Posts Tagged sexuality

[RESOURCE] Conversations About Intimacy and Sexuality: A Training Toolkit Using MI

The NIDILRR-funded Rehabilitation Research and Training Center on Community Living and Participation of People with Serious Mental Illness (TU Collaborative) has published Conversations About Intimacy and Sexuality: A Training Toolkit Using Motivational Interviewing (MI). The toolkit is designed to prepare direct service professionals to have discussions with people with mental health conditions on the topics of intimacy and sexuality. The toolkit was informed by the motivational interviewing technique and includes experiential exercises with instructions, evaluation forms, resources, and references to be used by trainers.

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[WEB SITE] Canadian documentary “Picture This” takes an honest look at sexuality and disability – Video

The sexuality of people with disabilities is something that is underrepresented—or not represented at all—which can lead to people with disabilities feeling either invisible or treated like an anomaly when it comes to their sexual lives.

However, a Toronto advocate has been raising awareness about sex and disabled people, and a Canadian film about him and his work is now available for online viewing.

On November 19, the National Film Board of Canada (NFB) released Jari Osborne’s short documentary Picture This for free online streaming. (Osborne’s previous NFB documentaries include Unwanted Soldiers and Sleeping Tigers: The Asahi Baseball Story.)

The 33-minute film profiles Toronto disability awareness consultant and podcaster Andrew Gurza, who identifies himself as a “queer cripple”, as he prepares for the second edition of a sex-positive play party, which has been labelled a “handicapped orgy” by the media and garnered international coverage.

Andrew Gurza with model
Andrew Gurza with model
JESSICA RAE

Gurza previously held a discussion in Vancouver in 2016, in conjunction with Vancouver queer organization Health Initiative for Men, that was filmed for and is featured in the documentary.

Among the topics Gurza discusses in the documentary, he describes the awkwardness and discomfort he has witnessed potential sex partners have been unable to hide (not to mention his own heartbreak) once they find out he is disabled. In addition, he also talks about the challenges of being both gay and disabled.

Picture This can be viewed below, or at the NFB website, and is also available on iTunes and Amazon.

https://www.nfb.ca/film/picture_this/https://www.nfb.ca/film/picture_this/embed/player/

 

Picture ThisJari Osborneprovided by the National Film Board of Canada

 

via Canadian documentary Picture This takes an honest look at sexuality and disability | Georgia Straight Vancouver’s News & Entertainment Weekly

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[Abstract + References] Changes in sexual functioning following traumatic brain injury: An overview on a neglected issue

Highlights

  • Sexuality has a significant impact on interpersonal relationships and psychological well-being.
  • Up to 50% of patients with moderate to severe TBI report sexual problems.
  • Sexual disorders in TBI are closely dependent on the damaged brain area.
  • TBI patients and their caregivers should be provided with information useful to achieve a better sexual health.

Abstract

Traumatic brain injury (TBI) is any damage to the skull and/or the brain and its frameworks due to an external force. Following TBI, patients may report cognitive, physiological and psychosocial changes with a devastating impact on important aspects of the patient’s life, such as sexual functioning. Although sexual dysfunction (SD) occurs at a significantly greater frequency in individuals with TBI, it is not commonly assessed in the clinical setting and little information is available on this crucial aspect of patients’ quality of life. As the number of people with TBI is on the rise, there is a need for better management of TBI problems, including SD, by providing information to patients and their caregivers to achieve sexual health, with a consequent increase in their quality of life. Discussing and treating sexual problems in TBI patients enters the framework of a holistic approach. The purpose of this narrative review is provide clinicians with information concerning changes in sexual functioning and relationships in individuals with TBI, for a better management of patient’s functional outcomes and quality of life.

References

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via Changes in sexual functioning following traumatic brain injury: An overview on a neglected issue – Journal of Clinical Neuroscience

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[Abstract] How is sexuality after stroke experienced by stroke survivors and partners of stroke survivors? A systematic review of qualitative studies

To synthesise how post-stroke sexuality is experienced by stroke survivors and partners of stroke survivors.

MEDLINE, PubMed, SCOPUS, CINAHL and PsycINFO were searched from inception to May 2018 using a combination of relevant Medical Subject Headings and Free Text Terms. Only papers published in English reporting original qualitative research were included. Methodological quality was assessed using the Critical Appraisal Skills Programme Qualitative Research Checklist. All text presented as ‘results’ or ‘findings’ in the included studies was extracted and subjected to a thematic analysis and synthesis which was discussed and agreed by the research team.

The initial search yielded 136 unique papers with a further 8 papers identified through reference checking. Following full-text review, 43 papers were included in the final synthesis. Two analytical themes were identified: sexuality is silenced and sexuality is muted and sometimes changed, but not forgotten. These themes were made up of six descriptive themes: struggle to communicate within relationships, health professionals don’t talk about sexuality, sexuality and disability is a taboo topic, changes to pre-stroke relationships, changed relationship with the stroke survivor’s own body and resuming sexual intimacy – adaptation and loss.

Stroke has a profound impact on how sexuality is experienced by both stroke survivors and partners of stroke survivors. Despite this, post-stroke sexuality is rarely discussed openly. Stroke survivors and partners value sexuality and may benefit from strategies to support adjustment to post-stroke sexuality.

via How is sexuality after stroke experienced by stroke survivors and partners of stroke survivors? A systematic review of qualitative studies – Margaret McGrath, Sandra Lever, Annie McCluskey, Emma Power, 2018

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[WEB SITE] Neurosexuality Needs to Be Better Addressed in Patients with Neurodisabilities

Summary: Experts raise awareness of neurosexuality challenges faced by patients with neurodisabilities, including members of the LGBTQIA+ community, and provide guidance for healthcare providers and caregivers.


For people with brain disorders, whether from injury or disease, rehabilitation is a complex process. Neurosexuality is an emerging area of study and practice that focuses on the relationships between brain and sexual function in individuals with and without neurological disorders. Experts on the subject, reporting in NeuroRehabilitation, discuss how sexuality can affect neurorehabilitation in patients suffering from a range of conditions, from stroke and spinal cord injuries to sexual behavior in patients with dementia.

Research addressing the relationship between sexuality and the brain has a long history in neurological and behavioral sciences. This increased awareness has led to a better understanding within the scientific community regarding the importance of sexuality as a health outcome to promote the quality of life of individuals with neurodisabilities.

“This thematic issue of NeuroRehabilitation emphasizes that neurosexuality care should be driven by a transdisciplinary approach to appraise the evidence base of the potential negative consequences of different neurodisabilities on sexuality and to build upon sound treatment strategies to address these complexities,” explained guest editors Alexander Moreno, PhD, Caron Gan, RN, MScN, RP, AAMFT, and Nathan D. Zasler, MD.

An important contribution to this issue advocates for changing the culture of neurodisability through language and sensitivity of providers in order to create a safe place for lesbian, gay, bisexual, transgender, queer, intersex, asexual, and people with other sexual orientations and forms of gender expression (LGBTQIA+). “The particular needs of LGBTQIA+ individuals living with a neurological disorder are neglected in clinical practice and research. The invisibility of LGBTQIA+ individuals with neurological disorders reflects the historical exclusion of marginalized identities and creates disparities of access to healthcare,” explained Alexander Moreno, PhD, Faculty of Human Sciences, Department of Sexology, Université du Québec à Montréal (UQÀM) and the Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Ari Laoch, MS, Virginia Commonwealth University, and Nathan D. Zasler, MD, Concussion Care Centre of Virginia, Ltd. and Tree of Life Services, Inc. (VA).

The invisibility of LGBTQIA+ individuals with neurological disorders translates into diminished quality of care or inappropriate care, lack of recognition of all family configurations, exclusion of family caregivers, and violations of human rights (e.g., the right to be treated with dignity). Shedding light on the diversity of individuals with neurological disorders has the potential to improve healthcare by helping rehabilitation professionals to be sensitive to the particular needs of LGBTQIA+ individuals. In addition, the results of this study help promote the inclusion of sexual and gender diversity in the curricula of future practitioners and delineate future directions for research. Most importantly, the current study provides concrete clinical recommendations aiming to orient healthcare professionals wanting to improve their practice.

The authors surveyed the literature concerning neurological disorders affecting LGBTQIA+ individuals. They found that the relative neglect of LGBTQIA+ individuals with neurological disorders in clinical practice and research is striking. Healthcare professionals working with individuals with neurological disorders have the responsibility to create safer spaces in their clinical practice, including the use of inclusive language, the modification of admission forms to reflect diverse realities, the inclusion of sexual orientation and gender identity in their institutional policies, and participate in continuing education to challenge misconceptions, stereotypes, and negative attitudes. The authors provide 20 recommendations to guide clinicians, researchers, and policy professionals about the care of the LGBTQIA+ community.

Moreno, Laoch, and Zasler emphasized that “being part of a positive change in the rehabilitation of LGBTQIA+ people with neurodisabilities is part of our obligation as healthcare providers who are self-reflective, critical, and willing to improve the quality of the services provided in an ethical framework.”

Additional contributions to the issue cover a variety of important topics.

Sexual Health After Pediatric Acquired Brain Injury (ABI)

The authors reviewed over 2000 studies and found that literature about sexuality in children and adolescents with ABI has mainly addressed physical issues (e.g., precocious puberty), with positive sexual health needing further development in topics such as body image, sexual orientation, and social competence including flirting, dating, and romance.

Sexual health after traumatic brain injury (TBI) in younger and older adults Sexual problems were more likely for older (average mid-40s) patients with TBI than for younger (average 30s) patients. Older patients showed lower sexual desire and suffered more from anxiety and depression. Younger patients did not exhibit these symptoms to the same degree, suggesting that clinicians should be aware of age differences when treating their patients.

Stroke and Sexual Functioning

A literature review of post-stroke sexual functioning describes how various dysfunctions are related to stroke location, laterality, and physical and psychological changes. Three programs are presented to address post-stroke rehabilitation.

Multiple Sclerosis (MS) and Sexual Dysfunction

For patients with MS, assessment and treatment of sexual dysfunctions are described, including sexual assessment tools especially for MS. The authors also explore related topics including relationships, fertility, pregnancy, and parenting issues. They emphasize that, like other neurological disorders, there is a need for more collaboration among providers in addressing sexual concerns in MS.

How perceptions of sexuality in individuals with amyotrophic lateral sclerosis (ALS) can affect care

Surveys of both patients with ALS, also known as Lou Gehrig’s disease, and ALS care providers revealed uncomfortable feelings when the subject of sexuality was raised. The authors call for more education among ALS specialists in sexuality and a policy change that guarantees the inclusion of sexuality in their guidelines.

Sexual Concerns After Spinal Cord Injury (SCI)

SCI can impact sexual response, male infertility and its treatments, as well as pregnancy issues. The authors emphasize the importance of providing education and specific sexual recommendations based on the individual’s remaining sexual potential, and to include their partners, when available. They also present basic and advanced treatments for sexual dysfunctions and discuss other challenges in the management of sexual dysfunction of individuals with SCI.

Studying Intimacy And Sexuality In Clients With Dementia

Obtaining consent to study individuals with cognitive impairment is a controversial topic. In the environment of a residential care facility, the authors propose a multi-step approach involving authorized representatives (e.g., family caregivers), professional caregivers working in the facility, a pre-consent phase, a consent presentation phase, and a final consent before data collection. Their reflections and suggestions illuminate the ethical challenges involved in the study of sexuality and intimacy in individuals with severe cognitive impairment.

In summary, the guest editors write, “We hope that this thematic issue provides an impetus for rehabilitation and other health professionals, students in the health sciences, and researchers to develop their competence and awareness of the importance of sexual neurorehabilitation in persons with neurodisabilities.”


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via Neurosexuality Needs to Be Better Addressed in Patients with Neurodisabilities – SexualDiversity.Org

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[Abstract] Provider perceptions of the assessment and rehabilitation of sexual functioning after traumatic brain injury – CNS

OBJECTIVE: To explore how health care professionals who work with individuals with TBI address issues related to the assessment and treatment of sexuality after TBI.
METHODS: A survey composed of 53 questions was developed to evaluate professional training, assessment of sexuality in individuals with TBI and attitudes towards sexuality. The sample consisted of 324 self-identified TBI health care professionals.
RESULTS: Ninety seven per cent of participants believed that sexuality should be discussed during rehabilitation; however, 36% reported talking about it. Seventy nine per cent reported that their patients have asked about sexuality after TBI, with 60% feeling calm and competent addressing the topic. The main reason for not discussing the topic was that patients do not ask for information (42%). Assessment (87%) and treatment of sexuality (82%) in individuals with TBI are considered a part of their professional responsibility.
CONCLUSION: Despite recognition of the importance of addressing the topic and the belief of it being their professional responsibility, many professionals reported lack of training. Working to increase comfort with the topic and providing comprehensive education on treating sexuality may be beneficial.

Source: Traumatic Brain Injury Resource Guide – Research Reports – Provider perceptions of the assessment and rehabilitation of sexual functioning after traumatic brain injury

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[ARTICLE] Effectiveness of a structured sexual rehabilitation programme following stroke: A randomized controlled trial – Full Text

Abstract

Background: Sexual activity is an integral part of life; it is important to address sexual health after stroke, but this is often poorly done.

Objective: To assess the effectiveness of a structured sexual rehabilitation programme compared with written information alone regarding sexual and psychological functioning (anxiety, depression, stress), functional independence and quality of life in an Australian stroke cohort.

Methods: A total of 68 participants were randomized to a structured sexual rehabilitation programme (treatment group; n = 35) or to written information alone (control group; n = 33). Outcome measures included: Sexual Functioning Questionnaire Short Form; Depression, Anxiety Stress Scale; Functional Independence Measure, and Stroke and Aphasia Quality of Life Scale-39 Generic. Assessments were performed at baseline, 6 weeks and 6 months after the intervention. Participant’s preferences regarding how they would like to receive information, who from, and how frequently, were collected at baseline.

Results: There was no difference between groups for any outcome measures. Half of the participants (51%) wished to receive information and were divided equally into preferring written information vs face-to-face counselling, with the majority (54%) preferring information after discharge from an inpatient setting.

Conclusion: Provision of written information alone appears to be as effective as a 30-min individualized sexual rehabilitation programme in an inpatient setting. Further research is needed regarding longer term outcomes and outpatient settings.

Stroke is a leading cause of death and disability (1). Sexual dysfunction is common after stroke, and has multifactorial causes: damage to the brain (causing decline in sexual desire/interest and coital frequency for both sexes, decline in vaginal lubrication and orgasm in females, and in erection and ejaculation in males, and physical changes, such as hemiplegia with resulting impairment of mobility) together with medical issues, such as medications and premorbid medical conditions (diabetes, hypertension, cardiac issues) and psychological factors (fear of new stroke, loss of self-esteem, role/relationship changes) are major contributors (2–5).

Sexuality is a broad concept and may be experienced and expressed in a variety of ways; including thoughts, fantasies, desires, beliefs, attitudes, values, behaviours, practices, roles, and relationships (6). Sexual activity is an integral part of life and the importance of addressing sexual health after stroke is well accepted (7). Despite this, it is common for sexuality to be poorly addressed, not just in stroke, but also in other neurological conditions, such as spina bifida (8) and spinal cord injury (9). The 2012 Australian National Stroke Audit Rehabilitation Services Report (10), which included 2,789 post-stroke patients across 111 Australian public and private hospitals, showed that only 17% of patients received information on sexuality. This is despite the opportunities provided through the staffing complement in rehabilitation settings. In practice, allied healthcare providers could have a primary or secondary role in sexual rehabilitation; they could be the sole providers of intervention or provide further intervention in their specific areas of expertise, such as physiotherapy training to optimize mobility in bed for sexual positioning, nursing education for catheter management, and dyspraxia training with speech therapy for sexual activities such as kissing. In addition, although current guidelines recommend the assessment and management of post-stroke sexual dysfunction (7), it is unclear what types of intervention (timing, content, intensity, setting) should be provided and how effective they are. The only intervention study currently available in the literature that addresses the impact of intervention on sexual activity following stroke suggests that a sexual rehabilitation intervention programme prior to hospital discharge increased sexual satisfaction and frequency of sexual activity one month post-discharge, but did not promote sexual knowledge (11). This study was conducted with culturally homogenous 40–49-year-old Korean couples and had significant methodological limitations (generalizability, pre-post design, and short follow-up). Patient’s preferences relating to sexual counselling, such as the timing of such counselling, also varied, creating further challenges for optimization of care (12, 13). Some studies show that most participants feel overwhelmed in the early adjustment period and that the best time to address sexual adjustment issues is towards the end of an acute rehabilitation hospitalization or shortly after discharge. In a pilot randomized controlled trial (RCT) conducted in 2014, the feasibility and importance of providing sexual rehabilitation following stroke was demonstrated; however, the “pilot” nature of the study did not allow for conclusive findings to be drawn (14).

The primary aim of this RCT was to assess the effectiveness of a comprehensive structured sexual rehabilitation programme compared with written information alone, on sexual and psychological (anxiety, depression, stress) function, and on functional independence and quality of life in an Australian stroke cohort. Building on the previous pilot RCT, to our knowledge this will be the first adequately powered RCT in this area. The findings will provide evidence that may lead to improved care.

Continue —> Journal of Rehabilitation Medicine – Effectiveness of a structured sexual rehabilitation programme following stroke: A randomized controlled trial – HTML

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[WEB SITE] Research Reports – Sexuality in individuals with traumatic brain injury and their partners – CNS

Neuropsychol Rehabil. 2016 Sep 28:1-10. [Epub ahead of print]

Downing M(1), Ponsford J(1).

Whilst previous research has detailed the impact of TBI on an individual’s
sexuality, few studies have investigated couples’ sexuality where one partner has sustained a TBI.

The study assessed sexual function in individuals with TBI and their partners. Fifty five individuals who had sustained TBI and their partners completed the Derogatis Interview for Sexual Function-Self Report (DISF-SR). All participants scored below the 50th percentile in relation to norms. Whilst participants with TBI obtained lower T-scores than partners on all subscales (except for sexual behaviour/experiences where scores were equivalent), as well as the total score, none of these differences was significant. Item analysis indicated that female participants with TBI reported significantly lower scores than female partners on frequency of having normal lubrication. Normative comparisons revealed that approximately one-third of individuals with TBI and one-fifth of their partners scored below the second percentile.

Given the high frequency of sexual problems in individuals with TBI, which also impact their partners, addressing sexual problems should be a priority in rehabilitation and beyond.

Source: Traumatic Brain Injury Resource Guide – Research Reports – Sexuality in individuals with traumatic brain injury and their partners

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[WEB SITE] Sex and Sexuality | Stroke.org

 

Talking about sex is hard for many people in general. Surviving a stroke and experiencing sexual dysfunction can add to the uneasiness of the subject. Part of getting back into a normal routine and life involves resuming a healthy sex life. The need to love and be loved, and to have the physical and mental release sex provides, is important.

more —>  Sex and Sexuality | Stroke.org.

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[WEB SITE] Sexuality and Traumatic Brain Injury

The connection between sexuality and traumatic brain injury (TBI) may not be immediately apparent, but decidedly, it exists.

When an individual sustains a traumatic brain injury and is in the acute and sub-acute stage of care, the primary goals are sustaining life and limiting the short and mid-term effects of the traumatic brain injury by appropriate care. Once that care has succeeded in achieving the immediate goals and the individual discharged for post-acute rehabilitation at a facility such as NeuLife Rehab in Mount Dora, Florida many other factors may surface and become relevant to the individual’s rehabilitation. Sexuality can be one of them.

When an injury involves the brain, it can be catastrophic or mild. Depending upon the part of the brain that is injured, comorbities and even the gender of the individual who sustained the injury, sexual issues may result. They can be of various types, including:

Decreased desire for sex

Increased desire for sex

Decreased arousal. This essentially means that while the individual has a desire for sex, his or her body does not respond in a way that allows sex to occur. Naturally, depending upon whether the traumatic brain injury occurred to a man or to a woman, the type of dysfunction will differ

Lack of or reduced ability to achieve ultimate satisfaction through sexual activity

Reproductive changes. In women, this can be caused by hormonal changes based upon the location of the traumatic brain injury and can result in the cessation of menstrual cycles for varying periods of time. Men can experience reduced sperm production. Either, or both, can result in difficulties in a woman becoming pregnant. In turn, this can result in psychological and relationship problems that may require specialized rehabilitation.

Continue –> Sexuality and Traumatic Brain Injury.

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