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….

It is estimated that 6.3 million people are being commercially sexually exploited globally at any given time based on the most recent 2021 report by the International Labour Organization and the Walk Free Foundation. Over 25% of these people are under the age of 18 and nearly 80% are women or girls….

Never underestimate the power of an incredible and responsive AOTA President and a cold email! I emailed Alyson after AOTA's Post Dobbs Report came out with recommendations for how to execute the recommendations in the report. Alyson was immediately responsive and enthusiastic about learning more….

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.

Jess was such an exciting Teach Me Sex guest and we want to send a huge thank you to them for sharing about themselves so we can continue learn more about the various ways people have sex and express themselves sexually!

We’ve all been there. We’re in the shower with our client. It’s their first shower since their stroke causing hemiparesis of their left arm. They’re working hard in rehab to restore motor control, but for now it’s dead weight. You can tell they're upset, thinking, and about to say something. And before they list the full account of what they can’t do with their arm they say, “look at me.”

TL;DR: check out these very short videos on 6 different ways to don an adaptive bra

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!