Sexuality after stroke
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Table III. Matrix of consensus and priority scores for timing of sexual rehabilitation following stroke
Tiered priority ratings
Consensus
High (< 1)
Moderate (1)
Low (> 1)
1. High; High to Intermediate
2. Intermediate; High to Low
3 months after the initial diagnosis of stroke
6 months after the initial diagnosis of stroke
1 year after the initial diagnosis of stroke
> 1 year after the initial diagnosis of stroke
1 month after the initial diagnosis of stroke
‘Topics that encourage the discussion and therefore pro-
blem solving around this topic is the starting point to further
explore this area. If the patient’s and partners feel it is ok to
talk about this subject then it allows open discussion.’
Timing sexual rehabilitation following stroke:
priorities and consensus
Participants did not exclude any of the timings sug-
gested during round 1, nor did they identify any addi-
tional times when sexual rehabilitation would be most
preferable. Table SII 1 shows the 6 potential timings
with consensus score and both priority scores. Table
III shows the potential options in a matrix, categorized
by consensus and priority tier. Analysis of open-ended
responses indicated that a single time-point was not
considered optimal for the delivery of sexual rehabi-
litation following stroke. This finding was attributed
to the idiosyncratic nature of stroke recovery and the
likelihood that sexuality would have different mea-
nings and different levels of relevance for individual
stroke survivors.
‘It affects different people at different points in time. It
would need to be when they are mentally ready to approach
that topic, when they have sorted out the ‘back to normal’
out of the hospital situation. Personally, I believe six months
post would be the right initial timing, but could be shorter
at three months.’
Nonetheless, participants indicated high levels of
consensus in prioritising delivery of services between
3 months to 1 year after stroke, reflected by comments
such as:
‘I was ready to receive education re [sic] sex around the
2 to 3-month mark. Before that, I was more focused on other
changes (i.e. communication, movement)’, and
Low; Low to Intermediate
Within the first 2 weeks following stroke
‘I think the topic should be broached before hospital
discharge so that people have an opportunity to consider
and ask about sexuality while they still have the input of an
MDT, and again after discharge, when people have had time
to consider their priorities. For people with long-term stroke
impairments, it would be important to revisit the topic of
sexuality again, after about a year, when priorities may have
changed and people have had time to try different approaches
and identify what is/is not working for them.’
Although participants did not identify any time during
the stroke recovery journey when sexual rehabilitation
was not relevant, all 4 stakeholder groups noted that
stroke survivors during the acute phase of recovery are
often overwhelmed with information. The acute phase
may therefore not be the best time to address sexuality.
‘In the first few weeks post-stroke clients are provided with
too much information and many become very overwhelmed.
Perhaps information given (very brief) at this early stage
would be useful; however, it should be followed up at a later
date.’
Methods of delivering sexual rehabilitation following
stroke: priorities and consensus
Participants did not exclude any of the potential met-
hods of service delivery offered in round 1. Table SIII 1
shows the 9 potential methods of delivering sexual re-
habilitation, with consensus and priority scores. Table
IV shows the final 9 options in a matrix, categorized
by consensus and priority. Analysis of responses to
open-ended questions suggested that individual face-
to-face consultation was preferred, due to the personal
and potentially sensitive nature of the content.
‘This topic is deeply personal and the people are very
vulnerable. Often it is too overwhelming and personal to
Table IV. Matrix of consensus and priority scores for modes of delivery of sexual rehabilitation following stroke
Tiered priority ratings
Consensus 1. High; High to Intermediate 2. Intermediate; High to Low
High (<1) Individual intervention sessions (face-to-face) with professionals
Group intervention sessions (face-to-face) with professionals
Online programme with individual support from professionals
Reading materials with individual follow up Peer to peer counselling
Online materials only
Moderate (1)
Low (>1)
3. Low; Low to
Intermediate
Online programme with group discussion board
Reading materials with group follow up
Reading materials only
J Rehabil Med 51, 2019