Managing Sex and Sensory Dysfunction: Why ‘Little Things’ Can Derail Your Sex Life

Has your partner ever said something along the lines of, “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"? Or have you said something similar to your partner? If so, chances are sensory processing difficulties are to blame.

Some people are aware that their reactions to so-called little things — like the background noise of a humming refrigerator or the texture of a fabric or a lube — can diminish or ruin their pleasure. But many people aren't even aware that these not so little things are bothering them. They just know they feel uncomfortable or irritable or not as engaged as they want to be, seemingly for no reason. And many people have no idea that sensory integration issues — also called sensory dysfunction or sensory processing disorder (SPD) — can derail sex in a variety of ways, adding stress to a relationship.

According to a 2013 study published in Neuro Image: Clinical, SPD affects an estimated five to 16 percent of school age children. We can assume that not all of them have been identified, diagnosed, or treated, therefore undiagnosed and untreated SPD in adults might be more common than we realize.

Though I’ve kept sensory processing in mind when working with my own clients, in general, adult sensory-sexual dysfunction still remains the walrus in the sex therapy office that even the elephant won’t acknowledge. It’s past time to ask, “what's the impact of sensory dysfunction on adult sexual behavior and enjoyment?”

The basics of sensory integration and dysfunctions

Though the title is outmoded, I first learned about sensory dysfunction in Asperger Syndrome and Sensory Issues (2000) by Brenda Smith Myles and others. The book offers an excellent explanation of human sensory systems including: tactile (touch), vestibular (balance), proprioception (body awareness), visual (sight), auditory (hearing), gustatory (taste), and olfactory (smell). Our brain helps us to discriminate and interpret sensations correctly and/or to protect us from them.

As Myles, the experts at The OT Toolbox, and other experts explain, sensory experiences evoke a reaction in a person as they become aware of the experience. 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 they sense it, and the ways in which their nervous system reacts to the sensory trigger.

In other words, we live our lives bombarded by multiple sensory experiences all the time, and experience a multitude of reactions that often happen quickly, all at once, and which take many forms.

According to Myles, people with sensory difficulties are often hypersensitive — they detect and react to smaller stimuli others might not notice — or hyposensitive — they only detect and react to larger stimuli — to sensory experiences. For example, someone who has a low threshold for noise, touch, smell, taste, and/or sound is hypersensitive, and will avoid too much exposure to those things. If they're forced into a situation with lots of sensory stimulation, they will likely get irritable, upset, or tired very quickly. A person who has a high threshold for various types of sensory input is hyposensitive, and will often seek out intense sensations. Many people are a combination of hypersensitive and hyposensitive, depending on the type of stimuli and how many stimuli they encounter at one time.

Some people have difficulty functioning during an uncomfortable sensory experience, while others may need much more of a certain kind of stimulation than they’ve been given or can request.

How sensory processing disorders affect sex and intimacy

Sexual intimacy involves a lot of different sensory experiences, and sometimes, that's just too much for people with sensory dysfunction. It sends them into a state called sensory overload. Now imagine you or your partner having an experience like this while in the middle of sexual intimacy. If you aren’t aware of your own and/or your partner’s sensory issues, there may be feelings of disappointment, sadness, or even anger if the sex somehow goes sideways or stops because of sensory overload.

To understand how this can play out in your relationship, imagine this scenario:

You have a partner who started out with you 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 they think will be helpful for both of you, but they don’t know that it’s hard to feel sexy when your teeth hurt, and the reason your teeth hurt 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! Your partner thinks you’re just making excuses and overreacting again. They might even think you don’t really love them 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.

Though that particular scenario is just a fictional example, it's illustrative of real experiences people have shared with me, like this comment on an article I wrote for Good Therapy in 2011:

“Something I have always dealt with is hyposensitivity to touch. When it came to sex, something I am very passionate about, I always felt like a freak. I could have sex for hours without having an orgasm. Only when I was truly relaxed and felt 'safe' with someone did I orgasm. I once went two years, having twenty partners and never once reaching orgasm with any of them. I felt like a freak… I did not understand. Occasionally I would find a woman who liked to give and receive forceful play, pinching, biting, slapping…nothing too rough but enough to bring slight pain and discomfort. I always found this a great turn on…because it grounded me and brought me to a very present place… Still I felt like a freak and was shy about it and never spoke to anyone about the way I felt… Foreplay and exploration has always felt good but I never knew how to approach my hyposensitivity with someone I was just getting to know… mostly I suffered in silence.” TM

This experience illustrates that hyposensitivity to sensory experiences, needing a lot of sexual stimuli to experience pleasure or achieve orgasm, can cause just as many sexual issues as hypersensitivity to sensory experiences. It also reveals how certain kinds of kinky play may provide eroticized assistance for people who experience forms of sensory dysfunction. For example, a desire for bondage may partially originate from a craving for deep, firm, reliable touch.

Managing sensory dysfunction to improve your sex life

If you're reading all of this and feel incredibly seen, then you might have sensory processing disorder, and it might be wreaking havoc on your sex life. Here's how you can begin to manage the issues you're having.

Begin with acceptance and self-assessment

First and foremost, take the time to sit with the fact that what you're experiencing is, in fact, real. You're not crazy or always overreacting or too sensitive or always making excuses. In 2013, researchers from UC San Francisco were able to link SPD to abnormalities in white matter microstructures, using diffusion tensor imaging (DTI). This research has helped to establish a biological basis for SPD. You have a real, diagnosable disorder, and armed with that information, you can start to manage your symptoms!

If you, or you and a partner, suspect that sensory issues might be having an impact on your sex lives, the first thing you need to do is learn more about SPD in general and how it affects each of you specifically. Thankfully, the internet has many resources for people who want to know more about SPD (also known as SID, sensory integration disorder). Growing awareness and acceptance of neurodivergent people and their experiences has also helped validate SPD for the general public, though sensory struggles have been known to occupational therapists for decades.

The OT Toolbox, an occupational therapy site, is a great place to begin. I also recommend doing a self-assessment using the Adult SPD Symptoms checklist. Go through the whole checklist yourself and then compare with your partner(s). Then, ask yourselves, and each other, if there are sensory difficulties on anyone’s checklist which may have a direct or indirect impact on your sex lives.

Here are a few common sensory experiences people struggle with that may have an impact on their sex lives:

• Being bothered by light.
• Being bothered by quick touch and needing firm, slow, deep touch (or the reverse).
• Preferring to be the toucher rather than the person touched.
• Being unable to touch anything messy and needing to wash hands right away.
• Being easily distracted by visual or auditory stimuli.
• Not noticing if your own hands and face are dirty, and/or being very bothered by someone whose hands and face are dirty.
• Difficulty with temperature regulation of the body.

Even if these experiences aren't things you and your partner(s) struggle with, you're likely to find some sensory experiences that impact your sex life. Now that you’ve identified them, what can you do about it?

Find a sex therapist who also thinks like an occupational therapist (or the other way around)

I’ll tell you right now. This won’t be easy. Consider the following:

Kids with sensory dysfunction issues can be luckier than adults, in that their symptoms are more noticeable. The kid who screams at the touch of play-doh, or who can’t handle bathing, or who bumps into everything and everybody, gets noticed, especially at school. In a best case scenario, that kid gets some help from teachers and an ILP/IEP (independent learning plan, individualized education plan) and/or help from occupational therapists (OT). The goal of these interventions is to increase skills for a more self-empowered management of the activities of daily living (ADL).

Adults with sensory processing difficulties seldom get the understanding that diagnosed children get, unless they’re already getting services and support for some other condition, such as autism or ADHD. Then sensory integration might be part of the treatment plan. Even so, such treatment plans may not address sexual concerns.

For example, someone I worked with told me that sensate focus exercises recommended by a sex therapist were useless because their (now ex) partner had sensory processing disorder and could not stand to do them. You begin to see the dilemma. Standard advice is just not good enough when sensory processing difficulties are involved.

But things are changing. As far back as 1980, Evelyn Andamo published an occupational therapy treatment model for sexual dysfunction, but it’s only in the second decade of this century that more clinicians and researchers have taken up this issue. Sex- and pleasure-positive occupational therapists are now starting to address sex as an activity of daily living.

One of the best examples of this is the OT After Dark podcast. The first episode, "Sex is an ADL," and the second, "Bondage Toys as Adaptive Equipment," are a great introduction to the ways in which sensory processing disorder can impact sex and what to do about it. Though the podcast is geared toward helping professionals, most episodes contain practical, informational nuggets that anyone can consider.

Unfortunately, it’s hard (or perhaps impossible) to find self-help books that focus exclusively on work-arounds for sex and sensory dysfunction. You and your partner(s) will have to devise strategies based on what works and what doesn’t work for you, and this takes honest communication as you embark on your own sensory detective adventures.

For example, your partner’s favorite sex toy may be too loud or too complex for you to really enjoy using it with them. Tell them that, and find another that works for you both.

Or perhaps you’d like to use a weighted blanket on your chest while receiving oral sex, but you’re afraid that will sound weird. Maybe your other partner needs certain adaptive equipment to be more comfortable during some sexual activities, but no one has the budget to pay for it. So, how can you improvise? Compassion, and willingness to explore, communicate, and adapt, will be key.

Don’t be afraid to imagine things that might sound silly at first. Sucking your thumb to feel grounded and relaxed or changing the color of your bedroom (getting rid of that awful yellow) just might be the key to much more pleasure.

Finally, learn to embrace all the sensory quirks in your relationship. Make them adorable. Take pleasure and joy in incorporating them into your lovemaking.

Sexuality professionals, please learn more!

One last thing I want to add for the sexuality professionals out there: sex therapists, sexuality counselors, sexologists, and sex educators, please check out OT After Dark’s Episode 25, which introduces OPISI, the first Occupational Performance Inventory of Sex and Intimacy. While you're at it, listen to their other episodes as well! Every episode has references you can check out to learn more.

And please consider offering the Adult SPD Symptoms checklist to all your clients, as a routine part of your intake — not to diagnose, but to begin a discussion of sexual workarounds. You might be surprised by how useful it can be.