By: Morgan Golcekar, MPH, OTAS

Sexual health and intimacy are often treated as concerns for younger adulthood, yet they remain central to well-being, identity, relationships, and quality of life across the lifespan. In health care and rehabilitation settings, however, these topics are frequently ignored, minimized, or avoided. For occupational therapy practitioners, this raises an important question: Are we doing enough to support sexual health and intimacy among older adults? Current research suggests that the answer is no. Although sexual activity falls within occupational therapy’s scope of practice, stigma, discomfort, and limited education continue to restrict meaningful support and intervention (Chilton et al., 2022; McGrath & Sakellariou, 2016).

Defining and Addressing Sexual Health With Older Adults       

Sexual health is not simply the absence of sexual dysfunction or disease. It includes physical, emotional, mental, and social well-being in relation to sexuality, making it closely tied to quality of life, identity, and relationships (Nunez et al., 2024). Despite this, older adults are often stereotyped as uninterested in intimacy, and these assumptions can lead healthcare providers to avoid sexual health discussions or dismiss concerns as a “normal” part of aging (Nunez et al., 2024). This issue is especially relevant to OT because sexuality can be expressed through many different activities, such as dating, caring for a partner, maintaining intimate relationships, or engaging in sexual activity itself. When OT practitioners avoid this area, they may overlook a meaningful occupation that is connected to participation, self-concept, and well-being (McGrath & Sakellariou, 2016).

Attitudes Toward Sexual Health in OT Interventions      

Research has shown that OT practitioners often recognize sexuality as important, but rarely address it in practice. In a study by Ceglie (2005), many practitioners viewed geriatric sexual needs as within OT’s scope, yet 88% reported that they never or rarely addressed sexuality issues with older adult clients during the previous year (Ceglie, 2005). More recent research suggests that this gap persists: Chilton et al. (2022) found that continuing education improved OT practitioners’ knowledge of older adult sexual health, but did not significantly change their attitudes. These findings suggest that education alone is not enough. Practitioners also need opportunities to examine implicit bias, personal discomforts, and values that may contribute to excluding sexuality from interventions.

Promoting Sexual Health for All Older Adults     

These conversations may be especially important for older adults with disabilities or chronic conditions. Changes in mobility, sensation, endurance, pain, cognition, or body image can affect intimacy and sexual participation, but they do not eliminate a person’s need for affection, connection, or sexual expression. Sexual health interventions must also be inclusive of LGBTQIA+ older adults, who may face intersecting stigma related to age, sexual orientation, gender identity, disability, and health status. Ribeiro-Goncalves et al. (2024) found that sexual stigma among LGB older adults is associated with poorer mental health outcomes, including anxiety, depression, and substance misuse. For OT practitioners, silence can unintentionally reinforce exclusion. Inclusive language, privacy, and respectful screening are therefore essential.

Improving OT Practice to Include Sexual Health Education

Improving practice to include sexual health for older adults requires action at multiple levels. Nunez et al. (2024) found that adults ages 45 and older identified several strategies to improve sexual health services, including increasing sexual health education, strengthening client-provider relationships, using community health promotion efforts, and reducing stigma surrounding sexuality in later life. The study also emphasized the need for accessible adaptive equipment, universal design, and community support (Nunez et al., 2024). These recommendations closely align with occupational therapy’s focus on accessibility, participation, and client-centered care. Rose and Hughes (2018) similarly emphasize that sexual health can be addressed through familiar OT approaches, including creating a safe environment, asking permission, and using strategies such as positioning, energy conservation, adaptive equipment, and environmental modifications.

To promote sexual health and intimacy in older adults, OT practitioners can begin with simple, intentional steps. We can normalize this topic by including sexual activity and intimacy in occupational profiles, using inclusive language, asking permission before discussing sensitive topics, and providing reassurance that sexuality is a valid and important part of health and well-being, no matter one’s age. We can also address barriers related to pain, mobility, positioning, adaptive equipment, medication side effects, body image, and communication. When concerns fall outside our scope of practice, we can still validate the concern and refer to the appropriate providers.

Promoting sexual health in older adults is not about forcing uncomfortable conversations or assuming every client wants to discuss intimacy. It is about creating space for clients to raise concerns, ask questions, and receive respectful support. Older adults should know that intimacy, sexual expression, and sexual identity remain valid parts of life regardless of the aging process. Research suggests that OT practitioners are not yet doing enough in this area, but meaningful change is possible. By addressing stigma, expanding education, promoting inclusive language, and treating sexuality as part of holistic care, occupational therapy practitioners can better support older adults’ participation in meaningful occupations, including intimacy and connection.

References

Ceglie, D. (2005). Occupational therapists’ role in addressing issues of sexuality among geriatric patients [Master’s thesis, D’Youville College]. 

Chilton, R. L., Weaver, J. A., Doerrer, S., & Ideishi, R. (2022). Addressing OT practitioners’ knowledge and attitudes about older adult sexual health and sexual activity through continuing education. American Journal of Occupational Therapy, 76(Supplement 1). https://doi.org/10.5014/ajot.2022.76S1-PO107

McGrath, M., & Sakellariou, D. (2016). The Issue Is—Why has so little progress been made in the practice of occupational therapy in relation to sexuality? American Journal of Occupational Therapy, 70, 7001360010. https://doi.org/10.5014/ajot.2016.017707

Nunez, M., Sakuma, Y., Conyers, H., Day, S., Terris-Prestholt, F., Ong, J. J., Pan, S. W., Shakespeare, T., Tucker, J. D., Kpokiri, E. E., & Wu, D. (2024). Community-engaged strategies to improve sexual health services for adults aged 45 and above in the United Kingdom: A qualitative data analysis. Sexual Health, 21, SH24143. https://doi.org/10.1071/SH24143

Ribeiro-Gonçalves, J. A., Jesus, J. C., Costa, P. A., & Leal, I. (2024). Sexual stigma and mental health of LGB older adults: A systematic scoping review. Sexuality Research and Social Policy, 22, 467–489. https://doi.org/10.1007/s13178-024-00965-w

Rose, N., & Hughes, C. (2018). Addressing sex in occupational therapy: A coconstructed autoethnography. American Journal of Occupational Therapy, 72, 7203205070. https://doi.org/10.5014/ajot.2018.026005