In this section you will find 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 peoples' 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, we answer 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 answers.

If you don’t see what you’re looking for here, email us at [email protected] . Your questions are confidential, and a trained peer volunteer will get back to you within three days.

THE QUESTIONS

There are human rights and legal rights ... do we have sexual rights?

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

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

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

Is facilitated sex an option?

Is tantric sex an option?

THE ANSWERS

1. There are human rights and legal rights ... do we have sexual rights?

There are several principles that the disabled community, reproductive health organizations, and legal professionals all agree on. Knowing these rights can help you to safely discover your own sexuality.

You have the right to:

• Expect to be treated fairly, respectfully and with dignity, regardless of age, gender identity, sexual orientation, race, ethnicity, citizenship, education, physical and/or mental abilities
• Get fair, safe and non-judgmental information, education and counselling for your sexual and reproductive health needs
• Learn about sex, sexual activities, contraceptives and sexually transmitted infections (STIs)
• Have loving, non-sexual, non-abusive relationships with friends, parents and other people you know
• Decide who can touch your body, when, where and for how long
• Object to anyone touching your body
• Say no
• Make your own decisions and be supported in your decisions with regard to your sexual health and reproductive choices
• Protect yourself and be protected – from unplanned pregnancies, STIs, HIV/AIDS and all forms of abuse
• Privacy and personal space to explore your sexuality
• Choose a lifestyle, including a sexual lifestyle that is comfortable for you
• Get information that is easy to understand and is disability neutral when making decisions related to pregnancy
• Decide if you want to be a parent and when
• Accept or refuse any service or treatment, including those related to special prenatal tests if you are pregnant
• Make a decision, without being forced by others, to accept or terminate your pregnancy

2. What is meant by the word disability?

Disability usually relates to physical or mental abilities.

Physical disabilities are mostly associated with physiological disorders, disfigurement or missing parts of the body. They 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. Peoples' bodies can also change over time. Everyone is different, as are their levels of ability. The key is knowing yourself.

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3. 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:

• desire and response
• genital arousal
• bowel and bladder control
• fertility
• mobility, which affects things like positioning and caressing
• limited birth control options

Any or all of these things can damage someone’s self image and self-esteem. Try not to let it. If you don’t feel comfortable with your body, speak with your partner, doctor or a counsellor. Any one of them may help you to see good things about yourself that you weren’t aware of.

For contraceptive options, visit our section on BIRTH CONTROL METHODS .

Remember that not all types of birth control protect against sexually transmitted infections (STIs). Take a look at our STI RISK RATER for information on sexl acts and STI risk.

THINGS THAT MIGHT AFFECT YOUR SEXUAL ACTIVITIES AND POSSIBLE WAYS TO DEAL WITH THEM

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 other erogenous zones if genitals are affected. It may still be pleasurable to watch your partner caress genitals or perform oral sex, even without physical sensation there.

The IUD is not recommended for birth control because problems may go undetected. The birth control pill or Depo-Provera may not be options if circulatory problems exist.

To check out other options, visit our section on BIRTH CONTROL METHODS .

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 – think of is as being part of foreplay. Masturbation may require assistance. Rocking in a waterbed may help with movements. Communicate with your partner about needs.

The 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 they do the opposite. Find positions that either promote or inhibit spasms, depending on what is better for you. 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 with manual stimulation of the genitals. Explore alternatives to intercourse. Use of an artificial penis (dildo) can be pleasurable. It may feel good to insert the flaccid penis into the vagina, and this may help with erections. 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.

Premature Ejaculation

Talk with your partner about the condition to avoid any surprises or misunderstanding. Birth control choices are not affected.

Urinary or Bowel Incontinence

Communicate with your partner about the possibility of an accident to avoid surprises and to 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.

Catheter Use

Ask a doctor if it is possible to remove the catheter during sexual activities; if so, make sure bladder is empty.

If not ... For women, tape the catheter to stomach or thigh; a 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.

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 environments. Wait 3 hours after eating food and drinking alcohol before getting into sexual activity. Use sex aids during sexual activity and masturbation. Talk with your partner about needs.

Shortness of Breath

Be in a well-ventilated or air-conditioned room. Ask a doctor about using bronchial spray before sexual activity. Avoid sex when under stress or tension. Wait 3 hours after food and alcohol consumption before getting into sexual activity. Find positions that don't put pressure on your 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, allowing the respirator to be as out of the way as possible. Go over your needs with your partner. 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 your doctor’s permission). Explore all kinds of sexual activities. Let your partner know about the need to use 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

Have your pelvis tilted during intercourse. You can do this when on your back by raising your knees above your hips. Avoid bulky pillows under your head. Keep your back and neck aligned. Keep your back supported with a firm mattress or surface. Avoid pelvic thrusting. Make sure your partner knows what works best. You can consider all birth control options.

Deformity

A healthy body image is important. Find different positions that are comfortable. Tell your partner about your feelings, concerns, expectations or anything else you would like to share. It may be difficult to insert or fit a diaphragm, sponge or cap due to pelvic deformity.

Amputations

Masturbation may be difficult with upper body amputations. Experiment with sex aids. Experiment with positioning. Share your thoughts with your partner. Use of a 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.

Latex Allergy

This doesn’t affect sexual activity. Simply 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.

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 and Depo-Provera are unusable if impairment is due to diabetes, glaucoma or vascular disease.

Medication

Some medication may cause fatigue, lower sex drive,or inhibit sexual response. It’s okay to discuss a drug’s side effects on your sex life with your doctor. 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.

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

No matter what the disability, sexual relationships are possible. So is pleasure. Healthy relationships are based on friendship, trust and respect. Often, a disability only needs to be taken into consideration when the two people are working out HOW to be sexually active. Creativity and flexibility are the keys. Certain positions might be impossible. Other positions might be fantastic. Open and honest discussion is needed to solve the special considerations a disability may present.

Overcoming any challenges requires good communication. A couple should talk about everything – from planning sexual activity, getting to know likes and dislikes, sharing sexual fantasies and other ways of turning each other on. It also means dealing honestly with anger, fear, frustration, shame and feelings about any loss of sensation associated with the disability.

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5. 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 something called a phantom orgasm can possibly happen in another part of the body.

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

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6. Is facilitated sex an option?

Facilitated sex involves having personal care attendants there while couples enjoy sexual activities. An attendant helps the client get into position for sexual intimacy and perhaps intercourse. If both people making up a couple have physical disabilities, facilitated sex can allow the partners to be physically closer together.

The idea is getting more and more attention. It makes sense to assist individuals with disabilities to get physically closer to a partner than they could by themselves. Another reason why facilitated sex is being talked about has to do with the public’s fascination with everything to do with sex – and having more than two people in the room. Would such an arrangement count as voyeurism? Is it an orgy?

Perhaps the most overlooked question: Is it anyone else’s business?

Challenges

There is more than physical contact in a sexual relationship – there are emotions as well. This is where facilitated sex can get in the way. Some people find the lack of privacy distracting and, as a result, the sense of intimacy is lost. It is tough to feel turned on while at the same time feeling self-conscious.

The couple’s relationships with the personal care attendant(s) can get complicated. There are many facilitated sex issues to discuss. 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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7. 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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8. Are there websites, books or videos that offer assistance in overcoming sexual issues related to disability?

www.spiderbytes.ca gratefully acknowledges the contribution of SexAbility to this section

SexAbility is a program in the The Anne Johnston Health Station, and has comprehensive resources and workshops related to sexuality and disability. It is located at

2398 Yonge Street. Call 416-486-8666 ext 248 or email [email protected] for details.

SEXUALITY AND DISABILITY RESOURCES

Sex and Disability – a four-part feature article about sexuality and disability by LisaTarricone:

Part 1 “There’s nothing as unimaginative as popular culture when it comes to sex. If any group can break that stranglehold, it’s the disability community.”

Part 2 “Repressive stereotypes, misconceptions, and lack of information often lead people with disabilities to second-guess their sexual potential and desirability. There are many voices in the disability community, however, that defy these stereotypes.”

Part 3 “When you’re insecure about your ability to ‘perform’ the thought of being intimate can be daunting. But there are always ways to find your sexual groove.”

Part 4 “Performance anxiety, pain, discomfort, low self-esteem, trauma … sex isn’t always a bed of roses for women, disabled or not. But some women are getting even, not mad.”

BENT: A Journal of CripGay Voices
www.bentvoices.org/Archives/archiveblank.htm

This webzine was created and edited by Bob Guter from 1999 until 2007 as the only one of its kind devoted to the lives of gay men with disabilities. Its archives include writings by women as well. Stories, poetry, discussions, and more are at this site.

Come As You Are - Sex & Disability
A Toronto-based sex-positive sex store serving a wide range of clientele. Wheelchair accessible.
Disability Resources: Making Sex Toys More Accessible | Sex and Disability Links | General Disability Links | The Ultimate Guide To Sex and Disability

GimpGirl Community
www.gimpgirl.com/

Started by young women with disabilities in 1998, this site is devoted to disability culture. It has links to sex and disability resources and information. The goal is “to give girls and women with disabilities a place to be themselves, and talk about the things that are important to them.”

Sexscape.Org
www.sexscape.org/

“Providing free and confidential information about sexual health since 1994. ” This site has some content about sexuality and disability. It includes an ask the expert section with an archive of questions and answers. The site is searchable and features a sex question of the week.

This site specifically has information and resources about sex and sexuality for people with disabilities. Be sure to look at their section on Disability and Illness .

SIECUS maintains a number of online 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 Innovationsin 1996

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