For stoma and catheter users
People that are new to using a catheter or stoma may find the thought of dealing with this new process very daunting. Also, partners – new or old – can have fears, concerns or feel overwhelmed. We have created this resource, for men and women, written by Damian Smith, a Spinal Cord Injury Nurse Specialist from the Spinal Injuries Association.
The impact on you and your partner
Following a spinal cord injury or a neurological condition where the bladder and bowels can be affected, it can make the thought of having sex be one which can increase the anxiety levels.
It needn’t be that way. Many of those fears can be easily managed. It just takes a little understanding of how your body works and what the options may be for you.
Communication with your partner is key. If they understand the issues you face, this will help them to know the impact it has on you and hopefully be sensitive to the situation.
Many people are reliant on catheters to manage their bladder. They may have specific ways to manage the bowels too. One of the biggest fears is the risk of incontinence while having sex. These are perfectly rational fears, but all can be managed.
Accidents may happen but the reality is that this is very rare.
Catheters
There are different types of catheters. Indwelling urethral or suprapubic catheters or self-intermittent catheters. There are also the condom sheath drainage systems used by some men.
Having sex with a catheter is certainly possible. A suprapubic catheter can be taped to the abdomen to prevent it getting in the way. It can be drained beforehand, and a spigot or catheter valve attached to minimise the tubing and manage without the drainage bag and allow for a little more discretion.
The same applies to a urethral catheter.
For females, a urethral catheter can be carefully taped away from the genital area, allowing some slack to avoid trauma.
A urethral catheter could be dislodged if accidentally pulled, hence the advice to tape it securely to the leg, or even the abdomen. Be aware of the close proximity of the vagina to the urethra so there could be the potential for the catheter to rub against the skin of both people.
For the men, a condom can be used over the top of the urethral catheter but do make sure the condom is applied to an erect penis, and the catheter has enough slack underneath to avoid any unnecessary trauma.
For those that may self-catheterise, simply drain your bladder beforehand to reduce the risk of accidental leakage.
For men that use a condom sheath to manage the drainage of their bladder, it may be possible to pass an intermittent catheter to drain the bladder fully beforehand.
Other sexual implications
Many men do not ejaculate naturally following a spinal cord injury. Some may not ejaculate at all, and some may ejaculate back into the bladder instead. This is called a retrograde ejaculation and does not cause any additional risk of a bladder infection. Just something to be aware of. If you are in a relationship and your partner is of a childbearing age, the usual contraceptive precautions should still be taken.
Females may not always lubricate in the same way as prior to their SCI before and during sex. A simple water-based lubricant, such as Aquagel, KY gel may be useful. Just be aware that some oil-based lubricants can affect the condom integrity for the male, whereas water-based ones won’t.
Bowel management
The bowels need some consideration too but can be managed effectively. Sticking to your usual routine, if you have one, will certainly help. Spontaneity is good but a little planning doesn’t hurt either, especially if you want some reassurance and peace of mind that there won’t be any unwanted accidents. This way, if you know when your bowels are emptied, then it is less likely any accidents will occur.
Having a stoma, like a colostomy, can be managed differently too. Generally, there is a bag to collect the waste and the stoma can activate and empty at any time of the day or night. It is possible to empty the bowel beforehand using either suppositories or an irrigation system. A discreet cap can then be placed over the stoma so that the bag is not needed while you have sex.
With a well-sealed stoma cap, it is resilient to bodily movements of varying degrees. Bodyweight or the movements from having sex shouldn’t affect the stoma – the adhesives for stomas are pretty robust. Skin on skin is fine in that respect. Just be prepared for any eventuality and that, even with an empty bowel, vigorous movement could push faeces through the bowel and or wind too. The likelihood would be slim though.
Although accidents cannot be completely ruled out, the risk that they will is very rare. You may still want to be prepared and consider the use of a mattress protector. With open communication, sensitivity and understanding, and consideration of the above points, there is no reason not to enjoy a healthy active sex life.
Signposts for further advice
Depending on your condition/disability, you may find further information pertinent to your situation:
- Contact SIA for those with a spinal cord injury.
- Various other charities e.g., Brain and Spine, MS society, Shine charity for Spina Bifida, Scope for Cerebral Palsy