Gynecologic Care and Sexuality Issues for Women with Disabilities

Approximately ten percent of the world's population has a disability. In the United States, it is estimated that there are 43 million disabled people and roughly 30% of them are women. There is often limited physical and structural access to health care for disabled women. As young girls, women with disabilities are often told that marriage is not a possibility, which can lead to feelings of asexuality. Barriers to contraception for women with disabilities may be twofold; attitudinal as well as knowledge based. Sexually transmitted disease detection and prompt management interventions may be hampered by a number of factors. Women with disabilities that become pregnant have identical issues in many ways as compared with nondisabled women. Fertility and sexuality are closely intertwined. As a woman with a disability undergoes an infertility evaluation, her sexuality as well as identity as a woman may be threatened. Disabled women are living longer and are reaching the age of menopause while remaining active and involved in their family life, social life, and in the workforce.     

Cross-Cultural Views of Disability and Sexuality: Experiences of a Group of Ethno-Racial Women with Physical Disabilities

The field of sexuality research as it pertains to women with physical disabilities from different ethno-cultural communities is limited. This may be due to the lack of understanding among health care providers and researchers regarding the issues related to sexuality for women with disabilities. The impact of cultural beliefs and values related to sex and sexuality can further hinder women with disabilities from expressing themselves as 'sexual beings.' The purpose of this paper is: 1) identify issues and barriers experienced by women with disabilities from different ethno-cultural communities within an urban setting and 2) identify commonalities in experience of women with disabilities along the lines of cultural values about disability and gender.     

Providing Comprehensive Sexual Health Care in Spinal Cord Injury Rehabilitation: Implementation and Evaluation of a New Curriculum for Health Care Professionals

A grant from the Paralyzed Veterans of America funded the development, implementation, and evaluation of a three-day interdisciplinary continuing education and training program in comprehensive sexual health care. The program was targeted toward health care professionals working in spinal cord injury (SCI) rehabilitation. The major goal of the program was to offer participants an opportunity to increase the knowledge, comfort, and skills necessary to understand and manage the sexual health care needs of people with SCI. The curriculum included clearly stated goals, behavioral objectives in operational terms, and multiple quantitative and qualitative program evaluations. In addition, the comprehensive curriculum incorporated extensive skills training including state-of-the-art standardized patient training techniques. Evaluation results indicated statistically significant and qualitatively important positive gains in knowledge, comfort, and skills. The five month follow-up study indicated that skills learned over the three-day workshop were successfully transferred to the work environment.     

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.     

Health Care for Women with Physical Disabilities: Literature Review and Theory

This paper identifies, describes and analyzes the significance of the literature as it impacts on health care for women with physical disabilities. It considers both scholarly reviews of the literature as well as the literature written by women with physical disabilities themselves. It covers the topics of the disability field itself, the mainstream feminist movement, experimental disability writings, characteristics of the literature, health issues, reproductive health services, sexuality and sexual abuse and the future challenge.     

Sexuality After Injury: Interviews with Women After Traumatic Spinal Cord Injury

The aim of this study is to illuminate sexual experiences in women after traumatic spinal cord injury (SCI), including psychological, physical and social barriers that will have to be overcome to resume a sexually active life with a partner. Interviews with eight women were performed. The women were 20–43 years old, previously healthy, with experience of stable heterosexual relationships both before and after SCI. The interviews covered three main areas: 1. The first sexual contact after injury: expectations, concerns, outcome; 2. Communication with partner on sexual matters, before and after injury; and 3. Sexual activity after injury: limitations, compensatory strategies. In addition, advice from the women to newly injured and rehabilitation staff/counselors was requested. Results suggest a strong influence of pre-injury sexual behaviour on post-injury sexual adaptation. A positive attitude towards sexuality and good communicative skills seem to be of particular importance for a favourable outcome of sexual rehabilitation. Even under such circumstances, however, SCI as a rule leads to significant loss of sexual ability. A realistic approach is therefore recommended in counseling, taking the mourning of loss of function into consideration, and allowing the patients to express their grief. Thus, sexual rehabilitation programs need to address a dynamic process of mourning and coping, rather than merely teaching skills for having sexual intercourse after SCI.     

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.     

Persons with Intellectual Disability: Sexual Behaviour,Knowledge and Assertiveness

BackgroundPersons with ID most often have incomplete, contradictory and imprecise knowledge of sexuality and sexual intercourse itself. They are not provided with sufficient information on their own body and sexuality, and are often discouraged from and sanctioned for trying to sexually express themselves. Sexual abuse due to low sexual assertiveness is also common.AimThe principal aim of this study was to establish the presence or absence of sexual activity in adults with ID residing in institutional housing, as well as the level and structure of their knowledge of sexuality, their sexual assertiveness and preparedness to react in a sexually dangerous situation.MethodsThe sample consisted of 100 participants with ID residing in institutional housing. The instruments used included the General Sexual Knowledge Questionnaire, What-if test and Hulbert index of sexual assertiveness. Comparative statistics included coefficient of linear correlation and multiple regression analysis.ResultsThe results showed that 82% of the participants are sexually active. Most participants admitted to sometimes having sexual intercourse against their wishes as well as to having difficulty asserting themselves. Their knowledge of pregnancy, contraception and sexually transmitted diseases was very low. Female participants and those that reported having sexual intercourse had more sexual knowledge and were also more sexually assertive.ConclusionKnowledge of sexuality and sexual assertiveness of persons with ID residing in institutional housing is very low. Additional information on sexuality is necessary, as well as support in learning to express their own desires and to deal with unwanted sexual activity.     

Sexual Self-esteem and Body Image of South African Spinal Cord Injured Adolescents

Although adolescents sustain a large portion of spinal cord injuries, the area of spinal cord injured adolescents and the issues surrounding their sexuality are under-researched. This is the first South African study on the sexuality of spinal cord injured adolescents and attempts to address this paucity. It is generally postulated that the sexuality of adolescents who have sustained SCI will be detrimentally affected by the consequences of having a physical disability, resulting in developmental lags relative to non-disabled peers. The focus of this article is to explore the impact of spinal cord injury on adolescents sexual self-esteem and body image. A qualitative study was conducted, with data being collected via in-depth individual interviews, which were subsequently analyzed thematically. A disparity was found between dominant ableist discourses of the SCI adolescent as a sexually immature and passive spectator, and the lived experiences of the participants involved in the study. The study concluded that entrenched socially constructed attitudes appear to limit the opportunities for spinal cord injured adolescents to express their sexuality more than the limitations by their disabilities.     

Sexual Pursuits of Pleasure Among Men and Women with Spinal Cord Injuries

Following a spinal cord injury, sexual relationships, intimacy, and pleasure remain important pursuits for individuals. This literature review examines the subjective experiences of sexual intimacy for men and women with spinal cord injuries, as well as their intimate partners. Several themes emerged that span gender differences and nationality differences. Specifically, studies indicate that despite individual struggles with neutering internal and external perspectives, they can lead satisfying sex lives that may be more creative and mutually pleasurable than their sex lives prior to the injury. This review also provides suggestions to improve sex education and therapy following a spinal cord injury.     

The Sexual Health Needs of Women with Spinal Cord Injury: A Qualitative Study

Sexual health as an important aspect of reproductive health, is a foundation for physical and emotional health which also affects couples and families’ wellbeing. Furthermore, disability could impact couple’s sexual relationships. Studies show that people with physical disability receive less sexual education which in turn exposes them to a higher risk for sexually transmitted infections. This qualitative study explored the sexual needs of women with spinal cord injury (SCI) aged 18–55 years old living in Tehran. In depth and individual semi-structured interviews were hold for data collection until data saturation was reached. They were recruited from the Organization of Welfare and Protection Center of Spinal Cord Disables of Iran. In this study 23 individuals were chosen using purposive sampling. The collected data was analyzed using the content analysis approach suggested by Graneheim and Lundman. The sexual health needs of women with SCI was explained in two themes and nine categories. The themes were “physical rehabilitation” and “couples’ sexual consultation”. The categories of the first theme were “resolving physical problems contributing to sexual relationships” and “complementary medicine application”. The categories of the second theme were “the husband’s emotional support”, “concentration”, “protecting sexual health”, “the need for having sexual relationships”, “diminishing factors for unpleasant sexual relationships”, “paying attention to wife’s readiness to start sexual relationships” and “decreasing factors that suppress spouse’s sexual desire”. This study showed that women with spinal cord injury require sexual rehabilitation. They overcome their physical problems with the help of complementary medicine and sexual counselling around the aforementioned categories for promoting the quality of their sexual health.     

Sexual Responsiveness in Women with Spinal Cord Injuries: Differential Effects of Anxiety-Eliciting Stimulation

Sexual dysfunction is a common problem in women after spinal cord injuries (SCIs). Recently, the use of anxiety-provoking stimulation has been explored as a means of improving sexual responses in able-bodied sexually functional and dysfunctional women. In this laboratory-based study, we assessed the sexual and autonomic responses of women with SCIs with varying degrees of preservation of sympathetic innervation to their genitals to respond to anxiety-provoking audiovisual (AV) stimulation. Subjects were 45 women with SCIs and 11 able-bodied women. For purposes of analysis, SCI subjects were grouped on the basis of the degree of preservation of sensation in the T11-L2 dermatomes. Results revealed that women with low sensory scores in these dermatomes achieved higher vaginal pulse amplitude (VPA) responses to audiovisual erotic stimulation after anxiety preexposure than after neutral preexposure; however, women with SCIs and the greatest degree of preservation of sensory function in the T11-L2 dermatomes, as well as able-bodied controls, did not. Moreover, these same 2 groups of subjects had a decrease in VPA responses during baseline periods in which an anxiety-provoking video sequence was shown, but not during the neutral sequence. It is concluded that these findings are due to the proximity of sensory and autonomic neurologic elements in the spinal cord. Moreover, they demonstrate the differential effects of sympathetic stimulation on genital sexual arousal.     

Inventory of Sexual Experiences and Response in Disability (IEReSDi): Construction and Validation of the Scale of the Sexual Response in People with Disabilities

Mexico has approximately 2300000 people who live with some severe disability. Disability is a health problem that has increased progressively and as such, has serious consequences for the person who experiences it, as well as for the family. The impact of the disability on sexuality is an undeniable aspect that frequently is reported in scientific literature; there is also a general consensus among clinical investigators of diverse countries with respect to the effects as much at the physiological as at the psychological level of sexuality. How these changes affect the Mexican population is unknown, due to the scant amount of research. The intent of the investigation was to construct and validate an inventory that made it possible to know what sexual experiences and response is of disabled men and women in the Mexican Republic. This study was aimed at validating the properties of three scales which specifically identify the experiences that comprise part of the study subjects human sexual response; altogether 609 subjects, 464 women (76.2) and 145 men (23.8) between the ages of 14 and 87 (x = 37), 245 unmarried and 364 living as a couple, the frequency of motor disability taking first place (308 subjects = 50.6), followed by mental disability (113 subjects = 18.6) and visual deficits (68 subjects = 11.2). This inventory consists of three areas: (1) sexual satisfaction in disability, (2) sexual response in disability, and (3) factors that interfere with sexuality in disability; the area of sexual response includes scales of desire, arousal and orgasm. The inventory was applied individually and the results were processed through statistical package SPSS, doing analysis of frequencies, t tests, variance, and chi-square test, as well as reliability tests. The results show in all cases, a greater tendency by men with some type of disability to search for and be involved in experiences of an affective and sexual type, which makes one suppose that gender roles have a big influence on sex following disability.     

Sexual Dysfunction Following Spinal Cord Injury: the Experiences of Malaysian Women

The aim of the study is to assess the changes in sexual life and sexual function in women after spinal cord injury using the validated Malay Version of Female Sexual Function Index. Thirty-three women with spinal cord injury from the Spinal Rehabilitation Unit of a tertiary hospital in Malaysia participated in this study. A comparison was made between this group of women and a control group comprising 34 women matched for age and marital status. The findings showed that 40% of the women continued to have sexual activity after injury. Frequency of sexual activity and desire was lower among women with spinal cord injury, but the ability to achieve arousal, lubrication, orgasm and overall sexual satisfaction did not differ from those of the control group. These findings imply that it is possible for women with spinal cord injury to have an active, satisfying sexual life in spite of changes in sexuality caused by the injury.     

Sexual Experience of Women with a Physical Disability: A Comparative Study

The sexual experience of 167 women was compared: 82 women who suffered from a physical disability; 85 women free of physical impairment. Each participant filled out an extensive questionnaire (Frenken & Vennix, 1978). Areas investigated were sexual acceptance, psychosexual stimulation, sexual motivation and general sexual satisfaction. Sexual knowledge and sexual experience were briefly explored. Conclusions, which can be drawn from the study, appear to be that women with a disability have a more rejective attitude towards sexuality, less sexual knowledge and less experience with intercourse. They are less satisfied with their sexual experience. No difference was found with regard to sexual desire and fantasy; likewise both groups share equal sexual motivation when actively living in a sexual relationship.     

The Impact of Urinary Incontinence on Sexual Function and Sexual Satisfaction in Women with Spinal Cord Injury

Sexual function is a major concern for many individuals following spinal cord injury (SCI). Sexuality after SCI is a complex issue that is influenced by a number of social, psychological and physiological factors, including urinary incontinence (UI). To examine the experience of sexuality for women with SCI, to determine the impact of UI on sexual function and sexual satisfaction in these women, and to identify their main concerns regarding UI and sexuality. Using a phenomenological approach, seven in-depth interviews combining the interview guide approach and standardized open-ended questions were conducted. Two main categories were identified: Sexuality and the impact of UI on sexuality. Related themes were uncovered within each category. Both categories revealed emerging themes including 13 for sexuality and 10 for the impact of UI on sexuality. Five additional themes relevant to the research question but that did not fit into the initial categories were also identified. Intimacy and the sexual experience were negatively affected by UI as a result of SCI, and by an excessive concern about autonomic dysreflexia. There is a significant shortage of information available for women with SCI regarding sexual function in general, but more specifically, a lack of information on sexual function as it relates to UI. Future research should focus on creating resources to assist in this area which may improve the quality of life for these individuals.     

Postinjury Marriage to Men with Spinal Cord Injury: Women's Perspectives on Making a Commitment

No previous research seems to have examined why able-bodied women might choose to marry men with a significant, permanent physical impairment. This exploratory study employed a grounded theory methodology to examine the courtship experiences of 8 able-bodied women who made postinjury marital commitments to men with a spinal cord injury (SCI). A tentative model of relationship development integrated salient factors which emerged from the data. Contrary to what one might expect to find based on maladaptive motivations attributed to nondisabled mates by some authors, the present findings suggest a substantial overlap with existing models of courtship. There were evident, though, significant individual factors and external social forces influencing relationship development in the context of disability. Participants described their mates as positively adjusted to their disability and as demonstrating autonomous attitudes which, along with personality variables, were considered important elements of attraction. Participants revealed: an openness to a relationship with a partner with SCI; prior personal experience with disability; flexibility regarding role performance; acceptance of disability and need for assistance; an attitude aimed at fostering their partner's independence; and, resiliency when faced with social disapproval.     

A Wise Wife and Good Mother: Reproductive Health and Maternity among Women with Disability in South Korea

As the first national survey on disability and reproductive health in South Korea, the present study was undertaken to describe experiences and needs related to pregnancy, childbirth, and postnatal care among women with physical disability (WWPD). Using a stratified random sampling method, 410 married WWPD between the ages of 18 and 50 participated in the survey regarding respondents’ socio-demographic profiles, disability-related characteristics, and reproductive health during pregnancy, childbirth, and postnatal care. Findings of this study indicated that most respondents wanted to have a child and perceived child care as possible with appropriate social support. Unlike the conventional wisdom and low societal expectation for these women to perform a maternal role, they gave birth and became caregivers for their child(ren) and family members. This study highlights a wide range of barriers experienced by WWPD with regards to taking care of their reproductive health. Implications for practice and policy are discussed.     

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.