Note: An earlier version of this blog was published on Carnal Nation.

I had a very angry couple in my office. She wanted to receive oral sex, and he couldn’t bear the feeling of anything with a slippery wetness, especially on or near his face. She was also tired of his insistence on a certain sexual routine. She said she’d no longer play his way if he couldn’t reciprocate by giving her what she wanted. For her, it was a straight forward quid pro quo. She’d been accommodating him, now it was his turn. This was not unreasonable. But he considered her request impossible. It wasn’t that he didn’t care, it was that he simply couldn’t do what she asked. Sensations of slippery wetness caused his nervous system to go straight into a “fight, flight or freeze” response. I asked him if he could tolerate the feeling of saran wrap against his mouth and face (which, unfortunately, is somewhat slippery), and I asked her if she’d accept oral sex if he used it. Neither one was crazy about the idea, but they said they’d try. Unfortunately, I never saw this couple again. I have no idea if this suggestion worked.

I know another woman. She cuts tags from the backs of her clothing, tugs at her uncomfortable brassiere and can’t stand tight waistbands or the stiffness of jeans.  Repetitive noises shatter her concentration and make her feel panicked. She’s kept awake by low volume humming from electronics and appliances. If someone drools into her mouth while kissing her, she feels repulsed, then violent and angry. Her fondest sexual wish is not more orgasms, but the time and space to fully enjoy the one solitary orgasm that occasionally comes her way during partner sex. She tells me that she’s been known to scream “let me integrate, let me integrate!” in the middle of orgasm, begging for a pause in stimulation so she can let the sensations sweep entirely through her body. But her lover’s fondest sexual wish is to cause her to have another orgasm, right away. If one is good, more is better, right? He struggles to understand how essential it is to cease all stimulation and simply hold her (deep, motionless touch) as she “integrates” the pleasure she’s already felt. This is because he’s been told (as many men have been told) that the way to be a “good lover” is to inflict as many orgasms as possible in the shortest amount of time. No matter how many conversations they’ve had, he still can’t shake the notion that multi-orgasmic lovemaking must certainly represent the apex of her desire (and his success), no matter how often she says otherwise.

So if you think “not tonight, dear, I have a headache” is a flimsy excuse, what would you think about “not tonight, dear, you’ve put the wrong sheets on the bed again and the refrigerator sounds terrible and you smell like you just got off an airplane and my cocoa has lumps in it and therefore I’m on overwhelm and can’t bear to be touched?”

Sensory integration dysfunction (SID), also known as sensory processing disorder (SPD), is the “walrus in the room” when it comes to clinical sexology and sex therapy. I say “walrus” because people commonly talk about the “elephant in the room” when they want to refer to a commonly acknowledged but unspoken issue. But no one ever imagines there might be a walrus along with or instead of an elephant – that’s how far off the radar “adult sexual-sensory dysfunction” seems to be. And since I think I’ve just coined this term  we can call it “ASSD” for short.

Here is a very simplified overview of sensory processing dysfunction. As you read, try to think about the implications for sexual intimacy.

Human sensory systems include: tactile (touch), vestibular (balance), proprioception (body awareness), visual (sight), auditory (hearing), gustatory (taste), and olfactory (smell). Our brain helps us to either discriminate and interpret sensations correctly and/or to protect us from them.

Integration of sensory experiences is a process which involves registering or being aware of the sensation; orientation or specific focus on the sensation; interpreting the sensation; organizing a response; and then executing a response which has been appropriately regulated or moderated. Understand that we are bombarded by sensory experiences all the time, so that this is not a simple one-at-a-time process. It’s all happening at once, on many levels, many fronts.

A sensory experience evokes a reaction in a person as he or she becomes aware of it. The reaction usually results in a behavior of some kind, even if it’s just a blink or an increased heart rate. Behaviors are based not just on what a person senses, but how he or she senses it, how the nervous system reacts to it.

People may have low or high “thresholds” for different sensations and sensory experiences, and it is not usually consistent across the range of senses. You might like really spicy food (high), but prefer very quiet music (low). You can be hypersensitive and overreactive, or hyposensitive and underreactive. If you are hyposensitive in one area, you will look for more of that kind of sensation. You will be a “sensory seeker.” Mosh pits are made for tactile sensory seekers. A hypersensitive person will be sensory avoidant. The person who flinches from an accidental touch is tactile avoidant.

Another way of putting it is that a person could be under-processing sensation,
over-processing sensation, or processing a sensation with interference (like “white noise”). In terms of treatment plans, it’s important to figure all this out.

Kids with sensory dysfunction issues are lucky. Or maybe I should say, “luckier” than adults. Because the kid who can’t stop running on tiptoes, or who screams at the touch of play-doh, or who can’t handle bathing, or who bumps into everything, is often noticed, and then usually (best case scenario) gets some help from teachers and/or occupational therapists and other specialists. The parents spend oodles of time supporting their child, read all they can, join organizations, go to conferences, and spend a bundle on special help and the sophisticated equipment, clothing, toys, and learning materials that have been designed for children with SID. The goal, of course, is to improve functioning and chances for a normal life through early intervention.

Adults with sensory dysfunction issues have to cope with the challenges of everyday life while struggling with their neurological responses to such things as ceiling fans, background noise, off-gassing synthetic carpets, too many people talking at once, uncomfortable work clothes, and so on. They may be socially shunned as “clueless,” “weird,” “geeky,” or “overly sensitive.” They seldom get the kind of support and understanding that many children get, unless they are already getting services and support for some other condition, such as autism or ADHD. Then sensory integration support might be folded into the treatment plan. We can easily imagine the troubles such people might have trying to cope with the demands of a job or profession.

Now imagine that you’re a person who is “weird,” “geeky” or “overly sensitive,” but you’re lucky enough to have a long-term relationship. Chances are your partner started out as loving and understanding, thinking that once you started to relax and feel secure in the relationship, you’d be less likely to react to the “little things” that seem to drive you nuts. But it’s been years now, and you haven’t changed. All sorts of things set you off. You’re still so nervous! Your partner has a hard time coaxing you into intimacy too, which she thinks would be helpful for both of you – but she doesn’t know that it’s because you can’t get an erection when your teeth hurt, and the reason your teeth are hurting is because that fresh coat of yellow paint on your bedroom walls puts you so much on edge that you’re grinding your teeth just to stay in the room! She’d think you were just making excuses and over-reacting again. She’d think you don’t really love her if something like a color would keep you from feeling aroused. The marriage counselor you both saw said that you had to make an effort to be “less selfish” and your partner agreed. You’ve had too many fights about sex over the years, and you’re very afraid of that kind of fight, so you don’t say anything when your partner begins to stroke you, and nothing much happens, so you just pretend you’re tired, and you shut your eyes against that yellow, which still bruises your nerves even though it’s dark, and so both of you go to sleep unhappy and hurt.

I think you get the picture.

Adults can see occupational therapists too – but not usually about their sex lives. I did find one article, dated March, 1980: Treatment Model: Occupational Therapy for Sexual Dysfunction by Evelyn M. Andamo (Sexuality and Disability, Vol. 3, Number 1, March, 1980). The abstract says, “occupational therapists should also look into the patients’ management of sexual activities in the resumption of their sexual roles. It presents the need for the patients’ sexual function to be evaluated and dealt with as a legitimate part of the occupational therapy service. Thus, a conceptual treatment model is described in order that occupational therapy may assist patients in resolving, or adapting to, their sexual dysfunction.”

My guess, based partially on the age of the article, is that the treatment model might be a little thin on sensory integration issues and is probably more focused on more obvious physical disabilities. In any case, it would be interesting to know how the occupational therapy community responded to this pioneering call for action.

I began thinking about sensory integration and sexual behavior when I began researching Asperger’s Syndrome and sexuality. I almost cried “bingo!” when I read this statement from one of my respondents: “Sensate focus exercises useless because of sensory integration issues in my aspie ex.” Sensate focus is a sex therapy staple and works pretty well for a lot of people, as these exercises are based on an incremental approach to improving intimate communication and pleasure. But the exercises presume a capacity for normal sensory functioning. I wonder how many sex therapy “failures” are due to unrecognized sensory dysfunction? I feel strongly that we need some really good alternative therapy designs, options and tools to deal with ASSD (remember, for the purposes of this article, that acronym stands for “adult sexual-sensory dysfunction”). At the very least, we need a marriage between clinical sexology/sex therapy and occupational therapy.

Ideally, sexual-sensory dysfunction should be addressed through a multi-disciplinary focus. Sexologists and sex therapists would be vital, sex-positive members of the team. Autism experts would be helpful because the autism/Asperger’s Syndrome community does recognize something of the quandary that teens and adults are in with regard to sexual intimacy, and the relationship of sensory issues to these difficulties. Occupational therapists (OTs) are crucial – they have the practical insight and expertise based on deep knowledge of how the body works and how it can heal. Well-trained, multi-disciplined surrogates would be helpful too.

If you’re interested, you can find a sensory processing checklist for adults at:

http://www.sensory-processing-disorder.com/adult-SPD-checklist.html