Foundations: Sexual

Activity as an ADL
- Ly d i a B r u g e r e , O T S -
 Upon completion of this module, students
will:

Learning
• Define key terms related to sexuality
• Recognize sexual activity as an ADL

Objectives
• Identify barriers to addressing sexual
activity in OT practice
• Recognize OT’s unique role in addressing
sexual activity
• Relate knowledge about sexual activity
to other ADLs/IADLs
 Sexuality: the intrinsic client factor
encompassing a person's sexual
attitudes, thoughts, beliefs, values,
practices, behaviors, and desires

Key terms Sexual activity: an activity of daily

living (ADL) involving engagement in
the expression of one’s sexuality
with self and others

Sexual health: a state of mental,

emotional, social, and physical well-
being related to sexuality

This is just the beginning - see Josie

To p o r c e r ’ s r e s o u r c e i n t h e O T l i b r a r y

( A O TA , 2 0 2 0 ; W H O , 2 0 1 0 )
Sexuality and OT
• Sexuality relates to every domain of
occupational therapy
⚬ Occupations
⚬ Contexts
⚬ Performance skills
￭ Motor skills
￭ Process skills
￭ Social interaction skills
⚬ Performance patterns
⚬ Client factors

( A O TA , 2 0 2 0 ; E l l i s & U n g c o , 2 0 2 3 )
Sexual Activity: The Forgotten ADL
• While it is common to discuss
toileting, sleep, bathing, and
dressing within the context of OT,
sexual activity often gets left
behind
• This is an ADL within our scope of
practice and is often closely linked
to our clients’ QoL
• In one study, 94% of individuals
with disabilities reported being
sexually active (Pendleton &
Schultz-Krohn, 2018)

(Hattjar, 2012; Pendleton & Schultz-Krohn, 2018)

 • Personal factors:
⚬ Lack of knowledge

Barriers ⚬ Lack of skills/preparation

⚬ Discomfort with topic
⚬ Personal stigma/bias
• Institutional factors:
⚬ Lack of time
⚬ Length of stay
⚬ Lack of prioritization
⚬ Roles/responsibilities
• Client factors:
⚬ Discomfort
⚬ Lack of knowledge
⚬ Stage of recovery
⚬ Low self-esteem
⚬ Age/societal norms

( A u g e r e t a l . , 2 0 2 2 ; E l l i s & U n g c o , 2 0 2 3 ; H a t t j a r , 2 0 1 2 ; Yo u n g e t a l . , 2 0 2 0 )
What if we don;t address sexual activity?
POSSIBLE OUTCOMES • Decreased arousal levels
• Decreased sexual interest
• Lower quality of life
• Social isolation
• Higher levels of
• Inadequate sexual
depression and anxiety
education
• Lower self-esteem
• Increased risk for STIs
• Hampered or impaired
• Strained relationships
sexual expression
• Disruption in roles and
• Difficulty performing acts
routines
required to engage in sex
• Lowered sexual ... AND MORE!
satisfaction

(Willis and Ungco, 2023)

 • People with disabilities are not

Stigma likely to be represented in the

media as sexual beings
• Implicit bias
• Society’s view of people with
disabilities as asexual vs.
hypersexual
• Perception and self-perception
• Education and exposure to the
idea of differently-abled people
having sex can help challenge
this narrative

(Ellis & Ungco, 2023; Hattjar, 2012; Rory, n.d.)

So how do we address sexual activity?
A C T I V I T Y A N A LY S I S THERAPEUTIC USE OF SELF
• What performance • What psychosocial
skills go into sexual components do we
activity? need to consider?
• What equipment may • How will we make
be needed? our clients
• How can we adapt comfortable?
and modify the task? • What barriers can we
• What are safety help our clients
considerations? overcome?

(Pendleton & Schultz-Krohn, 2018)

ADL Considerations
• Sexual hygiene
• Lubricant usage
• Positioning
• Safety considerations
• Equipment/tool recommendations
• Dressing/undressing
• “Date night” self-care
• Communication with partner

(Pendleton & Schultz-Krohn, 2018)

IADL; Medication Management
• Pain medication, birth control, antidepressants
• Side effects
⚬ Alertness
⚬ Sexual arousal
⚬ Desire
⚬ Erectile dysfunction
⚬ Lubrication
⚬ Blood clots
⚬ Changes in orgasm
• Communication with prescriber or pharmacist
• Caution client not to stop medication without
medical input
(Pendleton & Schultz-Krohn, 2018)
Occupational Justice
• Our responsibility as therapists
• Just as we cannot rely on other disciplines to
address ADLs such as toileting ...
• Researchers propose taking a sexual rights
approach, acknowledging that every human has
a r i g h t t o t h e i r s e x u a l i t y ( Yo u n g e t a l . , 2 0 2 0 )
• Including screening and assessment questions
on the topic of sexual activity
• Special consideration for vulnerable
populations
• Equity vs. equality

( E l l i s & U n g c o , 2 0 2 3 ; Yo u n g e t a l . , 2 0 2 0 )
From the Field:
ASK THE QUESTION

Start by asking, “Do you

have any concerns with
sexual functioning or
sexual activity?”

FA M I L I A R I Z E YO U R S E L F

There are a lot of

resources and research
out there - familiarize
yourself with it, expand
your knowledge
Resources
• HOPE Peer Educators:
https://www.sru.edu/offices/student-health-
services/health-promotion
• Counseling Center: https://www.sru.edu/life-at-
sru/health-and-wellness/counseling-center/services
• Student Health Services:
https://www.sru.edu/offices/student-health-
services
• Office for Inclusive Excellence: oie@sru.edu
• Pride Center: jjp1033@sru.edu
References
A m e r i c a n O c c u p a t i o n a l T h e r a p y A s s o c i a t i o n [ A O TA ] . ( 2 0 2 0 ) . O c c u p a t i o n a l t h e r a p y p r a c t i c e
framework: Domain and process (4th Ed.). AJOT.
Auger, L., Masse, J., & Higgins, J. (2022). Sexuality in occupational therapy: A call to action.
British Journal of Occupational Therapy, 85(9), 627-742.
https://doi.org/10.1177/03080226221107769
Ellis, K. M. & Ungco, J. (Eds.) (2023). Sexuality and intimacy: An occupational therapy
a p p r o a c h . A O TA .
G e r b i l d , H . , L a r s e n , C . M . , J u n g e , T. , L a u r s e n , B. S . , & A r e s k o u g - J o s e f s s o n , K . ( 2 0 2 1 ) . D a n i s h
health professional students' attitudes toward addressing sexual health: A cross-sectional
sur vey. Se xua l M e di c i ne , 9 , 1-9. https: / / doi. org/ 10. 1016/ j. esxm. 2021. 100323
H attjar , B. M . ( 2012) . Sex uality and oc c up ational therapy : Strategies f or p er sons w ith
d i s a b i l i t i e s . A O TA .
P e n d l e t o n , H . M . & S c h u l t z - K ro h n , W. ( 2 0 1 8 ) . P e d r e t t i ’ s o c c u p a t i o n a l t h e r a p y : P r a c t i c e s k i l l s
for physical dysfunction. Elsevier.
R o r y. ( n . d ) . Yo u r g u i d e t o t h e 6 b e s t d i s a b l e d s ex p o s i t i o n s . R o r y .
https: / / w w w. helloror y. com/ roar / disabled-sex/
World Health Organization [WHO]. 2010. Developing sexual health programmes: A framework
f or a c ti on . R etr ieved from https: / / w w w. w ho. int/ publications/ i/ item/ W HO -R HR -HR P-10. 22
Yo u n g , K . , D o d i n g t o n , A . , S m i t h , C . , & H e c k , C . S . ( 2 0 2 0 ) . A d d re s s i n g c l i e n t s ’ s ex u a l h e a l t h i n
occupational therapy practice. Canadian Journal of Occupational Therapy, 87(1), 52–62.
https://doi.org/10.1177/0008417419855237
 Reflection
Why is it so important to address sexual activity with
our OT clients?