Helping disabled regain sexual health

The Straits Times (5 August 2012)

Occupational therapist started clinic for such patients after realising their need for help


A female patient in her 30s, who had suffered a spinal cord injury, once told occupational therapist Shirlene Toh that she was going home soon, and she had a husband.

What she really meant was: What if my husband wants to have sex? Would I be able to?

"It occurred to me that we tend to focus on patients' physical condition, and if they are able to walk or return to work," said Ms Toh, 36.

"But there is also a psycho-social aspect of integrating back into their lives and taking on roles as husbands and wives."

Ms Toh looked up some information on the Internet for the patient.

But realising there was a need for such help, she pursued a master's degree in sexual health from an Australian university.

Upon her return, she set up the Sexual Wellness Service at Tan Tock Seng Hospital's Rehabilitation Centre in 2009.

Almost all patients below age 65 who are admitted for rehabilitation are assessed to see if they need sexual counselling and education. The clinic is the only one of its kind for physically disabled patients.

Many patients think their sex lives are over once they have had a spinal cord injury or stroke.

But if they are medically stable, they can still enjoy intimacy in their relationships, even if sexual intercourse is not always possible.

The clinic helps by counselling and identifying the different ways the patient and his or her partner can still enjoy sexual intimacy.

This is done by improving communication, exploring ways to be intimate, finding the right positions for sexual intercourse or using sex devices, said Ms Toh.

The clinic sees 30 to 40 patients each month. One out of seven is female. Many more are men as they tend to be the ones who suffer spinal injuries from accidents. They are also more likely to seek help for sexual dysfunction.

Ms Toh, who is also principal occupational therapist at the rehab centre, is the only trained sex therapist here specialising in sexual wellness of the disabled. There are two other occupational therapists at the hospital trained to provide sexuality education for stroke survivors.

The service is especially important given that many patients with spinal cord and brain injuries are in their 20s and 30s. Stroke patients are also getting younger, said Ms Toh.

Disabilities can affect a person's sexual function in different ways, depending on the extent of the injury. Some are still capable of erections while others have varying degrees of genital stimulation.

But relationships fail because of a breakdown in communication, without which there can be no intimacy, said Ms Toh. That is what she works on with patients and their spouses.

A 46-year-old telecommunications consultant, who became paralysed from the chest down after a rugby accident in 1986, hopes to get married and have children. Because of his disability, he needs the use of a device to get an erection.

"I've always had questions but never had the chance to ask. It's about time such a service was offered to the disabled. It has provided me with more information on what I can do to help myself," he said.

Dr Adela Tow, a senior consultant at the hospital's department of rehabilitation medicine, said patients who have undergone the sessions "live life with more confidence". "We have also observed a twinkle in their eye... and a closer relationship between partners."

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Source: The Straits Times © Singapore Press Holdings Limited. Reproduced with permission.