Ostomates
& Sexual Functioning
From Sexual Counseling for
Ostomates, By: Ellen A Shipes, RN, MN, ET, & Sally T. Lehr, RN
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 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, effective, 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, 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.