SEX & OSTOMATES
Ostomates & Sexual Functioning
By Ellen A Shipes, RN, MN, ET, and Sally T. Lehr, RN, Sexual Counseling for Ostomates
Fear and misunderstanding often result in the assignment of unnatural or supernatural qualities to that which is unknown. This article will present factual information about ileostomies and urostomies that will dismiss the fear and dispel the misunderstanding.
Ileostomies do not possess the extensive attributes of colostomies. They are more uniform in size and shape. Like the individuals they are a part of, however, no two are exactly the same. Ileostomies are usually temporary. They are most often performed to remove disease such as Crohn’s Disease, ulcerative colitis and occasionally cancer.
Since ileostomies are made in the small bowel, they are usually smaller than colostomies but have the same red color. Urostomies are the most varied of all the stomas in name, location, size and color. Urostomies are done because of trauma, congenital defects or disease, but the ultimate reason is to protect the kidneys by removing or bypassing the damaged or diseased portion of the urinary tract.
The urine is diverted to the abdominal wall by various methods. Location of the urostomy in the urinary tract determines the name. Stomas formed from part of the urinary tract will be pink, not red, due to a difference in tissue structure between the intestinal and urinary tracts. Bowel conduits will be red because they are constructed from a portion of the intestine.
Verbal and mental exclamations of “Gross!”, “Ugly!”, “Monstrous!”, “I can’t stand it!”, “It’s a sore!” and the like may be expressed by ostomates and their partners following surgery. Indeed, only members of the medical profession can truly gaze upon a stoma and its accompanying incision and state, “How nice! It looks great!”
Although the ostomate and partner may react poorly to the initial results of surgical intervention, the stoma itself should produce no physical change in sexual functioning once the individual has recovered from the surgical procedure. Since the stoma is often bright red and appears sore, it is commonly thought that sexual activity will cause stomal damage and pain.
Because the bowel and stoma have no nerve endings as such, even vigorous sexual activity should not result in pain. Slight stomal bleeding may be noted following an especially energetic lovemaking session because of the fragile nature of the stomal blood vessels. There is no cause for alarm as long as the bleeding remains minimal and does not persist for several hours.
The maintenance of sexual functioning varies widely following surgery. In men, the scope of physical change depends solely on the degree of damage to the nerves controlling erection and ejaculation.
Radical resection required for removal of malignancies of the bladder and rectum imparts a high degree of erection difficulty (impotence). In regard to surgery performed for colon cancer, studies cite the frequency of impotence as ranging from 24 percent to 75 percent.
Since a major part of sexual functioning depends on the desire, expectation, and motivation of the individual and partner, it is unwise to assume that erection failure is a foregone conclusion.
For women, the physical damage is not so extensive. Removal of the vagina or persistent coital pain are the only physical conditions that should preclude normal lovemaking. Each ostomate must be considered individually and all ostomates and their partners should have sexual counseling incorporated into their pre-and postoperative teaching. This will aid in reducing both fear and the psychological difficulties which frequently accompany ostomy surgery.