The case histories of four women with permanent ileostomy after total colectomy for ulcerative colitis were studied and each was interviewed. Five phenomena are identified: 'phantom rectum', the stoma regarded as a phallus, exhibitionism, erotic feelings toward the surgeon, and the emergence of more actively directed aggressive behavior. Two hypotheses are formulated: the creation of the ileostomy, a new mucocutaneous junction, allows for different expression of drive derivatives; the stoma is integrated into a changed body image as the wished-for phallus. Further data from psychoanalysis of such patients is required to test these hypotheses.