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Sexual and Reproductive Health

Body Image and Acceptance

Author, Year; Country
Score
Research Design
Total Sample Size		 Methods Outcome
Bailey et al. 2015; Canada
Observational/Qualitative
Level 5
N=9		 Population: 9 individuals (5 females & 4
males, age range= 21-63 years), type of
injury C3-T7 (AIS A-D, complete &
incomplete SCI), years post injury 4-36
years
Treatment: None
Outcome Measures: Interview consisting
of open-ended questions to determine
participants’ overall body image, how
participants themselves defined body
image, positive body image, and negative
body image.
  1. The following main categories were found: body acceptance, body appreciation and gratitude, social support, functional gains, independence, media literacy, broadly conceptualizing beauty, inner positivity influencing outer demeanour, finding others who have a positive body image, unconditional acceptance from others, religion/spirituality, listening to and taking care of the body, managing secondary complications, minimizing pain, and respect.
  2. Unique characteristics (i.e., resilience, functional gains, and independence) were also reported demonstrating the importance of exploring positive body image in diverse groups.
Merghati-Khoei et al. 2017; Iran
Qualitative Study
Level 5
N=53		 Population: 53 individuals with SCI; 41
men (mean age 24.4 ± 5.7 years) and 12
women (mean age 29.5 ± 8.3 years);
duration of SCI for men (46.0 ±41.6
months) and for women (97.3 ± 99.6
months)
Treatment: None
Outcome Measures: Semi-structured
Interview to understand how people with
SCI understand marriage.
  1. “Attractiveness,” “able body for breadwinning,” “sexually active,” and “reproduction” were dominant concepts (‘outer’ scenarios) for how Iranian adults with SCI understood marriage.
  2. The participants’ inner scenarios (beliefs) revealed that marriage would be welcomed if a potential partner accepted them as a “whole person” regardless of their SCI condition.
  3. Adults with SCI do not ignore or reject marriage, however it was a lower life priority due to major health concerns that they had internalized.
Smith et al. 2015; USA
Cross-sectional Study
Level 5
N=218		 Population: 218 individuals consisting of
120 males and 98 females (mean age=58,
7years); 38% had SCI.
Treatment: None
Outcome Measures: Patient Reported
Outcomes Measurement Information
System’s (PROMIS) sexual function item
bank measuring sexual function, sexual
satisfaction, and use of aids for sexual
activity; PROMIS Pain Interference – Short
Form; Patient Health Questionnaire-9
(PHQ-9); Mobility was measured with the
6-point Gross Motor Function Classification
System
  1. Consistent with studies of able-bodied adults, sexual function was the strongest predictor of satisfaction.
  2. Depression also predicted sexual satisfaction for women.
  3. Use of aids for sexual activity varied by disability type and was generally associated with better function.
  4. Lowest levels of sexual satisfaction were reported by men with SCI.
  5. Depression may negatively impact sexual satisfaction in women, beyond contributions of sexual dysfunction, and effective use of sexual aids may improve function in this population.
Bozan et al. 2015; Turkey
Observational
Level 5
N=50		 Population: 50 individuals- 29 male and 21
female patients; 10 had tetraplegia and 40
had paraplegia.
Treatment: None
Outcome Measures: Participants were
asked to rate how significant each
dysfunction (walking disorder, urinary
incontinence, fecal incontinence, and
sexual dysfunction) was in their view.
  1. 50% of male participants and 36% of female participants had urinary incontinence
  2. 46% of males and 32% of females had fecal incontinence.
  3. All participants had at least impaired walking, with complete inability to walk in a certain proportion of patients.
  4. 22% of males and 24% of female patients required walking-aids for walking. All male patients and 16 female patients reported sexual dysfunction.
  5. Male patients regarded inability to walk as the most significant dysfunction, followed by sexual dysfunction, absence of voluntary defecation, and absence of voluntary urination.
  6. In females, inability to walk and absence of voluntary urination were placed equal level of importance, followed by the loss of voluntary defecation. Interestingly, no female patients included sexual dysfunction in the ranking.
  7. The observed gender difference in the perceived significance of dysfunction because of SCI may be due to anatomical, cultural and social factors.

Four studies have recently been published examining body image, acceptance and SCI. Qualitative studies indicate that people with SCI have concerns about their body, its appearance, and its functionality that are particular to sexual behaviour. Studies also indicate that physical dysfunction, in particular loss of bowel and bladder control and inability to walk, pose specific problems for people with SCI, their sexual functioning, and their body image acceptance.

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