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Common Sexual Health Problems Following SCI, an individual faces physiological, emotional, and interpersonal changes that impact his or her sexual health. These changes manifest differently for men and women, and if not addressed, can have a profound impact on an individual, beyond their sexual health needs. These unattended concerns cause immense fears of “loss of manhood” or “womanhood” – and the fears often lead to despair, unwillingness to comply with strenuous rehabilitation programs and, most importantly, to impaired interpersonal relationships and family and social dysfunction. Comon problems that INDIVIDUALS face after SCI, related to sexual health , are: • Altered body self-image • Sexual dysfunction (erection, ejaculation, lubrication, orgasm) • Cardiovascular consequences with sexual activity • Management of bowel and bladder routine around sexual practices • Positioning for sexual activities • Spasticity management • Expressing intimacy with self and others • Accessibility issues (physical barriers, social stigmas) • Fertility and contraceptive issues. Typically, the combination of these issues, integrated with personal morals, ethics and societal perspectives, will influence the sexual health of an individual following SCI. A comprehensive approach is necessary to understand the issues, assess accurately and provide comprehensive care. Current Practice Comprehensive Sexual Health Care The current models of sexual health services in Canada are predominantly limited to addressing erectile dysfunction and anejaculation in men with SCI, with the exception of the interdisciplinary programs in British Columbia and Québec, which address a variety of sexual health and fertility issues. These models (10/12) are insufficient to meet the breadth and depth of consumer needs related to sexual health. The current model, utilized by the Sexual Health Rehabilitation Service, in Vancouver, has been used to comprehensively manage the multidisciplinary needs seen with sexual and fertility rehabilitation, via a Sexual Rehabilitation Framework approach, applicable to several disciplines (Figure 2.0).4 Figure 2.0 Sexual Rehabilitation Framework Sexual Health Action List Sexual Are a Consequence s Actions Sexual Drive/Intere st Sexual Functioning Abiliti es Bladder & Bowel Functio n Motor & Sensory Influen ces Factors Specific to S CI Fertility & Contracepti on Sexual Self View & Self Estee m Partnership Issu es The Spectrum of Services This framework outlines the clinical areas which require review when addressing an individual’s sexual health, and expands beyond specific genital functioning. This realistic approach is appropriate during inpatient rehabilitation and/or outpatient follow up, depending on the readiness of the individual. Current sexual health services are generally guided by research. However, the majority of research comes from case reports and observational studies, with limited Level I evidence, from clinical trials or systematic reviews. Further confounding the application of research-to-care are social norms and ethical considerations. Clinical Practice: Where Are We Now? Within Canada, clinical care varies, and expertise in addressing the sexual health and reproductive needs, of both men and women, are limited to a few key rehabilitation centers. Facilitating good clinical care for sexual health requires an interdisciplinary team whose role is briefly outlined in Table 1.0. (This list is intended to facilitate discussion but is not exhaustive.) 152 CAPTURING CAPACITY IN CANADIAN SCI REHABILITATION


O - Sexual Health
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