Disabled People Need Sexual Health Care Too

Image by Maria Iliou. From the Disabled Artist Guild.

Image by Maria Iliou. From the Disabled Artist Guild.

BY ROBIN MANDELL | ReadySexyAble.com

Most safer sex guides take it for granted that all of us are going to have the manual dexterity (ability to move our hands) to unwrap and use a condom, that getting STI testing is as easy as booking (and keeping) an appointment at a free or low-cost sexual health clinic, and that communicating with a partner about safer sex is as easy as having a few face-to-face conversations about it. For those of us who have any sort of physical, cognitive, or psychological disability, these and other “basic” safer sex strategies may not be so easy.

It doesn’t help that disabled people are assumed to be nonsexual, or to have more important things to worry about than the “luxury” of sexual feelings or a sexual relationship, or any number of other myths about sex and disability all of which miss the mark in one way or another.

People with disabilities who are sexually active, or planning to be sexually active, need to practice safer sex, and get regular sexual healthcare, just like anyone else.

A Quick Overview of Safer Sex

If you’re disabled, know that you have the right to whatever expression of your sexuality you want to have, and you have the right to be safe when expressing your sexual self, both alone and with partners.

Safer sex is about taking care of your sexual health, and protecting yourself from sexually transmitted infections (STIs). Preventing unwanted pregnancy is known as birth control, not safer sex, but it’s still part of your sexual healthcare if pregnancy is something that can happen to you or someone you’re sexually involved with.

Safer sex includes using barriers (such as condoms or dental dams) for genital contact with a partner, and getting regular sexual healthcare, including STI testing.

Let’s look at a few considerations around safer sex specific to being someone who has any kind of disability. You can get more safer sex info by reading through the other articles on this site.

Sexual Health Care

Most sexual health services aren’t set up to meet the needs of disabled people. In the U.S., many providers don’t get training in working with patients who have disabilities. Coupled with assumptions about disability and sex, this can lead to you not getting the sexual healthcare you need. That might be a healthcare provider who doesn’t ask you about sex, or asks in such a way that assumes you’re not having it.

Or, it means examination tables that don’t accommodate people whose bodies don’t move in the ways expected for traditional exams. This includes staff unable, unwilling, or untrained to assist with positioning your body on the table.

Or, it means reams of forms to fill out, and informational pamphlets and brochures that are only available in print.

Even one step into a building- or doorways that are too narrow- can keep you from seeing a healthcare provider of your choosing.

Healthcare providers aren’t immune to the myths about disabled people and sex, which can result in them assuming their disabled patients aren’t having sex and consequently not asking questions about sexual health, evaluating someone’s need for birth control or STI testing, or even conducting routine genital exams.

Sometimes healthcare providers can fall into the trap of thinking that any problem a patient presents with is related to their disability; or, it may be assumed that what would be a problem for some people (such as fertility problems or the need for frequent STI testing)) will not be a priority or even a problem for disabled people.

Steps you can take to get the sexual healthcare you need if you have a disability:

  • Look for a sex-positive healthcare provider.
  • Find a provider who can meet your disability needs. Members of the Gimp Girl community have put together this list of accessible gynecologists. The list is short, but can give you an idea of what sorts of accommodations you can ask for, and expect, from any private medical practice or clinic.
  • Be prepared to ask for the sexual healthcare you need. Sadly, preparing yourself might also include being ready to fend off judgment, condescension or surprise.If your provider doesn’t bring up sex, you can. You can ask for STI testing, or to discuss birth control options.
  • Be sure when you’re discussing birth control, or if you are being treated for an STI, that the treatment won’t interfere with any medication you take and that any possible side effects won’t trigger physical or psychological symptoms of your disability.

Some assumptions you might encounter:

  • “Oh, I guess we don’t have to talk about birth control, do we?” Quickly followed by the next question in the provider’s list.

Possible response: “Yes, actually, I do need to talk about that. I’ve been wondering what method would be easiest to use considering the problems I have with my hands.”

  • “Is there someone who can help you with your birth control pills?”

Possible Response: “No, I want to keep that private. Maybe I need a different kind that will be easier for me to use on my own.”

  • “I know it’s hard for us to do a pelvic exam on you. Let’s skip it this year.”

Possible Response: “I know it’s hard to examine me, but with what I told you about my sexual history, is a pelvic exam advisable medically? I don’t want to skip any steps I need for my health.”

Sometimes, if the provider assumes the answer to a question, like that you don’t need to have birth control, or of course you’re not sexually active so there’s no need to talk about that and they can move right along with the questions, their words are accompanied by nervous laughter. You might want to drop through a hole in the floor when hearing that, but just because they’re nervous doesn’t mean you have to be. As disabled people, we’re often encouraged to help people feel less nervous around us. This is your healthcare provider, though; it’s their job to meet your healthcare needs and to deal with whatever feelings they have around doing that on their own time. So, just take a deep breath and set them straight about what you need from them.

Once you’ve found a provider you’re able to work with, talk with them to make sure you’re getting the best care you can. The following resources might help you and them. (Unfortunately, most of the writing and research on this topic has been geared towards patients who have what medical people have defined as female genitals. If you don’t have a vagina/vulva, your healthcare needs will be different but your provider can still work with you to find creative solutions to disability-related problems that might come up during examinations.)

Table Manners and Beyond: The Gynecological Exam for Women with Developmental Disabilities and Other Functional Limitation, and Reproductive Health Care Experiences of Women With Physical Disabilities: A Qualitative Study are both resources you and your provider can read through together to help problem-solve any accessibility challenges you’re having with your healthcare.

Accessing Safer Sex Supplies

Transportation problems, inaccessible buildings, worries about being judged, or lack of trusted help can keep you from getting safer sex supplies. Perhaps you’re in a wheelchair and need to ask a store employee to reach your preferred pack of condoms. Or maybe you have a visual impairment and need to ask for help reading the wide variety of lube bottles. Being in these situations may make you feel vulnerable to being asked intrusive questions or judgmental comments. Considering that people ask visibly disabled strangers how they have sex, these fears aren’t unfounded. How can you get supplies while maintaining self-respect and privacy?

Many resource centres on college campuses and sexual or reproductive health clinics provide free condoms. If you get your healthcare needs taken care of at a private practice, and you have a good rapport with your provider, consider asking them if they can obtain condoms, gloves, or other safer sex supplies for you.

You also might consider asking a trusted friend to pick supplies up for you- they can find somewhere that offers them for free so no one has to pay -and handing them over when you see each other.

Many reputable suppliers also sell safer sex supplies online at decent prices and provide clear , detailed information on what you’re buying.

Communication

Do you have the words to talk about sex, and about your body? A lot of us, whether we’re disabled or not, don’t grow up learning the right words for our body parts, or clearly understanding how our bodies work.

When you’re talking to someone you are (or want to be) having sex with, making sure you can communicate accurately and clearly is important. You can’t consent to take part in a sexual activity if you can’t understand your partner, or if they can’t understand you. It’s hard to agree on safer sex practices if, say, one or both partners are unable to speak clearly, are hard of hearing or deaf, or has trouble paying attention to written or spoken words for more than a moment.

You and your partner might want to have a few ways you communicate with each other about sex, both when you’re discussing it and when you’re doing it.

Your communication toolbox can include talking or signing, gesturing, writing notes back and forth, or any other way you can both understand each other. If verbal communication is difficult, or doesn’t happen at all, you’ll want to agree ahead of time on how you’ll communicate things during sex like “I need more lube” or “let’s get the dental dam.”

If talking and writing are both difficult, you might try reading through safer sex information together, and using words or body language (such as nodding your head, shrugging, looking confused, and so on) to indicate when you’ve read something you want to start doing, or that you want to learn more about.

If you use any assistive or augmentative communication devices, you might find the following list of sexual vocabulary words and phrases useful. These can also help you when you’re communicating with a healthcare provider or caregiver.

A Word On Coercion

Disabled people are at an increased risk of experiencing sexual assault. Sometimes that abuse can take the form of sexual coercion, someone talking you into sex you don’t want to have, or attempting to convince you to ditch the safer sex practices you’ve made it clear you want to use. Some people with disabilities are told—sometimes by partners, sometimes by family or friends–that they should be grateful for any sexual attention they get even if it’s not precisely what they want or need.

I call BS on that!

If someone is trying to talk or force you into sex that isn’t safe for you in any way, and they’re trying to use your disability (or anything else) to convince you, that’s just not okay. A person’s disability is no excuse for abuse.

More Resources on Sex and Disability

The following are some sex-and-disability resources that you may find useful:

ROBIN MANDELL is a healthy sexuality and disability rights advocate based in the Washington D.C. area.
She holds a Bachelor’s degree in Women’s Studies from Queen’s University in Canada and a Professional Writing Certificate from Washington State University. Over the years, Robin has amassed extensive experience working with people at vulnerable times of their lives, both as a crisis hotline worker and a sexuality and relationships education advocate with Scarleteen.  Robin has discovered over the years that disability issues receive significantly less attention in academia and social justice movements than they’re due. She has developed a passion for starting dialogues on sex, disability and accessibility, and has come to the realization that, as much as she just wants to be like everybody else, she can use her visible reality as a blind woman to start these dialogues. Robin blogs on disabilities, sexualities, and the connections between them at ReadySexyAble.com and has published articles on various sexuality and sexual health topics at Scarleteen and Fearless press.