As February comes to a close and Valentine’s Day decor begins to be replaced, it is important to continue the conversation of love and all of its forms. For some, the concept of intimacy is much more complex due to differing abilities. While OTs know sexual activity is an ADL, how often do practitioners actually address clients’ sexual health?

AOTA defines sexuality activity as “engaging in activities that result in sexual satisfaction and/or meet relational or reproductive needs”. WHO further defines sexual health as a “state of physical, emotional, mental, and social well-being in relation to sexuality”.

All practitioners have an obligation to address client’s sexual health. Given that sexual satisfaction is highly related to health status, failure to address sexuality can lead to poor rehabilitation outcomes as well as occupational imbalance, alienation, or deprivation. Clients often wait for healthcare professionals to approach sexual issues first. They report feeling embarrassed, overwhelmed, and so concerned with more critical problems that worries related to sexual health are held off. When we fail to initiate or provide a safe place that encourages these conversations, we are perpetuating the denial of our clients’ innate right to sexual citizenship. We must also be mindful of the spread phenomenon, which is when society tends to replace an individual’s identity with their identity as a ‘disabled’ person; essentially labeling them as a-sexual or a-occupational in regards to sexuality.

So… What do we do?

We start addressing sexual health! First, we identify and challenge our own barriers, such as lack of knowledge, embarrassment,  or personal beliefs. We then define our scope, roles, and responsibilities; develop professional competency; and create clinical culture that is encompassing and accepting. We work with each other and our governing bodies to develop ethical guidelines that protect both therapists and patients, realistic reimbursement systems, and continuing education programs to encourage consistent and evidence-based assessments and interventions related to sexual health. 

The occupational profile is where we start with clients. Develop a therapeutic relationship that supports honest discussions. Use that trust to guide the conversation to pinpoint difficulties/impairments/deficits. There are endless physical, cognitive, psychological, and social factors that influence both participation and performance in sexual activities; therefore, there are endless interventions opportunities. Some examples include: energy conservation and pacing instruction, facilitative cognitive reframing, collaborative behavioral analysis, self-regulation techniques, adaptive sexual health devices, safe positioning, strength and endurance training, etc.

Here are some resources to help start you addressing your clients' sexual health:

• Billing & documentation: CPT code 97535: interventions to improve performance of ADLs & IADLs under which sexual health can be categorized. CPT code 97537: community & work reintegration. CPT code 97127: cognitive-based interventions that aim to improve performance across activities, including areas such as executive functioning & reasoning

• PLISSIT Model

• Pavlovich Sexuality Questionnaire

• Safe Zone training

• Social Justice Model of Health

• Adaptive sexual health device: https://abilitymagazine.com/disability-sex-and-adult-toys-by-and-for-people-with-disabilities/

• Video: https://youtu.be/kqDD2GzdhAc?si=biIaPH3ZR-Kgs3uv

• Podcast: OT After Dark

• Blog: https://getbumpn.com/blogs/bumpn-blog

• Articles: https://www.occupationaltherapy.com/articles/occupational-therapy-solution-for-safe-4512 ; https://www.researchgate.net/publication/233652926_Sexuality_and_Disability_A_Case_of_Occupational_Injustice

• Website: https://www.myotspot.com/sexuality-the-most-overlooked-adl/

How do you address your clients' sexual health? If you have any resources, tips, advice, etc, please share! The more comfortable we get discussing sexual health amongst ourselves,  the more comfortable we'll be discussing with our clients. 

Brittin Thomas, MSOT