This topic is about a man who has been married for over 20 years and recently underwent emergency ileostomy surgery due to severe ulcerative colitis. After spending a significant amount of time in the hospital, he and his wife have struggled with intimacy, having been intimate only once since the surgery. He feels his confidence has hit rock bottom due to her lack of physical affection and is concerned about his strong desire for intimacy without wanting to pressure her. He is unsure of what steps to take next, as he sees no signs of an affair and is trying to understand the situation.

Here are some pieces of advice and insights that might help:

1. Transitioning from Caregiver to Lover
- Long-term caregiving can be emotionally draining, making it hard to shift back to intimacy. This transition might require time, therapy, or couples counseling.

2. Open, Pressure-Free Communication
- Use "I" statements to express feelings without expecting immediate solutions, such as "I was thinking about how hard last year was for you; I love you."
- Create quiet, low-stress moments to open dialogue rather than trying to solve everything at once.

3. Professional Help
- Consider joint therapy to explore hidden emotions and redefine roles.
- Local ostomy support groups or hospital-based counseling can help normalize the experience. Even if partners are reluctant, offering the option is beneficial.

4. Rebuilding Self-Image and Confidence
- Understand the natural need for reassurance after a major body change. Balance self-validation with partner support to avoid draining your partner.
- Engaging in exercise, returning to work, and taking visible recovery steps can help both partners see the survivor, not just the patient.

5. Practical Intimacy Aids
- Products like Ostomy Secrets intimacy wraps can secure the pouch during sex and reduce visual or psychological barriers.

6. Patience with Gender-Based Timing Differences
- Some women may need more time to "switch gears" after a crisis. Pushing for intimacy can worsen avoidance.

7. Normalize and Demystify the Stoma
- Reassure that any leaks are manageable and not a big deal. Some partners may be triggered by past pain memories when seeing the stoma, so covering it or limiting exposure during pouch changes might help.

8. Personal Boundaries and Alternative Paths
- Some individuals have chosen to leave relationships when a partner could not accept the ostomy, while others have considered seeking affection elsewhere. Decisions vary, but self-respect is important.

9. Positive Mental Attitude (PMA)
- Maintaining optimism and demonstrating normalcy, like having a "spring in your step" or embracing a "new house, new beginning," can gradually shift your partner’s perception from caregiver memories to a healthy marital dynamic.