Disability and Sexuality

1. Disability and Sexuality Myths, Facts, and Teaching Strategies

2. Myth 1: People with disabilities are asexual • All people are sexual beings, including people with disabilities • People with disabilities have the right to sexual expression and to their sexuality • Someone with disabilities may just express their sexuality differently than those without disabilities • This myth encourages negative feelings about people with disabilities and their sexual expression

3. Myth 2: People with disabilities are childlike • People with disabilities are not “forever children”, they grow into adulthood and adult feelings just like people without disabilities • Seen as forever needing care and protection, which can lead to seeing them as asexual • This encourages a lack of sex education for people with disabilities because it is felt that they “don’t need it”

4. Myth 3: People with disabilities have more important things to worry about than sex • People living with disabilities often have other people dictating how to prioritize their lives • This often leads to people with disabilities being told that sex should rank as a low priority • As compared to things like hygiene, therapy, eating, communication • People have the right to prioritize sex and sexuality however they like in their own lives • When sex and sexuality are viewed as secondary and unimportant, the person with disabilities is given less of an opportunity to be a self-advocate

5. Myth 4: People with disabilities cannot have “real” sex • People with disabilities can and do have sex, however it may be different than what we think of as “real” sex • Sex can be many different acts, and there is no one definition of sex • The myth of a “correct” way to have sex can lead people with disabilities to believe that if they cannot feel, move, or act in a certain way, then sex is not for them, which is a falsehood

6. Myth 5: People with disabilities do not need reproductive health care • People with disabilities need STI-testing, pap smears, and information on contraception just as people without disabilities do • Doctors and nurses often skip speaking to their patients with disabilities about these issues • Because they feel that their patients are not sexually active • Because they feel that they will “encourage” sexual behavior • Doctors and nurses should not assume that their patients with disabilities are not sexually active, and they must recognize that all people are sexual, including those with disabilities

7. As women with disabilities should have equal access and information regarding contraception, doctors and nurses must also recognize the right of a woman with disabilities to have a child • Doctors and nurses should not assume that a woman with disabilities cannot care for a child • Doctors and nurses should talk with a woman with disabilities about what pregnancy would be like in detail • Good nutrition, health exams, vitamins • Specific aspects of pregnancy that would be affected by the woman’s disability and vice versa • Go through a plan for labor that takes the woman’s disability and labor preferences into account

8. When it comes to reproductive care, people with disabilities are at times the victims of institutional violence • Forced sterilizations or hysterectomies to prevent pregnancies • This happens more often in other countries, such as India • This is done sometimes in institutions, or at the request of the parents • This is also sometimes done to stop menstruation, so that the staff does not have to explain it to the person menstruating

9. What can doctors and nurses do? • Speak directly to the person with disabilities, even if they have a worker with them, or trouble speaking • Be sure to explain that all decisions regarding reproductive care are up to the person with disabilities, and that they should not do anything or have any procedure that they do not want • Try to assess whether the person is going through with a procedure or process because they want to, or because they have been coerced to do so • Be sure to offer STI-testing, pap smears, and contraceptive information in simple, easy to understand terms, and offer them as often as one would to a person without disabilities • Talk through each step of an exam before performing it

10. Myth 6: People with disabilities do not need sex education • Everyone is sexual, and everyone needs an education • Sexual ignorance is a huge stumbling block in the path to figuring out who we are as sexual beings • This is made worse for people with disabilities, who are often systematically denied that small amount of sex education the rest of us get • This can be because people worry that if people with disabilities are taught about sex, they will be encouraged to have sex • This is no more true in people with disabilities as it is in people without disabilities. This is simply false

11. Age-appropriate sex education for people with disabilities • This is very important to provide • Some key topics to discuss: • Sexuality and feelings • Anatomy • Puberty • Menstruation • Changes in the body • Private vs. public behavior • This can be a difficult topic to master • Cover what a public place is and what a private place is

12. Different types of relationships • Acquaintances • Family • Friendship • Dating • Marriage • Consent • This topic is especially important, as people with disabilities are more susceptible to abuse and manipulation • Consenting to separate acts • Rescinding consent

13. Self-care • Hygiene • Exercise • Accepting your body • Self esteem • Protection • Unwanted pregnancy prevention • STI prevention • Getting tested • How to express emotions properly • Identify different emotions and what they mean • Discuss positive ways to express each emotion to a friend, family member, or partner

14. Helpful tools for teaching sex education to people with disabilities • Anatomically correct tools are very important for clarity • Dolls • Pictures • Diagrams • Movies • Age and developmentally appropriate information

15. Role-playing • Private vs. public behavior scenarios • Consent situations • Relationship skills • Communication skills • Word choice • When teaching, use simple, concrete words • Use anatomically correct terminology, euphemisms can be confusing

16. Ask questions to probe understanding • Reinforce what was taught often • At the beginning and end of each class • Talk to all of the people that act as supports so everyone is on the same page • Use a range of teaching methods to increase retention • Games • Movies • Pictures • Dolls • Question and answer sessions

17. Sexual violence towards people with disabilities • Unfortunately, people with disabilities are often the victims of sexual violence because they are seen as easy to manipulate or coerce • Different types of sexual violence: • Child abuse • Children with disabilities are often taught that they should be compliant and passive when it comes to people interacting with their bodies, which can lead to a false assumption by the children that this extends to touching that makes them uncomfortable • Children with disabilities also often work with more adults who have control over them daily than other children • This leads children with disabilities more susceptible to abuse

18. Domestic abuse • This can be heightened for people disabilities because often the people they are living with (spouse, partner, family member) have a lot of control (physical, emotional, monetary) over them • Harder to extricate themselves from the domestic abuse situation because they may be dependent on the abuser • Institutional abuse • Stemming from educational institutions, mental institutions, medical institutions, or group homes • Forced medication (often tranquilizers) when there is behavior staff is unhappy with • Sexual activity • Reactions to boredom, such as yelling or fighting • Forced sexual behavior with workers or caretakers

19. Abuse Prevention Strategies • Comprehensive sex education is a prevention strategy in and of itself • Be sure to go over topics such as good touch vs. bad touch, what constitutes abuse, and who can assist in personal tasks such as dressing, hygiene, and using the bathroom • These topics are especially important to go over with children • Stress the importance of consent and what it means to consent to something • This is especially important in domestic situations • Regularly check in on institutions involved in a person’s life to make sure that they are not involved in institutional abuse • Pay attention to signs of abuse and take seriously any claims of abuse

20. Resources • http://www.sexualityanddisability.org/home.aspx • http://nichcy.org/schools-administrators/sexed • http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Disability_and_sexual_issues?OpenDocument • http://www.aamr.org/content_198.cfm • http://www.advocatesforyouth.org/index.php?option=com_content&task=view&id=479&Itemid=177 • www2.gsu.edu/~wwwche/Sex%20Ed%20powerpoint.ppt