Sexuality is an aspect of occupational therapy that is sometime uncomfortable to talk about, but it's absolutely in our scope of practice. Sex is an occupation, and it has a direct impact on older adult patients. Often, it is overlooked because of the myth that older adults are asexual. This is not the case because so many older adults admit their sex life over 50 years old is better than in their 20s. The aspect of sex most impacted by age is arousal. Sexual response definitely changes with age, and it's important to emphasize the importance of being less perfectionist, continue to engage in sexual intercourse, and be open to a new sexual repertoire.
As a provider, it's important to keep a few things in mind when addressing sex with patients:
- Everyone has had different experiences with sex, and discussing it can bring up feelings of sadness, resentment, anger, and shame. Others have always had a healthy sex life, so this recent change in functioning could be very painful to them.
- Sex should always be discussed in a private setting.
- Sexual orientation and gender identity should be addressed upon evaluation because they impact treatment and outcomes.
- A PLISSIT or DOUPE model should be used when addressing sexual health.
- DOUPE (Description of problem --> Onset --> Understanding the cause --> Past attempts at solutions or treatment --> Expectations for treatment)
- PLISSIT (Permission --> Limited Information --> Specific Suggestions --> Intensive Therapy)
Interventions:
Individual (1:1)
It's very necessary to become aware of the client's concerns and needs during the initial interview. A remediation approach may need to be taken following surgical procedures or other surgeries. Increasing range of motion, strength, and endurance may be necessary for sexual participation. In addition, addressing communication strategies and social participation are also necessary for quality sexual interaction. An intervention that could be used with an individual may be to practice communicating sexual needs aloud so that it can be carried over to the individual's sexual partner.
Group:
As mentioned above, sex should always be discussed in a private setting. I think a group session would be appropriate is if the group was made up of a client and his sexual partner. The OT could lead an education session with the group on modifications that to the environment or technique to improve the sexual experience. Any suggestion provided should be done using the PLISSIT or DOUPE model.In a group session, a therapist may suggest scaffolding in sexual activity a little at a time if the couple has been inactive for a long period of time. The therapist could also suggest being very open with communication and letting each other know their needs and wants. Different positions can be necessary for neurological conditions to reduce tremors or account for precautions after surgery or amputations.
MacRae, N. (2010). Sexuality and aging. In R. H. Robnett & W. C. Chop (Eds.), Gerontology for the Health Care Professional (pp. 235–258). Sudbury, MA: Jones and Bartlett.
