Background: The occupational therapy profession needs a framework to guide understanding of the occupational nature of sexuality and intimacy, assessment, intervention design, and measurement of outcomes. This study aimed to defne the occupational nature of sexuality and intimacy and develop a theoretical and occupation-based screen, in-depth self-assessment, and performance measure. Method: The Occupational Performance Inventory of Sexuality and Intimacy (OPISI) was developed following DeVellis's (2017) guidelines for scale development that involved mapping the construct, generating an item pool, determining the format for measurement, and reviewing the initial item pool. Results: The Occupational Therapy Sexual Assessment Framework (OTSAF) was developed to defne the occupational nature of sexuality and intimacy, depict how the theoretical constructs intertwine with the domain of occupational therapy, and guide scale development. The OPISI includes a self-screen, in-depth self-assessment, and an individualized measure to establish baseline performance and detect self-perceived change in ability, satisfaction, understanding, and confdence in skills and ability to improve occupational performance associated with sexuality and intimacy over time. Conclusion: The OTSAF defnes the occupational nature of sexuality and intimacy and informs the occupational therapy scope of practice. The OPISI includes theoretical and occupation-based tools to adequately screen, assess, and measure performance related to the complex occupational nature of sexuality and intimacy. Formal validation is needed prior to releasing the OPISI for clinical use. Comments The authors report that that they have no conficts of interest to disclose. Keywords OPISI, sexuality, intimacy, assessment, framework, occupational therapy Cover Page Footnote The authors would like to acknowledge Christopher Bentlage and Jeremy Warriner, who shared their experiences, highlighted the signifcance of sexuality and intimacy to individuals with disabilities, and invoked shame in our profession for our silence in addressing the topic in practice. We would also like to acknowledge Dr. George Szasz, a pioneer in sexual medicine, who readily shared his experiences, insight, and expertise throughout this process and supported our efforts to break the silence in addressing sexuality and intimacy in occupational therapy. Complete Author List Beth Ann Walker, Kasey Otte, Kelsey LeMond, Pamela Hess, Kandyse Kaizer, Tori Faulkner, and Davis Christy Credentials Display Beth Ann Walker, PhD, MS, OTR Kasey Otte, Kelsey Lemond, Pamela Hess, Kandyse Kaizer, Tori Faulkner, and Davis Christy (OTD, May 2020) Copyright transfer agreements are not obtained by The Open Journal of Occupational Therapy (OJOT). Reprint permission for this Applied Research should be obtained from the corresponding author(s). Click here to view our open access statement regarding user rights and distribution of this Applied Research. DOI: 10.15453/2168-6408.1694