The main points
- People with physical disability can express their sexuality in satisfying ways.
- The attitudes and support of other people are essential in enabling people of all abilities to have healthy personal and sexual relationships.
- Sexual abuse or exploitation is always wrong and should be treated as a very serious matter.
People with physical disability can express their sexuality in satisfying ways.
The attitudes and support of other people are essential in enabling people of all abilities to have healthy personal and sexual relationships.
Sexual abuse or exploitation is always wrong and should be treated as a very serious matter.
Sexuality is a key part of human nature. People with physical disability experience the same range of sexual thoughts, attitudes, feelings, desires, and fantasies as anyone else. To understand and enjoy sexuality, everyone needs adequate information and support from a young age.
Sexuality has psychological, biological and social aspects and is influenced by individual values and attitudes. A person’s sexuality develops throughout childhood and adolescence and is a key part of their identity. The way each person understands and interprets their sexuality varies significantly and often changes over time. Healthy self-esteem and respect for self and others are important factors in developing positive sexuality.
Most people with physical disability can have rewarding personal relationships. However, some may need additional support to develop relationships, explore and express their sexuality, and access sexual health information and services.
In Victoria, all people aged 16 years and over, including those with disability, are entitled to privacy and choice, within the law, regarding their sexuality and sexual activity. When someone has acquired physical disability in adulthood, finding ways to express their sexuality can be a key part of their rehabilitation.
Sexuality education for people with physical disability
A child’s sexuality education comes from a range of sources, including their parents, teachers and friends. People with physical disability also need sexuality education that:
- teaches them that people with disability can have fulfilling sex lives
- covers age-appropriate sexual issues that may be associated with their particular disability (for example, children who have a vision impairment from birth need to tell the difference between males and females by touch and it is helpful for them to have anatomically correct dolls when learning how to do this).
It is also important for parents to have access to the information they need to support their child in dealing with particular challenges they may face.
Social opportunities, sexual relationships and physical disability
The opportunity to mix with other people of both sexes, whether socially, at school or at work, is important in developing confidence and social skills. However, some people with physical disability may have fewer opportunities to form social and sexual relationships for a number of reasons, including:
- a lack of privacy
- being dependent on others for daily living
- a lack of confidence about their physical appearance and ability
- less knowledge of how to negotiate relationships and express their sexuality due to limited social experience or physical limitations
Sexual sensation and function and physical disability
There are many different types of disability. Physical disability may be caused by a genetic (inherited) condition, an illness or an accident. Sometimes, a person with physical disability may be less able to enjoy sex, which may be due to a range of issues, including:
- a lack of arousal
- erectile problems
- physical pain from sexual intercourse
- a lack of vaginal lubrication
- difficulty with sexual positioning.
Problems such as these may be the result of:
- the disability itself or its physical or emotional consequences
- a physical injury
- prescribed medications
- psychological illnesses including depression.
Examples of problems that people with physical disability may experience include:
- Some men who have multiple sclerosis experience impotence.
- Cerebral palsy can cause uncontrollable muscle contractions that can interfere with sex or masturbation and cause clamping of a woman’s vaginal muscles, making penetration impossible.
- Physical disability may make certain sexual positions difficult.
- Some people may have problems with sexual arousal or libido.
- Some people with a spinal cord injury may have limited or no sexual sensation in the genitals, but still feel sexual desire and arousal. In many cases, they may feel pleasurable sensations in other parts of their body, given the right stimulation.
A person with disability who is experiencing problems with sexual sensation or function can talk to a doctor, sex therapist or support group for suggestions on how to increase their sexual sensation or overcome other challenges.
They may need someone to help them get into or maintain sexual positions or explore different forms of intimacy that are less physically demanding than what they may be used to. These can include oral sex, mutual masturbation and using sex aids such as vibrators. There are many sex aids available that have been designed to be used more easily by a person with physical disability.
Incontinence and sexuality
Incontinence is the involuntary leakage of urine from a person’s bladder, or of faeces (bowel motion) from their bowel. Some types of physical disability can cause incontinence. A person with continence problems needs access to information about how this may affect their sexuality and relationships, as well as what they can do to enable them to enjoy sexual activity.
Body image, physical disability and sexuality
In some ways, society perpetuates a narrow view of how men and women should look, particularly through the media. A person with physical disability may feel less worthy of a healthy sexual relationship because they do not match this idealised image.
A person who acquires a disability later in life may feel negative about their body in comparison to how they felt before they acquired the disability. Talking with other people who have overcome body image concerns or a counsellor can help.
Contraception and reproductive rights for people with physical disability
All women and men, including those with disability, have the right to make their own informed choices about which method of contraception they use. To make these choices, people need adequate, accurate and accessible information about reproduction, the purpose of contraception and their contraceptive options.
The contraceptive choices available to a person with physical disability may be limited for a number of reasons, including:
- A diaphragm or contraceptive vaginal ring may not be suitable for a woman who has limited use or difficulty controlling the movement of her arms and hands (for example, a woman with quadriplegia or cerebral palsy) because they can be difficult to insert.
- Some medical conditions associated with certain disabilities can make taking the oral contraceptive pill or contraceptive vaginal ring less safe.
- Certain medication can interfere with oral contraception, the contraceptive vaginal ring, the contraceptive implant or emergency contraception (EC, also known as ‘the morning after pill’).
- A person with physical disability may find it difficult to put on and remove a condom.
- Some women with physical disability may need to have a contraceptive implant or intrauterine device inserted using sedation or under anaesthetic.
Physical disability tends to affect male fertility more than female fertility, since men with some physical disabilities may experience impotence. In most cases, a woman’s fertility is not disrupted by her disability, because ovulation and menstruation are controlled by hormones.
It is important to remember that emergency contraception (EC) can prevent pregnancy after having unprotected sex, for example, if a pill is missed, a condom breaks, or a woman is sexually assaulted. There are three types of EC now available. The copper IUD (intrauterine device) and EllaOne (tablet) are both on prescription from a doctor. Levonorgestrel tablet (also known as the morning after pill) can be bought from a pharmacy without a prescription. The pharmacist will ask questions to make sure it is suitable for the woman to take and that she knows how to use it. EC does not protect against STIs. EC can cost between $10.00 and $100.00. Action should be taken as soon as possible, ideally within 24 hours of having sex but can be taken up to 5 days after sex.
It is legal in Victoria for any woman to seek to terminate a pregnancy. All people are entitled to access support and counselling about issues relating to abortion.
Genetic services for people with physical disability
Some people with physical disability who are pregnant or are considering having a child may want to use genetic services, such as diagnosis, screening and testing, counselling, education, clinical research and information on the management of individuals and families with a history of particular health conditions. Access to services such as these will help people to make the best decisions for themselves and their children.
Pregnancy, parenthood and physical disability
Some women with physical disability who choose to have a child may need additional medical attention and support throughout their pregnancy. Some may need to give birth by caesarean section, depending on the nature of their disability.
People with physical disability can be loving partners and parents, maintain strong relationships and care for a child. Depending on the nature of their disability, a woman or man may need additional support with the physical demands of raising a child.
Sexual health and people with physical disability
People with physical disability should have the same choices regarding preventive health measures for sexually transmissible infections (STIs) and other conditions as people without disability, including:
- Condoms should be used to prevent the transmission of STIs. The person with disability may need to be provided with appropriate and accurate education about STIs and condoms, including the opportunity to practice how to put condoms on correctly.
- Women who are or have been sexually active should have a regular Pap test to help prevent cervical cancer. If a woman with physical disability has difficulty with Pap tests, she can contact PapScreen Victoria.
- People with disability should participate in immunisation programs, including the HPV (human papillomavirus) vaccine and immunisation program, which helps prevent cervical cancer.
- Women need to understand the importance of being aware of how their breasts normally look and feel and should be encouraged to see a doctor if they notice anything unusual.
- Women aged over 50 years need to consider having a mammogram for the early detection of breast cancer. A doctor can provide more information about this.
- Men need to understand the importance of seeing a doctor if they notice a lump or anything unusual with their testicles.
When providing health services to people with physical disability, doctors and other healthcare professionals need to take into account the particular disability and circumstances of the person. For example, certain gynaecological procedures can be difficult or painful for some women.
Sexual abuse or exploitation of people with physical disability
All people, including those with physical disability, have the right to enjoy relationships and sexuality without being abused or exploited. Unfortunately, statistics show that people with disability experience all forms of abuse at much higher rates than people without disability.
Reasons for this include:
- inadequate sexuality education on where and when it is acceptable to be touched by other people
- physical inability to resist, avoid or stop abusive behaviour from happening
- not knowing that a person has the right to decide what happens to their body, especially if they are used to other people constantly attending to their physical needs
- being raised in situations where they are used to being told what to do and therefore going along with requests or demands made by an abuser
- agreeing to engage in sexual activity to fulfil unsatisfied cravings for attention, affection or rewards.
Just as in the wider population, assaults against people with disability are more likely to be perpetrated by somebody they know, such as a family member, carer, work colleague or someone they live with. Research also shows that sexual assaults on people with disability are less likely to be reported.
Reasons for this include:
- Some people with disability find it difficult to communicate with others.
- A person may have limited knowledge or ability to report what happened to them.
- Some people wrongly think the effect of sexual assault on a person with disability is not as serious as an assault on someone without disability.
- A person may not be believed.
Any sexual assault is a very serious matter and should be referred to police and sexual assault support agencies.
The carers of a person with physical disability can help by modelling assertive behaviour, making referrals if the person needs further training or support, and explaining the basics of protective behaviours, including:
- Every person has the right to say what happens to their body.
- Everyone has the right to feel safe.
- There are laws to protect a person’s right to live safely without being harmed or exploited.
- There are many people who can be trusted, but also some who cannot be trusted.
- Some types of behaviour are appropriate for yourself and others, but some types are not.
- You can communicate assertively and say ‘no’ to unwanted behaviour.
- It is okay to change your mind about sexual behaviour or activity, even if you have already agreed to something.
- There are people who can help if you are being abused or exploited in any way.
Familt Planning Victoria Services
Cognitive Disability Referral & Secondary Consultations (Professional Advice)
When individualised counselling for sexualised behaviours of concern is deemed not appropriate, Family Planning Victoria offers a single session to parents, carers and/or professionals to discuss the situation and offer advice and resources to manage behaviours.
For more information, please visit Cognitive Disability Referral & Secondary Consultations (Professional Advice)
Counselling for Individuals with a Cognitive Disability
Family Planning Victoria works with individuals with cognitive disabilities, including intellectual disability, autism spectrum disorder and acquired brain injury, within the mild to moderate range where a sexualised behaviour of concern (SBoC) is driven by a lack of or gaps in sexual and relationship knowledge.
For more information, please visit Counselling for Individuals with a Cognitive Disability
Group Education for Individuals with a Cognitive Disability
Family Planning Victoria conducts tailor made, age and developmentally appropriate group education to increase the knowledge and awareness of RSH and relationship issues for people living with cognitive impairment.
For more information, please visit Group Education for Individuals with a Cognitive Impairment
Where to get more information, support or advice
- Your local doctor (GP)
- Family Planning Victoria's clinics
- Visit Better Health Channel
- Centre Against Sexual Assault (CASA)
- National Sexual Assault, Domestic and Family Violence Counselling Service
- Office of the Public Advocate Advice Service
- Victorian Civil Administrative Tribunal
- PapScreen Victoria