Judy Da Silva

May 2, 2013

Chronic Illness Concept Paper

University of Massachusetts, Dartmouth

Abstract
The formation of a stoma as a result following abdominal surgery represents a major change in a person's life, which will result in complex emotional, social, and physical concerns which include their sexuality. Patients who now have limited or no bladder or bowel control, who now have a stoma to manage elimination, have a particular awareness of the relationships of the sites of pleasure. People, who are incontinent or rely on a stoma care, must monitor their bladder and bowel, disguising the stoma and bag and controlling their body in sex as in other circumstances. The need to compromise their bodily boundaries with established partners, or to make known to new sexual partners, results in self-consciousness and social anxiety. The patient then needs to reconstruct ideas of privacy and dignity so that barrier in bodily control does not undermine the sexual relationship. For many patients, the stoma compromises their self-esteem and body image and they find it difficult to discuss their sexual feelings, especially after a body image changes. The nurse should then be able to help patients identify and adapt to alterations in sexual self-concept. Keywords: Body Image, Stoma, Sexuality, Self-Esteem

Many people suffer from diseases such as bowel cancer that may require the surgical removal of diseased portions of bowel. The bowel may have to be rerouted through an artificially created hole in the abdomen so that feces can still leave the body. This hole is called a stoma. A colostomy is an operation that connects the colon to the abdominal wall, while an ileostomy connects the last part of the small intestine (ileum) to the abdominal wall. The stoma may be permanent in the case of bowel cancer or serious injury, or it can be a temporary measure while the bowel recovers from events such as infection or inflammation. Coming into terms with a new way of life and body image after stoma surgery, is an interpersonal experience and how people react depends on the patient's feeling, attitude and experiences toward his/her own body (Black, 2000). Several weeks after surgery, the patient will discover the removal of the diseased portion of the bowel will improve their overall health. But what happens once intimacy is brought into the picture; how will the patient react then? Having sexual feeling and being a sexual being is part of what it is to be a human being and there are no age limits of enjoying a healthy sex life. Getting back into sexual activity after ostomy surgery can be an emotional and a challenging time for both the patient and their spouse. The patient will be coping with the effects of the surgery, adaptation to a new skill, and changes to self-perceptions. As patient becomes intimate, they may be worried about the discomfort during intercourse, or even about their spouses’ reaction to the pouch and stoma. Illness and loss of sexual appeal because the individual has a stoma can affect the way the individual feels about him/herself as a sexual being and having a stoma, whether permanent or

temporary, may make the patient feel less attractive and desirable to his/her partner (Black, 2000). The patient's self-esteem and sexuality can be very traumatic following bowel surgery. Removal of the rectum and stoma impacts sexual functioning differently in men and women. Stoma formation due to rectum and colon cancer may cause erectile dysfunction in males, decrease in libido, dyspareunia, bands around the vagina resulting in tightness and dryness in women. In addition to these sexual problems, individuals experience fears and anxieties regarding displacement of appliances, stool leakage and odor during sexual intercourse (Ayaz, 2009). The word stoma means mouth or opening in Greek. An ileostomy is created by bringing