Sexual health policies in stroke rehabilitation: A multi national study

Abstract

Stroke survivors and their partners have been found to have unmet sexual rehabilitation needs. Stroke guidelines recommend that sexual health should be part of standard care, but sexuality is not consistently addressed in stroke rehabilitation. This study explored sexual health policies at 9 specialized stroke rehabilitation centres around the world and the perspectives of health care personnel on working with sexual health. Five centres had routines on sexual health, while 4 had few or none. Personnel working at centres with routines felt more knowledgeable and comfortable working with sexual health, and responded more positively to having routines at their workplace concerning sexual health than did personnel at centres having few or no such routines. Those who felt comfortable more often felt knowledgeable addressing sexuality and more often worked at a centre having routines on sexual health. Sexual health policies should be implemented in stroke care in order to meet the needs of patients and their partners. Objective: To identify and explore sexual health policies at specialized stroke rehabilitation centres in relation to the perspectives of healthcare personnel concerning sexual health. Design: Cross-sectional study. Subjects: Nine specialized rehabilitation centres representing 7 countries, and healthcare personnel (n = 323) working with stroke rehabilitation at the 9 centres were included in the study. Methods: Two structured questionnaires were used: (i) an organizational-audit on sexual health policies; (ii) an anonymous web-questionnaire assessing the perspectives of healthcare personnel concerning sexual health. Results: Of the 9 centres, 5 scored high on having sexual health policy in stroke rehabilitation and 4 scored low. Healthcare personnel working at centres with high scores reported higher levels of knowledge and comfort in working with sexual health, and looked more positively on the workplace sexual health policies, than personnel working at centres scoring low on these factors. Most personnel expressed a need for knowledge on the topic. Being comfortable about addressing sexuality was significantly associated with higher levels of knowledge about sexuality and working at centres having sexual health policies. Conclusion: A lack of sexual health policy represents a barrier to evidence-based practice in stroke rehabilitation. Such protocols need to be implemented in standard care in order to meet the sexual rehabilitation needs of stroke patients and partners.

Sexual Functioning and Sexual Health in Female Patients following Stroke: A Scoping Review with Implications for Rehabilitation

“…The lack of sexual policies in healthcare services is not a rule, but ranges widely. That healthcare services do not follow recommendations on implementing sexual health, where they are present, in standard care is concerning [ 60 ]. In addition, there are misconceptions about sexuality by health professionals and patients who fear being judged upon sharing their concerns, schedule conflicts, time restrictions, and the weight of other professional obligations that contribute to complicating the issue.…”

“…In addition, there are misconceptions about sexuality by health professionals and patients who fear being judged upon sharing their concerns, schedule conflicts, time restrictions, and the weight of other professional obligations that contribute to complicating the issue. Vikan et al highlight that the majority of health professionals report having little or no knowledge about sexual health following stroke [ 60 ]. Physical limitations arising from stroke, such as aphasia, may contribute to barriers that hinder patients from expressing their concerns or posing questions about post-stroke sexuality.…”

“…We found that the risk of bias was present in all seven domains. These studies [ 59 , 60 , 61 , 62 ] did not adequately manage the confounding factors, and there were biases arising from the measurement of the exposure, in the selection of participants for the study or the analysis, due to post-exposure interventions and missing data, from the measurement of the outcome and in the selection of reported result procedures.…”

“… Shows the risk of bias (ROBINS-E) of studies regarding the changes in sexual functioning and SD experienced by post-stroke women [ 34 , 43 , 44 , 45 , 46 , 47 , 48 , 51 , 54 , 55 , 57 , 58 , 59 , 60 , 61 , 62 ]. …”

Sexual Satisfaction and Associated Biopsychosocial Factors in Stroke Patients Admitted to Specialized Cognitive Rehabilitation

“…In general, sexuality poststroke is poorly addressed in stroke rehabilitation, and several barriers that prevent patients and partners from receiving adequate sexual rehabilitation have been identified. 9 , 10 , 11 The scarcity of a biopsychosocial approach in clinical practice and research investigating sexuality poststroke represents one such barrier. Thus, evidence-based studies to guide clinical practice after stroke from a biopsychosocial perspective are called for to meet the diverse sexual rehabilitation needs, 12 , 13 , 14 , 15 also in stroke patients with cognitive impairments.…”