sex therapy through the lens of occupational therapy
Occupational therapists are health care professionals who help people to resume or maintain participation in a variety of tasks – their jobs, leisure and social activities, getting around, caring for themselves and their home, and much more. Even though occupational therapy covers a wide range of client concerns, an exciting opportunity that has recently come through for our practice is a collaboration with Aleah Johnson, a student of the Master of Science in Occupational Therapy Program at the University of Toronto, who is passionate about using occupational therapy to help clients with their sexual concerns. Occupational therapy for sexual concerns begins with her assessment to understand what aspects of sexual encounters or sexuality create difficulties for clients and creating a collaborative treatment plan to address these concerns. Sessions are offered both online and in-person.
Sensory Processing:
An individual may experience hyper-/over-stimulation, hypo-/under-stimulation, or a combination of both in regard to their sensory system. Overall, we have eight different senses which can greatly affect our ability to function in our daily tasks including sexual and intimate activities.
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Vestibular Sensory System – our sense of balance and body movement
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Things that may be affecting sexual interactions – positioning; pace; body movements such as thrusting, swinging, bouncing, etc.
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Proprioceptive Sensory System – our sense of body awareness
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Things that may be affecting sexual interactions – positioning; location of the sexual encounter; pressure on one’s body or the amount of pressure they are applying to someone else; etc.
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Our sense of Smell
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Things that may be affecting sexual interactions – smells including but not limited to breath, pheromones, bodily fluids, specific areas of the body more commonly associated with sexual activity, condoms, lube, etc.
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Our sense of Taste
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Things that may be affecting sexual interactions – tastes including but not limited to breath, pheromones, bodily fluids, specific areas of the body more commonly associated with sexual activity, condoms, lube, etc.
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Interoceptive Sensory System – sense of the internal state of our body (conscious and non-conscious)
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Things that may be affecting sexual interactions – anxiety and/or fear; sexual desire (high or low); orgasm; premature ejaculation; etc.
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Auditory – sense of hearing
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Things that may be affecting sexual interactions – sounds of someone’s voice, noises in the environment, sounds related to sexual activity (i.e., kissing, bodies making contact, sex noises made by a partner, bodily fluids, etc.); etc.
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Self-Regulation:
Self-regulation is our ability to recognize what we are feeling in our brain and body and our ability to either remain at or return to an appropriate level of alertness. We may explore your awareness of your bodily signals and if and how you attribute meaning to them. If there is a discrepancy at any point in this process, together we develop strategies to attend to these challenges.
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An example of a challenge that may benefit from self-regulation strategies includes premature ejaculation. I.e., are you able to recognize signs that you are coming close to ejaculation? How do you react to this feeling? From here, we develop strategies that help you remain aroused but refrain from becoming over-stimulated or needing to cope in unhelpful ways.
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Another example of how self-regulation strategies can support sexual functioning is in regard to erectile dysfunction, i.e., when someone is not connected to their arousal in response to physical or mental manifestations of anxiety or a lack of appropriate stimulation.
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It is also common for individuals to experience difficulties with behavioural rigidity and challenges with transitions, which both can be supported through the use of self-regulation strategies.
Environmental Analysis:
An environmental analysis consists of the occupational therapist learning more about the environment context in which the sexual activity is occurring (this could be both physical and social environment). Some things we look at include changing the physical environment in order to promote sexual satisfaction, before, during, and after the activity. This process also includes examining the context of the activity, for example the time of day, energy levels, state of the client’s health and wellbeing (using a holistic perspective – mental, physical, social, cultural, etc.), set up of the room, surfaces the activity occurs on, proximity to clean-up areas, etc.
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Sexual activities relevant to this – low desire; aversion to clean-up; confidence; positioning; etc.
These are just a few ways that occupational therapists can attend to the sexual needs of clients. While some may experience difficulties with these specific areas, it is common for individuals to experience multiple of these challenges simultaneously.