By Ostomy Canada Society
Based on the national webinar presented by Leslie Heath,– RN, BScN, MCISc-WH, WOCC(C)

This article is featured in the Winter 2025 edition of Ostomy Canada Magazine.

After ostomy surgery, it’s not uncommon to face more than just physical changes. Many people also grapple with emotional questions, especially when it comes to intimacy, sexuality, and relationships. For some, the quiet worry sounds like: Will I still be attractive? Can I date? Can I enjoy a healthy sex life?

In Ostomy Canada Society’s national webinar Beyond the Bag, Leslie Heath, a Nurse Specialized in Wound, Ostomy and Continence (NSWOC), addressed these concerns with compassion and clarity. Drawing on more than 35 years of experience in both inpatient and outpatient ostomy care, she offered a candid, empowering look at the realities and possibilities of life after surgery.

This article shares her key insights, blending clinical expertise, psychological guidance, and heartfelt encouragement to help you navigate sexuality, intimacy, and dating with confidence and hope.

Reclaiming Life After Surgery

Recovery after ostomy surgery doesn’t always follow a set schedule, and that’s okay. For some, various forms of intimacy feels possible again within months; for others, it may take years. Both timelines are completely normal.

“Ostomy surgery can be a shock,” Leslie explained. “You’re navigating the fear of the unknown, a changed body, and perhaps a sense of loss of control.” Her advice: release the urge to compare yourself to others and focus instead on your own unique journey.

Healing is more than physical, it’s also about emotional acceptance, and sometimes grieving the loss of your former body image. This is normal. Worries about future relationships can feel daunting. But, as Leslie reminded, “You don’t yet know what your new potential is and that’s a powerful place to start.” Self-acceptance and self-confidence is often reflected by your partner as you recover and explore your options for your new sexual norm.

Understanding Surgeries and Their Impact on Sexual Health

Pelvic surgeries can have significant, and often underdiscussed, effects on sexual function due to both anatomical changes and nerve involvement. Speak to your surgeon about the extent of tissue removal required and impact of the nerves and blood vessels around sexual organs.

1. Abdominoperineal Resection (APR)

This surgery removes the rectum and anus and results in a permanent colostomy. Up to 88% of men who undergo APR experience sympathetic nerve damage, often leading to erectile dysfunction and reduced ejaculation.

For women, APR may include vaginal resection, leading to pain, scar tissue development, vaginal dryness, discomfort with urination, and reduced sexual sensation.

After surgery, anal sex is no longer possible, so it may be helpful to explore other ways of connecting intimately.

Emotional withdrawal from intimacy is also common due to altered self-perception.

2. Pelvic Exenteration

A more extensive surgery that removes multiple pelvic organs, including reproductive structures. This results in complete infertility for both men and women and often leads to dual ostomies (colostomy and urostomy).

Leslie highlighted the value of having early conversations about sperm or egg banking for anyone who may want to have children in the future.

3. Radical Cystectomy

Involves the removal of the bladder and, in many cases, the adjacent sexual organs. For men, this may include the prostate and seminal vesicles, often resulting in erectile and ejaculatory dysfunction. For women, it typically involves the removal of the uterus, ovaries, and parts of the vaginal wall.

Even with nerve-sparing techniques, nerve damage is common. “Surgery teams aim to preserve nerve function,” Leslie explained, “but it depends on the disease and its spread.”

Pelvic Nerve Damage: A Closer Look

The pudendal nerve, responsible for sensation in the genitals and pelvic floor, is particularly vulnerable during pelvic surgeries. When damaged, it can lead to:

• Decreased genital sensation
• Difficulty achieving arousal or orgasm
• Erectile dysfunction in men
• Painful intercourse in women
• Changes in bladder or bowel control

Leslie pointed out that pelvic radiation can worsen these effects, causing fibrosis and scarring of blood vessels that further reduce blood flow and sexual responsiveness.

Navigating Male and Female Side Effects of Surgery

Men may face erectile and ejaculatory challenges, reduced semen volume, retrograde ejaculation, or dry orgasms. Some may require more stimulation to achieve even partial erections. These changes can be emotionally distressing and require open discussion with healthcare providers.

Women may experience reduced lubrication, scar tissue in the vaginal canal, changes in vaginal length, and decreased arousal. Radiation therapy may further impair sexual function, making intimacy painful or difficult.

If you’ve had ostomy surgery, have a chronic illness or received treatments for other conditions, you’ll also likely be taking one or more medications. Some types of medications that can interfere with sexual desire, erection, and sexual functioning. It’s a good idea to discuss your medications with your doctor or pharmacist to check for any sex related side effects.

Fortunately, many of these challenges can be managed with treatment. Leslie encouraged patients to speak up early, noting, ‘The sooner concerns are addressed, the better the outcome.’ Your surgical team should be able to help answer your questions or provide referrals to appropriate professionals (ie: Pelvic Floor Physiotherapy, Sexual Health Counsellor).

Fertility and Family Planning

While some women with preserved ovaries remain fertile, most major pelvic surgeries result in infertility. Leslie stressed that reproductive counselling, including egg or sperm preservation, should be offered pre-operatively to younger patients.

Natural childbirth may still be possible for some ostomates, depending on the type of surgery. “Many women with ileostomies or colostomies go on to have healthy pregnancies,” Leslie shared.

Sexual Identity, Intimacy, and the Role of Psychology

Intimacy is more than physical; it’s emotional, psychological, and social. After surgery, many patients feel a sense of disconnection from their bodies. It’s common to experience performance anxiety, fear of rejection, or diminished self-worth.

“Men tend to worry about performance,” Leslie noted, “while women are often more concerned with feeling desired and accepted.”

The first time you become intimate after surgery, things don’t always go perfectly. Your body may need more time to heal. This may also be a reflection of anxiety, fear of leakage, depression or even other previous sexuality issues.

She stressed the value of emotional support, reminding patients that mental health care is more accessible than ever. Social workers, sex therapists, and psychologists can all play a role in helping rebuild confidence and foster healthy, fulfilling relationships.

Dating with an Ostomy

Dating after surgery can feel especially daunting, but it’s absolutely possible.

Leslie shared practical, confidence-boosting tips to make the experience easier:

• Choose a familiar, comfortable spot for your first date.
• Wear something that makes you feel confident and at ease.
• Bring extra supplies, just in case.
• You don’t need to share about your ostomy right away, but try not to wait until the moment of intimacy.
• Let the conversation flow naturally; you may be pleasantly surprised by how accepting people can be.

And if someone reacts negatively? Leslie reminded, “That says more about them than it does about you.”

Practical Tips for Intimacy

To prepare for intimacy:

• Avoid gas-producing foods if possible, prior to intimacy.
• Empty your pouch beforehand; you may want to use deodorant drops in your pouch.
• Use pouch covers, belts, or intimate wear to cover and secure the appliance.
• Consider using a stoma cap (short-term, low-output use only).
• Try the “marshmallow trick”, eating two to three marshmallows 30 minutes before sex to slow output.
• Sexual positioning- Different positions may be more comfortable, ie, side lying.

Touch, consent, and communication remain the foundations of meaningful intimacy. “Go slow and explore the new you,” Leslie encouraged. Full penetration is not always necessary to have a fulfilling experience.

Treatment Options for Sexual Dysfunction

For Men:

• PDE5 inhibitors: Viagra, Cialis, Levitra (must have some nerve function)
• Suppositories: Muse (urethral)
• Injections: Alprostadil (penile)
• Vacuum erection devices
• Penile implants

For Women:

• Estrogen creams and lubricants
• Vaginal dilators for scar tissue
• Moisturizers and hydration
• Manual stimulation or self-exploration to increase comfort

All treatment options should be discussed with a physician/surgeon or sexual health professional.

Early intervention leads to better outcomes.

Special Considerations for Same-Sex Couples

Same-sex couples may experience unique challenges, especially if rectal tissue has been removed and the anus closed. Alternative forms of intimacy, oral, manual, and emotional, all become more important. Leslie emphasized that a stoma should never be used for sexual activity, as it poses serious medical risks.

If intimacy challenges persist, couples therapy with LGBTQ+ affirming professionals is strongly encouraged.

Redefining Intimacy and Moving Forward

A satisfying intimate life is still possible, even if it takes a new form. Leslie reminded viewers that intimacy isn’t limited to intercourse; it’s about closeness, trust, and genuine connection.

As a colleague Gwen Turnbull, RN, WOCN so beautifully put it:
“An ostomy should not be viewed as the end to living, but simply living with a new end in view.”

Resources and Support

• Visit: www.ostomycanada.ca
• Join: Ostomy Canada peer support groups and online communities
• Read: Hollister, Convatec and Coloplast ostomy Intimacy guides; other companies also have information available
• Explore: MeetAnOstomate.org
• Talk to: Your doctor, surgeon, NSWOC nurse, sex therapist, or mental health professional

Final Thoughts

You are more than your surgery. You are still capable of love, of passion, and of deep human connection. Whether you are exploring dating again or working to reconnect with your partner, know that help, understanding, and joy are within reach.

Your story doesn’t end with an ostomy. In many ways, it begins anew.

Watch The Webinar

Webinar Disclaimer: While Ostomy Canada Society and our guest presenters will do their best to help answer your questions, any questions requiring a healthcare professional to perform an assessment via telehealth or in-person should be directed instead to the Medical Lifestyle Advisory Committee. We also encourage you to reach out to your physician and/or an NSWOC in your area for further questions that aren’t answered during the webinar. Note as well that recommendations made during a webinar are not intended to be a substitute for seeking professional advice, guidance and treatment.