SEX &
OSTOMATES
Ostomates and
Sexual Functioning
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.