Sexual Education and Counselling for People With SCI

Sexual rehabilitation is recognized as an important component of the overall rehabilitation program for patients with SCI. However, retrospective studies identified a gap between services desired by patients and the services actually provided during rehabilitation (White et al. 1993; McAlonan 1996; Tepper 1999). As far back as 1982, Schuler et al. compared five sexual rehab programs for people with SCI and urged clinicians to evaluate the sexual rehab services provided. Though 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. Patients expressed “they wished sessions happened earlier in their stay” and “sexual health education sessions should be an offer, and not have to ask for it” showcasing the need for sexual health rehabilitation (Rodger, 2019). In an observational study, 90.1% of patients reported never being informed on the changes to sexual function after SCI (Koyuncu et al. 2022). Most patients expect that medical staff and the healthcare team start the conversation about sexual health rather than having to initiate it (Celik et al. 2014; New et al. 2017). Some recent research reported that few people with SCI receive information, are satisfied with the levels of education about pregnancy or sexual health (Celik et al. 2014; New et al. 2017).

A randomized control trial (Rezaei-Fard et al. 2019) found that there were improvements in women’s FSFI rating from 15.9 to 21.75 (p<0.05) after the use of the PLISSIT counselling model. There are two pre-post studies that have evaluated a specific sexual health program after SCI. 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.

Zarei et al. (2020) found with the use of a randomized control trial involving an app-based educational intervention, men had greater marital satisfaction and sexual satisfaction and adjustment at the three time points (p<0.001). In Hess et al. (2007), four men received an outpatient SCI sexual health program staffed by an interdisciplinary team; they rated their visits as positive.

A longitudinal study by Pebdani et al. (2013) suggested that sustaining a SCI affects both men’s and women’s decisions about having children, including the concerns of women about their ability to care for a child and to financially support a child. This indicates that this is an important topic that service providers and rehabilitation professionals (especially SCI specialists, primary care physicians, and SCI organizations) should be prepared to discuss.

Observational studies also suggest that those who receive sexual counselling or educational services may have higher levels of sexual satisfaction (Charlifue et al. 1992; Federici et al. 2019; Lopes et al. 2022; Rezaei-Fard et al. 2019; Valtonen et al. 2006; Zarei et al. 2020). Similarly, Giurleo et al. (2020) found that following education of sexual health resource sessions, patients reported greater sexual satisfaction. One pilot study found that education had a significant effect on FSFI desire score and overall, sexual function significantly increased (Hocaloski et al. 2016).   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). Thus, education to increase sexual self-esteem can improve sexual health for individuals with SCI.

Conclusion

There are 2 studies with level 1 evidence (Rezaei-Fard et al. 2019; Zarei et al. 2020) and 2 studies with level 5 evidence (Federici et al. 2019; Lopes et al. 2022) that education intervention improved sexual satisfaction and knowledge for SCI patients.

There is level 2 evidence (Schopp et al. 2002) which suggests that comprehensive gynecologic services may improve women’s health behaviours.

There is level 2 evidence (Pebdani et al. 2013) suggesting that sustaining a SCI affects both men’s and women’s decisions about having children, including the concerns about their ability to care for a child and to financially support a child, indicating that this is an important topic that service providers and rehabilitation professionals (especially SCI specialists, primary care physicians, and SCI organizations) should be prepared to discuss.

There is level 5 evidence (Hess et al. 2007) that a sexual health program may be positively received by patients with SCI.