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O - Sexual Health

Table 1.0 The Role of Vario us Disciplines in Sexual Health Provision Discipline Role in Sexual Health Provision Medicine (Physiatry, Sexual Medicine, Urology, Gynecology, Psychiatry) Medical treatment for sexual dysfunction and fertility, treatment of associated urinary and bladder incontinence, prevention and management of AD, routine gynecologic and urologic screening. Nursing Education and support re: effect of SCI and related issues on sexuality and relationships (includes management of bowel/bladder/spasticity/AD/medication side effects). Occupational Therapy Adaptation of sexual devices, positioning assistive devices. Physical Therapy Movement, positioning. Psychology Sex education, sex therapy. and Sexology (Relationship Therapy, Sex Education, Sex therapy) Social Work Adjustment to living with disability, applications for independent living environment and attendant services. Recreational Therapy Opportunities for engagement in social/sport activities, Urologist Social Worker Psychologist OT Nurse (RN) Nurse (RNA/RPN) Nurse Practitioner/ Advanced Practice Nurse Physiatrist Peer Support Coordinator thereby facilitating social, psychological adjustment. 0 5 10 15 20 25 Current Canadian SCI Sexual Health Services E-Scan data reveals that 12/12 sites report having a fertility/ sexual health service, 11 of which are onsite. Standards of care, in these sites, are heterogeneous, with variability in identification of key practice protocols. Five sites report having a treatment protocol; three, a standard of care; and three, a clinical practice guideline. Four sites report using other sources including a research protocol, SCI Reference Manual, GF Strong Sperm Retrieval Guidelines, and sexual device manual for persons with disability – PleasurABLE.5 Sources for the protocols identified included expert clinicians (Courtois et al.6; PVA guidelines; GF Strong’s Internal Standards for Vibratory Stimulation, Electroejaculation and Erectile Dysfunction, and the SCIRE Sexual Health chapter.7 The E-Scan data suggests consistent availability of interdisciplinary service providers, within healthcare facilities, but limited specific expertise in sexual health services, in terms of sexual health knowledge, clinical skills and expertise, by those service providers. Furthermore, teams are rare. Most centers have a designated sexual health individual, with limited formal training outside their respective discipline, and are subject to high expectations in terms of service delivery and relevant expertise. Figure 3.0 illustrates the limited accessibility of expertise in sexual health, across Canada. Table 2.0 displays the sexuality and fertility outcomes used in clinical practice reported by providers in the E-scan sites. Figure 3.0 Limited aces to expertise in Sexual Health acros the country Number of Sites Sites that have the service Service is a consult within the organization Service is a consult external to the organization Table 2.0 Sexuality Assesments, Outcomes , and Treatments Measure Sites that use the measure Sites that use the measure for clinical purposes Sites that use the measure for research purposes FERTILITY Serum Screening for Hypogonadism 7/12 7/12 0 Sperm Count 8/12 8/12 0 Pelvic Ultrasound 7/12 7/12 0 SEXUALITY International Index of Erectile Function (IIEF) 4/12 3/12 1/12 Assessment of Sexual Potential and Treatment of Sexual Dysfunctions in Men and Women with SCI 1/12 1/12 1/12 Rehab Team Assessment 1/12 1/12 0 Female Sexual Function Index 1/12 0 1/12 Clinical Questions 1/12 1/12 0 Locally Generated Scale 1/12 1/12 0 SEXUAL HEALTH | PARTICIPATION 153


O - Sexual Health
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