Sexual Health Among Individuals with Spinal Cord Injury: A Meta-Synthesis of Qualitative Evidence

To meta-synthesize the qualitative evidence on individuals' subjective experiences of sexual health following a spinal cord injury (SCI). PubMed, EMBASE, CINAHL, and PsycInfo were searched from 1960 to 2021 for qualitative research articles that examined sexual health (i.e., sex, sexuality, reproductive health, etc.) in adults with SCI. Only studies published in English, including first-person accounts of living with a SCI were included. Using qualitative meta-synthesis methodology, data (reported results) from each selected study were coded line-by-line to develop descriptive and analytical themes by two investigators. A total of 22 studies met inclusion criteria. Some articles inquired about specific aspects of sexual health (e.g., how their sexual experiences are affected by urinary incontinence), and others inquired broadly about the experience of sexual relationships (e.g., how people engage in sexual relationships after their SCI). The themes identified in each study were positioned within the Sexual Rehabilitation Framework (Elliott 2017) composed of eight domains: sexual drive/interests, partnerships, self-image, bowel/bladder, sexual function, motor/sensory, fertility/contraception, and secondary complications. Sexual health was shown to be a significant priority for individuals after a SCI and they are impacted in a multitude of ways. Individuals report wanting education and knowledge on sexual health post SCI. Health care professionals were perceived to lack the ability to meet their needs and resources were inadequate. Further, providers' approach, attitude, and insensitivity to patient needs were perceived barriers to adequate sexual health rehabilitation post SCI. The collective findings can inform (a) rehabilitation professionals' awareness of patients' sexual needs after SCI; (b) the development of SCI programming or services for sexual health rehabilitation; and (c) the design of future research studies (e.g., interventions for specific sexual issues).