Sexuality and Disability

sexuality and disability myth

Individuals with disabilities DON'T care about sexuality, intimacy and relationships.

- ex of potential barriers

•Stigma

•Self esteem/self-efficacy/body image

•Psychosocial implications

•Body structure/function impairments (Motor, Cognitive, Sensory)

Practice Framework, 3rd edition

Sexual activity as an ADL......" engaging in activities that result in sexual satisfaction and/or meet relational or reproductive needs".

Practice Framework, 4th edition

•Sexual activity: Engaging in the broad possibilities for sexual expression and experiences with self or others (e.g., hugging, kissing, foreplay, masturbation, oral sex, intercourse)

•New descriptions under "Personal care device management" within Health Management, including caring for sexual and contraceptive devices

•New "Intimate partner relationships" category within Social Participation, which may or may not include sexual activity.

Under-addressed in practice...

•Lack of knowledge

•Lack of comfort

•Perceived lack of relevance and importance of sexuality to people with disability

•Fear of causing offense or anger

•Lack of clarity re: professional roles and fear of "damaging" professional reputation

•Client factors such as age, gender or marital status

How to start the conversation (PLISSIT Model): P

•Permission: give the client permission to talk about sexual issues and ask questions.

How to start the conversation (PLISSIT Model): LI

•Limited information: explain what effect the disability might have on sexuality; give brief and accurate information at this stage; need to be comfortable talking about sexuality.

How to start the conversation (PLISSIT Model): SS

•Specific suggestions: help the client set realistic goals; provide specific suggestions for dealing with the specific problem related to the disability

How to start the conversation (PLISSIT Model): IT

•Intensive therapy: specific individualized program; advanced training required.

Case Study: Sam

•57-year-old male s/p myocardial infarction and CABG.

•Being seen in an inpatient rehab facility; was in the acute care hospital for 1 week prior to transferring to rehab.

•On sternal precautions

•Prior to MI and surgery, was (I) with all ADLs, IADLs and worked as an accountant. Enjoys traveling with spouse.

•Spouse is supportive

- What aspects of Sam's sexuality might be impacted as a result of his MI and CABG? Energy conservation, stamina, fear, socioemotional aspect, sternal precautions limit movement/positioning, self efficacy

- Using the "Permission" portion of the PLISSIT model, how would you first address sexuality with Sam? I would mention it when I am gathering the occupational profile, especially when talking about family life/spouse.

•Occupational Therapy Sexual Assessment Framework (OTSAF)

key terms

•Sexual knowledge

•Sexual activity

•Sexual interest

•Sexual response

•Sexual expression

•Sexual self-view

•Intimacy

•Sexual health

•Family planning

Occupational Performance Inventory of Sexuality & Intimacy (OPISI): initial screening tool

•13 item self assessment

•Assures the client that sexuality and intimacy are safe topics to address

•Introduces the various areas of occupational performance that they might have concerns about

Determines personal preferences for initial service delivery

Occupational Performance Inventory of Sexuality & Intimacy (OPISI): in-depth inventory

•"Check all that apply statements" in each of the OTSAF categories

•Follow up interview as needed

Occupational Performance Inventory of Sexuality & Intimacy (OPISI): performance measure

•Client rates their perceptions of performance in relevant areas on a 1-10 scale

•Ability, understanding, satisfaction and confidence

Sexuality after SCI: general considerations

•Changes in sensation

•Changes in ability to move

•Changes in body image and self concept

Sexuality after SCI: specific considerations for men

•Erectile dysfunction

Sexuality after SCI: Specific considerations for women

•Lubrication

•Menstrual periods

•Pregnancy

•Breast feeding

Sexuality after SCI: other

•Autonomic dysreflexia

•B&B

Sexuality after Stroke or TBI

Common changes and challenges

•Increased or decreased desire

•Emotional changes

•Cognitive and/or communication changes

•Motor impairments

•Fatigue

•Body image/self esteem

Sexuality and Aging

Common changes and challenges

•Physical changes

•Emotional changes

•Cognitive changes

•Other medical conditions

•Medications

Sexuality and Youth

•Adolescence is a critical time for developing sexual identity!

•Consider the type of education and timing of education

•High risk population for exploitation

Dealing with inappropriate sexual behavior

•Stay calm (Let the person know that the behavior is inappropriate; Give reminders as needed!)

•Discuss the issue with the rest of the team and client's family (Be consistent in the plan and approach to dealing with the behavior)

•Talk about the behaviors and sexual issues with the client. (Set FIRM boundaries)

•Help the individual find other appropriate and safe ways to express their sexuality