An Innocent Bystander

Sexual dysfunction after pelvic surgery has often been blamed on the presence of a stoma, but the stoma is actually an innocent bystander, says Mr Ian Lindsey, Consultant Colorectal Surgeon at John Radcliffe Hospital in Oxford.

In scientific terms, the presence of a stoma has never been proven to cause impotence in either men or women. A study by Lennard-Jones, in 1977, showed that there was no increased sexual dysfunction in ileostomists. Mr Lindsey concedes that there might be a physiological impact on couples who are having to deal with the presence of a stoma – but the problem of impotency, if it exists in this situation, is probably down to nerve injury rather than the stoma itself.

“In most cases, it is the surgery that has led to a person becoming impotent,” said Mr Lindsey.

“Nerve damage during surgery is the most likely cause, particularly after rectal excision operations for cancer and inflammatory bowel disease (Crohn’s disease and ulcerative colitis).”

Studies have shown that, after surgery in which the rectum has been removed, between 30 and 40 per cent of men experience Impotency. In women it is slightly harder to equate, partly due to the lack of clinical evidence. It is estimated however, however, that the number of women experiencing sexual dysfunction maybe similar to men.

“Things are improving with regards to awareness and surgical techniques that are helping us to map out the nerves and so avoid damaging them during surgery,” said Mr Lindsey.

“Much of the surgery we do, particularly in cancer patients, is deep in the pelvis, and we simply can’t see more of the vulnerable nerves in this area. Damage is unavoidable in some patient

Viagra benefits

There is some good news, however, in the studies have shown that Viagra can significantly improve sexual function in patients who have had rectal surgery. In a study written by Mr Lindsey and Professor Neil Mortensen, and published two years ago in Diseases of the Colon and rectum, the introduction of Viagra significantly improved or totally reserved impotency in 80 per cent of male patients. This was a major breakthrough, and The American Society of Colon and Rectal Surgeons judged the paper to be have had the most significant impact of any paper in colorectal surgery in 2001. Given the impotence is often caused by damage to the nerves during surgery, the use of Viagra has been shown to improve the performance of the undamaged nerves. The drugs reserve the symptoms by helping the residual nerves to function more effectively. But Mr Lindsey admits that women are less well served in terms of any clinical advancements in female sexual dysfunction.

"The amount of research done in male impotence far exceeds the work that has been done with women. But we are about to commence a new study that will look at the effects of Viagra on female sexual dysfunction. At the present time, Viagra is not licensed for use on women, however we are hopeful that the same positive results we have had with men can also be experienced by women.”

Men who have undergone pelvic surgery, and are impotent as a result, have number options in terms of the ability to maintain an erection. The use of pumps and injections was common in the past, but Mr Lindsey suggests that patients using these options could discuss using Viagra with their GP.

The age issue

Sensation during sex should not disappear completely, said Mr Lindsey, since the nerves governing sensation in the penis should not be effected by surgery. Age can be an issue, however. In a study conducted in Oxford, the incidence of impotence was higher in men over 50 after pouch surgery for inflammatory bowel disease. This, in part, may be related to the general decline in sexual nerves as a person grows older. Significant medical advances are taking place all the time. People who have pelvic surgery 15 years ago were being told that their sex lives were effectively over. Today, that is certainly not the case.

The problems of intimacy My stoma may get damaged during intercourse. The stoma itself is quite robust and is well able to withstand the intimacy of sexual intercourse, within normal limits. My pouch will get in the way. This is possibly true, so there are two strategies for dealing with this. Some men wear boxer shorts in bed with a fly opening. This keeps the pouch out of the way and is a popular selection. Apart from open-crotch underwear, some women wear a “boob tube” (a knitted stretch fabric tube) over their abdomen which holds the pouch in place. My Partner won’t find me attractive any more because I’ve got a stoma. It is extremely rare that couples break up when one partner has to have a stoma, and usually those cases, the stresses and stains of the marriage were showing long before the surgery. Let’s face it, in a loving relationship, love conquers all. Will it hurt? The short answer is maybe, but please read on! Stomas surgery is major surgery. Muscles that have been cut and rejoined during surgery need time to heal, so waiting until the person can move comfortably following the surgery is probably just plain common sense. Gentleness to successful intimacy.

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