PSYCHO-SEXUAL FUNDAMENTALS OF SEXUAL REHABILITATION OF MILITARY, VETERANS AND CIVILIANS WITH DISABILITIES
DOI:
https://doi.org/10.31732/2663-2209-2022-71-199-207Keywords:
disability, masculinity, PLISSIT model, sexual rehabilitation, sexual dysfunctions, sexuality, sexual scenarios, sexual functioning, sexual intercourse, femininityAbstract
The article highlights the psycho-sexual principles of sexual rehabilitation of military personnel, veterans and civilians with acquired disabilities. In particular, foreign professional publications are analyzed, and statistical data on the level of sexual disorders or changes in people with various injuries and traumas are presented. Attention is also focused on the lack of similar publications and research in the Ukrainian-speaking professional environment. It is noted that in Ukraine, rehabilitation programs for the military and veterans practically do not address a comprehensive approach to the rehabilitation of the sexuality of traumatized persons. The concept of sexuality as a complex combination of biological, social, psychological and other factors that encompasses human existence throughout life is explored. The spheres in which sexuality is manifested and experienced in all its uniqueness and individuality are highlighted. The high clinical significance of conversations about sexuality throughout the recovery process is noted, which should include both conversations with professionals of helping professions who should initiate such discussions and conversations within a couple or in support groups. The peculiarities of the impact of disability and trauma on sexual functioning, including the influence of false beliefs that can form a prejudiced attitude towards disability and sexuality, are outlined. The author emphasizes the high level of sexual problems that arise after surgical interventions against the background of misinformation or emotional experiences. In addition, the sexual functioning of a couple with a person with a sudden disability can be affected by a set of psychosocial factors, such as changing roles in relationships, general difficulties associated with the treatment and recovery process, depression, anxiety, changes in self-esteem or fatigue. Attention is drawn to the need to rethink one's own sexuality, ideas about masculinity and femininity, the formation of new sexual scenarios that would include the fact of disability, as well as a general expansion of the view of intimacy, which would move away from the widespread perception of sex as exclusively penile-vaginal contact. The article also highlights a wide range of aspects that may require therapeutic intervention when restoring the intimate life of a person who has suddenly become disabled.
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References
Alexander M, Courtois F, Elliott S, et al. Improving Sexual Satisfaction in Persons with Spinal Cord Injuries: Collective Wisdom. Top Spinal Cord Inj Rehabil 2017;23:57-70. 10.1310/sci2301-57
Annon J. Behavioral Treatment of Sexual Problems: Brief Therapy. Oxford, England: Harper & Row; 1974.
Annon J, The PLISSIT, Model J. Sex Educ. Therapy. 1976;2:1–15. doi: 10.1080/01614576.1976.11074483.
Barnartt S. N. (ed.) (2010). Disability As A Fluid State. Bingley: Emerald; 10.1108/S1479-3547(2010).
Basson R, Rees P, Wang R, Montejo AL, Incrocci L. Sexual function in chronic illness. J Sex Med 2010;7:374–388.
Byrne M, Doherty S, Fridlund BGA, Martensson J, Steinke EE, Jaarsma T, et al. Sexual counselling for sexual problems in patients with cardiovascular disease. Cochrane Database of Systematic Reviews 2016, Issue 2. [DOI: 10.1002/14651858.CD010988.pub2].
Calabrò RS, Cacciola A, Bruschetta D et al. Neuroanatomy and function of human sexual behavior: a neglected or unknown issue? Brain Behav. 2019;9(12):e01389.
Chapple A, Prinjha S, Salisbury H. How users of indwelling urinary catheters talk about sex and sexuality: a qualitative study. Br J Gen Pract. 2014 Jun;64(623): 364-71.
Charlifue SW, Gerhart KA, Menter RR, Whiteneck GG, Manley MS. Sexual issues of women with spinal cord injuries. Paraplegia 1992;30(3):192–9.
Cohen M. Physical and medical aspects of sexuality after traumatic brain injury. In: Aloni R., Katz S., editors. Sexual Difficulties After Traumatic Brain Injury and Ways to Deal With It. Springfield, Ill, USA: Charles C Thomas; 2003. pp. 42–56.
Courtois F, Charvier K.. Sexual dysfunction in patients with spinal cord lesions. Handb Clin Neurol. 2015; 130: 225– 245.
Dahlberg A, Alaranta HT, Kautiainen H, Kotila M. Sexual activity and satisfaction in men with traumatic spinal cord lesion. J Rehabil Med 2007;39(2):152–5.
Dune, T. M. (2013). Understanding experiences of sexuality with cerebral palsy through sexual script theory. International Journal of Social Science Studies, 1(1), 10.11114/ijsss.v1i1.6
Elliott SL. Ejaculation and orgasm: Sexuality in men with SCI. Top Spinal Cord Inj Rehabil. 2002; 8( 1): 1– 15.
Foley FW, Zemon V, Campagnolo D, Marrie RA, Cutter G, Tyry T, Beier M, Farrell E, Vollmer T, Schairer L. The multiple sclerosis intimacy and sexuality questionnaire - - re-validation and development of a 15-item version with a large US sample. Mult. Scler. 2013;19(9):1197–1203. doi: 10.1177/1352458512471876.
Fronek P, Kendall M, Booth S, Eugarde E, Geraghty T. A longitudinal study of sexuality training for the Interdisciplinary Rehabilitation Team. Sex. Disabil. 2011;29:87–100. doi: 10.1007/s11195-010-9177.
Gunning JN, Rubinsky V, Aragón A, Roldán M, McMahon T, Cooke-Jackson A. A Preliminary Investigation into Intersections of Sexual Communication in Bondage, Domination, Sadomasochism and Disability. Sex Cult. 2023 Jan 7:1-17. doi: 10.1007/s12119-022-10058-8. Epub ahead of print. PMID: 36643190; PMCID: PMC9825129.
Hess MJ, Hough S. Impact of spinal cord injury on sexuality: broad-based clinical practice intervention and practical application. J Spinal Cord Med. 2012 Jul;35(4):211-8. doi: 10.1179/2045772312Y.0000000025. PMID: 22925747; PMCID: PMC3425877.
Ide M. Sexuality in person with limb amputation: a meaningful discussion of re‒integration. Disabil Rehabil. 2004;26(14‒15):939‒943.
Jackson AB, Wadley V. A multicenter study of women's self-reported reproductive health after spinal cord injury. Arch Phys Med Rehabil 1999;80(11):1420–8.
Kattari SK. “Getting it”: identity and sexual communication for sexual and gender minorities with physical disabilities. Sexuality & Culture. 2015;19(4):882–899. doi: 10.1007/s12119-015-9298-x.
Kreuter M., Dahllöf A.-G., Gudjonsson G., Sullivan M., Siösteen A. Sexual adjustment and its predictors after traumatic brain injury. Brain Injury. 1998;12(5):349–368. doi: 10.1080/026990598122494.
Kroll K., Klein E.L. Enabling Romance: A Guide to Love, Sex, and Relationships for People with Disabilities. No Limits Communications; Baltimore, MD, USA: 2001. p. 86.
Ku J.H., Oh S.J., Jeon H.G. Sexual activity in Korean male patients on clean intermittent catheterization with neurogenic bladder due to spinal cord injury. Int J Urol. 2006;13:42–46.
Marck CH, Jelinek PL, Weiland TJ, De Hocking JS, Livera AM, Taylor KL, Jelinek GA. Sexual function in multiple sclerosis and associations with demographic disease and lifestyle characteristics: An international cross-sectional study. BMC Neurol. 2016;16(1):210. doi: 10.1186/s12883-016-0735-8.
Moreno J. A., Arango Lasprilla J. C., Gan C., Mckerral M. Sexuality after traumatic brain injury: a critical review. NeuroRehabilitation. 2013;32(1):69–85. doi: 10.3233/nre-130824.
O'carroll R. E., Woodrow J., Maroun F. Psychosexual and psychosocial sequelae of closed head injury. Brain Injury. 1991;5(3):303–313. doi: 10.3109/02699059109008100.
Rubinsky, V., & Hudak, N. (2022). Sex as enacted identity: gender, sexuality, & sexual creativity. In C. Noland, & J. Manning (Eds.), Sexuality & communication: theoretical and applied perspectives (2nd ed., pp. 101–116). Kendall Hunt.
Rubinsky V. Toward a typology of identity gaps in “non-normative” sexual partner communication. Archives of Sexual Behavior. 2021;50(4):1551–1567. doi: 10.1007/s10508-020-01870-0.
Sandel M. E., Delmonico R., Kotch M. J. Sexuality and intimacy following traumatic brain injury. In: Zasler N., Zafonte R., editors. Brain Injury Medicine: Principles and Practice. New York, NY, USA: Demos Publishers; 2013. pp. 954–973.
Sandel M. E., Delmonico R., Kotch M. J. Sexuality, reproduction, and neuroendocrine disorders following TBI. In: Zasler N. D., Katz D. I., Zafonte R. D., editors. Brain Injury Medicine: Principles and Practice. New York, NY, USA: Demos; 2007. pp. 673–695.
Sander A., Maestas K., Pappadis M., Sherer M., Hammond F., Hanks R., NIDRR Traumatic Brain Injury Model Systems Module Project on Sexuality After TBI Sexual functioning 1 year after traumatic brain injury: Findings from a prospective traumatic brain injury model systems collaborative study. Arch. Phys. Med. Rehabil. 2012;93:1331–1337. doi: 10.1016/j.apmr.2012.03.037.
Sexual health and its linkages to reproductive health: an operational approach World Health Organization, Geneva: Licence: CC BY-NC-SA 3.0 IGO. ISBN 978-92-4-151288-6 Assessed 1st September (2017).
Shakespeare T. The sexual politics of disabled masculinity. Sex Disabil. 1999;17( 1):53–64.
Simpson G. Addressing the sexual concerns of persons with traumatic brain injury in rehabilitation settings: a framework for action. Brain Impairment. 2001;2(2):97–108. doi: 10.1375/brim.2.2.97.
Sipski ML, Alexander CJ, Rosen RC.. Physiologic parameters associated with sexual arousal in women with incomplete spinal cord injuries. Arch Phys Med Rehabil. 1997; 78( 3): 305– 313.
Sipski ML, Alexander CJ, Rosen R. Sexual arousal and orgasm in women: effects of spinal cord injury. Ann Neurol 2001;49(1):35–44
Song HS, Oh HS, Kim HS, Seo WS. Effects of a sexual rehabilitation intervention program on stroke patients and their spouses. NeuroRehabilitation 2011;28(2):143-50.
Stratton H, Sansom J, Brown-Major A, Anderson P, Ng L. Interventions for sexual dysfunction following stroke. Cochrane Database Syst Rev. 2020 May 1;5(5):CD011189.
Taylor B, Davis S. The extended PLISSIT model for addressing the sexual wellbeing of individuals with an Acquired disability or chronic illness. Sex. Disabil. 2007;25:135–139. doi: 10.1007/s11195-007-9044-x.
Tepper M. Regain That Feeling: Secrets to Sexual Self-Discovery: People Living with Spinal Cord Injuries Share Profound Insights into Sex, Pleasure, Relationships, Orgasm, and the Importance of Connectedness. CreateSpace Independent Publishing Platform; Scotts Valley, CA, USA: 2015.
Tepper MS. Sexual education in spinal cord injury rehabilitation: Current trends and recommendations. Sex Disabil 1992;10:15-31. 10.1007/BF01102245
Verschuren JE, Geertzen JH, Enzlin P, et al. Sexual functioning and sexual well‒being in people with limb amputation: a cross‒sectional study in the Netherlands. Disabil Rehabil Jun. 2016;38(4):368‒373.
Wade DT. Measurement in Neurology Rehabilitation. Oxford: Oxford University Press, 1992.
Wendell S. (1996). The Rejected Body: Feminist Philosophical Reflection on Disability. New York, NY: Routledge.
Williamson G, & Walters A (1996). Perceived impact of limb amputation on sexual activity: A study of adult amputees. Journal of Sex Research, 33, 221–230.
Zhang H, Li B. Male genital sensation after spinal cord injury: a review. Transl Androl Urol. 2020 Jun;9(3):1382-1393. doi: 10.21037/tau-19-829. PMID: 32676423; PMCID: PMC7354288.
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