OTs In Pelvic Health

Sex In the Classroom: Incorporating Intimacy In Entry Level OT Curriculum

• Season 1 • Episode 88

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More about my guest, Sarah Sidar:
Sarah's website.

Where to find her on social media:
@balancedpelvichealth

References for this epsiode:
Ellis, K. & Ungco, J.C. (2023). Sexuality and Intimacy: An Occupational Therapy Approach. AOTA Press.

Hattjar, B. (Ed.) (2012). Sexuality and Occupational Therapy: Strategies for Persons with Disabilities. AOTA Press.

Kaufman, M., Silerberg, C., & Odette, F. (2007). The Ultimate Guide to Sex and Disability. Cleis Press.

OT's in Pelvic Health FB Group

Global Pelvic Health Alliance (www.pelvicglobal.com)
Pelvic Health Clubhouse (www.pelvichealthclubhouse.com)
Institute for Sex, Intimacy & OT (https://www.sexintimacyot.com/)

Resource for University Faculty: https://www.sexintimacyot.com/libraryproject

OT After Dark Podcast (www.otafterdark.com)

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Lindsey Vestal I am so excited to welcome Sara Sidar back for a third time on the OTs Pelvic health podcast. Sara has been an O.T. for over 20 years, specializing in Pelvic health for the last five, and she's in her third year teaching for Shenandoah University O.T. program in Virginia. Sara loves watching the light bulbs turn on as students learn new facts, grasp concepts and make connections. And one of her favorite topics to talk about in any of the classes she teach is sex. Why do you ask? Because this occupation is valued by so many. Yet addressed by so few. Join Sarah and the movement to bring sex into the classroom. We're going to hear all of her greatest tips and tricks in today's episode. Thank you so much for joining us. 


Lindsey Vestal New and seasoned OTs are finding their calling in Pelvic health. After all, what's more adult than sex, peeing and poop? But here's the question What does it take to become a successful, fulfilled and thriving O.T. in Pelvic health? How do you go from beginner to seasons and everything in between? Those are the questions and this podcast will give you the answers. We are inspired, OTs. We are out of the box. OTs We are Pelvic health OTs. I'm your host, Lindsey Vestal and welcome to the OTs and Pelvic health Podcast. 


Lindsey Vestal Sarah, thank you so much for returning for I think you're the only person to be on the OTs Pelvic health podcast for a third time. Welcome back. I'm delighted to be talking about sex in the classroom with you today. 


Sarah Sidar my gosh. I am so excited to be back. I can't believe that. 


Sarah Sidar But it's so much fun talking to you and listening to your podcast and, you know, sharing information with the world. So I'm super excited to be back. Thank you so much for having me. 


Lindsey Vestal Well, you are just an incredible human and I just always learn so much every time we talk. So it's the pleasure is all mine. 


Sarah Sidar I feel the same. Very much the same. 


Lindsey Vestal So, you know, you're in a unique situation because you're straddling many roles. And the ones that I'm thinking about right now that's really relevant to this conversation is the fact that you are both an assistant professor as well as a private practice owner. And so I think that you're in a unique position to be having these conversations because you can really see it from all the perspectives. And I do believe that's how we're going to move forward. I do think that's how we're going to see more intimacy conversations in the classroom and how this is just going to be a part. My my desire is that it's a hope, a part of our core curriculum to some degree. And you are really, really promoting that. And like I said, can see it from so many perspectives. So I'm extra, extra excited about this. And Sarah, I'd love to start off with just sharing. You recently spoke about this topic at the IATA 2020 for Aspire, which is I unfortunately wasn't able to attend your talk, so this is definitely selfish on my behalf. 


Lindsey Vestal Because I want to get caught up. I know you dropped some gems. So many people in our. 


Lindsey Vestal Community were raving about it. So tell us just just super briefly the title and kind of like some some gems or some takeaways either from your presentation or some conversations that might have ensued afterwards. 


Sarah Sidar yeah. So my title, the title of my presentation is called Sex in the Classroom Incorporating Sex and Intimacy into entry level O.T. Curriculum. And I actually kind of thought the instant I submitted my proposal for this short course, I immediately regretted it because I was like, This title is way too risque. 


Sarah Sidar There's no AOTA was going to accept this review, is going to look at it and be like, Nope, just like rejected out of hand. But that did not happen. It was accepted as really saying. 


Sarah Sidar I feel like progress, right? 


Sarah Sidar really? 


Sarah Sidar Definitely. So, yeah, I think And the other thing that was really exciting, just aside from my talk, there were actually a lot of talks about sex and intimacy, not just pelvic health, but addressing sex and intimacy at Inspire this year, which was super, super exciting. I just think, you know, the world is really kind of opened its eyes to how valuable these topics are to people and therefore how valuable they should be to us as O.T. is. So I guess just kind of kind of the bullet points. So like, you know, we'll get in depth, I suppose, in a few minutes, but kind of the big picture things that I really talked about was kind of part of it was kind of the historical context and why sex and intimacy can be so difficult to talk about. But the fact that it is a priority, a huge priority for so many of our clients to ask and have answered questions and have concerns about sex and intimacy related topics. And so it's not just our clients, but also our students and our entry level clinicians find addressing sex and intimacy to be very important. Yet our research shows that we're not addressing it anywhere near adequately in academic programs. So studies show across all health care professionals many multiple health care professions that graduates new graduates, whether it's doctors, nurses, OTS, don't feel comfortable addressing these topics. So everybody thinks it's important, but nobody's talking about it. Yeah, that's a problem. You know, that's a problem. And then I also kind of talked about some of the standards are a coat standards, things that I think until unless or until you're in academia, you don't really understand how programs work. And so there's a lot of misconception and misunderstanding of that. And so I have hope to kind of bring to light some of that background information as to kind of how programs work and so how you might be able to incorporate some of this content into entry level curriculum so that students graduate feeling more confident and competent and capable of of addressing these topics. 


Lindsey Vestal Yeah, yeah, yeah. Yes, I 100% agree with you. And I'm curious as to for for OTs, it it is hard to talk about sex and intimacy. Why do you think that's the case? 


Sarah Sidar Yeah. So I history is so interesting to me. I just think, you know, we have this space and time where we exist, and I think learning about the history of something just really gives us this broader context of why people may be potentially have certain beliefs that they have or why things are debatable when they seem sort of obvious or why things are not up for debate. When you're like. 


Sarah Sidar Why isn't anybody questioning that? 


Sarah Sidar You know, And so in preparation for my talk, I did dig in a little bit to the history of, you know, when and how and where and why sex and intimacy has or has not been addressed throughout our 100 year history, 100 plus year history in the field of occupational therapy. You know, we've been around over 100 years. So at some point somebody said, you know, hey, should we start talking about sex? 


Sarah Sidar And I was interested to know who are those people and what challenges did they have over the decades? And one of the really fascinating things that I uncovered is that so in kind of the 70s, 80s and 90s, a lot of things kind of happened at the same time, right? So we had kind of 60s going into 70s, a huge civil rights movement. A lot of that involved disability rights movement and kind of anti able ism. A lot of legislation being passed really kind of like definitive, you know, era of our history. And with that a lot of changes in perspective with occupational therapy as well in terms of our sort of ablest viewpoints of how people with impairments or disabilities could or could not function in the world or exist as sexual beings. And of course, with that comes debate and discussion and controversy. So one of the things that I uncovered, we all know, I think anybody who's graduated from school knows who Gary Keel Hofner was. Right. You know, father of model of human occupation, super well respected figure in in the art world. And a little known. But interesting fact is that Gary Cahill Hofner did not think that sex and intimacy should be addressed by occupational therapists. Wow. Yeah. And there are like emails between him and, like, students and other colleagues talking about how how so fascinating how sex is. He called it like a gosh, a biological imperative. 


Sarah Sidar Yeah. 


Sarah Sidar And therefore not in the purview of O.T. And which is fascinating to me on so many levels, like. Okay, So but, you know, at some point or another, if one that's a very closed minded view of what sex and intimacy is, right? Like clearly this comes from a kind of socio cultural context that he existed within that's not shared by everybody else. But even if you do take that kind of narrow view or like, you know, eating is a biological mandate. Yeah. Address feeding. If you live in a cold weather climate, I would say dressing yourself is a buy. Or if you live in the hot sun climate where you don't want to get burned, like dressing yourself as a biological parent. 


Sarah Sidar Right. So this is. 


Sarah Sidar So interesting to me that, you know, even within the context of somebody who was so at the forefront of progressing our profession in such important ways, you know, I'm not I'm not here to, like, knock anybody, right? Because I have so much tremendous respect for what Kill Hofner did for our profession in terms of really establishing validity of, you know, founded in frameworks and models on the validity of our profession. But at the same time, when you have such a powerful thing, you're saying, but but this isn't something that we do or we talk about or we address that's really going to reach its fingers out into a lot of different. You know, people and programs and academic institutions. 


Lindsey Vestal Yeah. 


Sarah Sidar So totally fascinating. But then over and this was as late as like 2002, which give you context, I graduated from my own program, my bachelor's degree in O.T. in 2002. So this is right around when I was an entry level clinician. 


Lindsey Vestal When you mentioned in 2002, what was the larger context? 


Sarah Sidar So Kiel, Hoffner, there were emails being passed back and forth between Gary Kiel, Hoffner and colleagues and some some kind of opinions being shared that that sex and intimacy was not within the purview of occupational therapy. 


Lindsey Vestal Even in 2002. 


Sarah Sidar 2002. Yeah. Yeah. And I have references in case anybody. 


Sarah Sidar In case anybody is interested, I do. 


Sarah Sidar Have references. But yeah, so that's like a little over 20 years ago and again, I graduated in 2002. 


Lindsey Vestal I just really think, just when you think we've come so far, you know, and then and you and that's this is why Sarah, I really do appreciate you bringing up the history here because, you know, we start off with thinking, you know, 100 over 100 years ago and then know we're talking about someone that I think we all admire and respect so much of a significant contribution to our profession, but doesn't mean that we're not going to see things differently. And this is one that we clearly see very differently. 


Sarah Sidar Yeah. 


Sarah Sidar Yeah, absolutely. Absolutely. So I think it's important to, you know, you it's okay to understand and accept and soak in the things that I think are really relevant, but it's also okay to question, you know, I think that's a questioning is always important. Like I say, you know, you got to wonder if there are things that are just kind of commonly accepted. I think it's important for us to ask the question why? And if there are things that are not commonly accepted. I also think it's important for us to ask the question why, you know, and dig into that a little bit. Yeah. But since that time, there are definitely some some individuals who have really progressed just in general, how we view occupation, how we view sex and intimacy, and just really kind of opened things up in, in really important ways to how we how we practice. 


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Lindsey Vestal So I'm curious, what what do you think the state of curriculum and intimacy topics are? Like where? Do you have any sense of how many programs are incorporating it? 


Sarah Sidar Yeah. So let me bring up so my stats here and again, I have references for anybody, any geeks like me who are interested that there has been there have been several studies over the years kind of trying to determine how much, how many hours, how many minutes, how much time, what percentage of time and various programs address sex and intimacy. And about 20 or so years ago, that figure was an average of only about 30 minutes. In the entirety of a program right now. Recently there has there was a study published in 2018 that did show some improvement. There were some I'll talk a little bit about some of the issues with this study in general. But the study did show that across MSU and 88 programs, there is an average of about seven hours of content dedicated to sex and intimacy, which is certainly an improvement from 30 minutes. That being said, you know, average doesn't necessarily always it isn't always the best representation of what is actually going on. Right. Because that could be one program that zero and another program that's 14 hours and then you get an average of seven. And so there are programs that are doing none, zero. There are programs that are doing as little as 30 minutes still and a few programs that I think are outliers that tend to pull that average up that are doing more than that. So the average on the whole is better. But I would say the state in general is is not that great. And for context, you know, I always give this comparison, You know, if you think about anyone who's listening and including you, Lindsey and me, think about your entry level program and think about how many how much time through the entirety of your program you or you might have discussed in any way, shape or form the occupation of getting dressed. 


Lindsey Vestal Okay. Yeah. 


Sarah Sidar And when I asked this question in my short course, people were like, How so? I was like, So how many hours do you think it's someone's like thousand? 


Sarah Sidar And I'm like, Well, it's. 


Sarah Sidar Probably not thousands, but but to give context like that tells you, I mean, and we and the thing is, we go through that occupation in so many different courses, right? So you do it. You talk about it in pediatrics class, you know, when it comes to, you know, that kind of developmental like how old's a kid going to be when they should realistically be able to put their socks on or tie their shoes, you know, adapted equipment. You know, we talk about different techniques for different types of conditions and adapted ways and devices that we can use to get I mean, it's like peppered throughout the entirety of our program because it's something that people do on a day to day basis. Yeah. You know, and and I also think because it's safe, right? Like there's not a whole lot that's taboo about putting your socks on, Right. Or maybe even putting your shirt on. So it's kind of like this safe, not going to offend anybody. Easy to address sort of topic. So we spend, you know, potentially hundreds of hours talking about that occupation. And so comparatively, seven is not a whole lot. 


Lindsey Vestal Right? So you're I think you're getting to to the crux of it there as it is in our society. Right. That it's that it's a taboo topic. So even though it's in our practice framework, even though we know unequivocally that sex and intimacy is in our scope of practice, it's still not making its way to the classroom. 


Sarah Sidar Right, right. And and if you think about it. So, you know, I think it's also important to understand the breadth of OT programs, you know, MSO, t otd programs, o t programs. They have hundreds of hours. You know, if you have multiple credit courses that you're taking for multiple semesters. And again, this is kind of some of the things that you don't realize, but we have the number of credit hours, but then you also have proxy hours, right? So for each, you know, if you take a three credit course, then you have a certain number of additional hours that you're expected to do, you know, independent research, reading, you know, working on assignments and things like that outside of just that classroom time. So that adds up to hundreds and hundreds of hours over the course of a program. 


Sarah Sidar Yeah. Yeah, yeah. 


Sarah Sidar Yeah. Proportion is so small when you think about it that way. 


Lindsey Vestal Well, I feel like this lends itself really beautifully to to my next question, which is about eco standards. For those of us who are not so familiar, would you please tell us what they are and kind of how it fits into this conversation? 


Sarah Sidar Yeah, sure. Yeah, this is definitely something that people like. Until I was I was a clinician for, you know, 18 or so years before I got into academia. And I got into academia and I was like, wait a second, standards. 


Sarah Sidar What's this? 


Sarah Sidar You know, unless you're an even as students, you know, you don't really entirely have an understanding of, of like, they're standards that we have to teach. 


Sarah Sidar So. 


Sarah Sidar So yeah, just to give again, some context to folks who might not know what that means. So every occupational therapy program, OTA, you know, OTD MSOT, whatever it is, in order to it has to be accredited by a coach. So that is our accrediting body that says we're a legitimate occupational therapy program. We're not scamming you. We're actually teaching quality, we're teaching quality occupational therapy. And that is a requirement to be able to sit for your boards. You have to attend an accredited program. And the way that a code maintains that accreditation is by publishing a set of standards. And so there's different standards. There's things called like A standards B standards, etc.. Some of them are more administrative, but the standards that dictate what kind of what we teach in our programs are typically called the B standards. And they are. There are. 


Sarah Sidar Tons. 


Sarah Sidar Of them. They just published the new the updated standards. So anyone else in academia, if you're like me, like, yay, we get to go through all of our. 


Sarah Sidar Courses and update them all. 


Sarah Sidar In case you didn't detect, that was sarcasm. 


Sarah Sidar Us. All of us in academia are like jumping for joy that we have to go through this kind of like. 


Sarah Sidar Lengthy process of of kind of updating all of our courses. But but basically what this says is it kind of dictates to us or it proves to a code and dictates to us what we have to show to show that we're legitimately teaching these students occupational therapy. And just to give you an example, I'm going to read one eight coat standard to you, just if that's okay. Just tell you what these read like. So this is standard B, point two, point one. And this was for Master's and OTD programs. And it reads Apply, analyze and evaluate scientific evidence, theories, models of practice and frames of reference that underlie the practice of occupational therapy to guide and inform interventions for persons, groups and populations in a variety of practice, contexts and environments. 


Sarah Sidar Yeah. Is that English? Yes. 


Sarah Sidar So basically to put that in like non academic terms, I have my students have to demonstrate that they can apply theories, models and frames of reference in actual real world practice settings. 


Sarah Sidar Okay. 


Sarah Sidar So that's that's kind of the translation, right? But notice how open that is written. It doesn't say. It doesn't give me. 


Lindsey Vestal A theory. 


Sarah Sidar Or a model or frame of reference. It says. I just have to teach some theories and models and frames of reference, and they have to demonstrate that they can apply those in real world settings, whether it's for an individual, a small group or a population. 


Lindsey Vestal Okay. Okay. 


Sarah Sidar Yeah. So. So I think, again, there's a lot of misunderstood. Like what? Why do O.T. programs teach what they do? Well, this is what we have to base it on. It's not just like willy nilly how we feel like it. We have to make sure that we're meeting these standards. But at the same time, we do have a lot of freedom within that to teach the theories and models and frames of reference that. Are most applicable. 


Lindsey Vestal Okay. 


Sarah Sidar Or that we feel are most applicable. 


Sarah Sidar Okay. 


Sarah Sidar Then we have to give students assignments to make to. To prove to ACO that we taught them that the students actually understood that. 


Lindsey Vestal Yeah. Okay. Okay. 


Sarah Sidar I hope that makes sense. 


Lindsey Vestal It does. That does. So we have a good basic understanding of a coat and it's, you know, obviously it's a it's a it's a great intention, right? Like it's yeah, it does make sense. It's standardizing our curriculum. And so does it give any reference, guidance, anything towards conversation around sex and intimacy. 


Sarah Sidar So that's the interesting thing is that there when it comes to things that are specific like that, you know, specific occupations like adls idols, you know, play even leisure activities. I have yet and anyone else in academia, please correct me if I'm wrong, so feel free. But I have yet to find the standard that is that specific. So what's interesting is that while, you know, teaching about sex and intimacy is not in, you know, explicitly written in any code standard, neither is tying your shoelaces. Yeah. You know, neither is brushing your hair or, you know, bathing. And I think that, again, that's kind of the nice thing about these standards, is that we do have the freedom to, you know, determine within this kind of broader perspective of, you know, one might be related to activity and also one standard might be related to activity analysis and other standard might be related to how various disease processes, you know, affect occupational performance. But within that, we do have a lot of freedom to address. The things that we feel are important in sex and intimacy, 100% can be one of them. 


Lindsey Vestal Well, that's exactly what I was thinking when I asked you that question. It was like actually, the vagueness could serve us in a lot of capacities, just like you said about the models. We know we need to talk about theory and models, but the standards don't necessarily spell out which ones. Yes. Yeah, there's there's creativity. There's room for for a lot of personalization there. What about, though, the the and I know you can't speak to every university or setting. Sure. But like so then at that point, let's say you wanted to develop something, of course, that mentions, you know, or even focuses on sex, you know, in an intimacy. What would be your next steps to get that, to get that approved, to get that, give that a green light? 


Sarah Sidar Yeah. Yeah. So I can speak certainly to my program and it'll be different in different and different programs. But how I have done this because I'm gradually, gradually starting to incorporate these topics more into the courses that I personally teach. And I think that's the first kind of step in going about it. For me as an instructor, I kind of have the overview of my course as a whole. So one of the courses that I teach is Anatomy is for their first semester, first year students. So to give an example, you know, this is a course that I teach. I have certain standards that I have to meet within those standards. You know what what is addressed almost in the way I look at it is what is addressed almost ad nauseum. Like, you know, we've used examples again of people getting dressed, you know, down to the amount of like dip flexion somebody needs in their, you know, picture grasp to pull up their socks. Right. Okay. So we've got plenty of that. What's missing? And and is there any way that I can incorporate And it might you might think at first glance like anatomy like how would you incorporate topics surrounding sex and intimacy and anatomy? Well, in in our in the way that we teach anatomy in my program it is very function based. So students already come into my program. They have a prerequisite having had to take kind of a basic anatomy course. So our anatomy course is a lot of application of how these muscles work on this body to move a certain way. Well, what's the pelvic floor? But. Skeletal muscle. Right. What are those muscles? And if it's important to know, you know how your bicep muscle flexes your elbow. Why can it not be equally important to know that if you're that your pelvic floor muscles have to relax to allow for comfortable penetration or have to relax to allow for adequate blood flow to the penis for, you know, erection. It's all it's all just kind of part of that anatomy. So I think kind of on an individual basis, if an instructor is like, man, you know, we're not I'm not this isn't being addressed in my program at all. I would say, just start with your class. What what do you teach? And I think that if you really look through, you're going to find ways that and I and I, I have examples from the short course that I taught that I that I that I talk about. You're going to find a lot of different ways that you can incorporate sex and intimacy topics. I would argue into almost every class that you teach. 


Lindsey Vestal So that was really helpful and really clear. Are there anything, any other actionable ideas or suggestions for anyone listening who you know is also passionate about promoting competency in entry level? OTs When addressing these topics with their clients. 


Sarah Sidar Yeah. So I would say it doesn't just stop with with academia because, you know, the majority again, the majority of people in academia, they have their expertise in their kind of area that they're really comfortable with. And sex and intimacy just might not be one of them. You know, and one of the things that evidence shows is, aside from, you know, time, the timing, your curriculum. So people think, well, okay, if I'm an include topics of sex and intimacy, am I going to have time to address it? And Well, and kind of like I talked about, well, you know, you can kind of see if you can balance things out. If you look at your course or if you look at your program, you think, okay, we spend X number of hours talking about, you know, dressing or bathing or whatever, can we replace some of that with sex and intimacy topics? So, you know, that kind of helps with like, do I have enough time to address it in my curriculum? The other thing that evidence shows or that research has shown is that a lot of professors just don't know how to talk about the topic. They're like, This is not my area of expertise. Even if I want to incorporate it into my curriculum, I just don't know how because I don't know the content. And this is where all you amazing clinicians out there come in. My institution loves our partnerships with our community partners, with our kind of local experts. We have people come in who are from like driving rehab, lymphedema, therapy experts. And if you are a clinician out there who has this expertise, who feels really comfortable and confident talking about topics of sex and intimacy, that's a great connection to make with your local university because they have the desire and you have the knowledge. 


Lindsey Vestal You love that. 


Sarah Sidar So people it's funny because when I talk to other people, they're like, you know, we're just talking about this, you know, cut off line, but like, should I just call up some local universities and see, you know, And I'm like, Yeah. Call them or email them a lot. And you can go online. Their faculty align like with my institution, you know, you can just do a search for us online. You can see who the program directors are, you know, who the various faculty are. Reach out. And a lot of universities are often looking for guest speakers, content experts and things. So if even if you're not in academia, don't think that this isn't something that is accessible to you or you know that you don't have a contribution to make. 


Lindsey Vestal That's fantastic. Thank you. Thank you for bringing that up and reminding because it benefits both so incredibly much. Yeah. And, and if you contact one setting and it's not a go, don't give up because there there are so many other settings that will be incredibly hungry for your expertise. You know, anyone listening to this that has an inkling don't give up the first time. If you if if it's not a welcome door. 


Sarah Sidar Yeah yeah 100% agree 100% agree. And I and once you get your name out there to other people will find you. I've had different universities contact me, you know, to be guest lecturers. I'm very taught various topics related to pelvic health or sex and intimacy. So, you know, once once somebody, once once an institution finds you like, watch out. 


Sarah Sidar They might keep, you know, others might come. 


Lindsey Vestal Be careful what you ask for. Yeah. 


Sarah Sidar Yeah, exactly. Awesome. Well, we. 


Lindsey Vestal Started off the podcast kind of talking about, you know, the fact that you're an assistant professor as well as a private practice owner. So I'd love to just talk briefly about your private practice. 


Sarah Sidar Just to kind of, you know. 


Lindsey Vestal Really consider the breadth and width of your expertise here. Sarah And I'd love to know, you know, what are some of the ways that you help clients with sexuality in your private practice? 


Sarah Sidar gosh, yeah. How much time you got now? I'm just. 


Sarah Sidar Hours. Yeah. 


Sarah Sidar Yeah. So my private practice is it's a mobile kind of mobile outpatient. So home based I go into go into my clients homes. And it's interesting because I was clinic based. I worked in a hospital based outpatient for a long time. And so I saw a huge variety of clients there, you know, all genders, you know, and all kinds of of complaints from, you know, continence to bowel to, you know, pain with intercourse, generalized pelvic pain, things like that. And I think a lot of that caseload kind of followed me into my private practice. A lot of the same doctors who referred to me before kind of continued to to refer to me now. And so I didn't I do still, I didn't really know what to expect. But I do still see a fair number of people with pelvic pain. And I don't it's I don't see as many people where their primary complaint is pain with intercourse anymore. But I do find that over the course of a conversation like a person will be referred to me for constipation and many of those people will have pain with intercourse as well, you know. And so that's certainly one way that I address it within my practice, just because a lot of my clientele have either it's a primary complaint or it's, you know, a secondary finding that they have pain with intercourse. And so I, I certainly address it from kind of that brain pain science standpoint, definitely through that sensory processing lens lens. I also find, interestingly, that I have a significant number of clients, even if they don't have pain with intercourse a lot of the times, because my clients are by definition, they all have some sort of a public health issue. A lot of the time it's just kind of a lack of arousal, a lack of interest. So it's not as much pain, but just not a decrease in satisfaction. Yeah, that makes sense. 


Lindsey Vestal It does, yeah. 


Sarah Sidar And I've actually found interestingly, that now that I have my private practice, I'm out of network with all insurances. And so that gives me a lot of freedom actually, I think, to address those kinds of issues in a way. That I don't feel like I really had the freedom to in my clinic as much anymore. So we have a lot of conversation, especially with people who kind of just have a lack of arousal, lack of interest, lack of satisfaction with sex and intimacy. I find myself having a lot of conversations surrounding definitely the sensory system and kind of the neurology of arousal, if that makes sense and kind of that psych psychological piece to it. And so I address it in that way very frequently. 


Lindsey Vestal Yes. And for anyone who's interested in hearing a little bit more about Sarah and the sensory system, there is a podcast episode that you were on. I think we titled it then the The Sensory System is the fast track to safety. Yes. So I would highly encourage anyone to listen to that because it's it's incredible. 


Sarah Sidar Yeah. Yeah. Well, and I think on that podcast, I focused a lot on kind of being trauma informed, you know, and sort of getting your clients to that, that sense of, you know, kind of psychological and physiological safety. But what I found more recently is that especially with folks who, again, just kind of lack of desire or lack of kind of satisfaction, you know, that Occupy Occupy. If you remember your copy and you have your occupational performance, but then you have your satisfaction, right? So the performance might be there, but the satisfaction might not be is that it really lets you look through that, that in a whole kind of new perspective, you know, so it's not just kind of the do I feel safe, but like what is that what what takes it that next step to really make me feel aroused, you know, and make me feel that excitement. And that's a really fun thing to kind of explore with people as well. 


Lindsey Vestal Yeah. I love that. Sarah, this has been so delightful. We're. We're so appreciative of you. Just really helping to demystify these these topics that we know are so incredibly important and clearly have, you know, some historical historical references as well as just the practicalities regarding, you know, how we can weave some of this this into the Otti mindset and the what understanding, because we all know, we all know that it's in our framework and we all know that it's 100% something we should be addressing and that we are qualified, uniquely qualified to address. So thank you for helping us gain some deeper understanding on this. And I have no doubt if you will have you will have might have me. I would love to have you back in the future for a fourth or fourth time. 


Sarah Sidar It's always such a pleasure doing this with you, Lindsey. I always have so much fun with it. So if, you know, if folks want to keep on listen and you know, I'm a talker, so I can be absolutely delightful. Sarah, thank you so much. Thank you. 


Outro Thanks for listening to another episode of OTs and Pelvic health. If you haven't already, hop on to Facebook and join my group OTs for Pelvic health, where we have thousands of OTs at all stages of their pelvic health career journey. This is such an incredibly supportive community where I go live each and every week. If you love this episode, please take a screenshot of this episode on your phone and posted to IG Facebook or wherever you post your stuff and be sure to tag me and let me know why you like this episode. This will help me to create in the future what you want to hear more of. Thanks again for listening to the OTs and Pelvic health podcast. 



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Lindsey Vestal

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