This post was written by our Resident Sexual Health Clinician, Dr. Kathryn Ellis, OTR/L, OTD, AASECT-SC, an occupational therapist and American Association of Sexuality Educators, Counselors, and Therapists Certified Sexuality Counselor. If you'd like her to answer your questions, submit them at the end of this page.
Occupational Therapy clinicians are trained in assessing how someone does an activity and figuring out how to make adaptations and modifications so the person can engage in the activity.
Sex is often an activity that people typically engage in without a lot of communication or planning. There can be a “we just do it,” or “it just happens,” attitude when it comes to sex, but this doesn’t bode well when it comes time for making modifications and adaptations.
Using an occupational therapy approach to learning how to adapt activities, let’s review some strategies for returning to sex after illness, injury, disability, or worsening of chronic illness.
Let’s review the process of trying anything new or adaptive. First, there is typically apprehension about how the experience will go. Since you’re trying something new, for example having sex post stroke, it’s typical for there to be uncertainty about how it will end.
Awkwardness is also a common aspect of trying something new, think about holding knitting needles for the first time and how uncoordinated and awkward it might feel. This is what is to be expected, when reengaging in sex after your body has experienced significant changes. So anxiousness and awkwardness can be normalized and welcomed as a normal experience.
Communicate about sex
As mentioned before, people don’t always discuss the expectations of what they are going to do during sex before sex starts.
Think about what sexual activities you want to do and feel comfortable doing and then communicate this with your partner so you’re both on the same page.
For example, a couple is used to a certain pattern for sex which starts with kissing and advances through heavy groping, oral sex, and finally, penetrative sex. If one partner feels more comfortable only exploring kissing and heavy groping, it’s essential to communicate this to the other partner who might naturally initiate oral and penetrative sex because this is what they’ve done in the past.
Downgrade the task
Downgrading and upgrading a task is common language for an occupational therapist.
Downgrading means to take an activity and do parts of the activity that is the “just right challenge.” As you master those skills, then increasing the challenge is upgrading it.
If we apply this to sex, it would be thinking of the whole sexual encounter that you want to have and looking at what activities would be easy to start with.
For example, someone’s vision for an enjoyable sexual encounter might start with listening and dancing to music, slowly undressing each other, a massage, fingering, oral sex, and using a sex toy.
In downgrading this activity, you can start with ones that require less energy expenditure, provide more stability, or cause less pain. Using the example above, this could be using a sex toy and getting a massage.
Trial and error
Occupational therapists can give suggestions for ways to adapt sexual activity; however, there’s no way to know if these suggestions will work unless people try them out.
Trying out different positions and using modifications, such as pillows or wedges, can provide the feedback for what works and what doesn’t work.
Suggestions from people with disabilities almost always include embracing trial and error, having an open mind, and being curious.
Sex is an activity in which we can feel a lot of pressure to make it “go well,” so you and your partner can set an intention or goal about exactly what “go well” means in the context of reengaging in sex. For example, “go well” can mean “we laughed and had a good time,” “we tried something new,” or “we felt pleasure in our bodies.”
Get Reps In
Repeated experiences help to lessen the awkwardness of a new task and hone new skills. Applying this to sexual activity means, yup you guessed it, your homework is to have more sex!
When learning anything new or different, you practice it. You likely had to practice getting back to other occupations, such as cooking post-injury and learn ways to adapt. The same goes for sex.
Your first time might highlight some challenges and may even be a little stressful, but with talking through the challenges and trialing different approaches over multiple encounters, the sex is sure to get more fun and comfortable!