of an orgasm but the change may cause some embarrassment to some. One might experience the feeling of not being a “real man” so it is important to have positive support from your partner. 

Changed sensitivity in the penis after your ostomy operation

As a result of nerve damage some might experience a reduced sensitivity in the penis and scrotum, or enhanced sensitivity that may result in the gentlest touch being uncomfortable or painful. 

Ostomates experiencing pain with erection and ejaculation

Pain with erection and ejaculation might occur for a short period after a bladder or intestine operation or following radiotherapy. The problem will most likely disappear within a short period of time. This is usually harmless and not a sign of any disease. If the pain continues or is severe, speak to your doctor about medication that may help.

Impotence after ostomy surgery

Only a small proportion of those who have had intestinal surgery are permanently impotent.

If you experience difficulties with impotency, try not to let it get you down. Your body needs time to normalise following such a substantial operation, and remember that erection, ejaculation and orgasms are mutually independent; a man is capable of reaching complete satisfaction without an erection.    

  • Try to determine the cause of the impotence. How much has it changed since your operation? A signal that there may be physical damage is that there is never, not during sleep, in the morning or when masturbating, any sign of an erection. 
  • Consider if something in your everyday life could be changed. Are you rested or tired leading up to sex? Do you receive sufficient physical or mental stimulation? How is your relationship with your partner in general? Conflict can effect impotency.
  • Tobacco, alcohol, some medication and some chronic diseases can increase the risk of problems with impotency. 
  • If you and your partner are not able to improve the situation by communicating and problem solving, contact your doctor, hospital or stomal therapy nurse before you let it ruin your relationship. Some problems can be managed by advice and guidance. If this is not sufficient you also have the possibility of being referred to a sexologist or urologist. 

Support

A tension ring or a regular condom wrapped around the root of the penis might also help the problem, as it helps the blood to not leave the penis, before the intercourse is completed. These solutions may however only be used for a maximum of ½ hour at a time.

Side effects of radiotherapy or chemotherapy

Radiotherapy can make the blood flow less rapidly, which makes it impossible to obtain a regular erection. The sensitivity of the genitals can likewise be changed. These side effects can develop within the first year after the treatment. Chemotherapy can similarly make erections and passion fade, but it should return after a week or two. Some types of chemotherapy and preventative nausea medicine can also affect hormone production. 

A small amount of chemotherapy treatments may cause permanent damage to the nerve system, which can lead to the semen being emptied into the bladder.     

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