"If Everyone Else Is Having This Talk With Their Doctor, Why Am I Not Having This Talk With Mine?": The Experiences of Sexuality and Sexual Health Education of Young Women With Spina Bifida

Oral contraceptive use in women with spina bifida in Sweden

BACKGROUND

Thanks to improved medical care, individuals with spina bifida (SB) live well into adulthood and go through the process of reproductive maturation and the development of sexual desires. However, access to reproductive counselling and contraceptive use has been reported to be lower for women with physical and intellectual disabilities compared to the general population.

OBJECTIVE

We investigated oral contraceptive use in women with SB, residing in Sweden and how use varies based on the level of lesion and demographic factors.

METHODS

This was a population-based case-control study using annual data from national registers from 2006 to 2015. The sample consisted of 7045 women aged 15-49 years, of which 1173 had a diagnosis of SB. χ2 tests and logistic regression were used to investigate the study objective.

RESULTS

The rate of oral contraceptive use in women with SB was 24.6 % compared to 34.5 % among the general population. After adjusting for potential confounders women with SB were found to have a lower probability of using oral contraceptives (OR 0.63 95 % CI 0.56-0.71) compared to women without SB. Among women with SB, those with diagnoses Q05.8 (Sacral SB without hydrocephalus) and Q05.9 (SB unspecified) had a higher likelihood of using oral contraceptives compared to other Q05 diagnoses.

CONCLUSION

Women with SB had a lower likelihood of being on oral contraceptives compared to the control group. Further research should investigate if the lower use indicates that oral contraceptives are not an inappropriate method of contraception for women with SB.

Transitioning young adults with spina bifida: Challenges and paths to success

INTRODUCTION AND BACKGROUND

Recent medical advances, including closure of myelomeningocele defects, shunting of hydrocephalus, and focusing on renal preservation have led to many individuals with spina bifida (SB) living into adulthood. This has led to more individuals with SB transitioning their care from pediatric-based to adult-based care models.

OBJECTIVE

We seek to explore the process of transition, with a focus on difficulties in transitioning individuals with SB. Additionally, we explore new problems that arise during the period of transition related to sexual function and dysfunction. We also discuss some of the difficulties managing neurogenic bladder and the sequalae of their prior urologic surgeries.

STUDY DESIGN

Each of the authors was asked to provide a summary, based on current literature, to highlight the challenges faced in their area of expertise.

CONCLUSIONS

Transitioning care for individuals with SB is especially challenging due to associated neurocognitive deficits and neuropsychological functioning issues. Sexual function is an important component of transition that must be addressed in young adults with SB. Management of neurogenic bladder in adults with SB can be challenging due to the heterogeneity of the population and the sequelae of their prior urologic surgeries. The aim is to ensure that all individuals with SB receive appropriate, evidence-based care throughout their lifetime.

Prevalence of sexual abuse and intimate partner violence in adults with spina bifida

BACKGROUND

People with disabilities and chronic medical conditions are known to be at higher risk of sexual abuse (SA) and intimate partner violence (IPV). People with spina bifida (SB) are vulnerable, but little is known about the prevalence of abuse in this population.

OBJECTIVE

To evaluate the prevalence and risk factors of SA and IPV in adults with SB.

METHODS

An anonymous international cross-sectional online survey of adults with SB asked about history of SA ("sexual contact that you did not want") and IPV ("hit, slapped, kicked, punched or hurt physically by a partner").

RESULTS

Median age of the 405 participants (61% female) was 35 years. Most self-identified as heterosexual (85%) and were in a romantic relationship (66%). A total of 19% reported a history of SA (78% no SA, 3% preferred not to answer). SA was more frequently reported by women compared to men (27% vs. 5%, p < 0.001) and non-heterosexual adults compared to heterosexuals (41% vs. 15%, p < 0.001). Twelve percent reported a history of IPV (86% no IPV, 2% preferred not to answer). IPV was more frequently reported by women compared to men (14% vs. 9%, p = 0.02), non-heterosexuals compared to heterosexuals (26% vs. 10%, p = 0.002), and adults with a history of sexual activity versus those without (14% vs. 2%, p = 0.01).

CONCLUSION

People with SB are subjected to SA and IPV. Women and non-heterosexuals are at higher risk of both.

Discussing sexual health in spina bifida: An individualized, patient-centered approach

This commentary is on the original article by Rague et al. on pages 389–397 of this issue.

Human immunodeficiency virus diagnosis and care among adults with intellectual and developmental disabilities who are publicly insured

BACKGROUND

This study aimed to assess the prevalence of human immunodeficiency virus (HIV) testing, HIV diagnosis and receipt of HIV care among adults with intellectual and developmental disabilities (IDDs) who are publicly insured in the USA.

DESIGN

This study is a cross-sectional analysis of Medicare-Medicaid linked data of adults with IDD who were publicly insured in 2012 (n = 878 186).

METHODS

We estimated adjusted prevalence ratios of HIV testing, diagnosis and receipt of antiretroviral therapy (ART). We also identified the relationship between predisposing (age, gender, race and ethnicity), enabling (Medicare, Medicaid or both; rural status; geographical location; and county income) and need-related characteristics (IDD diagnosis and other co-occurring conditions) associated with these outcomes.

RESULTS

Only 0.12% of adults with IDD who had no known HIV diagnosis had received an HIV test in the past year. The prevalence of HIV diagnosis among adults with IDD was 0.38%, although differences by type of IDD diagnosis were observed. Prevalence of HIV diagnosis differed by type of IDD. Among adults with IDD who were living with HIV, approximately 71% had received ART during 2012. The adjusted analyses indicate significant racial disparities, with Black adults with IDD making up the majority (59.11%) of the HIV-positive IDD adult population.

CONCLUSIONS

Adults with IDD are a unique priority population at risk for HIV-related disparities, and the level of risk is differential among subtypes of IDD. People with IDD, like other people with disabilities, should be considered in prevention programming and treatment guidelines to address disparities across the HIV care continuum.

Sexual and reproductive health education for patients with myelomeningocele

AIM

To evaluate the sexual and reproductive health education received by patients with myelomeningocele, the most severe form of spina bifida.

METHOD

A survey designed to assess the sexual and reproductive health education given by a healthcare provider to patients with myelomeningocele was offered to all English-speaking patients aged 12 years or older with a myelomeningocele clinic visit.

RESULTS

In total, 67 surveys were completed. Menstruation and menstrual management were discussed at a rate of 85% in females. Few patients had discussions with a provider about fertility (42%), sexuality (37%), risk of sexually transmitted infections (45%), or had a relationship with a reproductive healthcare provider (54%). Differences by sex were observed for contraceptive education. The rate of discussions increased with age. A total of 67% of female patients and 33% of male patients requested a referral to a reproductive healthcare provider.

INTERPRETATION

Sexual and reproductive health education is part of comprehensive care for all patients and those with disabilities should not be excluded. The lack of consistent education received by patients supports the need for increased attention to this topic. We encourage multidisciplinary myelomeningocele clinics to establish a process for delivering complete and patient-specific sexual and reproductive health education.

Advancing sexual health care in spina bifida multidisciplinary clinics and beyond

This commentary is on the original article by Lutz et al. on pages 1105–1111 of this issue.

Patients' and health care providers' perspectives of sexual and reproductive health services for people with disability: a scoping review protocol

OBJECTIVE

The objective of this review is to summarize the nature and focus of research that has been conducted into patients' and health care providers' perspectives of sexual and reproductive health access for people with disability.

INTRODUCTION

Article 25 of the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) requires people with disability to be provided with equitable access to sexual and reproductive health services. However, there are few scoping or systematic reviews examining the provision of inclusive sexual and reproductive health services to people with disability. Current and planned reviews are either not inclusive of a full range of disabilities or geographical regions, are limited to reproductive health, or focus exclusively on the perspectives of health professionals.

INCLUSION CRITERIA

Qualitative, quantitative, mixed method studies, and gray literature concerning sexual and reproductive health service access for people with disability will be included. The UNCRPD definition of disability will be adopted, together with a multidimensional conceptualization of "access."

METHODS

The review will be conducted in accordance with JBI methodology. A search strategy has been developed for MEDLINE, Embase, CINAHL, and gray literature. After de-duplication, results will be independently screened against the inclusion criteria by 2 reviewers. There will be no geographical limitations, but non-English-language publications will be excluded. Only literature published after the UNCRPD came into effect (May 3, 2008) will be included. Charting tools will be used for data extraction, and results will be presented in descriptive, diagrammatic, and tabular formats.

Solo and Partnered Sexual Behavior Among an International Sample of Adults With Spina Bifida

BACKGROUND

Spina bifida (SB) may differentially impact adults' participation in solo and partnered sexual behaviors, but little research investigates this topic.

AIM

Describe solo and partnered sexual behaviors among an international sample of adult men and women with SB.

MAIN OUTCOME MEASURES

Ever participated (no/yes) and recent participation (>1 year ago/within last year) in solo masturbation, cuddled with a partner, held hands with a partner, kissed a partner, touched a partner's genital, had genitals touched by a partner, gave a partner oral sex, received oral sex from a partner, vaginal sex, anal sex, and sex toy use.

METHODS

Data were drawn from a larger cross-sectional, internet-based survey assessing the sexual behaviors of an international sample of men and women with SB. We used logistic regression to examine the impact of background (gender, age, independent living, and relationship status) and health (shunt status, ambulation, and genital sensation) factors on each outcome.

RESULTS

The sample consisted of 345 respondents aged 18-73 years from 26 nations. Very few (<3%) had no lifetime experience with any solo or partnered behaviors; 25.0% reported participating in all behaviors at some point in their lives. The median number of past year sexual behaviors (of 16 total) was 7. Lifetime and recent participation were associated with demographic and health factors.

CLINICAL IMPLICATIONS

Despite impairment, adults with spina bifida do participate in solo and partnered sexual behaviors. Medical personnel who work with this population should include discussions about sexuality as part of routine care.

STRENGTHS & LIMITATIONS

Although this research measured solo and partnered sexual behavior in large international sample of adults with spina bifida, it is limited by its cross-sectional retrospective design and non-clinical convenience sample.

CONCLUSION

Despite disability, many adults with SB participate in solo and partnered sexual behavior. Medical and psychosocial supports are needed to help adults in this population enjoy sexuality in a healthy and safe manner. Hensel DJ, Misseri R, Wiener JS, et al. Solo and Partnered Sexual Behavior Among an International Sample of Adults With Spina Bifida. J Sex Med 2022;19:1766-1777.

Nurse-led eHealth transition care program for adolescents with spina bifida: A feasibility and acceptability study

PURPOSE

This study aimed to evaluate the feasibility and acceptability of a nurse-led eHealth transition care program for adolescents with spina bifida.

DESIGN AND METHODS

This study used a single-arm, pretest-posttest intervention study. Adolescents with spina bifida, aged 12-15 years, and their parents participated in the program. A 6-week program was delivered through an online platform in real-time by nurses. We evaluated feasibility and acceptability using criteria such as the completion rate, program satisfaction, changes in transition readiness, social support, career preparation behavior, sexual knowledge, and sexual worries at three time points from July to September 2021.

RESULTS

Thirteen adolescents completed all sessions and surveys (13/14, 92.9%). All adolescents expressed high satisfaction with both the content and delivery methods of the program. Significant benefits in transition readiness, career preparation behavior, and sexual knowledge were identified over the study period. However, the evaluation of social support and sexual worries did not demonstrate any significant improvements. Additionally, through family counseling, adolescents benefited from experiences such as reflecting on their current transition readiness, setting and achieving individualized goals and plans using a self-checklist with their parents and nursing professionals.

CONCLUSION

This nurse-led eHealth intervention was feasible and acceptable for adolescents with spina bifida. Furthermore, our results highlight the practicability and the potential for strategic dissemination of using this eHealth program in transitional care during the COVID-19 pandemic.

PRACTICE IMPLICATIONS

The eHealth transition care program contributes to broadening existing nursing interventions not only in medical areas but also in daily life areas.

Discrepancies in Educational Needs for Transition in Adolescents and Young Adults with Spina Bifida in South Korea: Use of the Borich Needs Assessment Model

PURPOSE

Transition is an important goal for ensuring that adolescents and young adults (AYAs) with spina bifida (SB) lead autonomous lives. This study aimed to identify the educational needs of AYAs with SB based on the discrepancies between perceived importance and proficiency levels during the transition process.

DESIGN AND METHODS

A cross-sectional study was conducted through face-to-face and online surveys from Jan-Dec 2020 of AYAs aged 13-25 years who had previously been diagnosed with SB. The survey consisted of 37 transition-related questions, of which 11 pertained to healthcare environments and 26 pertained to transition education needs SPSS and Excel were used for statistical analysis. Transition educational needs were analyzed by the Borich Needs Assessment Model. Higher the mean weighted discrepancy scores, lower the proficiency as compared to the perceived importance, indicating that the educational needs were high.

RESULTS

Overall, 108 responses were analyzed, and 56 (51.9%) AYAs were diagnosed with lipomyelomeningocele. The highest ranked educational needs were for "Health insurance system", "SB related urinary system diseases management", "SB related nervous system symptoms", and "Self-catheterization management". "The demands for 'SB related work life", "Urinary incontinence management", and "Constipation management" were significantly higher in young adults than adolescents.

CONCLUSIONS

During the transition process, activities perceived as important by AYAs with SB may differ from the activities that they can actually perform proficiently. It is important to assess their needs based on these discrepancies.

PRACTICE IMPLICATIONS

Transition education programs are needed that consider the individual educational needs and developmental stage-specific characteristics of AYAs with SB.

Sexual Risk Behavior and Sexually Transmitted Infections Among College Students With Disabilities

BACKGROUND

In the past 20 years, there has been an increase in the number of college students with disabilities (SWDs) in the United States. Students with disabilities may have not received relevant, or accessible, sexual health education from medical providers, parents, or school health educators. Because of the lack of this education, the college social environment, and developmental timing of traditional college aged students, SWDs are at risk of engaging in health compromising sexual behavior.

METHODS

We conducted a secondary data analysis of traditionally aged (18- to 24-year-olds) college students who completed the National College Health Assessment administered in Fall 2017 and Spring 2018 (N = 95,119). We use prevalence and generalized linear models to describe self-reported sexual health behavior and outcomes among college students without disabilities and SWDs, by disability category.

RESULTS

Findings indicate that college students with disabilities-particularly students with attention-deficient hyperactivity disorder, psychiatric conditions, and multiple disabilities-are at higher risk than students without disabilities to engage in health compromising sexual health behavior and that students with multiple disabilities have higher adjusted prevalence ratios of being diagnosed and/or treated for a sexually transmitted infection.

CONCLUSIONS

Students with disabilities are not a monolithic population and there is cross-disability variability of engaging in health compromising and health promoting behavior. These findings highlight the need for college health promotion specialists and clinicians to advocate for accessible, sex positive, disability inclusive sexual health education.

Sexuality of Female Spina Bifida Patients: Predictors of a Satisfactory Sexual Function

OBJECTIVE

 To assess the sexual function of women with spina bifida (SB), and to verify the factors that influence their sexual function.

METHODS

 A cross-sectional study in which a validated female-specific questionnaire was applied to 140 SB female patients from four different cities (Porto Alegre, Brazil; and Barcelona, Madrid, and Málaga, Spain) between 2019 and 2020. The questionnaires collected data on the clinical characteristics of SB, and female sexual function was assessed using the 6-item version of the Female Sexual Function Index (FSFI-6) validated to Portuguese and Spanish.

RESULTS

 Half of the patients had had sexual activity at least once in the life, but most (57.1%) did not use any contraception method. Sexual dysfunction was present in most (84.3%) patients, and all sexual function domains were impaired compared those of non-neurogenic women. The presence of urinary and fecal incontinence significantly affected the quality of their sexual activity based on the FSFI-6.

CONCLUSION

 The specific clinical aspects of the SB patients, such as urinary and fecal incontinence, should be properly addressed by their doctors, since they are associated with reduced sexual activity and lower FSFI-6 scores in the overall or specific domains. There is also a need to improve gynecological care among sexually-active SB patients, since most do not use any contraceptive methods and are at risk of inadvertent pregnancy.

The impact of neurogenic bladder bowel dysfunction in the sexuality of female spina bifida patients

INTRODUCTION

The sexual life of Spina Bifida (SB) women may be affected by their physical impairments. Data has consistently associated symptoms such as urinary and fecal incontinence with negative effects on social and intimate life.

OBJECTIVE

To analyze the female spina bifida patient sexual life and assess which factors - including bladder bowel dysfunction and bladder augmentation - influenced in the sexual function of patients in a multi-center cross-sectional study.

STUDY DESIGN

A cross-sectional survey with validated female-specific questionnaire was applied in 140 spina bifida female patients from four different cities (Porto Alegre/Brazil; Barcelona, Madrid and Málaga/Spain) between 2019 and 2020. Questionnaires collected data on spina bifida clinical characteristics and sexuality, which was assessed using the 6-item version of the Female Sexual Function Index (FSFI-6) in the Portuguese and Spanish validated versions. Female sexual dysfunction was defined as a FSFI-6 total score ≤19.

RESULTS

Sexual dysfunction was present in most (84.3%) patients with a median overall FSFI-6 total score of 14.5 (range 4-26), being all sex domains impaired. Bladder augmentation, type of spina bifida, spinal cord level, hydrocephalus, use of wheelchair and psychological disorder were not statistically associated with differences among rates of sexual activity or female sexual dysfunction. The presence of urinary incontinence (UI) showed both significant lower sexual intercourse and higher dysfunction rates (Summary Table). Urinary and fecal incontinence were significantly associated with worst scores in all domains, except for pain.

DISCUSSION

Urinary incontinence status was the most relevant factor since it impaired either female sexual dysfunction and sexual activity rates, as well as the FSFI-6 overall and specific domains. These findings are consistent with previous studies who also observed that desire, arousal and lubrication domains had negative effects from urinary loss on SB patients. Fecal incontinence status did not influenced in sexual activity of female sexual dysfunction rates, nevertheless it promoted lower scores in the overall and specific sexual domains.

CONCLUSION

Spina bifida is a complex condition that demands proper care to achieve a satisfactory sexual life, specially regarding neurogenic bladder and bowel dysfunction. Clinical aspects in the SB patient, such as urinary and fecal incontinence, should be properly addressed by pediatric urologists since they are associated with female sexual dysfunction and reduced sexual activity, as well as lower FSFI-6 scores in the overall and specific domains. There is also a need to improve communication about sexuality, because only 18.6% of the patients considered it that had received sufficient sex information from physicians.

Sexual Function of Men and Women With Spina Bifida: A Scoping Literature Review

INTRODUCTION

As most adults with spina bifida are either sexually active or interested in becoming sexually active, providers should understand how spina bifida impacts sexual function and options for treatment.

OBJECTIVES

The objective of this study is to summarize the current literature describing how features of spina bifida impact sexual function in men and women, effective available treatment options for sexual dysfunction, and to identify research gaps.

METHODS

Searches were conducted in PubMed, CINAHL Complete, PsychInfo, Cochrane Central, Scopus, and Web of Science Core Collection databases using keywords related to spina bifida and sexual function. 34 primary research studies were included.

RESULTS

Most men (56-96%) can achieve an erection, although it may be insufficient for penetration. Although 50-88% ejaculate, it is often dripping, retrograde, or insensate. Twenty percent to 67% achieve orgasm. Generally, men with lower lesions and intact sacral reflexes have better outcomes, although some men with all levels of lesion report good function. Sildenafil is efficacious at treating erectile dysfunction for most men. The "TO-MAXimize sensation, sexuality, and quality of life" procedure may improve sexual function in selected men with low-level lesions. Female sexual function and treatment is less well understood. Women may experience decreased arousal, difficulties with orgasm, and pain. No treatment has been studied in women. Bowel and bladder incontinence during intercourse appears to be bothersome to men and women. Although both men and women have diminished sexual satisfaction, their sexual desire appears to be least impacted. Present studies are limited by studies' small, heterogeneous populations, the misuse of validated questionnaires in the sexually inactive population, and the lack of a validated questionnaire specific to people with spina bifida.

CONCLUSIONS

Spina bifida impacts the sexual function of both men and women. Future studies should seek a better understanding of female sexual function and treatment, use validated questionnaires appropriately, and ultimately create a validated sexual function questionnaire specific to this population. Streur CS, Corona L, Smith JE, et al. Sexual Function of Men and Women With Spina Bifida: A Scoping Literature Review. Sex Med Rev 2021;9:244-266.

How to Discuss Sexual Health With Girls and Young Women With Spina Bifida: A Practical Guide for the Urologist

OBJECTIVE

To provide urologists with a practical guide for how to provide sexual health counseling to girls and women with spina bifida.

METHODS

The recommendations and research of several sources were synthesized to create this guidance, including clinical guidance from the Spina Bifida Association and American College of Obstetricians, the current literature on the sexual health of girls and women with spina bifida, and the multidisciplinary experience of the authors.

RESULTS

Sexual health education should be viewed by urologists as a continuous discussion, starting in early childhood and gradually building through adolescence. Developing a plan for when and how to bring it up, utilizing parents as educational partners, identifying who will provide the detailed one-on-one counseling if not the primary urologist, establishing a referral network for specialized care (eg, adolescent gynecologist, physical therapist, or sex therapist), becoming familiar with how spina bifida impacts sexual health, and being prepared for challenges are key to providing these girls and women with competent sexual health education. Urologists should also screen for abuse at each visit and be familiar with reporting and resources for when abuse is identified.

CONCLUSION

This guidance can serve to direct urologists in providing competent sexual health education to girls and women with spina bifida. This will ensure these girls and women receive the basic education they need, and that they can be referred to appropriate sexual health experts as indicated.

Let's Talk About Sex: Special Considerations in Reproductive Care and Sexual Education in Young Women With Spina Bifida

Medical advances in the last several decades have allowed an increasing number of children with spina bifida to reach adolescence and adulthood. As they reach puberty, girls with spina bifida face unique social and health challenges to their sexuality, such as orthopedic restrictions, continence, and pelvic floor disorders. Recent research efforts have focused on better understanding female sexual desires, dysfunctions, and activity and the role of the physician in educating this vulnerable population. This article aims to summarize current literature on sexual function, knowledge gaps, and the importance of tailored sexual education from providers in women with spina bifida.

"I Tell Them What I Can Feel and How Far My Legs Can Bend": Optimizing Sexual Satisfaction for Women With Spina Bifida

BACKGROUND

There is a high reported rate of sexual dysfunction among women with spina bifida, but little is known about the etiology of this or how sexual satisfaction could be improved.

AIM

To identify, through the words of women with spina bifida, perceived causes of diminished sexual satisfaction and recommendations to optimize partnered sexual encounters.

METHODS

In this qualitative study, we conducted semi-structured individual interviews with 22 women with spina bifida (median age 26.5 years, range 16-52 years) who have had a romantic partner. Using Grounded Theory, interviews were independently coded by 3 reviewers. Disagreements were resolved by consensus.

OUTCOMES

We identified overlapping themes of issues women experienced during sexual intimacy and strategies they learned to improve sexual encounters.

RESULTS

7 salient themes emerged from the data: (i) fear of rejection with resulting difficulty setting boundaries and the risk of coercion; (ii) conflict between spontaneity and self-care in sexual encounters; (iii) worry about incontinence during sex; (iv) trial and error in learning optimal sexual positions; (v) decreased genital sensation; (vi) safety considerations; and (vii) sharing advice with other women with spina bifida.

CLINICAL IMPLICATIONS

As sexual satisfaction is influenced by physical features as well as psychological, interpersonal, and sociocultural factors, optimizing sexual satisfaction of women with spina bifida is best managed with a holistic approach utilizing a biopsychosocial model.

STRENGTHS & LIMITATIONS

The sample included women with a diverse range of functional impairments. Women were forthright with their comments and thematic saturation was reached. Recruitment was primarily from a single Midwestern institution, which may have limited sampled perspectives.

CONCLUSION

While women with spina bifida encounter challenges during sexual encounters, strategies focused on improving communication with partners and addressing specific physical considerations can potentially enhance their sexual experiences. Streur CS, Schafer CL, Garcia VP, et al. "I Tell Them What I Can Feel and How Far My Legs Can Bend": Optimizing Sexual Satisfaction for Women With Spina Bifida. J Sex Med 2020;17;1694-1704.

Sexual health and education guidelines for the care of people with spina bifida

Sexual development is not only comprised of the changes to a person's body during puberty; it is a part of social development and should be considered in the context of basic and routine human desires for connectedness and intimacy, beliefs, values and aspirations. As is true for everyone, it is important that individuals with spina bifida have opportunities to acquire developmentally appropriate, relevant and accurate sexual health knowledge. Those with spina bifida need to be able to negotiate sexual desire, intimacy and sexual expression. They also need education about their sexual health and how to limit the negative outcomes of sexual activity related to sexually transmitted infections, unplanned pregnancy or sexual coercion, violence, abuse or exploitation. This article discusses the Spina Bifida Sexual Health and Education Healthcare Guidelines from the 2018 Spina Bifida Association's Fourth Edition of the Guidelines for the Care of People with Spina Bifida using the World Health Organization's framing of sexual health and reviews the literature on sexual health and education for individuals with spina bifida.