‘We innovate now’: sexual lives following lower limb amputation

Post written for the BPS Research Digest by guest host Petra Boynton, Senior Lecturer in International Primary Care Research, University College London and the Telegraph's Agony Aunt.

If your partner's undergoing a lower limb amputation (LLA) it is likely sex would be the last thing on your mind. You would, however, be preoccupied with the recovery and wellbeing of your partner or spouse. These are amongst the findings of a recent qualitative study by Verschuren and colleagues of 16 partners of people undergoing LLA.

The study, carried out in the Netherlands, asked respondents to reflect on their intimate lives pre- and post-LLA. Respondents noted they still wanted sex, experienced orgasm and desired their partners post-LLA. This may be reassuring to those who've undergone or are considering LLA who might be anxious about body image and confidence, and how their partner will view them. They also felt some areas of their sexual lives had improved somewhat following LLA as the problems associated with the amputation (such as chemotherapy, pain or infection) had hampered intimacy previously.

The way in which they had sex did change. This was mostly in relation to what participants described as the 'technical' part of sex – things like positions and balance that they had to rethink.

The aspect of the paper I found most interesting was how qualitative discussions from the participants revealed a more varied, positive and practical reaction to the LLA than an additional activity required by the research, where they scored their sex lives from zero to ten.

Predictably participants rated post-LLA sex less positively than pre-LLA sex. Closer analysis indicated this was more to do with frequency of sex and sexual activity. In fact, when it came to aspects such as closeness, cuddles, kissing etc, they were engaging far more often and with pleasure after LLA. They felt emotionally connected even if they were not physically connecting in the same way.

This  reminded me how careful we need to be as researchers when asking people people to describe their sexual experiences for us, and reminds us that narrow measures of sexual behaviour can be misleading.

The authors acknowledge that given 3300 people have LLA in the Netherlands annually this small sample may well not be representative of all partners. Problems around coping as a carer, demands of ongoing physical ill health, aging, mental or physical health co-morbidities, or disability could well have a bigger part to play on both sexual satisfaction and the quality of relationships – as has been observed in wider work on sex, disability and pleasure.

Participants stated they would have appreciated more information about what to expect in terms of their intimate lives from other professionals (physiotherapists, nurses etc). This is unlikely to happen without making practitioners aware this might be something they should discuss and supporting them to talk confidently on topics they may find sensitive or awkward.

What isn't mentioned in this paper – but is equally important – is considering those who do not wish to resume sex after LLA or whose relationship did not include much or any intimacy before LLA. Also, there will be those whose relationships were in crisis (whether or not related to the LLA). More research on this topic with a more diverse group of partners (of different ages, relationships status and sexualities) could help here, as would advice for those who are not in relationships but who undergo LLA and may want to negotiate new relationships and pleasure in the future.

_________________________________

Verschuren JE, Zhdanova MA, Geertzen JH, Enzlin P, Dijkstra PU, & Dekker R (2013). Let's talk about sex: lower limb amputation, sexual functioning and sexual well-being: a qualitative study of the partner's perspective. Journal of clinical nursing, 22 (23-24), 3557-67 PMID: 24580794