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Dimensions

Facilitating Sexual Health of


for Sexual Health
Children and Adolescents
with
• Self Image/Self Concept
Transverse Myelitis
• Sexual Relationships/Partnerships
• Sexual Functioning

Self Image Partnerships


& and
Concept Relationships
• Activities with others
• Roles
• Beliefs that we hold in relation to
ourselves (Ideal self, body image) • Communication
• External factors (clothing, friends,
jewelry, jobs, recreation)

Sexuality Across the Life


Sexual Functioning
Span
• Ability to give and feel • Not an “adults only” activity
pleasure • May produce anxiety for
• Participation in sexual parents
activities • Emphasis on sex roles,
• Reproduction understanding the body,
socialization skills

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“Research findings indicate Sexuality Education Program Content
should include information on
that students who responsible sexual behavior
understand their sexuality
and the responsibilities
that go with it are less • Social Skills
likely to encounter sexual • How to avoid being sexually exploited
• Appropriate body exposure
troubles than students
• Privacy of sexual behavior
who are uninformed”.
• Responsibility of sexual behavior
including abstinence
Johnson & Kempton, 1981 • How to prevent pregnancy

Important Issues for Issues for Kids Exploring


Parents of Kids with Their Sexuality
Disabilities

• Parents must be open/comfortable • Struggle to place the disability in proper


with topic of sexuality perspective
• Social graces are developed and • Demystify sexuality
learned - not inborn • Develop a positive body image
• Kids/adolescents should know how • Learn needed social skills
to tell others of their disability • Understand sexual functioning

Sexuality Education
Sexual Information for
Content for Parents of
Children and Adolescents
Kids with Disabilities
• Parents should demonstrate acceptance of child’s
body
• First experience with love and socialization will be • Ages 5 -8 years
provided by parents and siblings
• Social relationships with friends/siblings should be • Ages 8 - 11 years
encouraged
• Children need to learn role behavior of same sex • Ages 12 -18 years
parent
• Sexuality information is shared related to child’s
age

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Sexual Information for Sexual Information for
5-8 Years Ages 8 - 11 Years
• Correct names of body parts and their functions • Females should be taught about menses and
• Differences and similarities between girls and males about nocturnal emissions
boys • Signs and variability of puberty
• Elements of reproduction and pregnancy • Sexuality as part of total self
• Qualities of good relationships (friendship, • Information on reproduction and pregnancy
communication, respect, love) • Importance of values in decision making
• Decision making skills/All decisions have • Communication within family unit about sexuality
consequences • Masturbation
• Beginning of social responsibility, values, morals • Abstinence from sexual intercourse
• Masturbation can be pleasurable, but should be • Avoiding and reporting sexual abuse
private
• STDs including HIV/AIDS
• Avoiding/Reporting sexual exploitation

Sexual Information for Non Disabled Kids Get


Ages 12-18 Years Information from Many
Sources
• Health maintenance (breast exams, testicular exams)
• Sexuality as part of total self (communication, dating, • Peers at school, playground, school restroom
love, and intimacy)
• Swap information/share experiences
• Masturbation should be practiced privately
• Free access to magazines/reading materials
• Importance of values in guiding one’s behavior
• How alcohol and drug use influence decision making
• Expressions of sexuality
• Birth control and responsibilities of childbearing
Kids with physical disabilities are often dependent on
• Reproduction
adults (parents) or health care workers
• Role of condoms in disease prevention - pros and cons

“Disabled youngsters do need to


be given sex education. After all, Physiologic Aspects
they have to cope with the
physical changes of puberty as of Sexual Response
well as the emotional changes.
They may well have anxieties
about their future and need • For NORMAL sexual response,
reassurance that they are sexual all parts of nervous system
people who can form relationships have to be connected and in
with others. They need the balance.
information to enable them to
cope with and enjoy their • Psychologic desire must also be
sexuality.” present for successful sexual
performance
Davies, 1996

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Central Nervous System Sexual Desire and
Control Over Perception of Sexual
Sexual Functions Pleasure are mediated by
• All human behavior controlled
several areas in the brain
by CNS (sex) • Movement
• Brain controls the nervous • Sensation and perception
• Cognition
system • Attention and general affect
• No specific “sex center in the The brain exerts influence over the spinal cord
brain”

Physiology of
Spinal Cord contains “sex center”
in lumbosacral area Erection/Vaginal
Lubrication
• (Women) Entire LS area is involved in coordinating
nerve impulses to and from genitalia
• (Men) Sacral segments S2, S3, S4 control erection
and lumbar segments L1, L2, L3 control ejaculation
• Psychogenic
• Reflexic
The peripheral nerves relay impulses between the spinal
cord and genitalia and between the spinal cord and rest of
body. (Physical changes during sexual response cycle).

Psychogenic Erections Reflexic Erection


• Mental images or fantasy • Local stimulation to genitalia or sacral
• Impulses travel via autonomic nervous nerves
system • Sensory impulses travel to spinal cord
• Brain through spinal cord to lower • Connect with motor neurons
thoracic and upper lumbar levels • Causes reflex vascular engorgement and
• Fibers leave the spinal cord and travel to lubrication
blood vessels in penis and vagina/clitoris
• Vascular engorgement and lubrication

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Sexual Dysfunction Sexual Dysfunction
Primary Secondary
• Changes in sexual feelings and response • Results from symptoms that may be
directly related to the neurologic SCI caused by Transverse Myelitis
• Decreased libido (sex drive) • Pain
• Changes in sensation • Fatigue
• Decreased vaginal lubrication • Spasticity
• Problems achieving/maintaining erection • Bowel and Bladder Problems
• Reduced ejaculatory force or ability
• Change in orgasmic response
• Change in fertility (men)
• Changes in menstruation (women)

Sexual Dysfunction Management Strategies:


Tertiary Decreased Libido
• Effects caused by psychologic responses • Identify cause (anxiety, stress,
to the effects of Transverse Myelitis
depression)
• Poor Self Esteem
• Poor Self Image • Treat cause (counseling, stress
• Social Isolation management, medications)

Management Strategies: Management Strategies:


Sensation Changes Decreased Lubrication
• Self or partner exploration • Water-soluble lubricants (K-Y
• Use of vibrator Jelly, Replens)
• Identification of new • Hormone replacement therapy
erogenous zones (estrogen) at menopause
• Non-erotic stimulation

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Management Strategies: Medications for
Achieving/Maintaining Achieving/Maintaining
Erections Erections
• Use of vibrator
• Viagra
• Self/partner stimulation
• Prostaglandin E (suppository
• Vacuum erection device
into penile opening of urethra)
• Penile implants
• Papaverine (injected into shaft
• Medications of penis)

Management Strategies: Management Strategies:


Pain/Spasms Fatigue
• Identification of cause (spasms, • Pain Control
positioning, nerve pain).
• Planning sexual activity for
• Gentle range of motion or massage
highest energy time
(foreplay)
• Medication for spasms, neuropathic • Energy conservation
pain
• Attempts at different positions

Management Strategies: Management Strategies:


Bowel/Bladder Problems Psychologic Responses
• Bladder emptying prior to • Focus on attributes
activities • Identify as a sexual person
• Indwelling catheter • Communicate feelings to
management partner/therapist
• Bowel program (specific • Solicit help for personal care
consistent time) • Focus on Relationships
• Pre-plan how to manage
accidents

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Relationship Factors that
Affect Sexuality The transition from childhood to adolescence to
adulthood is challenging for all children - but
• Communication becomes a more difficult process for the child
with a disability - and for the child’s family.
• Maintaining Trust
•Develop trusting relationships
• Self Concept/Self Image
•Learn socially appropriate behaviors and
• Love
acceptable norms
• Romance
•Develop a positive body image/self esteem
• Intimacy
A child’s early experiences related to disability
• Fantasy can influence future adjustment to any residual
limitations, development of self esteem and
relationships and career choices.