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Tag Archive for: sexuality


Intimacy Following Injury or Illness

Sexuality is an incredibly important part of being human. Yet, when we are injured, ill, or suffering from physical, cognitive, emotional or behavioral difficulties, this too can suffer.

The following article, care of the Neurology Centre of Toronto, discusses some commonly reported sexual issues that occur after brain injury.  If you have issues with sexuality after an injury or illness, know that this can be common and can be improved.  Contact an Occupational Therapist, we can help.

Neurology Centre of Toronto:  Sex after Brain Injury: What does this look like for me?


Breaking the Stigma: Sexuality and Disability

Julie Entwistle, C.Dir. (c), MBA, BHSc (OT), BSc (Health / Gerontology)

Co-written by Lauren Halliwushka, Occupational Therapist

Unfortunately, in the ongoing quest for an inclusive and equal-opportunity society, “sex” still sells. What used to be in printed material (magazines, newspapers, and fliers) has turned into an online buffet of images that are posted by people of themselves (often filtered, patched and “enhanced”), by people of others (with and without consent), and by photographers, companies and others whose job is to capture the attention of, and entice millions of people, to buy a product, service or idea. The goal of these “sexy” images is to tap into our intrinsic human need and desire for sexuality by adhering to the societal expectations of what is attractive. 

It has only been in the last few years that the concept of “attractive” is changing. Models are increasingly featured in many different shapes, sizes, ethnicities and some campaigns (thank you Dove) are about “natural” beauty.  But despite this small move in the direction of selling with images of “various types of people” presented as “real”, there is one more similarity in advertising that we often overlook. The models are able-bodied, or to use a totally arbitrary term, they would be considered “normal”. 

Why then do we rarely see individuals with disabilities featured in sexually enticing advertisements? It goes back to society’s assumptions of what beautiful and sexy is. Disabled people, through their history of being marginalized, institutionalized, segregated, or otherwise pitied have not been routinely associated with ‘attractive” as a concept. We need to work together to continue to change this perception and to remove the stigma.

Individuals with disabilities are sexual beings. Like you and me, they also have urges, desires, needs, and fantasies. However, a subset of the general population doesn’t think so. According to a systematic review of qualitative articles, a prominent misconception among a sample of the general public is that individuals with disabilities are asexual. Biologically this is odd because individuals with disabilities undergo the same maturation processes as everyone including puberty, reproduction and hormonal surges. Yes, approximately 1% of individuals are asexual but this is all people, not just those with disabilities. Another common misconception is that individuals with disabilities are only attracted to other individuals with disabilities. Inter-abled couples do exist, and relationships can form before or after a disabling event. Compared to inter-racial couples, however, inter-abled are not as common. Why? Well, it is thought that individuals with disabilities may be unconsciously internalizing the stigma and perspectives of society, which further negatively impacts their self-esteem, self-efficacy, motivation, and perceived sexual autonomy. This claim is supported by a qualitative study that gained the perspectives of individuals with disabilities on the topic of sexuality. A significant theme that emerged is the innate belief that their sexuality was not equal to or desired by individuals without disabilities. As such, they were reluctant to pursue inter-abled relationships due to fear of rejection, the partner resenting their disability and the possibility of the partner falling into a caregiver role.

In addition, stigma unknowingly creates various systemic barriers that further reinforce societal and self-stigma among individuals with disabilities, creating a negative counter-productive cycle. There is plenty of literature that highlights the ineffectiveness or inaccessibility of sexual education within secondary schools for individuals with both visible and invisible disabilities. Sexual education focuses on “normal” (that ugly word again) people. Hence, from a young age, we are setting up individuals with disabilities for failure by reinforcing self-stigma and neglecting to acknowledge their sexual being.

Regarding the healthcare system, a study suggests that only 6% of licensed health care professionals engage in frequent discussions about sexuality with patients/clients with half of them stating they avoid the topic due to embarrassment. Keep in mind, this statistic is regarding all individuals, disability or not, which is even more surprising given that sexuality is a crucial component of someone’s health and – more importantly – intrinsic to human nature. No wonder individuals with disabilities are adopting self-stigma if health care professionals shy away from this topic.

This is not about changing what you see as attractive. This is about challenging the opinion that individuals with disabilities are not capable of being sexy and can’t (or shouldn’t or don’t) engage in sexual behaviors. Not only are all people, disabled or not, able to engage in any and all sexual behaviors, but they also have wants, needs and desires like the rest of us. Healthcare professionals that shy away from, or avoid, this topic should consider discussing this aspect of health with patients/clients when appropriate by adopting a comfortable strategy (such as the ex-PLISSIT model).

If you have personally felt, or still feel, the self-stigma surrounding sexuality, please discuss it with a trusted family member, friend or healthcare professional. Specifically, Occupational Therapists are trained to be open about this concept and to problem solve the barriers to sexuality and engagement in sexual activity as a very important “occupation (aka life role)” for all of us.

If you are interested in reading more, I recommend The Ultimate Guide to Sex and Disability by Dr. Miriam Kaufman.

Remember: Disability is extremely broad and can impact people in multiple ways. As with all people, consent is always required when engaging in any sexual activity.




1 Sinclair, J., Unruh, D., Lindstrom, L., & Scanlon, D. (2015). Barriers to Sexuality for Individuals with Intellectual and Developmental Disabilities: A Literature Review. Education and Training in Autism and Developmental Disabilities, 50(1), 3-16. Retrieved June 18, 2018.

2Miller, A. M. (2015, May 4). Asexuality: The Invisible Orientation? Retrieved from

3Esmail, S., Darry, K., Walter, A., & Knupp, H. (2010). Attitudes and perceptions towards disability and sexuality. Disability and Rehabilitation, 32(14), 1148-1155. doi:10.3109/09638280903419277

4McDaniels, B., & Fleming, A. (2016). Sexuality Education and Intellectual Disability: Time to Address the Challenge. Sexuality and Disability, 34(2), 215-225. doi:10.1007/s11195-016-9427-y

5Jones, L., Bellis, M., Wood, S., Hughes, K., McCoy, E., Eckley, L., . . . Officer, A. (2012). Prevalence and risk of violence against children with disabilities: A systematic review and meta-analysis of observational studies. The Lancet, 380, 899-907. doi:10.1016/S0140-6736(12)60692-8.

6Dukes, E., & McGuire, B. E. (2009). Enhancing capacity to make sexuality-related decisions in people with an intellectual disability. Journal of Intellectual Disability Research, 53(8), 727-734. doi:10.1111/j.1365-2788.2009.01186.x

7Haboubi, N. ,. J., & Lincoln, N. (2003). Views of health professionals on discussing sexual issues with patients. Disability and rehabilitation, 25(6), 291-296

8 Taylor, B., & Davis, S. (2006). Using the Extended PLISSIT model to address sexual healthcare needs. Nursing Standard, 21(11), 35-40. doi:10.7748/ns2006.


LGBTQ+: Three Strategies to Make Your Business More Inclusive

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)
Co-written by Jacquelyn Bonneville, Occupational Therapist and proud member of the LGBTQ+ community

Have you ever been on vacation to Jamaica, Dominica, or St. Lucia? Have you ever Googled pictures of the beautiful Maldives? Did you know that all of these countries, and some 70 others, have anti-homosexuality laws punishable by fine, imprisonment, or death? Globally we still have a long way to go, but like all progress, we must remain proud of the steps forward we are taking in regards for Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ+) awareness and rights.

Pride month is celebrated in June in every year in honour of the 1969 Stonewall riots in Manhattan, USA; a turning point for LGBTQ+ activism. If you don’t identify with this culture you may not feel that pride month is relevant to you, however, the spirit of pride month is to embrace diversity and peace, which all of us should celebrate, especially as proud Canadians.  This point, and the concept of peace, is even more prominent today considering the 2016 events in Orlando that resulted in the senseless killing of 49 innocent people as they attended a nightclub frequented by the LGBTQ+ community.

In honour of pride month, we’d like to offer 3 simple ways you can make your business more LGBTQ+ friendly:

 1.  Challenge Your Assumptions

It can be easy to assume that everyone is straight; when you ask a man if he has a wife, or a woman if she has a husband, you could be unintentionally making an awkward scenario for a non-straight person. If you have an intake form that only has two gender options (male or female), you could be instantly excluding someone or causing them to feel uncomfortable about your services.

As therapists, we are often in a position of asking about our client’s social supports. Instead of making assumptions, ask more open-ended questions such as “Are you in relationship with someone right now”, “who is your main source of support”, or “do you have a significant other?” Have an “other” option for gender on intake forms, or include sex as well as gender if someone’s sexual organs are relevant to your medical field. Consider expanding “married” on your intake process to include “common law” and “long term relationship”.  You’ll still get the information you need, but in a more inclusive way.

2.  Don’t be Afraid You’ll Use the Wrong Terminology

My husband’s name is Kelly.  Many times people have assumed he would be female:  he has been put on the girls’ draw in tennis tournaments, rendered us to win the prize for the “ladies best foursome” in a golf event, and often our mail and solicitation calls are directed to Mrs. Kelly. We’ve all called someone by the wrong name/gender accidentally before. It’s embarrassing – usually, they correct us, we apologize, and chances are you’ll never forget their name again. It happens, but in the grand scheme of things, it isn’t a big deal.

Gay, lesbian, queer, bisexual, bigender, cisgender, gender fluid, asexual, feminine/masculine of center, intersex, MSM/WSM, pansexual, trans*, two-spirit, ze – what does it all mean? If you are not part of any particular minority group, it can be difficult to know if you’re wording something ‘correctly’ and it may make you uncomfortable. You may even be afraid to offend someone – isn’t ‘queer’ an offensive term? It all comes down to individual preference – and you won’t know until you ask.

Instead of assuming a person is Sir or Ma’am, Mr. or Mrs. based on your assumption of their gender, get used to asking more inclusive, generalized questions as part of your daily routine. There is nothing wrong with asking a client/patient, “What’s your preferred name?” or “How should I address you?” And if you slip and use the wrong pronoun or term in addressing them, simply apologize, correct yourself, and move on. Besides, a good businessperson should have a healthy dose of humility – your clients will respect you more for trying to use their preferred terminology, even if you make a mistake. Don’t worry.

3.  Understand Some of the Systemic Barriers LGBTQ+ Persons may Face in Your System 

Knowledge of some of the challenges in your own business that directly affects persons of various sexual orientations and genders will only make your business more inclusive. Some questions that may be relevant to health care professions include:

  • Can a bisexual person donate blood in your city?
  • Is a transperson legally able to give emergency medical consent if their loved one is unconscious?

Will a queer person be safe in a shared hospital room if their partner comes to visit them?

Health care isn’t as easily accessible as you may think. It can be very challenging to find competent medical and rehabilitation practitioners that are educated on health factors more common in certain minority populations, and so not all people feel they can be open with their family doctor or access health care without judgment. Knowledge is power – keep an eye out for changing laws, trends, or factors affecting the LGBTQ+ population in your area.

In the end, consider adopting some of these strategies into your everyday life, and you’ll be making maximum impact with minimal effort. To quote a Futurama cartoon episode:  “When you do things right, people won’t be sure you’ve done anything at all.”

No one may notice you changed your language, or thank you for making the change – but to that client who needs to know that they’re safe with you, I guarantee you that your choice of inclusive words will make all the difference.

As Occupational Therapists we are lucky to be able to assess our clients holistically and to consider all of the factors that may be affecting their occupational performance including sexual orientation, gender, sex, and social support networks. We can constantly challenge our assumptions to help develop into even better practitioners.

Happy Pride Month!

Originally posted June 2016



The Occupation of Sexuality…

Recently on our blog we discussed the important occupation of sexuality in our post: “Occupation Is: Sexuality.” As issues of sexual dysfunction, or impaired intimacy, can be common for people with disabilities, we wanted to share a valuable resource that addresses just that: The Rose Centre. “The Rose Centre is a charitable organization that focuses on positive representations of love sex and disability. We recognize the multiple barriers to participation in love sex and relationships for disabled people and the lack of positive discussion around disability and sexuality. We also believe that sex and relationships can be fun and enjoyable for anyone. The organization provides programming and events which support this mission and that are open and welcoming to everyone.”

We encourage you to check out their programming and use this resource if and when you need it.