Let's talk about sex: lower limb amputation, sexual functioning and sexual well-being: a qualitative study of the partner's perspective

Examining the effects of acquired limb loss on the family network: a grounded theory study

Background: Individuals with acquired limb loss are faced with various challenges. Family networks become important in facilitating coping and recovery, but the limited research into their own experiences has so far only examined spousal and parental carers.Aims: This research aimed to: understand the experiences of acquired limb loss from the perspective of the family network; and to develop a theoretical model to explain how they experience limb loss of the other. The use of 'network' was adopted to include kin self-identified as family.Method: Participants (n = 14) were recruited nationally. Interviews were conducted in a process moving from unstructured, semi-structured and structured interviews, using Grounded Theory method.Findings: A theoretical model was developed around the interaction of five core categories. Families witness the difficulties faced by the person with limb loss, leading to a responsibility to provide support. Families subsequently experience various challenges of limb loss; together with numerous emotional reactions. Various forms of coping are used in order to resolve these experiences.Conclusions: Families are involved in the processes and challenges of an amputation in another family member, regardless of aetiology, gender or relationship structure. The theoretical model can be understood through the integration of existing research. The issues identified indicate potential considerations for services supporting such families.IMPLICATIONS FOR REHABILITATIONThe challenges and emotions experienced by family members have potential consequences for the support offered to the person with limb loss.This could ultimately influence the physical and psychological rehabilitation of the person with limb loss.Services should support families in witnessing difficulties in the person with limb loss, adjusting to relational changes and managing health care systems.

Prosthetic and orthotic students' attitudes toward addressing sexual health in their future profession

BACKGROUND:

Prosthetists and orthotists have a responsibility to direct treatment toward enabling their clients to perform desired activities and to facilitate participation of their clients in all areas of life. This may include provision of assistive technologies to help clients meet goals related to participation in sexual activities. To help prosthetic and orthotic students develop competencies in dealing with the sexual health of their future clients, it is necessary to generate knowledge of their own perceived competence and capacity.

OBJECTIVES:

To explore prosthetic and orthotic students' attitudes and competence toward working with sexual health and to evaluate reliability and validity of the Students' Attitudes Towards Addressing Sexual Health questionnaire.

STUDY DESIGN:

Cross-sectional study.

METHODS:

Students enrolled in all three years of an undergraduate prosthetic and orthotic program were requested to complete the Students' Attitudes Towards Addressing Sexual Health questionnaire ( n = 65). Reliability and validity were evaluated using the content validity index and Cronbach's alpha.

RESULTS:

Students felt unprepared to talk about sexual health with future clients and thought that they would be embarrassed if they raised the issue. No differences were identified between students enrolled in each of the three years of the program and few differences were observed between male and female students. The content validity index values were low but improved as the students' level of education increased. Internal consistency of the questionnaire was acceptable ( α = 0.86).

CONCLUSION:

Prosthetic and orthotic students are unprepared to address sexual health issues with their future clients. There is a need to provide students with training related to sexual health issues.

CLINICAL RELEVANCE

This study indicates the need for additional education of prosthetic and orthotic students in issues related to sexual health and how to address sexual health issues with clients. Results can be used to develop training programs for students and will serve to improve the sexual health of individuals who receive prosthetic and orthotic services.

Sexual behaviours and sexual health outcomes among young adults with limiting disabilities: findings from third British National Survey of Sexual Attitudes and Lifestyles (Natsal-3)

OBJECTIVE

To explore whether the sexual behaviours and sexual health outcomes of young adults with self-reported disabilities that they perceive limit their activities ('limiting disability') differ from those without disability.

DESIGN

Complex survey analyses of cross-sectional probability sample survey data collected between September 2010 and August 2012 using computer-assisted personal interviewing and computer-assisted self-interview.

SETTING

British general population.

PARTICIPANTS

7435 women and men aged 17-34 years, resident in private households in Britain, interviewed for the third National Survey of Sexual Attitudes and Lifestyles.

MAIN OUTCOME MEASURES

Self-reported sexual behaviour and sexual health outcomes.

RESULTS

Approximately 1 in 10 participants reported having a limiting disability. Sexual behaviours were similar between those with limiting disability and those without, with a few exceptions. Women and men with limiting disability were less likely to report having sexual partner(s) (past year, adjusted ORs (AORs) for age and social class: AORs: 0.71, 0.75, respectively). Women with limiting disability were more likely to report having same-sex partner(s) in the past 5 years (AOR: 2.39). Differences were seen in sexual health outcomes, especially among women; those with limiting disability were more likely to report having experienced non-volitional sex (ever, AOR: 3.08), STI diagnoses (ever, AOR: 1.43) and sought help/advice regarding their sex life (past year, AOR: 1.56). Women with limiting disability were also more likely to feel distressed/worried about their sex life than those without limiting disability (AORs: 1.61). None of these associations were seen in men.

CONCLUSIONS

Young adults with limiting disability, especially women, are more likely to report adverse sexual health outcomes than those without, despite comparatively few behavioural differences. It is important to ensure that people with disabilities are included in sexual health promotion and service planning, and targeted policy and programme interventions are needed to address negative sexual health outcomes disproportionally experienced by people with disabilities.

Talking with patients about sex: results of an interprofessional simulation-based training for clinicians

Sexuality is often a neglected topic in healthcare consultations. Several factors have been identified by clinicians as barriers to communication around sexuality, including lack of time, inadequate training, and personal discomfort. Within the Program to Enhance Relational and Communication Skills (PERCS), we developed a half-day interdisciplinary workshop that focuses on communication skills around sexuality and management of sexual problems with patients (PERCS-sexuality). This study reports on the efficacy of six PERCS-sexuality workshops enrolling 84 clinicians. Through a pre-post-questionnaire, participants rated their preparation, confidence, anxiety, communication and relational skills in talking with patients about sexual issues. Qualitative questions were also asked on their learning experience. The workshop increased participants' preparation (p = 0.000), confidence (p = 0.000), communication (p = 0.000), and relational skills (p = 0.000). Anxiety did not decrease. Qualitative comments focused on: Acquisition of communication and relational skills, Importance of patient's sexuality, Appreciation of group dynamics, and Personal insights. The findings suggest that PERCS-sexuality is a useful training experience to improve clinicians' attitudes and skills in addressing sexuality with patients.

Sexual activity after dysvascular lower extremity amputation

OBJECTIVE

This study examined the prevalence and correlates of sexual activity among individuals experiencing their first dysvascular lower extremity amputation.

DESIGN

A prospective cohort was recruited from 4 Veterans Affairs Medical Centers. Of 198 potential participants who met inclusion criteria, 113 (57%) agreed to participate within 7 days of amputation (baseline) and 6 weeks, 4 months, and 12 months post-amputation; 105 completed the sexual activity items at baseline. Measures included self-reported frequency of sexual activity; desire for more or less sexual activity; importance of sexual activity to satisfaction with life; Patient Health Questionnaire-9; Locomotor Capability Index-5; pain intensity/frequency; quality of life.

RESULTS

Depending on the time period post-amputation, 11%-24% reported engaging in any sexual activity, although a majority indicated that sexual activity is very important to their satisfaction with life. Frequency of sexual activity increased between 6 weeks and 4 and 12 months post-amputation. In univariate analyses, older age was associated with decreased sexual activity at all time points; at 4 and 12 months, greater mobility was associated with increased sexual activity. In multivariable models, mobility was associated with sexual activity at 4 and 12 months; age and race remained associated with sexual activity at 4 and 12 months, respectively. At all time points, frequency and importance of sexual activity were significantly associated with one another.

CONCLUSIONS

Although a minority of individuals engaged in any sexual activity during the study period, it remained an important factor in overall satisfaction with life. Younger age and improved mobility were associated with increased sexual activity. Rehabilitation specialists are encouraged to address sexuality and, if relevant, incorporate it into rehabilitation goals. (PsycINFO Database Record