Sex and a Stoma
Question:
My wife recently underwent surgery for ulcerative colitis and now has a temporary ileostomy. While we have talked a little bit about starting to have sex again, we’re both rather scared about doing this. Are there things I/we can do to make this easier?
Answer:
Resuming sexual activity after ostomy surgery can be an emotional and challenging time for both you and your wife. She will be coping with the effects of the surgery, adaptation to a new skill, and changes to self-perceptions (body image, attractiveness). As her partner, you may be worried about causing her discomfort during intercourse, or even about your own reaction to the pouch and stoma. There are some steps, which both you and your wife can take, to make the transition back to sexual activity more enjoyable for both of you.
Communication is critical to re-establishing your sexual relationship. The time around illness, surgery, and recovery is filled with emotion, so sharing your experiences with each other is important. Discuss those feelings and responses to the changes that have occurred. There will undoubtedly be fears about feeling sexy, about being able to stimulate each other sexually and about being able to respond. If you haven’t seen your wife’s pouch or stoma, consider exploring the pouch and the stoma together before engaging in sexual activity. Think about having a shower or bath together, using bathing as a safe opportunity to begin touching and caressing each other again. Find room for humour, as the stoma makes unexpected noises. Try to avoid timelines and specific expectations about resuming sexual activity. In general, surgeons suggest waiting about 3 weeks after surgery before initiating sexual activity, but this varies from person to person.
Some spontaneity may be lost, particularly in the beginning, as you learn to manage the pouch and stoma during sexual activity. A little planning can make it a special time and less worrisome for you both. Your wife should consider emptying her pouch before your time together. She may want to consider securing the pouch in some way to prevent it from moving during intercourse. This can be simply some tape across the pouch onto the abdomen, or may be the use of concealment devices such as cummerbunds or crotch-less underwear/lingerie; items that cover the pouch while exposing the genitals for intercourse. Lingerie may also add to her sense of sensuality as she learns to adapt to the changes in her body. Smaller, more discreet pouches may be an option depending upon the pouching style your wife is using. Products such as closed end pouches or stoma caps for two-piece systems, while having a limited capacity, avoid the use of hard clips and larger pouches during intimacy. Your wife will need to remember to switch back to her regular pouch after sex. An ET nurse can help you and your wife find lingerie resources and alternate pouches.
A gradual approach to the resumption of sexual activity may help you and your wife to feel more comfortable and confident with each other. Expecting full intercourse/penetration in your first experiences after her surgery may not be realistic. Spending time with each other kissing, touching sensitive areas, or engaging in mutual masturbation or oral sex may provide you both with sexual pleasure without worrying about any initial discomfort associated with intercourse. If you both feel ready for intercourse, your wife may find alternate positions such as side-lying more comfortable until she gains more strength and endurance. Vaginal dryness and lubrication should not be an issue for your wife given her surgery, but having a water-based personal lubricant, such as K-Y® Jelly, available might make intercourse more comfortable. It is important to note that you cannot use your wife’s anus or stoma for sexual activity. If there is an unexpected leak of the pouch during intercourse, bathing or showering together may lesson the embarrassment, and allow you to both continue with your sexual play.
If resuming sexual activity remains a challenge for you both, you may benefit from the expertise of a sexual counsellor. Ask your wife’s surgeon or an ET to provide you with options and a referral to a professional who can help to guide you and your wife back to a fulfilling sexual relationship.
Remaining sensitive to each other’s feelings and ongoing open communication will help you to resume sexual activity. Utilizing different resources to minimize the impact of the stoma and pouch may help in the transition. Your wife’s ET nurse and surgeon may help you in the selection and identification of those that will be most useful to you.