Sexual expression – a need for everyone!

As I live and work in Sweden where it’s prohibited to pay for sexual services (but not sell them) I have been positively forced to be comfortable to act outside “the box”. I believe that healthcare professionals in Sweden have avoided the question of sexual expression as their training does not include sexology. In other countries where sex workers are a part of society, health care professionals can refer people who have challenges in their sexual expression to a sex worker. While sex worker referrals can be a viable option it should be based on adequate professional assessment of the client’s abilities as well as needs, and not just as a simple way out of one’s comfort zone.

How do we express ourselves sexually, alone or with others, and how will bodily differences impact upon our possibilities to have sex in the way we desire?

Regardless of what one likes to do alone or with others certain body postures and positions will be needed, for example, a limb to reach a certain part of the body, which requires manipulation to a certain and wanted degree. In other words, your body, head, shoulders, trunk, pelvis, legs, feet, arms, hands and fingers follow your brain’s commands or nerve instructions. If these commands are in any way disconnected or affected one may need assistance or help to compensate for this.

In my work I have found this to be an activity challenge more than a sexual challenge.

It’s definitely a challenge within sexual health but not the main issue for the majority of my clients. When asked, they do not have any issues with the actual performance of sex or their sexual expression but they have great difficulties to reach the space needed for performing or expressing their desired sexual activity. As an occupational therapist my work is primarily focused on finding solutions to posture-related challenges as well as helping people to become autonomous in sexual activity, which many people don’t think of the “How” as much as the “What”.

Many of my clients have physical disabilities, pain and/or fatigue and their problems are often related to limitations in reach and/or manipulation, alleviating pain or discomfort and conserving energy. 

When I meet a client for the first time I’m open and very clear about sexuality and sexual health being Ok to speak about – but it’s their responsibility to ask the questions. My work at BOSSE deals with every aspect of life that can pose a challenge or difficulty, whether it’s related to one’s financial situation, work, social security, technical aids, transport, or any other aspect of life – including sexual health.

When sexuality-related issues are raised, I analyse what the person can do and want to do, and what aids the person has at home that could be useful – or even looking at everyday objects that could be used as aids. The main difficulties that come up is with transference, positioning, manipulation, calibration and communication – occupational therapy in its essence.

Examples include reducing friction as a way to conserve energy and moderate pain and re-thinking where to have sex, since pain and constricted movement can be worsened by using a bed. The client and I may explore options such as staying in the wheelchair, trying the dining room table, using a lift as a sex swing, and adapting sex aids for use without assistance. We also talk about rethinking sexual expression, learning new techniques and having an OT as a problem solver to adapt techniques to become more self-sufficient. Other examples are positioning with or without technical aids to ease reach and accessibility to another person or a sexual aid, manipulating toys or aids and learning how to calibrate less or more pressure to achieve adequate stimulation from it – and above all communication. Communicating adequately with yourself to be aware of touch, place on body, feelings and sensation when applying new techniques, and communicating with others about what you need and desire. Often, we need to broaden and penetrate (excuse the pun) with more in-depth questions about what the challenges entail. 

Best regards to all

Stefan Balogh, Occupational therapist/sexologist

Bosse advice, support and knowledge center since 1981.

Stockholm, Sweden