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

Abstract

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.

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Fig. 1: The four identified categories and overarching theme.

Data availability

Data generated and analysed for this study is available from authors on request. However, some limitations may apply in order to protect the identity of participants in this small study.

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Acknowledgements

We would like to thank all participants who took part in this study, as well as research assistants (Tarryn Jeftha and Sherwin Gerwell) who assisted with logistical arrangements, translation and contextual understanding.

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Authors

Contributions

CT was responsible for the study design, conducting interviews, interpreting results and drafting the manuscript. LB was responsible for the study design, interpreting results, revising the manuscript and approved the final version. DMC conceived the work that led to submission, was responsible for revising the manuscript and approved the final version. CJ contributed to the study design, interpreting results, revised manuscript and approved the final version. All authors agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Charlotte Thurston.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethics

We certify that all applicable institutional and governmental regulations concerning the ethical use of patient identifiable data were followed during the course of this research. Ethical approval was granted by the Western Cape Senate Research Ethics Committee (BM19/1/16). Written (nine) or verbal (one, telephone interview) informed consent was obtained prior to each interview.

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Thurston, C., Blom, L., Conradsson, D.M. et al. Sex, support and society: a journey to reclaiming sexuality for individuals living with paraplegia in Cape Town, South Africa. Spinal Cord (2020). https://doi.org/10.1038/s41393-020-00558-5

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