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.