title: Views and attitudes towards sexual functioning in men living with spinal cord injury in kerala, South India.
abstract: BACKGROUND
  Sexual dysfunction is a major concern for Indian men living with a spinal cord injury. Few first-hand reports exist about the experience of living with an altered sense of sexual identity and the inability to express sexual concerns.
  
  
  OBJECTIVE
  In this qualitative study, the authors explore views and attitudes towards sexual functioning in men living with a spinal cord injury in Kerala, India.
  
  
  METHODS
  Semi-structured and open-ended interviews were conducted with seven participants according to IE Seidman's phenomenological approach. Thematic analysis followed the analytic process outlined by Moustakas (1990).
  
  
  RESULTS
  Identification of seven interconnected themes included: Recalling an active sexual life, disconnection with sexual identity, incongruence between emotional and physical capability, spousal isolation, social readjustment of spouse, physical barriers to sexual functioning, coping, and reintegration.
  
  
  CONCLUSIONS
  Patient's descriptions of suffering demonstrate complexities of experience in sexual functioning. All patients were sexually active prior to the injury. This was now lost causing anxiety, distress, and sadness. A huge gap existed between sexual desire and physical capability. The patient and spouse were now isolated emotionally, socially, and physically. Physical barriers included urinary incontinence and indwelling catheters. While several self-evolved coping strategies were identified, support from palliative care services was not evident. Two important gaps exist in research and practice: (1) Attention to sexual issues and whole-person care. (2) Attention to quality of sexual life. Future qualitative studies on sexual dysfunction could provide a useful adjunct to current literature which is predominantly biomedical in its approach.
authors.affiliation: Department of Research and Training, Trivandrum Institute of Palliative Sciences, Trivandrum, Kerala, India.
authors.forename: Mm
authors.initials: M
authors.lastname: Sunilkumar
authors.affiliation: Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
authors.forename: Patricia
authors.initials: P
authors.lastname: Boston
authors.affiliation: Department of Research and Training, Trivandrum Institute of Palliative Sciences, Trivandrum, Kerala, India.
authors.forename: Mr
authors.initials: M
authors.lastname: Rajagopal
keywords: Indian men; Qualitative research; Sexuality; Spinal cord injury; Views and attitudes