What is an OTs role in addressing sexuality and intimacy?

Sexuality encompasses more than just sexual function. Sexuality covers sexual expression, sexual preference, sexual activity, sexual identity and sexual decisions. Intimacy is also an important aspect of life that, as human beings, we crave. Sexuality and intimacy are considered meaningful occupations and can have a major impact on an individual’s emotional wellbeing, and occupational therapists are perfectly situated to address sexuality and intimacy with those they are working with.

However, as a profession, is there enough being done to address the needs of clients in this area? Is there enough being done to open the lines of communication with clients to ensure them that you can offer a safe space to discuss the topic of sexuality? And as occupational therapists do you feel educated enough in the area of sexuality to comfortably and professionally address this with your clients, even at the most basic level?

Initiating conversation
Talking about sex has always been seen as a taboo subject, and it is especially sensitive when discussing challenges around sexual function, whether this be due to disability, illness, injury, mental health or other life changes. Every individual’s need for sexual activity and intimacy will be different and as OTs you must be able to understand the varying needs of your clients and be able to support and advise them accordingly.

Many of the clients you work with may not know who they should address sexual concerns with, so by opening up a line of communication you are letting them know that they can discuss concerns with you as their occupational therapist, which is the first step.

Jessica Si is an New York-based occupational therapist who works in an outpatient facility. She received a Doctorate of Occupational Therapy from the New York University and her doctoral work was focused on sexuality and occupational therapy. She has since set up a website dedicated to sharing resources and educating OTs on how to address sexuality and intimacy with clients. The website, ots-letstalkaboutsex.com, covers everything from how to integrate sexuality into the practice of occupational therapy, to the lingo for sex toys and devices and how they should be used.

Jessica recently hosted a webinar for Naidex and discussed the importance of OTs addressing sexuality in their practice, and presented clear paths that would allow OTs to address this professionally and sensitively. She advocated the PLISSIT model which outlines four increasing levels of intervention:

  • Permission – where the practitioner provides a safe and comfortable environment for their clients to bring up sexual health concerns
  • Limited Information – where practitioners discuss normal and abnormal sexual functioning information in relation to the client’s identified concerns
  • Specific Suggestion – where practitioners begin to provide recommendations that will help with client’s specific issue(s) with sexual functioning
  • Intensive Therapy – where a referral is made to a sexual health specialist, such as a sex therapist, which can provide the client with more comprehensive support and guidance

Taylor and Davis (2007) acknowledge that: “As the level of intervention increases, greater knowledge, training and skills are required, therefore, it is recognised that not all healthcare practitioners are expected to be competent and operative at all levels, but at a minimum a practitioner should be able to provide services at the fundamental level of “Permission”.”

A safe space
Creating an environment where your client feels comfortable and safe to discuss sexuality and intimacy is the most important thing, and you can do this by simply displaying posters or information in your work area about sexuality. You can also include questions in your ADL assessments, or in goal-setting sessions, because it is an activity of daily living and should be treated as such. If it is important to your client, then it should be a focus of your occupational therapy sessions. 

Jessica draws on the BETTER Model, a model that was created to help oncology nurses in addressing the topic of sexuality with their patients. It is an effective model to refer to when looking at how you can appropriately broach the subject of sexuality with your clients.

Bring Up
Bring up the topic of sexuality with your clients when discussing other issues regarding ADLs. This helps give clients assurance that sexual concerns are acceptable to discuss.

Explain
Explain that sexuality is a normal part of daily living and that you are concerned with quality of life including sexuality. This normalises the topic and helps clients feel more comfortable to talk about any concerns they may have.

Tell
Tell the client that you are prepared to offer resources and are able to find additional appropriate resources if you are not able to address all their questions or concerns. 

Timing
Recognise that a client may want to talk about sexual function issues at any time. The timing may not seem appropriate now, but clients should be assured that they can ask for information at any time.

Educate
Educate the client on potential changes that they may experience in sexual function as a result of their diagnosis and/or treatment. 

Record
Record the assessment and interventions that you utilised in the client’s medical records.

Being able to normalise the conversation around sexuality and intimacy with your clients will help to increase their physical and emotional wellbeing. There are many resources out there to assist you in addressing sexuality and to help signpost clients to the right services. You do not have to know all the answers, but you must ensure you are open to supporting your client to achieve the goals that are important to them and that will improve their quality of life.

Find out more at ots-letstalkaboutsex.com.

Article originally appeared in the Jun/Jul issue of The OT Magazine.

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