Survey on International Health Professional Training and Attitudes on Sexuality After Traumatic Brain Injury

Traumatic brain injury (TBI) is associated with a range of deficits that may negatively impact sexuality. Few studies have explored how professionals respond to sexuality issues among individuals with TBI. The present study aimed to examine the attitudes and level of training of international health professionals working with individuals with TBI and whether guidelines exist in their work settings related to sexual issues. A survey composed of 53 questions was developed to evaluate attitudes, professional training, and assessment related to sexuality among health professionals working with individuals with TBI. The sample consisted of 324 self-identified health care professionals. During their training, 83% of professionals reported not taking any specific courses, and 61% reported not taking any type of clinical practice related to sexuality issues after TBI. Approximately 70% reported knowing little information about sexuality issues related to TBI and believed it affected the way in which they address the topic with their patients. Professionals believed sexual expression among both cognitively intact (100%) and cognitively impaired (90%) patients was healthy. Sixty-nine percent reported their work setting had no guidelines to determine if an individual with TBI can consent to sexual activity or not. Sixty-six percent of professionals believed that a patient with severe TBI could consent to sexual activities; however 58% believed it is not their responsibility to determine that. Results demonstrated a need for enhanced educational curriculums with specific courses related to sexuality after TBI. Furthermore, institutions should develop guidelines for the assessment of capacity to consent to sexual activity.     

Sexuality and the Late Stage Huntington's Disease Patient

Huntington's Disease (HD) is an irreversible subcortical dementia resulting in uncontrolled movement; loss of intellectual function; impaired memory, thought, speech and perception; and emotional disturbance. This study assessed sexual interests, needs related to sexuality, and intimacy issues in severely impaired, late stage HD patients through use of structured interviews. Results of interviews of a small population of HD patients residing in a long-term care facility are provided; interviews focused on sexuality issues, patients' perceptions of their intimate and sexual relationships, and their interest in discussing sexuality concerns with staff. Almost half of the patient population displayed an interest in discussing sexuality issues. Interview results indicated the need for caregivers to recognize that patients are sexual beings, with sexual needs, fantasies and wishes. HD patients have the potential to develop feelings of attraction, which must be dealt with in a clear, careful, sensitive manner. Suggestions are offered for ways in which caregiving staff could compensate for the sexual losses, including: providing a private room for a married patient to have intimate time with a spouse; offering sexually-oriented videos or reading materials if the individual wants them; providing romance novels and films; considering the possibility of providing a patient with a means to stimulate himself or herself.     

Sexuality, intimacy, and marital satisfaction in Iranian first-time parents

This study aims at investigating the sexual relationship and intimate of postpartum spouses and the effect of those relationships on their marital satisfaction. A sample of 128 postpartum couples having given birth to their first child (6-36 weeks postpartum) participated in this study during 2009. A nonexperimental, cross-sectional survey design was conducted using Sexual Interest and Desire Inventory, Personal Assessment of Intimacy in Relationship Scale and Revised Dyadic Adjustment Scale. Using univariate and multivariate regression analysis, results suggested that there were higher levels of sexual desire reported by husbands and there was a significant positive relationship between sexuality and marital satisfaction, for both genders. Moreover, high intimacy diminished the negative effects of marital satisfaction due to reported low sexual satisfaction. Regarding negative effects of marital dissatisfaction in first-time families, it is important to assess main related issues such as postpartum sexuality and intimacy, to obtain knowledge for health care providers to provide support to the postpartum families.     

Renegotiating Sexuality and Intimacy in the Context of Cancer: The Experiences of Carers

There is a growing body of evidence to show that cancer can result in dramatic changes in sexuality, sexual functioning, and intimate couple relationships, with significant implications for both quality of life and psychological well-being. However, the experiences of intimate partners are often neglected in research on sexuality and intimacy in the context of cancer. This study used a material-discursive framework and a qualitative methodology to investigate the ways in which intimacy and sexuality are renegotiated in the context of cancer, and what factors are associated with successful or unsuccessful renegotiation, from the perspective of partners caring for a person with cancer. Twenty participants were interviewed, across a range of cancer types, stages, and age groups. Eleven participants reported that they were unable to negotiate other ways of being sexually intimate when penetrative sexual intercourse was no longer physiologically possible or desirable. Nine were able to renegotiate sexual intimacy in the context of cancer to include practices previously positioned as secondary to “real sex,” such as mutual masturbation, self masturbation, manual stimulation, oral sex, massage, the use of vibrators, kissing, and hugging. Grounded theory analysis identified two themes associated with renegotiation: “Alternative” sexual practices-redefining sexual intimacy, and couple communication and relationship context. Difficulties in renegotiation were associated with adherence to the coital imperative, sexual relationship or communication problems which existed prior to cancer, and the positioning of the person with cancer as a child or an asexual sick patient rather than a sexual partner. The implications for health professional intervention to ameliorate changes to sexuality in the context of cancer are discussed.     

Sexual life after breast cancer

The trauma of being diagnosed and treated for breast cancer can impact greatly on womens' psychosexual functioning and intimate relationships. Survivors of breast cancer report that issues of body image, sexuality and partner communication rarely are addressed by traditional health care providers (Ganz, Rowland, Desmond, Meyerowitz, & Wyatt, 1998). Psychotherapy can help women cope with difficult changes in body image and sexual functioning, and there is evidence that psychotherapy may prolong life (Speigel, Bloom, Kraemer, & Gottheil, 1989). However, many mental health professionals are not comfortable addressing sexual issues, nor are they well versed in the medical aspects of the disease and its treatment. It would seem that marital and sex therapists are better equipped than most to provide mental health services to breast cancer patients.     

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 Stroke Care: A Neglected Quality of Life Issue in Stroke Rehabilitation? A Pilot Study

Although there is a substantial body of literature on the physical and psychosexual consequences of stroke, there is a paucity of empirical studies on the experiences of rehabilitation professionals in addressing sexuality issues with patients during the rehabilitation process. This is the first small-scale pilot study in Northern Ireland, informed by a comprehensive literature review, which explores the experiences of health and social care professionals in addressing sexuality issues with patients and their perceptions of the training they require in this area of stroke rehabilitation. Questionnaire survey data were collected from community and hospital based stroke professionals in a Health and Social Services Trust in Northern Ireland. The study groups comprised nurses, doctors, physiotherapists, occupational therapists, speech and language therapists and social workers. The findings revealed that although the majority of staff had been asked for advice on sexuality issues during rehabilitation, most of them had received no training in this aspect of stroke rehabilitation since joining stroke services. The findings suggest that all rehabilitation professionals need to become more knowledgeable about sexuality issues in stroke care and could benefit from further education and training in comprehensive sexual health care.     

Sexuality in the palliative–terminal phase of cancer

The objective of this paper is to increase the knowledge on intimacy and sexuality during the palliative–terminal phase of cancer. For this purpose, qualitative information has been gathered during sexology consultations with surviving partners (usually when attending with a new partner). In the first stages of cancer the major targets are coping with the diagnosis and surviving. In this period most couples practice intimate cuddling. After the treatment stage, the process of recovery starts. Depending on the physical damage, their flexibility and their set of values, couples return to their premorbid levels of sexual functioning or below that. When the patient enters the palliative or the terminal stage other changes takes place. The need for pleasure, grief, love, relaxation, distraction, painkilling, affirmation or anger results in a wide variety of love-making. Some couples quit sex completely, some are satisfied with only petting, but others get into active, desperate and even violent sex. Frequently pain, tiredness, changed physical sensations and disturbed hormone levels interfere with these sexual needs. Listening to the reactions of patients in this terminal phase, sexology can learn some lessons. The variety of sexual reactions clearly shows that sex has many more meanings than only relation, recreation and procreation. Maybe the most impressive message is that sex is not only for the young, the healthy and the beautiful. In this phase quality of life becomes very important; patients, and their partners, deserve sexological care and attention. Since many treatment contraindications have disappeared, quality of life in general and quality of sexual life in particular can be improved by changing treatment interventions.     

In pursuit of intimacy: disability stigma,womanhood and intimate partnerships in South Africa

Notions of womanhood inculcate naturalised ideologies of femininity, sexuality, motherhood and caregiving. The paper asks how disability stigma intersects with womanhood to characterise intimate partnerships in South Africa. In-depth interviews with 30 women with a range of disabilities were conducted in informal settlements in Cape Town. Findings suggest that disability stigma may hamper attainment of normative womanhood and sexual relationships for women with disabilities in South Africa. Limited opportunities to meet potential partners, hegemonic gender expectations and restricted sexual and physical contact shape their intimate partnerships. However, women with disabilities also challenge ableist constructs of normalcy and discredit negative images of disabled womanhood. Because of this, theoretical models of intimate partner violence should consider the influence of disability on constructions of sexuality and norms in intimate partnerships. Building on women with disabilities’ stigma-avoidance strategies will help facilitate better relationship outcomes. Social norms interventions with broader society, communities, women with disabilities and their partners, family and carers can help destabilise assumptions that women with disabilities are unable to have long-lasting and fulfilling sexual and intimate partnerships. Moreover, accessible and relevant sexuality education and information on relationships, intimate partner violence, maternal and sexual and reproductive health care can ensure healthy and safe intimate partnerships for women with disabilities.     

Sourcing the crowd for health services improvement: The reflexive patient and "share-your-experience" websites

In countries where the notion of "reflexive patients" dominates the health policy landscape, patients are increasingly encouraged to publicize their personal experiences with health services provision by reviewing hospitals and professionals on the web. The number of websites where patients can review one or more aspects of their care (and read reviews posted by others) is growing. These sites are an example of the practice of crowdsourcing, where applications that facilitate user-generated content solicit feedback from a given public; site administrators then use this feedback for product development, quality improvement and policy change. The research presented here examines such developments in the context of ongoing discussions about reflexive consumerism and increased transparency in healthcare. It draws on data from a three-year study of share-your-experience sites in the U.S., U.K., and The Netherlands. Data is taken primarily from a discourse analysis of four of the six sites under study, including patient reviews of institutions and professionals (n=450). Supplementary data from interviews with stakeholders related to the Dutch sites (n=15) is also used. This is the first known study of multiple share-your-experience websites in different countries. It shows that monitoring as "reflexive" behavior is not automatic, but is encouraged by website creators who, hoping to use the posts for other purposes, act as mediators between patients and other healthcare stakeholders. It further argues that patients demonstrate more reflexivity than some stakeholders realize, although not necessarily in the way that Giddens proposed. It concludes with the argument that the focus on reflexivity in healthcare means that not only institutions must be more transparent about their performance; patients are expected to be more transparent about their choices, as well.     

Sexuality, Identity and Women with Spinal Cord Injury

Sexuality is an integral component of every individual’s identity. The literature offers limited information about the sexuality and sexual identity of women with spinal cord injury (SCI), beyond the physiological and neurological aspects. The qualitative study described in this paper aimed to explore the experiences and perceptions of a small sample of adult women with SCI regarding their sexuality post-injury. Semi-structured interviews were conducted with four women, which were audio-taped and then transcribed. Thematic analysis was adopted for analyzing the narrative data. Themes that were identified include: factors facilitating positive sexual adjustment, barriers to sexuality post-injury and lack of sexual education in the rehabilitation process. Women with SCI echoed the need to be recognized as sexual beings, despite disability. Health professionals must be willing to discuss issues of a sexual nature and need an understanding of how illness or disability may impact on sexuality, in order to adequately assist individuals with physical disabilities address sexual and intimacy issues.     

Sexuality and Nursing Process: A Literature Review

The purpose of this paper is to explore the literature on addressing sexuality and sexual health in nursing practice and using nursing care process for the assessment of sexual problems of individuals. Sexuality is a part of life and being human. Sexual function may be affected negatively owing to disease, treatment or surgery and changes may occur in the sexual function of any individual. In order to maintain the sexual function of individuals and improve the quality of life, health professionals must identify and solve sexual problems. Nurses can use nursing process in determining and addressing the sexual problems of individuals. The literature review was conducted utilizing several databases, selected because of their relevance to the subject under review and including CINAHL, Medline (PubMed) and Nursing Journals (PubMed). Results highlight the benefit of nursing care process in addressing the sexuality and sexual problems of people with various diseases. Nurses are aware that assessing sexuality, diagnosing sexuality problems, and evaluating outcomes of interventions to address patients’ sexuality concerns are part of holistic care. However, they often do not perform sexuality assessment in practice. The conclusion is nurses working in accordance with nursing procedures play a key role in achieving success and providing integrated care help individuals to express their sexual problems.     

Sexuality and People with Psychiatric Disabilities

This article explores the topic of sexuality and intimacy of people with severe mental illness by addressing a series of questions about the nature of psychiatric disability and its effects on sexual identity and behavior. After describing the characteristics of people with psychiatric disabilities, the paper explores where they fit in the disability rights movement and examines how society treats persons with psychiatric labels. Barriers to full sexual expression are explored, first, from consumer perspectives, and then from the research literature, including a look at impediments to use of contraception and safer sex practices. Finally, the analysis asks a series of questions about issues for women mental health consumers in the expression of their sexuality and access to women's health services, along with sexuality issues for gay, lesbian, bisexual, transgender, and HIV-positive consumers. Finally, the paper concludes with suggestions for ways the disability community and larger society can support mental health consumers' efforts to freely express their sexuality and combat stigmatizing societal representations of it.     

Sexual reactivation of chronically ill and disabled adults

Nurses, occupational therapists, and physical therapists have acknowledged the importance of their roles, and their lack of knowledge, as related to the sexual reactivation of chronically ill and disabled individuals. This article reviews the sexual implications for adults of arthritis, heart disease, stroke, and amputations. The purpose is to familiarize allied health professionals with the specific physical or pharmacological problems affecting sexual intimacy in these conditions and with the methods of intervention or remediation that may be used in rehabilitation. Suggestions are provided to help the allied health professional who feels uncomfortable with the topic of sexuality to begin to assume a responsive and responsible role toward holistic care.     

Mothers, daughters and sexual agency in one low-income South African community

Statistics indicate that sexual health problems like HIV/AIDS and teenage pregnancies are prevalent among young South African low-income women. To improve the effectiveness of preventative programmes for adolescents it is important to focus on adolescents' own understanding and experience of their sexual behaviour within the contexts in which it occurs. Female adolescents' experiences of their own sexuality are shaped by a range of contexts: from the very specific context of their intimate relationships to the broader contexts of gender, ethnicity and social class. It is therefore imperative to adopt a research approach that stratifies groups and develops interventions that are based on the needs, interests, sexual beliefs and behaviours of specific communities rather than developing general educational messages. The current paper is part of a larger study exploring female adolescent sexuality in a South African low-income rural coloured community. Twenty-five adolescent coloured women aged 14-18 years were interviewed about how they viewed their sexuality. The grounded theory analysis indicated that the participants demonstrated a limited sense of sexual agency in these constructions of their sexuality. The mothers of these young women were powerful agents in the young womens' constructions of their own sexuality and they unintentionally contributed to their daughters' limited sense of sexual agency. Mothers presented sex as a dangerous activity to their daughters. This discourse of sex as danger contributed towards a mutual understanding that sex should not be talked about. Daughters' deception of their mothers about their sexual activity maintained mother-daughter connections, but left them without an interactional space where they could talk freely to their mothers about sexuality.     

Perspectives of Portuguese People with Physical Disabilities Regarding Their Sexual Health: A Focus Group Study

The World Health Organization has considered sexual health as a major dimension of global health and a sexual right. However, the sexual health of people with physical disabilities is still poorly addressed by health and social care professionals, and it is very stigmatized by society. This study aimed to assess the perspectives of Portuguese people living with physical disabilities regarding issues affecting their sexual health. Nine women and 17 men with different physical disabilities participated in the study. Participants were recruited from a professional rehabilitation facility located in the North of Portugal and were assigned to four groups in one-hour sessions. Three main categories emerged from the content analysis: (1) meanings and beliefs regarding sexuality; (2) experiences of sexuality; (3) necessary changes. Despite the positive social changes towards sexuality, participants expressed that their sexual rights are still unfulfilled, as they live in a context that perpetuates their dependency. They pointed out low self-esteem, prejudice and social isolation, poor architectural accessibility and scarcity of financial support as some of the barriers to their lives and their sexual health. Finally, participants identified the main needs regarding their sexual health, such as: access to specialized information; training for health professionals. This study gives voice to people with physical disabilities and sheds light into both individual and contextual factors affecting their sexual health. Of utmost importance, this study draws attention to the need for reinforcing sexuality of people with disabilities in the social agenda and brings implications for future research and practice.     

"Opening a can of worms": GP and practice nurse barriers to talking about sexual health in primary care

BACKGROUND: There is evidence that health professionals do not discuss sexually related issues in consultations as often as patients would like. Although primary care has been identified as the preferred place to seek treatment for sexual health concerns, little is known either of the factors that prevent GPs and practice nurses initiating such discussions or of how they feel communication in this area could be improved. OBJECTIVE: The purpose of the present study was to identify barriers perceived by GPs and practice nurses to inhibit discussion of sexual health issues in primary care and explore strategies to improve communication in this area. METHODS: Semi-structured interviews were conducted with 22 GPs and 35 practice nurses recruited from diverse practices throughout Sheffield. RESULTS: The term 'can of worms' summarized participants' beliefs that sexually related issues are highly problematic within primary care because of their sensitivity, complexity and constraints of time and expertise. Particular barriers were identified to discussing sexual health with patients of the opposite gender, patients from Black and ethnic minority groups, middle-aged and older patients, and non-heterosexual patients. Potential strategies to improve communication about sexual health within primary care included training, providing patient information and expanding the role of the practice nurse; however, several limitations to these approaches were identified. CONCLUSION: GPs and practice nurses do not address sexual health issues proactively with patients, and this area warrants further attention if policy recommendations to expand the role of primary care within sexual health management are to be met.     

Talking about sex to oncologists and about cancer to sexologists

More than 50% of all cancer sufferers suffer from sexual problems. This can be a major issue for them, but is one which is often not dealt with appropriately. Both patients and professionals are reluctant to bring up the topic. The patients are embarrassed, and feel it may be seen as trivial compared to survival. Professionals may also be embarrassed, and may be unsure how to deal with sexual issues should they be discussed. Professionals may also have biased and judgmental attitudes to sex and sexuality, particularly in relation to age and sexual orientation, which interferes with their patient care. Research has shown that patients wish their doctors to discuss sexuality with them, and if mentioned at an early stage in the cancer journey, then the sexual outcomes may be better. There are also practical barriers to open discussion of sex with these patients, such as lack of time and opportunity in relation to the overwhelming issues that have to be faced in relation to the cancer. Sexual counselors with no clinical background would also benefit from some knowledge of cancer and its treatments in order to understand the physical impact of the disease. Improved professional education and increased awareness of sexual issues and modes of treatment coupled with the provision of early information to the patients should greatly improve patient care.