Presentation on theme: "Sexual abilities following physical disability By Raul G. Rosales, OTR."— Presentation transcript:
Sexual abilities following physical disability By Raul G. Rosales, OTR
Objectives: Overview of spinal cord injury (SCI) and sexual health Anatomy Interventions Information on CVA, Cardiac, Orthopedic sexual health
Spinal Cord Injury Sexuality is an important aspect of human nature According to OT practice framework, sexual satisfaction is an ADL, and therefore a responsibility of ours to address it if need be. Sexuality relates to everyone’s quality of life. It affects self esteem and self concept. Its an intrigal part of of human experience.
Sexuality and Sensuality Sexual expression is not only the act of intercourse itself, but may include: talking, touching, hugging, kissing, fantasizing. After a physical disability or when there are physical limitations, engagement in any type of sexual act decreases. Some individuals may feel like their objects of pitty, unattractive, asexual, self perception or worth.
Males may feel loss of masculinity and possibly threatened in the male role. Females may feel loss of parenting abilities, or may have difficulty with how she perceives herself attractively. As Occupational Therapists, we can assist with eliminating unnecessary obstacles, overcome anxieties, and appreciate personal uniqueness.
OT OT goals should include: Facilitation of self esteem Enable client to feel lovable Education provided to family members, as many times its difficult to transition to/from role of caregiver and lover. History information should be to learn how a person thinks and feels about sex and their body
SCI Maintaining a healthy sex life after a spinal cord injury is important to many. The effects studied relate to complete spinal cord injuries, and incomplete spinal cord injuries. And if upper motor neurons or lower motor neurons are affected. Simple test to determine if a SCI is complete or incomplete is whether a person has voluntary rectal contraction and whether they have the aibility to perceive sensation around their rectum.
Motor Neurons Upper motor neuron: neurons that originate in the motor region of the cerebral cortex or brain stem and carry motor information down to the lower motor neurons. Lower motor neuron: motor neurons that innervate skeletal muscle fibers and act as a link between upper motor neurons and muscles.
Sexual Arousal Sexual arousal leads to increased: breathing rate increased heart rate increase blood pressure increased blood flow to genitals- in men, this leads to erections and women lead to lubrication SCI doesn’t affect what happens in the brain, but it does affect how one is aroused and that happens in the spinal cord.
arousal There are two types of arousal: psychogenic and reflex arousal. Psychogenic arousal happens in the brain and travels down to the levels of T11-L2 of SC. This occurs with: visual stim., smells, thoughts etc. Reflex arousal happens in the lower levers of T11-L2 and are a impulses that are received from stimulation and cause a motor response and synapse in the spinal cord. This may be from someone brushing your leg, or stim. to genitals, or placing a hand on your knee.
After an SCI, most people will retain reflex arousal, but loose psychogenic. There is evidence to support that women who have light touch and pinprick sensation from waist to thigh (T11-L2) will maintain psychogenic response to stimulation. If an injury is high up, but a complete lesion, can not get aroused psychogenic If an injury is low or at cauda equina, that might get rid of reflex, but still get psychogenic.
Female orgasms and male ejaculations are usually decreased after SCI though not impossible. This is most likely due to the fact that coordinated nuro impulses from the sympathetic, parasympathetic, and somatic nervous systems are necessary for this to occur. Sympathetic nervous system: primary role is to stimulate body’s fight or flight response and maintain homeostasis. Parasympathetic nervous system: primary role is “rest and digest” and “feed and breed”. Items that occur while body is at rest especially after eating, sexual arousal, salivation, lacrimation, urination, digestion, defication.
exploration After SCI, its important to explore your body. Do so before you involve your partner. There are a lot of changes after SCI. Some are body image, bladder and bowel dysfunction, medications, emotional (depression). Always know that arousal and sexual abilities including pregnancy is possible after SCI. Its important to know your body! Though it may not be exactly the same as before, sexual intimacy and arousal are still possible.
Treatment Most research has concentrated on male erections. Women’s difficulties may stay emotional and psychological. For activity, water based lubricants are used to avoid tearing or cause pain. Men’s difficulties are with erection. They might be able to get one but not maintain. Oral medication: Viaga, Cialis, Levitra. These should not be used with nitrates eq: imdur. Nitrates are vaso dilators and combination of the two will cause severe hypotension.
Oral medications may cause: headache, fllushing, stuffy or runny nose, indigestion, upset stomach, dizziness. Some people may take nitrates for heart problems or dysreflexia. Autonomic dysreflexia is a severe condition that requires immediate medical emergency attention. Occurs most often in individuals with lesions above T6 and as low as T10. It’s a response that is triggered by overstimulation.
Its characterized by paroxysmal hypertension (severe onset of high blood pressure), throbbing head aches, profuse sweating, nasal stuffiness, flushing of the skin, slow heart rate, anxiety, and sometimes cognitive impairments. Autonomic Dysreflexia occurs when something is wrong. For example kinked catheter, constipation with impaction.
tx. cont. Other treatment may include: Injections: though overuse may cause scar tissue and cause penile deformities including priapism Medicated urethral system rerections (muse): medicated pellets placed into urethra where its absorbed Electrical stimulation Vacume pumps and rings: most commonly used form of treatment for erections. For those that can attain reflex arch erections but have difficulty maintaining, a silicone rubber ring is used. Should not be used for over 30 min. as insufficient blood flow to penis can cause ischemia.
If a male can not effectively produce and erection, then vacume pumps are used to produce the erection and a ring is used to maintain. Last resort are penile prosthesis. If after prosthesis are used, and complications arise like loss of feeling or UTI’s, the prosthesis will need to be removed. http://youtu.be/ZIQtKtsjDQY
Sex activity Re-establish routines Talk to partner Allow time for bowel and bladder programs Explore Explore Explore! Positions for activity. Sitting up: http://youtu.be/HatRXFL1TxQhttp://youtu.be/HatRXFL1TxQ Women: http://youtu.be/fUd8aUb20W0http://youtu.be/fUd8aUb20W0
Can a person with SCI have an orgasm? Regardless of the injury, you should be able to have one. It’s a reflex. Reflex happens around T12-S1. Ejaculation is not an orgasm. Orgasm is a feeling, witch depending on the level and severity of injury, may lessen the intensity. S Women with complete S2-S5 injury are less likely to achieve orgasm http://youtu.be/vOFJXgNCBr8
How to address Sexuality P-LI_SS_IT This is a basic framework developed by Annon (1976) to assist OT practitioners and other health care professionals in developing the interpersonal skills needed to approach and address such a sensitive matter. Permission- you are giving the permission to be sexual beings. This may include reassuring that their not the only ones. This area may also give patients the right not to engage in sex or conversations.
Limited information- allows the therapist to address sexual concerns with factual information. Present information like: fertility, contraception, community resources, ED, AD, body image, etc. And do only to their needs. Specific Suggestions- requires that the therapist obtain a sexual health history to gain specific information. This may include current problems and goals. Examples: positioning techniques, bowel and bladder mgt., adaptive equipment, alternate methods of pleasure, pressure relief. Intensive therapy- If suggestions given by therapist are not helpful, IT should be considered. At this point a patient is referred to a specialist.
Stroke after a CVA Just as with SCI, sex is not a performance. You don’t have to fail or succeed. It doesn’t have to be perfect every time. Explore! Talk and communicate with your partner. Talk about feelings after stroke, especially body changes, spasticity, sensation, or any other difficulties.
cva Practical problems can be overcome. Lie on your affected side so that your dominant side will be free and active. Talk to your doctor about difficulties with emotions or depression. As well as erection or lubrication difficulties. Bowel and bladder programs will assist with ensuring no accidents will occur during activity. If your constantly fatigued, activity in the morning will assure you are rested.
Sex after hip replacement Always speak to your surgeon regarding precautions. Precautions may include avoid bending hip past 90 degrees, avoid moving operated leg across midline, avoid rotating the toes of operated leg inward. Precautions should be maintained 4-6 weeks after surgery. http://www.recoversex.com/hip-replacement/sexual- positioning-following-total-hip-replacement - prettyPhoto http://www.recoversex.com/hip-replacement/sexual- positioning-following-total-hip-replacement - prettyPhoto
Missionary Position – This is generally a comfortable position for either a male or female with a new hip. The female assumes the bottom position. If she has a new hip, she can bend her knees slightly with her feet on the bed. Pillows can be used to support the legs on the outside. If the male has a new hip, he can stretch his legs out behind him. He can place a pillow between his knees to keep his operative leg from crossing the midline of the body. He supports his weight with his arms.
Face-To-Face Position – This position can be used for either a male or female. The person with the new joint is on the bottom and can recline on pillows propped behind the back. A female can bend her knees slightly with her feet on the bed. A male can put a pillow between his knees to keep the operative leg from crossing the midline of the body.
Sitting Position – This position can be used for either a male or female. In all cases, the male sits on the chair with his knees pointing away from the midline of his body and his feet on the floor. The female sits on his lap. She must be able to have her feet planted on the floor, particularly if she has a new joint. She must avoid leaning too far forward to prevent the hip from bending more than 90 degrees.
Kneeling Position – This position can be used for either a male or female. The female with a new hip lies on her back with her buttocks near the edge of the bed. Feet must be firmly planted on the floor with knees pointing away from the midline of the body. If the male has a new hip, he can assume the position of kneeling in front of his partner. For comfort, he can use pillows under his knees. He must keep his back straight and avoid leaning over his partner to prevent the hip from bending more than 90 degrees.
Side Lying Positions – This position can be used for either a male or female. In the spoon position, the person with a new hip can lie on either side. For a female with a new hip, pillows can be used to support the upper leg. A male with a new hip can drape his upper leg over his partner.
Other Side Lying Positions – This position can be used for a female with a new hip. With her partner on his side, she can lie on her back and drape both legs over his body, with legs apart to keep the operative leg from crossing the midline of the body. The female can also lie on her back and drape her non-operative upper leg over her partner’s body
Other Side Lying Positions – The partners can also face each other. The person with a new hip can lie on either side. The upper leg can be draped over the partner’s legs.
Standing Position – This position works for either a male or female. If the female has the new joint, she should lean on something firm and stay fairly upright to avoid bending the hip more than 90 degrees. If the male has the new joint, he should also avoid bending the hip more than 90 degrees.
Cardiac conditions Remember that sex is a workout If you are healthy enough to walk up two flights of stairs without difficulty, you are healthy enough for sex. After a heart attack—Patients should avoid sexual activity for 1-4 weeks after a heart attack, depending on their heart health and symptoms with exertion. After a stent implant—Patients should avoid sexual activity for 1-2 weeks after the implant—to make sure the stitches in the groin area have healed enough. During these implants, a catheter is inserted through a small incision in the upper thigh or groin.
After a cardiac device implant—most patients decide to avoid sexual activity for about 1 week. While their incision is healing, patients should avoid supporting their weight with their arms during sexual activity. After bypass or heart valve surgery——Patients are limited by the fact that it takes 6-8 weeks for the chest incision to heal. Keep in mind that pushing or pulling motions with the upper body should be avoided until the chest has healed. That includes supporting their weight with their arms during sexual activity.
After heart failure diagnosis—usually there are no limitations on sexual activity except in advanced cases. If symptoms are a problem, do not to support their weight with their arms, since that makes the heart work harder. http://www.allinahealth.org/ac/METchart.pdf
work cited page Internet resources: Allina Health System Press, Helping Your Heart, cvs-ahc-90648 (5/05), third edition, ISBN 1-931876-11-8 Recover sex-pleasure http://www.recoversex.com/hip-replacement/sexual- relations-after-total-hip-replacementhttp://www.recoversex.com/hip-replacement/sexual- relations-after-total-hip-replacement Sex after stroke http://www.stroke.org.uk/sites/default/files/F31_Sex%20after%20stroke.pdf http://www.stroke.org.uk/sites/default/files/F31_Sex%20after%20stroke.pdf Annon, J. (1976) The PLISSIT model; a proposed conceptual scheme for the behavioral treatment of sexual problems. Journal of sex education and therapy, 1-15. Sexuality and spinal cord injury. www.spinal-injury.net/sexuality-spinal-cord- injury.html
overview Sexuality doesn’t have to change Take time for you and your partner Don’t be afraid to explore and express Learn how the injury affects your mind and body Work to prevent and solve problems