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Intimate and marital relationships: An insider's perspective
Abstract
In this paper, the experiences of 28 men with a spinal cord injury (paraplegia) regarding meeting significant others and decisions
about long term relationships are discussed. Potential relationships were viewed along five major themes: 1) acceptance of
the individual; 2) awareness and assistance with accessibility; 3) altered divisions of labour; 4) the comfort of sexuality
and 5) long term plans. Individual experiences are influenced by prevailing views of sexuality and marial roles.
... In the main, the literature concerning societal attitudes towards the sexuality of people with physical disabilities suggests that people with physical disabilities are viewed as less sexual than non-disabled people. [10,12,[31][32][33][34] The beliefs, and the consequent attitudes, of the non-disabled have been proposed to have consequences for people with physical disabilities. [35][36][37][38] These include reticence to date people with physical disabilities, and so negative romantic appraisals of people with physical disabilities by non-disabled people, [5,32,34,[39][40][41] the exclusion of people with physical disabilities from family planning clinics, [7] and possibly even increased risk for sexual violence against people with physical disabilities. ...
... [10,12,[31][32][33][34] The beliefs, and the consequent attitudes, of the non-disabled have been proposed to have consequences for people with physical disabilities. [35][36][37][38] These include reticence to date people with physical disabilities, and so negative romantic appraisals of people with physical disabilities by non-disabled people, [5,32,34,[39][40][41] the exclusion of people with physical disabilities from family planning clinics, [7] and possibly even increased risk for sexual violence against people with physical disabilities. [42] Indeed, there is much evidence of an elevated rate of sexual violence perpetrated against women with physical disabilities when compared to non-disabled women. ...
There is a body of theoretical work, and some empirical research, which suggests that non-disabled people assume people with physical disabilities are not suitable romantic partners, do not have sexual drives or desires, or are not sexually active. It has also been proposed that people with physical disabilities face barriers to sexual healthcare access which are structural as well as social. The present paper explores nondisabled South Africans’ beliefs concerning the degree to which non-disabled respondents enjoy sexual and reproductive rights, and benefit from sexual and reproductive healthcare, compared to people without disability. Using a survey, we asked 1989 South Africans to estimate the degree to which people with physical disabilities and people without disability have sexual rights, and benefit from sexual and reproductive healthcare services, respectively. Respondents were more likely to support the idea that the population without disability were deserving of sexual rights compared to people with physical disabilities. Respondents were more likely to rate the degree to which people with physical disability benefit from sexual and reproductive healthcare as less than that for people without physical disabilities. These findings provide some of the first empirical support that non-disabled people perceive people with physical disabilities as having fewer sexual and reproductive rights, and deriving less benefit from sexual and reproductive health services, than the population without disability. To have diminished sexual rights, and benefit less from sexual and reproductive healthcare, we suggest, evinces a negation of the sexual and reproductive needs and capacity of people with physical disabilities.
... Another challenge faced by couples coping with illness and disability is that the more able-bodied partner typically takes on a significant caregiving role, which may interfere with both partners' perceptions of themselves as lovers (Milligan & Neufeldt, 1998;Yoshida, 1994). In fact, studies have suggested that the longer a spouse takes on significant caregiving duties, the more difficulty these couples face in returning to the levels of sexual intimacy they had before the illness or disability (L. ...
... Another challenge faced by couples coping with illness and disability is that the more able-bodied partner typically takes on a signifi cant caregiving role, which may interfere with both partners' perceptions of themselves as lovers (Milligan & Neufeldt, 1998;Yoshida, 1994). In fact, studies suggest that the longer a spouse takes on signifi cant caregiving duties, the more diffi culty faced by the couple in returning to the levels of sexual intimacy they had before the illness or disability (L. ...
... According to Juergens et al. (2009b), this misconception is the product of the three following beliefs: (1) that sex cannot be a high priority in the lives of persons with disabilities (Kaufman, Silverberg, & Odette, 2007); (2) that due to limited opportunities for sexual gratification, persons with disability do not develop a need for sex (Milligan & Neufeldt, 2001); and (3) that persons without disabilities perceive people with disabilities as helpless and childlike and therefore as asexual (Kaufman et al., 2007). Indeed, in their comprehensive review on attitudes toward disability and sexuality, Juergens et al. (2009b) reported that persons with disabilities were more accepted as coworkers and casual friends than as marital or dating partners (e.g., Olkin & Howson, 1994;Yoshida, 1994). Vilchinsky, Werner, and Findler (2010) also showed that interpersonal shyness and embarrassment that typically arises between people of the opposite sex on a first casual meeting, disappears when one of them is presented as having a disability. ...
Objective:
Research has shown that attitudes toward different disabilities form a hierarchy, with observers exhibiting more positive attitudes toward persons with physical disabilities than toward persons with psychiatric disabilities. In addition, investigations of attitudes toward persons with a disability indicate that they are often perceived as asexual. The current study examined whether involvement of persons with either a physical or psychiatric disability in a sexual relationship moderates the relation between their type of disability and attitudes toward them.
Method:
After reading one of six randomly assigned vignettes, university students (N = 195) filled out a semantic differential-based attitude scale (Katz & Shurka, 1977; Kravetz, Katz, & Albez, 1994). The six vignettes consisted of a male with a physical disability/with a psychiatric disability/without a disability, who was either involved/not involved in a sexual relationship.
Results:
An interaction between type of disability and involvement in a sexual relationship was found for two subscales of the attitudes scale, occupation and intelligence. Involvement in a sexual relationship was found to generate more positive attitudes when the target person had a physical disability but more negative attitudes when he had a psychiatric disability.
Conclusions:
Involvement in a sexual relationship seems to work in favor of persons with a physical disability because of the association of such a relationship with normality and adaptation. However, attributing such a relationship to persons with a psychiatric disability seems to be stigmatic.
... We could not locate normative data on the frequency of dating relationships from large surveys that used the same questions as we did, but our impression is that these rates are below average for adults. Evidence suggests that people with disabilities experience difficulty meeting and attracting potential romantic partners (Kreuter, 2000;Milligan, 2004;Rintala et al, 1997;Yoshida, 1994). People with disabilities may experience limitations in forming romantic relationships, but when in relationships, their psychological and relationship dynamics are similar to those of other persons. ...
Objective: To examine the relationship between adult attachment style and physical disability in intimate romantic relationships. Method: Participants were 50 individuals with adult-onset spinal cord injuries (SCI) and 50 individuals with congenital disabilities (CON) living in the community. The main outcome measures were adult attachment style and dyadic relationship adjustment. Results: Participants with SCI and CON did not differ in rates of secure versus insecure attachment, and the rates of neither group differed significantly from rates reported for persons without disability. Dyadic adjustment was clearly predicted by attachment variables and differed between the participants with SCI and those with CON; individuals with SCI reported greater total dyadic adjustment. Avoidance showed a strong negative association with dyadic satisfaction, but no association was found with dyadic cohesion. Social participation variables were associated with dyadic adjustment. For instance, mobility was positively associated with dyadic satisfaction. Conclusions: Dyadic adjustment in people with disabilities, as in other groups, is affected by attachment style, but disability and social participation variables may also affect dyadic adjustment. Clinicians should consider differences in attachment styles among persons with disabilities and their implications for intimate close relationships. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
... A small number of studies have discussed the possibility of forming new relationships after an SCI. Although some suggest that it is possible to form new relationships (Yoshida, 1994;Craig et al., 1999) many studies propose that there are physical and attitudinal barriers that inhibit the formation of relationships (Quigley, 1995;Kreuter et al., 1998;Kreuter, 2000;Chan, 2000;Manns and Chad, 2001;Song, 2005), such as a lack of wheelchair accessible public spaces. Chan (2000) and Manns and Chad (2001) suggest that instead of forming new relationships with individuals who are able bodied, individuals with SCI tend to socialize with other individuals with disabilities because they feel they have more in common. ...
The objective of this study was to examine the perspectives of individuals living with spinal cord injury (N=14) concerning the changes that occur in personal relationships after the injury. A qualitative study was completed and a finer-grained analysis of data collected from a primary study took place. The primary study had a cross-sectional and retrospective design in which participants with an acquired spinal cord injury were interviewed. Data collection took place in five regions of Ontario, Canada. A modified grounded theory analysis was performed on data related to relationships that was extracted from a primary study. Many study participants believed that their relationships with others provided them with support to assist in their recovery; however, for some participants this support led to their feeling overassisted by their family and friends. Study participants also discussed the barriers they experienced that limited the formation of new relationships; some participants also discussed the strategies they employ to deal with these barriers. Finally, many participants discussed how their relationships with others helped them to view their own spinal cord injuries positively and to take on new life roles. The findings of this study indicate that occupational and physical therapists and other health professionals should assist individuals with spinal cord injury to continue to participate in their relationships. Directions for future research are also discussed.
This quantitative study examines the attitudes of multidisciplinary staff regarding sex education among students with developmental intellectual disabilities and compares the attitudes of teachers working in regular education and those working in special education, and attitudes of religious versus non-religious teachers. One hundred and twenty teachers from various schools in the State of Israel participated in the study. The vast majority were women (91.7%), and the rest were men (8.3%). The prevailing level of religiosity in the study was secular (47.5%), and religious (43.3%). Most teachers had no experience working with children with special needs (60%). The study participants completed a demographic survey. The questionnaire used to examine the research questions was The Sexual Attitude Scale (SAS) (Hudson, Murphy, & Nurius, 1983) – a 25-item summated category partition scale that was designed to measure the extent to which an individual adheres to a liberal or a conservative orientation concerning sexual expression. One question was removed from the original questionnaire (statement 18: heavy sexual petting should be discouraged) and 5 statements were added, focusing on attitudes toward sex education for students with developmental intellectual disabilities. The study findings show that the level of conservatism among special education teachers was lower than the level of conservatism among regular education teachers, i.e., special education teachers expressed more positive attitudes. The study find-ings show that the level of conservatism among religious teachers was higher than the level of conservatism among non-religious teachers, i.e., non-religious teachers expressed more positive attitudes. It was also found that there is a positive and significant relation between the seniority of teachers and their degree of conservatism: the more years of experience teachers had, the more negative were their attitudes regarding the sexual education of students with Developmental Cognitive Disabilities (DCD). In contrast, there was no significant connection between age and level of conservatism. The study also examined the relationship between the role of the teacher and his attitudes. The study reveals surprising findings that show that the highest degree of conservatism was found among teachers and counselors, then, among professional teachers, and finally, school therapists who demonstrated the lowest level of conservatism. This means that the most positive attitudes were among the paramedical caregivers and the more negative among the educators and counselors.These findings suggest that training is needed for teachers in regular education, and among religious teachers, who are more conservative concerning sex education for people with special needs. It was also found that there is a connection between the teacher's role and his attitudes, and that the teacher's discipline should be addressed in the training. Veteran teachers have shown more negative attitudes, which is why training, for both teaching students and young teachers, and especially to veteran teachers, has an impact on their attitudes towards sex education among people with special needs. This training, beyond the knowledge provided, will facilitate changes of social attitudes to another, more positive view, towards people with special needs.
Using a sample of 312 people in a romantic relationship with a partner who has a spinal cord injury (SCI), this study examined the separate and combined effects of caregiving tasks, resilience, and received support on the participant’s level of psychosocial distress. We also tested whether such distress might mediate the effect of the predictors on romantic relationship closeness. Results supported the beneficial effects of both resilience and receiving high-quality support, although the timing of the injury moderated these effects. Injuries sustained after relationship initiation particularly threaten well-being and closeness and, along with the burden of caregiving tasks, alter the extent to which received support and resilience are associated with health and relationship benefits. These results suggest that support providers should be sensitive to the context of the SCI and, for scholars, indicate the importance of further theorizing context in the theory of resilience and relational load.
There is a growing recognition of the sexual and reproductive rights of people with disabilities, and since the World Health Organisation’s World Report on Disability, increased international attention has been given to these issues. Past research, however, suggests that this group encounter barriers to sexual and reproductive rights, which are both physical and attitudinal. Against this backdrop, this article employs a sequential mixed qualitative methodology to explore the practical and subjective experiences of 13 people with physical disabilities in South Africa, with regard to their sexual lives and experiences of sexuality. These experiences were marked by concerns about their ‘fitness’ as sexual beings and indicated that social forces were key in shaping their expectations for their own sexual life.
There is good reason to believe that the attitudes of persons without disability towards dating a person with a physical disability might be unfavourable. However, in general, and in the Global South in particular, there is a dearth of research in this area. This study sought to take the first step in addressing this lack of enquiry, by surveying the attitudes of a general population sample in South Africa towards dating people with physical disabilities, using a vignette. Data from 1723 survey respondents were analysed thematically. Findings reveal largely negative attitudes towards people with physical disabilities. Respondents without disability perceived numerous barriers to dating a person with a physical disability, including social stigma, anxiety and concerns about the burden of care they believed such a relationship would place upon them. However, there was some evidence to suggest that some positive attitudes do exist, and a few respondents were open to dating a person with physical disabilities. Findings contribute to a nuancing and expanding of the ‘myth of asexuality’ among physically disabled people by showing that people with physical disabilities are actively desexualised by persons without disability. Future research is needed to explore how the inclusive attitudes, of which we did find evidence here, can be further cultivated.
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.
This essay explores normative regulations of disabled people’s sexuality and its relationship with asexuality through narratives of disabled individuals. While asexuality has been persistently criticized as a damaging myth imposed on disabled people, individuals with disabilities who do not identify as sexual highlight the inseparable intersection between normality and sexuality. Disabled and asexual identity and its narratives reveal that asexuality is an embodiment neither to be eliminated, nor to be cured, and is a way of living that may or may not change. Claims for the sexual rights of desexualized minority groups mistakenly target asexuality and endorse a universal and persistent presence of sexual desire. The structurally and socially enforced asexuality and desexualization are distinguished from an asexual embodiment and perspective disidentifying oneself from sexuality.
This article presents a research review on the psychological and social aspects related with the sexuality of persons with spinal cord injury. The relevance that the impact of injury has on people and its environment, in general, and on sexuality sphere in particular, becomes an area of great scientific and social interest. This is explained by the constant growth in the prevalence and in the radical bio-psycho-social changes that the spinal cord injury involves. So, people must cope in their sexual life with changes as much in the physical as in the emotional areas as well as in social relationships. With this purpose, the available bibliography is revised trying to focus in i) the size of publications where the topic appears in, ii) the thematic areas object of study, iii) the publications methodology, to reach finally iv) the conclusions of our review.
Multiple Sclerosis (MS) significantly affects the sexual lives of individuals with MS and their partners. However, health
professionals often feel ill-prepared to assist these clients with sexual issues. Understanding a couple’s perspective is
essential for health professionals in providing relevant support and interventions. This study aimed to understand the impact
of MS on couples’ sexual relationships when the male partner was diagnosed with MS during the relationship. Using a qualitative
approach, a description of four couples’ “lived experiences” was gathered through semi-structured interviews with each partner
separately. Communication was identified as a key element in coping with the impact of MS. Men with MS were more likely to
comply with changes while women tended to take on martyr roles to protect their partners. Findings suggest clinicians should
facilitate open communication, recognize each partner’s intimacy needs and assist both partners to establish meaningful roles.
Self-advocacy groups and individual authors have increasingly expressed concern that persons with disabilities (PWD) are sexually disenfranchised by a society that inaccurately perceives them as asexual beings. The purpose of this paper is to evaluate the social and empirical foundations for the contention that PWD are indeed viewed as asexual and examine whether there is cause for ongoing concern and intervention. This review includes a consideration of the implications for both clinical practice and future research as well. It is concluded that despite significant gains in our biological and psychosocial understanding of sexuality in the context of disability, there remains much to be accomplished to effect needed change in the areas of professional practice, research, societal attitudes, and most importantly, in the lives of PWD.
Disability affects both the individual and his/her partner and, if health care professionals are to work with clients in a holistic manner, they will need to include the partner. A comprehensive review of the literature was completed to examine the impact of disability on sexuality as it relates to couple relationships and to explore strategies health care providers can utilize to help couples deal with these issues. The literature describes some common intervention strategies that have been shown to be effective in helping couples affected by disability or illness address the issue of sexuality. Specific concerns and difficulties faced by couples are also identified. Finally, the various intervention strategies will be incorporated into a framework known as the P-LI-SS-IT model. With this framework, health care providers will be able to determine the client's needs, as well as assess their own level of comfort and expertise in dealing with this very important task.
Among the many issues confronting a newly spinal cord injured (SCI) person are apprehension about the potential impact of the acquired disability on present or future intimate relationships.
To summarize the research regarding partner relationships and SCI.
Medline, Psychlit and Cinahl database researches were undertaken.
Several studies have focused on the issue of marital status before and after the onset of the injury. The results of the studies carried out on the prevalence of divorce are conflicting. Divorce rates have been reported to be anywhere from 8% to 48%. It appears that divorce rates tend to decline to the normal rate for the general population after the initial high risk period. Some studies have shown that marital status is a powerful predictor of independent-living outcome variables. Thus, marital stability is a concern in SCI care. The study investigating why able-bodied women might choose to marry men with a permanent physical disability, such as a SCI, showed a substantial overlap with existing models of courtship. It was also shown that a SCI person who strives to minimise the impact of the disability on a potential partner makes a more attractive candidate for a long-term relationship than an individual who has come to rely on others.
Partner relationships seem to be affected by a SCI, although not as much as is widely believed. There are, however, problems interpreting the varying results of the studies due to culture differences, changes in family life in society in general and the different methodologies used. Systematic research that puts the patients' and partners' problems into perspective is necessary. Uniformity in measurement instruments would facilitate comparisons of studies.
Sexual problems in patients suffering from multiple sclerosis. Lilius, H. G., Valtonen, E. J. and Wikström, J. (Departments of Physical Medicine and Neurology, University Central Hospital, Helsinki, Finland).
A questionnaire which allowed anonymous answering and which also included many other questions besides those dealing with sexual life was sent to 302 patients suffering from multiple sclerosis (MS). Sexual life had changed for 91% of males and 72% of females. About half of the patients replied that their sexual life was unsatisfactory or had ceased altogether. These patients were as a rule in a relative poor physical condition. In males, disturbances in erection (62%) were the most common problem, erection was normal in only 20%. In females the essential figures were: loss of orgasm in 33%, loss of libido in 27% and spasticity in 12%. There was no correlation between the incidence of sexual disturbances and the duration of the MS. It seems that the neurological disturbances in sexual life depend simply on the location of the plaques in the central nervous system.
The purpose of this study was the development of an assessment guide (Hanson Assessment of Sexual Health) which would assist the health provider with sexual assessment. The assessment guide focuses on the impact of functional impairments associated with chronic illness on sexuality. Demographic information and data on the effect of functional impairments on selected aspects of sexual expression was included. Sixty subjects, all diagnosed as having chronic disease, were interviewed. Results demonstrated that the Hanson Assessment of Sexual Health (HASH) did identify a high risk population, those persons who experienced a bad effect of functional impairments on important aspects of sexuality. Reliability and validity of the instrument are discussed. Clinical implications are presented and areas for further research are identified.
This paper presents the perspective of nondisabled people who do not stigmatize, stereotype, and reject those with obvious disabilities. We look at how nondisabled people who are in caring and accepting relationships with severely disabled others define them. Although the disabled people in these relationships sometimes drool, soil themselves, and do not talk or walk—traits that most would consider highly undesirable—they are accepted by the nondisabled people as valued and loved human beings. We look at four dimensions of the nondisabled people's perspective that helps maintain the humanness of the other in their minds: (1) attributing thinking to the other, (2) seeing individuality in the other, (3) viewing the other as reciprocating, and (4) defining social place for the other. The paper illustrates a less deterministic approach to the study of deviance, suggests that people with what are conventionally thought of as extremely negatively valued characteristics can have moral careers that lead to inclusion rather than exclusion, and argues that the study of acceptance needs to be added to the more common focus on rejection.
This analysis of the social aspects of sexual relations between disabled and nondisabled persons attempts to raise several issues and problems which have been neglected or avoided in prior research. Particular emphasis is placed upon a candid examination of the reduced probabilities of marriage or sexual relationships, the vulnerability, and the potential exploitation of visibly disabled persons. This investigation appears to indicate a need for extended research on the social dimensions of sexuality and disability, an expanded discussion of this subject, a reexamination of personal values, and increased efforts to eliminate the legal and emotional vulnerability and exploitation of visibly disabled individuals in personal relationships.
In a recent article (Sexuality and Disability, Vol. 5, No. 3), the authors discussed how health professionals can help patients with scoliosis, how back pain, and cerebral palsy achieve more confidence as sexual beings and improve their ability to experience sexual satisfaction. The current article, the second in the series, describes how selected musculoskeletal conditions causing pain, deformity, and loss of joint motion may affect sexual expression and recommends specific ways in which these problems can be dealt with, such as patient education and preparation for sexual encounters. The following musculoskeletal conditions, including case histories, discussions and illustrative figures, are covered:1.
Rheumatoid arthritis and total hip replacement;
2.
Amputations;
3.
Trauma (casts and open wounds).
A study of the preinjury and postinjury marriages of 55 spinal cord injured persons and their partners revealed several differences between the relationships. Although all patients had comparable levels of spinal cord injury, the disabled persons in preinjury marriages were judged to have less motivation for independence; a larger proportion of them received daily personal care assistance from their spouses. Furthermore, those in postinjury marriages were more likely to be employed and were judged to be better adjusted psychologically. Psychologists' assessment of marriages based on interviews with the spinal cord injured subjects and their spouses revealed that the postinjury marriages were happier than the preinjury marriages. Possible explanations for these findings are discussed, which include age and state of health, the impact of disability on the marital relationship and the personal assets of disabled persons who attract new partners.
Differences in perceived self-concept and sexual response before and after spinal cord injury were examined. Twenty-four women between the ages of 20 and 40 completed a questionnaire and participated in a brief taped interview. Most of the women viewed themselves as very or somewhat attractive and had been involved in a sexual relationship since injury. The majority viewed sexual relationships as very enjoyable, although many commented that changes in bowel and bladder function had inhibited sexual expression. The need for more effective sexual counseling was highlighted. A trend was noted for an interrelationship between sexuality and self-concept in adapting to acquired disability.
The outcome o,f marriages contracted after spinal cord injury suffered by males was examined via the questionnaire method. Of those whose first marriage occurred after their injury, the divorce rate was 24.4%. Of those whose were married prior to injury and then remarried following injury, 16.4% were divorced. If all post-injury marriages are considered, the divorce rate is 23.1%. This is close to the divorce rate of the United States as a whole. The outcome of post-injury marriages was also examined with respect to time since injury, level of injury, presence of post-injury children, and post-injury education and employment. Particular attention was given to those males who had never been married prior to their injury.
A questionnaire which allowed anonymous answering and which also included many other questions besides those dealing with sexual life was sent to 302 patients suffering from multiple sclerosis (MS). Sexual life had changed for 91% of males and 72% of females. About half of the patients replied that their sexual life was unsatisfactory or had ceased altogether. These patients were as a rule in a relative poor physical condition. In males, disturbances in erection (62%) were the most common problem, erection was normal in only 20%. In females the essential figures were: loss of orgasm in 33%, loss of libido in 27% and spasticity in 12%. There was no correlation between the incidence of sexual disturbances and the duration of the MS. It seems that the neurological disturbances in sexual life depend simply on the location of the plaques in the central nervous system.
Spinal cord injury is one of the most prevalent disabilities in the United States today. The disability invariably affects sexual functioning challenging the usual ways one thinks about sexuality. Rehabilitation and development of standards of care for sexual counseling in this population are essential. Outlined in this article are proposed standards of care for sexual counseling of the spinal cord-injured (SCI) client. Theoretical approaches, provision of counseling and nurse-client objectives which support development of these standards are identified. Also included is a discussion of the preparation and role of the nurse in providing sexual counseling.
Occupational therapists, as well as other rehabilitation professionals, are aware that sexuality counseling is an important aspect of rehabilitation. However, occupational therapists have limited resources within their profession for training in this area. This paper describes the development, philosophy, goals, objectives, and format of the module "Sexuality and Disability" offered to occupational therapy students at Tufts University. Evaluations from the 288 students who have taken this module to date indicate that all students considered the module a pertinent part of their academic program. Other occupational therapy schools might wish to incorporate a similar component into their curricula to expand the resources within the profession for training in sexuality counseling.
Spinal Cord is the official journal of the International Spinal Cord Society. It provides complete coverage of all aspects of spinal injury and disease.
Thirty men and five women aged 36-70 years with angina were questioned about their sexual activity. Twenty-nine (83%) had intercourse more than once a week and six (17%) abstained. In 19 (65%) angina occurred during intercourse, and four also complained of palpitation. Fourteen patients underwent 24-hour ECG (electrocardiogram) tape-recordings before and after beta-blockade, and indicated the time of intercourse in diary cards. Tape analysis before beta-blockade revealed an average maximal 24-hour heart rate of 124.0 +/- 7.2 beats/min, and 122.2 +/- 7.1 beats/min during intercourse. Two patients complaining of palpitation during intercourse developed supraventricular tachycardia (SVT) and two sinus tachycardia. Beta-blockade abolished the SVT and reduced the average maximal 24-hour heart rate to 82.1 +/- 6.0 beats/min (P less than 0.001), and 82.0 +/- 2.8 beats/min during intercourse (P less than 0.001). After 6 months, the 19 patients previously symptomatic were pain-free during intercourse, though six also required prophylactic sublingual nitrates. Four of the six who previously abstained were able to have a normal sex relationship. Twenty-four hour tape ECG recordings have shown that the heart rate during intercourse is similar to that during normal daily life. There is no reason why most patients with angina cannot have a normal sex life, and physicians should ask and advise routinely.
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.
Commonalities and differences in the neurophysiology of sexual response in persons with spinal cord injuries and the non-cord injured are described. Recognition of individual differences and other implications for sex education and counseling with the spinal cord injured are presented.
The purpose of this investigation is to analyse whether the frequency of coitus is changed in subjects who have suffered a stroke with resulting hemi motor deficit. 23 females and 62 males with hemiplegia or hemiparesis (mean age 57.5 ± 9 years) were studied. It is concluded that the majority of subjects who have sustained a stroke and have a residual motor impairment, however little, demonstrate decline in sexuality as illustrated by decline in frequency of sexual intercourse. Although in some subjects this decline might be physiologically explained we feel that the sexual dysfunction is more a reflexion of an unsuccessful coping process within the partnership. Consequently appropriate sexual information or counceling and, if needed, sexual therapy should be integrated in the rehabilitation process of hemiplegic subjects.
There is need for a greater readiness among the medical and paramedical professions to recognize the widespread occurrence of sexual problems in patients with arthritis and allied conditions. Sexual image, sexual drive, sexual competence, sexual expression, and sexual opportunity may all be adversely affected by the onset of arthritis, the type and degree of effect depending on the nature, severity, and duration of the disease and on the social and marital state of the patient. Single patients may have difficulty in forming stable sexual relationships and married patients in creating a mutually satisfying pattern of sexual expression. The physical and psychological state of patient and partner and the medication of both need careful consideration to determine contributory causes to the individual problem-complex of each patient. Based on the experience of 12 years' sexual counselling at a disabled living unit and an orthopaedic hospital, and of 4 years at a weekly clinic for disable people with sexual problems, the causes and means of amelioration of these problems are discussed.
Spinal Cord is the official journal of the International Spinal Cord Society. It provides complete coverage of all aspects of spinal injury and disease.
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