Journal of Rehabilitation Medicine 51-5 | Page 40

356 M. McGrath et al. Table II. Matrix of consensus and priority scores for topics to be included in post-stroke sexual rehabilitation programme Tiered priority ratings Consensus 1. High; High to Intermediate 2. Intermediate; High to Low High (<1) B.1 Having social conversations – engaging with others in social situations including ability to relate well with others and pick up social cues/body language. A.4 Resuming sexual activity after stroke. A.3 Myths about sexuality. B.3 Conversations with intimate partners – including expressing thoughts and need in relation to sexuality and understanding partners’ thoughts and needs in relation to sexuality. B.4 Communication with health professionals – strategies to support stroke survivors and partners of stroke survivors to express themselves and their needs relating to sexuality to health professionals. B.7. Strategies to initiate conversation about sexuality and intimacy needs with healthcare professionals when communication is difficult because of communication changes after stroke (e.g. aphasia, dysarthria, dyspraxia). B.5 Expressing emotional intimacy and closeness with partners C.1. Changes in cognitive function including attention, memory, when communication is difficult because of communication abstract reasoning and problem-solving, which impact on the person’s ability to fulfil their role as a partner in a relationship. changes after stroke (e.g. aphasia, dysarthria, dyspraxia). B.6 Initiating conversations about sexuality and intimacy including C.2 Changes in self-control including anger management, temper sexually intimate conversation with existing or new partners when control and /or becoming physically or verbally abusive. communication is difficult because of communication changes C.3 Impulse control – learning to manage impulse control including increased frequency and amount of public displays of after stroke (e.g. aphasia, dysarthria, dyspraxia). affection, which a partner may not be comfortable with. C4. Changes in emotional stability – including laughing and crying inappropriately and sudden changes of mood. D2. Changes to body image – including changes in the perception that a person has of their physical self and the thoughts and feelings that result from this perception. D.3 Changes in self-concept and self-esteem- changes in the individual’s belief about himself or herself including overall subjective evaluation of self-worth. D.4 Fear of rejection – concern regarding being rejected or seen in critical way which holds the individual back from expressing sexuality. C.5 Changes in cognitive function impact on the person’s ability to fulfil their role as a partner in a relationship. D.1 Changing gender roles – gender roles refer to social expectations regarding how men and women are expected to act and behave. E.2 Muscle spasticity – stiffness or contraction of muscles that interferes with normal movement. E.3 Change in sensation – changes impacting upon sensitivity to sensory stimuli such as touch, vision, taste or smell. E.4 Changes to continence – including incontinence and managing D.5 Changes in intimate relationships – negotiating new roles catheters. and ways of being in the context of intimate relationships. E.5 Control of pelvic floor muscles – exercises designed to help strengthen the muscles of the pelvic floor to enhance bowel and D.6 Changes in attraction towards intimate partner – including challenges switching from being a caregiver or care bladder control. recipient to being a partner. E.6 Changes to mouth function – reduced control of the mouth D.7 Managing grief and loss in relationships – including loss of muscles which may impact on ability to engage in kissing result in drooling, etc. a partner, becoming a carer or care recipient. D.8 Managing anger and guilt in relationships – including anger and frustration towards one’s partner. E.7 Pain – pain which is ongoing or occurs during specific activities and results in decreased ability to express sexuality E.9 Medication – understanding the impact of medication on E.1 Loss of function of body parts which changes the way in which a person may be intimate with another or the ability to sexuality and sexual activity. participate in sexual activities. F.2 Changes in sexual desire – also known as loss of libido this E.8 Fatigue – fatigue which impacts upon ability to engage in refers to a decrease in sexual activity which is having an effect on a person’s life and is causing distress. activities related to expressing sexuality. F1. Sexual pleasure – feelings associated with sexual arousal F.3 Sexual health and contraception -managing sexual well-being including sexual health checks and advice regarding contraception including exploring different/new forms of sexual arousal. B.2 Meeting new partners and forming new intimate relationships – use of social media, dating sites and identifying opportunities to access social situations to meet new people. F.4 Sexual aids and toys – provision of information regarding aids F.12 Resuming sexual activity – knowing when it is safe to resume sexual activity, fears about sexual activity and stroke, and toys to support sexual activity and sexual pleasure. initiating sexual activity alone or with a partner. F.5 Sexual service providers – provision of information regarding availability and selection of sex service providers. F.6 Changes in achieving orgasm – changes in reaching orgasm (also known as sexual climax) can happen during sexual intercourse or self-pleasuring (masturbation). F.7 Changes in sexual intercourse – sexual intercourse is commonly known as the insertion of the penis into the vagina (vagina sex) but also includes other forms of penetrative sex such as oral, anal or finger sex. F.8 Vaginal dryness – reduction in vaginal lubrication resulting in vaginal dryness, pain and/or discomfort during sexual activity. F.9 Changes in vaginal sensitivity – pain or changes in sensitivity to touch in the vaginal and/or genital area. F.10 Erectile dysfunction – changes in ability to achieve and maintain erection including frequency of erection and confidence in maintaining erection. F.11 Changes in ejaculation – changes in ability to ejaculate including premature ejaculation. F.13 Medication to enhance sexual activity. F.14 Changes in reproductive function –change in ability to produce, maintain, transport and discharge sperm within the female reproductive tract (male) or loss of ability to produced and transport female eggs to the fallopian tubes for fertilization (females). Moderate (1) Low (> 1) A.2 Why is it important to talk about sexuality? www.medicaljournals.se/jrm A1. What is sexuality? 3. Low; Low to Intermediate