Physical intimacy, or sex—let’s call it what it is—is a normal part of life. Most ostomates don’t just wish to be intimate; we want to copulate, procreate, fornicate, make love, and a stoma should not be a barrier to enjoying a healthy sex life. Still, before and after major surgery, it’s only natural to have a few questions and concerns you want answered.
Yet, when I researched the topic, there was little information available for people with a stoma on intimacy, and even less frank mention of sex. Much of what I found seemed to miss the closeness, excitement and affection I associate with an intimate life. So, I wanted to share plainly what I’ve learned about the value of building confidence in yourself and your body, as well as having open communication and mutual understanding with your partner.
Take time to recover
Any trauma to the body is going to need a certain amount of healing time, and this is especially the case after major surgery. Because ostomy surgery takes place near to the pelvis, engaging in penetrative sex before you are physically healed can be uncomfortable or painful. As well as the condition of your wounds, you should also consider the effects of postoperative fatigue or any medication you are taking. I found that the best way to assess how the healing was coming along was to listen to my body and discuss it with my stoma care nurse. You shouldn’t be embarrassed to show the nurse your wounds, especially if you’ve had your rectum removed. They will let you know if you need more rest or any additional treatments, so you can make a sensible decision about what your body is able to handle.
it’s only natural to have a few questions
After my operation, it took 5 weeks until I felt ready to have penetrative sex. I felt I was ready then because I had begun to feel much more active in other areas.
No need to rush
If you have a steady partner, it is a good idea to keep them informed throughout your recovery. Regularly letting them know how you feel, both physically and mentally, can help them know how to take care of you and avoid any potential awkward or harmful misunderstandings. My partner and I agreed that communication was the key to a good relationship. Therefore, I tried my best not to shut him out, and he was very much part of the entire surgery and healing process.
If, after surgery, you are looking to meet potential new partners, you may want to give yourself the time adjust and have the confidence to discuss your ostomy with them. When you tell potential partners about your ostomy, whether right from the beginning or after getting to know each other a little, is very much a personal choice for you.
communication was the key to a good relationship
If you and a partner wish to get more physical, there is no need to rush each other. For most of us, there are important stepping-stones up to full intercourse. This can begin with spending time alone together and talking, before starting to kiss, and then gently touching one another and engaging in plenty of foreplay. It is natural to have fears about sex, and it is usually best to be open and discuss them with your partner. You may want to ask them to be especially gentle the first time, as well as to not do certain things until you ask them to.
Frank and open conversation with a partner can address both of your anxieties
Anxieties are natural
Having any kind of surgery is difficult enough, and an operation as major and personal as stoma formation can be traumatising. Anxieties are natural, and you may wonder if you’ll still be able to become aroused or feel attractive, as well as have sex or reach climax. These are all perfectly normal concerns, and, for most ostomates, the answer is yes to each of them. Some people do experience sexual problems that either predate their operation or result from rare surgical complications. Otherwise, there are few reasons outside of your control that should prevent you from having an active and fulfilling sex life, and there is nothing in a stoma that would prevent someone from becoming aroused or reaching climax.
Sexuality is closely linked to body confidence, which often means coming to acceptance of your ostomy as part of yourself. Many ostomates face issues with their body image and undergo a journey to acceptance, which can be fast or slow. The aim is to be able to relax, not worry about your ostomy and enjoy yourself. Personally, I vowed to face my surgery with positivity and not let it hold me back. I came out of surgery seeing my body as no different to how it was before, and this gave me a fear-free approach to my sex life.
However, getting back to normal may take time, patience and support from both your partner and care team. Grief is not always straightforward, and, for some people, acceptance takes more work. If you are struggling, keep those communication channels open, and seek the support you need from partners, family and friends, as well as support groups (community or online) and your stoma care nurse. Hearing that other people, especially partners, are not fazed by your ostomy can be a big boost. You are not alone, and you do not need to rush.
Shelley’s partner was open with her
Talk together
If you do have a partner, it is also very important to remember that they also have needs. Having surgery doesn’t just affect you, but those close to you as well. They may have insecurities of their own, perhaps about whether you will still be interested in them or hope to return to your pre-surgery sex life. These can be soothed by talking together and updating each other on how you’re feeling, both physically and mentally—oversharing is preferable to awkward silence. If you are not ready to have full intercourse, cuddling, kissing and gentle touching can remind your partner of your romantic feelings for them.
My partner was very open about his feelings. From the beginning, I asked him to tell me of any fears he had. He was anxious about how he would feel about my body changing—not that he would find me unattractive, but because he hated the idea of someone cutting me up. I am glad that he told me, as it allowed me to reassure him and prevent those fears from festering and coming in the way of our intimacy. I discussed the procedure with him, and we looked at photos of similar operations. He attended my appointments, where he was free to ask questions. He even joined support groups to learn more from other ostomates.
He also wondered if he’d still feel needed and wanted in the same way after surgery, because I would get better and find some freedom in wellness. This was, again, a perfectly understandable emotion and one I could reassure him about and let him know he had nothing to worry about. That really helped our post-surgery sex life, because we trusted each other to be open and discuss concerns as they arose.
See also: ‘Back in the sack: sex with a stoma’, in StomaTips no 3, for how to make the most of romantic relationships and rekindle your sex life after stoma surgery
Conceal and reveal
For a variety of reasons, people can feel uncomfortable about showing their stoma pouch during intimacy. Fortunately, I discovered that there are plenty of options to conceal it, and that there are some great products and accessories to help you. These include mini ostomy bags and clips to pin the bag out of the way, as well as crotchless underwear and waistbands, that come plain, patterned or in lace.
we trusted each other to be open
However, I prefer to think that your bag doesn’t change how you look or define you, and there’s usually no need to hide it away or allow it to control your life. I tried being open and sharing pictures of my ostomy. The compliments I received—not for my body, but for my bravery in baring my bag—gave me buckets of confidence. I felt that knowing other people saw me that way reminded me that my partner must be incredibly proud of and attracted to me.
Confidence
Confidence is a big issue for so many ostomates. Personally, I had minimal issues with this. I believe that was down to my
pre-surgery attitude, which meant I could alleviate fears and discuss sex jovially with my partner. Not everyone is granted the time to adjust beforehand, nor to speak with a partner. If you don’t have a partner to discuss it with, talk to a close friend or your stoma care nurse. Sex is a perfectly normal thing to talk about, and you won’t have to go into any more detail than you want to.
Shelley Lawes is a blogger and patient advocate based in Kent in the UK
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