Do We Need Privacy? NO! We're Talking About Sex, Not Having Sex!

I often get asked by OTs how I create a private space to bring up the topic of sex. But, let’s be honest. It’s just not realistic. We’d be waiting for a long time before the opportunity of a private moment presented itself, especially in an acute care setting. Between the client's family and friends, nurses, doctors, and hospital staff you can almost guarantee there’s always someone in the room.  Or think about a busy pediatric outpatient clinic with all of the families and children in the gym.  Think there's always going to be privacy to ask about sexual development and concerns and questions parents may have?  

It’s just not realistic to think we have to first create a private space to ask about sex. 

But, how can you ensure privacy for the discussion if that's what the client wants? I like to first ask about sex and intimacy during the initial evaluation. Around whoever is in the room. Spouse. Kids. Grandma. Grandpa.  Other providers. I would say something like, “Oh, and some people with your, (insert diagnosis, surgery, condition, etc.), have questions about sex and intimacy. Do you have any questions? If you do, just let me know.”  

This opens the door.  Then if they say, "yes," I'll ask if they'd prefer some privacy to chat about the topic.  If they say "yes" than most people in the room naturally get the hint and will leave.  If a doctor knocks on the door during the discussion, I say, "we're in the middle of a private treatment session, please return in ___ minutes." 

Once the door is open and if a client says they do have questions, then it’s time to think about offering a more private space. Some people may be comfortable talking about it around others while some may not.  I have continually been surprised by how comfortable people are talking about sex with other people in the room.  

 Remember: There’s no wrong time to bring it up and ask.

 In an acute rehab setting, it could be appropriate to open the door during every re-evaluation.  For example, “Last time you said you didn’t have any concerns but I wanted to see if anything has changed?”

 Put it in perspective: 

Interestingly, a lot of research states that healthcare providers say they don’t think they have enough privacy to bring up the topic of sex and intimacy. Yet, we ask and talk about toileting, which is also considered a private topic, in public so why should sex be any different?

 Also, Think back to your first occupational therapy job. It may have taken you several weeks to find your groove with your interview style during the initial evaluation and feel confident managing room for your treatments.  You might have got caught up on all of the questions you wanted and needed to ask. It can take some time before you find your flow. But, with practice you found it. With that same type of practice, asking about sex and intimacy and managing the room will soon feel second nature.

Advocating for privacy for clients to have alone time.

Creating private time for clients in acute care or acute rehab for them to explore or connect with themselves or partners could mean talking and working with the multi-D team to create intentional “quite time."  This could be something informal like an hour off for a specific couple or client, or something more formal like every Wednesday evening for the whole floor between 8-9 pm. Creating privacy and private time is a great opportunity for you as the OT to advocate for clients sexual wellness and rehabilitation.

 Talking about sex and intimacy with your patients can seem like a daunting task so if you first just focus on opening the door the conversation likely flow and you'll be able to determine your next steps clinically.