Supporting Sexual Functioning and Satisfaction During Rehabilitation after Spinal Cord Injury: Barriers and Facilitators Identified by Healthcare Professionals

Abstract

Objective: To explore healthcare professionals’ perspectives on the barriers and facilitators impacting provision of support for sexual functioning/satisfaction during spinal cord injury rehabilitation.
Design: Qualitative, semi-structured interview design.
Methods: Sixteen healthcare professionals working in spinal cord injury rehabilitation settings were recruited (14 females, 2 males). Semi-structured interviews were conducted using a 9-item interview guide. Interviews were transcribed verbatim and inductively analysed following Braun and Clarke’s (2006) 6 phases of thematic analysis.
Results: Five inductive themes were generated describing healthcare professional-perceived barriers and facilitators impacting upon care delivery postspinal cord injury: (1) Integrating sexual wellbeing in rehabilitation; (2) Sex-informed multi-disciplinary teams; (3) Acknowledging awkwardness; (4) Enhancing approachability; and (5) Recognizing the partner.
Conclusion: Sexual functioning and satisfaction are priority areas for rehabilitation, yet they are persistently side-lined in multi-disciplinary team (MDT) rehabilitation agendas. Healthcare professionals do not feel supported to engage with their patients to improve and manage sexual functioning/satisfaction. Ensuring that healthcare professionals are equipped and made aware of sexuality-specific guidelines and operational frameworks, which can be easily interpreted, structured and implemented as a standard part of spinal cord injury rehabilitation is key. This would be instrumental in enabling healthcare professionals to be more informed and comfortable in creating an atmosphere in which sexual topics can be openly discussed to support individuals with spinal cord injury.

LAY ABSTRACT
Spinal cord injury can affect sexual functioning and satisfaction. However, support for sex is often overlooked in spinal injury rehabilitation. Healthcare professionals can feel uncomfortable, and lack confidence and training to address this with patients. There is a need to gain insight into what enables healthcare professionals to deliver better support for sexual wellbeing, and what limits them. Knowing what helps or hinders professionals in working with sexual issues after spinal cord injury would enable growth and development in tailored rehabilitation services. The aim of this study was to identify how healthcare professionals see the challenges facing sexual rehabilitation, focusing on issues that may affect the sexual functioning and satisfaction of patients. The results showed that healthcare professionals are concerned about the absence of professional support for sexuality in their rehabilitation services, they felt embarrassed when addressing sex, they felt they lacked specialist training, and had limited resources and materials to work from. Programmes are needed that provide education and psychological support for people with spinal cord injury who want to maintain sexual engagement and, critically, this requires improvements in knowledge and skills for the healthcare professionals who are providing spinal cord injury rehabilitation.