| Bladder cancer | Diagnosing bladder cancer | Treatment for bladder cancer |
| Sexuality & bladder cancer | Living with a stoma |
Damage to the nerves of the penis
If you need a urostomy you may be worried about adapting to changes in how your body looks and how you feel about your body. This is a normal reaction, as over the years we all develop an image in our minds about what our bodies look like. Although we may not be completely satisfied with that image, most people do get used to the way they see themselves. It is upsetting therefore to have that image changed permanently by a urostomy.
You may also be very concerned about the effect it may have on your personal relationships and lifestyle. You may be worried about rejection, continuing to have sex with your partner, or starting a new relationship. Many people find that once they have summoned up the courage to talk about their fears with a partner, their minds are set at ease. Just talking about your fears can help, and let others know how you are feeling. Fears of rejection are usually unfounded. Intimate relationships are built on love and trust. New partners can be understanding and supportive if you are honest about your worries from the start.
Most modern appliances are designed to be flat and unnoticeable under clothing, but the size and site of the stoma will be the most important factor in whether or not the bag or appliance is noticeable through your clothes. The style of clothing you wear is obviously important, but many young people with a stoma find that they can wear the tightest clothes without advertising that they are wearing a bag. Although you may remain conscious of your urostomy, few other people will ever notice unless you tell them.
Apart from the emotional changes, removal of the bladder (cystectomy) may cause problems with sex. It is often impossible to avoid damage to the nerves in the penis during the operation, although your doctor will do all they can to prevent nerve damage. Nerve damage can make it difficult for a man to get an erection. Radiotherapy can also mean poorer quality erections. However, it is now possible for men who have problems getting erections to be treated with injections into the penis. Oral medications like Viagra may also help with sexual functioning.
There are two other methods. One is the use of mechanical devices to produce an erection. These are called penile prostheses and involve the insertion, under general anaesthetic, of flexible rods or thin inflatable cylinders into the penis.
The other is the use of external vacuum devices to produce erections. They are simple, painless and easy to use, and are available from sex aid shops or on prescription.
In some women, the vagina (birth canal) may be shortened or narrowed during the operation to remove the bladder, although the doctor will take care to leave as much of the vagina intact as possible.
This can make penetrative sex difficult or uncomfortable at first. One of the best ways of overcoming this problem is to start having sex regularly and gently, as soon as you feel ready. This will gradually stretch the vagina, making it more supple, and will make sex easier and more enjoyable.
If the uterus has been removed, it can make a woman feel she has lost a part of her female identity. Talking to your doctor about any problems will help to bring fears and worries into the open. If you wish, they can refer you to a specialist in sexual problems, or a trained counsellor, for advice and support.
You may find it difficult or embarrassing to talk about any sexual problems you may have. However, most doctors are very understanding, and even if they are unable to help they can refer you to a doctor or therapist who specialises in sexual problems. These specialists can offer emotional support and advice on how to cope with sexual difficulties and related problems. It can be helpful to remember that they deal with situations like this every day and are used to discussing personal problems. If you have a partner, it may be helpful for them to see the specialist with you so that any fears and worries can be brought out into the open.
