A Multidisciplinary Approach to Sexual and Fertility Rehabilitation: The Sexual Rehabilitation Framework

Abstract

Many studies have identified improvement in sexual function as a priority for persons with spinal cord injury (SCI). Due to the various secondary sensory, motor, and autonomic consequences following SCI and due to the complexity of sexuality per se, this area can be overwhelming to many health care professionals. The literature indicate that sexual and fertility rehabilitation must be addressed in a biopsychosocial manner and include various disciplines. The multidisciplinary utilization of a Sexual Rehabilitation Framework (SRF) allows the medical and/or psychosocial factors that impede or improve sexual and reproductive function to be examined. The SRF is a user-friendly and simplified way to proactively address the major biopsychosocial areas of sexuality and to create a plan of action for the person with SCI. It is an adjunct tool to the full sexual history, and it encourages all disciplines involved in SCI rehabilitation to address the issue of sexual function in the same manner as they would other activities of daily living. Eight areas are included in the SRF: sexual drive/interest, sexual functioning, fertility and contraception, factors associated with the condition, motor and sensory influences, bladder and bowel influences, sexual self-view and self-esteem, and partnership issues. The use of the SRF is encouraged in both inpatient and outpatient settings. Multidisciplinary or interdisciplinary team work is encouraged in sexual and fertility rehabilitation to move clinicians toward providing proactive and comprehensive care for individuals with SCI or other chronic disabilities.

Sexual Health Communication Between Healthcare Professionals and Adolescents with Chronic Conditions in Western Countries: An Integrative Review

“…Healthcare professionals are aware of the importance of discussing sexual health, however barriers withhold them from initiating the discussion. The Sexual Rehabilitation Framework is a way to support healthcare professionals in addressing biopsychosocial areas of sexuality in adults with spinal cord injury [47]. An adjusted framework for adolescents with chronic conditions could be beneficial for healthcare professionals in child and adolescent care.…”

Conception and development of Sexual Health indicators to advance the quality of spinal cord injury rehabilitation: SCI-High Project

“…perception/expression of oneself as a sexual being) and sexual activity improves quality of life after SCI/D, 4 sexual health issues are poorly integrated into the current SCI/D rehabilitation care process encompassing both inpatient and outpatient settings. 4,[14][15][16] The structure, process and outcome indicators selected and developed by the SCI-High Sexual Health Working Group are intended to: (1) identify learning gaps, and improve capacity amongst regulated HCPs in sexual health; (2) articulate SCI/D patients' sexual health needs; (3) identify service delivery gaps, and better integrate sexual health into the SCI/D rehabilitation careprocess in order to create a permissive environment that enables open discussion and individual health inquiry; and, (4) improve patient sexual self-esteem, satisfaction and expression. It is vital to recognize that in order to advance sexual health rehabilitation care, consumer priorities should first be taken into consideration.…”

“…benchmarking) while building transparency in health care. 13,14 The SCI Rehabilitation Care High Performance Indicators (or "SCI-High") Project endeavors to advance SCI rehabilitation care by 2020 through consensus derived development, selection, implementation and evaluation of indicators of quality care for 11 Domains of rehabilitation care prioritized by clinicians, researchers and individuals living with chronic SCI/D. This manuscript describes the process involved in the selection, development and implementation of structure, process and outcome indicators for the Sexual Health Domain for adults with SCI/D from rehabilitation admission to 18 months post-admission.…”

Positive sexuality in men with spinal cord injury

“…All men had attended an inpatient program for sexual rehabilitation and were followed by a sex therapist as outpatients. Counselling and education about the consequences of spinal cord damage on sexuality is of paramount importance and helps men adjust to their new sexual capacities [6,10,[47][48][49].…”

“…There have not been any major changes in the treatment of either erectile dysfunction or incontinence over the last decade. However, the social environment is fast changing, and the extensive use of social media certainly changes the ways in which romantic or sexual encounters can occur [47].…”