Intimacy and sexuality when you have a colostomy, ileostomy and/or urostomy

Obviously, an operation changes your body, and it could possibly take a while for both you and your partner to get used to the changes. It is important to remember though, your ostomy does not decide whether or not you have a satisfying sex life, or how intimate you and your partner are.

Here we try and detail out some practical advice and considerations.

Happy Couple Talk about your ostomy with you stoma nurse, your partner or a new partner Opening up and talking about your feelings, your surgery and your condition will really help you to build confidence. Who to talk to about your ostomy and what to say?
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It's good to talk...

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 is natural for many following ostomy surgery. It is important however, for you to realise that you’re not alone! Talking about your stoma, your operation and how you’re feeling will help you to overcome any emotional stress you may have gone through, as well as building back up any confidence you may have lost in your appearance following surgery. 

 

Talking to your partner or loved ones

Post-surgery you may feel nervous or embarrassed about re-engaging in sexual activity with your partner. Whilst they won’t know exactly how you’re feeling, or be able to put themselves in your shoes, they are likely to be sympathetic to your situation and will want to help you to overcome any inhibitions you may have.  

Following surgery, you’re energy levels are likely to be somewhat lower than they were. If this is the case, then you can still remain intimate with your partner without it necessarily leading to intercourse. Be open and honest about any pain you may also be in, your loved ones will be understanding of your situation!

Talk to your stoma nurse

It’s important to remember that your Stoma care nurse isn’t just there to help you through your Stoma surgery.  If you don’t feel comfortable talking to your partner or loved ones about becoming intimate again, then your stoma care nurse will happily listen and advice as to how to overcome your concerns.

If you do practice anal sex, then please either talk to your surgeon or your stoma care nurse. 

How to tell a new partner about your ostomy?

Your stoma doesn’t define who you are – never forget that!

Whilst you may dread the thought of entering into a new relationship and being intimate, it’s advisable to be as open as you can be from the outset.  By taking the initiative in the conversation about your stoma, you lessen the chances of being put in an awkward situation further down the line.  

Ostomy support groups

Support groups are out there, and they want to help put you at ease!  Talking and listening to others that have been in your situation will help you to better deal with your condition and any embarrassment or concerns you have about it. Your stoma care nurse can point you in the direction of relevant groups that you may like to join.

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

Following ostomy surgery, it’s natural to have concerns about your body’s appearance. A radical change of the body, the fear of a serious decease, hospitalization and the operation itself are all together a very 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 but by your needs, which can still be fulfilled.

Focus on your partner’s needs

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

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.

How to feel comfortable when telling a new partner about your ostomy?

Most ostomates find it least complicated to have sexual intercourse in their own home. 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?

When thinking about the ostomy and the bag it might be difficult to relax and give yourself sexually. But such problems can be overcome. Both ostomy and the bag can endure sexual intercourse.  

Read more about products and stoma underwear relevant for the intimate situation here.

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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 the changes after an ostomy operation and how to address it
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Physical changes after an 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. For instance, 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. Assess your own experiences carefully.  

How about the stoma?

The ostomy is perfectly capable of coping you resuming your sexual 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 sexual life. 

Remember that the ostomy will often be most active 1-1½  hours after a meal, so bear this in mind and consider possibly changing beforehand to keep it from any unwanted disturbances! 

What can you do to make your sexual experiences even better?

It can help to try different sexual positions that shift weight away from your ostomy, supporting yourself with a pillow, and the use of lubricants.

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

Changes in the anatomy after your ostomy operation

The physical consequences of an ostomy operation and its impact on sexual life depends on different factors. This means that some of the functions regarding the sexual life can be temporarily or permanently damaged, and thereby not function as they previously did. 

It is important to get sufficient information about your surgery from the hospital. A drawing 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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Underwear and ostomy product advice

Ostomy underwear Ostomy underwear Special underwear that can help you feel attractive while still covering your pouch completely is available form specialist shops. Read tips for men and women
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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 ostomy. You can also transform a pair of beautiful lace knickers yourself by cutting a small opening in the bottom. Also, 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 vest during intercourse covering the ostomy. Alternatively, you can find wraps specifically designed to support the bag and keep it discreet.

 

Vanilla Blush – specialise in ostomy underwear for men & women

Coloplast have partnered with UK-based company Vanilla Blush who specialise in making underwear and lingerie for men and women with an ostomy. Find out more about their ostomy underwear here.

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Ostomy products that can help you Ostomy products that can help you There are a lot of products available that you can use while having sex in order for you to feel free, relaxed and enjoy the intimate moments. Read about precautions and considerations
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Planning ahead

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 be able to feel free, relaxed and capable of enjoying sexual life, you can make some precautions and considerations such as: 

  • Making sure the bag is clean and empty  
  • Use mini pouches, minicaps or ostomy plugs for intimate situations. 
  • Colostomists can irrigate. Be aware that this is not a one off. Watch our instructional video about Colostomy irrigation.
  • Roll up the bag and fasten the underside with a piece of tape. View all our products.
  • Cover the bag with a special cover or similar. 
  • Use stylish underwear that hides the bag and minimises sound.
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pregnant ostomate Fertility and pregnancy when having an ostomy You can get pregnant after a colostomy, ileostomy or urostomy surgery. Read about how the surgery might have an impact on your fertility and the different steps in 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

 

For women:

  • Major surgery on your bladder or bowel can sometimes result in reduced fertility due to the increased risk of adhesions or if the uterus has reclined.

 

For men:

  • Prior to any operations with a risk of nerve damage, you could discuss with your doctor the possibilities of having your semen deposited in a sperm bank. This would be done in the case that you might later want children.
  • Stress relating to an operation or medication/treatment can affect testosterone levels for a short period of time.
  • As long as the testicles remain untouched during surgery, there shouldn’t be the need for hormonal treatment. 

 

You can get help getting pregnant if you have an ostomy

For those with or without a stoma, there are many different options for getting pregnant. There is usually no reason why someone with a stoma can’t conceive, so contact your doctor to discuss your options.

Ostomates 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. Bear in mind that you should keep an eye on the shape and size of your stoma, in order to make sure you are cutting the hole for your ostomy baseplates correctly. If you need help seeing your stoma, you can always use a mirror.

At the beginning of your pregnancy, it is a good idea to have contact with an ostomy nurse, as special considerations regarding the products you use might be necessary. 

In the later stages of pregnancy, the stoma will typically just follow the changing shape of the abdomen. Keep an eye on the shape and size of your stoma, in order to make sure you are cutting the hole for your ostomy baseplates correctly. If you need help seeing your stoma, you can always use a mirror. 

Will the ostomy affect the birth?

Having an ostomy does not prevent you from carrying a baby to term and having a normal delivery. You can, without any risk for yourself or your baby, give birth.

 

If you are concerned, speak to your stoma nurse (and your midwife if you are already pregnant). 

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Overcoming intimacy complications following stoma surgery

woman smiling ostomate Intimacy related complications for women with an ostomy Read about potential complications for women regarding intimacy and sexuality after an 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 the sexual stimulation, and after repeated attempts, the anxiety of pain might compromise the pleasure and spontaneity of your sex life. Therefore it's important to find a solution to the pain you may 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 can help you.

If the vagina feels too tight

If the vagina feels to 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 to be done at a doctors/gynaecologists. 

If the vagina feels dry after you 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 can be a side effect after ostomy surgery

There are different ways to solve problems with increased discharges – 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 furthermore help strengthening the musculature of the floor pelvis by doing regular pelvic floor exercises. Discuss this with a physical therapist. In rare cases, s surgical procedure might be necessary.

Urinary problems after ostomy surgery

It is, for everyone experiencing urinary difficulties, important to look for guidance at a physical therapist or others that can help with rehabilitation of pelvis floor muscles through daily exercises.

To get a reference to a doctor, urologist or gynaecologist might furthermore be relevant, to find cause and possible removal of the problem, though examination and dialogue.

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

Ostomates experiencing changed sensitivity in clitoris

The nerve paths to clitoris might be damaged, and the sensitivity of clitoris might consequently change. It might consequently take some people longer to reach sexual stimulation. The area around the vaginal entry might on the other hand also 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 for ostomates of chemotherapy or radiotherapy

Aftercare can occasionally result in side affects that can influence the sex life. Chemotherapy can influence menstruation in such a way that it ends for a short or long period of time. Some type of 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 with whom you can discuss 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 an 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.

What is most frequently experienced is either a defective or lacking erection or problems regarding ejaculation.

If erection is insufficient

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

Lack of erection

It is also possible to make a surgical solution - this is a permanent solution. Medical treatment might also be a solution.  

Lack of ejaculation

The reason for lack of ejaculation are the nerve damages which either means that the ejaculations terminate or that the semen is pushed up into the bladder, where it is emptied with urination. This makes the urine look a little strange. This is quite harmless but the man will no longer be fully fertile. Most men does not experience any change in the orgasmic sensation, yet this it can mentally present itself as an embarrassment to some. One might experience the feeling of not being a “real man”. It is consequently important to have positive support from the partner. 

if you experience 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 problems will most likely disappear by itself within a short period of time. This is harmless and not a sign of any disease. Medication can in some cases be helpful. Discuss this with your doctor.  

Impotence after ostomy surgery

Only a few who have had intestinal surgery are permanently impotent after one year.

If you experience difficulties don’t let it bring you down. The body needs time to normalise following such a substantial operation, and remember that erection, ejaculation and orgasms are mutually independent; a man is perfectly capable of reaching complete satisfaction without an erection.    

  • Try to determine the cause of the impotence. How much was removed during your operation? A hint towards it revolving around physical damage is, that there is never, not during your 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 to your partner in general? Conflict effects potency.
  • Tobacco, alcohol and in some cases medication and some chronicle diseases can increase the risk of problems with potency. 
  • If you and your partner do not obtain results by communicating and problem solving, contact your general practitioner, hospital or an ostomate nurse, concerning dialogue and treatment, 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. 

Different support materials exist and can be used temporarily or as a permanent solution also when you have an ostomy

A tension ring or a regular condom folded 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 at 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 will return after a week or two. Some types of chemotherapy and preventive nausea medicine can affect hormone production. 

Very few chemotherapy treatments can cause permanent damage to the nerve system, which can lead to the semen being emptied in the bladder.     

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