Sexuality

Question 1

Sexuality

Answer 1

• The ability to recognize, communicate, and perform desired sexual activities
• Sexuality is not just intercourse. It is broader and includes oral/manual stimulation of a variety of body parts, psych aspects, etc.

Question 2

T/F: sex and sexuality is an activity of daily living

Answer 2

True

Question 3

What are OT practice implications for sex?

Answer 3

• Consider clients’ sexual concerns
• Ask clients whether they have concerns regarding symptoms and their impact on sexual activities
• Create environments that indicate to clients that their sexual concerns are valid and important
• Take steps to increase own comfort level with discussing sex and sexuality in own practice

Question 4

What are different types of sexual dysfunction?

Answer 4

• Primary sexual dysfunction - of organic etiology
• Secondary sexual dysfunction
• People can have both primary and secondary problems and therefore are not able to function adequately

Question 5

What should one know about female sexuality after a SCI?

Answer 5

• Amenorrhea - directly following the injury menstruation will cease but will come back and will not alter fertility
• Pregnancy and labor take normal course
• T6 is sensory level for uterus (painless labor/surgery)
• Increased weight can result in increased decubitus ulcers
• Respiratory problems can result as the uterus presses on the diaphragm
• Severe scoliosis can make carrying and delivering a baby difficult
• Decreased lubrication following injury
• Indwelling catheter

Question 6

What should one know about male sexuality after a SCI?

Answer 6

• There are two types of erections:
  1) Psychogenic is more common with incomplete lesions T12-L2 levels
  2) Reflexogenic is more common with complete lesions S2-S4 levels

Ejaculation requires the muscles to contract - T12-L2 and S2-S3

Prosthesis are an option if man is unable to obtain/maintain an erection

1) Medications - oral or injections
2) Vacuum device
3) Inflatable
4) Semi rigid rod implantation

Question 7

What are bowel and bladder issues that are common in women with SCI?

Answer 7

• Indwelling catheter - not same orifice as vagina
• Incontinence
• Time intercourse around bowel and bladder schedule

Question 8

What are bowel and bladder issues that are common in men with SCI?

Answer 8

• Texas catheter - condom type that can be removed for sex
• Indwelling - fold over to side if one desires genital intercourse
• Time intercourse around bowel and bladder schedule

Question 9

How can a CVA affect someone’s sexuality?

Answer 9

• Libido

- Functional problems that include decreased ability to communicate, contractures, perceptual problems, and mobility

Question 10

How can a TBI affect someone’s sexuality?

Answer 10

• Person is still neurologically capable
• Social appropriateness may be an issue
• Libido
• Functional problems may be an issue

Question 11

What are OT interventions for sexuality?

Answer 11

• Health promotion
• Remediation
• Modification

Question 12

What is Plissit?

Answer 12

• A model for addressing an individual’s sexual needs and questions

P - permission to ask questions regarding sex
Li - limited info (basics)
SS - specific suggestion
IT - intense therapy (with a sex therapist)

Question 13

What should be guiding interventions?

Answer 13

• Increase awareness of his/her own and partner’s body sensations
• Learn to enjoy own an others body
• Develop greater satisfaction in physical experience together
• Enhance intimacy both emotionally and physically
• Increase ability to talk openly about sexual thoughts and feelings
• Develop trust so that they can openly talk about other options for sexual behaviors

Question 14

What are institutional variables that may apply to TBI?

Answer 14

• Disjunction between what the patient needs and what the institution provides
• Service delivery which is appropriate for other types of patients can be a poor fit for individuals following brain trauma

Question 15

What are institutional variables for a mild brain injury?

Answer 15

• Seen in ER
• Receives no counseling or follow-up services
• Often patients who can relate their current problems to an injury which occurred weeks earlier and actively seeks out services

Question 16

What are institutional variables for rehabilitation?

Answer 16

• Severe problems in many domains leads to therapist to prioritize patient goals. Patient may be able to respond to more treatment than the therapist can provide
• Service provision limited by staffing or reimbursement constraints
• Integrated, high level of expertise care, and coordinated services that are critical for optimal TBI recovery can often be problematic
• Unrealistic expectations of insurance carrier, hospital management staff, patient’s family, and patient
• Course of recovery is often lengthy and unpredictable which often does not match with short period of treatment authorization from insurance carriers
• Tendency to feel unsupported by administration regarding resources and time management

Question 17

What are variables to consider when working with patients with TBI?

Answer 17

• Often a joy to work with but can also be very difficult as strong emotions can be engendered in the rehab environment
• Oftentimes the patient, family, and support system are in crisis and facing potentially profound losses. As a result, the staff is a convenient target of their grief
• Behaviors are often unsafe, repetitive, and difficult to handle
• Patient may refuse needed treatment and lack insight into their own behavior
• Patient can be personally challenging and professionally demeaning
• Many deficits of brain injury are complex and abstract so they are difficult for patients and family to accept
• Simple environment of a hospital inhibits recognizing the handicapping effect of deficits of executive dysfunction with decreased initiation

Question 18

What are professional challenges in working with patients with a TBI?

Answer 18

• There is a need for continuing education
• It is easy to feel overwhelmed by the complexity of the patients’ problems and the technical/conceptual requirements of treatment approaches
• Normal and customary approaches may seem inadequate
• Can be offended by patient behaviors
• There can sometimes be a blurring of interdisciplinary lines

Question 19

How can therapists meet challenges in the TBI population?

Answer 19

• Develop interdisciplinary relationships with all staff trained in basic interaction management
• Recognize what can be accomplished within certain time periods to help combat unrealistic expectations
• Realize that while the rejection and hostility from patients and families is difficult, they are rejecting the diagnosis and the realities of the consequences of brain injury and not the therapist
• Be honest and straightforward with families and patients
• Be direct, respectful, and positive without creating false hope
• Understand the time it takes to fully comprehend the nature of loss
• Manage behavior with specialized programs but know that behavior management is not a quick fix or cure all
• Spend more time observing what the patient does spontaneously
• Spend more time experimenting with different ways to get your patient to do something
• Be aware of personal affect and interpersonal behavior
• Never argue with a patient
• Problem solve by working on a problem from different perspectives
• Recognize the ability of a patient to split a team and do not scapegoat other team members