Symms Michelle R, Rawl Susan M, Grant Marcia, Wendel Christopher S, Coons Stephen Joel, Hickey Sara, Baldwin Carol M, Krouse Robert S
Indiana University, Division of Gastroenterology/Hepatology, Indianapolis, IN 46202, USA.
Clin Nurse Spec. 2008 Jan-Feb;22(1):30-40. doi: 10.1097/01.NUR.0000304181.36568.a7.
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.
Three Veterans Health Administration sites.
Four hundred eighty-one male veterans.
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.
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.
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.
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.
进行这项二次分析是为了加深我们对有造口术的男性在亲密关系和性功能方面所面临挑战的理解。我们检查了定量和定性数据，以研究患有肠道造口的退伍军人的性功能、亲密关系和健康相关生活质量（HR-QOL）。
三个退伍军人健康管理局站点。
481名男性退伍军人。
病例对照混合方法设计；病例为有造口术至少2个月的人，对照为进行了类似的非造口术的大肠外科手术的人。使用改良的希望之城生活质量-造口术问卷收集关于性功能、关系和HR-QOL其他方面的定量和定性数据。
总体回复率为49%。与对照组相比，造口者勃起功能障碍的患病率显著更高（P <.001）。尽管与对照组相比，术前有性生活的造口退伍军人比例更高（P <.001），但造口组术后恢复性生活的男性比例显著更低（P =.015）。与术后未恢复性生活的造口退伍军人相比，有性生活的人报告的HR-QOL总分更高，并且在改良的希望之城生活质量-造口术的所有4个维度（心理、社会、身体和精神健康）上得分更高。造口后恢复性生活的造口退伍军人还报告说，他们的造口对社交活动的干扰显著更少、孤独感更少、对个人关系的干扰更少以及对亲密能力的干扰更少。这些男性还报告说适应造口的困难更少。定性分析结果表明，亲密关系和性功能问题是造口者面临的最大挑战之一。
造口的存在与较低的性活动率和较高的勃起功能障碍有关。性活动率和性满意度较低与有造口的男性HR-QOL的社会和心理维度有关。针对男性造口者及其伴侣性问题的干预措施可能会防止这些患者的HR-QOL下降。
该研究结果对临床护士专家在支持和教育造口患者以尽量减少肠道造口对性健康和HR-QOL的负面影响方面的作用具有启示意义。启示还涉及到有必要教育当前和未来的护士评估性健康的重要性。
