“Not a whole woman”: an interpretative phenomenological analysis of the lived experience of women’s body image and sexuality following amputation

Background: Lower-limb amputations can lead to depression, performance anxiety, altered body image, relationships and sexual well-being. However, there is little published literature investigating how people experience changes to body image and their sexuality post-amputation and minimal literature exploring sexuality specifically from the female perspective post-amputation. Purpose: To gain an in-depth understanding of women’s experience of sexuality and body image following amputation of a lower limb to inform rehabilitation and clinical practice. Method: Semi-structured interviews with female amputees (n = 9) were conducted to collect rich contextual data. This qualitative data was analysed using Interpretative Phenomenological Analysis (IPA). Results: Three superordinate themes emerged from IPA data analysis: “I don’t like the way I am”, which illustrated participants’ changed relationship with their embodied selves, “Broken/not wanted” which reflected changes participants experienced in their romantic relationships, and “Same but different” which related to participants’ changed societal roles as women. Discussion: Participants’ accounts highlighted experiences of decreased sexual well-being, disrupted body image, stigmatisation and resilience. These accounts point to the potential utility of compassion focused approaches in therapeutic intervention, as well as the necessity for health professionals to involve spouses in sexual rehabilitation conversations and encourage patient-led peer support networks.Implications for rehabilitation Psychosexual assessment following limb loss involving open-ended questions will likely capture issues of sexual well-being as well as functioning, ensuring that interventions are comprehensive, targeted and relevant to the individual. Women struggle with reconciling their post-amputation kinetic representations of their selves to new ways of functioning, which may impact body image and prosthesis uptake. Compassion focused psychotherapeutic interventions could be effective in addressing problematic coping strategies post-amputation such as avoidance and disengagement while enhancing more self-compassionate coping styles. Couples distressed about their relationship may not engage in problem-solving discussions around sexuality, highlighting the necessity for health professionals to involve spouses in sexual rehabilitation conversations and interventions. Supporting the creation of gendered, peer-led groups to address issues related to sexual well-being is likely to improve overall quality of life for these individuals.