Background: Sexual dysfunction is a common problem after stroke. Sexual rehabilitation is recommended but little is known about the types or effectiveness of this intervention. Aim: To assess the effectiveness of a structured sexual rehabilitation programme alongside the use of written material in comparison with the use of written material alone, and to evaluate the impact of both interventions on sexual and psychological function in an Australian stroke cohort. Methods: Twelve participants (patients n=10; partners n=2) were randomly assigned to an intervention (n=4) or control (n=6) group. Standardised measurements were used to assess: sexual functioning (Changes in Sexual Function Questionnaire Short-Form) (CSFQ-14) (primary outcome); psychological functioning (Depression, Anxiety and Stress Scale) (DASS); physical functioning (Functional Independence Measure); and quality of life (Stroke and Aphasia Quality of Life scale–39-item generic version) (SAQOL-39g). All measures were assessed at baseline (T1) and six weeks after the programme (T2). Results: There was no significant difference between the intervention and control groups at T2 in sexual functioning (CSFQ-14), psychological functioning (DASS) and quality of life (SAQOL-39g); however, there was a trend in both groups toward improvement in all outcome measures at T2 compared with T1. Conclusion: This preliminary study demonstrates the feasibility and importance of providing sexual rehabilitation following stroke, and that sexual rehabilitation may improve sexual and psychological functioning and quality of life. Further studies are needed to confirm these findings for stroke survivors and their partners to address sexual issues that may arise and perceived rehabilitation needs.

This article describes a qualitative study which considered if a client's sexual expression was a legitimate domain of concern of the occupational therapist. The research used an inductive strategy of depth interviews with 10 practitioners who represented a breadth of practice (children, adults and elderly people; acute and community settings; and physical and psychosocial conditions, learning disabilities, alcohol abuse, HIV and AIDS). The focus of the study was to discover the attitudes, practice and confidence of occupational therapists to address sexual issues.Part 1 reviews relevant literature, outlines the methodology and briefly reports the results. Part 2 will discuss the results, especially their implications for professional education and practice, and the need for further research.

Little is written in the occupational therapy literature about sexual expression and professional practice. This opinion piece presents two opposing opinions. One argues for its inclusion as part of an holistic approach. The other, developed from published emails, argues for its exclusion, because sexual expression is not seen as an occupational activity. These professional perspectives are set against the lived experiences of physically disabled people. From this consumer perspective, the omission of sexual expression from practice can be viewed as potentially damaging. A proposed way forward is to increase the awareness and skills of occupational therapists in this domain of practice.

Part 2 of this article considers the implications of a study which asked if a client's sexual expression was a legitimate domain of concern of the occupational therapist. The majority of practitioners interviewed believed that it was compatible with the values of the profession and should be part of practice, but views differed about the scope and limits of the role. In reality, only half the respondents included sexual expression of the client within their practice, either routinely or occasionally.The results demonstrated disparity between ideology and practice. There was evidence of powerful emotive forces, encompassing cultural, contextual and personal issues, which explained why sexual activity was not regarded like other activities of daily living. The majority of participants did not feel adequately prepared to address this aspect of human function. Further research is required but the study has implications for both professional education and practice.

Background Health and social care professionals working with disabled people are increasingly recognising the importance of holistic practice that encompasses the sexual health needs of service users. For some this is a new and unfamiliar area of practice. A new sexual health model, the Recognition Model, developed to assist good practice, is proposed. Content The Recognition Model builds on evidence from an extensive research project into the practice of community physical disability teams (occupational therapists, nurses, physiotherapists, speech and language therapists and psychologists). At its core is the recognition of disabled people as having sexual desires and needs like anyone else. This research indicated potential limitations of the PLISSIT sexual health model. Conclusions The Recognition Model takes a team approach to protect and support the sexual health of service users. It draws on existing skills within the team, and depends on every team member, regardless of role, positively responding to direct or indirect questions asked by the service user, thereby affirming the relevance and priority he or she may attach to sexual expression.