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Sexual Health and Quality of Life Among Male Veterans With Intestinal Ostomies

SYMMS, MICHELLE R. MSN, RN, CGRN; RAWL, SUSAN M. PhD, RN; GRANT, MARCIA DNSc, RN, FAAN; WENDEL, CHRISTOPHER S. MS; COONS, STEPHEN JOEL PhD; HICKEY, SARA MPH; BALDWIN, CAROL M. PhD, RN, CHTP, CT, AHN-BC; KROUSE, ROBERT S. MD

doi: 10.1097/01.NUR.0000304181.36568.a7
Feature Article

Purpose: This secondary analysis was conducted to expand our understanding of the challenges men with ostomies face regarding intimate relationships and sexual functioning. We examined quantitative and qualitative data to examine sexual functioning, intimate relationships, and health-related quality of life (HR-QOL) among military veterans who are living with an intestinal stoma.

Setting: Three Veterans Health Administration sites.

Sample: Four hundred eighty-one male veterans.

Methods: Case-control, mixed-methods design; cases were those who had ostomies for at least 2 months, and controls had a similar major intestinal surgical procedure that did not result in an ostomy. Quantitative and qualitative data on sexual functioning, relationships, and other dimensions of HR-QOL were collected using the modified City of Hope Quality of Life-Ostomy questionnaire.

Results: The overall response rate was 49%. Prevalence of erectile dysfunction was significantly higher among ostomates compared with controls (P < .001). Although a greater proportion of veterans with ostomies reported being sexually active before surgery compared with controls (P < .001), the proportion of men who had resumed sexual activity after surgery is significantly lower among the ostomy group (P = .015). Compared with veterans with ostomies who did not resume sexual activity after surgery, those who were sexually active reported a higher total HR-QOL score and higher scores on all 4 modified City of Hope Quality of Life-Ostomy dimensions (psychological, social, physical, and spiritual well-being). Veterans with ostomies who had resumed sexual activity after their ostomy also reported that their ostomy had caused significantly less interference with social activities, less isolation, less interference with their personal relationships, and less interference with their ability to be intimate. These men also reported less difficulty adjusting to the ostomy. Results of qualitative analyses showed that problems with intimacy and sexual function are among the greatest challenges faced by ostomates.

Conclusion: Presence of an ostomy was associated with lower rates of sexual activity and higher erectile dysfunction. The lower rates of sexual activity and sexual satisfaction were related to the social and psychological dimensions of HR-QOL among men with ostomies. Interventions to address sexual concerns of male ostomates and their partners may prevent decrements to HR-QOL for these patients.

Implications for Practice: Results of the study have implications for the clinical nurse specialist role in supporting and educating patients with ostomies to minimize the negative impact of an intestinal ostomy on sexual health and HR-QOL. Implications also relate to the need to educate current and future nurses about the importance of assessing sexual health.

Author Affiliations: Division of Gastroenterology/Hepatology, Indiana University (Ms Symms); School of Nursing, Indiana University and Purdue University at Indianapolis, Indiana (Dr Rawl); Department of Nursing Research and Education, City of Hope National Medical Center and Beckman Research, Durante, California (Dr Grant); Research Service Line, Southern Arizona VA Health Care System (Mr Wendel); Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson (Dr Coons); Indiana University School of Nursing, Indianapolis (Ms Hickey); Southwest Borderlands Scholar Director, Office of International Health, Scientific and Educational Affairs, College of Nursing and Healthcare Innovation, Arizona State University, Phoenix (Dr Baldwin); and Southern Arizona Veterans Affairs Health Care System and College of Medicine, University of Arizona, Tucson (Dr Krouse).This research was supported by grant from the Veterans Affairs Health Services Research and Development Service IIR 02-221-2. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs.

This research was supported by a grant from the Veterans Affairs Health Services Research and Development Service IIR 02-221-2. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs.

Corresponding author: Michelle R. Symms, MSN, RN, CGRN, Indiana University, Gastroenterology, 550 N. University Boulevard, UH 4100, Indianapolis, IN 46202 (msymms@iupui.edu).

© 2008 Lippincott Williams & Wilkins, Inc.