I got the idea for this handout when I was conducting a 10 hour training for an interdisciplinary Brain Injury Unit team. The training was focused on interventions and considerations for sex and relationships for people with brain injury. The team asked a LOT of questions about how to respond to sexually relevant comments and questions. There were a lot of “well what about this scenario…?” and “what if this happens…?”

60% of people with brain injury report difficulties with sexual health. 75% demonstrate hyposexual difficulties, while 25% demonstrate hypersexual behaviors. Since there is often no guidance on how to navigate these symptoms or address the sexual goals of patients, staff can often be at a loss for what to do….

Clinicians can, rightfully so, feel cautions to challenge what clients admit as cultural messages. For example, "I grew up in a Catholic home and still view sex as 'dirty' and 'sinful,' and I’m having a hard time enjoying it,” or “My culture values young women, and women over 40 aren’t considered attractive anymore…

After the June 2022 Supreme Court decision “Dobb’s v. Jackson Women’s Health Organization” Alyson Stover, AOTA President, and Micheal Urban, the RA Speaker, requested a Post-Dobbs Task Force to identify the impact of the ruling on OT clients and OT practitioners. The task force, chaired by Emily Rothman and Rakhi Srivastava, identified areas within OTs scope of practice that are directly impacted by the Dobbs decision and generated a plan to address these areas and maximize OTs impact on those affected by the decision.

The history of how society has molded perceptions of women is a multifaceted narrative that has endured for centuries, influenced by cultural, regional, and media representations. Women have often found themselves defined by preconceived notions imposed upon them by others, commonly men. Within this context, different groups of women have experienced a spectrum of stereotypes, ranging from asexualization to sexualization, hypersexualization, and fetishization.

The 3rd part of our Pelvic Floor Series is highlighting affirmative clinician strategies for working with transgender and gender non conforming (TGNC) folks. This newsletter doesn’t get into the potential pelvic floor goals or sexual goals of TGNC clients, but is a good prerequisite for any OT/OTA clinician - not just pelvic health OTs.

Generally, pelvic floor muscles (like any other muscle group in the body) can have hypotonic or hypertonic tendencies. Our nervous system plays a major role in managing muscle tone. If a client is living in a constant state of anxiety and stress or they find sex stressful, it’s likely their pelvic floor muscles will have a difficult time coordinating with the system. Regulating the pelvic floor will be especially difficult during sex.

Our pelvic floor muscles form the base of our spine and deep core. They wear many hats: bladder and bowel elimination, sexual activity, support and stability, pressure management, and shock absorption. I often refer to this group of muscles as Grand Central Station: there are a million convoluted routes to take! There is a TON going on down there. Not only are there about 16-20 muscles, but numerous ligaments, tendons, nerves, and fascial connections that help us complete ADLs/IADLs without the very embarrassing occurrence of urinary or bowel leakage and passing gas uncontrollably.

Let’s talk about what roles these pelvic floor muscles & organs play in our favorite occupation - sex!

When it comes to discussing sexuality with our clients, occupational therapy practitioners (OTPs) and other healthcare providers can come up with all sorts of justifications not to. But here's the thing: most of these justifications have more to do with our own biases than with the clients themselves. It's time to challenge those biases and ask ourselves, "Why am I avoiding this conversation?”

Welcome to the second part of our three-part series on addressing sexuality and intimacy after spinal cord injury (SCI). Today, we’ll delve deeper into the crucial role that Occupational Therapists (OTs) play in supporting individuals with SCI in this aspect of their lives. With their expertise and unique perspective, OTs can provide invaluable guidance and interventions to empower SCI patients and promote a positive and fulfilling sexual experience. The OT can be the shining light of comfort and advocacy! OTs are perfectly situated to lead these efforts in a clinical setting both for their patients and for the interdisciplinary team. Let's continue our exploration of the strategies and approaches that OTs employ in this domain.

As Sexuality and Intimacy Trailblazers, we know that sexuality and intimacy are important parts of our lives, bringing us joy and enhancing our overall well-being. However, when someone experiences a spinal cord injury (SCI), these aspects can be profoundly affected. Today, we'll discuss when to address these topics, the impacts of SCI on sexual health, specific complications that can arise, and the role of occupational therapy in supporting individuals on this journey.

"Sexuality and intimacy contain so much more than the act of sexual activity. Beyond the physical mechanics of “sexual activity,” sexual and intimate occupations encompass a broad range of personally meaningful activities for building intimate partnerships, developing a sense of self, actualizing desire, and experiencing pleasure.” - Ellis & Ungco, 2023.

TLDR: Love the quote, ready to order? Read More to order the textbook.

Occupational therapy professionals will work with clients who may hire sex workers or who would benefit from working with a sex worker.

Here are 5 things OTs need to know to be prepared to address sex work with clients and to advocate for destigmatizing sex work:

The topic of dating and romance can be quite difficult to initiate with parents of adolescent clients, especially those with autism. However, as an occupational therapist (OT), you can help parents create a safe, calm, and judgment-free space for their teens to freely express their desires.

Despite anecdotal evidence regarding the potential for pleasure from anal play, it remains a taboo subject in the context of female sexuality. This partly stems from the fact that we often associate anal pleasure specifically with anal sex, namely anal penetration of a penis, which can be a daunting proposition for a woman who has never experimented with any sort of anal stimulation.

Working with clients on their sexual routines is one of my top 5 ways I fall in love with OT again and again - every time. It reminds me how perfectly situated Occupational Therapy Professionals are to discuss sexuality in our clinical practice. We understand the impact of routines and specifically how occupations are sequenced together to facilitate participation, satisfaction, quality of life, and in some cases a great roll in the hay!

The Bump’n Joystick adapter is the first sex toy designed for and by people within the disabled community. Research shows that impaired hand function is the biggest barrier to using sex toys currently on the market – over 50% of physically disabled people surveyed said they struggle to achieve an orgasm solo. The Bump’n joystick removes this barrier and makes self-love possible regardless of hand function, by utilizing a person’s gross motor movements.

So what is it?

When I first started addressing sexuality with clients and making recommendations for sex toys I went through the steps of printing out a screen shot of a vibrator on a work computer, folding it in half, and slyly giving it to my client in front of their families.

But now, thanks to the folks at Direct-Rec App, OT clinicians can share sexual wellness products directly and privately with their clients. Dang… where was this 10 years ago!?

I recently attended a webinar by Dr. Farris on Sexuality and Intimacy After Brain Injury with the Brain Injury Association of America. It was a great presentation that shed light on some important points that we as OTs should be making sure to address and incorporate into our practice.

What’s an OT to do when Valentine’s Day is approaching, the clinic is covered in hearts and cupids, you're wearing red or pink on every portion of your body, yet your client shows up and says, “I’m dreading Valentine’s Day.”

You dig a little deeper.

They say, “I’m dreading Valentine’s Day, because I know my partner will want to have sex with me and I have no desire for it.”

Ok, ok, ok, before you freeze up eyes wide open, here’s what you talk about: