An ostomy is a surgically created opening in the abdomen (a stoma) that allows bodily waste to be rerouted into an ostomy bag, which is then emptied periodically. It may be necessary for different reasons, such as inflammatory bowel disease (IBD), cancer, diverticulitis, or another medical condition.
Although it changes everyday life in terms of how you deal with urine and stool, that's not the only shift. Sex and intimacy with an ostomy bag can come with challenges.
"In this situation, you can have profound physical and emotional effects when it comes to intimacy," says Jamin Vinod Brahmbhatt, MD, a urologist and surgeon with Orlando Health in Florida. "This can be quite an adjustment, so it's important to understand the issues that may come up, and to talk openly with your partner, and also your care team if needed. Sexual well-being is an important part of your quality of life, so it's worth taking the time and making the effort to adjust to intimacy after an ostomy."
Here are five of the most common difficulties that might arise, along with some tips to ease them so you can get on the path toward fulfilling sex.
1. Lowered Confidence
One of the most prevalent issues when it comes to sex with an ostomy bag is decreased self-esteem. Changes in confidence can happen apart from intimacy and may occur even when a stoma is placed temporarily, according to research.
That's because the presence of an ostomy bag can sometimes change your body image perception, making you feel less attractive. When sex is thrown into that equation, it may become even tougher.
"Intimacy can be intimidating in a normal situation, so imagine adding worry onto that about potential odor, spillage, or discomfort," says Octavia Cannon, DO, an obstetrician-gynecologist at Alliance Obstetrics and Gynecology in East Lansing, Michigan.
How to solve it: Even in the most established relationship, the appearance and function of an ostomy bag can be difficult for your libido, Dr. Cannon says. That's where communication comes into play. It’s important for both partners to talk about their feelings openly and express vulnerability. "You have to be transparent and honest," she says. "Share your fears and desires. But also give yourself some grace."
2. Pain and Discomfort
In general, an ostomy bag should not cause any pain or discomfort and, in fact, you should see your doctor if those issues are ongoing, says Dr. Brahmbhatt. That said, intimacy might lead to pressure on the stoma that could cause temporary irritation or tenderness. Women may also experience pain due to shifts in the uterus or perineal area if the rectum has been removed as part of the surgery.
How to solve it: If sex with a stoma bag is your new normal, you may need to adjust by finding a new normal for your intimate moments as well, says Cannon. For example, you may need to be more creative with different sexual positions than you have in the past. Bonus: Research suggests that sexual creativity may improve relationship satisfaction and sexual well-being, too.
3. Worries About Intimacy With a New Partner
An open discussion with someone who's been with you since before the surgery can feel very different from approaching intimacy with someone new, says Brahmbhatt. In some cases, because an ostomy bag can be discreetly tucked beneath clothing, you might be talking about your ostomy for the first time on a date. That might feel uncomfortable, especially because you may not be sure how to bring up the subject.
How to solve it: Although you may not want to sound rehearsed during a date, practicing this conversation with a few trusted friends might be helpful, says Brahmbhatt. For example, you can role-play what you would say about what an ostomy involves, how it affects your life, that it doesn't mean you can't be intimate, and how you feel about it. Your friends can offer questions that a new partner might bring up, so you have time to think about how to address those concerns if they ever come up.
4. Concern About Leaks
A leaking ostomy bag can be caused by a number of factors, such as an improper fit, an overfilled bag, skin irritations, or just regular wear and tear. It's normal to be concerned about potential leaks as you're being intimate, since this might be embarrassing, Cannon says.
How to solve it: Simply emptying your pouch beforehand — even if there's not much in there — can go a long way toward giving you assurance about potential leaks during intimate moments, Cannon says. Depending on your ostomy type, you may be able to switch your pouch to a smaller one, which could also help with feeling more confident. "Even simple steps like these may help you focus on pleasure instead of your stoma bag," she says.
5. Decreased Libido
If you've talked with your partner, tried to be creative with sexual positions, and adjusted your ostomy bag but you're still struggling with libido, it's possible that it's not physical or psychological factors at play, but could instead be your medications, says Brahmbhatt. For example, some meds used to manage depression after surgery might have an effect on your level of desire.
How to solve it: To detect any issues with medication-related effects, talk with your health team and get a meds review, says Brahmbhatt. You may find that if you change a drug that's used to treat an issue like pain or depression, your libido could bounce back.
The Takeaway
Self-esteem can take a hit for some people after an ostomy procedure, which might make intimacy more challenging than it's been in the past.
Identify your main concerns and talk about them with your partner to reduce anxiety and build confidence.
Even a simple strategy like emptying your stoma bag or switching to a smaller bag before sex may be helpful.
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Hong KS et al. Psychological attitude to self-appraisal of stoma patients: prospective observation of stoma duration effect to self-appraisal. Annals of Surgical Treatment and Research. February 2014.
Kara Smythe, MD, has been working in sexual and reproductive health for over 10 years. Dr. Smythe is a board-certified fellow of the American College of Obstetricians and Gynecologists, and her interests include improving maternal health, ensuring access to contraception, and promoting sexual health.
She graduated magna cum laude from Florida International University with a bachelor's degree in biology and earned her medical degree from St. George’s University in Grenada. She completed her residency in obstetrics and gynecology at the SUNY Downstate Medical Center in Brooklyn, New York. She worked in Maine for six years, where she had the privilege of caring for an underserved population.
Smythe is also passionate about the ways that public health policies shape individual health outcomes. She has a master’s degree in population health from University College London and recently completed a social science research methods master's degree at Cardiff University. She is currently working on her PhD in medical sociology. Her research examines people's experiences of accessing, using, and discontinuing long-acting reversible contraception.
When she’s not working, Smythe enjoys dancing, photography, and spending time with her family and her cat, Finnegan.
Elizabeth Millard is a freelance writer based in northern Minnesota. She focuses on health, wellness, and fitness, and has written for Runner's World, Bicycling, Self, Women's Health, Men's Health, Prevention, Experience Life, and more. She is an American Council on Exercise–certified personal trainer and a Yoga Alliance-registered yoga teacher. She graduated from Harvard University with a bachelor's degree in English.
