Transgender & Disabled Sexuality: Illustrated Resources & Clinical Scenarios for OTs
Kathryn collaborated with Finley Baker (they/them) for this month's blog to share this incredible resource for OT practitioners, students, and professors. Finley is a recently graduated OTD Student from the University of Puget Sound in Tacoma, WA. For their capstone project, Finley created 22 illustrated sexual health educational resource cards for trans and non-binary people with disabilities. The illustrated cards are inclusive of other identities which are also infrequently represented within sexual health resources, such as, neurodivergent folks, poly and kinky populations, BIPOC, and fat bodies. If you’d like to contact Finley about this exciting resource, here is their email disabledtranssex@gmail.com.
The Disabled and Trans Sexual Health Resources offer visual education for a host of topics occupational therapists can be addressing, including non-speaking communication, vaginal dilator use, safe binding, fine motor limitations, and positions for limited endurance.
As many of you know, I am a BIG fan of using illustrations with clients when talking about sex. “This partner puts their hand here and that partner puts their knee there” gets pretty confusing real quick. A picture shows what it looks like and can help the patient understand exactly what you’re saying. Additionally, I think something magic happens when you present a client with a picture. It tells them, “wow, I’m not alone in this. So many people had this question or this issue that someone made an illustration about it!”
Gracious for Finley’s work, I asked them to develop case scenarios so we could share the application with this OT Community of Sexuality Trailblazers! Continue reading and also consider how each of these cases can be adapted to other populations, for example those who are cisgender and disabled, or transgender and non-disabled. Case example 5 & 6 reflect that recommendation.
Clinical Scenarios
Client: 23 year old trans-masculine person with asthma and frequent PTSD-related panic attacks
Scenario: You are an outpatient OT and your client has been referred to you for shoulder pain and rib slippage. You ask about their gender-affirming occupations and discover that they have been sleeping in their binder that is 2 sizes too small.
Postcard Use: You ask if they would like to talk about other options for binding and ask if they would like to see additional resources on the topic. They say yes, so you present the Binder Wear & Care and TransTape postcards and discuss healthy ways of binding. As they seem overwhelmed and anxious, you give them the postcards to take home and review again later.
Client: 67 year old trans feminine person who experienced a stroke 6 weeks ago and has a hemiparetic left arm (their dominant arm).
Scenario: You are a CHT working at an outpatient hand therapy clinic. Your client has been referred for increasing use of their hemiparetic arm during I/ADLs. When you note that sex is an ADL that OTs address, she discloses that she is worried about her ability to pleasure her wife like she used to due to her fine motor limitation.
Postcard Use: You ask if she would like to talk more about other options for intimacy as well as potentially bringing in adaptations to make pleasure more accessible. She says yes, and you present her with the Sex Toys for Limited Hand Use and the Non-PIV Intimacy postcards. You discuss what toys she has used in the past personally and what type of sensations her wife likes. You offer to bring her wife into the session, and she accepts.
Client: 40 year old autistic, non-binary trans masculine person who has fibromyalgia, pudendal neuralgia, and hEDS.
Scenario: You are a home health OT and you have asked if your client has any concerns surrounding sex. He says that he has been struggling to enjoy sex, as penetrative sex is too painful. In general, they feel like they are not getting enough sensation/proprioceptive input from their casual partners that prefer gentle touch. You provide them with the Adult Sensory Profile and they score highest in Sensory Seeking.
Postcard Use: You ask if they have explored kink or BDSM in the past, and they say no. You educate him on why kink is one of your suggestions given his sensory profile and chronic pain, and ask if he would like more information on the topic. He says yes, so you present the BDSM & Chronic Pain postcard information on your phone (from the website).
Client: 19 year old trans feminine person who has an incomplete high level SCI.
Scenario: You are an outpatient OT who is continuing to work on ADLs with your client. Last time at the end of session, they told you that they are extremely concerned about their lack of ability to maintain an erection and to potentially penetrate a partner, since they are upset about having a larger body.
Postcard Use: As her mom is also in the room with her, you ask your client if they would like her to stay or go. Your client chooses for her to go temporarily, and the mom is supportive. You start by talking about communication with partners, types of erections, and body image support. Then you ask if they would like additional specific suggestions, and you pull out the Thigh Harnesses postcard and discuss specific positions that could be used for penetrative sex, as requested.
Client: 52 year old cisgender woman who has a history of multiple traumatic brain injuries that has resulted in mild expressive aphasia.
Scenario: You are an in-patient rehab OT and you are working with your client on a variety of ADLs. You ask if she has any concerns surrounding sex and she says that since she got her first TBI, she hasn’t been able to tell her partner what she needs during sex. With permission from your client, you collaborate with the SLP for future sessions.
Resource Use: The mid-sex communication board is a low-tech AAC option for phrases that may be needed during sex. You present this option to your client, who wants to give it a try. You work with your client to customize the clip art and add personalized phrases that fit what she would like to say. You also bring up the Non-Speaking Sexual Communication postcard to discuss other options that could work for her.
Client: Group of 8 clients. Your group includes people who are cisgender, genderqueer, two-spirit, and/or non-binary. They may or may not be disabled.
Scenario: You are a mental health OT who is leading a series on sexual health with the current session being about gender expression and sexuality.
Resource Use: As an icebreaker, you have the coloring pages printed out and ready for group participants as they come in. You transition to a conversation about different forms of gender expression, what gendered norms you grew up with, and how societal messages around gender have affected your perception of yourself as a sexual being.