Intended for healthcare professionals

Clinical Review ABC of sexual health

A woman's sexual life after an operation

BMJ 1999; 318 doi: (Published 16 January 1999) Cite this as: BMJ 1999;318:178
  1. Asun de Marquiegui,
  2. Margot Huish

    Disfiguring and mutilating operations, especially of the face, breasts, genitals, and reproductive organs, often have a deleterious effect on a woman's self image and sexuality. 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.

    Embedded Image

    Disfiguring operations, especially of the face and sexual organs, often have a deleterious effect on a woman's self image and sexuality. (Detail from On Surgery (14th century manuscript) by Rogier de Salerne)

    Partners who adapt poorly to the new circumstances may also find it difficult to continue sexual activity, but an existing strong and intimate relationship encourages positive postoperative adjustment.

    Dealing with psychological and emotional states such as anxiety, fear, and depression about surgery is crucial to a woman and her partner. Medical teams should encourage women to discuss their worries, especially sexual anxieties, as problems become more entrenched and more difficult to treat over time. Postoperative surveys of women suggest that 28-50% wanted their doctor to address sexual difficulties. Rehabilitation is important in promoting adjustment and acceptance by facilitating the grieving process.

    Ileostomy, colostomy, and urostomy

    Women who have a stoma as a result of chronic illness such as irritable bowel disorder, ulcerative colitis, and Crohn's disease often experience a better psychological and sexual outcome than do those who undergo emergency surgery for, say, cancer of the colon. Healthy adaptation to a stoma depends on preoperative and postoperative counselling and understanding by stoma nurses. Patients' greatest fears are loss of control, bad odour, noise, leaking or bursting bags, unsightliness, and their partner's feelings towards them.

    Factors affecting sexual function after an operation

    • Disfigurement or mutilation altering the body image

    • Previous psychological and emotional states

    • Physical pain and hormonal, vascular, or nervous …

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