This topic revolves around a 30-year-old gay man who is grappling with depression, changes in his sexual life, and a sense of lost control after receiving a permanent colostomy. He has been dealing with depression for many years, but it has become more severe since his surgery a year ago. Here are some of the challenges he faces and advice offered to him:

- He was diagnosed with HIV at 23, which affected his ability to engage in receptive sex.
- The removal of a large colon tumor likely caused nerve damage, leading to weak and short-lived erections, making masturbation unenjoyable.
- He has a lifelong habit of hiding parts of his identity, including his sexuality, HIV status, and now his ostomy, which has led to deep feelings of isolation.
- His use of alcohol and marijuana has increased, he is often late to work, and he has lost interest in activities he once enjoyed, like video games.
- He feels worthless in the dating scene, believing he is too young to be an ostomate and has never had a boyfriend.

In a follow-up, he realized he never had the chance to grieve the loss of his natural bowel control and anus. After surgery, he was met with reassurances that felt dismissive, leaving him without closure.

Here are some pieces of advice and insights shared with him:

1. Psychological and medical support:
- Seek help from a mental health professional to work through grief, depression, anxiety, and hidden shame.
- Consult a doctor about medication for depression or anxiety and to address erectile function issues.
- Open conversations, rather than forced positivity, are crucial for healing.

2. Ostomy management for greater control:
- Consider colostomy irrigation to manage bowel movements predictably, which may help with body image and sexual confidence.

3. Community resources:
- Engage with the MeetAnOstoMate website for peer support and coping strategies.
- Explore the site's friendship/relationship section or other dating platforms, as many young ostomates have fulfilling relationships and sex lives.

4. Mindset and self-worth:
- Reframe your self-image positively; you are valuable and worthy.
- Learning to love yourself is the first step; those who truly value you will not be deterred by an ostomy.

5. Practical dating and relationship tips:
- While one-night stands may be less feasible, meaningful relationships are still possible.
- Be honest about your ostomy when you feel safe; genuine connections are built on honesty, and if someone cannot accept it, they are not the right partner.

6. Lifestyle suggestions:
- Reduce or eliminate alcohol and excessive smoking to improve mood and sexual function.
- Keep sharing your feelings; talking often can lighten the burden of depression and build resilience.