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Sex and Sensory Dysfunction

Adults can see occupational therapists too—but not usually about their sex lives. I did find one article, dated March, 1980: "Treatment Model: Occupational Therapy for Sexual Dysfunction" by Evelyn M. Andamo (Sexuality and Disability, Vol. 3, Number 1, March, 1980). (It costs $34.00 to order off the internet and one day, when I’m feeling flush, I’ll spring for it.) However, I can tell you what the abstract says, “occupational therapists should also look into the patients' management of sexual activities in the resumption of their sexual roles. It presents the need for the patients' sexual function to be evaluated and dealt with as a legitimate part of the occupational therapy service. Thus, a conceptual treatment model is described in order that occupational therapy may assist patients in resolving, or adapting to, their sexual dysfunction.”

My guess, based partially on the age of the article, is that the treatment model might be a little thin on sensory integration issues and is probably focused on more obvious physical disabilities. In any case, it would be interesting to know how the occupational therapy community responded to this pioneering call for action.

I began thinking about sensory integration and sexual behavior when I began researching Asperger’s Syndrome and sexuality. I almost cried “bingo!” when I read this statement from one of my respondents: “Sensate focus exercises useless because of sensory integration issues in my aspie ex.” Sensate focus is a sex therapy staple and works pretty well for a lot of people, as these exercises are based on an incremental approach to improving intimate communication and pleasure. But the exercises presume a capacity for normal sensory functioning. I wonder how many sex therapy “failures” are due to unrecognized sensory dysfunction? I feel strongly that we need some really good alternative therapy designs, options, and tools to deal with ASSD (remember, for the purposes of this article, that acronym stands for “adult sexual-sensory dysfunction”). At the very least, we need a marriage between clinical sexology/sex therapy and occupational therapy.

I have my ideas about the dream team of experts I’d pull together to explore and design some alternative therapy approaches. Let’s see if I can make this list seasonally appropriate (everybody sing!):

When I wrote my grant proposal, the funder gave to me:

Cash that totals up to $10 G...

When I wrote my grant proposal, the funder gave to me:

Two sexy colleagues

And cash that totals up to $10 G!

When I wrote my grant proposal, the funder gave to me:

Three graduate students

Two sexy colleagues

And cash that totals up to $10 G!

(I’m not going to type the whole thing out, so you just sing along with what the funder gave.)

Four autism experts

Five hot OTs!

Six doms a flaying (note: I’ll explain later)

Seven mummies laying (ditto!)

Eight maids a milking (ah... but milking what?)

Nine tantrikas gazing

Ten lords a leaping (think: major donors!)

Eleven surveys humming

Twelve focus groupings...

(All with cash that totals up to $10 G!)

Sexual-sensory dysfunction absolutely requires a multi-disciplinary focus. “Sexy colleagues” are, of course, sexologists and sex therapists, vital, sex-positive leading members of the team. Graduate students are self-explanatory (and let them have fresh and nimble minds!). The autism experts are necessary because the autism/Asperger’s Syndrome community does recognize something of the quandary that teens and adults are in with regard to sexual intimacy, and the relationship of sensory issues to these difficulties. (I’ll be writing more about Asperger’s later this month.) The occupational therapists (OTs) are crucial—they have the practical insight and expertise based on deep knowledge of how the body works and how it can heal. “Eight maids a milking”—what I wouldn’t give for a team of well-trained, multi-disciplined surrogates! The tantrikas represent a community that can also offer vital skills and insights (subtle body sex, anyone? It’s easy on those who are tactile hyper-sensitive...). And of course the surveys and focus groups provide quantitative and qualitative data.

Now for the doms and the mummies. Dear ones, hold on to your weighted sensory belts, which enhance proprioceptive feedback, and tuck yourself into your specially designed compression shorts and vests. I am about to deliver an interesting thesis. I believe a number of folks involved in BDSM have found brilliant and happy ways to provide processes equivalent to what one website describes as “stimulation of the ‘near’ senses (tactile, vestibular and proprioceptive)” which “leads to the growth of the neuron cell's dendrites and synapses” (quotes taken from a statement by Carol S. Kranowitz, M.A., a specialist in this field). The website says “a sensory diet includes a combination of alerting, organizing, and calming techniques that lead directly to the 'near' senses.” If that’s not a nice, functional description of the benefits of subspace, I don’t know what is!

Bondage, mummification, all types of sensory play, just to name the merest few, all can be put to good use for someone who craves grownup help in processing the near senses, erotically or otherwise. This strikes me as an elegant solution for many. However, not everyone with SID is attracted to BDSM or kink, or if they are, not everyone can manage the rigors of entering a crowded play space, conducting conversation and negotiating a scene in a noisy environment, or keeping focused while breathing rubbing alcohol fumes (which happens when equipment is cleaned). And so I have a strong hunch that some of the hypersensitive folks find their way to prodoms and sex workers, who must surely have insight into client sensory integration issues (even if they haven’t identified some client quirks as such). I’d like to hear from them.

I mentioned people with SID who may not be attracted to BDSM or kink—who may be trying to manage their sexual needs and relationships within a more vanilla or Western Judeo-Christian traditional context. There is not much for them. Requests they make for accommodation (“Honey, can we have sex under the weighted blanket, please?”) may not be understood, appreciated, enjoyed, or honored. These requests may seem “kinky,” simply because they are unusual, and as we all know, many people are afraid of sexual behavior that seems “abnormal.” I strongly advocate developing some alternative “vanilla” sex therapies for those in the SID crowd who need them.

I do understand that most professionals and concerned family members who are involved in occupational therapy; autism/Asperger's; and sensory integration dysfunction issues will be appalled at this expanded view of sexual behavior that is not only “okay” (in spite of the DSM-V and all prior incarnations) but also downright therapeutic, at least for some. This points to an even greater need for sexologists to reach out to other communities sincerely striving to improve quality of life for people who “don’t fit,” but who forget that pleasure, sex, and intimacy are hugely important to determining a person’s quality of life.

The upshot is, while professionals and family members spar over values, morals, and “normal behavior,” that little girl who screams at the touch of playdoh may grow up to need a “sensory diet” of mummification to be happy and functioning in her intimate life. That little boy who is visually overly sensitive may grow up to need a mask or blindfold when sensory stimulation (like sex!) threatens to overwhelm him. Will their partners, family, and friends understand these needs, or will these grown children be shamed or excluded from community? I certainly don’t think anyone needs a therapeutic “excuse” to enjoy BDSM or even sex in crotchless compression shorts (if such things don’t exist, we must certainly invent them!), but wouldn’t it be great if we could talk about sexual challenges with grownups who experience ASSD, and then round up a bunch of really knowledgeable multi-disciplinary folks who then—without bias, and with tremendous compassion and understanding—create appropriate, effective therapies for adults with sexual-sensory dysfunction? 

If you’re interested, you can find a sensory processing checklist for adults at:

This website included much information that was helpful to me:

I also recommend Asperger's Syndrome and Sensory Issues: Practical Solutions for Making Sense of the World by Brenda Smith Myles et al.

In the meantime, Santa, I’ve been good. “Ten major donors leaping” would make my day. I’d do some very nice things with their money.

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Amy Marsh
December 9th, 2009
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As Carnal Nation's wondrous publishing spree sinks slowly into the sands of time, I invite you to scroll down for links to all my "Love's Outer Limits" columns - a year's worth of weekly writing -...