Sexuality and the Patient with a Stoma

The formation of a stoma consequent to abdominal surgery represents a major change in a person's life, and results in complex emotional, social, and physical concerns including sexuality. The establishment of a stoma affects sexuality directly by disruption of nerve and blood supply to the genitals and indirectly by the effect on body image, self esteem, and by virtue of its position, problems with management of the stoma during sexual activity. Research indicates that the extent of these concerns are dependent on the disease state preceding the surgery and the type of stoma established as well as the ability of the patient to adapt to the changes. Health professionals play an important role in education and counselling stoma patients. They should therefore by sensitised to the issue and develop the competence to deal with it as needed.     

Sexuality and Adolescents with Autism

Appropriate education in sexuality is critical to the development of a person's positive self-esteem. The development of a healthy self-image may overcome potential feelings of depression and loneliness for the person with autism. This paper addresses the need for and challenges to providing sexuality education to individuals with autism. It summarizes teaching methods and approaches which have proven to be successful with this population.     

Sexuality and Intimacy in Alzheimer's Patients and Their Partners

Geriatric Sexuality remains one of the more sensitive and controversial issues to be confronted in today's clinical setting. Research indicates that older adults continue to be sexually active well into later life. Older adults with dementing illnesses experience deleterious changes in sexual functioning that can affect their quality of life. However, few health care professionals ask older adults about their sexual functioning. This paper addresses means of fostering acceptance by professionals and families and creating an environment that nurtures sexuality in couples coping with dementia.     

Sexuality in Samoan art forms

This article explores the manifestations of sexuality in Samoa as they are revealed through songs, poetry, dance, gestures, verbal expressions, stories, and games. For each of these art forms, texts and translations of original material are presented, as an aid to discerning the uses and functions of sexuality as they are applied by Samoans for Samoans; to this end, formalized joking of various types is seen as the medium through which the humorous element of sexuality is expressed. Elsewhere, sexuality functions to achieve and sustain individual attention. The explicitly sexual references in funeral and marriage songs, on the other hand, constitute affirmations of social values, incorporated in long-established rites. In what is tantamount to artistic license, performance of song, poetry, and dance containing sexual elements or references that would be prohibited in other contexts is constituted as acceptable behavior. In marked contrast to nineteenth-century writings, and the opinions of the popular press, sexuality in Samoa is far from free in its modes of expression, but rather adheres to traditional formalized patterns which determine its occasions, participants, and verbal and kinetic limits. Although not indispensable as a means of personal expression, it generally provides additional opportunities for the creative and aggressive individual to demonstrate his artistic talents and thereby contribute to his own social elevation. As an element of verbalized group sentiment, it is a positive assertion of Samoan values, a statement of social solidarity.     

Sexuality and Women with Spinal Cord Injury

Women with spinal cord injury (SCI) have unique concerns and problems related to their sexuality. The purpose of this study is to assess sexual issues in women with SCI, for better management and rehabilitation of such patients. Consequently, 40 such women were interviewed based on a standardized questionnaire. Evaluation of sexual activity, medical problems most significantly interfering with sexual activity, menstruation, pregnancy, child bearing and relationships was done. Interest in sex and importance of sex in lives did not change significantly after SCI. The key concerns after SCI were sexual, bladder and bowel dysfunctions, bed sores, pain, spasticity and satisfaction of partner and cultural taboos. Only, 30% women had received information on sexual matters, that too to isolated problems. There is a distinctive need for clinical attention, education, research and development around gynaecological/reproductive, sexual and urogenital issues unique to women with SCI in India.     

Women with Complete Spinal Cord Injury: A Phenomenological Study of Sexuality and Relationship Experiences

The phenomenological study described in this paper examines the sexuality and relationship lived experiences of 15 adult women who sustained complete spinal cord injury between the levels of T6 and L2 verified by a physiatrist. Audiotaped, semi-structured interviews were conducted by an interdisciplinary team of investigators. A set of themes and sequentially consistent patterns emerged from post-injury data that were labelled: Cognitive-genital dissociation, sexual disenfranchisement, sexual exploration, and sexuality reintegration. Sexuality and relationship issues in women with complete SCI are discussed, and indications for future studies and educational implications are presented.     

Sexuality,aging, and the education of health professionals

Expansion of medical personnel's knowledge of sexuality, especially for the aged, has progressed minimally from 1950s' tendencies toward avoiding the topic or fatalism in reflecting on it. Some progress has been made from past emphases on “plumbing” and most medical schools now provide at least some course work on sexuality. A reality of inconsistent content and teaching methodology persists, however, and its product is still widely viewed by sexuality educators as inadequate. This paper reviews research on academic programs preparing medical and health professionals for dealing with issues of sexuality.     

Sexuality in Morocco: Changing context and contested domain

This paper offers a critical review of what is known about the expression of sexuality in Morocco, by bringing together several domains of research-studies of Islamic doctrine, anthropological research on sexuality, ethnographies of Muslim countries, as well as recent studies of sexual behaviours and attitudes in Morocco. The traditional context of sexual behaviour in Morocco was shaped by the dynamic interplay among several forces: A relatively permissive religious tradition, an inegalitarian system restricting women's autonomy and privileging male satisfaction, and a keen awareness among women of the connections between sexual exchange and power relationships. This situation is rapidly changing as a result of momentous demographic and socio-economic transformations that have radically altered the frequency and quality of interactions between men and women and the realities of the marriage market, and contributed to the emergence of a youth culture attuned to global trends but rooted in local sensitivities. The case of Morocco illustrates the ways in which the domain of sexuality is contested as a result of discrepancies between Islamic doctrine and its application, changing relations between the sexes, socio-economic transformations, and competing claims for legitimacy and authenticity.     

Understanding of Sexuality and Reproductive Health Among Women With and Without Physical Disabilities

This study compares differences in how women with disabilities and women without disabilities learned about their sexuality and reproductive functioning. A written questionnaire was sent to a national sample of women with disabilities and their non-disabled woman friends recruited through independent living centers and announcements in the media. Responses were received from 504 women with disabilities and 442 women without disabilities. Participants were asked how old they were when they first learned about the physical aspects of sexual intercourse. Women with disabilities learned about the physical aspects of sexual intercourse at about the same age (M = 13.16) as women without disabilities (M = 12.93). The most commonly reported sources for learning about sexuality and sexual functioning for both groups were books and other printed material, having sex, partners, friends, and teachers in primary school. More women with disabilities received information from a woman with a disability and a rehabilitation counselor. Women in both groups indicated that sex was never or seldom the subject of general family conversation. On average the women with physical disabilities had their first date at age 16.6, which is later than women without physical disabilities (M = 14.91). Women with physical disabilities who reported having acquired sexuality information at a later age reported having sexual intercourse at an older age (M = 20.37) than women without physical disabilities (M = 17.75). Age at acquiring sexuality information was neither associated with frequency of intimate touch nor frequency of sexual intercourse. The results of this study can be used to generate recommendations for health care professionals concerning ways to respond more effectively to the special needs for sexuality information of physically disabled women.     

Sexuality and the patient with dementia

Caretakers in a geropsychiatric medical unit offering care to patients with dementia diagnoses were surveyed regarding their views of the sexual conduct of their patients. The majority of them described difficulties in managing patients who displayed sexual behaviors. Sexually active and interested patients were both male and female. The majority of the sexual encounters observed by caretakers was not considered to be consensual. Exploitation and sexual assault of vulnerable individuals who lack any way of defending themselves was a concern expressed. Caretakers' views of patient characteristics that predict sexual behavior and effective strategies to discourage sexual approaches of vulnerable patients are discussed.     

Affection and Sexuality in the Presence of Alzheimer's Disease: A Longitudinal Study

Affection and sexuality were studied longitudinally for two groups of couples, one with an Alzheimer's disease (AD) afflicted spouse and the other spouse the primary caregiver, and a second group with both spouses relatively healthy. Affectional expressions were not different for the two groups prior to illness onset but declined significantly for the AD group five years into the illness trajectory; affection remained stable for the well group. Based on follow-up data obtained two years later, outcomes for afflicted spouses were taken into consideration, and the pattern for affection was be reexamined. Affection increased significantly after nursing home placement of an ill spouse. Fewer AD than well couples were sexually active five years into the illness trajectory. The problem of hypersexuality in a few male afflicted spouses had abated two years later. The number of well couples who were sexually active also declined over time, but several couples continued at the same or higher levels of sexual intimacy. The study contrasts normal aging from pathological deviations within a human developmental perspective.     

Sexuality in aging: A study of 106 cultures

Human Relations Area Files data relating to sexual activity among older individuals in 106 traditional societies were studied to identify cross-cultural patterns of variability in sexual behavior occurring with age. In 70% of the societies for which data were available relating to the sexual behavior of older males, a continuation of sexual activity of various kinds was found to occur with aging. These groups were seen to have expectations for continued sexual activity for older men that implied little, if any, loss of their sexual powers until very late in life. Among females, reports of continued sexual activity and interest were found to occur in 84% of the files containing data on the sexual behavior of this age group. Reports of expressions of strong sexual interest by older women were common in these societies. In addition, 50% of the references to sexual activity of older females were found to relate to changes in the women's role as procreant. A lessening of inhibition in regard to sexual conversation, sexual humor, and sexual gestures was noted in 22% of these 106 societies. This diminution of restraint in regard to sexual conversation was reported more frequently among older women, 74% of the reports of such behavior referring to females. The continuance of sexuality in many societies during aging and the limitation of sexuality in other societies suggests that cultural as well as biological factors may be key determinants in sexual behavior in the later part of life.     

The Attitudes of Medium-Secure Unit Staff Toward the Sexuality of Adults with Learning Disabilities

The attitudes of staff toward the sexuality of adults with learning disabilities within a medium-secure hospital within the United Kingdom were examined using qualitative research methods. Four interviews were conducted with staff members of both sexes from differing occupations. Interviews were transcribed and analyzed using a method adapted from Worthen and McNeill (1996). The analysis revealed that staff members generally held liberal attitudes with respect to the sexuality and masturbation. However, with respect to sexual intercourse, homosexual relationships, and the involvement of adults with learning disabilities in decisions regarding their own sexuality, less liberal attitudes were detected. Concern was also noted with respect to the attitudes of female staff members towards the sexuality of adults with learning disabilities who have committed sexual offences. Training issues were also identified and implications for the service were discussed.     

Self-report assessment of female sexual function: Psychometric evaluation of the brief index of sexual functioning for women

Previous self-report measures of female sexual function have been either overly restrictive or inappropriate for use in large-scale clinical trials. Accordingly, we have developed the Brief Index of Sexual Functioning for Women (BISF-W), a 22-item, self-report instrument for the assessment of current levels of female sexual functioning and satisfaction. The BISF-W was administered at monthly intervals to a standardization sample of 269 women, ages 20–73 years. A principal components analysis yielded a three-factor solution—interest/desire, sexual activity, and satisfaction—which accounted for 51.2% of the variance. Concurrent validity was demonstrated by means of a comparison with the Derogatis Sexual Function Inventory. In addition, the BISF-W was compared to the Brief Sexual Function Questionnaire, a similar self-report measure of sexual functioning for men. Major advantages of the BISF-W are its ease of administration and scoring, suitability for use in both clinical and nonclinical samples, and assessment of key dimensions of female sexuality. However, based on its moderate test—retest reliability and internal consistency, further development of the instrument is indicated.     

Psychosocial Issues,Sexuality, and Cancer

It is well-documented in the literature that psychosocial factors play a significant role in the development and progress of, adaptation to, and survival from cancer. Cancer and its treatment often lead to psychiatric co-morbidity, precipitate spiritual crisis, compel lifestyle changes, and disrupt family and social relationships. One area most affected by cancer is quality of life, including sexual functioning. Cancer treatment may increase risk of infertility, difficulty with intimacy and sexuality, employment discrimination, increased general distress, and fear of recurrence. In addition to describing the psychosocial impact of cancer and its treatment, and discussing how psychosocial factors affect sexuality and sexual functioning, this paper concludes with options available to manage the sexual problems and related psychosocial issues in order to restore optimal sexual functioning.     

Sexuality and the Demented Patient

The older adult has not generally been presented by the media as sexually driven or as sexually active, except as a joke. Sexual activity, when displayed by older adults on television or movies, is often limited to hugs or kisses, a relatively dilute depiction when compared to some of the passionate, fleshrevealing glimpses seen in movies portraying younger populations in sexual encounters. When references are made to older adult sexual activity in television or movies, they are typically accompanied by a wink or guffaw. With this restrictive attitude toward older adults' sexuality, one must question whether sexual feelings or activities are likely to be topics that are seriously considered or even mentioned by the caretakers of the geriatric population, particularly caretakers of demented patients. The management of sexuality in this population, including consensual sexual activity as well as forced sexual encounters, are topics which merit attention and should be addressed by the facility and for individual patients in their care plans, in accordance with OBRA regulations.     

Aphasia and Sexuality

Changes in sexuality following stroke have attracted the interest of clinical researchers, but studies seldom include aphasic individuals, who comprise almost one third of the stroke population. Studies excluded those with moderate or severe aphasia because they cannot participate in interviews or complete questionnaires used in sexuality research. This pilot study investigated how stroke changed sexuality for aphasic people and their spouses. We sought their input as to when these issues should be addressed during the process of stroke recovery, and by whom. Interviews included a structured verbal questionnaire supported by gesture, written, and pictographic materials. Responses were qualitatively analyzed. We found that aphasia affects sexuality differently than for other stroke patients. They believe that improved communication skills would help their sex life. Aphasic individuals and their spouses are open to discussing sexuality with a physician and have specific medical, physical, and psychological issues they wish to address.     

Thermographic measurement of sexual arousal: A methodological note

A thermographic measure of sexual arousal in terms of the four stages of sexual stimulation (excitement phase, plateau phase, orgasm phase, and resolution phase) articulated by Masters and Johnson (1966) is described. A male and female masturbated to orgasm; the results are presented in terms of interpretations of both the thermographic image and the quantitative temperature profile. Possible future research applications are suggested, including sexual dysfunctions, sexual arousal, and gender differences.This research was supported by University of California, Los Angeles, Biomedical Research Funds and a University Research Grant.Requests for reprints should be sent to Paul R. Abramson, Department of Psychology, University of California, Los Angeles, 405 Hilgard Avenue, Los Angeles, California 90024.