title: Let's talk about sex: lower limb amputation, sexual functioning and sexual well-being: a qualitative study of the partner's perspective.
abstract: OBJECTIVE
  To describe the impact of patients' lower limb amputations on their partners' sexual functioning and well-being.
  
  
  BACKGROUND
  Annually, about 3300 major lower limb amputations are performed in the Netherlands. An amputation may induce limitations in performing marital activities, including expression of sexual feelings between partners. However, up until now, little attention has been paid towards this aspect in both research and clinical practice. The lack of studies on sexual activities and lower limb amputation is even more apparent with respect to partners of patients with such an amputation. Previous studies have shown, however, that the presence of a disease or disability may have a large impact not only on the patient's but also on the partner's sexual activities.
  
  
  METHODS
  Qualitative thematic analysis.
  
  
  METHODS
  Semi-structured interviews. The questions used in the interview were inspired by a generic framework about chronic disease and sexual functioning and well-being. In total, 16 partners of patients with a lower limb amputation who were at least 18 years old were recruited in different rehabilitation centres.
  
  
  RESULTS
  Seven major themes (i.e. importance of sexuality, thoughts about sexuality before the amputation, changes in sexual functioning and sexual well-being, amputation as the main cause of these changes, acceptance of the amputation, role confusion and communication about sexuality) were derived from the interviews. Minor changes in sexual functioning and sexual well-being were reported by the participants. Problems participants did encounter were solved by the couples themselves. For some participants, their sexual well-being improved after the amputation.
  
  
  CONCLUSIONS
  Participants in our study reported minor changes in their sexual well-being. Most of them indicated that communication about the changes expected and how to cope with these would have been helpful. It is therefore important that professionals address sexuality during the rehabilitation process with patients and partners.
authors.affiliation: Department of Rehabilitation Medicine, Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Jesse E A
authors.initials: JE
authors.lastname: Verschuren
authors.forename: Mariya A
authors.initials: MA
authors.lastname: Zhdanova
authors.forename: Jan H B
authors.initials: JH
authors.lastname: Geertzen
authors.forename: Paul
authors.initials: P
authors.lastname: Enzlin
authors.forename: Pieter U
authors.initials: PU
authors.lastname: Dijkstra
authors.forename: Rienk
authors.initials: R
authors.lastname: Dekker
mesh_terms: D000671:Amputation, Surgical; D005260:Female; D006801:Humans; D007866:Leg / Q000601:surgery*; D008297:Male; D012725:Sexual Behavior; D012747:Sexual Partners / Q000523:psychology*
keywords: lower limb amputation; partner; qualitative study; sexual functioning; sexual well-being