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Contrada M, Cerasa A, Pucci C, Ciancarelli I, Pioggia G, Tonin P, Calabrò RS. Talking about Sexuality in Stroke Individuals: The New Era of Sexual Rehabilitation. J Clin Med 2023; 12:3988. [PMID: 37373681 PMCID: PMC10299413 DOI: 10.3390/jcm12123988] [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: 02/27/2023] [Revised: 06/05/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
One of the largest causes of mortality and disability worldwide is stroke. In the last twenty years significant objectives have been achieved in the early and chronic treatment of motor and cognitive dysfunctions, increasing the quality of life in patients and their caregivers. However, there is an unresolved clinical issue that remains: sexual dysfunctions. Multiple etiologies, including organic (such as lesion localization, premorbid medical problems, and drugs) and psychosocial (such as fear of recurrences, loss of self-esteem, role shifts, anxiety, and depression), are associated with sexual deficits. In this perspective review, we reported the last piece of evidence about this crucial topic which drastically affects the quality of life of these patients. Indeed, although patients may often not disclose their sexual concerns, literature demonstrates that they seek help concerning this issue. On the other side, clinicians working in the rehabilitation field are not always comfortable or prepared to deal with sexuality and sexual function in neurological patients. A new phase of the training course should be launched including different physicians, nurses, rehabilitation specialists, and social workers, to learn how to deal with topics related to sexuality. As a result, professional sexual counselors should now become a structured part of stroke settings and rehabilitation with new effective tools (i.e., PLISSIT model; TDF program) for improving quality of life.
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Affiliation(s)
| | - Antonio Cerasa
- S. Anna Institute, Via Siris 11, 88900 Crotone, Italy
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy, 98164 Messina, Italy
- Pharmacotechnology Documentation and Transfer Unit, Preclinical and Translational Pharmacology, Department of Pharmacy, Health Science and Nutrition, University of Calabria, 87036 Rende, Italy
| | | | - Irene Ciancarelli
- Department of Life, Health and Environmental Sciences, University of L'Aquila, 67100 L'Aquila, Italy
| | - Giovanni Pioggia
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy, 98164 Messina, Italy
| | - Paolo Tonin
- S. Anna Institute, Via Siris 11, 88900 Crotone, Italy
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Hwang JHA, Fraser EE, Downing MG, Ponsford JL. A qualitative study on the attitudes and approaches of Australian clinicians in addressing sexuality after acquired brain injury. Disabil Rehabil 2022; 44:8294-8302. [PMID: 34951561 DOI: 10.1080/09638288.2021.2012605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE Studies indicate that up to 50% of survivors of acquired brain injury (ABI) experience persistent changes in sexuality. However, research on clinicians' perspectives in addressing sexuality issues post-ABI is limited. This study explored the attitudes and approaches, barriers and facilitators, and training preferences of Australian clinicians in addressing sexuality in individuals post-ABI. METHOD Purposive sampling was used to recruit 20 Australian multi-disciplinary clinicians from a related survey study. Semi-structured interviews were conducted and qualitatively analysed using thematic analysis. RESULTS Three broad themes were identified: ABI results in multi-faceted changes in sexuality; there is a fundamental discomfort in talking about sexuality; and, strategies proposed by clinicians may help to improve sexuality support. Participants also provided suggestions for sexuality training, which they believed should start at university. CONCLUSION Most clinicians are aware of sexuality issues post-ABI but fail to adequately address sexuality in individuals post-ABI due to personal levels of discomfort, perpetuated by institutional factors. Therefore, participants believe that changes made at individual and institutional levels may increase sexuality support for individuals with ABI. However, further research on the causes and treatment of sexual problems and patient perspectives is required to provide the evidence-based guidelines and training programs that clinicians require.Implications for rehabilitationUp to half of individuals experience changes in sexuality after ABI that restrict quality of life and relationships.The consequences of ABI and their impacts on sexuality are understood by Australian clinicians but remain largely unaddressed due to individual discomfort, perpetuated by institutional factors.This study suggests that professional training targeted towards understanding, assessing and treating sexuality issues post-ABI may help to reduce the discomfort.Adjustments should also be made at individual, policy and procedural levels to ensure that sexuality is addressed within rehabilitation post-ABI.
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Affiliation(s)
- Jill H A Hwang
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Elinor E Fraser
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Marina G Downing
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia.,Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Australia
| | - Jennie L Ponsford
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia.,Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Australia
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Gustafsson L, Arfaras T. Sexuality early after stroke. Aust Occup Ther J 2022; 69:511-513. [DOI: 10.1111/1440-1630.12841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 12/01/2022]
Affiliation(s)
| | - Toni Arfaras
- Australian Occupational Therapy Journal Melbourne Australia
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Calabrò RS. Post-stroke Sexual Dysfunction in Men: Epidemiology, Diagnostic Work-up, and Treatment. INNOVATIONS IN CLINICAL NEUROSCIENCE 2022; 19:12-16. [PMID: 36204166 PMCID: PMC9507142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Stroke is a leading cause of death and disability throughout the world. Although physical and cognitive impairments after stroke have been well studied, little is known about sexual functioning and satisfaction in these patients, despite being crucial aspects of quality of life. Post-stroke sexual dysfunctions seem to be common; in men affected by stroke, a decline in libido and poor or curtailed erection and ejaculation are frequently observed. Sexual disorders after stroke are thought to be due to multiple etiologies, including both organic (e.g., lesion localization, premorbid medical conditions, medications) and psychosocial (e.g., fear of recurrences, loss of self-esteem, role changes, anxiety and depression) etiologies. Thus, the exploration of sexual dysfunction and sexual counseling by trained professionals should be part of stroke rehabilitation.
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Calabrò RS, Cerasa A, Pioggia G. When patients don't tell, clinicians don't ask: the need for assessing sexuality in the rehabilitation setting. Ann Phys Rehabil Med 2021; 65:101610. [PMID: 34844014 DOI: 10.1016/j.rehab.2021.101610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/05/2021] [Accepted: 11/08/2021] [Indexed: 11/26/2022]
Affiliation(s)
| | - Antonio Cerasa
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy, Messina, Italy; S Anna Institute, Crotone, Italy; Pharmacotherapy Documentation and Transfer Unit, Preclinical and Translational Pharmacology, Department of Pharmacy, Health Science and Nutrition, University of Calabria, Italy
| | - Giovanni Pioggia
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy, Messina, Italy
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Jiménez E, Ordóñez F. A Pilot Study of the Psychosocial Impact of Low-Cost Assistive Technology for Sexual Functioning in People with Acquired Brain Injury. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3765. [PMID: 33916565 PMCID: PMC8038503 DOI: 10.3390/ijerph18073765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/01/2021] [Accepted: 04/02/2021] [Indexed: 11/17/2022]
Abstract
People with acquired brain injury (ABI) face limitations when performing activities of daily living, including sexuality. Despite the common use among this group of assistive technology to compensate for or neutralize the limitations deriving from their condition, there is very little literature on outcome measures in assistive technology for sexual functioning. The aim of this study was to explore the psychosocial impact of the use of low-cost assistive technology in people with ABI. The sample was made up of 18 users: 15 men and 3 women diagnosed with ABI. The PLISSIT model was used, as well as the Psychosocial Impact of Assistive Device Scale-PIADS as an assessment tool. Three types of low-cost assistive technology were developed: seat cushions, bed equipment, and back supports. All three types of AT obtained positive scores on the PIADS total scale and its three subscales: competence, adaptability, and self-esteem. Although the results of this study are positive, more research into outcome measures for products to improve sexual functioning in people with ABI is required.
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Affiliation(s)
- Estíbaliz Jiménez
- Facultad Padre Ossó, Universidad de Oviedo, 33003 Oviedo, Asturias, Spain;
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Na Y, Htwe M, Rehman CA, Palmer T, Munshi S. Sexual dysfunction after stroke-A biopsychosocial perspective. Int J Clin Pract 2020; 74:e13496. [PMID: 32100415 DOI: 10.1111/ijcp.13496] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/13/2020] [Accepted: 02/24/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Poststroke sexual dysfunction (PSSD) is widespread and underrecognised, affecting over half of stroke patients with significant effects on a patients' quality of life. We reviewed the postulated factors contributing to PSSD and explore the underrecognition by presenting a questionnaire study as well as examining existing literature. METHODS A literature search between January 1980 and December 2019 in electronic databases such as EMBASE, MEDLINE and PubMed was conducted. The questionnaire study involved all adult stroke patients attending the outpatient clinic over a 6-month period, containing multiple choice and open questions relating to prevalence, impact and provision provided for patients with PSSD. FINDINGS Poststroke sexual dysfunction is unlikely attributed solely to the physical effects of stroke. We present a biopsychosocial model summarising the wide range of factors which can contribute to PSSD. Less than 10% of patients receive any advice despite 90% of patients hoping for advice relating to sexual dysfunction in stroke. INTERPRETATION AND IMPLICATIONS A multidisciplinary, proactive involvement in screening and managing PSSD is required to successfully manage a commonly forgotten complication of stroke. As part of the wider theme of managing lifestyle factors poststroke (eg, smoking, driving advice, dietary advice, alcohol), the 'sexual function aspect' of patients' lives must not be ignored.
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Affiliation(s)
- Yuuki Na
- Department of Stroke, Nottingham University Hospitals NHS Trust, Nottingham, NG5 1PB, UK
| | - May Htwe
- Department of Stroke, Nottingham University Hospitals NHS Trust, Nottingham, NG5 1PB, UK
| | - Chaudhury Abdul Rehman
- Department of Stroke, Nottingham University Hospitals NHS Trust, Nottingham, NG5 1PB, UK
| | - Tracy Palmer
- Department of Stroke, Nottingham University Hospitals NHS Trust, Nottingham, NG5 1PB, UK
| | - Sunil Munshi
- Department of Stroke, Nottingham University Hospitals NHS Trust, Nottingham, NG5 1PB, UK
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