Views and attitudes towards sexual functioning in men living with spinal cord injury in Kerala, south India

Abstract

Context:Sexual dysfunction is a major concern for Indian men living with a spinal cord injury. Few first-hand reports exist about the experience of living with an altered sense of sexual identity and the inability to express sexual concerns.Aims:In this qualitative study, the authors explore views and attitudes towards sexual functioning in men living with a spinal cord injury in Kerala, India.Materials and Methods:Semi-structured and open-ended interviews were conducted with seven participants according to IE Seidman's phenomenological approach. Thematic analysis followed the analytic process outlined by Moustakas (1990).Results:Identification of seven interconnected themes included: Recalling an active sexual life, disconnection with sexual identity, incongruence between emotional and physical capability, spousal isolation, social readjustment of spouse, physical barriers to sexual functioning, coping, and reintegration.Conclusions:Patient's descriptions of suffering demonstrate complexities of experience in sexual functioning. All patients were sexually active prior to the injury. This was now lost causing anxiety, distress, and sadness. A huge gap existed between sexual desire and physical capability. The patient and spouse were now isolated emotionally, socially, and physically. Physical barriers included urinary incontinence and indwelling catheters. While several self-evolved coping strategies were identified, support from palliative care services was not evident. Two important gaps exist in research and practice: (1) Attention to sexual issues and whole-person care. (2) Attention to quality of sexual life. Future qualitative studies on sexual dysfunction could provide a useful adjunct to current literature which is predominantly biomedical in its approach.

Views and Experiences of Sex, Sexuality and Relationships Following Spinal Cord Injury: A Systematic Review and Narrative Synthesis of the Qualitative Literature

“…Of the 27 papers reviewed, 21 papers addressed the issue of sexual identity, and six did not [22,27,29,[30][31][32]. Of the 21 papers, two papers focused specifically on exploring identity as one of their main research aims [33,34].…”

“…The literature suggests that the attitudes of significant others are really important, regardless of whether those relationships are positive or negative. Some participants reported negative experiences post-injury with respect to existing relationships with significant others [19,20,24,28,30,44,45]. For example:…”

“…It is not like before, her love has decreased. However, I have to bear with my wife and learn to adjust (p. 16) [30] In some instances, negative attitudes post-injury seemed to contribute directly to relationship breakdown, particularly for women. The loss of sexual function was described as 'the beginning of the end' (p. 620) [39].…”

“…I had intercourse everyday but only once or twice a week and that does not give me any pleasure. (p. 15) [30] Men discussed not being able to achieve an erection, and men and women both talked about not being able to orgasm [23, 30-32, 36, 38, 40]. Some research participants also talked about how their injury made it difficult to find suitable sexual positions.…”

“…It's almost as if I can actually feel it and I just, I love the fact that I can feel it… (p. 406) [36] Some of the papers also reported how men began to focus more on their (female) partner's pleasure rather than their own, for example: I cannot give sexual satisfaction to my wife (through vaginal intercourse) so I use other methods to satisfy her.'(p. 17) [30] … because of my current situation I get to spend more time on my partner in bed. You know, we, guys, are a bit selfish.…”