Living with a disability, regardless of severity, often comes with regular contact with health services and allied health support. These supports are usually focused on maintaining health and supporting people with disabilities to maintain their ability to complete routine daily tasks. But one aspect of this often overlooked in health care is discussions about our relationships and intimacy.  

Social relationships, especially intimate ones, come with a range of health benefits including enhancing quality of life, better emotional wellbeing, more favourable mental health, an increased sense of belonging, stronger self-worth, and lowered stress (Friedman, 2018). People with a disability have the same desires for intimate friendships and romantic relationships as anyone else, but can often be limited in their ability to explore their sexuality due to barriers that make this more difficult, including limitations in social opportunities and networks, the stigma associated with disabilities in the wider community, a lack of access to sexual health services, physical challenges such as pain and fatigue, changes in relationship dynamics for partners now providing a caregiver role, as well as privacy or freedom to express their sexuality (Friedman, 2018) (BetterHealth Channel, 2023). So where do you start? 

There are many health services available in the community to help address these challenges, but knowing how to find them or where to begin is often another challenge in itself.  

Occupational Therapists are health professionals that specialise in supporting people to ensure they maintain the ability to engage in meaningful activities. This is inclusive of supporting people to complete daily self-care tasks such as showering and other personal hygiene, eating, as well as household tasks such as shopping, meal preparation, medication management, and a range of other daily tasks. This often involves looking at rehabilitative methods to support people to build their skills, changes to the environment to support participation, as well as the use of assistive aids and assistive technology, and these concepts can also be applied to engaging in sexual relationships and intimacy. It is a conversation that Occupational Therapists are perfectly situated to explore due to our training in addressing person specific goals and outcomes, task analysis, understanding of physical health and sensory processing, working with neurodiverse populations, and looking at adaptation and modification of tasks where necessary. 

While not every Occupational Therapist may be best equipped to help address challenges with sex and intimacy, having the conversation can usually be the first step in helping you seek the right support needed to address these challenges, and support you in finding the right professional for your needs. Should you not have access to any professional support, or don’t feel comfortable having this discussion with your care team, there are many other good starting points for people to access information to guide them through their health journey, including the following: 

Facebook groups (closed groups for privacy) 

  • Sexuality and Disability Support Group 
  • Disability and Sexuality 
  • SexAbled 
  • Sexual health for women with disabilities and chronic illness 
  • Disability – Inclusive Sexual Health Network 

Online Blogs: 

  • XES Products 

https://www.xesproducts.com.au/blogs/news 

  • Occupational Therapists for Sexuality and Intimacy 

https://www.otsi.com.au/blog 

  • Institute for Sex Intimacy and Occupational Therapy 

https://www.sexintimacyot.com/blog  

  • Shantelle Otten – Psycho-sexologist 

https://chantelleotten.com/blog/ 

Podcasts: 

  • OT After Dark 
  • The Spicy Boudoir 
  • Disability After Dark – Andrew Gurza 
  • Stroke Foundation – Young Stroke Podcast (dating after stroke) 

Websites: 

  • Sexual Education Counselling and Consultancy Agency (SECCA) – support for people with disabilities to learn about relationships, sexuality, and sexual health. 

https://www.secca.org.au/ 

  • XES Products – online sex toy store with a focus on empowering individuals physical, cognitive and sexual health conditions. 

https://www.xesproducts.com.au/ 

  • Queensland Health – Sexual health information including public health information and sexual health services available in Queensland 

https://www.health.qld.gov.au/clinical-practice/guidelines-procedures/sex-health 

  • Pleasurable – Sexual device manual for persons with disabilities 

https://facingdisability.com/resource/pleasure-able-sexual-device-manual-for-persons-with-disabilities 

Article written by,

Max Walton
Occupational Therapist

There are many important components to a healthy lifestyle, one of which is completing daily physical activity. This may look different for everyone, depending on their hobbies, occupation and interests, however regardless, it is vital for assisting to reduce the risk of chronic disease, improve mental health and enhance overall wellbeing. In some instances, further guidance on physical activity is required to assist with management of injury, chronic conditions and pain, which is where allied health professionals such as physiotherapists and exercise physiologists come into play.

The professions of exercise physiology and physiotherapy ultimately both have a common goal of improving movement and physical rehabilitation, however they each have varying areas of training and use unique methods of approach to your care. The following article will explore the primary differences within the professions, and which one may best benefit you.

Physiotherapy is a healthcare profession that at its core, aims to restore movement and function to people with pain, injuries, illnesses and disabilities. Physiotherapists may assess and diagnose musculoskeletal injuries and conditions, in addition to treating chronic diseases and neurological disorders. They often utilise a mixed-method approach consisting of exercise, education and manual therapy to assist their patients to have a greater quality of life and achieve their goals.

Physiotherapists use a variety of techniques to help their clients recover from injuries and manage chronic conditions. These may include:

  • Manual therapy: This involves hands-on techniques such as massage, joint mobilization, and dry needling to reduce pain, improve range of motion, and restore tissue function.
  • Exercise therapy: physiotherapists prescribe specific exercises tailored to each person’s needs and goals. These exercises may focus on strength, flexibility, balance, or endurance, depending on the individual’s condition.
  • Education and self-management: physiotherapists also provide education on how to manage pain, prevent re-injury, and maintain overall health and wellness.

When can a physiotherapist assist you?  

Physiotherapy can be helpful for people with a wide range of conditions, including:

  • Musculoskeletal injuries such as back pain, sprains, strains, and fractures
  • Vestibular rehabilitation
  • Sports injuries
  • Neurological conditions such as stroke, Parkinson’s disease, and multiple sclerosis
  • Chronic pain conditions such as fibromyalgia or arthritis.

Exercise physiology is a field that focuses on the physiological and metabolic responses to exercise and physical activity. Exercise physiologists use scientific principles to design exercise programs that can improve fitness, manage or prevent chronic disease and disability, and enhance performance. They work with people of all ages and abilities, from sedentary individuals to elite athletes.

Exercise physiologists use a variety of tools and techniques to assess physical capacity, design exercise programs, and monitor progress. These may include:

  • Goal setting and Assessment: exercise physiologists use muscular strength, cardiovascular, balance, mobility, confidence and self-efficacy assessments to evaluate and monitor a person’s physical capacity and identify areas for improvement.
  • Exercise prescription: Based on the assessment results and the person’s goals, exercise physiologists design holistic personalised exercise programs that target specific fitness components such as cardiovascular endurance, muscular strength, joint range of motion, flexibility, balance and mental health.
  • Coaching and motivation interviewing: exercise physiologists provide guidance, support, and feedback to help people adhere to their home exercise programs and achieve their goals.
  • Education: exercise physiologists also provide education on topics such as pain, stress management, and lifestyle modifications to help people optimise their health and well-being.

When can an exercise physiologist assist you?  

Exercise physiology can be helpful for people who want to improve their fitness, prevent or manage chronic disease, improve ability in activities of daily living, pain management, and receive support in exercise adherence to achieve their goals and manage setbacks.
You may consider seeing an exercise physiologist if you:

  • Want to increase your physical activity or start an exercise program but don’t know where to begin
  • Are recovering from an injury or illness and want to regain your physical function
  • Want to prevent or manage disability and chronic conditions such as obesity, diabetes, heart disease, neurological impairment, cancer, pulmonary conditions, age related strength and joint related changes and chronic musculoskeletal pain and injury
  • Have a specific goal such as improving mobility, increasing independence in activities of daily living, participating in old or new sports or leisure activities.

An exercise physiologist can help you design a safe and effective exercise program that is tailored to your needs and goals. They can also provide ongoing support and education to help you stay motivated and on track.

Key Differences between Physiotherapy and Exercise Physiology  

While Physiotherapy and Exercise Physiology have many similarities, there are several key differences between the two professions.

  1. Manual therapy: physiotherapists may provide ‘hands on’ treatment to provide massage, mobilisation, joint manipulation and dry needling. Whilst exercise physiologists have a focus on ‘hands off’ active treatments in the form of exercise programs and education.
  2. Timeline of injury/treatment: physiotherapists often treat the acute and subacute stages of injury, providing a diagnosis alongside their initial treatments, which may include manual therapy and exercise for restoring function and addressing pain. Exercise physiologists primarily focus on subacute to long term rehabilitation by providing targeted exercise interventions aimed at facilitating return to full function or patient self-management.
  3. Long-term behaviour and preventative health: exercise physiologists are frequently engaged for preventative health, providing targeted exercise and advice for those at risk of chronic disease, injury and mental health disorders. They are also skilled in facilitating long term behaviour change, by encouraging self-management through exercise and lifestyle modifications.

Physiotherapy and exercise physiology are both important fields that focus on improving physical function and well-being. While there are some similarities between the two professions, there are also some key differences in their scope of practice and treatment approaches. If you have an injury or chronic condition, seeking the advice of a qualified physiotherapist or exercise physiologist can help you manage your condition and improve your overall health. Additionally, by working together collaboratively, these two fields can provide a comprehensive approach to rehabilitation and return of function.

Article written by,

Kadell Pearce
Physiotherapist
BExSci M.Phty

Rachael Lear
Accredited Exercise Physiologist
BExPhysiol(Clin)