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Generally, pelvic floor muscles (like any other muscle group in the body) can have hypotonic or hypertonic tendencies. Our nervous system plays a major role in managing muscle tone. If a client is living in a constant state of anxiety and stress or they find sex stressful, it’s likely their pelvic floor muscles will have a difficult time coordinating with the system.  Regulating the pelvic floor will be especially difficult during sex.  

Here are 3 suggestions to activate the parasympathetic nervous system and give the pelvic floor the needed messaging to relax:

Diaphragmatic Breathing: As we inhale, the diaphragm pushes down into the system to create room for the lungs to expand. As the diaphragm relaxes down, the pelvic floor muscles adjust accordingly to the intra-abdominal pressure within the system, and these muscles “drop” and lengthen as well. As we exhale, the pressure leaves the body and both the diaphragm and pelvic floor muscles recoil to their original positions. Imagi...

Our pelvic floor muscles form the base of our spine and deep core. They wear many hats:  bladder and bowel elimination, sexual activity, support and stability, pressure management, and shock absorption. I often refer to this group of muscles as Grand Central Station: there are a million convoluted routes to take! There is a TON going on down there. Not only are there about 16-20 muscles, but numerous ligaments, tendons, nerves, and fascial connections that help us complete ADLs/IADLs without the very embarrassing occurrence of urinary or bowel leakage and passing gas uncontrollably. Carter et al. (2015) found that a strong and coordinated pelvic floor leads to enhanced sexual function and higher levels of sexual activity. To me, this is reason enough to learn about the backstage crew. 

Let’s talk about what roles these pelvic floor muscles & organs play in our favorite occupation - sex!

Before we start, we’ll get into the nitty-gritty with a quick anatomy refresher...

The pelvic ...

When it comes to discussing sexuality with our clients, occupational therapy practitioners (OTPs) and other healthcare providers can come up with all sorts of justifications not to. But here's the thing: most of these justifications have more to do with our own biases than with the clients themselves. It's time to challenge those biases and ask ourselves, "Why am I avoiding this conversation?"

Here are some common biases that hold us back from addressing sex:

"They have so many other things to worry about right now. Sex is probably the last thing on their mind." 

Look, we can't read minds. We have no idea what our clients are thinking unless we ask them. Just because they don't bring it up doesn't mean they don't have concerns. By initiating the conversation early on, we create a safe space for them to discuss their sexual well-being whenever they're ready.

"I don't want to offend them based on their background or beliefs." 

I've heard it all: "They're conservative," "They're from...

As Sexuality and Intimacy Trailblazers, we know that sexuality and intimacy are important parts of our lives, bringing us joy and enhancing our overall well-being. However, when someone experiences a spinal cord injury (SCI), these aspects can be profoundly affected. Today, we'll discuss when to address these topics, the impacts of SCI on sexual health, specific complications that can arise, and the role of occupational therapy in supporting individuals on this journey.

When to Address Sex and Intimacy:

So, the big question is: when should we start talking about sex and intimacy with SCI patients? 

The answer? at every point in their occupational therapy (OT) engagement! 

It's not about when exactly, but more about what to focus on depending on where the individual is in their injury timeline. In the inpatient setting, when people have recently experienced acute trauma, they may benefit from SCI sexuality education. On the other hand, those receiving outpatient care have more exper...

Occupational therapy professionals will work with clients who may hire sex workers or who would benefit from working with a sex worker.   

Here are 5 things OTs need to know to be prepared to address sex work with clients and to advocate for destigmatizing sex work:

1. Sex work is work. Sex work is a consensual transaction between adults, where the act of selling or buying sexual services is not a violation of human rights. Sex work is an umbrella term that can include escort services, street-level sex workers, pornography, exotic dancing, massage, internet work, phone sex operators and third-party support (drivers, managers, bartenders etc.). Sex work is NOT sexual exploitation or trafficking. If the exchange is non consensual, it is violence, and is not considered sex work under the definitions of the World Health Organization.
   Like any career, sex work is deserving of respect, non-judgement, and professionalism. 
2. Sex workers (SWers) have autonomy and agency. SWers choose the
...

Something OT practitioners need to keep in mind as we (humbly) approach the topic of sex with clients is how people can have sex in countlessly different ways –many that may be unfamiliar to us, and some of ways that may even be considered…

Kinky.

Kink is a broad term that describes aspects of sexuality that fall outside of the mainstream ideas of sexuality. In more detail, The Kink Clinical Practice Guidelines Project defines kink as “…sexual identities, erotic behaviors, sexual interests and fantasies, relationship identities, relationship orientations, and relationship structures between consenting adults not accepted by the dominant culture. We specifically include BDSM (Bondage/Discipline,  Dominance/Submission, Sadism/Masochism), Leather, and Fetish as important parts of the umbrella term of kink” (p. 4). 

 The Kink Clinical Practice Guidelines Project is composed of a multidisciplinary team of healthcare providers, therapists, educators, and advocates working in the area of s...

What’s an OT to do when Valentine’s Day is approaching, the clinic is covered in hearts and cupids, you're wearing red or pink on every portion of your body, yet your client shows up and says, “I’m dreading Valentine’s Day.”

You dig a little deeper.  

They say, “I’m dreading Valentine’s Day, because I know my partner will want to have sex with me and I have no desire for it.”

Ok, ok, ok, before you freeze up eyes wide open, here’s what you talk about:

Validate them: The hardest part about low desire when “sex is the last thing on your mind” is when it’s met with your partner’s higher desire – among all the things you’re juggling this can feel like a recipe for inadequacy, insecurity, resentment, guilt.

Knowledge is pleasure!  When your clients can understand the changes that happen in their body and how this impacts sexual health, they can also enlighten your partner better about what their experiencing.  

Next, know you can say no.  Reinforce to your client this exact message, h...