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Sexual Health | Participation S Elliott, MD; F Courtois, PhD; K McBride, BScN; D Ditor, PhD; C Craven, MD; and the E-Scan Investigative Team The World Health Organization (WHO) defines Sexual Health as a state of physical, emotional, mental and social wellbeing in relation to sexuality. Sexual health rehabilitation requires a positive and respectful approach to sexuality, sexual relationships, and reproductive wishes, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence. In this context, sexuality encompasses sex, gender identity and gender roles, sexual orientation, eroticism, pleasure, intimacy and reproduction. The impact of SCI has a profound and lifelong impact on every aspect of an individual’s life. After SCI, sexuality and the need for sexual health and fertility rehabilitation often does not get specific attention through evidence-based clinical practice. Despite current knowledge and research, in the area of sexual functioning, discomfort by both patients and professionals has resulted in limited attention to sexual health, within Canadian rehabilitation service delivery. Sexual functioning is complex, encompassing physical, emotional, behavioural and social areas - all of which are influenced by factors such as health, culture and attitude.1 Given the biopsychosocial nature of sexuality, and the profound impact of SCI, it is not surprising that individuals with SCI rate sexual functioning as either the first or second priority, with respect to quality of life, on needs surveys.2,3 Given the International Classification of Function (ICF) model for health, the model in Figure 1.0 illustrates the relationships between all aspects of an individual’s life and their sexual health. Figure 1.0 Model of sexual health , reproduction and related factors . Adapted from Elliot SL4 and used with permision. SEXUAL FUNCTIONING AND PLEASURE (BODY FUNCTION) SENSORY ABILITIES SEXUAL HEALTH & REPRODUCTION SEXUAL SELF-VIEW MOTOR ABILITIES (PARTICIPATION) BLADDER AND BOWEL INFLUENCES (PARTICIPATION) FERTILITY AND CONTRACEPTION CONTEXTUAL: PERSONAL FACTORS • Age and gender • Personality • Past sexual experience • Sexual preference • Culture & religion CONTEXTUAL: SOCIAL FACTORS • Current relationship with others • Attitude towards sexuality and disability, parenting CONTEXTUAL: ENVIRONMENTAL • Accessibility • Equipment availability FUNCTIONING: HEALTH FACTORS • ASIA grade • Medications • SCI health consequences SEXUAL HEALTH | PARTICIPATION 151


O - Sexual Health
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