Family systems approach to sexual dysfunction in neurologic disability

The treatment of sexuality issues among the disabled is improved by the use of tools drawn from the Family Systems Model. The systems perspective lends an overview of the unique meaning of sex to the individual client as he or she has learned it in the context of the family. The construction of a genogram and an ecogram map the psychosexual patterns that are affected by the onset of a disability, suggesting treatment that exactly matches the needs of the persons involved. Use of the model is beneficial for many other reasons than the increased effectiveness of treatment, however. It is faster and more effective than many other modalities. It is a good tool for training teams to better understanding their own family sexuality messages. Lastly, picturing of the issues supports the development of research and therefore resources for the treatment of sexuality matters among the disabled.ACSW, BCD     

An empirical study of the sexual abuse of people with intellectual disability

This study describes a comparison between the level of sexual knowledge and experience of sexual abuse among people with intellectual disability and people without intellectual disability. The Sexual Abuse section of the Sexual Knowledge, Experience, and Needs Scale (SexKen) was completed by 30 people with intellectual disability (18 females, 12 males) and 50 control subjects (32 females, 18 males). The results demonstrated a lower level of sexual knowledge among the people with a disability but no differences between the groups in the level of incest and other unwanted sexual activities. There was a high percentage of people with intellectual disability who believed that someone else decides about the level of their sexual experience. They also expressed less negativity about sexual abuse. These findings are discussed in the context of sex education programs for people with intellectual disability.     

Sexuality in neurologic disability: An overview

Sexuality concerns commonly arise in individuals with both acquired and congenital neurologic disabilities. As health care professionals it is critical to have an understanding of the potential consequences of neurologic impairment on sexuality as well as sexual function. Psychologic, latrogenic, and secondary medical issues must all be taken into consideration when addressing the primary sexuality concerns. An understanding of normal neuroanatomy and neurophysiology is critical if one is to propose interventional strategies in this patient population. Basic concepts regarding sexual functioning in specific neurologic conditions including spinal cord injury, cerebral vascular accidents, traumatic brain injury, peripheral neuropathies and multiple sclerosis will be reviewed. The General Rehabilitation Assessment Sexuality Profile will be reviewed as it pertains to the sexual history, sexual physical exam, and clinical sexual diagnostic testing. Lastly, treatment options for both genital and nongenital sexual dysfunction in neurologic disability will be examined.     

Sexual esteem,sexual satisfaction,and sexual behavior among people with physical disability

This study investigated the association between the severity and duration of physical disability and sexual esteem, sexual depression, sexual satisfaction, and the frequency of sexual behavior. A total of 1,196 participants completed the study. There were 748 participants (367 males, 381 females) who had a physical disability and 448 participants (171 males, 277 females) who were able-bodied. The age range of participants was 18–69 years, with a mean age of 36.39 years (SD = 10.41). The results demonstrated that people with more severe physical impairments experienced significantly lower levels of sexual esteem and sexual satisfaction and significantly higher levels of sexual depression than people who had mild impairments or who did not report having a physical impairment. The study also found that people with more severe physical disabilities engaged in mutual sexual activity significantly less frequently. Women with physical disabilities had significantly more positive feelings about their sexuality and significantly more frequent mutual sexual experiences than their male counterparts. For people with physical disabilities, the frequency of oral sex and nude cuddling were significant predictors of sexual satisfaction in men, while the frequency of deep kissing predicted sexual satisfaction in women. Furthermore, the viewing of erotica was significantly related to sexual dissatisfaction in men. Finally, it was found that people who had experienced their physical impairment for a longer period of time reported significantly more positive feelings about their sexuality. Implications of these findings are discussed and suggestions are made for future research.     

Self-concept,sexual knowledge and attitudes,and parental support in the sexual adjustment of women with early- and late-onset physical disability

Three groups of college women were compared on the following dimensions: sexual experiences, sexual satisfaction, self-concept, sexual attitudes and knowledge, and parental support for sexual development. Groups were composed of women with late-onset physical disability, early-onset physical disability, and no disability. Measures utilized included an extension of the Sexual Interaction Inventory, the Tennessee Self-Concept Inventory, the Sexual Knowledge and Attitude Test, and questionnaires developed for this study. The early-onset group reported fewer current sexual experiences than did the nondisabled group. The early-onset group was dissatisfied with the frequency of sexual behavior to a greater degree than the nondisabled group. Also, both disabled groups believed that they could enjoy sexual experiences more than they did at present in contrast to the nondisabled group. There were no group differences for self-concept, though several aspects of self-concept contributed significantly to sexual adjustment for the disabled groups. No group differences were found for sexual knowledge and attitudes or parental support for sexual development, nor did these variables relate to sexual adjustment. Group differences in sexual adjustment are discussed in terms of functional, emotional, and social implications. Recommendations for further research include following the social development of women with lateonset conditions, comparing the social skills and cognitions of the two disabled groups, and assessing men who have established intimate relationships with disabled women.     

Physical disability: The long-term effects of child sexual abuse

Purpose of the Study: To determine if there was a relationship between a physical disability and accessing memories of childhood sexual abuse. Procedure: Literature review, personal exploration, interviews of professionals in the field of disability and child sexual abuse, along with asmall study of adult women with acquired physical disabilities, utilizing a questionnaire and debriefing interviews. Findings: There are a variety of issues and responses, and states of readiness to deal with a history of child abuse that occur when confronting a new physical disability. However there is a commonality, that memories can be triggered. Conclusion: The shock of becoming physically disabled can trigger memories of trauma. Excerpted from Physical Disability: The Long Term Effects of Child Sexual Abuse, an Investigative Project, Sonoma State University, Rohnert Park, California.     

Psychophysiological aspects of sexual dysfunction

The argument is made that human sexual dysfunction is particularly well suited for investigation within the conceptual framework embraced by psychophysiology, due to the unique participation of both physiological and psychological components in the sexual response cycle. The literature relating psychophysiological research to the investigation of sexual dysfunction is reviewed, indicating promising applications in the diagnosis and treatment of some sexual dysfunctions as well as in the evaluation of sex therapy programs and the testing of medical theories about the etiology and maintenance of sexual dysfunctions.     

Chronic illness,disability and sexuality in people older than fifty

Many people feelt that when aging is coupled with chronic illness or disability, sexuality and interest in sex wanes or even dissipates entirely. Still others are certain that people who are ill or handicapped suffer a diminished role in life as a whole. Further, many believe people older than fifty are not even interested in sex. This article will probe these myths and prove them false. Sefra Kobrin Pitzele is the author of five self-help books and Editor-in-Chief of a literary magazine, EXPRESSIONS; Literature and Art by People with Disabilities and Ongoing Health Conditions.     

Female sexual dysfunction

This article briefly illustrates the complexities in the field of Female Sexual Dysfunction, both in terms of the circumstances in which the problems can arise, and the multiplicity of causations. It is often hard for a woman to find a language to describe the nature of her difficulty, which often means that obtaining access to appropriate professional help can be problematic. The main causes of female sexual dysfunction are outlined here, as described by the Working Group for a New View of Women’s Sexual Problems. These include social, political and economic factors, partner and relationship issues, psychological factors, and medical factors. There are difficulties with the classification of female sexual dysfunction, as current attempts neither reflect the full complexity of female sexuality, nor take account of the myriad possibilities of causation. The most commonly presenting sexual symptoms are described. These include desire and arousal problems, problems with orgasm, sexual aversion, phobia and ‘sexual anorexia’, sexual pain of non-medical origin, and vaginismus. Mention is made of life events which can trigger sexual dysfunction in women, making reference to physiological, emotional or relationship changes. The importance of careful assessment by a person skilled and trained in this field is stressed. A range of treatment options is covered, including psychological and physiological approaches, mechanical devices, and pharmacological agents. The sex therapy, programme, Sensate Focus, is included in table format. Possible referral routes are mentioned, and educational materials are listed after the references.     

利用DALY指标分析我国新生儿窒息的疾病负担

目的 利用伤残调整生命年(disability adjusted life years, DALY)指标分析我国新生儿窒息的疾病负担, 为政府合理分配有限的卫生资源提供科学佐证。方法 通过文献检索整理我国新生儿窒息的发生率、死亡率和伤残率数据;采用专家德尔菲法获得我国新生儿窒息所导致的失能权重;依据以上数据资料, 计算新生儿窒息的DALY。结果 我国不同地区新生儿窒息的发生率在1.14%~11.7%之间;全国5岁以下儿童出生窒息死亡率为221.3/10⁵。0~17岁儿童智力残疾率为0.9%, 其中新生儿窒息为第三位致残原因, 占8.6%。0~6岁听力残疾的儿童中, 因新生儿窒息所致残疾占6.34%。新生儿窒息导致的失能权重为0.390。2010年我国5岁以下儿童新生儿窒息DALYs为8 241 093人年, 每千人口DALYs为109.1人年。若新生儿窒息发生率和死亡率同时下降10%, DALYs可下降9.73%。结论 新生儿窒息是导致我国儿童死亡和残疾的主要原因之一, 由出生窒息所引发的疾病负担是巨大的。推广新生儿复苏技术、降低出生窒息的发生率和死亡率具有良好的社会效益。     

Retirement disability among workers in a natural gas distribution company

Epidemiological investigations of occupational disability are severely limited because of the inherent difficulties in standardizing definitions of disability and because of the lack of appropriate comparison data. Nevertheless, occupational disability is of great concern to workers. An investigation of disability, defined as permanent retirement due to medical disability, among hourly employees of a natural gas distribution company was undertaken in response to a request by the employees' union. Because of the above limitations, a hypothesis-generating rather than hypothesis-testing approach was taken, utilizing both disability retirement incidence rates and a prevalence survey of the living disabled retirees. It was hypothesized from the analysis that this group of workers did experience an excess of retirement disability for the period 1971–1980 when compared to estimated disability incidence rates of the general Social Security insured population, and that this excess may have been due in part to an excess of musculoskeletal disabilities associated with occupational physical stresses and strains.     

Clinical follow-up of couples treated for sexual dysfunction

The present status of 38 couples who had been treated at a clinic for sexual dysfunction 3 years previously was determined by a self-report assessment battery. The battery consisted of the Sexual Interaction Inventory, the Locke-Wallace Marriage Inventory, and the Sexual History Form completed at pretreatment, immediately posttreatment, 3 months after treatment, and at 3-year follow-up. An additional Follow-up Questionnaire was completed at the 3-year point only.At 3-year follow-up, analysis of data by diagnostic category indicated that sexual desire dysfunction for both men and women was particularly resistant to sustained behavioral change. Men with erectile difficulty reported significant improvement in their ability to maintain erections during intercourse but not in their ability to achieve erections prior to intercourse. Data from men with premature ejaculation revealed some immediate significant posttherapy gains, which, with the exception of length of foreplay, were not sustained at 3-year follow-up. For women with global inorgasmia, a significant increase in orgasmic response was reported. Data from women with situational orgasmic difficulties indicated some success in improving frequency of orgasm through masturbation and through genital caress; however, these changes did not reach statistical significance. Across all diagnostic categories, both men and women respondents reported increased satisfaction in their sexual relationship. Satisfaction in the marital relationship showed a more varied response pattern.This research was supported in part by grants #MH 14621-04, #MH2631, and the U.S. Public Health Service.     

Incidence of and reasons for disability pension in a Swedish cohort of middle-aged men

The prevalence of disability pensions was investigated among5 birthyear cohorts (1926–30) of male residents in Malmö,Sweden (N=7,697). They were invited to a screening programmein the mid-1970s. Disability pension and mortality data wereidentified from national computerized databases. At the endof follow-up (the calendar year oftheir 58th birthday), 1,391(18%) had been granted a disability pension and 655 (9%) haddied. The most frequent causes for disability pension, accountingfor 74% of the cases, were musculoskeletal diseases, mentaldisorders (including alcohol dependence) and diseases of thecirculatory system. Alcohol dependence was more common amongthose who refrained from participating in the screening programme,while musculoskeletal and neurological diseases were more commonamong those who did participate. Mental disorders (includingalcohol dependence) predominated in younger and musculoskeletaldiseases in older age groups. Both alcohol dependence and non-participationin health screening were related to the risk of a disabilitypension. To be used for identifying subjects at risk for disabilitypension, health screenings should be designed to reach as manyof the usual non-participants as possible and should be targetedat men in younger ages.     

Social construction of Anangu disability

ABSTRACT: The usual and common-sense definition of disability is based on a medical model that sees disability as a limitation or lack of competence on the part of the individual. This definition fails to acknowledge that in some cultures disability as a concept does not exist. This paper, based on research undertaken in 1994/1995, examines how the social construction of disability among the A n angu of the cross border region of Western Australia, South Australia and the Northern Territory, takes into consideration the important factors of history, culture and language. The theoretical underpinning of the research was symbolic interactionism, which led to collaborative ethnography becoming the methodology employed to collect and analyse the data. The findings of the research indicate that the social construction of disability among the A n angu occurs in three historical phases: the impairment, oppression and empowerment phases. The paper's purpose is to offer service providers to Aboriginal people with disabilities, information that will help them understand some of the attitudes, customs, mores and beliefs of their clientele.     

Sexual self views of women with disabilities: The relationship among age-of-onset,nature of disability and sexual self-esteem

The sexual self-esteen of 43 women with mobility impairments was examined on the basis of age-of-onset and nature (fluctuating versus stable health conditions) of disability. Based on past literature, it was hypothesized that women with earlier age-of-onset disabilities would report lower positive levels of sexual self-esteem compared to women with later age-of-onset disabilities. Subjects were acquired through two computer on-line services, two large urban universities, and nationally based disability-related organizations. A hierarchical multiple regression indicated that as age-of-onset of disability increased (i.e. the disability occurred later in life), positive sexual self-esteem decreased significantly. Future research should acquire participants from residential institutions other than rehabilitation facilities and those who remain at home. The necessity of creating psychological scales and tools applicable to this population is discussed.     

Perceptions of disability and occupational stress as discriminators of work disability in patients with chronic pain

Pain-related work disability can be influenced by a number of medical, physical, and psychosocial factors. The present study investigated the role of perceived disability, occupational stress, pain, and distress in patients with chronic pain disorders who work despite pain and patients who are work disabled. A total of 165 patients referred to a multidisciplinary pain treatment center for chronic pain (> 6 months) were studied. The two groups were compared on age, gender, education, marital status, duration of pain problem, pain severity, psychological distress, perceived disability, and perception of the work environment. A discriminant function analysis was computed entering pain severity, distress, perceived disability (physical and psychosocial) and work environment variables. The two groups were equivalent on age, gender, education, marital status, and duration of pain problem. The groups differed on diagnosis and insurance coverage with the work-disabled group diagnosed with low back pain and receiving Workers Compensation coverage more frequently than working controls. Univariate analyses indicated that the work-disabled group reported higher pain severity, perceived physical and psychosocial disability, and job stress than their working cohorts. The discriminant function analysis indicated that the perception of physical disability, supervisor support, distress, and work pressure were capable of correctly classifying patients with chronic pain who continued to work from those who were work disabled. These findings indicate the importance of evaluating perceived disability and job stress, and if present, directing intervention effort at these factors in order to facilitate work re-entry.