Sex, contraception and pregnancy

Sex can be resumed at any time, but having had major surgery you will need time to recover. It is worth separating the causes: difficulties can be due to surgery, but they can also be linked to anxiety, fear of failure, or concern about a partner’s feelings.

What surgery can affect

Following surgery to remove the rectum, some men may have difficulty getting an erection or problems with ejaculation. In most cases these problems are temporary. The mechanism is that pelvic surgery can injure nerves supplying the penis, which may be temporary due to bruising or permanent — and the risk of it occurring is very small. Sildenafil has been shown to be very effective, and younger patients who have not completed their families may wish to bank sperm, which can normally be arranged through the pouch team.

Some women may find intercourse painful, usually from perineal scarring; trying different positions may help. Vaginal dryness may occur as a result of surgery or anxiety, and lubricating gel can help. In most instances the discomfort is minor and does not interfere significantly.

Contraception

This is the practical point most worth carrying away: oral contraceptives may not be fully effective, as they may not be absorbed completely. The coil may not be advised either. There are other methods available, and if you are sexually active you should discuss them with your doctor or family planning clinic.

Pregnancy

With a pouch, careful consideration is required before planning a pregnancy, and a Caesarean section is usually advocated. With an ileostomy it is more open — many ostomists conceive and have successful pregnancies, though you may need to discuss the method of delivery with your obstetrician.

And a short list for practical reassurance: check that your bag is secure and empty, use a bag cover of some sort, secure the bag against your skin with tape — and one instruction stated plainly, that the stoma itself should not be used for sexual activity.

The conversation everything keeps pointing at

The mechanical problem and the relational one are separate, and the second gets more words. Some ostomists are concerned about how their partners may react to their stoma, and misunderstanding can lead to sexual difficulties. The remedy is unglamorous: talk to each other about how you feel.

And one line is worth keeping as a corrective to how much space this topic occupies in people’s heads before surgery: sex is only a part of life, and is as individual as the ostomist.

Timing, if you have a choice

The one piece of forward planning in any of this comes from the surgeons: women wishing to have children may want to consider deferring pouch surgery until after completing their family, because pelvic surgery can cause scar tissue that blocks the fallopian tubes. Younger men who have not completed their families may wish to bank sperm, which can normally be arranged through the pouch team.

Neither is presented as a recommendation to delay. They are presented as questions to raise before the operation rather than after, which is the only time they can be acted on.