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

Abstract

Research examining the effects of spinal cord injury on sexuality has largely focused on physiological functioning and quantification of dysfunction following injury. This paper reports a systematic review of qualitative research that focused on the views and experiences of people with spinal cord injury on sex and relationships. The review addressed the following research question: What are the views and experiences of people with spinal cord injury of sex, sexuality and relationships following injury? Five databases were relevant and employed in the review: CINAHL (1989–2016 only), PsychInfo, PubMed, Scopus and Web of Science, for research published between 1 January 1980 and 30 November 2019. After removing duplicates, 257 records remained and were screened using a two-stage approach to inclusion and quality appraisal. Following screening, 27 met the criteria for inclusion and are reported in the paper. The review includes studies from fifteen countries across five continents. Two main approaches to data analysis summary and thematic synthesis were undertaken to analyze the qualitative data reported in the papers. The analysis revealed four main themes: sexual identity; significant and generalized others, sexual embodiment; and; sexual rehabilitation and education.

Mental Health and Spinal Cord Injury: Clinical Considerations for Rehabilitation Providers

“…Research on primary effects of SCI on sexual functioning predominantly focuses on issues related to male, heterosexual normativity, including erectile dysfunction, penile sensation, and hypogonadism [ 27 , 28 ]. Women’s physiological effects include reduced ability to experience orgasm, although fertility and reproduction are often unaffected.…”

“…Women’s physiological effects include reduced ability to experience orgasm, although fertility and reproduction are often unaffected. Beyond the physiological effects of SCI on sexual functioning, secondary (e.g., pain, bowel/bladder management) and tertiary (e.g., changes in body-image, self-identity, relationships) effects post-injury are often reported to be more disruptive to sexuality and sexual expression [ 27 ]. Psychological factors, such as changes in sexual self-esteem (i.e., feelings of worth as a sexual partner and sense of self as a sexual being) and anxiety about physical and emotional intimacy post-injury, also affect sexual wellness.…”

“…Sexual health and sexual rehabilitation are typically addressed minimally or not at all during acute rehabilitation [ 27 ], as other rehabilitation needs are prioritized during early stages of adaptation to SCI. However, addressing sexual health and intimacy early on and during follow-up care is critical, as sexuality is an important aspect of health and well-being for many people.…”

“…Rehabilitation settings are optimal for addressing such concerns, where interdisciplinary approaches to sexual health education and interventions can result in more robust outcomes. Rehabilitation psychologists are educated and trained to (1) assess sexual health needs, (2) identify and address psychological factors impacting sexual health and expression, and (3) co-treat with other disciplines to address factors impacting sexual expression, such as working with occupational and physical therapists on optimal positioning and consulting with physicians about options for medications and devices to assist with sexual performance [ 27 , 29 ].…”

Sexuality and relationship experiences of women with spinal cord injury: reflections from an Indian context

“…A review of sexuality, disability, and rehabilitation literature on persons with SCI reveals a severe gender bias: a historical neglect and narrow conceptualisations of women’s sexuality. 7–9 This has been explained by the lower incidence of SCI among women and the marked gender differences in the impact of SCI on sexual function in men and women. Since SCI does not affect a woman’s ability to menstruate, to become pregnant, to carry and deliver a child vis-a-vis a man experiencing erectile dysfunction and infertility after SCI, their sexuality is “assumed” to be less compromised and hence has historically merited less attention in the literature.…”