Disability and sexuality

Most people are sexual beings, with sexual thoughts, attitudes, feelings, desires and fantasies. Having a physical or cognitive disability does not change your sexuality or your desire to express it. The World Health Organization describes sexuality as a basic aspect of being human that cannot be separated from other parts of life.

If your disability affects your physical ability to have a regular sex life, or knocks your confidence, you may feel worried about sex. Many people, with or without a disability, feel anxious about sex and sexual performance, and these feelings are completely natural. The same is true if your disability comes from a chronic illness.

In general, you are entitled to privacy and to make your own choices about your sexuality and sexual activity. Your disability may affect the sex life you would like to have. You may need to approach sex differently, and you may have questions or concerns about your physical or emotional health.

Concerns you may have about sex#

It is natural to feel frustrated about the effects of a disability on your sex life. You might be:

• Concerned about finding a partner, or about whether a partner will find you attractive.
• Lacking confidence about your sexual abilities or performance.
• Concerned about how your body moves or works.
• Anxious about your partner’s feelings about you.
• Worried about pain during sexual activity.
• Experiencing less energy and desire for sex.
• Concerned about whether you can have children.
• Worried about what others will think, and about discrimination.

It may help to understand that you and your partner can find new or different ways to satisfy each other.

If these concerns feel overwhelming, consider talking to your healthcare professional. If that feels embarrassing or frightening, remember that sex is a completely natural subject and your healthcare professional should be used to such questions. They can advise on your situation, including whether relationship counseling, an aid or device, or ways to support your body during sex might help. If they cannot help, they may refer you to a specialist who can answer your questions and ease your fears. Learning as much as you can about your disability in relation to sex can also help, and aids such as sex aids may be useful.

Social myths and discrimination#

Society holds many myths about disability and sexuality that are frustrating, offensive and simply wrong. These include the idea that a person with a disability does not need sex or cannot have “real sex,” that they have more important needs than sex, or that they should not have children.

Many people treat sex for people with a disability as a taboo subject and rarely discuss it openly. Society also tends to hold an idealized image of who is “sexually attractive,” and anyone who does not fit that image, with or without a disability, can feel diminished or dismissed. Information about disability and sex often focuses only on function or fertility, rather than perfectly natural feelings such as attraction, desire and love. To be seen as a non-sexual being can be devastating.

If these myths are affecting your life, you may be tempted to avoid sex or limit your chances of meeting a partner. A lack of privacy, because of carers or living arrangements, can make sex feel particularly challenging. Support and information are available if you need help developing relationships, exploring and expressing your sexuality, or accessing sexual health information.

The importance of emotions#

Just as sexuality is part of being human, so is love. At our core, most of us want to be loved and accepted, and you will know how important love is to you.

If you are a carer, friend or partner of a person with a disability, be aware of how important it is to express your love or regard. If you are not in a romantic or sexual relationship, the most important thing to remember is that you are not defined by your disability or illness. You are a person who desires and loves like anyone else, and you have a right to that.

If you are in a relationship and dealing with issues around disability and sexuality, these tips may help:

• Communicate. Openly discussing your feelings and concerns is the best way to solve problems together. State your needs clearly, around intimacy and sex and also everyday life.
• Read up. Learning all you can about sex in relation to your condition can help you feel more comfortable, including when talking to your healthcare provider.
• Seek help. If problems seem bigger than you and your partner can work out, consider counseling for an outside perspective. Depression is more than sadness and needs to be addressed.
• Keep an eye on each other. Watch for signs of poor health or other issues, such as depression.
• If your partner is also your carer, remember that carers need support and respite.
• If you acquired your disability, for example through an accident or chronic illness, try to accept that your relationship may change, and work out a new “normal” for you both. Staying socially connected, addressing stress such as money worries and new divisions of labor, and doing something kind for your partner every day can all help build intimacy and loving feelings.

Practical matters: enjoyment, contraception and sex education#

Enjoyment#

It takes energy to take part in and enjoy sex, so your disability may get in the way to some extent. Factors that can limit your ability to be sexual include:

• Pain. Chronic pain in particular can make you feel less like sex. But finding sexual pleasure in ways that minimize discomfort may even help ease the pain for a while.
• Fatigue. Sex can feel like just another burden when you are tired. If your energy is better at certain times of day, consider sex then, or take it slow and easy.
• Mental state. If you are not feeling positive, or you are dealing with anxiety or depression, you are unlikely to feel like sex. Talk to your doctor or a counselor about your feelings and seek help.
• Medication, which can affect your sexual interest, thoughts and moods. Talk to your healthcare professional about your concerns.

Contraception#

You have the right to make your own informed choices about contraception, though your disability may narrow the range of options available to you. Talk with your healthcare professional.

Sex education#

A young person with a disability needs sex education as much as any other young person. As well as a general approach, it should also cover:

• The fact that people with a disability can have fulfilling romantic and sexual lives.
• Any sexual issues that may be associated with their disability.
• Social rules, such as public and private behaviors, and personal boundaries.

For a young person with a cognitive disability, sex education should be delivered in a way they can understand. If you are a parent, it helps to have appropriate information on hand about puberty, menstruation, and romantic and sexual relationships. Most disabilities do not affect when menstruation starts. A young person with a cognitive disability may need longer to get used to the changes that come with puberty, so it can help to prepare them beforehand. Puberty generally starts from age 8 to 13 in girls and 9 to 14 in boys.

Sexual abuse and people with disability#

Rates of abuse, especially sexual abuse, are shockingly high for people with a disability. This abuse often goes unreported, and frequently occurs before the person reaches adulthood.

If you are a friend, family member or carer of a person with a cognitive disability and you are concerned about their wellbeing, you can contact a disability abuse and neglect hotline. Such services can help you find the best way to deal with an issue and usually refer you to an appropriate service. Independent advocacy services that safeguard the rights and interests of people with a disability can also help with queries about abuse and other legal matters.

Key points#

• A physical or cognitive disability does not change your sexuality or your right to express it.
• Anxiety about sex is common, and your healthcare professional can advise on aids, devices, counseling or referrals.
• Many social myths about disability and sexuality are simply wrong; you are not defined by your disability.
• Communication, learning about your condition, and seeking help when needed all support intimacy in a relationship.
• Young people with a disability need sex education too, and rates of abuse are high, so support and reporting services are important.

Where to get help#