The rehabilitation management of sexuality and fertility issues in people with disabling health conditions

Sexual health is a state of physical, emotional, mental and social well-being in relation to sexuality. Disabling health conditions can impact sexual function, identity, self-esteem and self-image, fertility and pregnancy. People can experience primary impairments such as a loss of sensibility or erectile dysfunction, but also consequences of secondary impairments like incontinence, pain, fatigue, or spasticity. Moreover, limitations of activities and participation restrictions can impact intimacy, sexuality and reproduction. Therefore, sexual issues should be an integral part of quality rehabilitation care. Components of a sexual rehabilitation programme are information/education of patient (and partner), practical advice, finding new positions, medication, using assistive devices and aids (like vibrator, sex toys, lubricating gel, massage oil), pelvic floor training, coping strategies and addressing self-image and self-esteem. People should be encouraged to explore their changed bodies and experiment. Sexual rehabilitation requires a personalized biopsychosocial and integrative approach by the entire multiprofessional team, including peer counsellors.