Urostomy, Colostomy, or Ileostomy

A urostomy sends urine through a new passage and then through an opening called a stoma in the abdomen. A colostomy and ileostomy are both openings in the abdomen for getting rid of body waste (stool) from the intestine. In an ileostomy, the opening appears in the part of the small intestine called the ileum. In a colostomy, the opening is in the colon (large intestine).

A urostomy interferes less with your sex life if you make some common-sense changes. First, make sure your appliance fits correctly. Check the seal and empty your ostomy appliance before sex. This will reduce the chance of a major leak. If it does leak, be ready to jump into the shower with your partner and then try again. It is also wise to avoid foods like asparagus that give urine a strong odor. Some people now have “continent urostomies” that stay dry without an appliance. With a continent urostomy, a section of the intestine is cut out. The ends are reconnected so the intestines can work normally. From the section of intestine that was removed, a reservoir and nipple valve/stoma is constructed. The reservoir is connected to the ureters, which prevents backup into the kidneys. Urine is drained from the reservoir several times a day with a catheter that is put in through the stoma/nipple valve. Therefore, there is no need for a bag to collect urine.

A nice pouch cover can make an appliance look less “medical.” Patterns or ready-made covers are available from your enterostomal therapist or ostomy supply dealer.

Another choice is to wear a special small-sized ostomy pouch during sexual activity. If you have a 2-piece system, turn the pouch around on the faceplate. Then the emptying valve is to the side. If you wear an elastic support belt on your faceplate, tuck the empty pouch into the belt during sex. Or you can wear a wide sash around your waist to keep the pouch out of the way. Another way of keeping the pouch from flapping is to tape it to your body. You may also find that you feel more comfortable wearing a T-shirt to cover your appliance.

To reduce rubbing against the appliance, choose positions for sexual activity that keep your partner’s weight off the ostomy. If you have an ostomy but like to be on the bottom during intercourse, try putting a small pillow above your ostomy faceplate. Then, your partner can lie on the pillow rather than on the appliance.

If you have a colostomy, you can do the same thing. Since a colostomy is not active all the time, you may be able to plan sexual activity for a time of day when you know yours is usually not active.

If you irrigate your colostomy, you may be able to wear just a stoma cover or a small safety pouch during sex. You can also avoid eating foods that produce gas on days when you are likely to make love.

Laryngectomy

Laryngectomy is the surgery that removes the voice box. It leaves you unable to talk the normal way and you breathe through a stoma (opening or hole) in your neck. Since the air you breathe can’t be purified by the nose’s natural filter, a stoma cover is needed. Besides catching dust and particles, the stoma cover hides the mucus that the stoma secretes. A scarf, ascot tie, or turtleneck can look nice and hide the stoma cover. During sexual activity, a stoma cover may look more appealing than a bare stoma.

During sexual activity, a partner may at first be startled by breath that hits at a strange spot. On the positive side, one patient quipped, “Now when I kiss, I never have to come up for air!”

You can lessen odors from the stoma by avoiding garlic or spicy foods and by wearing cologne or after-shave lotion.

Sometimes problems in speaking interfere with communication between some couples. If you have learned to speak using the esophagus , talking during lovemaking is not a big problem. It does take more effort, though, and you lose some of the emotional overtones. A speech aid built into the stoma might also work well. However, neither method lets you whisper in your partner's ear.

If you use a hand-held speech aid, communication during sex is likely to be awkward and distracting. You can say a great deal without words, however, by guiding your partner’s hand or using body language.

Talking is not needed in many sexual situations. With a new partner, you may want to discuss the kinds of touching and positions you like before you start making love. You may also want to pre-select ways of signaling important messages you may want to share during sex.

Treatment for Facial Cancer

Some cancers of the head and neck are treated by operations that remove part of the facial bone structure. Because the scars that result are so public, they can be devastating to your self-image. Surgery on the jaw, palate, or tongue can also impair speech.

Recent advances in facial replacement devices and in plastic surgery now give many people a more normal look and clearer speech. Even ears and noses can be made out of plastic, tinted to match the skin, and attached to the face. All of these things can be a great help to a person’s appearance and self-esteem.

There are a number of other things a person can do to improve self-esteem. See the next section, "Keeping Your Sex Life Going," which includes ideas for coping with changes in appearance. Also, you may wish to contact the organization Let’s Face It. Please see the "Additional Resources," section for further information.

Limb Amputation

Treatment for some cancers, most often primary tumors of the bone, can include amputating (surgically removing) a limb. Amputations may call for some changes in lovemaking. A patient who has lost an arm or leg may wonder, for example, whether to wear his artificial limb during sex.

The answer depends on the couple. Sometimes the prosthesis (or artificial part) helps with positioning and ease of movement. However, the straps that attach it can get in the way. Without a prosthesis, the partner with an amputation may have trouble staying level during intercourse. Pillows can be used to support the remaining part of the limb.

Amputations may create chronic pain or pain where the limb used to be. These side effects can interfere with sexual desire and distract a person during sex. The American Cancer Society offers information about managing pain control.

Loss of One or Both Testicles

Testicles are as symbolic of manhood as breasts are of womanhood. Although some men are not upset about their new appearance, others fear a partner’s reaction. This is particularly true of men who are not in a long-term relationship.

Men treated for prostate cancer that has spread beyond the local area may have both testicles removed (orchiectomy) to stop production of the hormone (testosterone) that nourishes the cancer. The structure at the top of the testicles (epididymis) remains, however, so the scrotum (sac that holds the testicles) does not look empty. After the orchiectomy, some men may also have hormone therapy. (See the information under Hormone Therapy in the section"Effect of Cancer Treatment on Male Sexuality.”)

In men with testicular cancer, the surgeon usually removes the testicle with cancer and leaves the normal one. Only a very few men ever develop a second tumor in the other testicle. Since this operation also removes the epididymis above the testicle, that side of the scrotum does look and feel empty.

Men with testicular cancer are usually young. They may be single and dating. They may be athletic and feel embarrassed by the missing testicle when showering or in locker rooms. To restore a more natural look, a man can have a testicular prosthesis surgically implanted in his scrotum. The prosthesis is filled with silicone gel, and it comes in many sizes to match the remaining testicle. When in place, it looks and feels like a testicle. The only evidence left of the operation is the scar, which is often partly hidden by pubic hair.

When part of the scrotal skin must be removed, a testicular prosthesis may not be able to make the scrotum look normal.

Penectomy

When a man has cancer of the penis or of the bottom end of the urethra, the best treatment may be amputation of part or all of the penis. These operations are rare, but they can have a devastating effect on a man’s self-image and his sex life. If cancer of the penis is diagnosed early, local radiation or chemotherapy creams can sometimes be used to treat it. These treatments often have little effect on sexual pleasure and function. More commonly, however, the only way to stop the cancer is to remove part or all of the penis.

Partial penectomy removes only the end of the penis. The surgeon leaves enough of the shaft to allow the man to direct his stream of urine away from his body.

Men are usually surprised to learn that a satisfying sex life is possible after partial penectomy. The remaining shaft of the penis still becomes erect with excitement. It usually gains enough length to achieve penetration. Although the most sensitive area of the penis (the glans or “head”) is gone, a man can still reach orgasm and have normal ejaculation. His partner also can still enjoy intercourse and often reach orgasm.

If the shaft cannot be saved, the man must have a total penectomy. This operation removes the entire penis, including the roots that extend into the pelvis. The surgeon creates a new opening for the urethra (tube from the bladder) between the man’s scrotum (sac for the testicles) and his anus (the outside opening of the rectum). The man can still control his urination because the “on-off” valve in the urethra is above the level of the penis.

Some men give up on sex after total penectomy. Since cancer of the penis is most common in elderly men, many have already stopped sexual activity because of other health problems. If a man is willing to put some effort into his sex life, however, pleasure is possible after a total penectomy.

He can learn to reach orgasm when sensitive areas, such as the scrotum, skin behind the scrotum, and the area surrounding the surgical scars, are caressed. He or his partner may try placing a finger an inch or two inside the anus to caress the prostate (see diagram in section “Elements of Male Sexual Desire and Response"). Some people prefer to use plastic or latex gloves with a water-based lubricant to touch this area, and short fingernails are a must. As long as the rectum or prostate is healthy and has not been injured by surgery, trauma, or cancer,  many men find this quite pleasurable. It does take some practice, since at first it may feel strange or cause the man to feel he has to urinate.

Having a sexual fantasy or looking at erotic pictures or stories can also increase excitement. You may want to use the touching exercise (described in “Resuming Sexual Activity With Your Partner,” in the section "Keeping Your Sex Life Going") to learn about new areas that feel pleasurable to you.

You can help your partner reach orgasm by genital caressing with your fingers, by oral sex, or by stimulation with a vibrator. The activity some couples have after total penectomy can give hope to those coping with lesser changes in their sex lives.

Revised: 09/07/2007