Sexual Counseling: The Forgotten Aspect of Ostomy Rehabilitation

Abstract

Ostomy surgery not only diverts the urinary or intestinal tract to and through the abdominal wall, it also causes an upheaval in an individual's body image and sexual functioning. Without proper care and rehabilitation, it can be one of the most overwhelming and disruptive surgeries performed. It is estimated that about 450,000 Americans of all ages, genders, and sexual orientations have an ileostomy, colostomy, or urinary diversion and that approximately 120,000 new surgeries are performed each year. After ostomy surgery, both the loss of control over elimination of stool and/or urine and the need to wear an external collection device, called an ostomy pouching system, create feelings of depression, low self-esteem, and fear of rejection by current or potential sexual partners. In some cases, these concerns become so extreme that individuals withdraw entirely from their family or other types of socialization. As a consequence of removing the bladder or the rectum, many males experience erectile dysfunction (ED) or retrograde ejaculation. Many women are concerned about body image, pregnancy, or being sexually desirable. Because it is estimated that the average age of individuals with stomas is about 68, education about sexuality and sexual functioning after ostomy surgery is often overlooked. Due to reduced postoperative hospitalization stays, new patients are often discharged with little or no instruction or counseling. Health care educators and professionals must have a clear understanding of the ramifications of ostomy surgery on their clients and their clients' partners in order to assist them in regaining their feeling of sexuality and desirability.