Teaching Sexuality and Spinal Cord Injury (SCI) from a Nursing Perspective

Transcription

1 Teaching Sexuality and Spinal Cord Injury (SCI) from a Nursing Perspective By: Emmanuela Pierre Charles MSN, RN, FNP C and Marie Denise Jeune BSN,RN, CRRN

2 What is Sexuality? Sexuality is a physical and emotional part of life Sexuality is an integral aspect of the human experience. Sexuality affects how we view ourselves as individuals; in our families and communities; relationships with others; and our moral, spiritual, and cultural beliefs.

3 Dr. Jean Watson Book: The philosophy and Science of caring, 2008 Watson s Theory of Human Caring is a nursing practice model that Promotes healing and wholeness for self and others. Caritas process #9 : Administering Sacred Acts Sexuality is loaded with symbolic, emotional, spiritual and cultural sensitivity, yet it is one of the most beautifully expressed needs, in that our sexuality defines our identity and is an expression of our very being (Watson 2008, p. 171).

4 Sexuality A broader term that includes: Physiological Psychological Emotional Sociocultural

5 Physiological Discuss changes patients may experience regarding sexuality following a spinal cord injury Pain, weakness, pressure ulcers, sensory loss, erectile dysfunction, ability to orgasm, lack of bowel and bladder management, and sexual dissatisfaction.

6 Psychological Assess their views on sexual identity Assess their desire of being sexually intimate with others.

7 Emotional Assess their readiness Discuss what their body perception is?

8 Social Society portrays men and women with disabilities as asexual Simple gestures such as touching and hugs are not very common

9 Self Perception Most patients with SCI expressed that they feel angry and depressed as they try to adjust to the changes in how their body looks, feels, and functions. Most of them expressed feeling of low self esteem and loss of dignity.

10 Community Perception Family and friends show great concern about the injured individual and may not view them the same. Spouses and significant others often avoid the subject and the act of intimacy and sexual encounter. Negative community perception of the SCI population can yield to increase insecurities related to body image, relationships, and sexuality.

11 Where do you start? First assess your own biases and personal comfortability regarding the topic (sex, sexuality). Second, assess what does sexuality mean to the person being taught.

12 Initiating the conversation First assess the person s readiness to speak about the topic. Age Onset of disability Sexual orientation

13 Why Is It Hard For SCI Patients To Get Intimate? 1) Negative assumption 2) Extreme discomfort for sexual activity 3) Lack of sexual education

14 What We Need to Know! The impact of a spinal cord injury on sexual function is largely dependent on their age. There are specific SCI related changes in sexual response to which the individual must adapt. Patients must also understand the impact their injury may have on their sexual functioning. Alterations in sexual response occur based on the location and degree of the SCI.

15 What We Need to Know! Cont The ability of persons with SCI to experience psychogenic and reflex genital arousal and orgasm.

16 Ways To Cope With an Altered Body Image Remind patient that their physical appearance is only a fraction of their body. Focus on yourself as a whole person. The injury did not change who they are inside. They are still the same person. Find new and creative ways to do things you enjoyed before the injury. Focus on your strength instead of your weaknesses.

17 Reproduction Female Minority minority Engage in sexual activity more than male after their injuries Woman are able to bear children under the supervision of a specialized physician. Male Sperm levels remains unchanged however motility can be affected.

18 Managing Neurogenic Bladder and Bowel Bladder Timing is essential Bowels Educating the patient regarding what can occur with their bladder during sexual activities. Best way to prevent an incontinent episode to occur is having a schedule intermittent catheterization to empty the bladder. Sticking to a bowel care regimen can prevent incontinent episode to occur

19 Ways to Stimulate Arousal Erogenous zone Ears, neck, Chest, underarm Lips, face, tongue Hands, fingers, feet, toes

20 Other Methods of Arousal Sex toys Masturbation Medications Devices

21 Devices for Positioning Body Bouncer Intimate Rider

22 Devices for Positioning cont Liberator Shapes Liberator Shapes

23 Devices for Positioning cont Wheelchair Hoist Sex Swing

24 Available Treatment Penile prostheses Intracavernosal injection of vasoactive agents Intraurethral alprostadil Vacuum erection devices 3 (FDA) approved drugs to treat erectile dysfunction Sildenafil, vardenafil, and tadalafil

25 Engaging in Sexual Activity Talk with your partner about how your body looks and feels. Give yourself permission to try new ways to be sexual. Sexual intimacy is not just about intercourse. There are many ways to be sexual and to express your love or attraction. Explore and enjoy finding out ways that work best for you and your partner. Be open to new positions that are more comfortable. Pillows can help with balance or positioning. You can also purchase devices to assist with positioning and movement during sex.

26 Engaging in Sexual Activity cont Intimacy and affection can be tremendously healing after a spinal cord injury. Being sexual again is a psychological boost for most people after an injury. Encourage patient to communicate to their health care team about the safest positioning for sexual activity based on your specific injury and any surgical procedures you may have had after your injury During the patient s initial healing period, more gentle activities, such as touching, kissing, and intimate stroking, may be preferable to sexual activities that do not require repositioning and movement. Patient should be encourage to ask their health care provider if there are any questions or concerns.

27 Movie Clip SgqGEX_DOw?t=5m27s

28 References Resources Websites Paralyzed Veterans of America: Books Sexual Function in People with Disability and Chronic Illness: A Health Professional's Guide, by Marca L. Sipski & Craig J. Alexander Sexuality and Reproductive Health in Adults with Spinal Cord Injury: What You Should Know: by Paralized veterans of America