Sex and Disability: How to Get Help in Intimate Situations

by Dr. Linda R. Mona

Getting assistance has been on the minds of disabled people for quite some time but only recently has been discussed in a few academic articles and amongst community members in a variety of different venues. The most frequently asked questions about sex and personal assistance services (PAS) are: With what types of disabled sex activities might an individual with disability need assistance? And, how would you find a person willing to assist with such a private yet important activity?

While choosing the right sex toy and/or modifying it can assist a person with a disability with being sexual, sometimes those changes are just not enough to help facilitate the activity. There are people with disabilities who may need assistance from another person for masturbation or having sex with someone else. PAS refers to a person assisting someone with a disability to perform tasks aimed at maintaining well-being, personal appearance, comfort, safety, and interaction with the community and society as a whole. And, while sex is not specifically included within the typical definition of PAS, it certainly does fall within the domain of "well-being."
Below are examples of sexual activities that individuals with disabilities may need PAS for experiencing their sexual pleasure:

Physical Impairments
Removing clothes; positioning for masturbation; positioning for partner sex; transferring in and out of the wheelchair onto the floor, couch, or bed; stimulating a partner's body with your hand or sex toy; stimulating your own body with a hand or sex toy; cleaning up and getting redressed; using birth control (condoms, diaphragm, birth control pill, etc.)

Visual Impairments
Preparation for sex; e.g., transportation to and from your partner's location, shopping for sex toys, discussion and interpretation of sexual positions often only drawn in books

Hearing Impairments

Sign Language interpretation before and/or during sexual activity with a hearing partner, phone interpretation if TTY or other telecommunication services are not available
There is, of course, a wide array of what people need help with and who will agree to assist. For example, someone may need assistance with setting up to use a sex toy; e.g., taking the product out of its box, positioning it in a person's hand, and turning on the power, but may be fine with actually stimulating herself/himself. On the other hand, another person may need help with the whole process; e.g., all of the above, plus, holding the sex toy in place where the person desires the stimulation. It is very important to think about these issues before you look for a personal assistant and ask for help.

Although people with disabilities have been using PAS for sex over the years, there has been much controversy about how one asks for such assistance and what others have found successful in negotiating such a relationship.

Below are some ideas about how to prepare to and have a conversation with a potential personal assistant about helping with sexual activities:
  • Develop a concrete list of activities with which you need assistance; e.g., removing clothes, masturbation, touching a partner, using a condom or diaphragm, using a sex toy
  • Establish boundaries and rules; e.g., indicate how long you estimate that an assistant might stay in the room, and be able to identify the activities with which you do and do not want assistanceAgree upon a communication system to be upheld between the assistant and the disabled person within the sexual encounter; e.g., establishing particular words, hand signals, eye blinks to indicate when to start, stop, and leave room.
  • Partner involvement when both individuals have disabilities; e.g., communicating with a partner about her/his physical abilities, feelings about assistance with sex, what her/his understanding of the assistant's involvement is prior to interviewing a potential service provider.
  • Think about safety issues when choosing a provider; e.g., checking appropriate general references for this person, making sure that a friend knows what is going on and may be able to check in to see if the situation is safe, determining a way to call for help if you feel uncomfortable.

Not surprisingly, this topic has been quite controversial for many reasons. Agencies that provide funding for PAS will not specifically indicate that they would approve sexual activity as one of the areas of basic needs for people with disabilities. However, bowel, bladder, and menstrual care are typically approved as appropriate activities.

Sex is personal, private, and a basic need. So what do people with disabilities do? They ask for assistance from friends or service providers other than their usual personal assistant. Most often they pay out of pocket for this service. Or sadly, some disabled people choose not to pursue their sexual experiences. While people without disabilities may take for granted their right to experience their sexuality, people with disabilities have to fight for this right at various times throughout their lives. Is it all worth it? Absolutely!

Dr. Linda R. Mona is a nationally recognized expert, and well-known advocate, for disability rights. She has authored numerous presentations and papers on the topic of sexuality and disability, in particular, and often runs workshops on this very important topic.

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