Sexuality and Intimacy Behaviors in the Elderly with Dementia: The Perspective of Healthcare Professionals and Caregivers Abstract This paper discusses sexuality and intimacy behaviors of the elderly with dementia living in residential care. The study explores this thematic from the perspectives of healthcare professionals and family caregivers. The methodology used is based on a qualitative method approach. The research was conducted in Portugal, using semi-structured face-to-face in-depth interviews. Thirty-two people participated in this study. The qualitative data was analyzed using thematic analysis to help identify repeated patterns of meaning in the dataset. The following key findings emerged: (1) participants identified the presence of sexuality, intimacy and sexual behavior in elderly people with dementia, primarily due to the physiological needs of individuals; (2) sexuality was mostly considered as an important manifestation of love, affectivity and proximity; (3) social and cultural beliefs influenced participant’s perception of the issue, some considering it a taboo subject; (4) participants expressed the need for these behaviors be considered natural and acceptable as sexuality and intimacy are inherent in humans and contribute to an individual’s quality of life hence they should also be dealt with in a practical manner; (5) a general limitation in training and institutional guidelines was identified; (6) decision-making in the area of sexuality should be determined by the elderly if they maintain the ability to manifest what their wishes are. As life expectancy increases along with dementia cases, a better understanding of sexuality in dementia, is of great importance as it could potentially help increased the quality of life for these individuals.

From the Editor of Sexuality and Disability : Are We Still Interested? Are We Still Invested?

Professional Educational Opportunities

Autism and Adult Sex Education: A Literature Review Using the Information–Motivation–Behavioral Skills Framework Abstract Adults on the autism spectrum report comparable levels of desire for sex and sexual satisfaction as adults who are not on the spectrum. However, there has been little empirical focus on the need for sexual and relationship-oriented education for youth on the spectrum as they transition to adulthood. In this review, we use the Information–Motivation–Behavioral Skills Model of sexual health behavior change as a lens through which to understand the experiences of adults on the autism spectrum. We present those insights infused with emerging data and best practices in the field. Overall, it appears clear from the extant literature that providers need to recognize the specific characteristics of autism when developing sexual education curricula. Specifically, the social communication and sensory profile of people on the autism spectrum appears to interact with access to information, motivation to engage in healthy sexual activities, and the development of skills needed to engage in healthy sexual behavior. Finally, the voice of adults on the spectrum is essential to guide the emerging understanding of healthy sexuality.

Sexual Function, Social Isolation, Loneliness and Self-Esteem in Patients Undergoing Hemodialysis Abstract Sexual dysfunction is one of the most common problems in patients undergoing hemodialysis, which causes mental and psychological problems. Identification of the related factors is necessary to prevent the psychological complications of sexual dysfunction. This study investigated the relationship among sexual dysfunction, loneliness, social isolation, and self-esteem. In this cross-sectional correlational study, 132 patients undergoing hemodialysis with inclusion criteria were selected through census sampling from hemodialysis centers in Kerman, Iran. Demographic questionnaire, Rosenberg self-esteem scale, young schema questionnaire-short form, revised UCLA loneliness scale, the female sexual function index, and the international index of erectile function were used to collect data, which were analyzed with SPSS18 using descriptive and analytical tests. The mean total score of sexual function was 12.29 ± 7.78 in women and 29.46 ± 21.29 and in men, which was indicative of poor sexual function of patients. The level of self-esteem of the majority of subjects (47.7%) was in the mean range of 16.58 ± 7.03. The mean total score of social isolation of patients was 17.06 ± 7.62 at an average level, and the mean total score of the loneliness of the patients was 38.15 ± 13.70 at a low level. There was no statistically significant correlation among sexual dysfunction, loneliness, social isolation, and self-esteem (P > 0.05). The results of the study suggested the necessity of planning and implementing plans for the improvement of the sexual function of patients. On the other hand, interventions to improve social isolation, level of loneliness, and self-esteem in patients undergoing hemodialysis should be planned and implemented.

Supporting Parents as Sexuality Educators for Individuals with Intellectual Disability: The Development of the Home B.A.S.E Curriculum Abstract All individuals with intellectual and developmental disabilities (I/DD) have the right to develop and express sexuality in an emotionally satisfying and socially appropriate manner. Questions have arisen as to whether sexuality education for this population should be the responsibility of the school or the family. Parents of children with I/DD report they want to be the primary sexuality educators for their children, but often overlook the responsibility because they do not know what to talk about, when to talk about it, or how to modify content so their child will understand. Available resources for parents of individuals with I/DD tend to provide opportunities for independent learning; Few in-person trainings where these parents can learn how and what to talk about regarding sexuality with their children exist. This article describes how the Home Based Adolescent Sexuality Education for Intellectual Disabilities (Home B.A.S.E.) curriculum was created to educate parents on their role as the primary sexuality educators for their adolescents with ID. The vision of the Home B.A.S.E. educational workshop is to increase parents’ comfort and confidence in discussing sexuality and healthy relationship topics with their adolescents with ID. This curriculum has unique features considered in its development including: (1) The belief that sexuality is a human right for individuals with ID; (2) The perspective of individuals with disabilities speaking about their sexual rights and relationships; (3) Activities based on adult, social, and transformational learning theories; and (4) A small interactive group format that meets over multiple sessions.

The Effect of Modified Cardiac Rehabilitation on Erectile Dysfunction and Coping with Stress in Men Undergoing Coronary Artery Bypass Graft (CABG): A Clinical Trial Abstract Erectile dysfunction and stress are among common post-CABG surgery complications. The present study was conducted to assess the effect of modified cardiac rehabilitation on “erectile dysfunction” and “coping with stress”. In the present clinical trial study, 126 male patients undergoing CABG surgery were randomly assigned to treatment (63 patients) and control (63 patients) groups. Control group received conventional cardiac rehabilitation program over 26 sessions. Treatment group received modified cardiac rehabilitation program, including Kegel exercise and training on stress coping strategies in the first four sessions of their rehabilitation program. Patients were assessed before and after cardiac rehabilitation program using the International Index of Erectile Dysfunction (IIEF-5) questionnaire and Endler and Parker Coping with Stress Scale. Data were analyzed in SPSS using ANOVA, T, and Chi square tests. Mean erectile function score significantly increased in both treatment and control groups, but the difference in mean scores for improvement in erectile function was greater in treatment group (P < 0.001). Analysis showed no significant difference in mean differences between two groups in all subscales of stress coping. Intragroup analysis showed significant differences in both groups between mean differences before and after intervention in task-oriented styles {treatment group (P < 0.002), control group (P < 0.001)}, and social diversion-oriented. The results showed that conventional and modified cardiac rehabilitation can be effective in improving erectile dysfunction and stress coping in task-oriented and social diversion-oriented styles in the men patients with left ventricular ejection fraction over 30% following CABG surgery. However, modified cardiac rehabilitation has greater benefits for improving erectile dysfunction.

Review of Curricular Features of Socio-sexuality Curricula for Individuals with Developmental Disabilities Abstract The need for socio-sexuality education for individuals with developmental disabilities (DD) is widely acknowledged. However, there are relatively few socio-sexuality education curricula developed for individuals with DD. Additionally, there are fewer still evaluations of these curriculum. While the content contained in the curriculum is critically important, other features add to the practicality and feasibility of curriculum use by educators, parents, and other service personnel. This review evaluated the quality of curricular features found in comprehensive, commercially available socio-sexuality curriculum for individuals with DD. Results indicated that most curricula were user-friendly, medically accurate, age-appropriate, included reference aids, and had representation of culturally diverse populations; however, features related to staff training, parent involvement, theoretical integration of methods, and assessment were less frequently present. The importance of considering aspects of curricular features when adopting a socio-sexuality curriculum and future directions are discussed.

Sexuality Among Adults with Congenital Deafblindness: A Cross-Sectional Survey Study Among Primary Carers Abstract Research investigating the sexuality of individuals with physical or intellectual disabilities is increasing. However, little is known about the sexuality of people with congenital deafblindness (CDB). The aim of the current study was to create a profile of the sexuality of adults with CDB in Denmark. Data was collected from the primary carers of 95 adults with CDB by use of a survey with questions about sexual behavior, the object of sexual behavior, level of sexual frustration, and pedagogical support for sexual satisfaction. The data were analyzed with regard to gender, age, severity of deafblindness, communication, activities of daily living (ADL), cognitive abilities, and carer characteristics. The results revealed that approximately half the number of participants showed sexual behavior while the other half did not. In the majority of cases, sexual behavior was self-stimulation, while, for the rest, sexual behavior was directed toward other people and/or objects. Around one out of ten participants was provided with pedagogical support to help satisfy their sexual needs. Sexual behavior was significantly associated with high scores for communication skills, ADL, and cognitive abilities. Further, high ADL and cognitive abilities were associated with the provision of pedagogical support for sexual satisfaction. Around one out of ten participants, all of whom were men, experienced sexual frustrations. The findings of the current study—the first quantitative study on sexuality among individuals with CDB—are comparable to the findings of studies among individuals with developmental disorders and underline the need for sexuality-related support for individuals with disabilities including those with CDB.

Talking About Sexuality in the Context of Rehabilitation Following Traumatic Brain Injury: An Integrative Review of Operational Aspects Abstract An integrative review of the literature reporting operational aspects (how, when, who, with what) of rehabilitation professionals’ discussion of sexuality with individuals with mild to severe traumatic brain injury (TBI) was conducted. Searches were carried out in seven databases. Records published from 2000 to 2017 were screened and selected (n = 504). The methodological quality of empirical studies was evaluated using the Mixed Methods Appraisal Tool. Seventeen full-text articles, book chapters, books, and essays were included and analysed in this integrative review. Prerequisites for discussing sexuality were identified. The PLISSIT model’s usefulness in getting professionals to talk about sexuality was highlighted by nine sources (52.9%). An interdisciplinary team approach, with different aspects of sexuality covered by specific professions, was principally endorsed. Five sources (29.4%) reported that the best timing to initiate a discussion about sexuality would be during early rehabilitation. Nine sources (52.9%) supported the provision of written materials or other supporting resources, such as websites and videos. To integrate sexuality as a component of TBI rehabilitation, professionals need to be aware of their role, the information and education that should be provided, the appropriate timing, the tools that might be helpful, and the support from their organizations. There is a need for more intervention studies to assess the efficacy, alternating or combining different operational aspects identified in this review.