The Highs and Lows of Sensory Processing and Sexuality: What OTs need to consider

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.

A great research article discussing sensory features and sexuality was recently shared with me by one of the authors, Anne Kirby, so naturally I was excited about it and wanted to share it here with you!

 Autistic Narratives of Sensory Features, Sexuality, and Relationships (full article linked here)

Using a qualitative approach, Gray et al. (2021) sought out to explore how autistic sensory features (i.e. sensory sensitivities and sensory seeking behaviors) impact the experiences and relationships of autistic people. This includes the impact of low and high neurological threshold sensory patterns, sensory modalities and sexual identity.

By referencing several books and online forums, Gray et al. (2021) read the narratives of 78 participants to learn more about how touch, sight, sound, smell and sexual identity may is experienced by someone with autism. From the 78 narratives the researchers found that:

A low sensory threshold, specifically to touch/tactile input, was the most commonly reported.

AND

A high sensory threshold and desire for things like more friction, firm touch, rough stimulations like hitting biting, bondage, was less common but still prevalent. 

While one person may have a desire for firm and deep pressure someone else may struggle with low sensory threshold and subsequent sensory overload, which ultimately has a negative effect on arousal (think their enjoyment of the sensations) and their desire to engage in future sexual activity. 

 What I really appreciated the researchers pointing out is how the unique sensory features of autistic people influences their sexual experiences, but also the way they engage in social activities where they might meet a sexual partner. 

When it comes to addressing sex and intimacy, as OTs, we know it requires more than just looking at the occupation of sex. We need to have a good understanding of how that person functions across all areas of occupation...ADLs, IADLs, social participation.. the list goes on!

Even more... how does a sexual experience make that person feel? Participants referenced in this particular article (Gray et al., 2021) mention that sexual experiences also help them with self-regulation by providing a calming affect and better ability to manage throughout the day. While sex may sound like a great way to start the day for some, others reported feelings of frustration, distress and confusion. Some participants also shared that they're asexual and have no desire to participate in sexual or romantic activities.  This reminds me of how I've worked with probably just as many people on how to decline sex and normalize saying "no" to sex as I have worked with people who are wanting to say "yes" to sexy time.   

Here are some great quotes shared from the narratives that I enjoyed reading:

“I'm very sensitive to touch, which usually heightens my sexual experiences.”

“High-pitched electronic sounds (from anything like smoke detectors to adult toys) can be extremely painful.”

“I am not particularly sensitive so I need more friction to achieve orgasm.”

“Kissing and sex sometimes involves too much texture, bodily smells, tastes, heat and intimacy that I get overloaded and frightened” [emphasis added]

“I don't always like the odor of body fluids.”

“I prefer a firm touch. I like to be held tightly and sometimes bound.”

So how can we as OTs apply these findings to people with low or high sensory thresholds??? 

• First and foremost, acknowledge that all of your clients are sexual beings and engaging in conversation about sexual and reproductive health!!!!
• Be aware but don't make assumptions about sensory features (NEVER MAKE ASSUMPTIONS!).  Ask curious questions about sensory preferences or have the client take the Adult Sensory Profile
• Invite clients to talk about their likes and dislikes
• Do they feel like their personal sensory thresholds support or impede their ability to participate in sexual and intimate experiences? What about dating? Are they comfortable communicating this to their partner/s, new partners?  Addressing non-sexual occupations like leisure and social participation may help the client ease into talking about sex
• Address and educate on adaptations and functional coping strategies:
• Not interested in types of sex that is penetrative or involves body fluid and tastes (example: oral, anal, vaginal, fingering)? Some people prefer masturbation, virtual sex, reading erotica or kink which allow them to avoid any sexual contact  (Gray et al., 2021).  An example of this might be someone who does not like the sensation of genital hair rubbing together.  The OT might suggest both partners wax or shave their hair, or try positions that reduce anterior friction. 
• Substances (topical or ingested), such as lidocaine based numbing gels, may be used to help with tolerating sensations.
• Remind the client that being able to communicate their preferences and boundaries to their partner is an important part of having positive sexual experiences. (See my previous posts on Sexual Communication and Sexplay for addressing this!)
• It's helpful to have open communication after each sexual and intimate experience to talk about likes and dislikes (Gray et al., 2021). 
• If your client is working on finding sexual activities they enjoy, have clients get very clear and specific on what they think they are interested in exploring first (cue client-lead therapy).  Make sure to educate them on receiving sensations using mindfulness and consider placing sensations on a scale from intolerable to enjoyable.  Then the client can decide on when they're ready to move on to a new sensation or activity or stick with the current one with a curious attitude.  
• Clients who have a low threshold will likely benefit from scheduling sexual activities for a time they have the most amount of touch reserve - so for example in the morning, after some "me time" or sensory deprivation time.   

Reference

Gray, S., Kirby, A. V., & Graham Holmes, L. (2021). Autistic Narratives of Sensory Features, Sexuality, and Relationships. Autism in Adulthood. Published. https://doi.org/10.1089/aut.2020.0049