Can you still have sex with a stoma bag? (Picture: Getty/

When I was first diagnosed with ulcerative colitis, a form of inflammatory bowel disease, I had a lot of questions.

I had been living undiagnosed for years, up until my bowel perforated and I was given a stoma bag. I wanted to know how to change it. How it would affect my weight after being severely underweight for a long time. Whether I would need to take any medication.

My rectum had been stitched up, which meant I was to go to the toilet through the stoma bag, so my back passage was out of action for ten months, until I had the stoma reversed.

The reversal meant I was able to go to the toilet ‘the usual way’ again. My small intestine was stitched to my rectum, and everything was opened up again.

I had more questions.

While everything medical was explained to me, I wanted to know what my sex life would be like. I was intrigued as to whether I could have anal sex, something I didn’t do regularly but that I still wanted to be a part of my sex life.

I wasn’t given much information at all. That’s because in the world of inflammatory bowel disease, anal sex isn’t a huge discussion.

It’s often assumed that you shouldn’t do it so as not to cause further damage.

But this isn’t always the case.

After speaking with Crohn’s and Colitis UK, the UK’s top inflammatory bowel disease charity, I found that still, there isn’t much research around anal sex.

They say: ‘Anal penetrative sex can be enjoyed by both men and women, using fingers, toy or a penis. Tenderness in the area due to Crohn’s or colitis or following surgery, or the presence of perianal fistulas, may interrupt this practice.

‘Currently, there are no studies to indicate whether having penetrative anal sex might, for example, trigger a flare-up. There is also little guidance about how long you may need to wait, after surgery to form an internal pouch, before having anal sex.

‘However, your IBD team or surgeon should be able to advise you. They can also refer you for support from specialist counsellors, if you feel this would be helpful.

‘Some people choose to insert fingers, a sex toy or a penis into a stoma. This is not recommended as the bowel attached to the stoma is quite thin and bendy. Penetration of the stoma could lead to serious bowel damage.

‘Some people practise oral-vaginal, oral-penile and oral-anal sex. You and your partner may feel concerned about this if your bowel cannot be guaranteed to behave well.

‘The use of a dental dam (a small square of vinyl placed over the vulva or anus), provides a barrier for safer sex and may ease your concerns during oral sex. Your IBD team would be able to advise you where you can buy these.’

With all this in mind, here are some things to consider if you’re curious about having anal sex while living with inflammatory bowel disease.

Have an open conversation with your partner

It is so important to have an open conversation with your partner about having anal sex, to make sure everyone involved is comfortable and offers enthusiastic consent.

It’s all the more important to talk about it when you have inflammatory bowel disease, because you need to make your partner aware that it may not ‘work’ for you, and that you need to take things extra slowly so that it is not painful and does not cause any damage.

Make sure you use a lot of lube

Like any anal sex, lots of lube is required — but especially when you have a bowel disease.

You also need to ensure that you are very relaxed. To do this, you can stimulate the anal area and practice other foreplay to make you feel calmer and more ready.

Use small toys to get started and to test the waters

If you haven’t had anal sex before, it can be helpful to use small toys first, to ensure that you like the feeling and that you’re not causing any penetrative damage.

Make sure you only use toys designed for anal stimulation, that have a flared base to prevent them getting stuck inside.

Use protection

Ensure you use a condom or dental dam when having anal sex, and check that your lube won’t degrade the material.

Stop if it hurts

This is a no brainer. If it hurts, stop. You need to be completely comfortable and remember that you have a chronic illness.

Do not engage in anal sex, or continue anal sex, if it is painful and unenjoyable for you. Don’t do something you’re not comfortable with for the sake of someone else’s enjoyment.

Avoid if you are currently flaring

If you are flaring, you should avoid anal sex completely – especially if you have had a bowel resection or removal, because the small intestine isn’t designed for penetration and is a lot thinner than the large bowel.

Instead, you could engage in anal stimulation and foreplay without penetration.

You need to take care of yourself when you are flaring, and penetrative anal sex could cause further damage and activate an even worse flareup.

Talk to your doctor if you have any concerns

Always talk to your doctor about whether you are able to have anal sex. Ask them all the questions. Don’t shy away from anything.

Remember that your sex life is important and a chronic illness doesn’t mean you should not have a healthy and enjoyable one.

Make your decisions based on medical reassurance and knowledge. Having this knowledge will help you to decide whether penetrative sex is right for you.

Remember that penetrative anal sex isn’t everything, and it might not work for you. If it doesn’t work, don’t force it.

There are lots of things you can do besides penetration, such as anal play, oral anal sex, and anal stimulation.

You are deserving of a healthy and enjoyable sex life — as long as it is safe, pleasurable and most importantly consensual.

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