Barriers to Engaging in Sexual Pleasure: The OT’s Role & Resources for People with Disabilities

Written By Lindsey Novakovic

The Occupational Therapy Practice Framework, 4th Edition includes sex as an occupation — specifically, an activity of daily living.

And yet, sex continues to be the “forgotten ADL”, especially for individuals with disabilities.

Sexual pleasure can be difficult and/or feel impossible for people with disabilities. Occupational therapists have the knowledge and skills to educate, advocate, and treat the barriers to engaging in sex.

It’s all within the scope of our practice.

Let’s take a look at attention, for example. Attention is a process skill and requires the nuances within sustaining performance, the application of knowledge, organization and timing, spatial awareness, and adaptation…all of which are within our wheelhouse to address.

How about depression? We are trained generalists who have the skills to work with individuals with various mental illnesses to address inhibitory behaviors and promote occupational engagement. Shame? Trauma? Perceptions of the self and others? they all follow.

Keep reading below and crack open your OTPF. It’ll all come back to you.

Here are some of the barriers to participating in the occupation of sex that occupational therapists could work with:

  • Arousal [10, 16]

  • Attention [20, 21]

  • Anxiety [11, 14, 19]

  • Chronic pain [1, 5]

  • Decreased lung capacity [3]

  • Depression [9, 11]

  • Fatigue [2]

  • Hyper- or hyposensitivity [15, 16]

  • Hyper- or hypotonic pelvic floor [7]

  • Incontinence [7, 12]

  • Lack of adaptive sex toys *

  • Lack of education (i.e., adapting sex to client needs—positions, devices, equipment) *[22]

  • Lack of communication during sex [4]

  • Limited range of motion [6, 13]

  • Muscle weakness and/or soreness [12, 18]

  • Paresis or paralysis [23]

  • Pain during sex [4]

  • Perceptions of self and others’ sexuality [17]

  • Shame [4]

  • Spasticity [12]

  • Trauma [4]

Oh, and OTPs and OTAs: As an individual with a disability, here’s a tip if you want to collaborate with your client to address any of these barriers: Center your intervention around PLEASURE, NOT their barrier.

For example, let’s use one of my own barriers, chronic fatigue. Yes, my barrier is chronic fatigue, and you still want to address this in the intervention, but what is the MAIN goal of my occupational participation in SEX?

Pleasure.

Remember to always keep the client’s goals in mind. Barriers can look like goals, but they aren’t…they are barriers to participation.

Where to go from here

There are tons of resources available for people to explore their bodies—OMGyes is a fantastic one for women. Below are some others.

Sex toys and aids for disabled people

XES Products

This entire website is amazing. They have incredible blogs talking about different types of sex toys they offer as well as blogs and narratives about disability and sexuality.

Hot Octopuss Blog Post

This blog has a handful of resources for aids, including a link to the Liberator (manufacturer of a bunch of positioning aids) brochure of a ton of positioning ideas and how to use all their cushions.

HelloTouchBot

Founded by the wonderful Marie, a disabled queer woman, who struggled to find a product that fit her needs for an increased range of motion and a range of dilators. Her partner, an engineer, helped her develop Lattice, an incredible, adapt-to-your-angle, long-arm-switch-out dilator that not only looks totally out-of-this-world but is 3D printed to be affordable and customizable!

NOTE: I’m happy to continue sharing resources and insight I find, however it is important to remind readers that I am an Occupational Therapist Student. The above should be taken as medical advice; readers should consultation their medical team before trying or adding anything new to their lifestyle. For more information, please read the Terms & Conditions.

References

  1. Ambler, N., Williams, A. C., Hill, P., Gunary, R., & Cratchley, G. (2001). Sexual difficulties of chronic pain patients. The Clinical journal of pain, 17(2), 138–145. https://doi.org/10.1097/00002508-200106000-00006

  2. Blazquez, A., Alegre, J., & Ruiz, E. (2009). Women with chronic fatigue syndrome and sexual dysfunction: past, present, and future. Journal of sex & marital therapy, 35(5), 347–359. https://doi.org/10.1080/00926230903065179

  3. Farver-Vestergaard, I., Frederiksen, Y., Zachariae, R., Rubio-Rask, S., & Løkke, A. (2022). Sexual Health in COPD: A Systematic Review and Meta-Analysis. International journal of chronic obstructive pulmonary disease, 17, 297–315. https://doi.org/10.2147/COPD.S347578

  4. Fearring, St. (2021, April 26). Addressing Barriers to Female Sexual Pleasure – Let’s Get Educated. Retrieved June 17, 2023, https://www.matingstraighttalk.com/addressing-barriers-to-female-sexual-pleasure-lets-get-educated/

  5. Flegge, L. G., Barr, A., & Craner, J. R. (2023). Sexual Functioning Among Adults with Chronic Pain: Prevalence and Association with Pain-Related Outcomes. Pain medicine (Malden, Mass.), 24(2), 197–206. https://doi.org/10.1093/pm/pnac117

  6. Fritz, H. A., Dillaway, H., & Lysack, C. L. (2015). "Don't Think Paralysis Takes Away Your Womanhood": Sexual Intimacy After Spinal Cord Injury. The American journal of occupational therapy : official publication of the American Occupational Therapy Association, 69(2), 6902260030p1–6902260030p10. https://doi.org/10.5014/ajot.2015.015040

  7. Grimes, W.R. & Stratton, M. (2023, May 3). Pelvic Floor Dysfunction. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Retrieved June 20, 2023, https://www.ncbi.nlm.nih.gov/books/NBK559246/

  8. Kaplan H. S. (1988). Anxiety and sexual dysfunction. The Journal of clinical psychiatry, 49 Suppl, 21–25.

  9. Kennedy, S. H., & Rizvi, S. (2009). Sexual dysfunction, depression, and the impact of antidepressants. Journal of clinical psychopharmacology, 29(2), 157–164. https://doi.org/10.1097/JCP.0b013e31819c76e9

  10. Kingsberg, S. A., Schaffir, J., Faught, B. M., Pinkerton, J. V., Parish, S. J., Iglesia, C. B., Gudeman, J., Krop, J., & Simon, J. A. (2019). Female Sexual Health: Barriers to Optimal Outcomes and a Roadmap for Improved Patient-Clinician Communications. Journal of women's health, 28(4), 432–443. https://doi.org/10.1089/jwh.2018.7352

  11. Laurent, S. M., & Simons, A. D. (2009). Sexual dysfunction in depression and anxiety: conceptualizing sexual dysfunction as part of an internalizing dimension. Clinical psychology review, 29(7), 573–585. https://doi.org/10.1016/j.cpr.2009.06.007

  12. Melo, E. M. V., Schoeps, V. A., Oliveira, F. F. L., Mendes, M. F., & Olival, G. S. D. (2023). Sexual dysfunction in Brazilian patients with multiple sclerosis. Disfunção sexual em pacientes brasileiros com esclerose múltipla. Arquivos de neuro-psiquiatria, 81(4), 350–356. https://doi.org/10.1055/s-0043-1767824

  13. Oliva-Lozano, J. M., Alacid, F., López-Miñarro, P. A., & Muyor, J. M. (2022). What Are the Physical Demands of Sexual Intercourse? A Systematic Review of the Literature. Archives of sexual behavior, 51(3), 1397–1417. https://doi.org/10.1007/s10508-021-02246-8

  14. Pyke, R. E. (2020). Sexual Performance Anxiety. Sexual medicine reviews, 8(2), 183–190. https://doi.org/10.1016/j.sxmr.2019.07.001

  15. Sales, J. M., Smearman, E. L., Brody, G. H., Milhausen, R., Philibert, R. A., & Diclemente, R. J. (2013). Factors associated with sexual arousal, sexual sensation seeking and sexual satisfaction among female African American adolescents. Sexual health, 10(6), 512–521. https://doi.org/10.1071/SH13005

  16. Silverstein, R. G., Brown, A. C., Roth, H. D., & Britton, W. B. (2011). Effects of mindfulness training on body awareness to sexual stimuli: implications for female sexual dysfunction. Psychosomatic medicine, 73(9), 817–825. https://doi.org/10.1097/PSY.0b013e318234e628

  17. Sinclair, J., Unruh, D., Lindstrom, L., & Scanlon, D. (2015, March). Barriers to sexuality for individuals with intellectual and developmental disabilities: A literature review. Education and Training in Autism and Developmental Disabilitites 50(1), 3-16. https://www.researchgate.net/publication/279328597_Barriers_to_Sexuality_for_Individuals_with_Intellectual_and_Developmental_Disabilities_A_Literature_Review

  18. Sonkodi, B., Kopa, Z., & Nyirády, P. (2021). Post Orgasmic Illness Syndrome (POIS) and Delayed Onset Muscle Soreness (DOMS): Do They Have Anything in Common?. Cells, 10(8), 1867. https://doi.org/10.3390/cells10081867

  19. Strand, N., Fang, L., & Carlson, J. M. (2021). Sex Differences in Anxiety: An Investigation of the Moderating Role of Sex in Performance Monitoring and Attentional Bias to Threat in High Trait Anxious Individuals. Frontiers in human neuroscience, 15, 627589. https://doi.org/10.3389/fnhum.2021.627589

  20. Tuckman, A. (2019). ADHD After Dark: Better Sex Life, Better Relationship. NY: Routledge.

  21. Tuckman, A. (2019, October, 22). Barriers to a Better Sex Life When One Partner Has ADHD. Retrieved June 17, 2023, https://www.psychologytoday.com/us/blog/sex-matters/201910/barriers-better-sex-life-when-one-partner-has-adhd

  22. Young, K., Dodington, A., Smith, C., & Heck, C. S. (2020, February). Addressing clients’ sexual health in occupational therapy practice. Canadian Journal of Occupational Therapy, 87(1), 52-62. https://doi.org/10.1177/0008417419855237

  23. Zizzo, J., Gater, D. R., Hough, S., & Ibrahim, E. (2022). Sexuality, Intimacy, and Reproductive Health after Spinal Cord Injury. Journal of personalized medicine, 12(12), 1985. https://doi.org/10.3390/jpm12121985

*Some barriers indicated were described during personal interviews with individuals with disabilities.

Lindsey Novakovic https://spoonieot.com
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