Men's Health: Sexual Rights, Psychological Adaptation and Rehabilitation Guidance for People with Disabilities and Chronic Diseases

Disabilities, Chronic Illnesses, and Sexual Life

Disability is not only a pathological physical phenomenon but also a matter of self-perception and social evaluation. The sexuality of people with disabilities is essentially a socio-cultural issue. Within a specific socio-cultural context, attitudes and perceptions towards disability and sex determine people's unique reactions to these issues. Traditional cultural attitudes of belittling and disregarding people with disabilities, along with misunderstandings and prejudices about sexuality, have led to the complete neglect of the sexuality of people with disabilities.

Sex is the foundation of reproduction and evolution in the entire biological world. Human sexuality is fundamentally different from animal sexuality. Animal sexual activity is merely a biological instinct, a reproductive function. Human sexual activity is not only a biological connection but also the most fully expressed interaction between the mind and body, exhibiting extremely rich and complex forms with strong socio-cultural characteristics. Sex is a basic human right and need. Sex is a highly complex system where biological, psychological, social, and cultural factors closely intertwine and interact, influenced by various aspects. If these factors themselves are unbalanced, causing disorder and imbalance, sexual problems and sexually transmitted diseases will occur.

People with disabilities face not only societal barriers to sexuality but also limitations imposed by objective realities. Firstly, they have far fewer opportunities to acquire basic sexual knowledge than the general population. Secondly, the consequences of their disabilities not only impair certain physiological functions but also restrict and alter their responses to others, damaging their self-confidence, causing body image issues, and leading to gradual withdrawal and a profound sense of isolation. Consequently, they rarely have the opportunity to establish romantic or partner relationships. Furthermore, they are unaware of the impact of a particular disability on sexual function, the specific sexual problems it may cause, or how to address these issues. Therefore, psychological, social, and cultural factors are prominent in the relationship between disability and sexuality. These factors, combined with physiological conditions, make the sexual problems of people with disabilities far more complex than those of the general population.

Where there is life, there is sexuality; where there is the right to life, there is the right to sexuality. Although people with disabilities have gained some basic rights in general areas such as education, healthcare, employment, recreation, and activities, and society and the public are slowly but surely recognizing these rights, for a person with sexual capacity, these rights are far from sufficient. Therefore, providing sex education to people with disabilities not only enables them to correctly understand and address their sexual issues, but also helps them better understand themselves, cope with life's challenges, and improve their social values ​​and quality of life. People with disabilities have the following rights:

① The right to access sex education.

② The right to receive sex education.

③ The right to sexual expression.

④ The right to marriage.

⑤ Parental rights.

⑥ The right to access social services.

Sexual dysfunction is the result of the combined effects of physiological, pathological, psychological, and social factors. Due to the physiological limitations caused by disability and the psychosocial reactions to disability, sexual dysfunction in people with disabilities is often much more severe than in able-bodied individuals. Among all human functions, sex most fully embodies the interaction between mind and body, and many psychosocial factors can directly or indirectly affect sexual function. Furthermore, sexual status has a significant impact on social adaptation; poor sexual adaptation often leads to changes in self-concept and social values. For example, patients with sexual dysfunction often suffer damage to their self-esteem. They are more anxious, irritable, and frequently feel incompetent, which negatively impacts all aspects of their lives and work. Because sex is an important part of life, sexual problems for people with disabilities are more sensitive than for others. Therefore, sexual readjustment plays an invaluable role in all aspects of rehabilitation for people with disabilities. Many studies have shown that if people with disabilities adapt well sexually, they perform better in all their daily activities, regain a sense of wholeness, and achieve sexual readjustment, which promotes the overall rehabilitation process. Sexual readjustment is the core of comprehensive rehabilitation for people with disabilities.

From the perspective of the cause of disability, disabilities can be divided into disabilities caused by congenital developmental defects and acquired disabilities. Examples include trauma, surgical removal of functional tissues from vital organs due to illness, etc. Regardless of the type of disability, as long as the penis is normal and can achieve an erection, the person should have the ability to engage in sexual activity. Some individuals with congenital genital disabilities, such as incomplete penile and testicular development, lack of erectile function, or acquired absence of the penis or erectile function due to trauma or surgical removal of the penis or testicles, are unable to engage in sexual activity.

The socio-psychological factors of disabled individuals significantly impact their sexual function. An individual's age, gender, education level, personality traits, interpersonal relationships, and occupational skills can all mitigate or exacerbate physical damage and physiological limitations, thus varying the impact of disability on sexuality. In a sense, individual-level socio-psychological factors have a greater influence on the development of sexual function than physical disability itself. Disabled individuals often experience personality and emotional problems, as well as unique psychological reactions. They frequently exhibit depression associated with their disability, display childish emotions characterized by impulsivity, irritability, and self-centered behavior, develop passive and dependent behaviors, and harbor unrealistic and isolated thoughts about life's challenges. These abnormal psychological states and emotions have a far greater impact on and damage to sexual function than the disability itself.

The influence of socio-psychological factors is also reflected in the marital and family lives of people with disabilities. Although the physiological functions of people with disabilities are limited to varying degrees, their libido remains normal. They continue to have sexual fantasies and engage in sexual activity. However, their anxieties about their sexual ability far outweigh their anxieties about the physical appearance caused by their disability and the limited physiological functions. Due to the limitations of physiological function, many people have to change their sexual activity patterns after becoming disabled. More severe disabilities can also reduce the frequency of sexual activity and decrease libido. However, it should be affirmed that, with appropriate medical and rehabilitation training guidance, most people with disabilities who have normal external genitalia can successfully participate in marital and family life.

(I) Sexual Life of Patients with Spinal Cord Injury

1. Sexual Rehabilitation for Spinal Cord Injury

Spinal cord injury is a relatively common disease. Many factors can cause spinal cord injury, including congenital malformation, inflammation, tumors, tuberculosis, and trauma. Different degrees of disability and different locations of spinal cord injury can result in different manifestations of disability.

The characteristic of cervical spinal cord injury is quadriplegia, with sensory disturbances affecting the upper limbs and below the neck. Because nerve impulses from the brain cannot pass through the damaged spinal cord segment, visual sexual arousal will not cause penile erection. However, appropriate local stimulation (such as penile friction, catheter movement, bladder filling, etc.) can reflexively induce penile erection through the thoracolumbar spinal cord. This penile erection is not determined by conscious will but is caused by stimulation below the level of the injury. This erection allows for sexual intercourse with the assistance of a woman, enabling her to reach orgasm. However, the patient himself will find it difficult to achieve the orgasm experienced by a normal person. This is because orgasm requires the participation of the central nervous system, i.e., the brain. In male patients with high-level paraplegia, the transmission of information for central nervous system arousal is interrupted; without the participation of the central nervous system, it is difficult to achieve orgasm. Some patients, with appropriate training, can visualize and amplify a sexual sensation, achieving a very intense experience and thus experiencing orgasm, purely as a central nervous system event.

The disability consequences of thoracic spinal cord injuries are similar to those of cervical injuries. The biggest difference is that thoracic injuries preserve more normal skin sensation than cervical injuries. Sacral spinal cord injuries can cause penile erectile dysfunction. Because the lower centers for erection are located in the 1st to 3rd sacral segments, damage to this segment prevents erection. It should be emphasized that although the physiological functions of spinal cord injuries are limited, libido still exists. Many spinal cord injury patients experience loss of libido due to abnormal psychological factors. However, some patients also experience simultaneous brain damage, affecting their libido. Spinal cord injury patients still have an interest in sexual activity and possess a certain level of sexual ability. Literature has recorded that approximately half of spinal cord injury patients regained their libido during hospitalization; after recovery, they not only continued sexual activity but also experienced sexual fantasies more frequently than healthy individuals. 2. Management of Sexual Dysfunction in Spinal Cord Injuries

Erectile dysfunction is the most common problem encountered by men with spinal cord injuries. It is crucial to avoid hastily diagnosing these patients with erectile dysfunction, as this can create a sense of hopelessness and despair. Even men with normal erectile function can experience erectile dysfunction under severe psychological stress. Therefore, a thorough clinical examination of the sexual function of spinal cord injury patients is essential, including nocturnal penile tumescence monitoring, papaverine tests, corpus cavernosum angiography, and pressure measurements. Treatment and rehabilitation training should be tailored to the specific findings. In cases of severe organic erectile dysfunction where erectile dysfunction is impossible, surgical penile prosthesis implantation may be considered. If no organic lesions are found, this type of sexual dysfunction is often caused by emotional, psychological, or cognitive issues related to the disease, such as depression, lack of self-confidence, guilt, or misconceptions that spinal cord injury inevitably causes sexual dysfunction. In such cases, efforts should be made to reduce the patient's depression and anxiety, encourage them to learn more about sexual physiology, and improve their self-confidence.