Achieving Sexual intimacy after a Stroke

Occupational Therapy and Sexuality

Occupational therapy (OT) addresses common ADL's such as bathing, feeding, grooming, dressing and toileting. However, you might ask yourself ... what about sex?  Well, you are in the right place, a specific performance area in the domain of occupational therapy is Sexual Expression. According to the American Occupational Therapy Association, sexual expression is defined as "engaging in desired sexual and intimate activities."(1) As OTs we are concerned with maximizing function in selected activities including sexually expressive activities.(2) OT practitioners can address client's sexuality needs by providing info on the effects of CVA(stroke) on sexual functioning and adaptive strategies.

What is happening to me?

Following your CVA, you may have noticed many changes in your sexual functioning such as:

Do not feel alone, many men and women have similar concerns about engaging in sexual activities following a CVA. If you are single, married, straight, gay, young or old this information is helpful in addressing an area most of us are afraid to discuss openly.

How does an OT address this issue?

The same way, we address other AIDL's... by analyzing the activity and simplifying it into sub-components that we can focus on during therapy. This is just a sample breakdown, lets look at a couple of sub-components.

Tactile: The ability to perceive and interpret the light touch of a gentle caress or deep pressure from a body massage. 

Olfactory: The ability to interpret odors/scents.

Helpful Hints for the person with a CVA

1. Lie on the affected side, to free the uninvolved side for touching, cuddling and for additional support.
2. Discuss with your partner on exploring alternate positions since it may be difficult for you to achieve certain positions.
3. Sex is not only the physical ... incorporate scented candles, oils or sprays, creams or lotions to stimulate the senses and heighten foreplay experiences.
4. In order to minimize on the. risk of skin breakdown, use bed linens that are softer and less irritating to the skin.
5. Have your partner give you a massage to relax spastic muscles.
6. Avoid strenuous activities before engaging in sex, keep an activity log throughout the day to determine which time of the day is suitable for you and your partner.
7. In the case of decreased vaginal lubrication, water based lubricants are highly recommended. Consult with your gynecologist for additional information.
8. Give yourself and your partner ample time to ensure lubrication and/or erection,
9. If you experience decreased hand control, your therapist can recommend using Velcro, straps or built up handles to improve handling on sexual devices.
10. Explore non- coital activities such as visual imagery, mutual masturbation or oro-genital stimulation.
11. Void before engaging in sexual activities to avoid accidents.
12. Consult with your physician if your medications are creating sexual side effects. Your doctor may be able to provide alternatives.
13. Most importantly, maintain consistent communication with your therapist and partner to verbalize any new concerns.

What can I look forward to in therapy?

While in therapy, your OT will devise a treatment plan that could include the following: 

1. Bed mobility training: Transitions including supine to sidelying and/or segmental rolling to facilitate appropriate positioning.
2. Neuromuscular facilitation techniques to effect normal movement patterns of the involved extremity and redistribute tone in areas of hypo/hypertonicity.
3. Weightbearing in sifting, standing, quadruped and other developmental postures to facilitate muscle co-contraction around weakened joints.
4. Sensory re-education to the affected extremity to improve sensory perception of tactile stimuli.
5. Activities such as ball toss to improve active range of motion and hand coordination
6. Fine motor activities such as stringing beads, peg board designs, or removing checkers from putty using 3 pt pinches in prep for manipulating sexual devices and other tools.

So ... where can I got more info like this?

American Heart Assn. 
1800-AHA-USA1  
www.americanheart.org 

Stroke Clubs of America 
805 Twelfth Street 
Galveston, TX 77550 
409-762-1022 

Sexuality and Disability Training Center, 
Boston University Medical Center, 
88 East Newton St., 
Boston, MA 02118, 
617-638-7358

(1.) AOTA: Uniform Terminology for occupational therapy- 3rd ad. Bethesda, MD, 1994 The Association.

(2.) Nikki Couloumbis, MS, OTIR/L: Providing Sexuality Interventions to the Physically Disabled and Older Adult Populations, 312001.

 Enjoy Safely!

Prepared by: Tracey-Ann Barclay, OTS   Columbia University, 
The Jamaica Hospital Medical Center, Division of Occupational Therapy  
July 30, 2001