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Integrating sexuality into rehabilitation – the role of psychosexual therapy

When society talks about rehabilitation, we often think of physiotherapists in the gym practicing exercises. We think of mobility training and regaining independence, with images of people learning how to walk again often in the spotlight.

One of the less highlighted areas of rehabilitation is sexuality post-injury, illness or disability. Sexuality is a central aspect of being human throughout life and encompasses sex, gender identities and roles, sexual orientation, eroticism, pleasure, intimacy and reproduction. Experienced and expressed in many ways including thoughts, fantasies, roles, and relationships, (1) many aspects of sexuality can change after a catastrophic injury, but sex, intimacy and sensuality doesn’t end.

Addressing sexuality after injury has been well-documented in peer reviewed literature as best practice, yet, research shows that less than 15% of clinicians working in rehabilitation feel confident talking about sexuality with their patients. (2-5) How best can we support our clients with sexuality issues after-injury if so few clinicians are talking about it?

Research shows that for patients who are living with illness, injury or disability, sexuality is an important topic where they would like support, yet many report it continues to be a neglected issue in rehabilitation. (6,7)

The Sexuality Service is providing holistic rehabilitation which integrates sexual health into rehabilitation. The service provides psychosexual therapy, often referred to as sex therapy, alongside traditional allied health, nursing and medical therapies, to deliver a true multidisciplinary approach.

Psychosexual therapy is a talking therapy and a specialised form of counselling that deals with problems primarily related to sex, sexual health and sexuality concerns. Psychosexual therapy is for singles and those in relationships regardless of age or physical impairments. It addresses many aspects of pleasure, regaining sexual confidence and the functional aspects of human sexuality in partnership with medical, nursing and other allied health disciplines. Psychosexual therapy is part of Royal Rehab’s rehabilitation team and our psychosexual therapists are qualified health professionals who have postgraduate, specialist qualifications in psychosexual therapy and are members of the Society of Australian Sexologists (SAS).

Having a dedicated rehabilitation team member who is willing, able, and wanting to address sexuality helps the whole rehabilitation team becomes more confident talking about the topic. The confidence in knowing we can refer anything outside of our comfort zone or scope of work to sexuality trained colleagues allows the whole team to support clients.

Like all aspects of rehabilitation, helping clients achieve their rehabilitation goals takes a team approach so it makes perfect sense to include psychosexual therapy as part of a rehabilitation treating team.

Reference

  1. World Health Organization. Defining Sexual Health: Report of a Technical Consultation on Sexual Health. 28-31 January 2002. Geneva: WHO, 2006.
  2. McGrath, M., Lever, S., McCluskey, A., et al.: Developing interventions to address sexuality after stroke: findings from a four-panel modified delphi study. J. Rehabil. Med. 51(5), 34–42 (2019)
  3. Stein J, Hillinger M, Clancy C, Bishop L. Sexuality after stroke: patient counseling preferences. Disabil Rehabil 2013; 35: 1842–1847.
  4. Park JH, Ovbiagele B, Feng W. Stroke and sexual dysfunction – a narrative review. J Neurol Sci 2015; 15: 7–13.
  5. Rosenbaum T, Vadas D, Kalichman L. Sexual function in post-stroke patients: considerations for rehabilitation. J Sex Med 2014; 11: 15–21.
  6. Desiree Latella, Maria Grazia Maggio, Rosaria De Luca, Giuseppa Maresca, Denise Piazzitta, Francesca Sciarrone, Luigi Carioti, Alfredo Manuli, Placido Bramanti, Rocco Salvatore Calabro, Changes in sexual functioning following traumatic brain injury: An overview on a neglected issue, Journal of Clinical Neuroscience, Volume 58, 2018, Pages 1-6,
  7. Auger, LP., Pituch, E., Filiatrault, J. et al. Priorities and Needs Regarding Sexual Rehabilitation for Individuals in the Subacute Phase Post-stroke. Sex Disabil 38, 653–668 (2020).