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Disability and Sexuality
“People with physical or intellectual disabilities in our society are often regarded as non-sexual adults. Sex is very much associated with youth and physical attractiveness, and when it is not, is often seen as "unseemly". If sex and disability are discussed, it is very much in terms of capacity, technique, and fertility - in particular, male capacity and technique and female fertility—with no reference to sexual feelings” (Zola, 1988). If we accept that sexual expression is a natural and important part of human life, then perceptions that deny sexuality for disabled people deny a basic right of expression. The perception of people with disabilities as non-sexual can present a barrier to safe sex education, both for workers who may be influenced by these views, and for disabled people themselves in terms of gaining access to information and acceptance as sexual beings. Many people become institutionalised at an early age and grow up to lead sheltered and restricted lives. This in itself creates a barrier to forming close relationships with others in the wider community and sets them at an even further social disadvantage. They become totally dependent on the institution for their emotional as well as physical needs and find it difficult to relate to others outside the institution.
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'. 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.
Where to get help - Your doctor
- SHFPACT Disability and Education Unit Tel. (02) 6247 3018
- Disability ACT Tel. 13 34 27
- Canberra Rape Crisis Centre Tel. (02) 6247 2525
Things to remember
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.
Problems include body image concerns, reduced sexual function, loss of sensation, and the prejudice of others.
Sexual assault and abuse
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.
People with intellectual disabilities are more vulnerable to sexual abuse and are more likely to be abused because:
• They often do not understand what is happening to them.
• They are less able to protect themselves.
• They are unlikely to report abuse.
• They are less likely to be believed even if they do report sexual abuse.
In response to suspicions or disclosure of sexual abuse you should deal with the allegations as you would for anyone else. You are legally mandated to report abuse of children.
Discussing sexuality
For most people with an intellectual disability abstract concepts are difficult to understand and given the complexity of most issues regarding human relationships and sexuality issues, you need to be specific about what and how information is given to people with intellectual disabilities. This can be done by remembering these key points in communication:
• Keep language simple and concrete.
• Repeat what you say.
• Demonstrate wherever possible. Use simple and clear pictures, realistic models, or the actual object. Demonstrate using the person’s own body.
• Check and recheck that the person has understood. Rephrase and ask the same questions in different ways to check that the person has understood the information or instructions.
Menstruation
Most women with an intellectual disability begin menarche at the usual time and go on to menstruate with the same regularity as their non disabled peers. The management of menstruation or menstrual disorders in women with an intellectual disability should be no different to that provided for any other woman.
Masturbation
• Masturbation in an appropriate place is generally regarded as acceptable socio/sexual behaviour for men and women of all ages and abilities.
• Concern is often expressed regarding the frequency and type of masturbation and/or the inability to ejaculate. As a general rule these are not usually medically based but it is important to exclude any underlying medical or psychiatric condition.
Homosexuality
• Homosexuality occurs at roughly the same percentage in people with intellectual disabilities as it does in the rest of the population.
• Many people with intellectual disabilities have spent long periods of their lives in institutions, usually living in same sex units and their sexual experiences may have been limited to same sex, sexual activity.
• Each individual should be given opportunities to socialise and experience a wide range of relationships in order to help them more fully understand their own sexual preferences.
Inappropriate socio-sexual behaviour
For various reasons some people with an intellectual disability may engage in what is considered socially inappropriate behaviour in relation to sexuality. This behaviour is sometimes seen as the result of a ‘high’ sex drive and you may be asked to prescribe anti-androgens such as Depo Provera and Androcur to curtail sexual libido. Medication on its own should never be a first approach to treatment. It is not appropriate to prescribe these drugs simply because the person is ‘perceived’ by others to have a problem with their sexuality. A holistic approach should be taken and should include social, psychological, educational, medical and psychiatric aspects of the problem behaviour.
Menstrual Suppression
There may be some circumstances when the suppression of menstruation could be considered appropriate and to be in the woman’s best interests. This should only be considered if trials of other options have proved to be inadequate or if the woman is able to make an informed decision. Menstrual suppression is still considered to be an ethically contentious issue by the Guardianship List and advice from them should be sought whenever there is doubt as to the appropriateness of this alternative.
Sterilisation
Any sterilisation procedure should only be considered for the same therapeutic reasons that you would consider them for anyone else. These procedures including endometrial ablation and vasectomy are considered by law to be major medical procedures in all Australian states.
Therefore:
• If a person is under 18 years of age the matter must go through the Family Court.
• If an adult is not able to give informed consent then the matter must be referred to the appropriate guardianship authorities.
Information on this page was sourced from: http://www.stdservices.on.net/std/social_aspects/disability.htm
http://www.fpq.com.au/factsheets_brochures/menu_disability.stm
http://www.fpahealth.org.au/sex-matters/factsheets/audience_index.html
http://www.amazon.com/Ultimate-Guide-Sex-Disability-Disabilities/dp/1573441767
http://www.shfpact.org.au/index.php?option=com_content&task=blogsection&id=9&Itemid=34
http://www.wwda.org.au/sexualit.htm
http://www.wwda.org.au/womdis16.htm
http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Disability_and_sexual_issues
http://www.cddh.monash.org/assets/fs-sexuality.pdf
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