This study evaluated QOL and sexual function of patients with a stoma. The IIEF, IFSF, and SQOLS scores of patients with a stoma were found to be low, reflecting poor patient QOL and sexual function.
Participants had an overall SQOLS mean score of 45.10 ± 18.88 with low subscales in all domains. On the SQOLS, the highest subscale score was for work/social function and the lowest score was for sexuality/body image. QOL impairment was most significantly related to the sexuality/body image domains in these patients.
The lifestyles of patients with a stoma can be affected in different ways owing to physical and psychological problems. Physiological problems such as change in bowel habits, loss of stool control, and involuntary flatulence and odor may adversely affect body image, and the stoma may restrict daily and social activities. Consequently, descriptive and cross-sectional studies9,12,25,26 have shown patients with a stoma may experience isolation, low self-esteem, and body image change, negatively affecting their daily lives and QOL.27 Research that reports a decrease in the QOL in patients with a stoma includes a cross-sectional study (N = 2329) by Nichols28 in the United States that compared patients with a stoma to a healthy general population and showed patients with a stoma have more difficulty engaging in physical activity. A cross-sectional survey (N = 255) by Ito et al29 conducted among Japanese patients reported physical activity and social function were affected negatively by a colostomy. In a descriptive study that included 50 patients with a stoma, Zając et al30 also found QOL was affected. A questionnaire survey31 involving Muslim patients (N = 100) indicated QOL was lower after creation of a stoma, which supports previous research showing a stoma adversely affects QOL and sexual life,5,8-12 findings supported by the current study.
In the current study, most patients reported their sexual life and daily activities were affected negatively after creation of the stoma. A review study by Szczepkowski32 reported patients experience a change of body perception, decline in self-esteem, degeneration of sexual function, problems with spousal harmony, and many different psychiatric problems, most notably depression. The descriptive study by Karadağ et al11 showed patients suffer social isolation due to odor and leakage (N = 43).
Men and women with a stoma commonly express fears about sexual problems and the appearance of the stoma, stool leakage, odor, noise, and opening of the colostomy bag during sexual intercourse, as well as refusal by their partners.3,5,7,10 In a descriptive study by Nugent et al8 conducted among 542 patients with a stoma, 80% said QOL was affected and 40% suffered effects on their sexual life after stoma creation. According to a review of 17 studies by Sprangers et al,33 individuals with a stoma have a higher rate of sexual and psychological problems. In open-ended, tape-recorded interview study of 9 Swedish patients with a stoma, Persson and Hellström10 indicated most experience anxiety about their sexual life and believe their sexual attraction was decreased. A systematic review by Brown and Randle17 reported individuals think their body is not like the old one after stoma surgery and they do not want to have sexual intercourse because they feel less attractive.
Stoma surgery affects the sexual lives of males and females differently.3,8,27,34 Stoma surgery may lead to ED in men and loss of libido, dyspareunia, vaginal tightness, vaginal dryness, and sexual dysfunction in women.5,10,34-37 Major physiological issues for men include ED and ejaculatory difficulties. For women, dyspareunia is the most common physiological problem.34 A systematic review33 of 17 studies reported 66% to 100% of men with a stoma suffer impotance, erection, and ejaculation problems; a study5 involving women showed 5% to 30% with an ostomy have sexual problems. Sexual problems are reported at different rates in studies by Karadağ et al11 (74.4%), Nugent et al8 (40%), and Silva et al12 (95% of ostomy patients and 81% of colostomy patients). A review by Bekkers et al35 indicated sexual problems occurred within the first 4 months after stoma creation. A retrospective case control study (N = 42) by Ozturk et al36 reported patients of both genders with a colostomy experienced sexual dysfunction. In a cross-sectional study in Iran among 96 stoma patients, Mahjoubi et al37 found sexual dysfunction and satisfaction problems in both men and women, with women suffering to a greater extent. Results of a descriptive study (N = 261) by Milbury et al38 showed 65% of men with colorectal cancer experience moderate to severe ED postoperatively and 42.5% of women experience severe sexual dysfunction. Additional studies underscore the extent of sexual problems in patients with a stoma.7,39-42 The change of appearance, presence of a colostomy bag, and perceived compromise in personal hygiene after the stoma is created can lower the patient’s sexual desire.
In this study, the median scores of sexuality/body image and overall SQOLS of the patients with a temporary stoma were higher than persons with a permanent stoma; this could be a factor of collecting data within the first year of the patients having a stoma. In a retrospective, case controlled study in Turkey involving 42 male and female patients with a colostomy, Ozturk et al36 reported a higher frequency of sexual problems in patients with a permanent colostomy. A descriptive study (N = 178) in Turkey by Kuzu et al2 found sexual life was negatively affected in both male and female patients with a permanent stoma. Results of a prospective study (N = 131) by Konanz et al43 also indicated sexual function was lower in persons with a permanent as compared to a temporary stoma. A multicenter, cross-sectional study (N = 737) in Poland by Golicki et al44 found both genders with a temporary stoma had better QOL and sexual function. A cross-sectional study45 (N = 102) found male and female stoma patients with cancer had more sexual problems than non-cancer patients.45
However, other cross-sectional and descriptive research46 has shown that type of stoma does not have either a positive or negative effect on self-esteem. These results can perhaps be explained by the elderly patient population of the study. Temporary stomas can be closed within 1 year, except in special conditions; permanent stomas are lifelong for the patient.36 Moreover, permanent stomas usually are created in older age groups and for persons in the late stages of cancer.47 Wide excisions to remove the malignant tissue increase the risk of damaging the nerves involved in stimulating sexual organs. Permanent stomas may affect all aspects of a patient’s life. In this study, 54.5% of men were diagnosed with severe ED, and all female patients experienced sexual dysfunction.