The collaboration with individuals regarding their sexual health is an important component of patient-centered health care. However, talking about sexual health in primary care settings is an area not fully addressed as a result of time limitations, medical task prioritization, awareness or knowledge deficit, and discomfort with the topic of sexuality. A critical shift in professional focus from disease and medical illness to the promotion of health and wellness is a prerequisite to address sexual health in the primary care setting. This article provides guidance for practitioners in primary care settings who are caring for persons with spinal cord injury. Clinicians should seize the opportunity during the encounter to reframe the experience of disability as a social construct status, moving away from the narrow view of medical condition and “find it, fix it” to a broader understanding that provides increased access to care for sexual health and sexual pleasure.

Short of the rich literature on sexuality in men following spinal cord injury, started largely by physicians and mental health professionals within the United States Department of Veterans Affairs (VA) system following earlier wars, little attention has been paid to the sexual healthcare of wounded warriors with other serious combat-related injuries. The recent wars in Iraq and Afghanistan-Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND)-resulted in physical injuries including traumatic brain injuries (TBIs), amputations, and serious burns. There are wounded warriors who are left blind or deaf, and a significant percent of OEF/OIF/OND warriors acquire other "invisible" injuries. While the signature injury of the war in Iraq is said to be TBI, there are a substantial number of service members surviving with posttraumatic stress disorder (PTSD). Many with serious injury are struggling with co-occurring depression. Furthermore, many of our wounded warriors are surviving with polytrauma (multiple traumatic injuries, i.e., amputation plus burns). One specific constellation of injuries seen too frequently among our service members in Afghanistan is referred to as a Dismounted Complex Blast Injury (DCBI) sometimes resulting in orchiectomy and/or penile injury. As with other blast injuries, burns, shrapnel injuries, vision loss, hearing loss, TBI, and PTSD often accompany DCBIs. All of the above injuries have significant sexual, endocrine, psychological, and relationship issues that need to be addressed.This article presents an overview of the effects of serious, combat-related injuries on sexual health and provides medical and other health professionals a framework within which to address comprehensive sexual healthcare using a medical rehabilitation model.Sexual healthcare for persons with combat-related disabilities presents a complex array of biopsychosocial and relational issues that call for a coordinated interdisciplinary approach that connects physical health, psychological health, and sexual health. Tepper MS. Sexual healthcare for wounded warriors with serious combat-related injuries and disabilities. Sex Med Rev 2014;2:64-74.

Wounded troops in the wars in Iraq and Afghanistan are surviving their injuries at greater rates now than in all previous major American wars, and our returning troops face physical, mental, and sexual health challenges when trying to build and re-establish intimate relationships. We are seeing relationship difficulties like intimate partner violence, child abuse, divorce, partners taking on care giving roles, higher incidence of risky sexual behaviors among single veterans, and special challenges faced by women and gay and lesbian soldiers. Healthy intimate relationships can contribute to a person's recovery from physical and mental trauma, while a lack of them can contribute to ongoing mental health problems and even suicide. Fortunately, we now see greater availability and acceptance of mental health services and resources for supporting intimate relationships in the military.

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.

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.

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.

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.

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.

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.