Sexual health care for people with physical disabilities

A Multidisciplinary Approach Improves Sexual Health Care for Youth with Duchenne Muscular Dystrophy

We sought to determine the prevalence of sexual health counseling in patients with Duchenne muscular dystrophy in a single-institution setting. Keywords related to sexual health and development concerns were documented at least once for 75% of patients across the duration of their care. Integration of sexual health discussions was facilitated by comprehensive multidisciplinary support, particularly with the inclusion of specialists in endocrinology and adolescent medicine.

A Missing Piece of Occupational Therapy Education: Attitudes About Sex

Following a lecture on sexual health and function, occupational therapy students were surveyed regarding their past sex education and their comfort level with the topic of sex. Students indicated a lack of sexual education received from parents/guardians and a prevalence of fear-based education from formal or informal sources. Results reflected a significant increase in students' perceived comfort level with the topic following the lecture from a provider trained and certified in sexual health. As sexuality falls within the domain of occupational therapy, these results suggest a need for comprehensive sex education taught to students by qualified instructors.

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

BACKGROUND

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

AIM

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

MAIN OUTCOME MEASURES

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

METHODS

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

RESULTS

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

CLINICAL IMPLICATIONS

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

STRENGTHS & LIMITATIONS

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

CONCLUSION

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

Reproductive and Sexual Health in Males with Physical, Hearing, and Vision Disabilities

Objective This study aimed to determine reproductive health, sexual functions, and sexual satisfaction levels of males with disabilities. Methods: The study had a cross-sectional, descriptive, and correlational design and was conducted on 136 males with disabilities. Data was collected using an introduction form, International Index of Erectile Function, the Erectile Performance Anxiety Index (EPAI), the Premature Ejaculation Profile (PEP), and the Sexual Satisfaction Scale (SSS). Results: The total EPAI score was 19.86 ± 8.98(10-50), the total PEP score was 9.91 ± 4.20(0-16) and the total SSS score was 86.79 ± 18.20(44-119). Conclusions: Education and counseling on reproductive and sexual health should be given based on their individual needs.

"He told me it would be extremely selfish of me to even consider [having kids]": The importance of reproductive health to women with spina bifida and the lack of support from their providers

BACKGROUND

As more women with spina bifida (SB) enter their reproductive years, the number having children is significantly increasing. However, little is known about their understanding of their ability to get pregnant or their experiences in considering, planning, or interacting with providers during a pregnancy.

OBJECTIVE

We sought to determine what women have been told and understand about their reproductive health, their attitudes towards having children, and their experiences interacting with providers when seeking reproductive health care.

METHODS

In this exploratory study employing qualitative research methods and following Grounded Theory, interviews with women with SB 16 years or older were transcribed verbatim and analyzed by three coders.

RESULTS

Interviews of 25 women with SB ages 16-52 (median 26) revealed the following themes about their reproductive health perceptions and experiences: 1) poor understanding of reproductive health and potential, 2) interest in having a family, 3) facing provider's opposition to their reproductive goals, 4) going into pregnancy and delivery unprepared, 5) the importance of provider support for reproductive goals. Five women experienced an unintended pregnancy.

CONCLUSIONS

Although having children is important to most women with SB in this study, they report a poor understanding of their reproductive potential with several noting unintended pregnancies. They feel uninformed and unprepared during pregnancy and face discouragement from providers. Those experiencing supportive providers report a more positive experience. This demonstrates the urgent need to educate women with SB about their reproductive health and the providers who care for them how to support and counsel these women.

Role of family caregivers regarding sexual and reproductive health for women and girls with intellectual disability: A scoping review

BACKGROUND

While people with intellectual disability (ID) face disparities relating to sexual and reproductive health (SRH) services, little is known about the role of family caregivers who assist women and girls with ID access SRH services. This scoping review examined the findings of studies to elucidate the role of family caregivers with regard to SRH for women and girls with ID.

METHOD

We used Arksey and O'Malley's six-stage scoping framework, with Levac, Colquhoun and O'Brien's revisions, to evaluate identified sources. We searched three electronic databases, six ID journals and reference lists in full-text articles. Inclusion criteria included (1) primary and secondary source research studies in peer-reviewed journals; (2) published in English; (3) all research methodologies (i.e. qualitative, quantitative, mixed methods and systematic reviews or commentaries); (4) published between 2000 and 2016; and (5) studies from any country.

RESULTS

The search yielded 2062 studies; 57 articles met inclusion criteria. Most studies employed purposive, convenience or criterion sampling. Participants included people with ID, family caregivers, paid caregivers and health-care professionals. Findings were summarised thematically: (1) menstruation and menopause; (2) vaccinations and preventive screenings; (3) supporting sexuality and healthy relationships; (4) coordinating with health-care providers and (5) contraception and sterilisation.

CONCLUSIONS

Findings from this scoping review underscore the need for more and better-quality research, including how family caregivers assist women and girls with ID access perinatal and preventive SRH services and sexual abuse education. Family caregivers, women and girls with ID and health-care providers need increased access to information about SRH.

Knowledge and sources of accessing sexual and reproductive health information among visually impaired women in Ghana

Objective

This study aims to explore the knowledge and sources of accessing sexual and reproductive health services and care information among visually impaired women in Ghana. Qualitative data involving in-depth interviews and focus group discussions were conducted among 21 visually impaired women selected through purposive and snowballing sampling techniques. Thematic Analysis was used to analyse the data.

Results

The study showed that visually impaired women were active seekers of SRH information (knowledgeable about SRH information and understand the relevance of accessing such information) and passive recipient of SRH information (through formal and informal sources). However, some contextual factors (lack of family and caregivers support services) created barriers for visually impaired women when accessing SRH information. Government advocacy and awareness campaigns on SRH services should consider both formal and informal sources. Family caregivers and SRH health centres should provide adequate support services for visually impaired women regarding information on SRH service.

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

INTRODUCTION

Women with spina bifida are sexually active, but most never discuss this topic with providers.

AIM

To determine what women with spina bifida understand about their sexual health, how they learned about it, what questions they have, and their experiences with their sexuality.

METHODS

For this qualitative study, women with spina bifida ages 16 and older without marked developmental delay were individually interviewed. 25 women with spina bifida participated (mean age 27.1 years, range 16-52). Interviews were independently coded for themes by 3 reviewers, using Grounded Theory, with disagreements resolved by consensus.

MAIN OUTCOME MEASURES

We identified overlapping themes regarding the women's perception and experience of their sexuality and sexual health education.

RESULTS

17 of the 25 (68%) participants had been or were currently sexually active. 5 themes emerged regarding their understanding of their sexuality and their sexual experiences: (i) being perceived as asexual, (ii) sources for sex education, (iii) need for spina bifida-specific sex education, (iv) impact of spina bifida-specific features on sexual encounters, and (v) perceived relationship between low sexual self-confidence and risk for sexual assault.

CLINICAL IMPLICATIONS

Women with spina bifida are sexual beings, but they are perceived as asexual by providers, which prevents them from getting adequate sexual health education and leaves them with misconceptions and unanswered questions, as well as vulnerable to sexual abuse.

STRENGTH & LIMITATIONS

The strengths of this study include the diversity of women interviewed, including their age, severity of disability, and experiences with their sexuality, as well as the ability to reach thematic saturation. The limitation of this study is that most women received treatment at a single Midwestern tertiary referral center in the United States.

CONCLUSION

Including sexual health discussions in the usual care of women with spina bifida is critical to enhancing their sexual confidence and experience and preventing sexual abuse. Streur CS, Schafer CL, Garcia VP, et al. "If Everyone Else Is Having This Talk With Their Doctor, Why Am I Not Having This Talk With Mine?": The Experiences of Sexuality and Sexual Health Education of Young Women With Spina Bifida. J Sex Med 2019;16:853-859.

[Andrology - Whom and how are patients being referred?]

INTRODUCTION

Andrology focuses in male sexual and fertility diseases. Its referral should be thoughtful and tailored in order to select the correct cases.

OBJECTIVES

The aim of this work was to evaluate the referral to our department and improvement points.

MATERIAL AND METHODS

A retrospective analysis was performed of the Andrology consults between January 2014 and December 2015.

RESULTS

We evaluated 96 of the 102 consults performed. About 60% of patients were referred with erectile dysfunction complaints, 15% with penile curvature and 8% with ejaculatory dysfunction. About 27% had previously tried phosphodiesterase 5 inhibitor, and 40% lacked recent metabolic workup.

DISCUSSION

The high prevalence of sexual complaints coupled with a high number of naïve patients could be due to difficulties by the referral doctors when analyzing and characterizing male sexual dysfunction according to the current sexual response cycle model. The lack of patient categorization accordingly to Princeton criteria (III) shows the difficulties found when selecting patients to start the first line of treatment for erectile dysfunction.

CONCLUSION

Sexual dysfunction are highly prevalent in the general population. Healthcare providers should improve diagnostic and treatment skills in this field of Urology.

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.

Lifestyle Choices Can Augment Female Sexual Well-Being

Female sexual wellbeing is complex and it's an important part of a comprehensive approach to women's health. Unfortunately, this aspect of health often is not discussed during medical appointments which can be isolating for female patients. Low libido is the most common female sexual dysfunction. There are multiple causes of low libido that may be physical, cultural, emotional, medical psychological or due to her relationship with her partner. A healthy lifestyle is one way to help women overcome low libido and a few examples include exercise, mindfulness and yoga. Ultimately, these lifestyle approaches can enhance sexual satisfaction.