Can a patient have sex with a ureteral (urinary drainage) stent?

Sexual Activity with Ureteral Stent

Yes, patients can have sex with a ureteral stent in place, but they should be counseled that significant sexual dysfunction is common and temporary, affecting approximately 80% of patients, with recovery expected after stent removal. 1, 2, 3

Impact on Sexual Function

Male Patients

• Erectile dysfunction occurs in approximately 83% of men with indwelling ureteral stents, with mean International Index of Erectile Function-5 (IIEF-5) scores dropping from 23.2 to 13.5 after stent placement. 1
• Specific impairments include decreased erection confidence (4.59 vs. 2.76), reduced maintenance ability (4.67 vs. 2.43), and diminished intercourse satisfaction (4.61 vs. 2.31). 3
• Pain during erection or ejaculation is a significant complaint, with pain scores increasing from 0.37 pre-stenting to 2.83 post-stenting. 3
• The sexual dysfunction is primarily related to bothersome lower urinary tract symptoms caused by bladder irritation from the distal stent curl and urine reflux to the renal pelvis. 1, 4

Female Patients

• Sexual dysfunction affects women even more severely than men, with mean Female Sexual Function Index scores dropping from 32.15 to 23.6 after stent placement. 1
• Approximately 30% of women (6 of 20 in one study) completely avoided sexual activity due to stent-related anxiety. 1
• In women who remained sexually active, 86% reported sexual dysfunction compared to 42% of men. 2
• The impairment in women appears more psychological in nature, related to anxiety about the stent rather than purely physical symptoms. 1

Counseling Recommendations

Pre-Stenting Discussion

• Patients must be counseled before stent placement about expected sexual dysfunction, as this significantly impacts whether patients attempt sexual activity (68.3% attempted when counseled vs. 26.7% when not counseled). 3
• Emphasize that sexual dysfunction is temporary and reversible, with most patients recovering normal function within 4 weeks after stent removal. 3
• Discuss that decreased libido affects approximately 45% of patients during the stent dwell time. 2

Setting Expectations

• Patients should understand that approximately 80% will experience bothersome urinary symptoms including dysuria (40%), urinary frequency (50%), and urgency (55%). 2, 4
• Flank pain occurs in 32% and gross hematuria in 42% of patients, which may further discourage sexual activity. 2
• Sleep disturbance (20%) and anxiety (24%) are common and contribute to decreased sexual interest. 2

Symptom Management During Stent Dwell Time

Pharmacologic Approach

• A multimodal approach with alpha-blockers and anticholinergic medications is most effective for managing stent-related symptoms that interfere with sexual function. 4
• Alpha-blockers help reduce lower urinary tract symptoms that contribute to erectile dysfunction in men. 4
• Anti-inflammatory medications can address pain during sexual activity. 4

Practical Considerations

• Sexual activity is not contraindicated from a safety standpoint—there is no risk of stent migration or damage from intercourse itself. 5
• Patients should be reassured that attempting sexual activity will not harm the stent or worsen their urologic condition. 1
• Quality of life is significantly impaired in 45% of patients with stents, and sexual dysfunction is a major component of this. 2

Recovery Timeline

• Most patients experience complete recovery of sexual function within 4 weeks after stent removal, with scores returning to baseline levels. 3
• The temporary nature of dysfunction should be emphasized during counseling to reduce anxiety. 3
• Follow-up assessment of sexual function after stent removal can help identify the rare patient with persistent issues requiring further evaluation. 3

Critical Pitfalls to Avoid

• Never fail to counsel patients about sexual dysfunction before stent placement, as this leads to unnecessary anxiety and complete avoidance of sexual activity. 3
• Do not dismiss patient concerns about sexual dysfunction as trivial—this is a major quality of life issue affecting the majority of patients. 1, 2
• Avoid prolonged stent dwell times when possible, as longer duration increases complications and symptom burden. 2
• Do not assume that because stenting is "routine," the impact on sexual health is minimal—the evidence clearly shows otherwise. 1, 2, 3