Interviewing people with chronic illness about sexuality: an adaptation of the PLISSIT model

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.

Introducing a Clinical Practice Guideline in Physiotherapy to Address Sexuality in Adults with a Neuromuscular Disorder

Purpose:

We present the development and the key elements of a clinical practice guideline (CPG) in physiotherapy aiming to address sexuality, more specifically impairments and limitations that can interfere with sexual activity in adults with a neuromuscular disorder (NMD).

Method:

The CPG was based on the Rare Knowledge Mining Methodological Framework (RKMMF) and included a literature review, consultation with physiotherapists, and validation by an interdisciplinary team. The EX-PLISSIT (extended, permission, limited information, specific suggestions, intensive therapy) model and the Competency Profile for physiotherapists in Canada were also used as frameworks to divide the CPG into sections. Here, we present the methodology for the CPG development and key elements related to physiotherapy assessment and treatment related to sexual activity in people with NMDs.

Results:

An extensive CPG was developed through a literature review, consultations, and a validation process. A total of 75 articles were included in the review. Twelve physiotherapists and four health professionals reviewed the CPG. Physiotherapists should address the following in their assessment: relationships; assistance required during sexual activity; urinary, vaginal, or anorectal symptoms; erectile dysfunction; pain; fatigue; and the impact of the NMD on sexuality. Interventions can target physical activity, positioning, muscle weakness, fatigue, decreased range of motion, erectile dysfunction, sensitivity disorders, lubrication, pain, incontinence, and cardiorespiratory implications.

Conclusions:

The CPG promotes the importance of addressing sexuality and proposes different interventions that physiotherapists should integrate into their practice.

Sexual Health in COPD: A Systematic Review and Meta-Analysis

COPD has a profound impact on the lives of patients and their partners, but the influence on physical, psychological and social aspects of sexual health has not been reviewed systematically. Searches for studies of the impact of COPD on sexual health were conducted independently by two authors in the databases of PubMed, PsycINFO, Embases, CINAHL, Web of Science, Scopus and The Cochrane Library. English-language quantitative and qualitative studies assessing one or more aspects of sexual health in patients diagnosed with COPD were narratively reviewed and, when possible, subjected to meta-analytic evaluation. A total of 31 studies, including 4 qualitative, were included. Twelve studies assessing erectile dysfunction with the International Index of Erectile Function were subjected to meta-analysis. The pooled prevalence of erectile dysfunction was 74% (95% CI: 68-80%) in a total of 1187 patients with COPD, compared with 56% (37-73%) in 224 age-matched, non-COPD controls. The sexual health outcomes assessed in the remaining studies varied considerably, compromising the comparability of the results. None of the qualitative studies had sexual health as their primary focus. Compared with non-COPD individuals, erectile dysfunction appears to be more prevalent among patients with COPD, but more studies including non-COPD controls are needed to confirm this finding. In addition, the impact of COPD on other physical, psychological and social aspects of sexual health remains unclear due to the lack of comparable assessment methods and study designs.

The effect of counseling based on the PLISSIT model on sexual quality of life of married women with multiple sclerosis referring to MS center in 2019: a randomized, controlled trial

Multiple sclerosis is the most common progressive neurological disability in young adults. Sexual quality of life is mainly attributed to feelings of sexual attraction, showing interest and participating in sexual activity. The PLISSIT model shows 4 levels of intervention: Permission, limited Information, Specific Suggestions, and Intensive Therapy. The purpose of this study was to investigate the effect of counseling based on the PLISSIT model on the sexual quality of life of married women with multiple sclerosis referring to MS center in 2019. This randomized controlled trial study was conducted on 62 married women with multiple sclerosis. In the experimental group, based on the PLISSIT model, face-to-face counseling was conducted weekly in 4 sessions and each session lasted between 45 and 75 min. The control group received no intervention. Due to ethical issues, after completing the research, an educational guide on the quality of sexual life was given to the control group. The data collection tool was a questionnaire of sexual quality of life containing 18 questions. Data were analyzed using descriptive statistics and SPSS software. The results showed that there was no significant difference between the two groups before the intervention (P > 0.05). However, 2 weeks and 2 months after the intervention, the overall level of sexual quality of life in the experimental group was significantly better than the control group (P < 0.05). This study showed that counseling based on the PLISSIT model could have better results on the quality of life in sex.

Psychobehavioral Treatment Options for Sexual Dysfunction in Multiple Sclerosis: A Systematic Review

BACKGROUND

Sexual dysfunction in multiple sclerosis (MS) is a significant but overlooked impairment, and treatment options are rare. The aims of this systematic review were to identify psychological interventions used to treat sexual dysfunction in MS, to estimate their benefit, and to note appropriate treatment approaches for research projects and clinical use.

METHODS

A systematic review update was conducted to find psychological interventions aiming to improve sexual dysfunction in MS. A comprehensive search and review of MEDLINE, PsycINFO, CINAHL, and PubMed were completed, and the effects and quality of selected studies were reported.

RESULTS

Six publications with 295 participants were identified. All selected studies assessed the effectiveness of psychological interventions on sexual dysfunction or sexual satisfaction in people with MS; four studies directly targeted sexual dysfunction in MS, one was a mindfulness yoga program to improve fatigue and quality of life, and one other presented a secondary analysis of a study targeting depression in MS. All six studies reported significant improvements in sexual dysfunction or sexual satisfaction and somewhat in psychological variables.

CONCLUSIONS

A pressing need for development and adequate evaluation of psychological interventions for sexual dysfunction in MS remains. In addition, assessment of sexual dysfunction in MS and its treatment should be more focused in clinical care.

Empowering Patients and Health Professionals to Address Sexual Health in the Context of Anorectal Malformations and Hirschsprung's Disease

The aim of this study is to develop a tool that is aligned with patients' and health professionals' needs to address sexual health in the context of anorectal malformations and Hirschsprung's disease. A multiphased participatory action-research was conducted. First, an inventory of needs was made through interviews (11 patients, 11 professionals), three online focus groups (4 patients, 20 professionals), and a questionnaire (38 patients). Subsequently, four cocreation sessions with in total four patients and nine professionals were organized to translate the needs into a tool (in the form of a website). The websites' functionality was assessed via a questionnaire (n = 34). The website, directed to patients, their parents, and professionals, stimulates awareness, fills knowledge gaps, and shows possibilities for support. The website is expected to change restrictive attitudes toward sexual health and improve the legitimization of the topic needed for the allocation of resources and sexologists' involvement in current care pathways.

Differences in the Sexual Function and Sexual Healthcare Needs of Pregnant Women Who Underwent in Vitro Fertilization and Women Who Conceived Naturally at Each Trimester: A Prospective Cohort Study

Introduction

Infertility may negatively impact sexual function. Women with fertility problems usually prioritize treatment for infertility, but their sexual function in each trimester of pregnancy is poorly researched.

Aim

To compare the sexual function and sexual healthcare needs of women who underwent successful in vitro fertilization (IVF group) and women who conceived naturally (CN group) during each trimester.

Methods

Longitudinal prospective cohort study was conducted from August 2016 to July 2018. The IVF group (n = 100) was recruited from a leading reproductive treatment center; the CN group (n = 100), at the prenatal clinic of a medical center in central Taiwan. Questionnaires were mailed to women in the 10th–11th gestational week; 70 women in the IVF group and 75 in the CN group completed all 3 questionnaires, during the 10th–11th, 20th–21st, and 30th–31st gestational weeks.

Main Outcome Measures

Female Sexual Function Index and Nursing Intervention on Sexual Healthcare needs were compared between groups in each trimester.

Results

Most participants reported sexual dysfunction concerns during pregnancy. In the first trimester, the Female Sexual Function Index score was significantly lower in the IVF group than in the CN group (18.13 ± 6.27 vs 20.34 ± 5.87, respectively; P < .05). Sexual healthcare needs at the permission level were significantly lower in the IVF group than in the CN group (10.78 ± 2.41 vs 11.79 ± 2.67, respectively; P < .05).

Conclusion

The IVF group had lower sexual function in the first trimester than the CN group. Sexual function improved in the second trimester in the IVF group but decreased throughout pregnancy in the CN group. The CN group had a greater need for sexual healthcare nursing intervention at the permission level than the IVF group.

Huang C-Y, Liou C-F, Lu Y-C, et al. Differences in the Sexual Function and Sexual Healthcare Needs of Pregnant Women Who Underwent In Vitro Fertilization and Women Who Conceived Naturally at Each Trimester: A Prospective Cohort Study. Sex Med 2020;8:709–717.

Chronic Disease Burden, Sexual Frequency, and Sexual Dysfunction in Partnered Older Adults

This research evaluates the relationship between chronic disease burden and partnered sexuality of older adults by using data from the National Social Life, Health, and Aging Project. Ordinary least squares and logistic regressions identify how chronic disease burden is associated with sexual frequency and sexual dysfunction for men (N = 893) and women (N = 641). Results indicate that an increasing chronic disease burden is negatively associated with men's sexual frequency, while a greater burden of chronic disease is related to a greater risk of lubrication problems for women and orgasm problems for men. The findings reveal gender differences in how disease is linked to older adults' sexual lives.

The effectiveness of the Permission, Limited Information, Specific suggestions, Intensive Therapy (PLISSIT) model based sexual counseling on the sexual function of women with Multiple Sclerosis who are sexually active

OBJECTIVE

This study was conducted to evaluate the effectiveness of sexual counseling based on the Permission, Limited Information, Specific Suggestion, Intensive Therapy (PLISSIT) model on the Sexual Dysfunction (SD) of married sexually active women who suffer from Multiple Sclerosis (MS). This is the first sexual intervention applied by a midwife as a health professional on MS patients in Iran where the cultural and religious limitations are important challenging issues.

STUDY DESIGN

This randomized clinical trial was carried out in Iranian Community of Support for MS Patients in Tehran, Iran. The participating women who had a definite diagnosis of MS and SD, Expanded Disability Status Scale (EDSS) scores <7, and aged 18-55 years were randomly assigned to experimental (EG, n=43) and control group (CG, n=45). Participants in the EG group received 4 weekly sexual counseling sessions based on the PLISSIT model (90-120min per session).

MAIN OUTCOME MEASURES

Sexual function was assessed three times (before the intervention, and 2 months and 3 months after the intervention) using the Female Sexual Function Index (FSFI). Chi-square test, Fisher's exact test, and Repeated Measures ANOVA were employed to analyze the data.

RESULTS

The mean total FSFI score of the women in EG improved at 2 and 3 months after the intervention when it was compared with the FSFI score before the intervention (p<0.05). There was no significant difference in the total FSFI score when the data of 3 evaluations was compared in CG. A significant increase in the mean score of 6 subgroups was seen in EG (p<0.05) but not in CG.

CONCLUSION

According to this study, utilizing the PLISSIT model as a framework for sexual counseling can improve sexual function in women who are sexually active and suffer from SD due to MS.

The Correlation Between Breastfeeding Success in the Early Postpartum Period and the Perception of Self-Efficacy in Breastfeeding and Breast Problems in the Late Postpartum

INTRODUCTION

The research was conducted to determine the correlation between breastfeeding success in the early postpartum period and the perception of self-efficacy in breastfeeding and breast problems in late postpartum.

METHODS

This analytic and cross-sectional research was carried out at Aydın Obstetrics and Gynecology and Children's Diseases Hospital. Three hundred twenty-seven primipara mothers who had delivered a single baby of healthy term at 37 or more gestational weeks with no previous experience with breastfeeding and who agreed to cooperate participated in the research.

RESULTS

The mothers' mean gestational week of delivery was 39.25 ± 1.10 weeks, and it was found that 56.0% had delivered by cesarean section and 57.0% had started to breastfeed immediately after the birth. The mothers' LATCH mean score was 6.55 ± 0.86; their postnatal breastfeeding self-efficacy mean score was found to be 59.10 ± 7.21. Mothers who had high success in breastfeeding at early postpartum were found to experience fewer problems with their breasts (Z = -2.65, p < 0.05), gave birth by vaginal delivery (Z = -2.88, p < 0.05), and had not received anesthesia during the delivery (Z = -2.52, p < 0.05). In the correlation analysis, it was seen that mothers with high success in breastfeeding also had high self-efficacy scores (r = 0.210, p = 0.003).

CONCLUSION

The results of the research indicated that breastfeeding success in the early postpartum period reduced breast problems and increased the perception of breastfeeding self-efficacy in the late postpartum period.

Investigating the sexual function and its associated factors in women with chronic illnesses

AIMS AND OBJECTIVES

To evaluate sexual dysfunction and the factors that affect sexual dysfunction in women with chronic disease.

BACKGROUND

Sexual dysfunction is one of the most common problems in women with chronic disease. There is limited understanding of the related factors of sexual dysfunction in women with chronic disease, with research currently limited to other problems and problems related to chronic diseases.

DESIGN

This research was conducted as a descriptive survey.

METHODS

This study involved 100 female inpatients at clinics of internal medicine of a university hospital. Data were collected with a patients identification form and a female sexual function index (KCFI). Kruskal-Wallis test, test of significance of difference between two means and test of significance of difference between two pairs were used in the data analysis.

RESULTS

Sixty-five percentage of women in the sample were defined to have sexual dysfunction. The majority of women expressed pain during sexual intercourse, problems in orgasm and satisfaction, and reluctance to have sex. Older age, being unemployed, being in menopause, fatigue, sleep disorder, and pain and weakness in extremities were the factors that were found to significantly affect the prevalence of sexual dysfunction (p < 0.05).

CONCLUSIONS

This study concluded that sexual function of women with chronic disease is affected negatively. Chronic disease-related symptoms, experienced changes in the body and psychosocial problems are changing the lives of women. Ultimately, these changes also affect sexual activity.

RELEVANCE TO CLINICAL PRACTICE

Determination of the factors affecting sexual activity in women with chronic disease is important for women' ability to cope with sexual dysfunction and keep it under control. To be able to accomplish this, it is necessary for healthcare personnel, the partners and family to work together.

Sexuality and stroke: the effects and holistic management

Since the days of the early pioneering work of authors such as Glover (1985) and Woods (1987), there has been a proliferation of research and practice guidelines related to the effects of ill health on individuals' and couples' sexuality and sexual health (Reis et al, 2010; Sadovsky et al, 2010; Royal College of Nursing, 2000). This article reviews the common difficulties experienced by individuals and couples affected by stroke regarding to their sexuality and sexual health. Furthermore, it presents and explores a possible model of care that can be used in practice to address these difficulties with people affected by stroke.

Effects of Breast-feeding Adaptation, Attitude and Practice of Primipara Depending on Method of Postpartum Breast-feeding Education

PURPOSE

This study was done to identify the effects of individual postpartum breast-feeding education on adaptation, attitude and practice of breast-feeding in primiparas.

METHODS

A quasi-experimental nonequivalent design was used to examine the effects of individual postpartum breast-feeding education among primiparas. The data were analyzed using chi2-test, Fisher's exact test and paired t-test.

RESULTS

There was a significant difference in breast-feeding adaptation (t=-12.94, p<.001), breast-feeding attitude (t=-2.71, p=.011) and breast-feeding practice (chi2=16.47, p<.001) between the group education (experimental group I) and individual education after group education (experimental group II).

CONCLUSION

The results indicate that individual education on breast-feeding compared to group education has more positive effects on increasing breast-feeding adaptation, attitude and practice in primiparas. This result also indicates that many primiparas should be given opportunities of various types of education to improve breast-feeding practice such as individual approaches and postpartum breast-feeding education programs.