The word "disability" covers a huge range of conditions: physical disabilities like spina bifida, sensory disabilities like blindness, "invisible disabilities" like epilepsy, developmental disabilities like Down’s syndrome, psychiatric disabilities like bipolar disorder … the list goes on and on. Some people are born with a disability; others acquire one later in life - in fact, most people, if they live long enough, will experience a disability of some kind before they die. Disabilities can be so mild that they don’t have any effect on day-to-day life, or so severe that they require full-time care and assistance.

So there are very few things that apply to all disabled people. In fact, the main thing we have in common is that we have to deal with other people’s stereotypes and prejudices.

One common stereotype is that disabled people just aren't sexual. Media images of disabled people often present us as pathetic or child-like. Even images that are supposed to be more positive can have the same effect: "saintly" or "heroic" doesn’t always fit well with "just plain horny".
Of course, some disabled people, just like some non-disabled people, may choose to be celibate for part or all of our lives. And some conditions like depression or chronic fatigue syndrome may reduce interest in sex, at least temporarily. But there isn’t anything about having a disability that magically prevents someone from having sexual feelings. We feel desire and lust just like anyone else.

The other common myth is that, if disabled people do have sexual feelings, then we must go around in a permanent state of sexual frustration, either because we "can’t have sex", or because nobody could possibly want to have sex with someone with a disability.

Many disabled people get thoroughly tired of being asked questions along the lines of "Um, can you, like, DO IT?" - with "IT", of course, being penis-in-vagina intercourse.

For a start, disabled people are just as likely as anybody else to be lesbian, gay or bisexual, so penis-in-vagina intercourse may not be something they are interested in. And many people (with and without disabilities) find that intercourse isn’t necessarily the best or most pleasurable form of sex anyway.

In some cases, a particular disability might mean that intercourse is difficult or unsatisfactory for a particular person. For example, spinal cord injuries or diabetic neuropathy might mean that someone has reduced sensation in their genitals, or that a guy’s ability to get erections might be affected. But of course, as all good Scarleteen readers should already know, there’s a lot more to sex than just intercourse.

Some disabilities may mean that you need to make practical adjustments to partnered sex, but these are usually pretty simple - with good communication and a bit of imagination (and if you don’t have those, you probably shouldn’t be having sex with anyone in the first place).

For example, someone with a hearing impairment might want to make sure that the lights stay on during sex so that they can lip-read or sign to their partner. Joint or back problems might make certain positions uncomfortable or tiring. In many cases, the most important thing is simply making your partner aware of how you function ­ for example, letting them know that that the side-effects of some medications can make it harder to reach orgasm, or warning them if you sometimes have seizures or muscle spasms. In my case, my disability (Asperger’s syndrome) can make my nervous system over-react to touch, so I need to make sure that people (friends or lovers) know not to touch me unexpectedly.

Of course, disabled people have to practice safer sex and birth control just like anyone else. This should be obvious, but it doesn't seem to occur to some people that anyone with a disability might get pregnant or contract an STD. In a few cases, a particular disability may affect your choice of safer sex or birth control methods. For example, some doctors feel that oral contraceptives (birth control pills) should not be prescribed to women who have poor circulation or mobility, as they may have a higher-than-average risk of thromboembolism. Many people with spina bifida are allergic to latex, so they need to use non-latex gloves, condoms and dams for safer sex.

Having a disability can sometimes make it harder to find a sexual partner. It can be difficult to socialize and meet people if social events are held in inaccessible buildings. Prejudice can also be an issue, especially in the teenage years ­ for many teenagers, dating seems to be more about "getting" someone who’s seen to be a good "catch" than who you actually want to be with. And sadly, even in adulthood, there are some non-disabled people who can’t imagine anyone with a disability as a possible partner. That’s their loss.

But there are plenty of people out there who don’t have that problem. Contrary to the media images we're fed, being attractive and sexy has nothing to do with having a "perfect" body or being "normal". If you fall for someone's gorgeous grin and deranged sense of humour, the fact that they use a wheelchair to get around may turn out to be a minor detail.

In a way, having a disability can actually become a positive advantage when it comes to sex. It means that you need to learn how to communicate and be up-front about what works for you and what doesn’t. Having to change and adapt the standard "script" means you have to be flexible and creative. And you have to focus on what actually feels best for you and your partner, instead of getting hung-up about what’s "normal" or how you’re "supposed" to have sex.

And those are the real secrets of great sex for everybody.

"When I was first injured, I went out on a date. I was worried about whether I would fall out of my chair trying to get out of the car. Then I had a bladder accident, and I wondered whether or not to tell the guy, 'I peed on your seat.'" One of the biggest problems that many people have, especially shortly after their injuries, is their own self-image. "Loving yourself is one of the most important steps," said Steve, a man with paraplegia. "At first, you just want your body to function, and later you try to fit your body into society. At first I was very down on my injury and I really wasn't projecting who I was. But as I interacted with people and they kind of reflected who I was a little better than I did, my relationships improved." "You're still a person," said Shannon, a woman with paraplegia. "You're sexual, you have feelings." All the panelists agreed that the best way to put people (including yourself) at ease is communication. In a sexual situation, the partner with a disability usually needs to educate the other person about the ways in which his or her body is different, and both partners need to communicate about what they like, what seems to be working for them, and any problems they might be having.

Choosing the right partner is important. "It's easy to tell who's going to be comfortable and who's not," Laura said. "I didn't want to spend energy and time with someone who was going to have issues with my disability." "The chair can act as a screening device," Shannon said, explaining that some people see the wheelchair first, while others see you first as a person. Amit, a man with paraplegia, said he had trouble figuring out how to initiate dating with people. "It's hard to make the first move," he said. "You're still caught up in that aggressor mentality." In time, however, he learned "little tricks for how to get somebody close to you. The biggest thing is to ease yourself in slowly and figure out what you want to do." Practical advice for having sex included minimizing accidents by emptying your bowel and bladder first, being careful to position yourself in a way that avoids too much friction or pressure, and using humor to help you cope. "Because of my spasms, we call our bed at home 'the vibrabed'," Shannon said.

Men with higher injuries may need direct stimulation of the penis in order to have an erection and/or ejaculation, since the injury may impair the connection between the brain and sex organs while leaving the lower reflex system intact. Men with low injuries may need to use a vacuum device, an injected drug, or a penile implant to get or maintain an erection, since the nerves that actually go to the penis and prostate may be impaired. "It's very important to explore," Steve said. "If you're interested in improving your sexual function, seeing a rehabilitation physician and getting a referral to a urologist who has a special interest in working with people who have SCI is a good idea." "There's an advantage to having gone through spinal cord injury," he added. "There's a body focus that I didn't have before my injury. It gives you a great advantage as a partner. People find you quite open...creativity and romance and communication become a much stronger part of relationships with disability." "You use what you have left," Laura said. "You do what you have to do, and it's OK." 

© 1999, 2000 Dept. of Rehabilitation Medicine  [University of Washington]