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...

Our pelvic floor muscles form the base of our spine and deep core. They wear many hats:  bladder and bowel elimination, sexual activity, support and stability, pressure management, and shock absorption. I often refer to this group of muscles as Grand Central Station: there are a million convoluted routes to take! There is a TON going on down there. Not only are there about 16-20 muscles, but numerous ligaments, tendons, nerves, and fascial connections that help us complete ADLs/IADLs without the very embarrassing occurrence of urinary or bowel leakage and passing gas uncontrollably. Carter et al. (2015) found that a strong and coordinated pelvic floor leads to enhanced sexual function and higher levels of sexual activity. To me, this is reason enough to learn about the backstage crew. 

Let’s talk about what roles these pelvic floor muscles & organs play in our favorite occupation - sex!

Before we start, we’ll get into the nitty-gritty with a quick...

When it comes to discussing sexuality with our clients, occupational therapy practitioners (OTPs) and other healthcare providers can come up with all sorts of justifications not to. But here's the thing: most of these justifications have more to do with our own biases than with the clients themselves. It's time to challenge those biases and ask ourselves, "Why am I avoiding this conversation?"

Here are some common biases that hold us back from addressing sex:

"They have so many other things to worry about right now. Sex is probably the last thing on their mind." 

Look, we can't read minds. We have no idea what our clients are thinking unless we ask them. Just because they don't bring it up doesn't mean they don't have concerns. By initiating the conversation early on, we create a safe space for them to discuss their sexual well-being whenever they're ready.

"I don't want to offend them based on their background or beliefs." 

I've heard it all: "They're conservative,"...

Welcome to the second part of our three-part series on addressing sexuality and intimacy after spinal cord injury (SCI). Today, we’ll delve deeper into the crucial role that Occupational Therapists (OTs) play in supporting individuals with SCI in this aspect of their lives. With their expertise and unique perspective, OTs can provide invaluable guidance and interventions to empower SCI patients and promote a positive and fulfilling sexual experience. The OT can be the shining light of comfort and advocacy! OTs are perfectly situated to lead these efforts in a clinical setting both for their patients and for the interdisciplinary team. Let's continue our exploration of the strategies and approaches that OTs employ in this domain.

Education and Understanding:

One of the primary responsibilities of OTs is to educate SCI patients about the impact of their injury on sexual health. By providing comprehensive education, OTs help individuals understand the changes in their...

As Sexuality and Intimacy Trailblazers, we know that sexuality and intimacy are important parts of our lives, bringing us joy and enhancing our overall well-being. However, when someone experiences a spinal cord injury (SCI), these aspects can be profoundly affected. Today, we'll discuss when to address these topics, the impacts of SCI on sexual health, specific complications that can arise, and the role of occupational therapy in supporting individuals on this journey.

When to Address Sex and Intimacy:

So, the big question is: when should we start talking about sex and intimacy with SCI patients? 

The answer? at every point in their occupational therapy (OT) engagement! 

It's not about when exactly, but more about what to focus on depending on where the individual is in their injury timeline. In the inpatient setting, when people have recently experienced acute trauma, they may benefit from SCI sexuality education. On the other hand, those receiving outpatient care have...

Occupational therapy professionals will work with clients who may hire sex workers or who would benefit from working with a sex worker.   

Here are 5 things OTs need to know to be prepared to address sex work with clients and to advocate for destigmatizing sex work:

1. Sex work is work. Sex work is a consensual transaction between adults, where the act of selling or buying sexual services is not a violation of human rights. Sex work is an umbrella term that can include escort services, street-level sex workers, pornography, exotic dancing, massage, internet work, phone sex operators and third-party support (drivers, managers, bartenders etc.). Sex work is NOT sexual exploitation or trafficking. If the exchange is non consensual, it is violence, and is not considered sex work under the definitions of the World Health Organization.
   Like any career, sex work is deserving of respect, non-judgement, and professionalism. 
2. Sex workers...

If you've been following along then you know this is the last post of my three part series: The Selfies, Sexplay and Sexual Communication. 

This week we're talking about Sexual Communication. Whether it's with a casual partner, one with relationship potential, or long time partner helping our clients learn how to establish sexual communication in their relationship is an important part of addressing sexuality and intimacy. 

If they are not already communicating about sex with their partner we may need to help them learn how to be the initiator, which can be uncomfortable for them. 

Establishing sexual communication is the foundation of good sexual experiences and most people will find it refreshing to share their preferences and boundaries.

So how do you teach sexual communication??

 Tip #1 - Teach your client to discuss their boundaries/ limits:

While reasons for setting sexual limits widely vary, it is not uncommon for individuals to set...

We've all seen them. The sex scenes in movies that too often portray those initial moments afterwards to be euphoric and filled with mutual pleasure and happiness. But, we know that just isn't always reality! It can actually be an awkward or uncomfortable time for couples. Add pain, difficulty with communication, or a physical limitation to the mix and it can really become a difficult time to figure out what to say. I often get asked by client's, "how do I ask for what I want?" and "what if I want my partner to do something different?" or often what is more likely is that I'll find out that sex just ends "bad" with one or all partners frustrated or feeling like there's a lack of connection. 

Early on in my clinical practice I developed what I like to call, The 3 A's.

• Accolades

• Affirmations

• Appreciation

These are the three things I, and we as OTs, can recommend as talking points for our clients after sex. 

Accolades- Tell them what you...

Documentation and billing are often the perceived showstoppers for doing sex and intimacy interventions.  Let me tell you, I get a ton of questions about this, so you are not alone if you’re wondering,

“how the heck do I bill for, ‘Ronnie will mount Sammie during sex with mod I”?

So here is a quick and dirty blog post about documentation and billing to match the actual simplicity of this task.   

Goals:

First off, I don’t write goals like the one above. (Although straight to the point, it doesn't quite meet the expectations of a S.M.A.R.T. goal ;) )

But, here are some examples of goals I do write, which specifically have to do with sex and intimacy.  Please note, they are generalized so you'll want to modify them to the clinic you work in and the assessments you typically use:

1. Client will engage in sexual activity with a decrease (insert pain scale) in self-reported pain. 
2. Client will engage in...