Shifting the Focus: Centering Euphoria & Pleasure in Sexual Health

Written By Kathryn Ellis

A note from Kathryn: Collaborating with Professor Neu is like walking into the most sparkly celebration of occupational therapy every time we’re together. Lucky for me, we’ve been spending quite a bit of time together as we prepare and plan for the 2nd Annual Virtual OT Sex Summit on Nov 7 & 8th. Dev truly inspires me with their perspectives on inclusive practice and the joy that occupational therapy can be to practice when we feel both prepared and connected to our clients. If you’d like to experience more of Dev’s magic, please join us for the Summit where Dev will be our Emcee for the weekend!


Guest Writer: Devlynn “Dev” Neu, MS, OTR/L, CSOT (they/he)

Until 2018, narratives largely centered dysphoria in connection with transgender and gender diverse (TGD) experiences (Ashley & Ells, 2018). With that, a deficits-based narrative and pathology-focused lens dominated conversations around sexual health and TGD folks. Imagine if we led our discourse around intimacy while only ever spotlighting pain, lack of access, or the negative outcomes. What if we never got to pleasure? Well, this is an invitation for us to shift the focus - to putting euphoria at the forefront of discourse around TGD experiences. What if the goal is unmitigated and unwavering gender-based euphoria, and not just decreasing dysphoria.

Follow me on the journey below to explore that very possible reality - what does it look like when euphoria is at the center. 


What is Euphoria, who is it for?

Gender euphoria is a term that can be used to describe or understand the immense sense of comfort, pleasure, happiness, and alignment experienced during times of positive gender fulfillment and congruence (DeRolf et al., 2023; Reid & Way, 2025; van de Brink et al., 2019). It's the feeling or experience of having the opportunity to connect to our innermost self (gender identity) and freely explore and express that outwardly (gender expression). To me, gender euphoria is the pleasure we feel in the freedom of being and being seen. Euphoria is for everyone. Many people have unmitigated opportunities each day to decide how they dress, style their hair, apply their makeup, and express who they are and how they want to be perceived to others - yet some people do not have this reality. 


Not all of us have equitable opportunities to access and experience gender-based euphoria. As of now (early July, 2026), over 800 anti trans policies and/or legislation have been proposed (Trans Legislation Tracker, 2026). This volume of bills almost exceeds the year end total of 2025, which was already a record breaking year with a 500% increase in total bills compared to 2022. TGD people represent an estimated 1-3% of the US population, the amount of anti-TGD targeted legislation is not only disproportionate - it is dangerous (Kahn et al., 2024; Meerwijk & Sevelius, 2017; Zhang et al., 2020). These policies and legislation largely target 5 categories: education, healthcare, sports, bathroom, and performance. All essential areas of occupation that directly target a TGD person's ability to access and participate in occupations and environments that provide opportunities for experiencing euphoria and pleasure. 


What is sexual health?

Sexual health has a broad-spanning definition that encompasses a wide range of topics such as gender identity, sexual expression, relationships and pleasure. It’s a term we can use when discussing topics like sex education, gender affirming care, sexuality, and more to make sure we’re inclusive of all communities, especially those that are often left out of sexuality and intimacy discourse like the LGBTQIA+ and Disability communities. 


What does Euphoria look like?

For me, it can look like this - having the opportunity to be and belong in the clothes I want to wear, with fierce eye shadow, dazzling dangly earrings, stunning red heels, a pussy bow, and with a sassy strut down the street. Euphoria looks and feels different for everyone. 


How do we access euphoria?

  • Supporting and/or accessing daily occupations that align with how one wishes to express themself. This can look like providing options for donning everyday clothes for an acutely ill client in a hospital rather than offering an identity-depriving hospital gown; supporting and offering occupational exploration and choice for youth and adolescents rather than limiting care to binary gender expectations (boys wear blue, girls wear pink).

  • This can also look as simple as offering someone your chosen name and pronouns, asking theirs, and affirming the language they provide. Euphoria is an internal experience that can be influenced by external factors, like being affirmed through how we are perceived by others

  • It really comes back to the simple roots of OT - the person, their environments, and their occupations. 


What can I do to shift the focus?

  • Engage in critical self reflection and self assessment. Try out these prompts:

  • How does my gender identity show up in my daily occupations? 

    • What does it mean to me? 

    • How do I express my gender through occupations?

  • What does euphoria look like or feel like for me?

  • How does gender show up in my practice? 

    • In my clinical reasoning?

    • In my assessments? 

    • In the interventions I select?

  • Talk the talk - center euphoria in discussions, experiences, and care for TGD people. Be the example of setting euphoria as the goal, how can we create more opportunities for our clients to experience euphoria through occupations? How can I specifically advocate for more opportunities for those we know face inequities and disparities?

  • Be aware of and engage with policy and legislation, OT is political. Policy and legislation directly impacts the care we can provide, who can access the care, and how the care is reimbursed. 


What happens when we increase access to euphoria?

The outcomes are quite vibrant - the narrative points to joy & hope (Reid & Way, 2025). When one has the opportunity to experience sustained gender euphoria, they can experience trans joy. When we TGD people experiencing euphoria, joy, thriving, wellbeing, and aging, we experience hope. Hope for euphoria. Hope for pleasure. Hope for the equitable opportunity to experience life and occupation.


Resources for OT, Sexual Health, and Euphoria


References



Ashley, F., & Ells, C. (2018). In favor of covering ethically important cosmetic surgeries: Facial feminization surgery for transgender people. The American Journal of Bioethics,1812, 23–25. https://doi.org/10.1080/15265161.2018.1531162


DeRolf, A., Belkiewitz, J., & Wasmuth, S. (2023). Gender as Occupation: The" Doing" of Authentic Expression and Reciprocally Affirming Care for Transgender Individuals. The Open Journal of Occupational Therapy, 11(4), 1-6. https://doi.org/10.15453/2168-6408.2116


Kahn, F. K., Wiepjes, C. M., Colon-Cabrera, D., Tollit, M. A., Hoq, M., Feldman, D., ... & Pang, K. C. (2025). Effect of assigned sex on the age at which individuals seek specialist gender affirming care. International Journal of Transgender Health, 1-8.https://doi.org/10.1080/26895269.2025.2503221


Meerwijk, E. L., & Sevelius, J. M. (2017). Transgender population size in the United States: a meta-regression of population-based probability samples. American Journal of Public Health, 107(2), e1-e8.https://doi.org/10.2105/AJPH.2016.303578


Reid, H., & Way, K. (2025). Defying the deficit: Imagining intersections of occupation, gender euphoria, and trans joy. Journal of Occupational Science, 1–16. https://doi.org/10.1080/14427591.2024.2437773


Trans Legislation Tracker. (2026). United States bills: Anti-trans legislation. https://translegislation.com/bills/2026


van de Brink, F., Vollman, M., & van Weelie, S. (2019). Relationships between transgender congruence, gender identity rumination, and self-esteem in transgender and gender non-conforming individuals. Psychology of Sexual Orientation and Gender Diversity, 7(2), 230-235. https://doi.org/10.1037/sgd0000357


Zhang, Q., Goodman, M., Adams, N., Corneil, T., Hashemi, L., Kreukels, B., ... & Coleman, E. (2020). Epidemiological considerations in transgender health: A systematic review with focus on higher quality data. International Journal of Transgender Health, 21(2), 125-137.https://doi.org/10.1080/26895269.2020.1753136






Kathryn Ellis
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