When people think about spinal cord injury rehabilitation, they usually picture learning to walk again, transferring safely from bed to chair, or figuring out how to dress and bathe independently. Those are critical pieces of recovery.
But there is another part of life that rarely makes it into care plans or team meetings: intimacy and sexual health.
In this episode of The Charity Charge Show, we sit down with three leaders who are changing that reality:
- Gillian Gulan, OTR/L, Occupational Therapist and creator of the Adaptive Intimacy Lab at MetroHealth
- Marcia Meermans, Philanthropy Officer at the MetroHealth Foundation
- Mark Bogosian, Director of Engagement at the Christopher and Dana Reeve Foundation
Together, they walk through the story of how a simple but honest patient question, a brave idea, and a strong funding partnership led to one of the most unique quality of life projects in the country.
How a Single Question Exposed a Major Gap in Care
For more than 15 years, Gillian has worked as an occupational therapist helping patients with spinal cord injuries relearn critical daily tasks. Eating, dressing, using the bathroom, getting in and out of bed, driving, returning to work.
Her hospital, MetroHealth in Cleveland, is one of only 18 spinal cord injury model systems in the United States. The rehab team is large and specialized, with physical therapists, speech therapists, vocational rehab, and more.
On paper, it looked comprehensive.
Then a 17 year old patient asked Gillian during a session:
“Am I ever going to have sex again?”
She had no answer.
She did not know what to say, how it fit into her scope of practice, or where to send him. That moment forced a hard realization. For all the talk about independence and quality of life, no one was truly addressing sexual health.
From there, Gillian began a personal and professional journey:
- Looking for educational materials and finding only dated, low quality handouts and an old VHS style video from years ago
- Trying to have sensitive conversations in open gyms or shared rooms, with no privacy for patients
- Realizing that something as basic as a safe, dignified space for these topics simply did not exist
The gap was obvious. The question was whether anyone would be willing to address it.
From Quiet Concern to a Bold Proposal
Inside MetroHealth, Gillian began to test what might be possible. She talked with colleagues at national spinal cord injury meetings. She explored program development projects with occupational therapy students. She asked herself what a real solution would look like, not just another handout.
In the back of her mind, one idea kept resurfacing.
A dedicated space for sexual health and intimacy education. A place where patients and partners could:
- Have private, respectful conversations
- Access updated educational materials and videos
- See and try adaptive equipment before spending hundreds of dollars out of pocket
- Ask direct questions without shame or judgment
An Adaptive Intimacy Lab.
Even inside a progressive rehab system, putting that idea on the table took courage. As Gillian joked, she was not sure if people would think she was brave or foolish. But she knew her patients needed it, and that made the decision clear.
She brought the concept to her leadership team, who encouraged her to work with the MetroHealth Foundation to explore a grant. That is where Marcia came in.
The Power of the Right Funder at the Right Time
The MetroHealth Foundation serves as the 501(c)(3) fundraising arm for MetroHealth, Cleveland’s public safety net hospital. The foundation has a long history with the Christopher and Dana Reeve Foundation, stretching back to 2010.
The relationship is personal as well as professional. Christopher Reeve himself received care at MetroHealth after his spinal cord injury. Over the years, the Reeve Foundation has funded several projects at the MetroHealth Rehabilitation Institute.
When Gillian and a colleague first approached Marcia, they did not lead with the intimacy lab. They floated a more conventional idea, such as portable ramps for patients going home. That concept quickly ran into practical barriers such as storage.
Then Gillian shared her real idea.
Marcia did what strong philanthropy officers do. She listened, examined whether it aligned with MetroHealth’s mission and values, and tested the concept with her colleagues. Internally, leaders agreed. This was clearly a quality of life issue, and it deserved serious consideration.
The Reeve Foundation’s Quality of Life grants program provided the perfect framework.
- They run two grant cycles per year
- They provide a clear application template and structured questions
- Their focus is on meaningful, high impact quality of life projects for people living with paralysis
Marcia and Gillian worked together on the proposal. Gillian and her clinical team handled the heavy clinical lift, while Marcia ensured the application matched the funder’s requirements and communicated the vision clearly.
When the grant reached Mark’s desk, it stood out immediately.
“One of the Most Audacious and Life Saving Projects We Have Ever Funded”
The Reeve Foundation receives roughly 400 applications per cycle and funds about 50. That means only a small percentage of projects receive support.
Mark has spent his entire career in philanthropy reviewing grant proposals. Even with that experience, this one hit differently.
He describes the Adaptive Intimacy Lab as:
- “Audacious” and “bold”
- Deeply aligned with real, unmet needs in the paralysis community
- A project that directly addresses issues almost no one else is willing to tackle
Most grants focus on equipment, ramps, adaptive sports, transportation, or peer support. Those areas are vital. But sexual health and intimacy are rarely brought forward, despite being central to quality of life.
One external reviewer, who has lived with paralysis for more than 20 years, shared a painful reality. In her own life, she has lost four friends to suicide tied to loneliness and lack of intimacy.
People are not just curious. They are desperate for honest information and guidance.
That is why, in Mark’s view, this project is not a “nice to have.” It is life saving. He ranked it at the top of his list and advocated strongly for funding inside the Reeve Foundation’s internal review process.
The application was approved. The Adaptive Intimacy Lab would move from idea to reality.
What the Adaptive Intimacy Lab Actually Looks Like
The lab is not just a room with pamphlets. It is a carefully built environment designed to give patients privacy, dignity, and practical support.
Inside the space, patients and their partners can:
- Meet privately with Gillian or other trained staff
- Use updated educational materials, including QR codes and digital resources instead of outdated paper sheets
- Watch instructional content on modern screens rather than rolled in televisions with old tapes
- See and try adaptive wedges, ramps, pillows, and other tools on a queen size bed that mirrors a home environment
One subtle but important feature is the ability to test equipment before purchase. Insurance does not cover most intimacy related adaptive gear, and items can cost several hundred dollars.
Two community consultants with spinal cord injuries shared powerful feedback during early sessions. Each had spent roughly 850 dollars on a piece of equipment they thought would help, only to discover it was not usable for their bodies or situations. If they had access to a space like this beforehand, they could have saved that money and the frustration that came with it.
The lab changes that dynamic. Patients can try items, experiment with positioning, and decide what truly works before spending a dime.
A Shift in Culture: From Silence to Open Conversation
The lab did not just change what patients could access. It changed how the entire rehab team talked about sexual health.
Before the project, sexual health was rarely discussed openly among staff. Most clinicians did not feel equipped to raise the topic. When Gillian first started working on the grant, a physician walked past her laptop, saw sexual health materials, and immediately admitted he was not doing enough in that area.
Since the lab opened:
- Physicians are having more direct conversations with patients about intimacy
- Nurses feel more confident raising topics and then referring patients to Gillian for deeper work
- The outpatient team is engaged as well, so patients who are not ready to discuss intimacy during early inpatient rehab can revisit it later
Gillian jokes that she has been nicknamed the “sex OT,” which took some getting used to. Underneath that nickname is something serious. The team now sees sexual health as part of rehabilitation, not an awkward side topic.
That shift has profound implications for patients.
What It Means for Patients Living With Spinal Cord Injury
On the patient side, the impact is both emotional and practical.
For many newly injured patients, depression and hopelessness are common. Some are young adults who do not want to get out of bed, do not see the point in therapy, and cannot imagine a future that looks anything like a “good life.”
Gillian has learned that a simple, honest offer can break through:
“If you get out of bed, I will take you to the Adaptive Intimacy Lab and we can talk about sex.”
That line gets attention. It validates a fear that many patients are carrying quietly. They want to know if they can still have intimacy, romance, and physical connection.
Once in the lab, patients and their partners can:
- Ask questions they were too embarrassed to say out loud before
- Talk about concerns on both sides, not just for the person with the injury
- Receive tailored education around positioning, safety, and comfort
- Explore what intimacy can look like after injury, rather than assuming it is over
In one example, a patient casually accepted educational handouts during a discussion about bowel and bladder management. Gillian offered the option of a deeper session in the lab and suggested bringing his girlfriend. Two days later, the girlfriend showed up asking to visit the room.
Together, they met with Gillian, used the bed and wedges, discussed medical concerns, and left with clarity and a plan.
At its core, the lab exists to restore something simple: hope. Hope that life can still be meaningful, connected, and full, even after a life changing injury.
Philanthropy That Goes Beyond the Check
Throughout the episode, Mark and Marcia return to one core theme. True philanthropy is about relationships, not just transactions.
The partnership between MetroHealth and the Reeve Foundation did not happen overnight. It grew over years of shared work, consistent communication, and mutual respect.
A few key lessons stand out for nonprofit leaders and practitioners:
- Long term relationships pay off
The Adaptive Intimacy Lab grant was not the first touchpoint. Previous grants, clinical collaboration, and even the historic connection with Christopher Reeve’s own care built trust over time. - Strong funders listen to lived experience
The Reeve Foundation did not push MetroHealth toward a safe, generic project. They were willing to support a sensitive, under addressed issue because it clearly mattered to the community. - Good grantmakers care about more than compliance
For Mark, the site visit to see the finished lab was as important as the application. Meeting the team, seeing the pride they took in the work, and hearing from community members confirmed that this was a wise investment. - Healthcare systems cannot do everything alone
As costs rise and needs grow, philanthropy and partnership will only become more important. Projects like this show what is possible when hospital foundations and mission aligned funders work together.
Looking Ahead: A Model Worth Replicating
None of the guests on this episode view the Adaptive Intimacy Lab as a one off project. They see it as the beginning.
Mark is clear about his ambition. He wants to see similar labs in:
- Every spinal cord injury model system
- Rehabilitation hospitals across all 50 states and U.S. territories
- International centers that serve people living with paralysis
MetroHealth is ready to serve as a prototype, sharing lessons, design insights, and outcomes with other institutions. The Reeve Foundation is eager to keep telling this story and encouraging other organizations to step up.
At the heart of it all is a simple belief.
If rehabilitation is truly about quality of life, then intimacy and sexual health belong on the table. Not as taboo subjects, but as core components of care.
