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In this section you will find sexual health information that supports youth with disabilities in making healthy and informed decisions about their sexuality.

Sex (which has come to mean sexual intercourse) and sexuality (which embraces the whole self) are very often merged in people's minds. From this comes the MYTH that if you don't or can't have sexual intercourse, you are not a sexual person. In reality, people who don't regularly have intercourse can be very sexual...and sexy.

Sexuality encompasses more than the physical act of having sexual intercourse, it includes the emotional, intellectual and sensual components as well. Or as Anna Freud put it...Sex is what you do, sexuality is who you are.

Below are a few common questions that people with disabilities often ask. Perhaps these are questions that you have thought about but didn't know where to find the answer.

If you don't find answers to your questions here, email us at askus@spiderbytes.ca. Your questions are confidential, and a trained peer volunteer will respond to your question within three days.

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What is meant by "Disability"?

Disability is usually defined in terms of being "physical" or "mental".

Physical disabilities are mostly associated with physiological disorders, disfigurement or anatomical loss. It can affect any number of body functions, including neurological, cardiovascular, respiratory, reproductive, digestive and urinary systems. These are just a few of the categories. There are many more.

Mental disabilities are defined as being any mental or psychological disorder, such as mental retardation, organic brain syndrome, emotional or mental illness and specific learning disabilities. Again, these are just a few examples.

There are many types of disability. Everyone is different, as are their levels of ability. The key is knowing yourself.

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What are some of the more common issues regarding sex and physical disability?

While not all physical disabilities are the same, the issues remain the same for every person who has experienced altered sexual function, including...

  • sexual desire and response
  • genital arousal partnership functions
  • bowel and bladder functions
  • fertility and contraception
  • mobility (positioning, caressing, etc)
  • limited birth control options

Any or all of these things can negatively affect the self image and self-esteem of a person with a disability. Try not to let it. If you don't feel comfortable with your body, speak with your partner, or your doctor, or a counsellor. They may help you to see good things about yourself that you didn't know you had.

You will find below information and possible solutions of things that might affect your sexual activities.

Remember that not all birth control options protect against sexually transmitted infections (STIs). Go to Risk Rater for information on sexual acts and STI risk.

Loss of sensation
Communicate with your partner about what feels good and where it feels pleasurable. Become aware of which body parts are involved and to what degree. Emphasize stimulation of unaffected body parts. Discover new erogenous zones if genitals are affected. It may still be pleasurable to watch your partner caress genitals or perform oral sex, even without genital sensation. The IUD is not recommended for birth control because problems may go undetected. The Birth Control Pill or Depo-Provera may not be an option if circulatory problems exist. Visit the Birth Control section for other options

Lack of muscle strength
If the arm or hand is affected, you may use aids such as a vibrator for stimulation of yourself or your partner. You may need assistance with positioning, which could be part of foreplay. Masturbation may require assistance. Rocking in a waterbed may help with movements. Communicate with your partner about needs. Diaphragm, cap, sponge, foam, IUD, and condom are all viable birth control options if assistance is available. The Birth Control Pill or Depo-Provera may not be an option if poor circulation exists.

Muscle spasms
Some people find spasms increase pleasure, others find it deters it. Find positions that either promote or inhibit spasms. For women with leg spasms causing the legs to draw together, rear entry may be more pleasurable. Communicate with your partner about needs and positions. The Diaphragm, sponge, cap, foam, and condom may be suitable for birth control but may require assistance. The IUD may be a problem if menstrual self-care and increased bleeding is a problem. The Birth Control Pill or Depo-Provera may not be an option if poor circulation exists.

Inability to get or sustain an erection. (Erectile Dysfunction)
Communicate with your partner. Some men with Spinal Cord Injury can get reflex erections via manual stimulation of the genitals. Explore alternatives to intercourse. Use of an artificial penis can be pleasurable. It may be pleasurable to insert the flaccid penis into the vagina, and this may help with erection. Penile implants can be discussed with a urologist. Rings over the penis may produce pseudo-erection by preventing the blood supply from leaving. If erectile dysfunction is a temporary problem try other techniques. If it is caused by medication, explore other alternatives with a doctor. Using a condom may be difficult. It may be better to find other alternatives for safe sex. Visit the Birth Control section for other options.

Premature ejaculation
Communicate with your partner about the condition to avoid any surprises or misunderstanding. Birth control choices are not affected. Visit the Birth Control section for options.

Urinary or bowel incontinence
Communicate with your partner about the possibility of an accident to avoid surprise and ease anxiety. Plan sexual activities around a program or schedule. Limit your fluid intake prior to sexual activity. Try urinating before sexual activity. Keep towels handy and protect the mattress in case of an accident. Visit the Birth Control section for options.

Catheter use
Ask a doctor if it is possible to remove the catheter during sexual activities; if so, make sure bladder is empty. For women, tape the catheter to stomach or thigh; rear entry position may be more comfortable. For men, tape the catheter to penis and place condom over it once the penis is erect. Use extra lubrication. Ask your doctor if it is possible to temporarily clamp the catheter and remove the drainage bag during sexual activity. Communicate with your partner about needs and expectations. Visit the Birth Control section for options.

Fatigue or endurance
Find positions that do not require physical exertion, and take a less active role. Activities other than intercourse are less strenuous. Avoid sexual activity when anxious or in extremely hot, cold or humid environment. Wait 3 hours after food and alcohol consumption before engaging in sexual activity. Use sex aids during sexual activity and masturbation. Communicate with your partner about needs. Visit the Birth Control section for options.

Shortness of breath
Use well ventilated or air conditioned room. Ask doctor about using bronchial spray before sexual activity. Avoid sex when under stress or tension. Wait 3 hours after food and alcohol consumption before engaging in sexual activity. Find positions that don't put pressure on chest or diaphragm and do not require high energy. Communicate with your partner. You can consider all birth control options.

Use of a respirator
Find positions that are comfortable when the respirator is out of the way as much as possible. Communicate with your partner about your needs. You can consider all birth control options.

Pain in joints
Find positions that do not put pressure on joints. Incorporate heat treatment into foreplay (with doctor's permission). Explore all kinds of sexual activities. Communicate with your partner about the need for certain positions. The Birth Control Pill or Depo-Provera may be unusable due to poor circulation. The IUD may be unusable due to possible increase in anemia. Use of diaphragm, sponge, cap, foam or condom may require assistance and can be incorporated into foreplay.

Pain in back or neck
Maintain pelvic tilt during intercourse i.e. when on back, raise your knees above your hips. Avoid bulky pillows under your head. Keep the back and neck aligned. Keep your back supported with a firm mattress or surface. Avoid pelvic thrusting. Communicate with your partner. You can consider all birth control options.

Deformity
A healthy body image is important. Find different positions that are comfortable. Communicate with your partner about your feelings, concerns, expectations etc. It may be difficult to insert or fit a Diaphragm, sponge, or cap due to pelvic deformity. Visit Birth Control section for other options.

Amputations
Masturbation may be difficult with upper body amputations. Experiment with sex aids. Experiment with positioning. Communicate with your partner about your needs. Use of diaphragm, sponge, cap,or condom may require assistance and can be incorporated into foreplay. Using an IUD may not be possible if you are unable to check for strings.

Lack of vaginal lubrication
Communicate with your partner and use artificial lubrication. Go slow, prolong foreplay to allow time for lubrication to develop. Incorporate relaxation techniques such as massage into foreplay. If lack of lubrication is due to medication, ask your doctor about alternatives. Visit the Birth Control section for options.

Latex allergy
No implications on sexual activity. Do not use latex materials. Make sure condoms are latex free. Some options for protection during sexual activity include the use of non-microwaveable plastic wrap instead of a dental dam or non-latex gloves. Visit the Birth Control section for other options.

Blindness or visual impairment
Emphasize body exploration through touch, smell, and imagination. Your partner could approach and stimulate you from your seeing side, if visual impairment is partial. The Birth Control Pill or Depo-Provera is unusable if impairment is due to diabetes, glaucoma or vascular disea. Visit the Birth Control section for other options.

Medication
Some medication may cause fatigue, lower sex drive,or inhibit sexual response. It's okay to discuss side effects on sex life with your doctor as it is the only way they will learn about the drug. Ask your doctor questions like why do I need this med?...how does it affect my sex life?... are there other alternatives? The Birth Control Pill or Depo-Provera may be in conflict with other medications. Visit the Birth Control section for other options.

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Is it possible for a person with a disability to have a healthy sexual relationship?

Regardless of disability, sexual relationships are possible, so is pleasure. Relationships are based on friendship, trust and respect. Often the disability only needs to be taken into consideration when the two people consider HOW to be sexually active. Creativity and flexibility are the keys. Certain positions might be impossible. Open and frank discussion is needed to solve the unique considerations a disability may present.

Overcoming the challenges a disability presents requires effective communication. The couple should discuss everything, from planning sexual activity, communicating likes and dislikes, sharing sexual fantasies and other ways of enhancing arousal. It also means dealing honestly with anger, fear, frustration and sense of loss if there has been a loss of sensation associated with the disability.

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Does being paraplegic or quadriplegic with a loss of sexual function necessarily mean a loss of sexuality?

Sexual function may be impaired but sometimes it can, like other functions, be increased. After spinal cord injury, the spinal centre for sexual function is generally intact: it is the communication from the brain to the spinal centre that is usually disrupted. Unless some sensation in the area of the sexual organs remains, the usual sensation of orgasm is lost, but "phantom" orgasm elsewhere in the body may be experienced.

The physical and emotional aspects of sexuality, despite the physical loss of function, continue to be just as important for people with disabilites as for non-disabled people.

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Is "Facilitated Sex" an option?

Facilitated sex involves having one or both of the partner's personal care attendants in the room while the couple is participating in sexual activities. Their role is to help the couple position themselves for sexual intimacy and perhaps intercourse.

The idea has been getting its share of headlines lately for a number of reasons. First and foremost, it helps individuals with disabilities to get physically closer to their partner than if they were alone together. Another reason is the public's fascination with sex, and specifically having more than two people in the room. Is it voyeurism? Is it an orgy? Perhaps the most overlooked question...is it anyone else's business?

For a couple where both people have a physical disablility, facilitated sex can move the partners physically closer together. But as it has been mentioned earlier, there is more than physical proximity to a sexual relationship, there is an emotional component as well. This is where facilitated sex seems to get in the way. Some people find the lack of privacy distracting, and as a result the sense of intimacy is lost. It is difficult to feel turned on while at the same time feeling self conscious.

The couple's relationships with their personal care attendants can also get complicated. There are many facilitated sex issues that are being discussed, for example:
Is it appropriate to ask a personal care attendant for sexual assistance?
How might a request to facilitate sex effect the employment relationship between the disabled person and the personal care attendant?

For some, facilitated sex may provide a solution. For others, it requires further thought or investigation.

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Is "Tantric Sex" an option?

The traditional view of sex is that it focuses on orgasm and the release of pent up sexual tension. The climax is achieved only after escalating stimulation and excitement.

Tantric sex, based on various eastern philosophies, offers an alternative to the traditional view of sex. In Tantra, excitement is the beginning, not just a means to the end. Instead of moving quickly towards a climax, Tantric philosophy teaches the participant to slow down, remain in the moment and relax. In the traditional view, sexual energy builds and is then lost. In the Tantric view, energy is not lost, but gained! Instead of using a partner for one's own gratification, Tantric partners provide energy to each other.

The philosophy teaches that sensuality and sexuality begin with oneself. Barriers to these experiences during sex include concentrating too much on the performance and not enough on the sensations...judging others, making comparisons with the past that invalidate the present...and focusing on the expectations instead of the pleasure available at that moment.

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Are there websites, books or videos that offer assistance in overcoming sexual issues related to disability?

  • Spiderbytes gratefully aknowledges the contribution of SexAbility to this section.
    SexAbility is located at the The Anne Johnston Health Station and has comprehensive resources related to sexuality and disability.
    How to Contact SexAbility:
    Anne Johnston Health Station
    2398 Yonge Street
    Toronto, ON
    M4P 2H4
    416-486-8666 ext 248
    E-mail: :SexAbility@ajhs.ca


    SEXUALITY AND DISABILITY RESOURCES
    www.accessibility.com.au
    On this site, there is a four-part feature article about sexuality and disability by Lisa Tarricone.

    www.bentvoices.org
    This webzine is primarily by and for gay men with disabilities. It also has writings by women as well. Stories, writings, poetry, discussions, etc are at this site. You have to subscribe - it's free.

    www.comeasyouare.com
    Check out the disability resources page, which has really useful links to other disability and sexuality sites.

    www.gimpgirl.com
    A site devoted to disability culture. It has links to sex and disability resources and information.

    www.sexscape.org
    This site has some content about sexuality and disability. An 'ask the expert' forum with an archive of questions and answers as well as a search engine and a sex question of the week are the main feature.

    www.disabilitysex.com
    Offers information about sex, love and relationships for the disability community. The site includes articles on sexual help, sex tips, dating, pregnancy, news, products and more.

    www.sexualhealth.com
    This site specifically has information and resources about sex and sexuality for people with disabilities. Be sure to look at their links to other resources about disability and sexuality.

    www.siecus.org
    SIECUS maintains a number of on-line bibliographies, including one of the most comprehensive sexuality and disability lists available on the internet. Even better, each title comes with a brief description and all the ordering information needed.

    BOOKS

    The Ultimate Guide to Sex and Disability: For All of Us Who Live with Disabilities, Chronic Pain and Illness
    Written by Miriam Kaufman, Fran Odette, & Cory Silverberg. Published in 2003.

    Enabling Romance: A Guide to Love, Sex and Relationships for the Disabled. Written by Ken Kroll. Published by Random House in 1992.

Caution: Do Not Open Until Puberty! An Introduction to Sexuality for Young Adults with Disabilities. Written by Rick Enright. Published by TVCC Innovations in 1996.

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