This topic revolves around a 47-year-old woman who has a stoma and is experiencing some challenges after becoming sexually active again following a long period of celibacy and multiple abdominal surgeries. She has noticed slight vaginal bleeding and pain during sex and is unsure whether these issues are due to her age, the long break from sexual activity, or changes from her surgeries. She is hesitant to discuss these concerns with her doctor due to past experiences of rejection and low self-esteem.

Here are some helpful pieces of advice and insights for her situation:

1. It is important to seek professional evaluation as soon as possible.
- Schedule an appointment with an OBGYN or consultant and describe the pain and bleeding in detail.
- It's crucial to rule out any gynecological causes such as cervical changes, fibroids, post-surgical adhesions, inflammation related to pouchitis, or any damage from radiation.
- Make sure to stay up-to-date with cervical smear tests, especially since she is overdue for one.

2. A long period of sexual inactivity can lead to vaginal tightness and dryness.
- The vaginal tissue might have become similar to a "near-virgin" state. To ease pain and reduce spotting, consider gradual stretching, a slower pace, extended foreplay, and using water-based lubricants.
- Regular, gentle intercourse can help the vagina adjust again.

3. Age alone, at 47, is unlikely to be the sole cause of bleeding. These symptoms are not typically considered "normal" for mid-life intercourse.

4. If intercourse continues to be painful or feels risky, consider exploring alternative forms of intimacy.
- Many couples, including those with ostomies or partners with erectile dysfunction, find satisfaction and closeness through non-penetrative sexual activities.

5. Emotional support and body image are important.
- Struggles with self-esteem are common after ostomy surgery. Connecting with others who have ostomies or joining support communities can be beneficial.
- Often, positive reactions from a partner can significantly ease personal anxiety.

6. There are practical aids available for intimacy.
- Websites like ostomysecrets.com offer attractive underwear and pouch covers that help keep appliances discreet during sexual activity.

7. For those interested in dating and relationships without intercourse, there are resources available.
- The dating website "Date 4 Love" caters to individuals seeking sex-free relationships and can be found online.