The OT Role in sexual enablement

by Kevin Reel, Kelly Young and Sylvia Davidson – OTs in Toronto, Canada

Kevin-ReelKelli-Youngsylvia davidson

Occupational therapists work with their clients to try to find solutions to problems that interfere with being able to do the things that are regularly important in life – every day, over a span of time and throughout life. These are what we call ‘occupations’: those roles and activities in which we engage (by choice and by virtue of life’s evolving duties) that bring various types of meaning and purpose to our lives. Occupations in this sense are more than ‘jobs’, they include or contribute to the many roles we take on throughout life and for certain sustained periods in life – student, parent, caregiver, volunteer, worker, partner – and involve many more specific tasks such as shopping, cooking, cleaning, dressing, self-care, reading, and writing, to name a few. Leisure is another important area of meaningful and purposeful activities and occupations. Together, these activities that occupy our time regularly help define who we are and how we feel about ourselves and our lives.

Being able to have a satisfying fulfilling sex life is one of these ‘occupations’. It is closely tied to self-identity and feelings of satisfaction with life. When an injury, illness, disability or other problem limits a person’s ability to engage in their usual sexual activities or ‘sexual expressions’, an occupational therapist can help people find ways to do as much as possible again.

An occupational therapist will be able to help with understanding the physical and psychological challenges that might be getting in the way of a good sex life. They will be able to recommend some strategies for managing certain physical limitations or symptoms that may make engaging in sexual activities problematic. This may involve ways to plan for sexual activity that prepare for the difficulties, finding tools and equipment that help get beyond any physical limitations and coaching to help develop confidence in the social aspects of sexual activities and the relationships in which they often happen.

An occupational therapist may also, where a strong therapeutic relationship is developed, be able to assist clients with some of the identity issues that are enmeshed with one’s sexuality and ability to feel comfortable to express it in different places and ways. This may include is someone struggling with their gender identity, or an older person trying to come to terms with loss of a partner and how that has an impact on their self-identity (as a partner/spouse or as a carer, for example). In addition, many of the psychological and spiritual elements of human sexuality are within the realm of an occupational therapist’s role.

Where something is beyond the therapist’s scope, they will be able to help find an appropriate person to help.

An occupational therapist (OT) will be able to help a person understand the physical and psychological challenges that might be getting in the way of a good sex life. This can mean talking about our anatomy and how our bodies work while we are having sex and what to expect as things change, possibly due to illness or just throughout the life course. The way that our minds work with sex is also a key aspect of enabling sexual expression. OTs can help people understand how self-esteem, gender identity, sexual orientation, body image and past sexual experiences can affect the way we approach sex. An OT might also suggest a more specialized professional to help – those who have the skills for more involved therapy like massage, relationship and family counseling and more intense sex therapy.

OTs typically adopt a shared problem-solving approach, working with clients to find out what might be most useful for each individual. They can recommend strategies for managing many physical limitations or symptoms that make engaging in sexual activities more of a challenge. This can include finding ways to deal with pain or limited movement, relaxation techniques to help with anxiety, tension or spasms, desensitizing scar tissue, and conserving energies throughout the day to have more energy for sexual enjoyment. An OT may also suggest various toys, tools or other things like lubricants and moisturizers to make having sex easier and more satisfying. Sometimes they can also adapt these tools and toys to make them possible to use or easier to use. It may also be helpful to think about how to incorporate other essential tools – like wheelchairs, hoists, catheter bags or breathing equipment – into a sexual routine. Coaching can help develop confidence in the social aspects of sexual activities and the relationships in which they often happen and help maximize pleasure and other benefits of sexual expression.

by Sylvia Davidson,Kevin Reel and Kelli Young,
Ots in Toronto, Canada