Sexuality and Disability 2006 Oregon Statewide InService Conference

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Sexuality and Disability 2006 Oregon Statewide
In-Service Conference

• Barbara Barton, Ph.D.
• Western Michigan University

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Definitions

• Sex refers to the biological characteristics
  that define humans as female or male.
• Sexuality a central aspect of being human, and
  encompasses sex, gender identities and roles,
  sexual orientation, eroticism, pleasure,
  intimacy, and reproduction. Its influenced by
  the interaction of biological, psychological,
  social, economic, political, cultural, ethical,
  legal, historical, religious, and spiritual
  factors.

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And

• Sexual health a state of physical, emotional,
  mental, and social well-being in relation to
  sexuality.

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Its importance

• The quality of personal relationships in general,
  and sexual ones in particular, exerts great
  impact on a (persons) self-esteem and support
  network.
• (Merritt, 2004)

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Life goals

• To work.
• To play.
• To love.

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Myths regarding people with disabilities

• Asexual
• Hypersexual

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Which result in

• Avoidance in dealing with it
• Taboos against the discussion of sex
• Lack of education and information on how sexual
  activity, sexual health, and sexuality relates to
  people with disabilities.
• Less attention paid to sexual access by
  advocates

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Methodologic Problems

• Sexual function is not directly observed
• Limited baseline data on sexual dysfunction
• No standardized, widely used assessment
  instrument or process
• Consumers do not typically report sexual health
  problems
• Counselors do not routinely ask about consumers
  sexual health

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Continued

• Counselor discomfort
• Consumers anticipate a nonempathic response
• Other counselor factors
• Embarrassment
• Feeling ill prepared
• Sexual health not relevant to consumers needs
• Underestimation of prevalence of sexual health
  problems
• Time constraints
• (Nusbaum, Hamilton, 2002)
• (Marwick, 1999)
• Inclusion of sexual health and history during
  assessment process increases consumer rapport.

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What barriers to healthy sexuality might occur
for people with disabilities?
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How would these issues be different for women
versus men?
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Components of Sexuality

• Biologic sexuality
• Sexual orientation
• Gender identity
• Sexual behavior
• Emotional and interpersonal satisfaction

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Early onset (congenital disabilities)

• Sexual development is affected
• Gender roles
• Language of sex
• Self-exploration
• Formal sexual health class content is replaced
  with personal learning
• No privacy
• Limited peer interaction
• touch only occurs by health care professionals

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Medical/physiological issues

• Flexibility
• Bowel/bladder
• Spasms
• Erection/ejaculation problems
• Vaginismus/anorgasmic/lubrication issues
• Effects of medications
• Communication problems with partner
• Fatigue

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Psychological Issues

• Body image
• Lack of desire (adynamia)
• Social isolation
• Hypersexuality (disinhibition)
• Depression
• Lack of education/information on compensatory
  strategies

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Treatment options Physical

• Implants
• Pumps
• Medication/positioning
• Creative use of toys
• PCAs for positioning
• Problems
• No accessible OB-GYN tables or scales
• Lack of physician comfort

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Treatment options Psychological

• A rehabilitation counselor who is comfortable and
  knowledgeable about topic
• Peer groups
• Online help
• Therapy
• Self-help books

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P.L.I.S.S.I.T. Model for approaching sexual
health problems

• Permission for counselor to discuss sexual
  health with a consumer for consumers to discuss
  sexual health concerns now or any time in the
  future.
• Limited Information clarify misinformation,
  dispel myths, and provide factual information in
  a limited manner.

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Continued

• Specific Suggestions provide specific
  suggestions directly related to the particular
  problem.
• Intensive Treatment provide/refer highly
  individualized therapy for more complex issues.
• (Annon, 1974)

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Organic and psychological causes that lead to
poor sexual adjustment

• Vascular disease
• Endocrine disorders
• Musculosketal disorder
• Neurological disorders
• Psychogenic factors
• Other diseases (i.e. cancer, MS, AIDS)
• Substance abuse

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Message for consumers

• You are not alone. It is common to experience
  sexual problems at sometime in life.
• Many problems are transient or can be worked out
  with patience and a caring partner.
• If there is physical pain, seek medical
  evaluation for a physical cause.

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Continued

• It is crucial to have open and honest discussions
  with your partner.
• If you have feelings you dont understand, or
  have difficulty coping with guilt fear, conflict,
  or shyness, dont be afraid to see a counselor.
• Be willing to find resources to help you develop
  skills in communication, relaxation, and
  pleasuring techniques.
• (Source Keene State College)

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Dispelling Sexual Myths

• Ejaculation and orgasm are not the same thing
• It is not necessary to ejaculate every time you
  have sex
• Orgasm is possible without ejaculation
• Sexual activity without orgasm and ejaculation is
  still sex and is a viable option versus having no
  sex at all
• There are many ways to receive and give sexual
  satisfaction without intercourse
• Sexual pleasure and orgasm are possible through
  touching, kissing, masturbation, oral, and anal
  sexual activities
• Good sex does not have to be spontaneous talking
  about and planning activity can lead to good sex.