Academic journal article The Canadian Journal of Human Sexuality

Sexuality and People Living with Physical or Developmental Disabilities: A Review of Key Issues

Academic journal article The Canadian Journal of Human Sexuality

Sexuality and People Living with Physical or Developmental Disabilities: A Review of Key Issues

Article excerpt

INTRODUCTION

The recognition that people living with disabilities are entitled to be sexual beings is a relatively new one. Prior to the 1970s, little of no research was conducted on the sexuality of people with disabilities (Milligan & Neufeldt, 2001). Historically, Western culture has viewed people with disabilities as asexual or potentially deviant. Although arguably less pervasive today than in the past, the myths surrounding the sexuality of disabled people are still very much with us. As Anderson and Kitchin (2000) put it,

   Cultural representations of" disabled people
   as "sick and sexless" are supported and
   sustained by a set of myths. Myths in relation
   to disability and sexuality include disabled
   people being asexual, that is lacking a
   biological sex drive, being unable to partake
   in sexual activity, and that disabled people
   (particularly those with a developmental/
   intellectual disability) lack the requisite social
   judgement to behave sexually in a socially
   responsible manner (p. 1164).

A recent review of available research shows that sex acts involving persons with disabilities are viewed more negatively than when these same behaviours are considered in the context of non-disabled persons (Milligan & Neufeldt, 2001). As DeLoach (1994) argues, the existence of such attitudes serves not only to isolate and marginalize the disabled, they also lead to the internalization of negative attitudes and beliefs by the disabled themselves. In some cases, the presumption of asexuality can become a self-fulfilling prophecy, leading people with disabilities to retreat from intimacy and sexuality (Milligan & Neufeldt, 2001). Health professionals are not immune to such beliefs. All individuals who work with people with disabilities need to be aware of the destructive impact that negative attitudes about sex can have on the health and well-being of their clients. Health professionals must also be prepared to work constructively with people with disabilities to fully maximize their potential as sexual beings.

This paper will examine the issues relating to sexuality faced by people living with disabilities. First, a critical overview of the traditional model of sexual response in terms of its applicability to people with disabilities will be presented. Second, some of the sexuality issues faced by people living with physical disabilities (congenital and acquired) and developmental disabilities (e.g., involuntary sterilization, capacity for responsible sexual behaviour, care giver attitudes) will be discussed. This will be followed by an examination of sexuality issues shared across type and onset of disability (increased HIV/AIDS risk, vulnerability to sexual abuse, reduced access to sexuality education for youth, privacy, sexuality related information and healthcare, and sexual partners). The final section offers recommendations for providing sexuality education and sex therapy for people with disabilities.

MASTERS AND JOHNSON'S SEXUAL RESPONSE MODEL: APPLICATION TO PEOPLE WITH PHYSICAL DISABILITIES

Traditional models of sexual response have focused on an orderly, staged sequence of physiological functioning. For example, Masters and Johnson's (1966) ground-breaking and widely adopted model of sexual response categorized "normal" sexual functioning as proceeding through four stages: (1) excitement, (2) plateau, (3) orgasm, and (4) resolution. This model provides the basis for the diagnosis and treatment of sexual dysfunctions as categorized in the Diagnostic and Statistical Manual of Mental Disorders-IV-TR (DSM) (American Psychiatric Association, 2000). In other words, an "impairment" or "disturbance" in any one or more of these stages leads, in the strict application of this diagnostic scheme, to the diagnosis of sexual dysfunction. Most guides to the assessment and treatment of sexual dysfunctions are based on the DSM classifications (for example, see Winze & Carey, 2001). …

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