16. Sexuality and Intimacy

The patient is able to express sexuality/intimacy concerns.

It is not unusual for persons with an ostomy to have concerns about resuming relations or whether their sex life will change or if they will be less attractive to their partner. Fears of rejection, odour, leakage, and performance are natural. Patients need to be encouraged to share their feelings and concerns. Understanding each other’s feelings is a very important part of coping with an ostomy. An ostomy should not limit or curtail sexual activity. In fact, many people report that the experience of the surgery and the knowledge that the disease is treated has brought their families and loved ones closer together.

During sexual activity, one may want to experiment with different positions to find the one most comfortable. Prior to sexual intimacy they will want to empty their appliance to minimize concerns about leakage or spillage. A closed end pouch, mini pouch, a frilly half-slip, crotchless panties, or a tube top stretched over the abdomen can often help to keep one from thinking about their ostomy. It is advisable to have patients/families seek additional professional help if difficulties are not resolved.

With some surgeries such as an abdominal perineal resection or cystectomy, physical alteration in sexual function may occur. Nerve damage can occur resulting in an inability to obtain an erection. Patients need to be advised pre-operatively of this risk and reassured post-operatively that interventions exist which can improve sexual function.

PLISST Model

The PLISST model is a model used in sexual counselling and can be helpful when addressing sexual issues and concerns with your patient.

P – Permission
Let your patient know it is okay to have concerns about body image and sexuality. Use open-ended statements such as: “Many people have concerns about their partner’s reactions following surgery. Is this an area of concern for you?” With this statement you are normalizing concerns and giving permission for the patient to share concerns/fears.

LI – Limited Information

• Talk openly and honestly about sexuality and body image.
• Create a therapeutic relationship that is trusting, and open.
• Explore their thoughts and feelings about surgery and the ostomy.
• Questions you may ask include: How do you feel about your body now, and how do you think your feelings will change with surgery? How do you normally cope with changes and losses? Who is your partner? Do you feel your partner is supportive? Do you feel you have a strong relationship? Do you have open communication or are topics around intimacy taboo? What are your specific concerns about living with an ostomy?
• Clarify misconceptions

SS – Specific Suggestion

• Discuss “helpful hints” with your patient/partner
• Share information.

T – Therapy
There will be times when a patient and his/her partner require intensive therapy which can only be offered by a trained professional. The important thing to remember is to recognize when problems and issues extend beyond your knowledge base and to consult others with added expertise in the area.

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