Sexual Health Education for SCI Clinicians

People with SCI often express their sexual health concerns to the people they feel most comfortable with, so it is recommended that all persons working with people with SCIs understand the effects of SCI on sexual function (Biering-Sorenson et al. 2013). Education and support to health professionals is critical to ensure that these professionals are able to comfortably and knowledgeably address relevant patient concerns about sexual health and help patients achieve their best sexual life after SCI.

Discussion

Almost all healthcare professionals agree that sexual rehabilitation following injury should be a crucial part of SCI rehabilitation, but are limited by their lack of area-specific knowledge and confidence to address sexual health concerns effectively (Longoni Di Giusto et al. 2022). One OT in the Barrett et al. (2022) study said:

 “I think it needs to become a standardized assessment or discussion like everything else, like are you able to wash and dress? …These are the types of regular discussions we have with clients. I don’t think we have discussions about sexual function, but we should. It should be standardized across the board.”

Multiple studies demonstrated significant increases in knowledge, attitude, and confidence from education sessions addressing SCI and sexual health (Rassem et al. 2022; Hencklein et al. 2021; Barret et al. 2022; Burch 2008; Tepper 1997; Cole & Stevens 1975; Held et al. 1975; Milligan & Petchers 1988; Giannoten et al. 2006; Post et al. 2008; Pieters et al. 2017; Mims et al. 1974; Cohen et al. 1996). Participants found value in education sessions and most importantly, patients observed a significant increase in level of care following education (Pieters et al. 2017). The education sessions for clinicians increased the number of times that sexual health was discussed with patients allowing them to ask questions and seek help earlier in their rehabilitation (Pieters et al. 2017). A pre-post study (Rassem et al. 2022) found that following education session nurses felt confident and have sufficient knowledge to educate patients and offer counselling. One prospective controlled trial and multiple pre-post studies have shown that sexual health workshop participants show significant increases in knowledge, skills, and comfort after workshops, and a number of these gains are maintained at three-month, six-month, and two-year follow-up (Simpson et al. 2006; Giannoten et al. 2006; Tepper 1997; Chubon 1981; Cohen et al. 1994, 1996; Fronek et al. 2011).

Conclusion

There is level 1 evidence from 1 RCT (Fronek et al. 2005; 2011), level 2 evidence (Simpson et al. 2006) and level 4 evidence (Giannoten et al. 2006; Tepper 1997; Chubon 1981; Cohen et al. 1994, 1996) that educational workshops can improve clinician knowledge, comfort and attitudes towards sexual health counselling.

There is level 2 (Simpson et al. 2006) and level 4 evidence (Fronek et al. 2011, Giannoten et al. 2006) that gains can be made in knowledge, attitudes, and comfort in addressing sexual health issues are maintained at six-month follow-up.

There is level 2 evidence from 1 poor quality RCT (Sawyer et al. 1983) that microcounselling sessions can improve clinician’s ability to respond appropriately to sexual concerns of patients.

There are 2 studies with level 4 evidence (Hencklein et al. 2021; Rassem et al. 2022) that education sessions increased knowledge and confidence for sexual health counselling and education for people with SCI.

There are 2 studies with level 5 evidence (Bryant et al. 2022; Longoni Di Giusto et al. 2022) that most health professionals agree that sexual healthcare and education is important in SCI education.

There is level 4 evidence (Giurleo et al. 2022) that clinician education sessions helped improve sexual satisfaction for patients.

There is level 5 evidence (Bryant et al. 2022) that 97% of health professionals wanted more sexual health training for people with SCI.