This topic is about providing intimacy advice for gay men who are bottoms and living with an ostomy. A 33-year-old man is seeking practical advice on how to navigate sexual experiences with an ostomy, as he feels too embarrassed to discuss this with his doctor. Here are some helpful tips and insights from others who have been in similar situations:

1. Before engaging in sexual activity, empty your pouch. You can then fold or roll it upward and secure it:
- Some people use a long Hollister pouch, folding it in half and holding it with two small paper binder clips known as "IGGIE clips."
- Others prefer using decorative or lace ostomy belts or snug underwear with strategic cut-outs to keep the appliance flat and stable.

2. Consider these positioning tips:
- Avoid positions that press the pouch against the mattress if you are lying face-down.
- If you are face-up, ask your partner to minimize belly-to-belly pressure.
- Experiment with different positions to find what feels most comfortable while ensuring the appliance is not squeezed or tugged.

3. Keep these safety cautions in mind:
- Do not insert anything into or around the stoma during sexual activity, as this can cause serious injury requiring emergency care.
- If much of the rectal stump has been removed, which is common after some surgeries, it is wise to consult a medical professional before any anal penetration.

4. Consider seeking professional guidance:
- Although it may feel awkward, discussing specifics with a colorectal surgeon or ostomy nurse can be beneficial. They can clarify what is safe based on the exact type of ostomy (ileostomy vs. colostomy) and your remaining anatomy.

5. Remember, many people with ostomies resume a satisfying sex life. Once you figure out pouch management and comfortable positioning, most other aspects remain the same.