Skip to main content
SpringerLink
Log in

Gastrointestinal ostomies and sexual outcomes: a comparison of colorectal cancer patients by ostomy status

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

Research examining effects of ostomy use on sexual outcomes is limited. Patients with colorectal cancer were compared on sexual outcomes and body image based on ostomy status (never, past, and current ostomy). Differences in depression were also examined.

Methods

Patients were prospectively recruited during clinic visits and by tumor registry mailings. Patients with colorectal cancer (N = 141; 18 past ostomy; 25 current ostomy; and 98 no ostomy history) completed surveys assessing sexual outcomes (medical impact on sexual function, Female Sexual Function Index, International Index of Erectile Function), body image distress (Body Image Scale), and depressive symptoms (Center for Epidemiologic Studies Depression Scale—Short Form). Clinical information was obtained through patient validated self-report measures and medical records.

Results

Most participants reported sexual function in the dysfunctional range using established cut-off scores. In analyses adjusting for demographic and medical covariates and depression, significant group differences were found for ostomy status on impact on sexual function (p < .001), female sexual function (p = .01), and body image (p < .001). The current and past ostomy groups reported worse impact on sexual function than those who never had an ostomy (p < .001); similar differences were found for female sexual function. The current ostomy group reported worse body image distress than those who never had an ostomy (p < .001). No differences were found across the groups for depressive symptoms (p = .33) or male sexual or erectile function (p values ≥ .59).

Conclusions

Colorectal cancer treatment puts patients at risk for sexual difficulties and some difficulties may be more pronounced for patients with ostomies as part of their treatment. Clinical information and support should be offered.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Notes

  1. To examine the role of partnered status in influencing sexual outcomes in the current sample, we compared partnered vs. unpartnered participants on sexual outcomes using general linear models. Most partnered women completed the SFQ (40/46) and the FSFI (38/46). Most partnered men completed the SFQ (69/75) and the IIEF (72/75). A few unpartnered women (1/13) and men (3/7) completed the SFQ, the FSFI (4/13), and the IIEF (4/7). On the SFQ, partnered patients reported higher impact on sexual function (M = 2.54; SD = 1.06) than unpartnered patients (M = 1.49; SD = .35; p = .05). Partnered and unpartnered participants did not differ on body image, depression, or male sexual function or erectile function (p values ≥ .12). On the FSFI, partnered patients reported marginally higher sexual function (M = 16.63; SD = 10.94) than unpartnered patients (M = 6.68; SD = 9.09; p = .09).

  2. Data were analyzed on the following number of patients within the never had ostomy, past ostomy, and current ostomy groups, respectively: medical impact on sexual function—78/98, 15/18, and 20/25; female sexual function—28/40, 4/7, and 10/12; male sexual function and erectile function—53/58, 11/11, and 12/13.

References

  1. Howlader N, Noone AM, Krapcho M, Garshell J, Neyman N, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z, Cho H, Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds) (2013) SEER Cancer Statistics Review, 1975–2010, National Cancer Institute. Bethesda, MD, based on November 2012 SEER data submission, posted to the SEER Website, April 2013. Available from http://seer.cancer.gov/csr/1975_2010/

  2. Wilson IB, Cleary PD (1995) Linking clinical variables with health-related quality of life: a conceptual model of patient outcomes. JAMA 273(1):59–65

    Article  CAS  PubMed  Google Scholar 

  3. Traa MJ, De Vries J, Roukema JA, Den Oudsten BL (2012) Sexual (dys)function and the quality of sexual life in patients with colorectal cancer: a systematic review. Ann Oncol 23(1):19–27. doi:10.1093/annonc/mdr133

    Article  CAS  PubMed  Google Scholar 

  4. Ameda K, Kakizaki H, Koyanagi T, Hirakawa K, Kusumi T, Hosokawa M (2005) The long-term voiding function and sexual function after pelvic nerve-sparing radical surgery for rectal cancer. Int J Urol 12(3):256–263. doi:10.1111/j.1442-2042.2005.01026.x

    Article  PubMed  Google Scholar 

  5. Schmidt CE, Bestmann B, Kuchler T, Longo WE, Kremer B (2005) Ten-year historic cohort of quality of life and sexuality in patients with rectal cancer. Dis Colon Rectum 48(3):483–492

    Article  PubMed  Google Scholar 

  6. Di Fabio F, Koller M, Nascimbeni R, Talarico C, Salerni B (2008) Long-term outcome after colorectal cancer resection. Patients’ self-reported quality of life, sexual dysfunction and surgeons’ awareness of patients’ needs. Tumori 94(1):30–35

    PubMed  Google Scholar 

  7. Reese JB, Shelby RA, Keefe FJ, Porter LS, Abernethy AP (2010) Sexual concerns in cancer patients: a comparison of GI and breast cancer patients. Support Care Cancer 18(9):1179–1189. doi:10.1007/s00520-009-0738-8

    Article  PubMed Central  PubMed  Google Scholar 

  8. Sprangers MA, Taal BG, Aaronson NK, te Velde A (1995) Quality of life in colorectal cancer. Stoma vs. nonstoma patients. Dis Colon Rectum 38(4):361–369

    Article  CAS  PubMed  Google Scholar 

  9. Tekkis PP, Cornish JA, Remzi FH, Tilney HS, Strong SA, Church JM, Lavery IC, Fazio VW (2009) Measuring sexual and urinary outcomes in women after rectal cancer excision. Dis Colon Rectum 52(1):46–54. doi:10.1007/DCR.0b013e318197551e

    Article  CAS  PubMed  Google Scholar 

  10. Nordstrom GM, Nyman CR (1991) Living with a urostomy. A follow up with special regard to the peristomal-skin complications, psychosocial and sexual life. Scand J Urol Nephrol Suppl 138:247–251

    CAS  PubMed  Google Scholar 

  11. Ross L, Abild-Nielsen AG, Thomsen BL, Karlsen RV, Boesen EH, Johansen C (2007) Quality of life of Danish colorectal cancer patients with and without a stoma. Support Care Cancer 15(5):505–513. doi:10.1007/s00520-006-0177-8

    Article  PubMed  Google Scholar 

  12. Sideris L, Zenasni F, Vernerey D, Dauchy S, Lasser P, Pignon JP, Elias D, Di Palma M, Pocard M (2005) Quality of life of patients operated on for low rectal cancer: impact of the type of surgery and patients’ characteristics. Dis Colon Rectum 48(12):2180–2191. doi:10.1007/s10350-005-0155-0

    Article  PubMed  Google Scholar 

  13. Manderson L (2005) Boundary breaches: the body, sex and sexuality after stoma surgery. Soc Sci Med 61(2):405–415

    Article  PubMed  Google Scholar 

  14. Krouse RS, Herrinton LJ, Grant M, Wendel CS, Green SB, Mohler MJ, Baldwin CM, McMullen CK, Rawl SM, Matayoshi E, Coons SJ, Hornbrook MC (2009) Health-related quality of life among long-term rectal cancer survivors with an ostomy: manifestations by sex. J Clin Oncol 27(28):4664–4670

    Article  PubMed  Google Scholar 

  15. Kasparek MS, Hassan I, Cima RR, Larson DR, Gullerud RE, Wolff BG (2012) Long-term Quality of Life and Sexual and Urinary Function After Abdominoperineal Resection for Distal Rectal Cancer. Dis Colon Rectum 55 (2):147–154, doi: 110.1097/DCR.1090b1013e31823d32606

  16. Montedori A, Cirocchi R, Farinella E, Sciannameo F, Abraha I (2010) Covering ileo- or colostomy in anterior resection for rectal carcinoma. Cochrane Database Syst Rev 5:CD006878. doi:10.1002/14651858.CD006878.pub2

    PubMed  Google Scholar 

  17. Milbury K, Cohen L, Jenkins R, Skibber JM, Schover L (2012) The association between psychosocial and medical factors with long-term sexual dysfunction after treatment for colorectal cancer. Support Care Cancer 21(3):1–10. doi:10.1007/s00520-012-1582-9

    Google Scholar 

  18. Sharpe L, Patel D, Clarke S (2011) The relationship between body image disturbance and distress in colorectal cancer patients with and without stomas. J Psychosom Res 70(5):395–402

    Article  PubMed  Google Scholar 

  19. Ramirez M, McMullen C, Grant M, Altschuler A, Hornbrook MC, Krouse RS (2009) Figuring out sex in a reconfigured body: experiences of female colorectal cancer survivors with ostomies. Women Health 49(8):608–624. doi:10.1080/03630240903496093

    Article  PubMed Central  PubMed  Google Scholar 

  20. Bossema ER, Seuntiëns MWM, Marijnen CAM, Baas-Thijssen MCM, van de Velde CJH, Stiggelbout AM (2011) The relation between illness cognitions and quality of life in people with and without a stoma following rectal cancer treatment. Psychooncology 20(4):428–434. doi:10.1002/pon.1758

    Article  PubMed  Google Scholar 

  21. Fucini C, Gattai R, Urena C, Bandettini L, Elbetti C (2008) Quality of life among five-year survivors after treatment for very low rectal cancer with or without a permanent abdominal stoma. Ann Surg Oncol 15(4):1099–1106. doi:10.1245/s10434-007-9748-2

    Article  CAS  PubMed  Google Scholar 

  22. Den Oudsten BL, Traa MJ, Thong MSY, Martijn H, De Hingh IHJT, Bosscha K, van de Poll-Franse LV (2012) Higher prevalence of sexual dysfunction in colon and rectal cancer survivors compared with the normative population: a population-based study. Eur J Cancer 48(17):3161–3170

    Article  Google Scholar 

  23. Syrjala KL, Schroeder TC, Abrams JR, Atkins TZ, Brown WS, Sanders JE, Schubert MA, Heiman JR (2000) Sexual function measurement and outcomes in cancer survivors and matched controls. J Sex Res 37(3):213–225. doi:10.1080/00224490009552042

    Article  Google Scholar 

  24. Brotto LA, Heiman JR, Goff B, Greer B, Lentz GM, Swisher E, Tamimi H, Van Blaricom A (2008) A psychoeducational intervention for sexual dysfunction in women with gynecologic cancer. Arch Sex Behav 37(2):317–329

    Article  PubMed  Google Scholar 

  25. Rosen R, Brown C, Heiman J, Leiblum S, Meston C, Shabsigh R, Ferguson D, D’Agostino R Jr (2000) The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther 26(2):191–208

    Article  CAS  PubMed  Google Scholar 

  26. Alder J, Zanetti R, Wight E, Urech C, Fink N, Bitzer J (2008) Sexual dysfunction after premenopausal stage i and ii breast cancer: do androgens play a role? J Sex Med 5(8):1898–1906

    Article  PubMed  Google Scholar 

  27. Speer JJ, Hillenberg B, Sugrue DP, Blacker C, Kresge CL, Decker VB, Zakalik D, Decker DA (2005) Study of sexual functioning determinants in breast cancer survivors. Breast J 11(6):440–447. doi:10.1111/j.1075-122X.2005.00131.x

    Article  PubMed  Google Scholar 

  28. Hendren SK, O’Connor BI, Liu M, Asano T, Cohen Z, Swallow CJ, Macrae HM, Gryfe R, McLeod RS (2005) Prevalence of male and female sexual dysfunction is high following surgery for rectal cancer. Ann Surg 242(2):212–223

    Article  PubMed  Google Scholar 

  29. Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A (1997) The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology 49(6):822–830

    Article  CAS  PubMed  Google Scholar 

  30. Canada AL, Neese LE, Sui D, Schover LR (2005) Pilot intervention to enhance sexual rehabilitation for couples after treatment for localized prostate carcinoma. Cancer 104(12):2689–2700. doi:10.1002/cncr.21537

    Article  PubMed  Google Scholar 

  31. Rosen RC, Cappelleri JC, Gendrano N 3rd (2002) The International Index of Erectile Function (IIEF): a state-of-the-science review. Int J Impot Res 14(4):226–244

    Article  CAS  PubMed  Google Scholar 

  32. Hopwood P, Fletcher I, Lee A, Al Ghazal S (2001) A body image scale for use with cancer patients. Eur J Cancer 37(2):189–197

    Article  CAS  PubMed  Google Scholar 

  33. Andresen EM, Malmgren JA, Carter WB, Patrick DL (1994) Screening for depression in well older adults: evaluation of a short form of the CES-D. Am J Prev Med 10(2):77–84

    CAS  PubMed  Google Scholar 

  34. Jess P, Christiansen J, Bech P (2002) Quality of life after anterior resection versus abdominoperineal extirpation for rectal cancer. Scand J Gastroenterol 37(10):1201–1204

    Article  CAS  PubMed  Google Scholar 

  35. Grant M, McMullen CK, Altschuler A, Mohler MJ, Hornbrook MC, Herrinton LJ, Wendel CS, Baldwin CM, Krouse RS (2011) Gender differences in quality of life among long-term colorectal cancer survivors with ostomies. Oncol Nurs Forum 38(5):587–596

    Article  PubMed Central  PubMed  Google Scholar 

  36. Wiegel M, Meston C, Rosen R (2005) The female sexual function index (FSFI): cross-validation and development of clinical cutoff scores. J Sex Marital Ther 31(1):1–20

    Article  PubMed  Google Scholar 

  37. Annon J (1976) The PLISSIT Model. Journal of Sex Education Therapy 2:1–15

    Google Scholar 

  38. Ayaz S, Kubilay G (2009) Effectiveness of the PLISSIT model for solving the sexual problems of patients with stoma. J Clin Nurs 18(1):89–98. doi:10.1111/j.1365-2702.2008.02282.x

    Article  PubMed  Google Scholar 

  39. Sprunk E, Alteneder RR (2000) The impact of an ostomy on sexuality. Clin J Oncol Nurs 4(2):85–88

    CAS  PubMed  Google Scholar 

  40. Schover LR (1999) Counseling cancer patients about changes in sexual function. Oncology (Williston Park) 13(11):1585–1591, discussion 1591–1582, 1595–1586

    CAS  Google Scholar 

  41. Reese JB, Porter LS, Somers TJ, Keefe FJ (2012) Pilot feasibility study of a telephone-based couples intervention for physical intimacy and sexual concerns in colorectal cancer. J Sex Marital Ther 38:402–417

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Acknowledgments

This study was supported by an American Cancer Society grant PF-09-154-01-CPPB. Portions of this research were presented at the 6th Biennial Cancer Survivorship Conference in Arlington, VA, 15 June 2012.

Conflict of interest

The authors have no financial relationship with the organization that sponsored the research or any other conflicts of interest to report. The first author maintains full control of the data and agrees to allow the journal to review the data if requested.

Author information

Authors and Affiliations

  1. Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Dr. Suite 100, Baltimore, MD, 21224, USA

    J. B. Reese, P. H. Finan, J. A. Haythornthwaite & K. R. Regan

  2. Department of Oncology, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA

    M. Kadan, L. A. Diaz Jr. & N. S. Azad

  3. The Swim Across America Laboratory and The Ludwig Center for Cancer Genetics and Therapeutics at Johns Hopkins, Baltimore, MD, USA

    M. Kadan & L. A. Diaz Jr.

  4. Department of Radiation Oncology, Johns Hopkins Hospital, Baltimore, MD, USA

    J. M. Herman

  5. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    J. Efron

Authors
  1. J. B. Reese
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. H. Finan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. A. Haythornthwaite
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Kadan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. K. R. Regan
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J. M. Herman
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. J. Efron
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. L. A. Diaz Jr.
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. N. S. Azad
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. B. Reese.

Additional information

Relevance to inform research, policies, and/or programs

This study contributes to the research understanding the sexual outcomes and body image distress of colorectal cancer patients by ostomy status (never, current, and past). Identifying which groups are at greatest risk for worse adjustment will inform future intervention studies targeting these at-risk groups. Data from this study can also help guide clinical discussions with patients about sexuality and body image.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Reese, J.B., Finan, P.H., Haythornthwaite, J.A. et al. Gastrointestinal ostomies and sexual outcomes: a comparison of colorectal cancer patients by ostomy status. Support Care Cancer 22, 461–468 (2014). https://doi.org/10.1007/s00520-013-1998-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-013-1998-x

Keywords

Search

Navigation