Results

DEMOGRAPHIC DETAILS

Seventy people were interviewed (18% of the potential study population), 31 were men and 39 were women, with a mean age of 47 (SD 10) years. This was not significantly different from the age and sex distribution of the study population. The diagnoses included multiple sclerosis (33%), focal dystonia (33%), stroke (14%), head injury (6%), and various other conditions including generalised dystonia and spinal injury (14%). Most of the sample was mild to moderately disabled with a mean score of 3.5 on the OPCS scale. Twenty subjects scored zero (no disability) and three scored 10 (very severely disabled). Forty two people scored two or more on the GHQ, implying psychiatric morbidity.

RELATIONSHIPS

Sixty seven per cent (n=48) of the sample were married or cohabiting. Of those living alone 10% (n=7) had a stable relationship.

Of those in cohabiting relationships 30 subjects scored in the above average range of the GRIMS suggesting a high level of satisfaction with their relationship. Six had an average score. Seven scored in the range “poor” or “bad” and five had scores indicating severe relationship problems. In total 25% of those in a cohabiting relationship had problems of a sufficient magnitude to cause concern.

The influence of gender and diagnosis on relationship satisfaction was examined using a Mann-Whitney U test. There was no significant difference in relationship satisfaction between men and women (p=0.37). Examination of the two principal diagnostic groups showed that subjects with a diagnosis of multiple sclerosis or dystonia did not differ significantly in relationship satisfaction from other diagnostic groups (p=0.28 and 0.52 respectively).

A significant correlation between higher GRIMS scores (indicating poor relationship satisfaction) and increasing severity of disability was found (Spearman’s r=0.29, p<0.05). Duration of illness did not significantly influence relationship satisfaction (Spearman’sr test, p=0.29).

There was no significant difference in relationship satisfaction between those who were and were not psychologically distressed as measured by the GHQ (χ² squared p=0.48).

SEXUAL FUNCTIONING

Fifty one per cent (n=36) of the sample had experienced a change in sexual function, sexual activity, or had become abstemious. Of these people, over half (n=19) expressed concern about this change (table 1). Those who were concerned showed significantly less psychological distress (assessed by the GHQ) than those not concerned (Fisher’s exact test p=0.04). Change in sexual function alone did not correlate with psychological distress.

Gender was not significantly associated with change in sexual functioning but was associated with concern about sexual function (contingency coefficient=0.28, p<0.01), with men being more concerned than women.

The overall disability score was not significantly associated with either change in sexual activity or concern about that change, but there were associations between particular subgroups on the scale assessed by the Mann-Whitney U test.

Change in sexual functioning was significantly associated with difficulties in the areas of personal care (p<0.02), locomotion (p<0.02), and continence (p<0.01).

Concern about sexual function was associated with continence (p<0.01).

Abstinence from sexual activity was significantly associated with the overall severity of disability (p<0.01), and in particular with the subscale scores for personal care (p<0.02), locomotion (p<0.01), and intellectual function (p<0.01). Those with greater difficulties in these three areas were more likely to have become abstinent.

The influence of diagnosis on change in sexual function, concern, and abstinence was explored. A significant association between a diagnosis of multiple sclerosis, change in sexual function (contingency coefficient=0.30, p<0.01), and abstinence (contingency coefficient=0.36, p<0.01) was found but not between this diagnosis and concern.

SEXUAL AND RELATIONSHIP FUNCTION

Of the 48 people in cohabiting relationships 21 had not experienced a change in sexual function or activity and did not have any major relationship problems. Only one person experienced relationship difficulties in the absence of any sexual disturbance. The distribution of results for relationship and sexual functioning is shown in table 2.

Sexual function and relationship satisfaction were explored for association using a Mann-Whitney U test. Scores on the GRIMS scale of marital satisfaction were significantly associated with change in sexual function (p<0.01), concern about the change (p<0.01), and abstinence (p<0.01). People who were less satisfied with their relationship were more likely to have experienced altered sexual functioning and concern about this.

PREDICTING CHANGE IN AND CONCERN ABOUT SEXUAL FUNCTION

To assess which subjects were likely to experience change in and concern about sexual function, a series of logistic regression analyses were conducted.

The level of relationship satisfaction as measured by the GRIMS score was the greatest predictor of a change in and concern about sexual function and this accounted for 10% and 9% of the variance respectively. The greater the degree of distress between the partners, the greater the likelihood of a change in sexual function and concern about that change. Gender accounted for 6% of the variance in predicting concern about sexual function with men being more concerned than women. Relationship dysfunction was also the greatest predictor of sexual abstinence, accounting for 6% of the variance. The severity of disability accounted for 5% of the variance.

Overall a high GRIMS score (⩾34, indicating relationship problems) was the best predictor of sexual change, concern about that change, and abstinence.

PREDICTING RELATIONSHIP DISSATISFACTION

The predictors of relationship satisfaction were examined using a linear regression analysis. Change in sexual function and duration of illness were the most powerful predictors of relationship dissatisfaction, accounting for 21% and 7% of the variance respectively.

Discussion

This study provides descriptive data about sexual and relationship functioning among a self selected sample with neurological disability. Due to the low response rate reliable prevalence data cannot be derived.

Sexual and relationship dysfunction are not life threatening consequences of neurological disease, but their occurrence may be associated with a considerable amount of unhappiness and poor quality of life.32-35 Of those subjects who were aware of a change in sexual functioning over half were concerned about the change. This represented 27% of the study sample and supports the results of Szasz et al.16 In addition, 25% of couples were experiencing relationship problems sufficient to warrant intervention. This offers an indication of the proportion of people who might wish to access services dealing with sexual and relationship issues in the context disability.

For relationship satisfaction the greatest predictive factor of dysfunction was change in sexual functioning with duration of illness also contributing. The cause of sexual dysfunction is often multifactorial in origin incorporating an interplay of psychosocial and physical factors.36 Assessment and treatment of those factors, which are accessible, should provide a better therapeutic outcome and this is certainly an area to be further researched. Offering an assessment by a couple’s therapist to those seeking help with sexual problems is a possible model and this has been successfully applied in a multidisciplinary diabetic clinic.37 There is evidence that combining marital therapy with psychosexual therapy results in a better outcome than either therapy alone.38

This study has demonstrated the close association between sexual and relationship dysfunction among people with neurological disability. Further research is needed to explore the most effective means of treating these common problems.