Let’s talk about sex, occupational therapist says

(Photo: DoD)

Even under the best circumstances, talking about sex can be difficult. Imagine, then, how service members who’ve experienced a physical or psychological injury might feel about the topic. Helping wounded warriors address sex and intimacy is the mission and – pardon the expression – the passion of Kathryn Ellis.

“The cultural stigma that it’s not OK to talk about sex runs really deep,” said Ellis, an occupational therapist at Walter Reed National Military Medical Center in Bethesda, Maryland. Health professionals may avoid the subject because they don’t feel either competent or confident to deal with it, she added.

“Maybe they feel like they’re not allowed to bring it up, or it’s not appropriate, or the patient doesn’t want them to,” she said. “But we need to treat sex and intimacy as any other valued conversation we have with service members.”

Ellis has been working at Walter Reed Bethesda since 2011. “She’s very knowledgeable on this topic,” said Laurie Lutz, chief of training, education, and simulation at the Extremity Trauma and Amputation Center of Excellence (EACE) at the Defense Health Headquarters in Falls Church, Virginia.

“She’s the one we reach out to for clinician education,” Lutz said.

EACE was the primary sponsor of this year’s Federal Advanced Amputation Skills Training symposium, which brought together health and wellness experts throughout the Department of Defense and Veterans Administration to communicate best practices in caring for wounded warriors and others with limb loss. Amputation is a catastrophic event causing impaired mobility and possibly secondary health and psychological issues, Lutz said.

Ellis was one of the featured speakers at the symposium. During her presentation, she paraphrased pioneering sex researchers Masters and Johnson: “Absence of sensation doesn’t mean absence of feelings. Inability to move doesn’t mean inability to please. Inability to perform doesn’t mean inability to enjoy. Loss of genitals doesn’t mean loss of sexuality.”

Along with holding a master’s degree in occupational therapy, Ellis is certified in sexuality counseling from the American Association of Sexuality Educators, Counselors, and Therapists. But this certification isn’t required for OTs to address intimacy, she said.

“Occupational therapy focuses on the physical, cognitive, and emotional components of the activities humans find meaningful,” she said. “Successful rehabilitation is resuming satisfying experiences in valued life occupations, including sexual activity and intimate social participation.”

At Walter Reed Bethesda, sex and intimacy is addressed in occupational therapists’ standard evaluation of clients. “We bring it up to identify particular concerns and needs, and then get clients connected with the services they might need,” Ellis said.

Other professionals may be brought in, including physical therapists, urologists, and behavioral health providers. Wounded warriors may face physical and psychological issues that can impact intimacy and sex, including bowel and bladder dysfunction, decreased energy, loss of sensation, memory problems, and poor self-image.

“A key focus is to improve our clients’ self-awareness and confidence so they can communicate more effectively what they desire in an intimate relationship or during a sexual encounter,” Ellis said.

And that’s important, she said, because positive intimate and sexual experiences lead to an overall better quality of life.

“I always encourage OTs and other health care providers to look at intimacy and sex from a wellness promotion point of view,” she said.

Ellis said sex and intimacy after physical or psychological injury may be more complicated than before the injury, and it’s certainly different.

“But I do think it’s possible that it can be better,” she said. “Our goal as occupational therapists is to give wounded warriors skills they can utilize as they recover to help them maintain positive sexual encounters and intimate relationships throughout their lifespan. And that’s the true success of OT intervention.”

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