Sexuality in Occupational Therapy: A Call to Action

Sexuality is an integral part of human occupation (Sakellariou and Algado, 2006), and it has been shown that participation in sexual activities is related to better overall quality of life (Anderson, 2013). Sexuality is an area of concern for occupational therapy (OT) as it represents a significant life occupation (AOTA, 2014) that can be impaired by multiple health conditions (Meesters et al., 2020, Downing et al., 2013, Radic et al., 2013). Sexuality encompasses a variety of significant activities including sexual activities such as (but not limited to) masturbation or intercourse, intimate activities like communicating between partners, kissing and dating (Sakellariou and Algado, 2006). Various daily activities can also be related to sexuality such as self-care, grooming, management of medication and interpersonal leisure (Hyland and Mc Grath, 2013). Despite the principle of holism that should characterize OT practice (Finlay, 2001), few occupational therapists integrate sexuality as part of their interventions, research or teaching. The fact that this reluctance towards addressing sexuality was outlined in the literature over 40 years ago (Sidman, 1977), that the topic is among clients’ priorities (Auger et al., 2020) and that the situation still appears to be stagnant (Mc Grath and Sakellariou, 2015) is quite alarming.

Interestingly, most occupational therapists believe sexuality is an important subject to address with clients and part of their professional responsibilities (Haboubi and Lincoln, 2003, McGrath and Lynch, 2014). Hence, it appears that occupational therapists do not need to be convinced that sexuality is relevant in their practice, but rather want to be supported and equipped in the exercise of their professional role with regard to sexuality. Therefore, there is a promising potential towards improving inclusion of sexuality in OT practice, research and education if we begin to take more time and resources reflecting HOW to better address sexuality than WHY don’t we do it.

Given the current state of the literature, we know what are the barriers that prevent occupational therapists from addressing sexuality. Lack of knowledge and skills as well as discomfort about addressing the topic are among the most reported barriers (Hyland and Mc Grath, 2013, McGrath and Lynch, 2014, Lepage et al., 2021). Although numerous barriers interact to create that situation, many of these can be overcome by specific interventions targeting occupational therapists and their practice context, such as provision of training (McGrath et al., 2021, Low et al., 2021) and getting access to more resources and specialized support (Auger et al., 2021).

Promising work by fellow OT researchers contributes to the body of knowledge regarding strategies to better target sexuality by occupational therapists. Heron and Owen-Booth’s (2022) recent study explored how three occupational therapists actually included this topic as part of their practice. Also, Muslemani and collaborators (2019) published a guide for OT practice with people with neuromuscular diseases regarding sexuality and intimacy. Finally, Walker and collaborators (2020) have developed a theoretical framework and an assessment tool about sexuality and intimacy in OT. Building on such groundwork, there is a clear and urgent need to better train clinicians and students to enable them in actualizing their role with people who face challenges in participating in sexuality-related activities in a satisfying way. There is a need for experts in the field to disseminate evidence and training, in order to reach the greatest number of occupational therapists and thus foster a concrete change in practice, research and teaching. Addressing sexuality in OT academic curricula and developing and implementing standardized assessment methods and evidence-based interventions are crucial to support occupational therapists in delivering sound, relevant and efficient services or teaching while considering clients’ and students’ diversity and culture. Moreover, there is a need to influence clinical settings in order to dedicate appropriate resources to detect and target issues related to sexuality for clients who require it.

Yes, it is important to TALK about sexuality; however, time has come to move to the next steps and TAKE ACTION globally in order to achieve effective and observable changes within our profession. Let’s go beyond documenting these barriers and devote instead our resources to improve current state of knowledge, practice and teaching about sexuality from an OT perspective so that our clients can get the holistic approach they deserve!