Contraception and a stoma

Hear from Kate, a community stoma care nurse.

If you are sexually active you may have concerns about your ostomy’s impact on contraceptives or family planning.  Most forms of contraceptives are equally effective for people with and without stomas. Any of the common methods are possible— condoms, barriers ( such as the cap or an intrauterine device), the pill, or an injection.  Men may have vasectomies as a permanent means of family planning.

It is important, however, to consider certain factors depending on your situation.

If you are taking the contraceptive pill and you have a colostomy it is vital that you pay close attention to the consistency of your bowel movements and are aware of foods that may upset your digestive system. Loose stools may lead to the pill or morning after pill not being absorbed effectively. This could put you at risk of becoming pregnant. If you are concerned that your pill may not be working effectively, take extra precautions such as using condoms. If you have taken the morning after pill and have loose stools or diarrhoea, please speak to your GP as soon as possible.

If you have an ileostomy or ileo-anal pouch, it is recommended that you use a barrier method of contraception (condom) in addition to your normal contraceptive pill (if you use this method of contraception). This is because the contraceptive pill can be less effective if you have an ileostomy. Please speak to your GP or family planning nurse further about this.

There is some evidence that birth control pills may be less effective for people with ileostomies as absorption may be unreliable.  The theory is that the medication passes through the digestive system very quickly without being fully absorbed into the body, which may decrease its effectiveness. You might need to have your dosage adjusted if your small bowel is not absorbing the medication well. Or, you may need to consider other methods of hormonal contraception, such as injections or a birth control patch. Talk to your healthcare professional or your family planning clinic to find the birth control method most effective for you. It is also important to discuss with your surgeon how much small intestine you have left, as this may also affect the absorption of the contraceptive pill.

Some types of stoma surgery may change the anatomy of the vagina and uterus. Because of this, diaphragms, caps, intrauterine devices (IUDs), or coils may not be a good choice anymore. This is because insertion and retention may be difficult. Ask your surgeon if there have been any changes to your anatomy that might impact contraception.

Condoms are an effective alternative for those having difficulty using other contraception methods. Condoms are highly reliable, provided they are used correctly and consistently.

As I said earlier choosing the right method of contraceptive for you will depend on certain factors. Your healthcare professional is always the best person to talk to when considering your best, most effective method of contraception.

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