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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. 

The most important thing when considering assessment and intervention is that it has to match the Rancho Los Amigos Level of the patient.  

1. If a patient is not responsive to stimulus and nonverbal, they can’t consent to sexual activity and furthermore the stimulation and arousal, for example from a partner, would be contraindicated to their need for calming input. 
2. If a patient is at a stage where they are engaging in familiar occupations, masturbation could likely be a familiar occupation for them just like brushing their teeth. 
3. If a patient is at a stage where they are able to achieve new learning, the education has to be...

 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. The number of people overall in forced labor (either sex or labor exploitation) increased over 10% between 2016 and 2021. In the United States, 16,721 victims of human trafficking were identified by calls made to the National Human Trafficking Hotline in their most recent 2021 report. As with any form of abuse, statistics such as these are an underrepresentation of the actual occurrences due to the many factors that interfere with survivors reporting such abuse. As an OT/OTA it’s not if you’ll work with a client who has experienced or is at risk for commercial sexual exploitation (CSE), it’s when. 

CSE is defined as the use of force, fraud, or coercion to...

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.  When she came to visit, she spent the day curiously learning about all things sex & intimacy OT with a highlight being the sex toys and The Institute's Educational Illustrations Library Project.

As sex and intimacy Champions, we know we’re often deprioritized in OT conversations. Let me tell you, not with Alyson! Alyson is a fierce advocate for sex and intimacy conversations, integrating this topic throughout curriculum, and fulfilling our holistic promise to our clients by addressing their sexual health goals. Alyson has taken action to ensure sex and intimacy is more of a priority within AOTA conversations and we are celebrating these...

Photo credited to Disabled and Here.

Kathryn collaborated with Dr. Jess Gagui again for this week's blog as a follow up to their last blog focused on the historical context of hypersexualization and fetishization of BIPOC women and femmes.  Be sure to give that a read if you haven't already.  This week focuses on intervention strategies you can use when working with folks who voice experiences of hypersexualization, fetishization, asexualization, and body criticism for not fitting the standard of beauty: for example, white, thin, able bodied.  While last week's blog centered BIPOC women and femmes, we think you’ll find these intervention strategies helpful for many other populations you work with. 

Clients’ experiences related to identity and culture aren’t off limits to clinicians:

Clinicians can, rightfully so, feel cautions to challenge what clients admit as cultural messages.  For example, "I grew up in a Catholic home and...

Bottom line up front: While this report is sobering and presents many gaps, we'd like to highlight this Community of Sex & Intimacy OT Champions who are actively addressing sexual health with their clients.  You are trailblazers and change makers and your clients are lucky to be working with you.  

Click here to read the report. 

Read on to learn more…  

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...

Photo credited to Disabled and Here.

Bottom Line Upfront: Halloween season is upon us.  We’re doing a deep dive into exactly why people should not dress up as a “sexy version” of another culture’s attire, for example a sexy Native American or a Geisha. If you need a nudge on this or are curious to learn more...read on!

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. In this week's newsletter, we are privileged to have Jess Gagui, OTD, OTR/L, a biracial Asian/Latina woman, collaborating with me to shed light on common experiences...

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're better OT/OTAs for this insight and education.  Watch the video to learn about sex, relationships, unlearning harmful beliefs, and why some people don't connect with the term sexy".  We offer strategies throughout the interview you can use with your OT clients and yourself!    

Want more time with Jess? I get it, they rock! Jess is a collective member and research consultant for Laurel Research Collective which focuses on accessibility and research for the Autistic LGBTQIA+ community.  You can follow them on Instagram at @jbdg.theot. 

Watch the vide here! 

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

You: “I’m here for the story, Kathryn”

Me: K, cool, buckle up - this is a fun one! 

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.” 

“Look at me.”

      … “I’m a mess” 

      … “I don’t look so hot”

      … “I can’t be in front of my husband like this”

      … “how can I have sex when I look...

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.     

TGNC individuals may utilize gender-affirming practices such as tucking, binding, packing and can experience gender euphoria when they do so.  Gender euphoria is the experience of feeling joy related to your gender, gender expression, and participation in gender affirming experiences.  It’s important to mention that gender euphoria can be experienced while engaging in any occupation, not just during sexual activity.  

Gender dysphoria is a discomfort or distress related to a disconnect between a person's gender identity, sex assigned at birth, and genitals.  The medical model...

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.  

Here are 3 suggestions to activate the parasympathetic nervous system and give the pelvic floor the needed messaging to relax:

Diaphragmatic Breathing: As we inhale, the diaphragm pushes down into the system to create room for the lungs to expand. As the diaphragm relaxes down, the pelvic floor muscles adjust accordingly to the intra-abdominal pressure within the system, and these muscles “drop” and lengthen as well. As we exhale, the pressure leaves the body and both the diaphragm and pelvic floor muscles...