Sexuality (CREATED BY BECKY, THANK YOU BECKY!) Flashcards
absence of disease from biomedical perspective
health
more than just absence of
disease and beyond just physical wellbeing…. biopsychosocial perspective
wellness
treatment/health-disease paradigm includes
disability
symptoms
signs
With wellness paradigm, this includes treatment paradigm but also
awareness
education
growth
multidimensional paradigm of wellness includes
mental
emotional
spiritual
social
physical
environmental
= SELF
A wellness paradigm means shifting focus from _ and _ to _
illness and prevention to WELLNESS
pathogenic orientation, assess clinical variables, treat patient symptoms via a prescription
what we do at PT school, learning how to treat this
illness
normogenic orientation, assess behaviors, treat risk factors via lifestyle modification
prevention
salutogenic orientation, assess perceptions, treat whole person & their dispositions via values clarification
wellness
wellness assesses perceptions of a person’s…
- general health status
- social support system
- role/social functioning
- self-efficacy
- perception of functional status in self-care/home management activities, work/community/leisure activities
merging wellness into rehab requires PT to
- modify traditional approach by changing focus from illness to wellness
- become wellness role model
- incorporate wellness measures into exam, consider pt within their system
4.** offer services beyond traditional pt-provider** relationship - become facilitator or partner with pt to empower them on their journey toward wellness vs an authority figure/expert
Neurologic PTs can assist patients optimize health/wellness by addressing barriers at individual, relationship, community, and societal levels.
Barriers to PTs addressing this into practice:
- lack of time
- low knowledge
- client complexity
- lack of HPW resources
- concerns regarding payment, scope of practice
recommendations of neurologic clinical practice:
optimize movement (include fitness, lifestyle)
reinforce importance of sleep health, nutrition, stress, smoking cessation in context of primary, secondary, tertiary prevention
besides the level of SCI, what impacts erections
- diabetes
- Rx
- Obesity
- high cholesterol
- depression
- tobacco use
- alcohol use
- treatment for prostate cancer
- MS, PD
SCI population: increase in CV risk factors exacerbated by inactivity
diabetes
IGT
met syndrome
obesity
__ is the #1 cause of morbidity in aging SCI population
cardiopulmonary disease
all encompassing concept that looks at how the individual as well as society view the person and roles
they are expected to assume. Includes how people look and how they think they look.
body image
way people feel about themselves; formed through social, cultural, personal attitudes/beliefs plus person’s internal history relating to self; composed of many aspects including body image and
sexuality; also includes ability to help others and affect the environment (social/vocational roles).
self-worth or self-concept
an integral component of health & wellness; it is an activity of daily living; involves more than the sex act: incorporates gender identity, attractiveness, sexual attitudes &
beliefs, sexual confidence, sexual validation, and sexual behaviors & practices
relates to body image, self-worth and representative of how the person is
dealing with his/her world
sensuality/sexuality
Predictor of adjustment to disability, of success in vocational training and marital satisfaction in women with disabilities
sexuality
Factors influencing a person’s response to changes in body image
- Prior losses
- Patterns of development
- Family, cultural values, beliefs, attitudes
- Personal control
- Sin & stigma
- Social support
Is fertility often affected in women following SCI?
What about men?
seldom affected in women
men: dysfunction of penis, testicles and/or fertility
pregnancy will cause function/mobility changes in woman with disability, requiring modification to ADLs and equipment
sexual function for women after SCI:
female orgasm is a reflex response of the
autonomic nervous system
factors influencing person’s response to changes in body image
- Prior losses
- Patterns of development
- Family, cultural values, beliefs, attitudes
- Personal control
- Sin & stigma
- Social support
If the level of SCI is above ___, then sexy thoughts from brain
cannot get through SC. For men that are able to get an psychogenic erection, they may be able to get erection but not enough for intercourse.
T11
Psychogenic sexual pathways are at what level of SC
T11-L2 (arousal occurs with visual/mental stimulation)
If you see this card you must either text or message Becky on Slack: “Thank you Becky for the decky!”
Thank you Becky for the decky!
even with higher level lesions (cervical/thoracic) reflex erections are possible in most men
with an injury at __ or above
T10 or above
reflexogenic sexual pathways are at what SC level
S2-4
occurs with direct physical contact, is involuntary and can also occur without any
sexual/stimulating thoughts; even with higher level lesions
REFLEXOGENIC (even with T10 or above)
may get an erection when bladder is full or during sleep. May or may not be able to use this for sexual activity depending on length of time erection lasts
spontaneous
What should we know about erections/intercourse for men with SCI
- erections not reliable/adequate for intercourse
- ability to ejaculate/sperm motility lower in males with SCI
- in males, orgasm may not always lead to ejaculation or retrograde ejaculation may occur
- Ability to father child: with aid of advanced reproductive technology to ejaculate semen via vibrostimulation and
electroejaculation, then insemination via IUI, IVF, etc - Incontinence during intercourse can be minimized with timing catheterization or using Rx.
What sexual function is impacted for women after SCI
Significant lowering of sexual desire, impaired lubrication, and orgasmic ability after SCI; also difference in erogenous zones
and reaching orgasm in women with SCI compared to women without SCI.
Women with SCI may need to be educated that longer and potentially more intense genital stimulation is necessary to
achieve orgasm and pregnancy & achieving orgasm depends on level and completeness of injury.
If _ sensory dermatomes are spared, women may experience lubrication during intercourse.
Use of Rx like sildenafil may increase arousal ability
T11-L2
with LMN lesions, for women,
_ _ often absent, so lubrication recommended
vaginal secretions
for sexual function in women: _ may occur post SCI
amenorrhea
TBI effects on different areas of the brain:
amygdala
sexual disinhibition/hyper sexuality
TBI effects on different areas of the brain: brainstem
decreased libido
inappropriate processing of info
TBI effects on different areas of the brain: hypothalamus
general initiation
dyscontrol of sexual behavior
hormonal regulation
TBI effects on different areas of the brain:
frontal lobes
sexual apathy, loss of initiative
TBI effects on different areas of the brain:
pituitary gland
infertility, decreased secondary sex characteristics, decreased libido
TBI effects on different areas of the brain:
septum
decreased libido
impotence
decreased ability to experience pleasure/orgasm
TBI effects on different areas of the brain:
temporal lobe
diminshed responsiveness
TBI effects on different areas of the brain:
thalamus
hyper sexuality
what is the main challenge for patients after TBI in terms of sexual function
disinhibited or socially inappropriate behavior
demonstrating a lack of restraint, a lack of initiation, or an
inability to initiate. Sexual dysfunction (hyper sexuality, hypo sexuality) may result due to these challenges.
what is the primary reason for sexual dysfunction after stroke
psychological issue
more than 50% males post CVA report ED
What is the strongest predictor of sexual dysfunction after amputation?
body image self-consciousness during sex
also reports of reduced libido post amputation
problems contributing to sexual dysfunction after disability
- medication side effects
- depression/psych issues
- neurogenic problems
- pain/spasticity
- traumatic structural changes in CNS resulting in hypo/hyper sexuality
- neuro B&B
- cognitive/communication/behavior
- substance abuse
- fatigue/weakness
- sensory changes
- altered body image
What is the PLISSIT model
Permission
Limited Info
Specific Suggestions
Intensive Therapy
