McGrath et al (In press) How is sexuality after stroke experienced by stroke survivors and partners of stroke survivors? A systematic review of qualitative studies. Clinical Rehabilitation, https://doi.org/10.1177/0269215518793483
I don’t suppose these findings will come as any surprise, but it’s always good to have evidence that supports what we think is, or is not happening. Here in Australia, the results of the national audits support the authors’ conclusion in the abstract, that, after stroke, “sexuality is rarely discussed openly”. In Journal Club 2016, you’ll find an explanation based on a review of the literature, about how stroke impacts sexual function. The page is titled: Altered Sexual Function. So, as a follow-up, this month’s JC directs you to McGrath et al’s (In press) systematic review which investigated and systematically reviewed the “real world” experiences of those who are directly affected.
Please find “Humble Opinion” as a comment to this post, and the Abstract under the Journal 218 page.
This is a systematic review (SR) of qualitative (not quantitative) studies and the authors increased the scientific integrity of their work, by adhering to the ENTREQ recommendations. Whether or not an SR of qualitative studies is as rigorous as an SR of quantitative studies is not up for debate, as the methods used here are directed by the investigators’ aims.
What can we learn from an analysis of the lived experiences of 649 adult, stroke survivors? The first thing is that, as so often occurs, those with aphasia are so often excluded from this type of research, although there were at least 10 captured studies that included this cohort. Also, perhaps not surprisingly, we learn that most studies have been undertaken in the USA, Canada and Norway. However, most importantly, what we also learn is that two themes were identified in this investigation: 1) Sexuality is silenced and 2) Sexuality although muted and sometimes changed, is not forgotten.
With the first theme, the silence does not only come from those directly affected, but is “echo-chambered” by our contribution, or lack of, as health professionals. The second theme, however, appears more specific to those directly affected by stroke; but that’s not to say that we don’t still have a professional role and responsibility in this. There were some differences between experiences associated with whether the partner was a man or woman, with the latter generally struggling with a potential mis-match between carer and intimate partner. As you can imagine I’m sure, in many, the impact caused deep frustration and sometimes despair and almost always resulted in changes in a couple’s relationship. Intimacy is so very precious and its hard to imagine a life where what is used to be has changed, in many cases, so extraordinarily.
As the authors discuss, “the silence is further compounded by strong social norms which limit the extent to which people with disabilities are expected to have, or are supported to express their sexuality(ies)”. As the authors also state: “Interventions to address post-stroke sexuality are underdeveloped and typically have focussed on sexual activity”.
Along with others of you, I suspect, I’ve been watching the great courage required to compete in the Invictus Games. I admire how competitors put themselves and their sometimes-broken body and/or mind “out there”. What a brave thing to do! Surely we can be just as brave? As health professionals, the authors remind us of “the need to raise awareness about this potential impact of stroke..and include questions about sexuality as a routine item in rehabilitation”. As we say here in Australia, “Come-on Aussies, come on.”! It’s time we were all more courageous in this area.
As I always say; this is just my humble opinion – I leave it up to you to read this article for yourself.
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