Discussing Sex and Intimacy in the Rehabilitation Setting. Kathryn Ellis, OTR/L November 14 th, 2015 AOTA Student Conclave

Transcription

1 Discussing Sex and Intimacy in the Rehabilitation Setting Kathryn Ellis, OTR/L November 14 th, 2015 AOTA Student Conclave

2 Disclosure: the views expressed in this presentation are those of the author and do not necessarily represent the official views/positions of the Department of Defense, or Walter reed National Military Medical Center. The author has no conflicts of interest to disclose. The devices discussed in this section are not specific recommendations; rather, they are general example to provide information to a large group with varying injuries. The author was not solicited or compensated by the manufacturers of the products in this presentation. No endorsement is explicit or implied.

3 Objectives Increase comfort level Increase knowledge

4 Sex, Intimacy, and Rehab Sex is an ADL Managing intimate relationships is an IADL Healthcare providers address Cognitive Psychosocial Physical

5 Poly-trauma Injuries Affecting Sex and Intimacy SCI (Spinal Cord Injury) TBI Orthopedic injuries Urogenital injuries Amputation Soft Tissue Nerve Hormonal and endocrine Prolonged hospitalization Psychological changes PTSD, depression, anxiety

6 Typical Non-Polytrauma Patient Diagnoses Rheumatoid Arthritis Post-surgical Neuromuscular Disease Stroke Oncology Brain injury

7 Timing and Approach Important to initiate conversation early on: Normalize sex as one of many ADL s Provide patient options Identify who they can talk to Identify options/resources Don t make assumptions as providers Not ready to talk about it, Shouldn t they be focused on rehab?

8 PLISSIT MODEL Permission Limited Information Specific Suggestions Intensive Therapy

9 Areas of Possible Concern Medication Pain Testosterone Changes Performance Positioning Fine / Gross motor deficits Loss of sensation Decreased energy levels Planning/organizing around busy schedule Self-perception Body image Self- esteem All resulting in Avoidance Decreased desire and initiation

10 Engaging in Intimacy Maintaining intimate relationships Developing new intimate relationships Confidence Affirming yourself and your partner Intimacy Dates

11 Engaging in sexual activity Erogenous zones Desensitization Body awareness Self-esteem Non-intercourse activities Positioning aides Pleasure toys Bowel and bladder management Medication management Safety Communication / scripting Expectations pleasure vs performance Planned Sex is not boring sex!

12 Patient and Provider Resources Healthcare Providers Primary Care Physicians Urologists, Gynecologists, Behavioral Health (Psychologists/Psychiatrists), OT/PT Nurses Social Workers Fertility specialists Certified Sex Counselors or Therapists Peer connections or support groups Internet

13 Reference/Resources The Ultimate Guide to Sex and Disability: For all of us who live with disabilities, chronic pain, and illness by Miriam Kaufman, M.D., Cory Silverberg, and Fran Odette Ester Perel The Secret to desire in a long term relationship TED talk An Intimate Look at the Sex Lives of People Living with Disabilities by Sara Coughlin Pleasure Able: Sexual Device manual for persons with disabilities by Kate Naphtali, Edith MacHattie, MOT, Stacy Elliott, MD Michael Stokes Photography Sexuality and Occupational Therapy: Strategies for persons with disabilities by Bernadette Hattjar PVA.org Sex and Intimacy for Wounded Veterans: A Guide to embracing change by Kathryn Ellis, MOT, and Caitlin Dennison, MOT

14 Reference/Resources Satcher, D., Tepper, M., Thrasher, C., & Rachel, S. (2011). Breaking the Silence: Supporting intimate relationships for our wounded troops and their partners: A call to action. International Journal of Sexual Health, 24: 1, Cameron, R., Syme, M., Fraley, S., Chen, S., Welsh, W., Mona, L., Cordes, C., Klein, L., & Smith, K. (2001). Sexuality Among Wounded Veterans of Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn: Implications for rehabilitation psychologists. Rehabilitation Psychology, 56: 4, Breyer, B., Cohen, B., Bertenthal, D., Rosen, R., Neylan, T., & Seal, K. (2014). Sexual Dysfunction in Male Iraq and Afghanistan War Veterans: Association with postraumatic stress disorder and other combat-related mental health disorders: A population-based cohort study. Journal of Sex Medicine, 11: 1, Ponsford, J. (2010) Sexual Changes Associated with Traumatic Brain Injury. Neuropsychological Rehabilitation, 13:1-2, Ramchand, R., Tanielian, T, Fisher, M., Vaughan, C., Trail, T., Epley, C., Voorhies, P., Robbins, Robinson, E., & Ghosh-Dastidar, B. (2014) RAND Coorporation.