Kristine L. Engel, RN, MSN, CRRN - Paralyzed Veterans of America

A Transdisciplinary Education Model 

for Advancing Sexual Health in 

Adults with Spinal Cord Injury 

Presented by 

Michelle Wesline, RN 

Kim Burie, MSW, APSW

Disclosures 

This continuing education activity is managed and accredited 

by Professional Education Service Group. The material 

presented in this activity represents the opinion of the 

faculty. Neither PESG, nor any accrediting organization 

endorses any commercial products displayed in 

conjunction with this activity. 

Commercial Support was not received for this activity. 

Kim Burie, MSW, APSW and Michelle Wesline, RN have no 

financial interest or relationships to disclose.

Obtaining CME/CE Credit 

If you would like to receive continuing education 

credit for this activity, please visit: 

http://pva.cds.pesgce.com/

Froedtert Hospital: 

Spinal Cord Injury Center

Learning Objectives 

• Review the significance of sexuality and 

reproductive health as a concerning and under 

addressed topic for individuals with Spinal Cord 

Injury (SCI) 

• Discuss the healthcare providers’ role in providing 

sexual health education to individuals with SCI 

and their partners 

• Describe the journey one organization took to 

implement best practice guidelines regarding 

sexual health education for staff caring for 

individuals with SCI

Sexuality 

• Complex 

• Unique 

• Evolves over a lifetime

Best Practice Guidelines 

The Consortium of Spinal 

Cord Medicine 

published “Sexuality 

and Reproductive 

Health in Adults with 

Spinal Cord Injury”, an 

evidence-based clinical 

practice guideline, in 

January 2010

“…many professionals are 

uncomfortable providing information 

about sexuality within the context of 

rehabilitation after spinal cord 

injury.” 

Consortium for Spinal Cord Medicine. Sexuality and Reproductive 

Health in Adults with Spinal Cord Injury: A Clinical Practice 

Guideline for Health-Care Professionals. Paralyzed Veterans of 

America (PVA); 2010.

What We Know 

• Addressing sexuality & fertility issues 

during hospitalization was controversial & 

seldom done 

• Myths & misconceptions existed 

• People with SCI & their families were 

poorly informed of resources surrounding 

sexuality & reproductive health

What We Know 

• Sexuality & fertility are consistently identified 

as priority topics for people with SCI 

• Education surrounding sexuality & reproductive 

health becomes increasingly more important 

the months & years following injury 

• Although providing education is a key role, 

many clinicians are uncomfortable discussing 

this topic with patients & families

“…it is our role to ensure that they 

[patients] have accurate information 

about sexuality and the emotional 

support to make that decision.” 





SCI Education Team for Sexuality 

& Reproductive Health 

• A interdisciplinary team convened to 

implement sexuality & fertility education 

based on best practice guidelines 

• Team members were selected to include 

representatives from the entire continuum 

of care program

Project Goals 

• Increase awareness that providing 

comprehensive education is a key role & 

responsibility for clinicians 

• Improve quality of care through education based 

on best practice evidence 

• Improve documentation surrounding education 

provided to patients and their partners 

• Establish a method for providing continuing 

education for existing staff & new hires to the 

department

“…we realize that life does not end 

after a spinal cord injury nor does 

the ability to have fulfilling intimate 

relationships and a satisfying 

sexual life.” 





Project Development: Method 

The PLISSIT Model for sexual health 

education & counseling served as the 

framework to guide the project 

Permission 

Limited Information 

Specific Suggestion 

Intensive Therapy

Permission 

• Create an open atmosphere to discuss 

sexuality and sexual functioning 

• Discuss the fact that many people have 

questions/concerns about sexuality 

• Provide private time for the patient and 

their partner

Limited Information 

• Relates to an individual's readiness to receive 

information/education 

• Varies from one individual to another and 

may change over time 

• General and basic education 

• Know your own limitations in knowledge and 

comfort 

• Collaborate with team members and use 

resources as necessary

Specific Suggestions 

• Requires advanced knowledge and clinical 

skill 

• Involves obtaining a sexual history, 

identifying specific problems and setting 

goals 

• Addresses an individual’s specific issues

Intensive Therapy 

Requires formal training and documented 

competence in sex therapy, sexuality 

counseling, or psychotherapy.

Our Journey

Local Sexual Health Center 

• Education for the implementation 

committee: Sexuality and Disability 

• We explored and learned

“… we realized that sexuality is a 

complex integration of biological, 

cultural, spiritual, social, relational, 

and psychological factors. Sexual 

expression is not only what occurs 

in the privacy of one’s own home, 

but goes to the core of how we 

relate to other people and how we 

feel about ourselves.” 





Circles of Sexuality 

Sensuality 

Sexualization 

Intimacy 

Sexual Health 

and 

Reproduction 

Sexual 

Identity

“In this culture, people with 

disabilities are expected to be 

perpetual children, which means 

that sexual expression would not be 

appropriate and may be considered 

perverted.” 

Doress-Worters PB, King L, Lennett J, Norsignian J, Sanford WC (ed), 

Yanco J. Our Bodies, Ourselves: For the New Century. New York, 

NY: Boston Women’s Health Book Collective; 1998:248.

Sexuality & Disability 

Sensuality 

Sexualization 

Intimacy 

Sexual Health 

and 

Reproduction 

Sexual 

Identity

Values and Beliefs 

Formed by personal 

histories and 

experiences, society, 

culture, religion, 

professional 

knowledge and 

experiences 

Values and beliefs often lead to biases, both 

positive and negative

Biases 

• Information should be medically accurate 

and factual 

• Professionals should address sexuality in 

a nonjudgmental manner 

• Follow standardized guidelines 

• Acknowledge your own biases, especially 

if they lead to discomfort

Implementation: 3 Phases 

1 

2 

3 

Phase 

Phase 

Phase 

Survey to measure knowledge & comfort 

to providing sexual health education 

& gain staff “buy-in” 

Program Meeting (1 st of 2) 

Development of 3 unique education 

requirements 

2 online modules 

Program Meeting (2 nd of 2) 

Implementation of the education 

Program Evaluation

Phase 1

Staff Assessment 

Knowledge, Comfort, Approach and 

Attitude towards Sexuality Scale 

(KCAASS)

Section 1: Knowledge 

On a scale of 1-4, please indicate your current level of knowledge in dealing with the following topics as 

they relate to people with spinal cord injury.

Section 2: Comfort 

Please rate the following items on a scale from 1 (nil discomfort), to 4 (high discomfort) on the amount of 

discomfort you would feel in these situations.

Section 3: Approach 

Please rate the following items on a scale from 1 (nil discomfort), to 4 (high discomfort) on the amount of 

discomfort you would feel in these situations.

Section 4: Attitude 

Read the following statements and indicate by circling the appropriate number whether you disagree or 

agree from 1 (disagree strongly) to 4 (agree strongly).

Additional Questions 

Please answer the following questions.

Pre-Education Results

Requested Education Topics 

• Sexual function in SCI: sensation of orgasms/erections in 

men & women with SCI 

• Care of bowel & bladder during sex 

• Fertility options/methods/costs & childbearing 

information 

• Sex positions & assistive devices, including medications 

• Scripting: how to handle difficulties in approach of 

sexuality topic 

• LGBT information

Gaining Staff “Buy-In” 

• Promotional Flyers “Bringin’ Sexy Back” 

• 2011 Spring Program Meeting “Kick-off” 

We’re Bringin’ Sexy Back……….. 

You Ready?

SCIC Program Meeting 2011 

• Program goals for sexuality & 

reproductive health education shared 

• Pre-education data examined – 

KCAASS results 

• Guest speaker facilitated discussions 

& activities


• Active discussion defining sexuality 

• Examined personal biases 

regarding sexuality & disabilities 

• Activities to increase comfort level 

around sexuality concerns

Feedback 

Very mixed responses 

• Some enjoyed the work out sessions 

• Some did not see the relevance 

• Some did not think it was “appropriate” material

Phase 2

Online Educational Module 1 

Content 

• Sexuality following 

spinal cord injury 

• PLISSIT Model 

• Staff’s role in 

education 

• Sexual function post 

SCI 

Method 

• Interactive online 

module 

• Interactive with built 

in activities & quiz

Module 1 Demonstration 

https://ecs.fmlh.edu/courseware/Dept/5SE/5SE000037/player.html



























Online Educational Module 2 

Content 

• Components of a 

sexual H&P 

• Practical, physical & 

emotional 

considerations 

• Intensive treatment 

for sexual dysfunction 

& infertility 

Method 

• Interactive style 

maintained & content 

built upon the first 

module



















Happy 25 th Anniversary, SCIC!! 

Gary Karp 

• Author 

• Motivational speaker

Implementation of Education 

• Allow staff completion of both modules 

• Devise learning plan for new hires 

• Team developed agenda for Spring SCIC 

Program Meeting 2012 final piece of 

education series

Trip to The Tool Shed 

• Visited and toured the erotic 

boutique, The Tool Shed 

(www.toolshedtoys.com) 

• Staff provided education 

• Staff open to learning about disability, 

specifically the needs of the SCI population 

• “Hands on” experience 

• Purchased devices for education 

• Guest speaker at SCIC Program Meeting


Team developed an agenda for the 

meeting 

• Guest speaker from The Tool Shed 

• Interactive booth displays 

– Medical management 

– Assistive devices 

– Role play 

– Resources


Guest Speaker 

Laura Stewart 

Educator and Erotic Boutique Owner


Medical Management 

Farhad Sepahpanah, MD 

Physical Medicine and Rehabilitation 

Spinal Cord Injury Medicine 

Clement J. Zablocki VA Medical Center in Milwaukee, WI


Assistive Devices 

Laura Stewart and her partner, Hudson 

The Tool Shed in Milwaukee, WI 

Sandi Kaszkowski, COTA 

Spinal Cord Injury Center 

Froedtert Hospital in Milwaukee, WI


Role Play 

Kathryn Zao, PhD 

Psychologist, Spinal Cord Injury Center 



Resources 

Donna Johnson, RN, BSN 

Coordinator of the Spinal Cord Injury Program 

Froedtert Hospital in Milwaukee, WI 

Danielle Siclovan, RN*** 

Neurosciences Director of Nursing 


3 

Phase

Sexuality Program Evaluation 

Administer the KCAASS to staff 

• Post education 

• Evaluate the results of the 3 phase 

education program

Pre & Post Education: Knowledge 

• 47% improvement: sexual positioning 

• 35% improvement: 

– Professional issues in dealing with sexuality 

rehabilitation 

– Changes in people’s perception of their sexual 

identity following SCI 

– Care of bladder and bowel during sexual activity 

– Assistive devices and medications for achieving 

erections 

– Communication in relationships 

– Courtship and dating

Pre & Post Education: Comfort 


– Patient says, “I can’t feel anything 

anymore, so what’s the point?” 

– Male patient asks, “Will I ever be able to 

have children?” 


– Female patient asks, “I like to be on top but 

my legs don’t hold me” 

– Female patient asks, “Why am I so dry 

during sex?”

Pre & Post Education: Approach 

• 26% improvement: You walk into a room and 

find a patient masturbating 

• 15% improvement: You walk into a room and 

find a patient and his/her partner engaged in 

sexual foreplay 

• 11% improvement: Patients asks you for a 

date

Pre & Post Education: Attitude 

• 19% improvement: People with a spinal cord 

injury would find it hard to get a partner

Pre & Post Education: 

Additional Questions 

• 43% improvement: In the last month, how 

many times have you responded to a 

patient’s questions about sex? 


many times has a patient brought up the topic 

of sexuality? 


many times have you initiated conversation 

about sexuality with a patient?

Pre & Post Education: Barriers 

• 49% improvement: I don’t know enough 

about it 


– I’m not comfortable 

– It’s not my role 

• 10% regression: 

– There was no appropriate time 

– The patient is inappropriate regarding this 

topic

Program Evaluation: Strengths 

“It definitely made people aware of how awkward 

a sexual conversation can be for some people” 

“Stations were good” 

“Knowledge base was very good” 

“Ease at which a sensitive subject was 

presented” 

“Very informative – hands on booths very good 

“Presenters not embarrassed or uncomfortable”

Program Evaluation: 

Recommended Improvements 

“Reflection was uncomfortable” 

“It wasn’t really about spinal cord patients” 

“More tips on what we could actually talk to our 

patients about” 

“Anyone can look at a sex toy magazine and find 

ideas, but I wish we could have had ideas for 

addressing the issues our patients may bring up” 

“I was very uncomfortable throughout the entire 

session”

Bottom Line 

• Seems like more people are talking 

about it 

• Patients are inquiring 

• Currently discussing if need to 

teach more of A&P, due to 

feedback

Implementation Committee Members 

• Kristine L. Engel RN, 

MSN, CRRN 

• Sharon Feldmann PT, 

MS, OCS 

• Donna Johnson RN, BSN 

• Patricia Meurer RN, BSN 

• Nicole Rosin, RN, APNP 

• Cathy Sandmayr RN, 

MSN 

• Mary Voegeli RN, 

MSN, CRRN, APNP 

• William Waring MD 

• Michelle Wesline RN 

• Kathryn Zao PhD

Special Acknowledgment 

Special thanks to the Froedtert Hospital 

Foundation. Their generous support funded 

the purchase of adaptive equipment and 

educational materials as well as payment for 

guest speakers and off-site education.

What questions 

do you have? 

? 

Michelle Wesline, RN mwesline@froedterthealth.org 

Kim Burie, MSW, APSW kburie@froedterthealth.org

References 

1. Burns SP, Hammond MC, eds. Yes, You Can! A Guide to Self-Care for Persons with Spinal Cord 

Injury. Washington DC: Paralyzed Veterans of America (PVA); 2009. 

2. Consortium for Spinal Cord Medicine. Sexuality and Reproductive Health in Adults with Spinal Cord 

Injury: A Clinical Practice Guideline for Health-Care Professionals. Paralyzed Veterans of America 

(PVA); 2010. 

3. Doress-Worters PB, King L, Lennett J, Norsignian J, Sanford WC (ed), Yanco J. Our Bodies, 

Ourselves: For the New Century. New York, NY: Boston Women’s Health Book Collective; 1998:248. 

4. Everaert K, deWaard WIQ, Van Hoof T, Kiekens C, Mulliez T, D’herde C. Neuroanatomy and 

neurophysiology related to sexual dysfunction in male neurogenic patients with lesions to the spinal 

cord or peripheral nerves. Spinal Cord. 2010;48:182-191. 

5. Fronek P, Booth S, Kendall M, Miller D, Geraght T. The effectiveness of a sexuality training program 

for the interdisciplinary spinal cord injury rehabilitation team. Sex Disabil. 2005;23:51-63. 

6. Health Info & Services page. Planned Parenthood. http://www.plannedparenthood.org/. 2012. 

Accessed August 14, 2012. 

7. Kendall M, Booth S, Fronek P, Miller D, Geraghty T. The development of a scale to assess the 

training needs of professionals in providing sexuality rehabilitation following spinal cord injury. Sex 

Disabil. 2003;21:49-64. 

8. Preventing pain during sex page. American Cancer Society. 

http://www.cancer.org/Treatment/TreatmentandSideEffects/PhysicalSideEffects.htm. April 25, 2011. 

Accessed August 14, 2012.

Kristine L. Engel, RN, MSN, CRRN - Paralyzed Veterans of America

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?