Sex, support and society: a journey to reclaiming sexuality for individuals living with paraplegia in Cape Town, South Africa

• Published in: Spinal cord 2021-02, Vol.59 (2), p.225-233
• Main Authors: Thurston, Charlotte, Blom, Lisa, Conradsson, David Moulaee, Joseph, Conran
• Format: Article
• Language: English
• Subjects: 692/700/228/491; 692/700/478/174; Anatomy; Biomedical and Life Sciences; Biomedicine; Content analysis; Gender; Health services; Human Physiology; Intimacy; Medicin och hälsovetenskap; Neurochemistry; Neuropsychology; Neurosciences; Norms; Paralysis; Paraplegia; Paraplegics; Psychological factors; Public health; Qualitative analysis; Sex; Sexuality; Spinal cord injuries
• ISSN: 1362-4393; 1476-5624; 1476-5624
• DOI: 10.1038/s41393-020-00558-5

Study design Qualitative descriptive study with inductive thematic content analysis. Objectives To explore how individuals living with paraplegia in South Africa experience sex and intimacy and how they perceive the related health services and support they received whilst adapting to life post injury. Setting Community based in Cape Town, South Africa. Methods Purposive and snowball sampling were combined to enrol ten individuals with paraplegia who were all users of the public health system and had been injured for more than 1 year. Semi-structured interviews were conducted, and data analysed using inductive thematic content analysis. Results Four categories were derived and captured by the overarching theme of ‘a journey to reclaiming sexuality’, as depicted by each participant. Psychological consequences of the injury led to challenges with sex and intimacy including a strong emphasis on partner satisfaction. A perceived lack of support mechanisms particularly in relation to poor timing of health services and insufficient peer support led to a lack of understanding and difficulties adjusting to changes in sexual function. Meaningful relationships including elements of sex and/or intimacy were rediscovered following a re-adjustment period although participants often felt disabled by society as socio-cultural norms, such as gender concepts, influenced each individual journey. Conclusions Complex interactions between intrinsic psychological factors, such as low sexual self-esteem and external factors such as socio-cultural norms, affect sex and intimacy in individuals with paraplegia in this novel context. South Africa’s health system should be strengthened to support optimal sexual outcomes of persons with a spinal cord injury.