The Value of An Occupational Therapy Sexuality and Intimacy (OTSI) Program

It's been several years in the making so I'm so excited to share my very first peer-reviewed publication and the things I've learned! 

(You can check out the full article here) Sexuality and Intimacy Rehabilitation for the Military Population: Case Series

With help from my colleagues, I sought out to find the effect of sexuality and intimacy interventions on injured service members.

Like many client populations, service members can struggle with sexuality and intimacy secondary to physical, emotional, and/or mental injury/illness. Trauma such as amputation, spinal cord injury, and PTSD (to name a few) can lead to trouble with self-esteem, genitourinary dysfunction, pain, loss of desire, testosterone deficiency, body image challenges, and more.

During the time that I completed this case series I was working at a Military Treatment Facility (MTF). This particular facility has an Occupational Therapy Sexuality and Intimacy (OTSI) program, which they've had in place for years. This program was designed to promote sexual health and intimacy after injury and illness.

Unfortunately programs like this have not become a staple in the care and interventions provided across other military, veteran, or civilian healthcare organizations. But, as you'll soon read, we as OTs can be the ones to advocate for them in our place of work and provide evidence of why they are important. 

These are the 5 key themes that emerged as important factors that positively influence the efficacy of an OTSI program.

1. Using the Therapeutic Relationship to Establish a "Safe Space"

It’s unlikely that clients will discuss sensitive topics without being asked and invited to do so. Providing a safe space to allow the client to work through personal challenges is important. It's also equally important that you, as the therapist, use therapeutic use of self when initiating the conversation. 

2. Defining Sex and Intimacy

A common misconception may be that sex is just intercourse. But, it can be influenced by emotional intimacy. A key aspect of the intervention program must include:

• Expanding client's definition of sex from performance-based to pleasure-based by focusing on erogenous zones (other than genitals).
• Understanding differences between sexplay and foreplay.
• Understanding the relationship between sex and intimacy.
• For individuals with visible injuries,  addressing self beliefs relating to body image that governed the client’s life before injury, and adapting them to life post injury.
• Broadening the client’s understanding of the complex nature of both sex and intimacy is an important step to re-engage in sexual activity.

3. Promoting Communication

Successful communication and collaboration is key to building and maintaining intimacy within a relationship. Discussions may include using positioning aids, sex toys or prosthestics, trying different positions and recommendations on technique and scheduling sexual activity. It's important to also acknowledge and address the client's  emotional regulation skills, stress management, and self care routine as these all impact positive self esteem.

4. Understanding Role Identity

For individuals with acquired injuries, it is often not common for them to receive assistance from their partner prior to their injury. Having to adjust to accepting this help can take time which often results in excessive stress even on the strongest relationships. We can help the client reengage in occupational responsibilities and be successful in their valued familial and societal roles.  This in turn improves self esteem and identity which boosts ego and often sexual interest and desire. 

5. Modifying Routines

In our study, participants all reported modification in both techniques during sexual activity and sexual routines. By evaluating and modifying routines, the client can schedule sex to accommodate for pain and fatigue, integrate necessary communication of expectations or flirtation to reduce anxiety or facilitate desire prior to sex and explicitly discuss how sex will end so both partners feel satisfied as they transition from erotic or intimate time back into the folds of daily life.

Key Takeaways:

-Remember that holistic intervention is important

-Evaluation and treatment of sexuality and intimacy can have a significant positive impact on quality of life and meaningful social reintegration

-We can work towards incorporating these 5 key themes into our daily practice.

-We as OTs are uniquely trained to address both internal and external barriers to engagement in activity! That makes us qualified to holistically assess physical, cognitive, and emotional factors and have a positive impact on sexual and intimate activities.

-If there is a multidisciplinary sexual rehab team where you work don't be afraid to reach out and join it. And if there isn't one, be a trailblazer and advocate for one!