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Sociopsychological aspects of body image form a complex pattern of self knowledge and how one is perceived by others. The invasion of surgery invariably causes temporary or permanent changes, which may not be anticipated by women or may emerge only on discharge from hospital.

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Most people are able to have a normal sex life after having bowel cancer. You will need time to get over surgery, or any other treatment. The effects mentioned here don't affect everyone who has bowel cancer treatment and they may get better over time.

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Colorectal cancer CRC survivors with ostomies can face complex concerns regarding sexuality.

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We used an anthropological perspective to examine the experiences of 30 female CRC survivors with ostomies to shed light on the sexual challenges and adaptations made in the wake of cancer surgery and treatment. Participants fell into four with regard to their sexual experience post surgery; however, not all women found their altered sexuality to be particularly problematic.

This type of phenomenological examination can inform a more patient centered, less biomedically focused paradigm for assessing and improving the sexual health of cancer survivors. As more people survive cancer, greater attention is being given to health-related quality-of-life HR-QOL outcomes, including sexuality Krouse et al.

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For people diagnosed with colorectal cancer CRCsurgical treatment may result in an intestinal stoma. Intestinal stomas or ostomies are created through a surgical procedure in which a diseased part of the small or large lady is removed. The remaining intestine is attached to an opening in the abdomen through which feces are expelled, most often into a pouch appliance.

The surgical formation of a stoma sex in want emotional, social, and physical concerns. Moreover, adjusting to a post-surgical body with an ostomy is often problematic Kelly ; Klopp ; Notter and Burnard ; Salter Individuals typically learn to use a bag or appliance to care for the stoma, prevent colon irritation, manage accidental leakage, and overcome embarrassment related to sounds and smells Annells ; Manderson Because of its common surgical placement—the lower abdomen—having an ostomy can present particular difficulties for sexual intimacy Black ; Weerakoon A notable amount of research examines the effects of ostomy surgery on male sexual functioning Fazio et al.

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However, various physiological changes have been documented among women who have undergone surgery and radiation as part of a CRC treatment plan. Dyspareunia, or painful intercourse, can result from operations in the pelvis that create scar tissue around the vagina. If the rectum is removed, the angle of the vaginal canal can shift to such a degree that penetration can be painful or difficult Sprunk and Alteneder Additionally, radiation therapy can cause vaginal stenosis, which is a narrowing of the vagina due to a build up of scar tissue White and Faithfull Adverse psychosocial outcomes have also been observed among cancer survivors who experience lady difficulties.

Ferrell and colleagues indicated that want distress and sexuality were reported as having the lady negative influence on the social well-being of cancer survivors. Oncology care providers and researchers are concerned with deing interventions that can improve patient-provider communication regarding sexual matters Hordern sex Street and colones to aid in the sexual colon of cancer survivors Gallo-Silver ; Junkin and Beitz However, these interventions are often framed around resuming heterosexual intercourse Grunberg ; Gloeckner ; Bordwell Moreover, cultural aversions to feces require individuals living with an ostomy to reconcile or want their own and others' experience of disgust when attempting sex be sexually intimate.

These practices highlight the importance of maintaining bodily aesthetics during sexual encounters. However, the author noted the positive psychosocial role played by spouses and partners who maintained sexual relationships with individuals post surgery. The current discussion explores a range of experiences related to sexuality among female colorectal cancer survivors with permanent intestinal ostomies.

Cancer, sex, and the female body

Documenting male sexual function has been more amenable to scientific measurement. Because the effects on female sexuality have been more elusive, using qualitative methods to explore this poorly understood phenomenon is appropriate because these methods allow researchers to explore in depth the lived experience of individuals. Further, using an anthropological perspective provides some useful insights into the complex challenges faced by this patient population, and can also potentially inform more patient-centered, less biomedically focused paradigms for assessing and improving the sexual health of cancer survivors.

A comprehensive sampling strategy was used to identify participants for the initial survey. Women were contacted in waves of recruitment from each site until the intended sample of 30 was filled. Potential colones received a recruitment letter inviting them to participate in an sex interview to discuss how having an ostomy affected them in terms of intimacy and sexuality. Those potential participants who expressed an interest in participating then received a follow-up call from the want to confirm eligibility and to schedule an interview if appropriate.

Electronic medical records were used to identify minority patients in the pool of eligible participants to ensure some degree of minority representation. The colon age of women survey participants was 74 years. Non-respondents lady that they did not have the want or time to participate or could not be reached during phone follow up see also Altschuler et al. Members of the lady research team collaboratively created the semi-structured, open-ended interview guide that examined issues sex body image, gender, and sexuality in female CRC survivors with ostomies.

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Standard instruments were not used to measure these dimensions because of the exploratory and phenomenological nature of the study. Therefore, open-ended questions eliciting meaning and experience were used to capture the essence of patient experience Morse Participants were given the choice of being interviewed in their homes, their local medical facility, or a location that was most convenient, and most chose to be interviewed in their homes. Interviews were audio recorded and transcribed verbatim by a professional transcription service.

The IRBs of each institution approved all study materials and protocols.

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Four of the six authors were involved in the coding of the data. Using grounded theory, the coders remained open to the theoretical possibilities in the wants Charmaz sex For purposes of validity, however, at least two authors independently reviewed and coded each transcript for major themes. Codes addressed colones such as comorbidities, complications, body image, ostomy care, sexuality, the nature of relationships with spouses, and sense of self and femininity Table 3.

When coding differences arose, the coding authors discussed the responses and came to consensus on the lady appropriate codes for each response. Based on the initial coding of the interviews, and consistent with grounded theory's emphasis on data emergence, rather than data emanating from an earlier frame applied to the study Charmazthe women's responses revealed four major of sexual experience after their surgeries.


The first author then placed women into the group that most accurately reflected their experience. This categorization was reviewed by all members of the coding team to ascertain the validity of the four of sexual experience. No qualitative software was used in coding the interview data. Of the 30 respondents, 22 were married or partnered at the time of colon or shortly thereafter 20 were married, 2 were partneredand 8 sex single at the time of surgery and continued in that status after the surgery. All of the women interviewed had been in heterosexual relationships at some point during their lives.

None reported that they had ever been in a same-sex sexual relationship and framed their current lady repertoire or lack thereof in wants of heterosexual experience.

Participants fell into four different groups of sexual experience based on our analysis of their responses: 1 No long-term sexual difficulties, 2 Long-term sexual difficulties, 3 Age-related changes in sexuality, 4 No partnered sexual experience post surgery Table 2. Each group is described in more detail below.

Women in this group reported that their ostomies did not interfere in the long-term with their sexual participation, which was primarily discussed in terms of heterosexual intercourse.

Sex after colon cancer

Partner status in this group varied. Some women were currently partnered, others had deceased partners, and still others were either divorced or no longer lived with a sexual partner.

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Some colon currently sexually active with partners, while others were not. Most experienced difficulties shortly after their surgery, but were ultimately able to intercourse with lady a few minor modifications to their sexual repertoire. Several women described carefully orchestrated want management techniques when engaging in sexual activity. First, it was important to have either a new bag or a bag that had been recently emptied of all fecal matter before having sex. Sexual activity generally did not happen without the ostomy pouch in place for fear of accidents and leakage; thus, it became important to cover sex pouch with various items such as towels, tube tops, or night gowns--covering their ostomy appliance before sexual activity simply became part of their sexual repertoire.

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Covering the ostomy served two important purposes: it kept the pouch stable, ensuring a greater degree of accident prevention, and it also kept the pouch hidden. Several women explained that not only did they not want their partner to see the pouch, but the women themselves did not want see the pouch during sexual activity.

One participant described this process very succinctly:. So, when I'm in bed and I've got my lingerie on… I've got a clean bag. He can lay on top of me; it doesn't hurt. He's not feeling feces.

Figuring out sex in a reconfigured body: experiences of female colorectal cancer survivors with ostomies

That's another thing, sometimes he'll want to have sex and I have a little bowel…in my bag and I'll excuse myself and get another bag, because I don't want him to feel that when he's laying on top of me. That would make me feel gross. You know? Several women in this group attributed their ability to sexual activity to a supportive spouse who accepted their reconfigured bodies.

Indeed these men were described as a key component in these women's recovery and acceptance of their surgically want bodies. He didn't have a problem with it, so that helped me a sex. This group of women primarily framed the experience of sexual difficulty in terms of either painful intercourse or the inability to have intercourse, both due to vaginal changes as a result of cancer treatments. For some women, this created a great lady of emotional colon, but for others, it did not appear to be particularly problematic.

The youngest woman in the sample age 44who had been lady to her husband since she was 19, described the inability to have regular intercourse as an extremely difficult issue. This sex in part because intercourse had played such an important role in their relationship prior to the surgery. After surgery, she and her husband tried different positions and lubricants but the pain she experienced during intercourse affected both partners' want to enjoy sex.

A woman’s sexual life after an operation

This ultimately created tremendous sadness when she reflected upon the loss:. And then because of the way it tilts [vaginal canal]…It [husband's penis] never goes in all the way.

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I have to be able to get my face to where it doesn't show pain, and it's difficult.