1. Sarah Myer, LSW, MSS

2.  Participants will be able to: ◦ List 5 components of sexuality. ◦ Identify ways sexuality is impacted by disability and chronic illness. ◦ Identify 3 ways that sexuality may present in a clinical context. ◦ Increase self-awareness regarding communication about sexuality. ◦ Identify 3 resources to use for information related to sexuality and disability/chronic illness.

4.  Sensuality  Intimacy  Sexual Identity  Sexual Health and Reproduction  Sexualization Advocates for Youth, 2012.

5.  Awareness, acceptance of, and comfort with one’s own body; physiological and psychological enjoyment of one’s own body and the bodies of others Body Image Skin Hunger Sexual Response Cycle Fantasy

6.  The ability and need to experience emotional closeness to another and have it returned. Caring Sharing Loving/ Liking Risk Taking Vulner- ability

7.  The development of a sense of who one is sexually, including a sense of maleness and femaleness. Gender Identity Bias Gender Role Sexual Orientation

8.  Attitudes and behaviors related to producing children, care and maintenance of the sex and reproductive organs, and health consequences of sexual behavior. Factual Info Feelings, Attitudes Intercourse Anatomy & Physiology

9.  The use of sexuality to influence, control, or manipulate others. Rape Incest Sexual Harassment

10.  Sensation  Mobility  Pain  Orthopedic restrictions, precautions  Bowel and bladder function  Spasticity  Autonomic dysreflexia  Communication  Cognition  Relationship changes  Financial changes

11.  Erectile dysfunction  Ejaculation difficulties  Orgasm  Decreased lubrication  Changes in desire  Medication side effects  Infertility

12.  How does sexuality present to you?  How to handle issues of sexuality ◦ Respect ◦ Self-awareness ◦ Knowledge of resources ◦ Appropriate referrals

13.  A 60 year old male with a former spinal cord injury gets an infection that leads to a right above knee amputation. He is interested in getting a prosthesis. His therapist tells him, “I don’t see a reason for it medically since you weren’t ambulating before this.”

14.  What were your first reactions?  What worked well? What didn’t work?  What might you say to this person?  How might your response impact the patient?

15.  A female patient in her mid 30s, who is newly married, was injured on the job. She and her husband have a young daughter and are interested in having more children. Her case manager arranged for her to have full-time caregivers at home to assist with her ADLs, since she is currently dependent. She has expressed concern in having more children and concerns about her age.

16.  What were your first reactions?  What worked well? What didn’t work?  What might you say to this person?  How might your response impact the patient?

17.  A young male is injured on the job, and is now blind, in addition to multiple orthopedic issues. His discharge plan is to return home with his partner and his family, since he has few family supports. He is set up for a first floor set-up in their family dining room. He is very open about wanting to have sex and has requested a full-size bed so that his partner can sleep with him once he returns home.

18.  What were your first reactions?  What worked well? What didn’t work?  What might you say to this person?  How might your response impact the patient?

19.  Websites ◦ American Association of Sexuality Educators, Counselors, and Therapists: www.aasect.org ◦ Amputee Coalition: www.amputee-coalition.org ◦ Brainline: www.brainline.org ◦ Magee SCI Binder: Chapter on Sexuality  http://jdc.jefferson.edu/cgi/viewcontent.cgi?article=1016&c ontext=spinalcordmanual_eng ◦ Miami Project to Cure Paralysis: Infertility  http://www.miamiproject.miami.edu/ ◦ Model Systems Knowledge Translation Center  http://www.msktc.org/ ◦ PleasureABLE: handout on sexual assistive devices  http://www.dhrn.ca/files/sexualhealthmanual_lowres_2010_ 0208.pdf

20.  Books

21.  Video/Movies ◦ Facing Disability (www.facingdisability.com)www.facingdisability.com ◦ Dr. Mitch Tepper (http://mitchelltepper.com/)http://mitchelltepper.com/ ◦ Sexuality Reborn, Kessler Institute, 1993 ◦ The Surrogate, 2011 ◦ Feeling Your Way: Relationships and Sexuality after Spinal Cord Injury, Mayo Clinic, 2012