9.3 Sexuality and sexual health Sexuality refers to the way people experience and express themselves sexually. Sexual health (or sexual wellbeing) is the state of physical, emotional, mental and social wellbeing in relation to sexuality. Literature that reports on sexuality and the impacts of amputation on sexual health of adults is limited, and the majority of studies concern only males [144-146]. While sexual interest remains at normal levels after limb amputation, there is a connection between psychosocial functioning, body image and sexual functioning for a person of any gender experiencing limb amputation [144, 146-149]. There are reports that nearly 75% of adults with limb amputation experience some restriction in sexual activity following the amputation. In men with lower limb amputation, the factors contributing to sexual dysfunction are the person’s emotional state, pain, level of amputation and quality of life. The impacts are greater for males with transfemoral amputations than for males with transtibial amputations [144, 150]. For women with lower limb amputation, peer support was helpful in dealing with the challenges of dating and intimate relationships [151].
The PLISSIT approach uses the premise that most people experiencing sexual problems can resolve them if they are given permission to be sexual, to desire sexual activity and to discuss sexuality; if they receive limited information about sexual matters; and if they are given specific suggestions about ways to address sexual problems. Greater knowledge, training and skills are required of the practitioner as the level of intervention increases. So a ‘generalist’ health professional may consider they have the competency (knowledge and expertise) to support the person using the levels permission, limited information or specific suggestions (PLISS) levels, but not necessarily for the subsequent level(s) [153, 154]. The key factor is seeking the person’s permission (to be sexual and discuss sexuality), reflection and review at each step. Permission helps to normalise discussion of sexuality. Some people may seek to skip the first level (s) and wish to go straight to intensive therapy [155].
People with lived experience of limb amputation report that health and rehabilitation professionals infrequently discuss sexuality with the person with limb amputation [144, 145, 152]. Among people with limb amputation who report some restriction in sexual activity, fewer than 10% have received guidance or counselling from their health professionals on how to manage the issues [130]. Silence on sexuality from the person does not imply the person has no concerns. It is important that sexuality is considered in standard rehabilitation care [144].
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A gradual stepwise approach called Permission (P), Limited Information (LI), Specific Suggestions (SS), Intensive Therapy (IT) (commonly referred to as the PLISSIT approach) is used by health professionals for people with sexuality concerns [153]. The approach has been used with people who have acquired disability or chronic illness [154].
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icare Guidance for people with a limb amputation 2021
