Sexual Education and Counselling for SCI Patients
Sexual rehabilitation is recognized as an important component of the overall rehabilitation program for patients with SCI; however, retrospective studies identify a gap between services desired by patients and the services actually provided (White et al. 1993; McAlonan 1996; Tepper 1999). As far back as 1982, Schuler compared five sexual rehab programs for persons with SCI, and urged clinicians to evaluate the sexual rehab services provided (Schuler 1982). While the ideal timing for sexual education for SCI patients has not been determined, Fisher et al. (2002) showed a significant increase in sexual activity between discharge from inpatient rehabilitation and 6-months later, and they suggested that the first 6 months post-discharge are optimal for sexual health interventions.
Discussion
Surveys of people who have completed rehabilitation after SCI have expressed a need for more education and counselling on sexual health concerns. Some recent research reported that few people with SCI receive information, are satisfied with the levels of education about pregnancy or sexual health, and that most expect medical staff to start the conversation about sexuality rather than having to initiate it (New et al. 2016; Celik et al. 2014).
There are only two pre-post studies that have evaluated a specific sexual health program after SCI. In Hess et al. (2007), four men received an outpatient SCI sexuality program staffed by an interdisciplinary team; they rated their visits as positive, but analysis of sexual satisfaction or knowledge was not done (i.e. level 5 evidence). Schopp et al. (2002) investigated the effect of comprehensive gynecologic services on the health behaviour of women with SCI. The authors note a trend towards desired behavioural improvement in one outcome measured, namely, increased willingness to receive a mammogram. The other outcome measure (adoption of health-promoting behaviours) was not shown to change.
Observational studies suggest that those who receive sexual counselling or educational services may have higher levels of sexual satisfaction (Charlifue et al. 1992; Valtonen et al. 2006). In addition to physical challenges, SCI can alter a person’s sexual identity and sexual self-esteem, further complicating a person’s efforts to date potential partners or develop new intimate relationships (Fritz et al. 2015).
Conclusion
There is level 5 evidence (Hess et al. 2007) that a sexual health program may be positively received by patients with SCI.
There is level 4 evidence (Schopp et al. 2002) which suggests that comprehensive gynecologic services may improve women’s health behaviours.
