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Mair L, Moses J. Adaptations to adult attachment and intimacy following spinal cord injury: a systematic review. Disabil Rehabil 2024; 46:1962-1978. [PMID: 37326037 DOI: 10.1080/09638288.2023.2218650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 05/04/2023] [Accepted: 05/21/2023] [Indexed: 06/17/2023]
Abstract
PURPOSE Experiencing spinal cord injury (SCI) can be life-changing for individuals and their families. Previous reviews have focused on coping and psychological adjustment, sexual function and sexuality, or factors facilitating or impeding interpersonal relationships after SCI. However, there is a very little synthesis of research focusing on changes to adult attachment and emotional intimacy post-SCI. This review aims to examine the mechanisms of change in adult attachment and intimacy in romantic relationships following SCI. MATERIALS AND METHODS Four online databases (Psycinfo, Medline, CINAHL, and Scopus) were searched for qualitative papers concerning romantic relationships, attachments, and intimacy post-SCI. Sixteen of the 692 papers met the inclusion criteria. These were quality assessed and analysed using meta-ethnography. RESULTS Three main themes emerged from the analysis: (a) strengthening and maintaining adult attachment; (b) changes in roles; and (c) changing views of intimacy. CONCLUSION Many couples face significant changes to adult attachment and intimacy following SCI. Systematic ethnographic analysis of their negotiations enabled the identification of underlying relational processes and adaptation strategies associated with changes to inter-dependence, communication, role revision, and re-definition of intimacy. The findings indicate that healthcare providers should assess and respond to challenges faced by couples post-SCI using evidence consistent with adult attachment theory.
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Affiliation(s)
- Luned Mair
- South Wales Doctoral Programme in Clinical Psychology, Cardiff University, Cardiff, UK
| | - Jenny Moses
- South Wales Doctoral Programme in Clinical Psychology, Cardiff University, Cardiff, UK
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Barrett OEC, Ho AK, Finlay KA. Sexual function and sexual satisfaction following spinal cord injury: an interpretative phenomenological analysis of partner experiences. Disabil Rehabil 2024; 46:86-95. [PMID: 36576221 DOI: 10.1080/09638288.2022.2159073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 11/25/2022] [Indexed: 12/29/2022]
Abstract
PURPOSE This study explored how partners/spouses of people with Spinal Cord Injury (SCI) experienced intimacy, sexual function, and sexual satisfaction post-SCI. MATERIALS AND METHODS Qualitative, semi-structured interviews were conducted with the partners/spouses of people with SCI living in the community in the United Kingdom. Twelve participants (7 females; 5 males) were recruited using purposive sampling. A nine-item semi-structured interview design was used. Interviews were transcribed verbatim and analysed via Interpretative Phenomenological Analysis (IPA). RESULTS Three superordinate themes were demonstrated: (1) Stolen sex through unpreparedness; (2) Redefining sex; and (3) Compromised commitment. Partners struggled to come to terms with the shock of radically altered post-SCI sexual relationships, questioning how their changed sexual relationship and sexual identity conflicted with caring requirements. To minimise post-SCI relationship changes, some partners engaged in strategies to protect against, distract from and avoid sexual intimacy, whereas others were able to retain adapted pre-injury patterns of intimate behaviour. CONCLUSION Compromised sexual function and satisfaction significantly disrupt relationship dynamics post-SCI, initiate voluntary celibacy, and limit the perceived viability of continued sexual intimacy. Specialist partner-support provisions are urgently needed, recognising that partner support needs are not restricted to the inpatient rehabilitation phase but importantly extend long past discharge into the community.
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Affiliation(s)
- Olivia E C Barrett
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Aileen K Ho
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Katherine A Finlay
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
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3
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Osborne JB, Rocchi MA, McBride CB, McKay R, Gainforth HL, Upper R, Sweet SN. Couples' experiences with sexuality after spinal cord injury. Disabil Rehabil 2023; 45:664-672. [PMID: 35191794 DOI: 10.1080/09638288.2022.2040611] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE To explore sexuality after spinal cord injury (SCI) from the perspectives of individuals with SCI and their romantic partners. METHODS A sample of 8 Canadian adults with SCI (6 men, 2 women) and their partners participated in this study (N = 16). Semi-structured dyadic and individual interviews were conducted, discussions surrounding sexuality and intimacy were extracted, and a qualitative description of the interview data was performed using thematic analysis. RESULTS Three major themes were identified: the changing definition of sex; emotions; and practical support. Couples' conversations around the changing definition of sex after SCI addressed the taboo topic of sexuality and the importance of communication between couples, peers, and healthcare providers. Emotions included fears of losing intimacy, embarrassment in managing bladder and bowel interference, and acceptance in balancing being a romantic partner and a caregiver. Finally, couples reported challenges accessing practical support including medical interventions and sexual health nurses, but saw value in peer mentorship programs. CONCLUSION Couples explored a changing definition of sex following SCI that was complicated by the taboo nature of discussing sexuality, experienced a range of emotions throughout the recovery process, and had difficulties navigating the healthcare system for appropriate support.IMPLICATIONS FOR REHABILITATIONHealthcare professionals should promote discussion and provide support for sexuality following SCI, but during initial rehabilitation may be too early.Healthcare providers should prepare people with SCI and their partners for the inevitable trial-and-error process involved in sexual rehabilitation.Rehabilitation professionals could direct couples to SCI peer mentorship programs to help normalize the experiences and emotions of sexual rehabilitation.
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Affiliation(s)
- Jake B Osborne
- Faculty of Medicine, University of Ottawa, Ontario, Canada
| | - Meredith A Rocchi
- Department of Communication, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Rhyann McKay
- School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Heather L Gainforth
- School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Randy Upper
- Lawson Health Research Institute, London, Ontario, Canada
| | - Shane N Sweet
- Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada
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4
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Experience of Recently Graduated Occupational Therapists in Addressing Sexuality with Their Clients. SEXUALITY AND DISABILITY 2022. [DOI: 10.1007/s11195-022-09762-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
AbstractHealth care consumers have emphasised the importance of being able to express themselves in a sexual nature, regardless of their health conditions. Unfortunately, literature based on experienced occupational therapists and students, indicates sexuality is poorly addressed, despite being a meaningful occupation. There is limited literature based on Australian experiences or the experiences of recent graduates, therefore this study aimed to explore how comfortable and prepared 11 recent graduates who studied in Australia, were in addressing sexuality, as well as the enablers and challenges experienced. A qualitative research design was utilized, with results demonstrating that undergraduate curricula are not adequately preparing new graduates to feel equipped with the knowledge, skills, comfort and preparedness to address sexuality. Enablers such as education, professional development and supportive workplaces, can aid to facilitate positive change in this area of practice, which may improve client outcomes.
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Nery-Hurwit MB, Kalpakjian CZ, Kreschmer JM, Quint EH, Ernst S. Development of a Conceptual Framework of Sexual Well-being for Women with Physical Disability. Womens Health Issues 2022; 32:376-387. [PMID: 35337722 DOI: 10.1016/j.whi.2022.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 01/27/2022] [Accepted: 02/09/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Women with physical disability (WWPD) experience more sexual dysfunction, are typically less sexually active, and engage in fewer intimate relationships than women without physical disability. Although patient-reported outcome measures can help researchers and providers to meet the needs of this population, current measures fail to reflect the relevant experiences of WWPD. The purposes of this study were to 1) understand the experiences of WWPD related to sexual wellness, 2) identify the gaps in the current Patient-Reported Outcomes Measurement Information System Sexual Function and Satisfaction, and 3) develop a conceptual framework for the measurement of sexual well-being on which a new supplemental measure will be built. METHODS WWPD (n = 59) were recruited from an online health registry through a large academic medical center and took part in semistructured focus groups and interviews exploring experiences with sexuality, intimate relationships, sexual function, and sexual and reproductive health care. Interviews were transcribed and coded using an inductive approach to thematic analysis. RESULTS Participants expressed that their sexual well-being extends beyond simply physical function and includes aspects of their environment, society, and intrapersonal and interpersonal factors. From themes that emerged from the qualitative data, we developed a conceptual framework of sexual well-being, which includes sexual health and sexual self-efficacy. The framework is composed of five constructs that impact sexual health and sexual self-efficacy: physical factors, intrapersonal factors, environmental factors, relationships and partner opportunity, and stigma. CONCLUSIONS This conceptual framework can be used to develop patient-reported outcome measures items relevant to the experiences of WWPD, facilitate conversations between providers and patients, and identify areas to target for sexual wellness interventions.
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Affiliation(s)
- Mara B Nery-Hurwit
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, Michigan.
| | - Claire Z Kalpakjian
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, Michigan
| | - Jodi M Kreschmer
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, Michigan
| | - Elisabeth H Quint
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Susan Ernst
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan
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Sharma S. Sexuality and relationship experiences of women with spinal cord injury: reflections from an Indian context. Sex Reprod Health Matters 2022; 29:2057652. [PMID: 35521663 PMCID: PMC9090379 DOI: 10.1080/26410397.2022.2057652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
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.
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Affiliation(s)
- Seema Sharma
- Assistant Professor, Public Health, Azim Premji University, Bhopal, India. Correspondence:
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Moreira PS, Bittencourt EDS, Paixão GMD, Omura KM. Avaliação de motéis e pousadas em relação à acessibilidade para pessoas com deficiência ou restrição de mobilidade. CADERNOS BRASILEIROS DE TERAPIA OCUPACIONAL 2022. [DOI: 10.1590/2526-8910.ctoao22863017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Introdução Pessoas com deficiência se deparam com inúmeras barreiras no desempenho da atividade sexual; dentre elas, está o acesso a locais acessíveis destinados a essa finalidade. Objetivo O objetivo do presente estudo foi mapear e avaliar a acessibilidade arquitetônica de estabelecimentos que têm como atividade-fim o sexo, tais como motéis e pousadas, localizados na região metropolitana de Belém. Método Trata-se de uma pesquisa de caráter quantitativo, transversal, descritivo, na qual foram avaliados 22 estabelecimentos, através de um questionário de avaliação de acessibilidade elaborado pelos pesquisadores, contendo 11 questões objetivas sobre a acessibilidade arquitetônica de banheiros, rampas de acesso, elevadores, sinalização, formas de comunicação, altura da cama e área de circulação. Resultados Os resultados acerca da sinalização sonora e visual demonstraram que 32% dos estabelecimentos não apresentam nenhuma das formas de sinalização, assim como comunicação alternativa e piso tátil. Em contrapartida, 82% dos estabelecimentos avaliados apresentaram altura dos interfones, interruptores e sinalizadores dentro dos padrões. Em relação à acessibilidade dos banheiros, 43% dos estabelecimentos não apresentaram nenhum mobiliário acessível. Conclusão O presente estudo demonstra resultados não satisfatórios quanto aos parâmetros básicos de acessibilidade dos motéis participantes, constituindo-se graves barreiras ao acesso do público com algum tipo de deficiência. Conclui-se que há a necessidade de maiores discussões sobre o assunto, além de fiscalização para o cumprimento das normas de acessibilidade e mobiliário acessível para que pessoas com deficiência possam usufruir desses serviços.
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Bryant C, Gustafsson L, Aplin T, Setchell J. Supporting sexuality after spinal cord injury: a scoping review of non-medical approaches. Disabil Rehabil 2021; 44:5669-5682. [DOI: 10.1080/09638288.2021.1937339] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Chloe Bryant
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Louise Gustafsson
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- School of Allied Health Sciences, Griffith University, Brisbane, Australia
| | - Tammy Aplin
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- The Prince Charles Hospital, Allied Health Research Collaborative, Chermside, Australia
| | - Jenny Setchell
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
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Bathje M, Schrier M, Williams K, Olson L. The Lived Experience of Sexuality Among Adults With Intellectual and Developmental Disabilities: A Scoping Review. Am J Occup Ther 2021; 75:12529. [PMID: 34780616 DOI: 10.5014/ajot.2021.045005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Sexuality is an important part of the human experience. However, little is known about the experience of sexuality from the perspective of adults with intellectual and developmental disabilities (IDD). OBJECTIVE To review evidence about the lived experience of sexuality among adults with IDD to inform future research and practice. DATA SOURCES We located articles using search terms summarized into three categories: intellectual disability, sexual activity, and feelings/opinions. Articles were indexed in the following electronic databases: CINAHL, Scopus, PubMed, and PsycINFO. Study Selection and Data Collection: Arksey and O'Malley's methodology was used to review scientific literature published between 2008 and 2018. The studies were in English, were located in peer-reviewed journals, and described the experience of sexuality from the perspective of people with IDD or observations of expressed sexuality. FINDINGS Seventeen articles met inclusion criteria. Four main themes emerged: intimate relationships, oppressed sexual activity, knowledge, and identity. Findings indicate that sexuality is a part of the lives of many adults with IDD, regardless of their engagement in sexual activity. CONCLUSIONS AND RELEVANCE Barriers to expression of sexuality exist for people with IDD. Some of these barriers are internal, although many are external. The results provide support for addressing sexuality among adults with IDD. What This Article Adds: This review provides evidence to support occupational therapy practitioners in including sexuality as a part of their holistic view of clients and as an area for advocacy.
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Affiliation(s)
- Molly Bathje
- Molly Bathje, PhD, OTR/L, is Assistant Professor, Department of Occupational Therapy, Rush University, Chicago, IL;
| | - Mallory Schrier
- Mallory Schrier, BS, is OTD Student, Department of Occupational Therapy, Rush University, Chicago, IL
| | - Katherine Williams
- Katherine Williams, BS, is OTD Student, Department of Occupational Therapy, Rush University, Chicago, IL
| | - Linda Olson
- Linda Olson, PhD, OTR/L, FAOTA, is Assistant Professor, Department of Occupational Therapy, Rush University, Chicago, IL
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Nevin S, Melby V. Talking about post-injury sexual functioning: The views of people with spinal cord injuries-A qualitative interview study. Int J Nurs Pract 2021; 28:e12977. [PMID: 34034357 DOI: 10.1111/ijn.12977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 04/12/2021] [Accepted: 05/09/2021] [Indexed: 11/29/2022]
Abstract
AIM This study aimed to explore perceptions of people with spinal cord injuries regarding the information they received during their rehabilitation programme on post-injury sexual functioning. BACKGROUND Spinal cord injury is a traumatic, life-altering event that is associated with loss of motor and sensory function and sexual impairment. Existing evidence suggests that sexual issues are poorly handled during the rehabilitation phase of the patient's journey. DESIGN A descriptive qualitative design was utilized in this study. METHODS Twenty-nine people with spinal cord injury participated in qualitative in-depth interviews between November 2017 and April 2018, and data were analysed using the Burnard (1991, https://doi.org/10.1016/0260-6917(91)90009-y) thematic analysis framework. RESULTS Some participants indicated they were sexually inactive prior to their spinal cord injury. They testified that they had not received information on post-injury sexual functioning. Many participants who received post-injury information on sexual functioning reported dissatisfaction with the content and timing of this information. CONCLUSION Personal conversations between spinal cord injured patients and dedicated members of the interdisciplinary health team can enhance the quality of rehabilitation care and patients' satisfaction with rehabilitation care. Nurses are central clinicians in the rehabilitation programme of spinal cord injured patients and should engage in individually designed conversations about post-injury sexual functioning.
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Affiliation(s)
- Sheila Nevin
- The Spinal Cord Injuries Unit, Belfast Health & Social Care Trust, Belfast, UK
| | - Vidar Melby
- School of Nursing and Institute of Nursing and Health Research, Ulster University, Derry-Londonderry, UK
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Przydacz M, Golabek T, Dudek P, Chlosta P. The Multiple Sclerosis Intimacy and Sexuality Questionnaire (MSISQ-15): translation, adaptation and validation of the Polish version for patients with multiple sclerosis and spinal cord injury. BMC Neurol 2021; 21:103. [PMID: 33685399 PMCID: PMC7938601 DOI: 10.1186/s12883-021-02132-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 03/01/2021] [Indexed: 11/24/2022] Open
Abstract
Background Polish physicians and researchers lack an extensive and precise instrument in their native language for evaluating sexual dysfunction in individuals with neurogenic disorders. The aim of this study was to create a culturally adapted, validated, Polish language version of the Multiple Sclerosis Intimacy and Sexuality Questionnaire (MSISQ-15) for persons with multiple sclerosis (MS) and spinal cord injury (SCI). Methods International recommendations and standardized methods for instrument validation were followed. Sexually active patients with MS and SCI completed the MSISQ-15, International Index of Erection Function (IIEF-15, men), and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-31, women). IIEF-15 and PISQ-31 were used as reference questionnaires. Responses were collected at baseline (test) and after 2 weeks (re-test). Results We recruited 299 Polish-speaking patients with MS or SCI. Interviews disclosed that the translated questionnaire had optimal content validity/cross-cultural adaptation. MSISQ-15 scores correlated significantly with the severity of sexual dysfunction as evaluated by IIEF-15 (r = − 0.487) and PISQ-31 (r = − 0.709). These correlations substantiated the high quality construct/criterion validity. An analysis of reliability presented good internal consistency (Cronbach’s alpha of 0.93 for the total score of MS patients and 0.86 for the total score of SCI patients) and reproducibility (intraclass correlation coefficients of 0.91 for the total score of MS patients and 0.92 for the total score of SCI patients). There were no ceiling or floor effects. Conclusions The Polish version of MSISQ-15 exhibited excellent measurement properties. It is a suitable and reliable instrument to assess sexual dysfunction in MS and SCI individuals. The Polish MSISQ-15 will enhance routine clinical practice and assist research for neurogenic patients in Poland. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-021-02132-9.
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Affiliation(s)
- Mikolaj Przydacz
- Department of Urology, Jagiellonian University Medical College, ul. Jakubowskiego 2, 30-688, Krakow, Poland.
| | - Tomasz Golabek
- Department of Urology, Jagiellonian University Medical College, ul. Jakubowskiego 2, 30-688, Krakow, Poland
| | - Przemyslaw Dudek
- Department of Urology, Jagiellonian University Medical College, ul. Jakubowskiego 2, 30-688, Krakow, Poland
| | - Piotr Chlosta
- Department of Urology, Jagiellonian University Medical College, ul. Jakubowskiego 2, 30-688, Krakow, Poland
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Earle S, O’Dell L, Davies A, Rixon A. Views and Experiences of Sex, Sexuality and Relationships Following Spinal Cord Injury: A Systematic Review and Narrative Synthesis of the Qualitative Literature. SEXUALITY AND DISABILITY 2020. [DOI: 10.1007/s11195-020-09653-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
AbstractResearch examining the effects of spinal cord injury on sexuality has largely focused on physiological functioning and quantification of dysfunction following injury. This paper reports a systematic review of qualitative research that focused on the views and experiences of people with spinal cord injury on sex and relationships. The review addressed the following research question: What are the views and experiences of people with spinal cord injury of sex, sexuality and relationships following injury? Five databases were relevant and employed in the review: CINAHL (1989–2016 only), PsychInfo, PubMed, Scopus and Web of Science, for research published between 1 January 1980 and 30 November 2019. After removing duplicates, 257 records remained and were screened using a two-stage approach to inclusion and quality appraisal. Following screening, 27 met the criteria for inclusion and are reported in the paper. The review includes studies from fifteen countries across five continents. Two main approaches to data analysis summary and thematic synthesis were undertaken to analyze the qualitative data reported in the papers. The analysis revealed four main themes: sexual identity; significant and generalized others, sexual embodiment; and; sexual rehabilitation and education.
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Kalpakjian CZ, Kreschmer JM, Slavin MD, Kisala PA, Quint EH, Chiaravalloti ND, Jenkins N, Bushnik T, Amtmann D, Tulsky DS, Madrid R, Parten R, Evitts M, Grawi CL. Reproductive Health in Women with Physical Disability: A Conceptual Framework for the Development of New Patient-Reported Outcome Measures. J Womens Health (Larchmt) 2020; 29:1427-1436. [PMID: 32429740 DOI: 10.1089/jwh.2019.8174] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background: Barriers in the built environment, enduring stereotypes and biases, and limited disability competency of health care providers compromise access to and quality of reproductive health care for women with physical disabilities. One way to improve our understanding of critical factors that drive reproductive health inequity and its impact on access to care is to use patient-reported outcome measures (PROMs) that capture relevant and meaningful information about experience. In this study, we developed a conceptual framework as the foundation for relevant and clinically meaningful patient-reported outcome measures targeting the interface of disability and reproductive health. Materials and Methods: We conducted semistructured focus groups and interviews to assess women's experiences around their reproductive health and contextual factors related to disability. We used deductive and inductive qualitative coding approaches to develop the conceptual framework. Results: Eighty-one women between the ages of 16 and 50 with a self-reported physical disability, defined by an impairment of mobility, participated in 13 focus groups (N = 64) and 17 individual interviews. Five major themes characterized the conceptual framework that emerged-knowledge about reproductive health, communication about reproductive health, relationships, the reproductive health care environment, and self-advocacy/identity-all of which had some relationship with five major reproductive health issues-pregnancy and labor/delivery, periods and menstrual management, contraception, sexuality and sexual functioning, and pelvic examinations. Conclusions: This conceptual framework will serve as a foundation for PROM and guide intervention development to reduce reproductive health inequity and improve reproductive health outcomes of women with physical disabilities.
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Affiliation(s)
- Claire Z Kalpakjian
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Jodi M Kreschmer
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Mary D Slavin
- Boston University School of Public Health, Boston, Massachusetts, USA
| | - Pamela A Kisala
- Center for Health Assessment Research and Translation, University of Delaware, Newark, Delaware, USA
| | - Elisabeth H Quint
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | | | - Natalie Jenkins
- Langone Health Department of Research/Rusk Rehabilitation, New York University, New York, New York, USA
| | - Tamara Bushnik
- Langone Health Department of Research/Rusk Rehabilitation, New York University, New York, New York, USA
| | - Dagmar Amtmann
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - David S Tulsky
- Center for Health Assessment Research and Translation, University of Delaware, Newark, Delaware, USA
| | - Roxanne Madrid
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Rebecca Parten
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Michael Evitts
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Carolyn L Grawi
- Ann Arbor Center for Independent Living, Ann Arbor, Michigan, USA
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The Multiple Sclerosis Intimacy and Sexuality Questionnaire (MSISQ-15): validation of the Italian version for individuals with spinal cord injury. Spinal Cord 2020; 58:1128-1133. [PMID: 32332876 DOI: 10.1038/s41393-020-0469-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 04/04/2020] [Accepted: 04/06/2020] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Psychometric study. OBJECTIVE The aim of the study was to translate and culturally adapt the MSISQ-15 into Italian and to administer it to individuals with a spinal cord injury (SCI). SETTING Rome's Wheelchair Rugby Team and three spinal units in Italy. METHODS Translation and validation of the MSISQ-15 were performed based on international guidelines. The questionnaire, which was in a paper and online format, was administered with the Short Form-12 Health Survey (SF-12) and the Spinal Cord Independence Measure Self-Report. RESULTS Sixty-five participants were recruited. Internal consistency coefficient of MSISQ-15 scale, assessed by Cronbach's alpha, was 0.75. Test-retest reliability interclass correlations was, for example, 0.86. The construct validity was calculated and showed statistically significant results in relation to the mental health status investigated with the SF-12. CONCLUSIONS The MSISQ-15 is a valid, reliable, and useful questionnaire for investigating how often the symptoms of an SCI interfere with a person's satisfaction or sexual activity.
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15
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The Relationship Between Hopelessness and Sexual Problems in Spinal Cord Injury. SEXUALITY AND DISABILITY 2020. [DOI: 10.1007/s11195-020-09631-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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16
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Angel S, Kroll T. Sex Life During the First 10 Years After Spinal Cord Injury: A Qualitative Exploration. SEXUALITY AND DISABILITY 2020. [DOI: 10.1007/s11195-020-09620-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lorenz TK, Ramsdell EL, Brock RL. A Close and Supportive Interparental Bond During Pregnancy Predicts Greater Decline in Sexual Activity From Pregnancy to Postpartum: Applying an Evolutionary Perspective. Front Psychol 2020; 10:2974. [PMID: 31998201 PMCID: PMC6966960 DOI: 10.3389/fpsyg.2019.02974] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 12/16/2019] [Indexed: 12/31/2022] Open
Abstract
A common topic for advice given to parents after childbirth – both from relationship experts and popular media – is how to “bounce back” to one’s pre-pregnancy sexuality, with warnings that postpartum declines in sexual frequency will take a serious toll on one’s relationship. However, these admonishments may not accurately reflect the ways in which the unique reproductive context of pregnancy and the postpartum transition alter associations between sexual frequency and relationship quality. Evolutionary perspectives on reproductive strategies would suggest that in the postpartum context, decreased sexual activity would help target parental investment in the current offspring (rather than creating new offspring); however, if the parental relationship is lacking in intimacy and support, continued sexual activity may help seal the cracks in the bond. We tested this theory in a longitudinal dyadic study of changes in relationship quality and sexual frequency from pregnancy to 6 months postpartum among 159 heterosexual couples. We found that across three different measures of relationship quality taken from interviews and behavioral observation of couple interactions, higher relationship quality (i.e., greater support, intimacy, and responsiveness) predicted greater decline in sexual frequency whereas sexual frequency remained relatively stable in lower quality relationships. These findings suggest that, during the postpartum transition, decreased sexual frequency may not be a reliable signal of poor relationship quality.
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Affiliation(s)
- Tierney K Lorenz
- Department of Psychology and Center for Brain, Biology and Behavior, University of Nebraska-Lincoln, Lincoln, NE, United States
| | - Erin L Ramsdell
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, United States
| | - Rebecca L Brock
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, United States
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Rodger S. Evaluating sexual function education for patients after a spinal cord injury. ACTA ACUST UNITED AC 2019; 28:1374-1378. [PMID: 31778344 DOI: 10.12968/bjon.2019.28.21.1374] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM this article shares findings from a service evaluation exploring the views of patients relating to the specialist sexual function education and information provided following a spinal cord injury. BACKGROUND education optimises patients' involvement in their own decision-making and care processes, with the aim of promoting adherence to agreed plans, reducing the risks of post-injury complications, promoting independence and improving quality of life. Sexual function is a well-known quality-of-life indicator and it has been widely documented that it is not well addressed following spinal cord injury. A previous service evaluation exploring education provided to patients with spinal cord injury identified the need for improved provision of sexual function education/information. As a result, weekly 1-hour sessions focused on sexual function for up to three patients of the same sex were held, facilitated by a clinical nurse specialist. The sessions had an open forum structure. They were initially designed to discuss thoughts and feelings around intimacy and sex after a spinal cord injury, but focused on group members' requests. In addition, patients were offered a one-to-one session where the 'mechanics' of sex could be discussed in further detail. DESIGN AND METHODS a service evaluation used a questionnaire survey to collect data from a purposive convenience sample of spinal cord injury patients. Data were collected between July and September 2018. Participants completed a locally designed paper questionnaire, which included Likert-style questions and space to add free text comments. Descriptive analysis of the data was used. RESULTS survey results suggest that the newly formed sexual function education session is positively evaluated in terms of usefulness and all attendees to date would recommend this session to other patients. CONCLUSIONS AND RECOMMENDATIONS following completion of data analysis, findings will inform the further development of sexual function education, with a particular focus on tailoring it to the patient and reducing the stigma around talking about sex.
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Affiliation(s)
- Sian Rodger
- Clinical Nurse Specialist, London Spinal Cord Injury Centre, Royal National Orthopaedic Hospital, Stanmore, London
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Packham TL, Wainio K, Wong MK. Persons with Complex Regional Pain Syndrome Renegotiate Social Roles and Intimacy: A Qualitative Study. PAIN MEDICINE 2019; 21:239-246. [DOI: 10.1093/pm/pnz173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Objective
Persons with complex regional pain syndrome often experience allodynia, where touch is painful. Allodynia is associated with poor prognosis, but the impacts on roles, activities, social relationships, and intimacy remain unclear. There is a need to examine intimacy in complex regional pain syndrome from a lived experience perspective.
Methods
We conducted a secondary analysis of cognitive debriefing interview data from 44 persons with complex regional pain syndrome who completed a patient-reported questionnaire. Using interpretive description and thematic analysis, we analyzed items and responses addressing allodynia, relationships, and intimacy.
Results
Two themes were developed to understand intimacy related to the pain experience: a renegotiated social identity and participation and a reinvented intimate self. These themes included elements of a) loss of control, b) loss of shared experiences, c) feeling that their condition was misunderstood, d) a need for self-preservation, e) altered self-concept, and e) the concept of intimacy is broader than sexuality. Our findings suggest that complex regional pain syndrome has pervasive impacts on relationships and intimacy that merit discussion with their health care team.
Conclusions
Persons with persistent pain need to be supported in roles and activities that allow them to express intimacy in their everyday lives.
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Affiliation(s)
- Tara L Packham
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario Canada
| | - Kaitlyn Wainio
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario Canada
| | - Ming-Kin Wong
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario Canada
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Thrussell H, Coggrave M, Graham A, Gall A, Donald M, Kulshrestha R, Geddis T. Women's experiences of sexuality after spinal cord injury: a UK perspective. Spinal Cord 2018; 56:1084-1094. [PMID: 30140048 DOI: 10.1038/s41393-018-0188-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 07/23/2018] [Accepted: 07/25/2018] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Cross-sectional phenomenological qualitative study. OBJECTIVES To investigate women's experience of sexuality after spinal cord injury (SCI) with a focus on rehabilitation and manging practical impact. SETTING Women with SCI living in the community in United Kingdom (UK). METHODS Participants were recruited via three UK SCI centres, ensuring tetraplegia, paraplegia and cauda equina syndrome representation. Single semi-structured interviews exploring individual's experiences around sexuality following SCI were recorded and transcribed for thematic analysis. RESULTS Twenty-seven women aged 21-72 years, sexually active since SCI were interviewed, each lasting 17-143 min (mean 55 min). Six key themes emerged: physical change, psychological impact, dependency, relationships and partners, post injury sexual life and sexuality rehabilitation. CONCLUSIONS Sexuality remains an important, valued aspect of female identity following SCI; sexual activity continues and though altered remains enjoyable and rewarding. Sexuality rehabilitation should commence early, preparing women for altered sexual sensation, disclosure of altered sexual function to partners, and encouraging early self-exploration. Techniques optimising continence management in preparation for and during sex should be taught. Participants identified a need for women-only education and support groups, increased peer support, self-esteem, communication and social skills training and even fashion advice and pampering sessions during rehabilitation. Support and education for partners are needed. Staff require support to be knowledgeable and confident in addressing women's sexuality needs. Use of the Ex-PLISSIT model for psychosexual support could help staff to better meet these needs.
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Affiliation(s)
- Helen Thrussell
- Buckinghamshire New University, High Wycombe Campus, Queen Alexandra Road, High Wycombe, HP11 2JZ, UK. .,National Spinal Injuries Centre, Stoke Mandeville Hospital, Mandeville Road, Aylesbury, Bucks, HP21 8AL, UK.
| | - Maureen Coggrave
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8W, UK
| | - Allison Graham
- National Spinal Injuries Centre, Stoke Mandeville Hospital, Mandeville Road, Aylesbury, Bucks, HP21 8AL, UK
| | - Angela Gall
- London Spinal Cord Injury Centre, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK
| | - Michelle Donald
- National Spinal Injuries Centre, Stoke Mandeville Hospital, Mandeville Road, Aylesbury, Bucks, HP21 8AL, UK
| | - Richa Kulshrestha
- Midland Centre for Spinal Injuries, The Robert Jones & Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, Shropshire, SY10 7A, UK
| | - Tracey Geddis
- National Spinal Injuries Centre, Stoke Mandeville Hospital, Mandeville Road, Aylesbury, Bucks, HP21 8AL, UK
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Ferreira DV, Matão MEL. Sexuality and reproduction in women with spinal cord injury. FISIOTERAPIA EM MOVIMENTO 2017. [DOI: 10.1590/1980-5918.030.004.ao08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Introduction: Spinal cord injury (SCI) is debilitating and results in different social representations for the women affected in terms of their sexuality and reproduction. Objective: Describe the experience of women with SCI regarding sexuality and reproduction under these conditions. Methods: Participants were 11 women with SCI who were submitted to a semi-structured interview. The content of the interviews was inputted into ALCESTE software, a computerized technique used for text analysis. Results: The dendrogram obtained shows two clusters and five subcategories. Cluster I contains issues related to living with SCI and consists of four classes: everyday life, sexuality and reproduction, difficulties, and coping. The so-called class of perceptions is in cluster II, which addresses subjective aspects. The classes in cluster I revealed symbolism associated with sexual relations, reproduction, affective relationships before and after SCI and relationships with the body. The results indicate that sexuality among women with SCI is marked by a mixture of feelings. While they are insecure about expressing themselves sexually, they also report fear of abandonment and loneliness, possibly due to conflicts about accepting their new image, which in most cases was characterized by low self-esteem. Conclusion: The representations of the sexuality and reproduction of the women studied here are vital in the process of accepting and coping with SCI, as well as recovering their social, affective and sexual relationships.
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Fritz H, Patzer D, Galen SS. Robotic exoskeletons for reengaging in everyday activities: promises, pitfalls, and opportunities. Disabil Rehabil 2017; 41:560-563. [DOI: 10.1080/09638288.2017.1398786] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Heather Fritz
- Health Care Sciences, Wayne State University, Detroit, MI, USA
- Institute of Gerontology, Wayne State University, Detroit, MI, USA
| | - Diane Patzer
- Center for Spinal Cord Injury Recovery, Detroit Medical Center, Detroit, MI, USA
| | - Sujay S. Galen
- Health Care Sciences, Wayne State University, Detroit, MI, USA
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Factors Which Facilitate or Impede Interpersonal Interactions and Relationships after Spinal Cord Injury: A Scoping Review with Suggestions for Rehabilitation. Rehabil Res Pract 2017; 2016:9373786. [PMID: 28127471 PMCID: PMC5227179 DOI: 10.1155/2016/9373786] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 10/20/2016] [Accepted: 11/16/2016] [Indexed: 11/22/2022] Open
Abstract
Interpersonal interactions and relationships can influence an individual's perceptions of health and quality of life in the presence of disability. In the case of people with spinal cord injury (SCI), positive interpersonal interactions and relationships have been shown to contribute to resilience and adaptability. Understanding factors which facilitate or impede the development and maintenance of relationships after SCI may form the basis for proactive relationship support for people with SCI. To gain a broad insight into these factors, a scoping review was undertaken. Databases were searched for English language studies published between 2000 and 2015 that informed the review question. Sixty-two (62) studies were identified. Thematic analysis was conducted on data extracted from the studies and 51 factors which may facilitate relationships and 38 factors which may impede relationships after SCI were noted. The majority of factors could be categorized as environmental or personal according to the domains of the International Classification of Functioning, Disability, and Health (ICF). The facilitating factors included partner and social support, reciprocity in relationships, and presenting oneself positively. Impeding factors included physical environmental barriers, real and perceived social biases, and poor self-image. Factors identified may inform the provision of supportive, holistic rehabilitation for people with SCI.
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