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?”

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.

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:

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?

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:

I had the pleasure of speaking with Dr. Sam for my latest Teach Me Sex episode and it was a great one! Dr. Sam DuFlo PT, DPT, PRPC is a physical therapist as well as the owner and founder of Indigo Physiotherapy, based in Maryland. She and her team of fellow healthcare workers including PTs, lactation consultants, Craniosacral therapists and bodywork therapists focus on pelvic health, pelvic physical therapy, prenatal and postpartum training, oncology and women’s/men’s/pediatric/transgender health concerns. You can learn more about Dr. Sam and Indigo Physiotherapy here!

Something OT practitioners need to keep in mind as we (humbly) approach the topic of sex with clients is how people can have sex in countlessly different ways –many that may be unfamiliar to us, and some of ways that may even be considered…

It's no surprise that as sexual beings we all have our own sexual preferences. Our likes, wants, and needs are unique to each of us and shape our sexual and intimate experiences. But what about our dislikes? Or aversions to certain stimuli? What if the enjoyment and pleasure of sex can quickly turn to pain and kill the mood. For some of us, this might be when our partner lightly touches our skin or grasps too firmly. What is this experience like and how can OT play a role in this??? Many of the clients I have work have sensory preferences and high/low thresholds, and this can be even more so for people with autism or sensory regulation difficulties.

I am thrilled to share my latest "Teach Me Sex" interview with Anita Martin, an experienced COTA, Certified Clinical Sexologist, and founder of Sex Assist. Goodness was it educational!... and steamy! With 15 years of experience as a COTA, Anita has found her passion and niche in the occupation of sex and intimacy. She now owns and operates her business, Sex Assist, through which she helps both individuals and couples find a better outlook through sex and improve their communication. How amazing is that!? She is also a bartender and foodie at heart, which I think makes her even more relatable!

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?