Sex is an ADL, too
A Clinical Pearl by Talli Rosenbaum, MSc, PT, IF, AASECT Certified Sex Therapist

In our Clinical Pearl Series, MedBridge instructors share their expertise through research reviews, case studies, and op-ed articles.

Physical therapists are trained to provide treatment to restore function, improve mobility, relieve pain, and prevent or limit permanent physical disabilities of patients suffering from injuries or disease (Bureau of Labor Statistics, U.S. Dept. of Labor, 2004). PTs are invested in helping patients function in their roles, whether its housework, recreation, or employment. PTs help patients achieve independence and function in activities of daily living (ADL). ADLs typically refer to bathing, showering, dressing, eating, movement, and personal hygiene.

Sex is not typically counted amongst the standard ADLs. Nevertheless, sex is a valued human activity that requires strength, endurance, and mobility, and the ability to function sexually is also related to a person’s sense of self-efficacy and role identity. Sexual functioning is an important ADL and should be addressed as well.

Physical disability, orthopedic injury, neurological impairments, or the presence of pain are all conditions that potentially affect sexual function. Physical therapists in a variety of settings encounter patients with these conditions.

To address issues surrounding sexuality, it is important that the health professional takes the time to reflect on his/her own biases, values, attitudes, and beliefs regarding sexuality to be able to communicate openly, non-judgmentally, and effectively, and create a supportive and safe environment to assist clients and partners with their needs.

How comfortable do you feel bringing up the topic of sex with your clients? Research suggests that many physical therapists feel they have not been properly trained to address issues of a sexual nature. Some may be embarrassed or hesitant to discuss sexuality and may project these feelings on to their patients. Health professionals may also mistakenly assume that sexuality is not a concern due to advanced age, disability, or marital status.

This course is intended to provide physical therapists, as well as all other rehab specialists, with the skills and tools to address sexuality and sexual functioning in their clients.

One tool that has proven useful in approaching sexuality is the P-LI-SS-IT model (Annon 1976). This model is commonly used to determine the level of participation a professional should have with clients, and is a key model for approaching sexuality with a client. There are four stages in the model, including: Permission, Limited Information, Specific Suggestions, and Intensive Therapy. Physical therapists in general practice, as well as pelvic floor physical therapists, can learn to provide the first three elements, while only a trained psychotherapist should provide intensive therapy.

To learn more about helping patients with sexual issues, take Talli Rosenbaum's new course, Part A: Sex and Sexuality in Physical Therapy Practice, only on MedBridge.


  • Weerakoon, P., Jones, M. and Kilburn-Watt, E. 2004: Allied health professional students' perceived level of comfort in clinical situations that have sexual connotations. Journal of Allied Health 33:189-193.
  • Annon JS. The PLISSIT model: A proposed conceptual scheme for the behavioral treatment of sexual problems. J Sex Educ Ther 1976;2:1–15.
  • Green A, Tripp D, Sullivan M, Davidson M. Relationship between empathy and estimates of observed pain. Pain Medicine. 2009; 10:381–392. [PubMed: 19254339]
  • Pynor, et al (2004) A preliminary investigation of physiotherapy students’ attitudes towards issues of sexuality in clinical practice

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West Houston Medical Center
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Outpatient Physical Therapy
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