Sexual Activity & Intimacy: Challenges for OT
Despite the current support and the identified potential for furthering OTs role with sexual activity and intimacy, there are challenges present that impact the feasibility of providing services.
Lack of Confidence
OTs seldomly address sex and sexuality issues within their clients (Hyland & McGrath, 2013; Jones, Weerakoon, & Pynor, 2005; McGrath & Lynch, 2014). Research has indicated that an OT's perceived lack of skills related to this topic discourages them from implementing it into their practice (Hyland & McGrath, 2013; Jones et al., 2005; McGrath & Lynch, 2014). Furthermore, sex and sexuality are often left out of the curriculum in OT programs which fails to build confidence within this area (Lohman et al., 2017). OTs have reported a need for more information within OT programs including how to communicate about sexual health topics, how to intervene to address sexual dysfunction, and how to identify sexual health needs (Areskoug-Josefsson & Fristedt, 2019).
Research has highlighted that some OT's have personal discomfort regarding sex and sexuality which may lead to them feeling embarrassed if they address it with their clients (Jones et al., 2005). This often leads to OTs avoiding the topic in practice (Jones et al., 2005).
Generally, social discourse limits the right to sexuality to heterosexual, young, able-bodied males while denying individuals who do not fit this model right to sexuality (Tepper, 2000). In terms of partnerships, social discourse in Western societies also privileges heterosexual monogamous relationships that consist of young and able-bodied adults with a focus on reproduction (Shildrick, 2007; Tepper, 2000; Weeks, 2002). Furthermore, professional values have been formulated by a foundation consisting of a middle-class worldview, which privileges some occupations over others (Hammell, 2009) and in which sexuality and sex are expected to be private and remain hidden (Kennedy & Ullman, 2003).
Lack of Support
OTs have reported a lack of support from practice settings as barriers to addressing sex and sexuality (Hyland & McGrath, 2013). Specifically, OTs have disclosed institutional guidelines that stress the importance of restricting sexual behaviors of service users, a lack of space to discuss these matters privately, and acute hospital services perception of sexuality being irrelevant in context as factors (Hyland & McGrath, 2013).
Asexualizing attitudes about clients or populations, such as those who are older, have the potential to influence whether an OT will address sex and sexuality in practice (Couldrick et al., 2010). Research also supports that many perceive sexuality for people with disabilities as irrelevant and unimportant (Hyland & Mc Grath, 2013; Couldrick et al., 2010).
Many parents of children with developmental disorders hold the opinion that sexuality is not a priority for their children (Krantz et al., 2016). They often react to age-appropriate behaviors associated with sexuality with expressions of denial or patronizing remarks (Krantz et al., 2016). This can pose a challenge for children seeking information and support even when an OT attempts to address sex and sexuality for their younger clients in an age-appropriate manner.
OT's have reported that they fear they will embarrass their clients by raising the topic of sex and sexuality (Hyland & McGrath, 2013; McGrath & Lynch, 2014). OT's have also expressed fear of being professionally discredited (McGrath & Lynch, 2014).