Disability and sexual issues

Sexuality is a key component of human nature. People who are intellectually or physically disabled, whether from birth or through accident or disease later in life, may find it difficult to express their sexuality in satisfying ways. Perhaps they have reduced sexual function or feeling, have body image concerns or are unsure how to negotiate the sexual act because of lack of knowledge or physical incapacity. Disabled people may suffer from reduced opportunities for sex for various reasons, including lack of privacy. Finding ways to express sexuality can be a vital part of rehabilitation in the case of physical disability acquired during adulthood.

Body image concerns
Western culture has firm ideas on how men and women should look. A person with a disability may feel unattractive, or even 'less worthy' of sexual partnership, because they can't live up to the idealised image. If the disability was acquired later in life, the person may remember how they used to look and feel unattractive by comparison. Talking with others who have overcome their body image problems may be helpful.

Sex education
A child's sex education is gathered from a range of sources, such as their parents, school and friends. Difficulties for the disabled child include:

There is a misconception that disabled people are non-sexual (or should be) and don't need sex education.
Some people assume that intellectually disabled people are potential sexual deviants, and should be denied sex education in case it 'gives them ideas'.
A child with intellectual disabilities may be confused by sex education unless the information is presented to them in ways they can understand.
The child may have trouble distinguishing between private and public behaviours.
Sex education is usually of a general nature, and doesn't address the potential sexual problems a particular disability may cause.
Parents may not have the knowledge to advise the child on how to overcome their particular sexual problems.
Children who are blind from birth need to distinguish between the sexes by touch. Parents can provide anatomically correct 'life dolls' for tactile exploration.
Sexual function
Physical disabilities may interfere with sexual functioning. Some men with multiple sclerosis suffer from impotence. Physical disability may prevent certain lovemaking positions, cause problems with sexual arousal or reduce libido. Some conditions (such as cerebral palsy) cause uncontrollable muscle contractions, which can interfere with lovemaking or masturbation and cause clamping of the vaginal muscles that makes penetration impossible. Suggestions from your doctor or support group may be helpful. You may need someone to help you get into or maintain sexual positions, even if the thought of a 'sexual assistant' is initially embarrassing. Other suggestions include activities that are less physically taxing than penis-in-vagina sex, such as oral sex, mutual masturbation and the use of vibrators.

Sexual sensation
People with spinal cord injuries, for example, may have reduced or lost sexual sensations in their genitals, but may still feel desire and arousal. In many cases, a 'phantom' orgasm can be felt in other areas of the body, given the right stimulus. Some disabilities, such as cerebral palsy, may cause painful muscle cramps during sexual activity. Professional advice from your doctor or support group on how to maximise sensations is recommended.

Reproductive rights
Society tends to believe that people with intellectual disabilities should be non-sexual. In many cases, sex education is withheld on the assumption the individual 'won't need it'.

The forced sterilisation of intellectually disabled people is an issue, which was addressed in 1992 with the establishment of a legal framework on child sterilisation. Research by the Australian Human Rights and Equal Opportunity Commission suggests that intellectually disabled girls and women have been unlawfully sterilised. The law states that a court or tribunal authority is needed before a child can be lawfully sterilised – unless the sterilisation is associated with surgery to treat malfunction or disease, and that sterilisation is a last resort option. Anecdotal evidence supports the suggestion that these laws are flouted. It is also possible that the laws are too vague and open to interpretation.

Contraception
In most cases, a woman's fertility is not disrupted by her disability, because ovulation and menstruation are controlled by hormones. However, contraceptive choices may be limited for a number of reasons, including:
A woman with quadriplegia will be unable to insert diaphragms.
Contraceptive pills may contribute to an unacceptably high risk of blood clots.
Medications may interfere with the contraceptive pill and implants.
Physical disabilities may limit condom use.
Pregnancy
Disability tends to impact more on male fertility than female, since men with some disabilities are troubled by impotence. Women with disabilities are generally as fertile as women without disabilities. A disabled woman who decides to get pregnant may encounter prejudice from unthinking people. For example, others may be shocked that a disabled person would contemplate having sex, let alone have a baby. Other issues include antenatal care – a pregnant disabled woman needs close medical attention and observation throughout her pregnancy, and may require a more controlled experience of childbirth, such as caesarean section.

Sexual assault
People with disabilities are vulnerable to sexual assault and exploitation. Compliance is often encouraged in people who are institutionalised, which makes them less confident in their dealings with others. Since there is a misconception that disabled people are non-sexual, it is often assumed that a sexual assault will not 'hurt' them in the same way as it hurts people without disabilities. The prejudice of others often compounds the painful experience of sexual assault for a disabled person. Support groups and rape crisis centres may be of great benefit.

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Posted by Health Care , Published at 8:05 AM and have 0 comments