I just hate the thought that there is a hole right in me. I leave my T-shirt on during sex now. I could never stand the thought of my wife actually seeing the stoma [surgically created opening into abdomen].”

HUSBAND WITH COLOSTOMY

An ostomy is a surgical procedure by which an artificial opening is created in the abdomen so that the urine or intestinal contents flow into a collection sac attached at the sight of the opening (the stoma). There are three basic types of this surgery. A colostomy is most often performed because of cell disease (cancer) of the rectum or colon and in some cases of inflammatory bowel disease and diverticular disease. An ileostomy is most typically done in the case of inflammatory bowel disease. An ileal conduit is constructed to divert urine to a sac because of impaired bladder function, removal of the bladder, or neurological damage in this area.

The effect of the above surgeries is varied, but in general the sexual-response system as viewed from the fourth perspective is left intact. Depending on degree of damage to nerves in the area of surgery, some men may experience erective problems, ejaculatory problems, or retrograde ejaculation. The ileal conduit procedure seems to have the most effect on erection, but even then more than one fifth of the men I interviewed (of a total of 122, including men not in the couples sample) reported no effect on erection. More than half of the men interviewed who had a colostomy (total 38) reported no erective or ejaculatory problems.

Women with ostomies may experience painful intercourse or some change in vaginal sensations. I found that postural adjustments helped greatly in many of the cases of coital pain, as some of the women were unintentionally compensating for the stoma and surgery by moving their bodies in ways that stressed different muscle groups. Of the forty women ostomy patients I interviewed, eight reported painful coitus that they attributed to the surgery. Thirteen, including these eight women, reported a change in vaginal sensations. As with the men, primary concerns were with appearance, partner acceptance, and odor that may come from the stoma.

I have found that the most effective counseling in these cases comes from partners of the patient talking to partners of other patients who have had an ostomy and resumed sexual functioning. This type of surgery requires some time before full physical stamina returns, so again the bywords are to take time, communicate, and move beyond the intercourse and mutual-orgasm orientation. I tell my patients that it is stamina more than stoma that will slow sex down at first.

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