Information For Health Professionals
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Roles and Responsibilities
Whose responsibility is it to broach the topic of sexual expression for clients living with a disability?
We all play a part in addressing sexual quality of life for people with a disability. The topic of sexual expression and self-pleasure requires a multidisciplinary approach due to the complexity of care required to address client’s needs in a holistic apporach.
Registered Nurse/Clinical Nurse/Clinical Nurse Consultant (RNs) - Address overall medical management and changes of sexual function for clients. They develop positive relationships with clients, with clear communication to develop and achieve client-based goals. RNs complete comprehensive assessments surrounding sexual expression and self-pleasure, while providing a safe environment to identify solutions to client sexual quality of life needs. RNs furthermore manage a client’s continence management in relation to sexual expression in a holistic approach. With the client’s guidance and in accordance to the client’s sexual expression goals, RNs further assist with the case coordination and communication between the other health professionals in the multidisciplinary team..
Occupational Therapist - Provides education on a wide range of areas addressing sexual expression and self-pleasure. This includes managing personal hygiene during sexual activities; adapting the external environment to aid sexual expression; adapting and providing sexual devices for altered function; assisting with routine development to address sexual expression or self-pleasure.
Physiotherapist - Addresses changes in physical function and sexual anatomy affected by clients condition. Physio's also provide education on skills such as positioning in bed, balance, managing muscle spasms and maximising comfort in sexual positioning.
Social Worker - Provides education and counselling for clients, partners and their families.
Psychologist - Assists with exploring emotional components of sexual expression.
Medical Doctor - Assists with maximising sexual physiology and reducing medical issues interfering with sexual function. Doctors provide education on components of the individual’s disability or possible complications that may occur due to the condition. Medical Doctors furthermore prescribe medications assisting with sexual expression.
Counsellor - Facilitates honest and open communication between partners surrounding sexual expression, issues, wants and needs. They can assist with the discussion of accepting new boundaries, expectations, and roles.
Sexologist - Facilitates honest and open communication about sexual behaviours, interactions and feelings, and assists clients to address issues about sexual expression to improve their sexual quality of life.
If you would like to connect with a health professional specialised in this field, we are here to support you!
Discussion About Sexual Expression
Issues in Professional Practice
Health professionals feel as though they have a lack of knowledge and skills in providing care in this area.
Research shows that clients feel unsatisfied with the support and information provided to them on sexual expression during their rehabilitation journeys.
Health professionals dismissing or ignoring the topic of sexual expression in practice reinforces to the client that sex is not something that people with a physical disability should think or talk about.
Tips and tricks on how to discuss the topic of sexual expression and/or self-pleasure
Please remember, it should not be the client’s responsibility to begin the conversation of how to experience sexual expression or self-pleasure.
Sex is considered an activity of daily living. It is just as important to one’s overall health and wellbeing as completing showering, personal hygiene, dressing or eating.
It is vital to ensure that you do not bring in your own personal biases or preconceived ideas into the session with your client.
How to use open communication to bring up the topic of sexual expression
Establish rapport and build the clients whole story with clients and family.
Establish a comprehensive sexual history (see below points to guide discussion and assessments and models further down this page).
Remember to ask the 6 Ps
Partners (sexual orientation)
Practices (oral, vaginal, anal, other)
Protection (from STIs)
Past history (of STIs)
Protection (from pregnancy)
Performance/ problems
Preparing for emotionally challenging discussions
Prepare the patient
Engage empathetically
Engage with optimism
Prepare the patient for future steps
Policies And Guidelines
Relevant polices and guidelines for health professionals
Policies and guidelines have been developed to ensure best evidence in practice is adhered too. If you’re unsure, please check out the following resources at the bottom of this page.
The clinical guidelines following a spinal cord injury address the following aspects providing care
Psychosocial aspects of sexuality.
Physical aspects of sexuality management - e.g., bladder and bowel management, sexual devices, autonomic dysreflexia and safe sex.
Sexual function with both men and women following SCI.
LGBTQ+ Awareness and good practice guidelines
Be aware that 1 in 10 people identify as LGBTQ+ While people who identify as LGBT+ may be using Occupational Therapy services for reasons unrelated to their identity, an inclusive approach is still required for good practice.
Consult the evidence: Utilise an evidence-based approach to practice and keep up to date with emerging evidence in relation to LGBTQ+ people.
Use Occupational Therapy theory and skills to be inclusive of the LGBTQ+ community
Take a client-centred approach LGBTQ+ friendly approach.
Be guided by the client Ensure you provide a safe space, respect confidentiality, and take a professional approach with people who identify as LGBTQ+
Use the correct terminology The correct terms to use when referring to LGBTQ+ clients are lesbian, gay, bisexual, or transgender, or their preferred term for their sexual orientation or gender identity. If you are unsure, ask your client in a respectful way.
Respect preferred name and pronouns
The family planning disability strategy identifies four key areas to better services, develop goals and provide an action plan on how to implement the changes in the following areas.
Partnerships with people with a physical disability
Reach and serve
Policies, laws and budgets
Research
Queensland sexual health strategy aims to address sexual and reproductive health concerns fundamental to one’s overall health and wellbeing. The sexual health strategy highlights the need for a positive and respectful approach to sexuality and sexual relationships practice, as well as the need of having pleasurable and safe sexual experiences, free of coercion, discrimination, and violence.
Australian Indigenous health strategy aims to address sexual and reproductive health matters with a focus on culture, traditions, customs and history in sexual quality of life for indigenous Australians.
Assessments And Models
There are multiple step by step tools available to aid health professionals to discuss the topic of sexual expression with their clients:
PLISSIT & EX-PLISSIT
The PLISSIT model guides current practices in healthcare on the inclusion of sexuality in clinical conversation and provision of sexual intervention. This model identifies four levels of intervention:
Permission where the practitioner provides a safe and comfortable environment for their clients to bring up sexual health concerns and provides permission to be sexual, to desire sexual activity and discuss sexuality.
Limited Information where practitioners discuss normal and abnormal sexual functioning information in relation to the client’s identified concerns.
Specific Suggestion where practitioners begin to provide recommendations that will help with client’s specific sexual functioning concerns.
Intensive Therapy interventions may require a greater level of knowledge, training and skills and practitioners may refer to specific health professional at this stage.
The Ex-PLISSIT model builds on the PLISSIT by emphasising the importance of permission-giving at all stages, with explicit permission serving as the model's core component (Taylor & Davis, 2007). Another Ex-PLISSIT model extension encourages a learning cycle of reflection and evaluation, initially with client interventions and then with practitioner practices.
BETTER Model
The BETTER Model was created to assist oncology nurses in discussing sexuality with their patients. This approach can also be applied by other health professionals to guide discussions with clients about sexuality.
B- Bring up the topic of sexuality with your client when discussing other issues regarding ADL competence. This provides assurance that the topic of sexuality is acceptable to discuss.
E- Explain you are concerned with quality-of-life issues, including sexuality. This normalises the topic of sexuality, you may also want to convey that patients can talk about any concerns they have.
T-Tell patients that you can support them with appropriate resources and support through scheduled Occupational Therapy sessions to address their concerns. Or you can refer to other health specialists if required.
T-Timing might not seem appropriate now but acknowledge that they can ask for information at any time. You should provide assurance to your client, that they can ask for information at any time.
E- Educate clients about possible changes they may experience in sexual functioning as a result of diagnosis and/ or treatment.
R- Record your assessment and interventions in patients’ medical records.
Recognition Model
This model emphasises a multidisciplinary approach to care in order to assist service users' sexual health. The concept acknowledges that people with disabilities have the same desires and sexual interests as everyone else
WHODAS
A generic assessment instrument, applicable across adult populations for all conditions to produce standardised disability levels and profiles. Directly linked at the level of the concepts to the International Classification of Functioning, Disability and Health (ICF) addressing 6 domains of functioning including: Cognition, Mobility, Self-care, Getting along, Life activities and Participation.