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O - Sexual Health

Best Practice Indicators • Routine introduction of sexual health/fertility services during inpatient rehab • Access to a multidisciplinary team available to address sexual health needs • Access to sexual health services after discharge from inpatient rehabilitation • Evidence of documentation of a sexual health assessment • Documentation of sexual health goal setting • Documentation of sexual health goal attainment • Documentation of guideline adherence or implementation • Opportunities to revisit sexual health goals/goal attainment. Principles for Future Advancement of Sexual Healthcare Key Clinical Priorities Currently, there is no standard of care in sexual rehabilitation and fertility, although there are excellent sites throughout North America and Europe that have similar approaches and intercommunicate. Three areas which require particular attention, and are best supported through evidence, are suggested: 1. Maintain a client-centered focus towards addressing sexual health for people with SCI. While paying particular sensitivity to gender, culture and social expectations, readiness to address sexuality and fertility, and a motivation to return to sexual practices, must be respected. 2. A comprehensive sexual health history and physical, and a multidisciplinary approach is required to maintain an individual’s sense of sexual wellbeing, quality of life and fertility potential. This includes risks and benefits of medical treatments, along with consideration of associated health issues, including autonomic dysreflexia. 3. Implementation of sexual rehabilitation principles 1) Maximizing physiology 2) adapting to remaining limitations, and 3) being open to new experiences, requires both the client and the healthcare provider to place appropriate attention on mental, physical and accessibility considerations, regarding sexuality.8 Some guides are available for the socialization aspects of sexuality, for the use of medical interventions, and for innovative use of equipment and devices. Barriers to full implementation of such guidelines, and to those referenced in this chapter are vast, including the various societal and ethical norms seen across Canada. A comprehensive education and training program for sexual health clinicians, in the area of sex and disability, would be one way to address such gaps in care. (In British Columbia, Dr. Stacy Elliott, her colleagues and other educators and academics, will be contributing to the development of a sexual health training program for individuals with disability). The intent of a training curriculum would be to close the gap between what is known in sexual health rehabilitation, and what is used in clinical practice, and to do so through an accessible route, such as online training, with supervision at designated sites. This would allow further dissemination of knowledge and practical application of client care, across Canada, and provide the ability to do much needed research, in the area of sexual and fertility rehabilitation. Key Policy Priorities There are many policy-related implications necesary to support the implementation of sexual health guidelines and clinical practice expectations . 1. Fund and allocate resources to support a multidisciplinary approach to sexual healthcare, for all people with SCI, throughout the continuum of care. 2. Incorporate sexual health programs for healthcare professionals, throughout academic training institutions and into clinical practice. Create formal, sexual health clinician training programs that include classroom instruction and hands-on training, in a supervised environment, by an accredited body for healthcare professionals. 3. Provide client’s right for privacy and protection of confidentiality, throughout the care received within facilities, as it relates to sexual health. Develop policies that recognize and respect the client’s rights for privacy and autonomy for sexual activity, in care facilities. Key Research Priorities Research priorities in sexual health to support the advancement in care, in clinical practice: 1. Bridge the gap between what is known about sexual health rehabilitation in the SCI continuum of care and the implementation of the few existing guidelines. 2. Funding to advance research in sexual sensation, orgasm and pleasure. 3. Develop and evaluate assistive techniques, from psychological to mechanical, to facilitate sexual sensation and arousal. SEXUAL HEALTH | PARTICIPATION 157


O - Sexual Health
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