Disability and Sexuality Issues
An important issue
confronting the patient with a disability, and a vital component of
self-concept, is sexuality. Sexuality involves not only biologic sexual
activity but also one’s concept of mas-culinity or femininity. It affects the
way a person reacts to others and is perceived by them, and it is expressed not
only by physical intimacy but also by caring and emotional intimacy.
Sexuality problems faced by patients with disabilities include limited
access to information about sexuality, lack of opportu-nity to form friendships
and loving relationships, impaired self-image, and low self-esteem. The person
with a disability may have physical and emotional difficulties that interfere
with sex-ual activities. For example, diabetes and spinal cord injury may
affect the ability to have an erection. The patient who has suf-fered a heart
attack or stroke may fear having a life-threatening event (eg, another heart
attack or stroke) during sexual activity. He or she may fear loss of bowel or
bladder control during inti-mate moments. Changes in desire for sex and in the
quality of sexual activities can occur for the patient and the partner, who may
be too involved as the caregiver to have desire and energy for sexual
activities.
Unfortunately, society and some health care providers con-tribute to
these problems by ignoring patients’ sexuality and by viewing disabled persons
as asexual. Health care providers’ own discomfort and lack of knowledge related
to sexuality issues pre-vent them from providing the patient with disability
and his or her partner interventions that promote healthy intimacy. Nurses
caring for persons with disability must recognize and address sex-ual issues in
order to promote feelings of self-worth, which are es-sential to total
rehabilitation. The nurse should give the patient “permission” to discuss
sexuality concerns and show a willingness to listen and help the patient
overcome these concerns. The nurse also has a key role to provide appropriate
patient education about how specific disabilities affect sexual function. For
example, arthritis produces fatigue and morning stiffness, making planned
afternoon sex a better alternative; spinal cord injury impairs erec-tions and
ejaculations; and traumatic brain injury may produce an increased or decreased
interest in sexual behavior. Classes, books, movies, and support groups are
useful tools to help pa-tients learn about sexuality and disability. When open
discussion and education about disability and sexuality do not result in a
pa-tient’s achieving his or her sexuality goals, the nurse should refer the
patient for ongoing counseling with a sex counselor or thera-pist. The patient
may need training in communication and in so-cial and assertiveness skills to
develop desired relationships.
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