Sexual health and quality of life among male veterans with intestinal ostomies.
OBJECTIVE
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.


METHODS
Three Veterans Health Administration sites.


METHODS
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.


CONCLUSIONS
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.


CONCLUSIONS
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.
Symms
Michelle R
MR
Indiana University, Division of Gastroenterology/Hepatology, Indianapolis, IN 46202, USA. msymms@iupui.edu
Rawl
Susan M
SM
Grant
Marcia
M
Wendel
Christopher S
CS
Coons
Stephen Joel
SJ
Hickey
Sara
S
Baldwin
Carol M
CM
Krouse
Robert S
RS
D000368:Aged; D001130:Arizona / Q000453:epidemiology; D001294:Attitude to Health; D002140:California / Q000453:epidemiology; D016022:Case-Control Studies; D004766:Enterostomy / Q000009:adverse effects / Q000523:psychology; D007172:Erectile Dysfunction / Q000453:epidemiology / Q000209:etiology / Q000523:psychology; D006304:Health Status; D006801:Humans; D007196:Indiana / Q000453:epidemiology; D007398:Interpersonal Relations; D008297:Male; D008571:Men / Q000523:psychology; D008960:Models, Psychological; D009720:Nurse Clinicians / Q000458:organization & administration; D015404:Nursing Methodology Research; D036301:Qualitative Research; D011788:Quality of Life / Q000523:psychology*; D012307:Risk Factors; D012725:Sexual Behavior / Q000523:psychology*; D012944:Social Support; D011795:Surveys and Questionnaires; D014728:Veterans / Q000523:psychology*