Training the Interdisciplinary Team in Sexuality Rehabilitation Following Spinal Cord Injury: A Needs Assessment

Sexual Rehabilitation and Relational Satisfaction in People with Multiple Sclerosis and their Partners

Sexuality is an integral part of our existence. Multiple Sclerosis (MS) can complicate the lifelong course of sexual development and the ways in which one defines and expresses sexuality. Unfortunately, these issues are not adequately addressed by the health professionals involved in the rehabilitation process. Present research attempts to study the effect that can arise on the sexual and relational satisfaction of couples having a partner with MS after the implementation of a sexual rehabilitation program. 60 couples where one partner has MS and the other does not, were divided into three groups and accepted the PLISSIT (PLISSIT stands for Permission, Limited Information, Specific Suggestions, Intensive Therapy) sexual rehabilitation program as follows: Group a (n = 40, control group) completed self-referencing questionnaires at three times (initial measurement, after 10 weeks and 6 months later), group b (n = 40) did 10 weeks of sexual counselling and completed the same questionnaires at the same times and group c (n = 40) followed the PLISSIT programme and was evaluated in the same way at the same times. The implementation of PLISSIT improved Sexual Dysfunction (SD) levels, increased sexual satisfaction between partners along with general relational satisfaction. PLISSIT can be used by professionals involved in the management of the disease as a comprehensive psychosexual rehabilitation program for MS patients and their partners.

A Survey of Latin American Rehabilitation Professionals on Addressing Sexuality-Related Concerns After Spinal Cord Injury

To examine rehabilitation professionals' training and education, attitudes, beliefs or misconceptions, and assessment of issues related to sexuality in individuals with Spinal Cord Injury (SCI) and their romantic partners. 318 healthcare professionals from Latin America (LA) who worked with individuals with SCI completed an online survey. 99.0% affirmed that sexuality is an issue that should be addressed during the rehabilitation of people with SCI. 86.0% reported being asked questions about sexuality after SCI by their patients and/or their partners, but only 33.2% of the professionals affirmed that it was very likely for them to initiate a conversation about the topic. Only 35.4% reported discussing sexuality issues with patients and their partners as a regular practice; further, 61.5% of the sample reported not being prepared at a scientific, therapeutic, and/or educational level to be able to advise people with SCI in the area of sexuality. 95.9% indicated they would be interested in attending courses, seminars, or conferences tailored to the topic of sexuality after SCI. Participants agreed nearly unanimously (96.8%) that it would be easier to discuss sexuality with people with SCI and their partners if they had more training on this topic, which they believed should have been received during their undergraduate (63.5%) and advanced (34.9%) studies. Findings provide insight into the way sexuality is addressed and attended to in the field of rehabilitation in LA and inform initiatives to improve the provision of care in the realm of sexuality for individuals after SCI.

Sexuality Support After Spinal Cord Injury: What is Provided in Australian Practice Settings?

This study sought to understand what sexuality support Australian health professionals currently provide to people with spinal cord injury (SCI) and their perspectives on what changes may better support the sexuality needs of people with SCI. Australian Health professionals who had worked with people with SCI within the last 10 years were invited to participate in an online survey. Results were analyzed using content analysis and descriptive statistics. The 39 participants were from a range of health professions including medical, allied health, nursing, and peer support. Participants worked in various service settings, with the highest frequency in the community (33%) or inpatient rehabilitation (28%). Analysis indicated 85% of participants had provided sexuality support, however this provision was rarely routine. Discussing sexuality education topics were reported to be routinely provided for less than 16% of participants. Overall, 32% of participants felt sexuality was addressed ‘not well at all’ in their workplace. Qualitative analysis of open-ended responses produced five themes: barriers to supporting sexuality, health professionals require training, utilizing a team approach, responsibility to initiate conversation, and involving others in support. Barriers to provision included stigma and lack of education. Commonly suggested strategies to improve practice included: increasing sexuality training, utilizing a team approach, initiating the conversation of sexuality early, and consensual inclusion of significant others in sexuality support. The results therefore indicate sexuality support is not routinely provided to people with SCI and findings suggest a need for sexuality training, utilizing a team approach, initiating the conversation, and including significant others.

Sexuality and relationship experiences of women with spinal cord injury: reflections from an Indian context

Spinal cord injury (SCI) is one of the most devastating physical disabilities. It leads to varying degrees of loss in sensations and mobility below the level of injury and causes loss in autonomic functions, such as bladder/bowel control, and sexual impairments. Research, mostly conducted in the developed western nations, reveals that coming to terms with one's sexuality after SCI is most crucial for early reintegration in the society and quality of life for persons with SCI. Thus, experts advocate that the sexual rehabilitation of persons with SCI is an integral component of comprehensive rehabilitation. In the Indian context, however, the sexuality of persons with SCI, particularly women, has been largely overlooked by the disability rights movement, and discourses on gender, sexuality and rehabilitation. This article is based on an in-depth study of the experiences of sexuality and intimate relationships of 24 women with SCI in India. It demonstrates that sexuality and intimate relationships are integral aspects of health and well-being for women. But there are wide gaps in the sexual rehabilitation and support needs for women with SCI in India, making their sexual adjustment extremely challenging. By analysing women's journeys of sexual adjustment and rediscovery of sexual pleasure that echo their voices as sexual beings, this article argues for the development of evidence-based and gender-sensitive sexual rehabilitation services for women with SCI in India.

Sexual health knowledge and needs among young adults with congenital heart disease

Advances in the treatment of congenital heart disease (CHD) have increased life expectancy, entailing medical surveillance for a considerable number of adolescents and young adults with CHD for issues arising in areas such as sexual health. This study aimed to assess the sexual knowledge and the needs for sexual health education among this group. The participants comprised 53 young adult outpatients (27 males, median age: 23 years) who had undergone surgical interventions (median: 3 times) for CHD. The Knowledge related to Safe Sex Practice scale (KSSP), an assessment tool containing 15 questions on sexual knowledge, was administered, and the rates of correct answers for each item and the overall scale were compared with the age and sex of a control group (n = 164). The overall mean KSSP score of the participant group (10.5 ± 1.8) was significantly lower than that of the control group (11.1 ± 1.9, p = .035). The KSSP scores of the participants with low peripheral oxygen saturation (SaO2 < 95%) were significantly lower (9.77 ± 1.85) than those with normal SaO2 (11.06 ± 1.85, p = .009). Regarding sexual health education, the participants reported receiving information about contraception as more important than other areas of sexual health. The rate of incorrect answers was higher for questions regarding natural ways of contraception utilizing infertile periods in the menstrual cycle. Based on an informed understanding of those with CHD, healthcare providers in this field should develop customized sexual health education for adolescents and young adults with CHD and implement customized sexual health education, including effective contraception methods.

Addressing Sexuality Among People Living With Chronic Disease and Disability: A Systematic Mixed Methods Review of Knowledge, Attitudes, and Practices of Health Care Professionals

OBJECTIVE

To systematically review health care professionals' practices and attitudes toward addressing sexuality with people who are living with chronic disease and disability.

DATA SOURCES

Scopus, PubMed, PsycINFO, Cumulative Index to Nursing and Allied Health, Allied and Complementary Medicine Database, and MEDLINE were searched to August 2020 for English language publications. Reference lists of relevant publications were also searched.

STUDY SELECTION

Eligible studies reported on knowledge, attitudes, and behaviors of health care professionals about addressing sexuality in the context of chronic disease and disability. The search yielded 2492 records; 187 full texts were assessed for eligibility and 114 documents were included (103 unique studies). Study quality was rated using the Mixed Methods Appraisal Tool.

DATA EXTRACTION

Characteristics of included studies were recorded independently by 2 authors. Differences were resolved through discussion or by a third author.

DATA SYNTHESIS

A sequential, exploratory mixed studies approach was used for synthesis. Pooled analysis showed that 14.2% (95% CI, 10.6-18.9 [I²=94.8%, P<.001]) of health professionals report routinely asking questions or providing information about sexuality. Professionals reported limited confidence, competence, and/or comfort when initiating conversations about sexuality or responding to patient questions. Sexual rehabilitation typically focused on the effect of disease, disability, and medication on sexual function. Broader dimensions of sexuality were rarely addressed.

CONCLUSION

Despite recognizing the value of sexuality to health and well-being, most health professionals regardless of clinical context fail to routinely include assessment of sexuality in their practice. Professionals have limited knowledge and confidence when addressing sexuality and experience significant discomfort when raising this topic with people living with chronic disease and disability. Multicomponent implementation programs are needed to improve health professionals' knowledge, competence, and comfort when addressing sexuality for people living with chronic disease and disability.

Sexuality education for health professionals: A literature review

Abstract The objective of this study was to review the scientific literature addressing educational actions related to the training of health professionals in sexuality between 2003 and 2013. The results obtained show that college seniors, recent college graduates, or those working in hospitals and other health care facilities are not adequately prepared to meet patients' needs regarding sexuality. Several studies have shown improvement in the health practitioners' ability to deal with patients' sexuality issues after participating in training programs in sexuality, regardless of the course load. According to the articles reviewed, in order to improve the performance and comfort level of health practitioners to deal with patients' sexuality concerns, investments in educational actions are necessary.

Training rehabilitation teams in sexual health care: A description and evaluation of a multidisciplinary intervention

BACKGROUND

Sexual health problems are more prevalent among people with a chronic illness or physical disability than among the general population. Although sexual health care in the rehabilitation setting in the Netherlands is a growing field of interest, integrating sexual health in the overall care for rehabilitation patients has proven to be a challenge.

METHODS

This article describes a training designed for rehabilitation professionals working in operational multidisciplinary teams. The main objective of this training is to help create a professional environment in which sexual health problems can be discussed, if possible prevented and when needed treated. A pretest-posttest design was used to measure the impact of this educational program given to six teams in the Netherlands.

RESULTS

The results demonstrated that the staff's knowledge, comfort levels and approach levels significantly increased. Team members were more active concerning sexual health and patient care.

CONCLUSION

These findings clearly indicate that rehabilitation workers can benefit from a custom fit design team training on sexual health care. Strategically working with the modus operandi of a multidisciplinary team, such as task definition, determining pro- and reactive roles and formal agreements, appears to be of importance in integrating sexual health in the overall care for patients. Implications for Rehabilitation Sexuality and intimacy are important aspects of quality of life and difficult to integrate in rehabilitation treatment. A multidisciplinary Team Training Sexual Health Care (TTSHC) has been developed with core themes: talking about sex, using a biopsychosocial approach, identifying and understanding sexual health issues, applying the existing expertise of the MDT for sexual health care. After the TTSHC all the participants of the MDTs show significantly more active behavior concerning sexual health and patient care. Defining roles and responsibilities in the MDT is important for integrating sexual health care in rehabilitation treatment.

Improving the rehabilitative management of client sexual health concerns after neurological disability: evaluation of a staff sexuality training programme in New Zealand

Objective: To evaluate the effectiveness of a staff sexuality training programme as a means of improving the rehabilitative management of client sexual health concerns after neurological disability.

Design: A prospective controlled pre- and posttest evaluation design with six-month follow-up.

Subjects: Seventy-four multidisciplinary rehabilitation and disability staff who attended a two-day workshop, and a control group of 25 staff members who did not receive the training.

Setting: Two workshops were held at major rehabilitation centres in the North and South Islands of New Zealand respectively.

Main measures: The Sex Attitude Scale, as well as three purpose-designed measures including an objective knowledge test, a self-rating inventory of skills and clinical activity, and a single-item measure of the degree of staff comfort.

Results: Workshop participants showed significant increases in knowledge, skills and comfort comparing pre-to post-workshop scores. A number of these gains were maintained at the six-month follow-up. There was an associated increase in the level of reported staff activity in addressing patient/client sexual health concerns in the six months to follow-up, compared to a similar time period preceding the workshop. In contrast, the control group had similar pre-workshop scores to the workshop participants, but recorded no increase on the measures, or in their level of reported activity, at the six-month follow-up.

Conclusions: The programme showed initial promise as an effective intervention in upgrading the capacity of staff working in rehabilitation and disability agencies to address the sexual health concerns of their patients/clients.

Disability and Sexuality: Knowledge, Attitudes, and Level of Comfort Among Certified Rehabilitation Counselors

This study investigated certified rehabilitation counselors’ (CRCs) attitudes, knowledge, and comfort in addressing disability and sexuality issues. One hundred ninety-nine CRCs completed a modified version of the Knowledge, Comfort, Approach and Attitudes toward Sexuality Scale to determine the effect of knowledge and attitudes on level of comfort in addressing sexuality issues with consumers. Counseling and education-type comfort and comfort with sexual solicitations or discovering consumers in sexual situations (approach) were assessed separately. Participants demonstrated low discomfort on the education and counseling-related comfort scale ( M = 1.84, SD = .82) and medium discomfort on the approach-related comfort scale ( M = 2.78, SD = .96), positive attitudes ( M = 1.53, SD = .74), and average knowledge ( M = 2.40, SD = .842). Results of regression analyses indicated that 17% ( R 2 = .172) of the variance on comfort and 19% ( R2 = .189) of the variance on approach could be accounted for by CRCs’ knowledge and attitude, indicating that these were contributing to CRC comfort levels in addressing sexuality with consumers. Implications include the need for continued research concerning factors affecting CRC comfort in addressing sexuality-related issues with consumers, and the need for increased CRC education and training in sexuality and disability.