This topic is about the challenges of maintaining intimacy and romance in a long-term marriage when one partner has an ileostomy. A 65-year-old man, who has been living with Crohn’s disease and an ileostomy since 2009, shares his experience of feeling like his marriage has turned into more of a roommate situation. His wife helps with his ostomy care but shows little romantic interest, and their sexual activity has been minimal for many years. He struggles with mild erectile dysfunction and feels lonely, even considering the possibility of finding a new partner who might share his desire for intimacy.

Here are some pieces of advice and insights shared by others:

1. Show appreciation and rebalance roles
- It's important to express gratitude for your partner's caregiving and, if possible, take over your own pouch care to shift the dynamic from "patient-nurse" to "partner-partner."
- Demonstrate affection through small gestures like eye contact, kissing goodnight, and acts of kindness without immediately seeking sex.

2. Communicate openly and consider professional help
- Long-standing marital issues often predate the ostomy. A couples or relationship counselor can help explore underlying issues.
- Honest discussions about needs, boundaries, and non-sexual intimacy are crucial, as pressure for sex can harm trust.

3. Recognize hormonal and age-related factors
- Menopause can reduce female libido, cause vaginal dryness, and increase fatigue, which is common in many marriages, not just those involving an ostomy.

4. Redefine intimacy and "sex"
- Explore alternatives to intercourse, such as mutual massage, manual/oral stimulation, erotic touch, shared fantasies, new positions, or bedroom aids.
- Simple gestures like sharing a glass of wine or initiating cuddling can help reopen physical closeness.

5. Address erectile dysfunction thoroughly
- Beyond low-dose Viagra, consider seeing a urologist. Some have found success with:
- Trimix compounded injections, which are described as a "miracle drug" with no pain.
- Penile implant surgery, which may initially be uncomfortable but can restore reliable function.
- Commercial PDE-5 inhibitors like Viagra or Levitra, which might need dosage adjustments.

6. Understand that ostomies need not end sex lives
- Many people with colostomies or ileostomies maintain active intimacy, showing that stoma appliances are not an insurmountable barrier.

7. Accept that intimacy levels vary over time
- Many long-married couples experience waning desire. Patience, creativity, and mutual effort are key to sustaining a satisfying connection.