A new programme of sex education and counselling for spinal cord injured adults and health care professionals

Abstract

THROUGHOUT the world today men and women with traumatic paraplegia and quadriplegia are making increased demands on the health care system to do more than simply manage them through their immediate post injury period. They require workable solutions to the totality of psycho-social problems inherent in a continued state of disability. Yet, Professor Timothy J. Nugent, past President of the National Paraplegia Foundation (I97I), pointed out that many of the as sumptions of the past and some of the advice given in clinics today actually result in more psychological, emotional and social trauma than the physical situation justifies. He believes that the social-psychologic trauma is not simply experienced by the individual, but that it has been imposed on him and can become fixed after many years.In the past, traditional medical and surgical care for paraplegia has tended to focus on treating the patient for such common medical complications of spinal cord injury as joint contractures and decubitus ulcers. Rehabilitation therapy has concentrated on fostering independence in self care. Vocational rehabilitation has trained the patient for returning to his job or has provided him with a new, marketable skill. Within the larger framework of acute, restorative and rehabili tative treatment of the spinal cord injured lies the relatively ignored area of diagnosis and treatment of sexual function after spinal cord injury.Those with spinal cord injury protest that like able-bodied people, they also are entitled to a satisfactory sex life, a respectable self image and the expectation of being treated like other people who have a need for emotional, sexual expression. They are becoming less content to lead lives affected by the myths commonly believed by many medical personnel and others in society. Some of these myths suggest that handicapped people have no sexual needs or desires; others imply that people with physical disability have excessive or perverted sexual needs. Unfortunately, when patients are treated by health care professionals who hold these beliefs, the tenor of treatment may be such that it predisposes the patient to act and live according to the beliefs of the treater. In some cases, the physician's personal anxieties regarding sexuality make him virtually inaccessible to the patient who wishes to seek advice on this subject. The subtly rebuffed patient cannot distinguish between the physician's discomfort and the appropriateness of his sexually oriented questions or needs. Often the result is that open discussion is made impossible.

I. Social, sexual and personal implications of paraplegia

“…Little is known of the psychological impact of sexual dysfunctions. Some commentators have suggested that patients are more concerned about these than about any other aspect of their disability (Bloom, 1974;Breslin, 1971;Cole et al, 1973), but this may overstate the case. In one study paraplegics rated sex the least of the major functional losses resulting from their injury; 52 per cent thought the loss of the use of their legs the most important, 35 per cent the loss of control over bowel or bladder, and only 13 per cent the loss of sexual functioning (Hanson and Franklin, 1976).…”

The effects of a sexual issues discussion group on the sexual attitudes and behaviors of physically disabled college students

“…Among the exceptions are reports by Cole (1973) and his associates describing the Disability Sexual Attitude Reassessment Program at the University of Minnesota and reports by Romano and Lassiter (1972) and Eisenberg and Rustad (1976) describing programs at the University of Michigan and the Cleveland Veterans Hospital, respectively (Cole, 1973;Romano and Lassiter, 1972;Eisenberg and Rustad, 1976). Even more rare are published data on the effectiveness of sexual adjustment 14 counseling programs.…”

“…The litera ture (Brockway, Green and Kanter, 1978;Cole, 1973;Mayers, 1978) suggests that special training in social techniques can prevent painful ineptitudes and lead to a deeper realization of constructive social rela tionships. Participation in groups of people at similar adjustment states is helpful.…”

“…The program's goal is to provide sex information which would encourage positive attitudinal development (Eisenberg and Falconer, 1978, p. 8). Cole (1973) developed a program of sex education and counsel ing for spinal cord injured adults and health care professionals which uses small group discussions. He found that the disabled were ready and able to discuss their sexual concerns much more openly and less defensively than the able-bodied groups.…”

“…A review of the literature (Brasher, 1978;Cole, 1973;Mayers, 1978) suggests that group counseling is an effective approach to use with disabled individuals. In addition, sexual group counseling seems to have advantages over individual sexual counseling in a number of important ways.…”