Mitchell S. Tepper

Sexuality and Disability: The Missing Discourse of Pleasure

In the realm of sexuality and disability there is public discourse on deviance and inappropriate behavior, abuse and victimization, asexuality, gender and orientation with regard to women, and reproductive issues in women and men. However, there seems to be a missing discourse of pleasure. The purpose of this talk is to shed some cultural and historical insight into why this may be so, to argue why sexual pleasure is important to quality of life, to point out a few of the consequences of not including a discourse of pleasure, to share some of my research on sexual pleasure in people with spinal cord injury (SCI), and to make a plea for inclusion of sexual pleasure in the disability studies agenda.

Letting Go of Restrictive Notions of Manhood: Male Sexuality, Disability and Chronic Illness

In this article I share my personal story and professional perspectives on the impact of disability on male sexuality. Because disability is experienced in the context of gender, I have integrated literature on concepts of male socialization and learning about sex. I explore how acquiring a disability may affect sexuality and create treatment concerns. Finally, I make treatment suggestions for working with men with disability or chronic illness.

Women with Complete Spinal Cord Injury: A Phenomenological Study of Sexuality and Relationship Experiences

The phenomenological study described in this paper examines the sexuality and relationship “lived experiences” of 15 adult women who sustained complete spinal cord injury between the levels of T6 and L2 verified by a physiatrist. Audiotaped, semi-structured interviews were conducted by an interdisciplinary team of investigators. A set of themes and sequentially consistent patterns emerged from post-injury data that were labelled: Cognitive-genital dissociation, sexual disenfranchisement, sexual exploration, and sexuality reintegration. Sexuality and relationship issues in women with complete SCI are discussed, and indications for future studies and educational implications are presented.

Sexual education in spinal cord injury rehabilitation: Current trends and recommendations

Persons with spinal cord injuries (SCI) (N=458) representing a national sample were surveyed by mail to determine trends in the provision of sexual education and sexual counseling services in rehabilitation programs. Of the competed responses (N=251), 45% remembered receiving such services. When sexual education/counseling services were provided, the components of the services varied considerably, and; for the most part, the subject of sexuality was superficially treated. Only 48% of those who received such services reported the services they received met their needs (N=53). The odds of not receiving sexual education or sexual counseling services for female respondents were about two times greater than for male respondents. The study also reveals a gap between services provided during rehabilitation and services desired by consumers. Recommendations are then offered for the development of sexual education and sexual counseling programs that may better meet the needs of persons with SCI.

Providing Comprehensive Sexual Health Care in Spinal Cord Injury Rehabilitation: Implementation and Evaluation of a New Curriculum for Health Care Professionals

A grant from the Paralyzed Veterans of America funded the development, implementation, and evaluation of a three-day interdisciplinary continuing education and training program in comprehensive sexual health care. The program was targeted toward health care professionals working in spinal cord injury (SCI) rehabilitation. The major goal of the program was to offer participants an opportunity to increase the knowledge, comfort, and skills necessary to understand and manage the sexual health care needs of people with SCI. The curriculum included clearly stated goals, behavioral objectives in operational terms, and multiple quantitative and qualitative program evaluations. In addition, the comprehensive curriculum incorporated extensive skills training including state-of-the-art standardized patient training techniques. Evaluation results indicated statistically significant and qualitatively important positive gains in knowledge, comfort, and skills. The five month follow-up study indicated that skills learned over the three-day workshop were successfully transferred to the work environment.

Sexual response in women with complete spinal cord injury

ConclusionsThere is still much we do not know about sexuality and women with SCI. Nevertheless, positive steps are being taken to learn more about the physiological and interpersonal aspects of sexuality. Ultimately, these efforts will enhance the quality of life for women with SCI.

Women with Complete Spinal Cord Injury: A Phenomenological Study of Sexual Experiences

This study examines psychosocial, emotional, and relationship aspects of sexuality in the lives of 15 women who sustained complete spinal cord injury (SCI) between the levels of T6 and L2. Phenomenological interviews were organized to chronologically sequence events with the intention of describing the trajectory of sexuality in women with complete SCI. A set of themes emerged from postinjury data that were labeled cognitive-genital dissociation, sexual disenfranchisement, and sexual rediscovery. Broadening the scope of the research beyond the physiological offers insight as to the interplay between the mind and sexual response and guidance for educational and therapeutic interventions.

Use of Sexually Explicit Films in Spinal Cord Injury Rehabilitation Programs

Sexual Attitude Reassessment (SAR) seminars, popular in the 1970s for use in progressive spinal cord injury (SCI) rehabilitation programs, have lost favor. The practice, however, of using only one sexually explicit film (SEF) as the primary method of providing sexuality education has taken its place. The use of SEFs is a sensitive teaching issue. Used “properly,” a SEF may facilitate a more receptive attitude toward sexuality and SCI. Used inappropriately, a SEF may result in adverse reactions. This paper reviews the theoretical rationale for using SEFs, the traditional use of SEFs in SARs that focus on attitudes and values, and empirical studies of the use of SEF. Recommendation is made for a paradigm shift from a general focus on changing attitudes and values to a more targeted focus on improving judgments of self-efficacy when using one SEF. Theoretical support is given based on observational learning and social cognitive theory.

Discussion Guide for the Sexually Explicit Educational Video Sexuality Reborn: Sexuality Following Spinal Cord Injury

The use of sexually explicit media in education is a sensitive teaching area because of the range of adverse reactions sexually graphic images may evoke. The person planning to use a sexually explicit video needs to create a safe environment with time for discussion and they must be prepared to facilitate discussion that will elicit reactions and help viewers deal with them. This paper provides clear goals, objectives, rationale, and guidelines for using Sexuality Reborn. It also provides recommended topics for discussion including references to the key scenes, discussion questions, and comments.