Sexual function, fertility and body image after bowel cancer

NICE NG151 (1.2.1, 1.2.4 and 1.2.6) asks teams to give information on the possible effects of treatment on bowel and sexual function before a decision is made, to have appropriate specialists discuss altered bowel, urinary and sexual function after surgery, and to give information about short-term, long-term, permanent and late side effects including altered sexual function and changes to self-perception and social identity. Bowel Cancer UK says cancer and its treatment may affect body image, emotions and relationships, and that side effects may also affect the ability to have sex; it suggests talking to someone close or to the specialist nurse, and says a stoma care nurse specialist can help with the sudden change to the body, that a stoma should not stop you doing what you enjoy, and that underwear and swimwear made for people with stomas can help. On fertility it says some treatments for bowel cancer affect fertility in men and women and the team should discuss this at diagnosis; that radiotherapy to the pelvis will often cause infertility and an early menopause and will affect the uterus so that a successful pregnancy is not possible even with fertility treatment, with surrogacy among the options a team will explain; that chemotherapy can cause temporary or permanent infertility depending on the drugs and doses, with periods sometimes returning six months to a year later and sometimes not; that having periods does not by itself mean pregnancy is possible; and that both men and women should use contraception during radiotherapy and chemotherapy and for about a year after treatment ends. The NHS says a colostomy will not affect fertility but to check with the doctor that you are fully recovered before trying to get pregnant, that you can continue your sex life as before once you feel ready, that trying different positions may help if there is discomfort, and to talk to the stoma nurse about sex, relationships or body image.