Sexuality and Disability Flashcards
Which is not a way that disability impacts sexuality?
- Physical limitations may cause the client to question his or her ability to experience sexual pleasure
- Being perceived as unattractive and possibly unloveable can cause the client to believe that he or she can never be intimate with anyone…which can lead to a sense of despair, significantly lower levels of sexual esteem and sexual satisfaction, and significantly higher levels of sexual depression (tends to be seen with those with more severe physical impairments)
- Others may regard the person with a disability as asexual, hypersexual, an object of pity, and unattractive
- “The client’s sense of masculinity or femininity may be threatened by the disability” (e.g. men sometimes feel emasculated after a disability due to physical limitations & women feel less attractive and undesirable)
- Feelings of incapability to love and be loved
ALL are ways that disability affects sexuality
How can an OT help a person with sexuality?
- Sexual activity as an ADL:
Implies that the OT role is related to physical performance including: how to prepare for sex &
how to have sex - Engaging in sexual activity requires awareness of the role of sex
- Sex as social participation (acknowledges the need for intimacy, physical contact, expression of feelings) &f or parenting
***Pedretti states that OT’s can work with clients in all areas related to sexuality and sensuality, such as: QOL; role delineation; cultural aspects; impulse control; energy conservation; muscle weakness; hypertonicity & hypotonicity; appreciation of body; psychosocial issues; ROM; joint protection; motor control; cognition; increased or decreased sensation
What is a therapists rights when it comes to discussing sexuality?
- protect yourself from sexual advances (physically, psychologically, and emotionally)
- have and maintain personal values and beliefs about sexuality
- set limits and confront sexual harassment
What is a therapists responsibility when it comes to discussing sexuality?
- respect the personal values and beliefs of others re: sexuality
- report sexual abuse
- provide evaluation and treatment as needed
- make appropriate referrals
- know your biases and level of comfort
The PLISSIT model is a progressive approach to guide the OT in helping the client deal with sexual information. Explain the model.
P: Explicitly give Permission:
refers to allowing the client to feel new feelings and experiment with new thoughts or ideas regarding sexual function (validate thoughts & feelings in safe, therapeutic atmosphere)
LI: Limited Information:
explaining what effect the disability can have on sexual functioning (an explanation with great detail is not usually necessary early in the counseling process)
SS: Specific Suggestions:
it may be in the therapist’s domain to give specific suggestions on dealing with specific problems that relate to the disability, such as positioning
this is the highest level of input the average OT should attempt without advanced education and training in sexual counseling
IT: Intensive Therapy:
should be reserved for the rare client who has an abnormal coping pattern in dealing with sexuality
an extensive counseling background is needed to provide intensive therapy
refer to community resources/counseling/therapy when above & beyond scope pf practice
Name three skills an OT may assess in considering a cognitively impaired client’s capacity to consent to sexual activity
- Client’s awareness of relationship
- Clients’ ability to avoid exploitation
- Client’s awareness of potential risks
What spinal cord injury levels are involved in the ability of men to have psychogenic erections? Reflex erections?
Reflex (produced by touch) and Psychogenic (mentally induced)
Psychogenic erections: the brain sends messages down the spinal cord to the spinal nerves originating at level T10 through level L2 to stimulate an erection
Reflex erections: Capability usually remains intact unless S2-4 pathways are damaged
What are the issues related directly to fertility for men with spinal cord injuries
- Anejaculation (no ejaculation possible)
- Retrograde ejaculation (ejaculation drips back into bladder)
- Reduced sperm motility
Describe two mechanical strategies for helping men with spinal cord injuries ejaculate sperm.
- Vibrators or massagers
2. Vacuum pumps - (generate potential for erection)
List medications and other tools used to help men with spinal cord injuries attain and maintain an erection.
- Oral medications for blood flow to the penis - (e.g. Viagra, Levitra, Cialis…may cause side effects) (the medication does not cause an erection - sexual activity is still required for this to occur)
- Penile injections (Caverject/alprostadil) - (can cause scar tissue to build up & make an erection difficult)
- MUSE (Medicated Urethral System for Erection) - (a small medicated pellet that the patient inserts inside the opening at the tip of his penis (urethra); allows the surrounding tissue to relax & blood to fill the penis)
- Surgical implants - (not recommended though due to potential skin breakdown)
How does spinal cord injury impact a woman’s sexuality?
Limited vaginal lubrication; Risk for UTI’s; Potential autonomic dysreflexia (men too); Disruption in menstrual cycle or amenorrhea (absence of menstruation); Hygiene issues related to menstrual care due to lack of education, poor hand function, and poor sensation;
Inadequate health care services (e.g. doctors may not complete full pelvic exam because they may not consider that these women are having sex or it may be difficult to get on the exam table); Muscle weakness in the genital area; Problems achieving orgasm
What are recommendations an OT can make to help with these issues?
Referral to physician
Suggest talking to doctor about medication: (Viagra to stimulate low libido; can potentially increase lubrication & sensation too)
Water-based gel for lubrication and to decrease pressure and friction (K-Y Jelly)
Educate about a bladder and bowel program (e.g. reduce fluid intake prior to sexual activity; empty catheter prior to sexual activity; avoid eating prior to sexual activity; if using a Foley or suprapubic catheter, tape to inside of leg or abdomen; and maintain consistent bowel program)
The partner should be encouraged to touch and caress the sensate parts of the client’s body- if sensation is essentially absent in a part of the body, the partner should gently describe where touch is taking place
The client and partner should experiment with new erogenous areas- these areas usually are located at the level of the last intact dermatome or sensate surface area of the skin; good client-partner communication can facilitate the location of these areas
Clients should be encouraged to use positions that take advantage of any movement that is present for sensual and sexual activity
What is a “phantom orgasm”?
reassignment of sexual response to areas of the body which are unaffected by the injury; It has been described as “a highly pleasurable fantasized orgasm (which occurs by) mentally intensifying an existing sensation from some neurologically intact portion of the body and reassigning the sensation to the genitals.”
List three pregnancy complications women with spinal cord injuries may experience.
UTI’s, pressure ulcers, increased spasticity, respiratory difficulties, kidney problems, autonomic dysreflexia (injury at T6 or above);
Effect of the increased body weight on transfers;
Need for increased bladder and bowel care;
Loss of pelvic area sensation (unaware when labor contractions begin);
Induction of labor may be contraindicated if a person has a spinal cord injury at T6 or above and the medical staff members are not trained to deal with the respiratory problems or dysreflexia that can result;
Thromboembolism (with high thoracic or cervical lesions, respiratory function may be impaired with the increased burden of pregnancy or the work of labor, requiring ventilator support)
