Disability and Sexual Rehabilitation

In recent years, understanding of the human body has increased immensely. Despite notable improvements in understanding, there are topics that both metal and physical health professionals find it difficult to talk to patients about. Such is the case of sexuality. Even though sexuality is a normal and natural part of human development, many professionals find it difficult to discuss this subject with their patients. As such, many patients often rely on anecdotal or incorrect information about sex and sexuality, rather than asking their healthcare providers questions about sex and sexuality.

Clearly, the issue of sexuality is one that is difficult for many professionals to discuss with patients. Unfortunately, this subject becomes even more difficult to approach when an individual has suffered some type of physical injury-i.e. a spinal cord injury-that may limit sexual activity. Although professionals may find it more difficult to talk with patients about sexuality after physical injury the reality is that patients struggling with physical injury will need to have comprehensive answers to their questions. As such, professionals need to learn how to address these issues and provide thoughtful and helpful advice to their patients.

With the realization that talking about sexuality with a patient that has incurred a physical injury can be so difficult for professionals, there is a clear impetus to understand what steps professionals can take to alleviate the challenges associated with this process. To this end, this investigation considers what has been written about the steps that counselors should take in dealing with issues of sexuality for patients that have suffered some type of physical injury. Through a careful consideration of what experts have noted on this subject, it will be possible to elucidate the specific skills that should be used by counselors in helping individuals with disability address issues of sexuality.

Review of the Literature

Westgren and Levi (1999) in their investigation of sexual issues in patients after suffering spinal cord injuries found that the level of frustration of most patients was quite high overall. According to these authors, most patients struggling with disability find it difficult to talk about issues of sexuality with members of their treatment team. As a direct result disabled patients internalize their frustration, making rehabilitation a more difficult process. To alleviate some of the frustration associated with sexual functioning after injury, Westgren and Levi recommends providing ongoing support and assistance to disabled patients, such that they feel comfortable discussing issues of sexuality. This may warrant the counselor initiating conversation about sexual functioning as a means to provide the client with a clear indication that it is acceptable to discuss these issues. Regardless of what methods are used for "breaking the ice" Westgren and Levi argue that ongoing support with respect to issues of sexuality is important to help the client understanding the changes that physical disability engenders.

While some individuals with physical disabilities may find it difficult to address issues of sexuality, others will actively seek answers about sexual function after injury. Farrow (1990) in his examination of how the specific methods that should be used by counselors to help patients seeking information about sex after injury, maintains that counselors should be willing to approach the subject with the client in an open and honest manner. The client should not be made to feel ashamed because of his or her sexual desire or feelings. Farrow argues that sex role and sex identity are critical components of the individual's psychological well being. For this reason, these issues must be addressed by the counselor to help the client establish a more integral understanding of self-esteem and self-worth. By communicating with the client in an open and honest environment, the counselor will be able to instill trust and alleviate the stress that can accompany questions about sexuality.

Ducharme (1996) in his examination of sexuality after spinal cord injury argues that counselors need to help patients focus on the development of their sexual lives in the present, rather than their hopes for the future. In responding to the question "As time passes will my sexual functioning get back to where it was before I got hurt?" Ducharme makes the following observations: "If your sexual functioning was changed because of the injury, however, there is probably a good possibility it will not totally return to what it was before. Try to enjoy your sexuality for what it is today, rather than waiting and hoping that it change" (p. 21). This is clearly sage advice for counselors working with patients that have incurred physical disability. In many cases the development of permanent physical disability will have a permanent impact on the sexual function of the individual. By realizing the limitations caused by the disability, clients can move forward in their sexual lives, rather than waiting for a change that may never come. Counselors that help clients focus on the here and now can ensure that clients enjoy what ever level of sexual functioning that is possible after physical injury.

Finally, Southern (1999) in his examination of what counselors can do to help physically disabled clients enhance their sexuality notes that counselors must be willing to talk with clients about the specific methods that can be used to enhance sexual experiences for the client. According to Southern, there are a wide range of sexual activities in which one can engage that do not involve intercourse. Mutual masturbation, oral sex and external stimulation using vibrators are all potential subjects that should be discussed with the disabled patient experiencing sexual frustration and/or dysfunction. Again, the willingness of the counselor to speak with the client in an honest and straightforward manner is critical to overall success. Counselors need to make clients aware of the resources that they have available to them for improving their sex lives.

Conclusion

Synthesizing all of the information that has been presented in this investigation, it becomes evident that even though sexuality after physical injury is a critical issue for basic human development and function, the issue poses considerable challenges for both the disabled individual and the counselor. Based on the information provided here, it seems reasonable to argue that counselors working with physically disabled patients must be willing to actively engage in conversation about sexuality and the specific methods that patients can use to improve their overall sexual functioning. For clients that are not willing to approach the subject on their own, counselors should provide the supportive environment that would allow the client to discuss these issues. For clients that are willing to approach these subjects, counselors should provide information in a comprehensive manner that is both honest and straightforward. By approaching these issues in this manner, it will be possible for clients to feel more comfortable about their own sexuality and sexual functioning.

As examined by scholars, the issue of sexuality after physical injury is one that is paramount to the psychological rehabilitation of the individual. Issues of sexuality impact the psychological functioning of the individual and his or her ability to frame and conceptualize images of self-esteem and self-worth. For these reasons, counselors must be willing to address issues of sexuality with clients that have incurred physical disability in an environment that is both supportive and nonjudgmental. Only by addressing these issues in a positive, self-respecting manner will clients with disabilities be able to develop and understand the issues that impact their overall sexual functioning.

References

Ducharme, S.H. (1996). Sexuality After Spinal Cord Injury: Answers to Your Questions. Baltimore, MD: Paul H. Brooks Publishing Company.

Farrow, J. (1990). Sexuality counseling with client who have spinal cord injuries. Rehabilitation Counseling Bulletin, 33(3), 251-260.

Southern, S. (1999). Facilitating sexual health: Intimacy enhancement techniques for sexual dysfunction. Mental Health Counseling, 21(1), 15-32.

Westgren, N., & Levi, R. (1999). Sexuality after injury: Interviews with women after traumatic spinal cord injury. Sexuality and Disability, 17(4), 309-319.