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Journal of Rehabilitation, Volume 76, Number 4

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Journal of Rehabilitation
2010, Volume 76, No. 4, 37-41

Sexuality and Societal Beliefs Regarding


Persons Living with Disabilities
Martin G. Brodwin
California State University, Los Angeles

Pauline Cheryl Frederick


California State Department of Rehabilitation

The purpose of this article is to help sensitize counselors to some of the issues involving
sexuality and persons living with disabilities. Sexuality and persons with disabilities
(PWD) is a subject not often discussed in society. Stereotypes associated with PWD presume that they are not sexually attractive, are incapable of having sexual desires, and that
any kind of sexual expression is inappropriate. This article discusses myths and misconceptions about sexuality and disability, psychosocial issues facing PWD, gender expression of sexuality, and intimate relationships.
To be human is to be sexual (Winder, 1983).

hen the word sexuality is mentioned, a person having a


physical disability or a profound disfigurement is not at
the forefront of the conversation. If not associated with
youth and physical attractiveness, sex is viewed as unnatural
(Orange, 2009). Best (1993) wrote that an individuals sexuality is
a total collection of ones characteristics that identifies and communicates ones sexual nature. Orange reported that when sex and
disabilities are discussed, approaches such as affection, caring,
and loving are rarely mentioned. A greater emphasis is placed on
capacity, techniques, fertility, and dysfunction. Best noted that a
persons sexual nature includes, but is not limited to, gender,
physical appearance, capabilities, body adornment, behavior, and
life style. Sexuality is an integration, acceptance, and self-realization of all these aspects. One must also have the ability to communicate these traits, and receive and accept sexual communication choices to and from others. The purpose of this article is to
help sensitize rehabilitation counselors to the myths and misconceptions regarding sexuality and people living with disabilities
(PWD).
Important components of sexuality are body image and selfperceived appearance; people who are physically attractive tend to
be treated better and are perceived as being more sexually appealing (Atkinson, Lindzey, & Thompson, 1994). Gatens-Robinson
and Rubin (2008) stated that Americans strongly value attractive
physical appearance. Chen (1998) remarked that the standards for
health and beauty have been defined since the beginning of
Western civilization. Westerners are obsessed with having an
impeccable physically fit body that includes being tall and slim.
For people with physical disabilities, inner beauty is often overshadowed by less attractive or unacceptable outer appearances.
Because Americans place such a great emphasis on appearance,
Martin G. Brodwin, Division of Special Education and
Counseling, California State University, Los Angeles, (5151 State
University Drive, Los Angeles, California 90032.
Email: mbrodwi@calstatela.edu

PWD suffer significant stigmatization (Cash, 2004). As a result,


deviation from the concept of a normal body image receives little
acceptance or tolerance in the media. Because of this, PWD often
find themselves emotionally traumatized and left with eroded
egos.

Myths about Sexuality and Disability


Negative attitudes about persons living with disabilities have
been prevalent from early Egyptian, Greek, Roman, and Chinese
civilizations to the modern day (Arokiasamy, Rubin, & Roessler,
2008). These attitudes are portrayed in all forms of communication and media from ancient times to recent writings in most cultures and nations. They influence the way PWD are treated
throughout society. Avoidance and maltreatment of PWD evolved
partially from these myths and misperceptions (Kopala & Keitel,
2003).
With negative attitudes, myths are formed and perpetuated
concerning people living with disabilities. Best (1993) and
Orange (2009) wrote that myths affect the sexuality, self-concept,
and motivation for independent living of PWD. Cornelius,
Chipouras, Makas, and Daniels (1982), identified several common myths they believe not only affect the sexuality of PWD, but
also impact self-concept, self-esteem, and motivation for independent living. These myths include:
Disabled people are asexual.
Disabled people are over-sexed and have uncontrollable urges.
Disabled people are dependent and child-like and, thus, need to be
protected.
Disability breeds disability.
Disabled people should stay with and marry their own kind.
If a disabled person has a sexual problem, it is almost always a
result of the disability.
If a nondisabled person has a sexual relationship with a disabled
individual, it is because she or he cannot attract anyone else (pp.
2-4).

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Shakespeare (1999, 2000) and Vash and Crewe (2004) argued


that society is unwilling to engage in discussions concerning the
sexuality of people living with disabilities. Sexual issues are of
low priority to professionals. As a result, many PWD continue to
face negative assumptions about their sexuality. Examples of
these assumptions include: PWD are asexual, or at best sexually
inadequate; and PWD cannot ovulate, menstruate, conceive, or
give birth, have orgasms, erections, ejaculations, or impregnate.
Olkin (1999) discussed the many myths and incorrect
assumptions associated with disability and sexuality, such as:
Disabled persons lack basic biological sex
drives.
It is unacceptable for people with disabilities to
be sexual beings.
People with disabilities are incapable of functioning sexually.
Persons with disabilities lack the requisite
social skills and sound judgment
needed to
behave in a sexually responsible manner.
No able-bodied people will find persons with
disabilities desirable as romantic and sexual
partners, or if they do, it implies something is
wrong with them or that they are settling for
less.
Women with disabilities are less affected sexually than are men with disabilities, because of
their presumed more passive sexual role (pp.
227-228).

Psychological, Self-esteem, and Self-concept Issues


In addition to societal influences on the sexual development
of PWD, psychological issues such as self-concept and selfesteem play a role in the healthy expression of sexuality. Chronic
illness and disabling conditions may delay normal sexual development of a young person (Alexander, 1997). One may be confused about sexual feelings, which may have been caused by
delayed psychosocial development, often leading to low selfesteem. This delay communicates an inability to take on appropriate social roles. As a result, a PWD may develop and internalize an inferiority complex after having repeated negative and
unpleasant social experiences (Chen, Brodwin, Cardoso, & Chan,
2002).
Beyond the myths that persist are the psychological issues
faced by people living with disabilities as they relate to sexuality
and disability. These issues affect an individuals self-esteem.
Self-concept and body image have both positive and negative
effects on sexuality. If one has a negative perspective about her or
his disability, ones sexuality is negatively affected (Olkin, 1999).
It has been thought that a persons concept of her or his sexuality
may be influenced by feelings of attractiveness, self-esteem, and
adequacy to perform sexual activities. Sexual self-acceptance
(comfort with ones body as a sexually responsive organism) is
key for development of positive self-esteem (Cole, 1988). Serious
injury with permanent residuals or chronic disease often diminishes both self-confidence and self-esteem (Vash & Crewe, 2004).

Emotionally, sexuality encompasses expressions of intimacy,


affection, caring, and love. Onset of disability can distort these
and other emotions and lead to anxieties, which may prevent a
person from perceiving and expressing intimate feelings (Orange,
2009). If an individuals disability is acquired after adolescence,
one already may have a history of sexual experience. Those with
congenital or early onset disabilities develop a sense of sexual
identity that includes the disability, which may not be fully and
realistically integrated into ones self-concept and body image. If
one is exposed to prejudice, the negative effects may be internalized, forcing one to see self only as a disabled person, resulting in
a diminished self-concept and lowered self-esteem (Olkin, 1999).
The way a person was raised to view herself or himself is a
strong indicator of whether one was able to see oneself as a sexual being (Olkin, 1999). When an individual is more accepting of
self, self-benefiting behaviors are projected. Positive self-esteem
often leads to functional and productive behaviors, including sexuality. Self-esteem is not contingent on the disability, but rather on
the consequences that occur in ones evaluation of the disability
and possible consequences. Another factor that plays a role in
self-evaluation is the way one thinks others are viewing her or
him. Interpretation and understanding of treatment by others can
be a determining factor in developing and maintaining appropriate self-esteem (Wiederman, 2002).
Self-esteem, self-concept, and psychological variables are
some of the predictors that determine ones sexuality. Having a
positive self-concept, despite negative influences during self-concept development, is directly related to PWD thinking of themselves as being or becoming sexually attractive (Davidson &
Moore, 2005). Of those PWD who hear negative statements
repeatedly from family members (for example: one should never
hope for much in life, and one could never be attractive to a sexual partner due to a disability) few were able to reject negative
influences and define their sexuality and attractiveness realistically. Yet, those raised by families that encouraged exploration of
personal and professional potential manifested more positive sexuality (Nosek, 1996).

Gender, Sexuality, and Disability


Stereotypes related to concepts such as victimization, helplessness, dependency, social isolation, and suffering are issues
PWD face, partially depending on ones gender. Stereotypic
expectations of femininity and masculinity are interpreted as
oppressive for both genders. Gender identity emerges from collected feelings of what constitutes being a woman or man
(Davidson & Moore, 2005). Feelings associated with womanhood
and manhood may be diminished by disability and be replaced by
feelings of being less than a whole person. Perceived loss of gender identity promotes activity loss that represents gender identity
and sexuality (Anderson, 1992). For a woman, a disability can
reinforce the image of dependency. For a man, the loss of ability
to have a normal erection, ejaculation, and fertility can have a
devastating, emasculating affect. Both sexes experience limitations in movement, altered sensations, and other physical changes

Journal of Rehabilitation, Volume 76, Number 4


in appearance and function that can assault a persons self-concept
and gender identity (Wiederman, 2002).
Traditionally, women have been perceived as innocent, vulnerable, sexually passive or asexual, dependent, and are objectified, as well as being considered caregivers, sexual partners,
mothers, and wives (Shakespeare, 1999). Society fails to recognize the importance of sexuality for the well-being of all women
and perceives persons with disabilities as not entitled to love,
imposing their own barriers, and encouraging the repression of
their sexuality (Tilley, 1996). This is done by the images of
women the media portrays. For example, the media depict women
as being perfect with perfect bodies; as a result, women with disabilities often feel as if others do not see them as whole, especially not as sexual beings.
The barriers to open expression of sexuality they face include
the physical environment, societal attitudes, and possible abusive
behaviors from family members and people close to them (Vash &
Crewe, 2004). Societys negative attitudes, such as women with
disabilities are unappealing, worthless, burdensome to society,
and unable to fulfill their proper roles as women can cause rigidity and feelings of defeat. Removing physical requirements from
the concept of sexual wellness and redefining womanhood in its
proper perspective throughout all segments of society would
improve all aspects of physical and emotional well being among
women who are living with disabilities (Nosek, 1996).
Many men base their sexual identity solely on the stereotypic views of masculinity (Orange, 2009). For example, men are
socialized to be strong, self-reliant, successful, manly, and good
sexual performers. Criticism results when men portray masculinity with what is perceived by others as weakness, frailty, and emotional (Shakespeare, 1999). At an early age, men are primed that
manhood is conditional rather than absolute, leaving men in constant fear of losing their manhood, and hence their identity. If men
were taught that manhood is not lost or gained through genital
functioning or the inability to perform traditional male-coded sexroles, there would be less emotional suffering and devaluation of
self when masculine identity is challenged due to disability
(Tepper, 2000).

Culture, Sexuality, and Disability


Cultural patterns and beliefs influence society. This section
explores these patterns and beliefs and the relationship to PWD.
Orange (2009) wrote that culture involves socially transmitted
behavior patterns and characteristics of a community or population (p. 269). Cultural beliefs influence the way people view their
place in the world, as well as being instrumental in shaping their
sexuality. Sexual enculturation establishes values and rules for the
nature of sex and beauty. Both mainstream white and minority
cultures view PWD as weak, unattractive, and undesirable (Chen,
1998). Western culture tends not to view PWD as acceptable candidates for reproduction or being capable of having sex for pleasure. Sexual portrayals of people living with intellectual or physical disabilities do not fit the targeted market profile, therefore
causing them to be absent in the mainstream mass media.
In many non-western cultures, disability is seen as a mani-

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festation of misfortune caused by others (for example witchcraft,


sorcery, or evil eye), by oneself or ones ancestors, or by fate,
nature, or the will of God (Comfort, 1978; Vash & Crewe, 2004).
Attitudes towards disabilities are influenced by the perception of
origin of the disability. As a result, individuals as well as their
families may be stigmatized. The negative values and beliefs
toward sexuality and PWD have an affect on a persons sexual
attitudes, beliefs, and behaviors. Living with a physical impairment may mean having to come to terms with a body that departs
from the cultural norms of acceptability and attractiveness (Vash
& Crewe).

Relationships, Sexuality, and Disability


For people who reside in residential programs, sex is something that is not part of their lives. To be sexually active, one, of
course, needs access to a partner. Work, college, or other social
environments are where most people meet potential partners.
Many PWD do not have the opportunities to attend college,
become employed, or achieve access to public spaces because of
physical and social barriers (Shakespeare, 2000). Additionally,
people are more accepting of PWD as colleagues or friends, but
hesitant to have them as potential dating or marriage partners
(Chen et al., 2002).
Important components of developing healthy relationships
with others include confidence in oneself, ability to communicate,
and self-disclosure. To be sexual, individuals need self-esteem,
confidence, and the ability to communicate (Orange, 2009). These
may be compromised in PWD because of myths, prejudices, and
misunderstandings and, for PWD, the scope of opportunities to
develop relations can be limited particularly for those individuals
who live in residential programs. If people feel good about themselves and project self-assurance, others will notice and take them
seriously, perhaps viewing them as potential partners (Kroll &
Klein, 1995). The constant negative experiences a couple encounters in society challenge a potential relationship when one person
has a disability and the other does not. More distressing is when
family members talk the non-disabled partner out of dating or
marrying the person with a disability. Family members may even
refuse to accommodate the disabled partners needs, such as providing or recognizing the need for accessibility (Chen et al.,
2002).
Attraction and intimacy are the focal factors one looks for
when searching for a partner (Chen, 1998). Most people have
been told the same romantic fairytales and take in the perfect body
images the media portrays. When compared to the general population, PWD often wait a long time to begin dating and experiencing their first sexual relationship; they are less likely to get
married, one reason being a lack of acceptance by society (Best,
1993; Miller, Chen, Glover-Graf, & Kranz, 2009).
People marry for various reasons: love, companionship,
financial support, to escape from unhappy homes, and as a safeguard against loneliness (Chen et al., 2002). A relationship can
become unbalanced due to the onset of one partners disability.
Issues such as amount of time spent together and apart, closeness

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and distance that may challenge the relationship, role of social


activities, and degree to which one is a caregiver versus lover
needs balance in the relationship (Miller et al., 2009). A couples
marital happiness is related to satisfaction with the exchange of
positive behaviors, such as constructive communication patterns,
partners drawing together, couples personal growth, affirmative
changes in values, and greater emphasis on family and personal
relationships (Olkin, 1999).

As a positive self-concept develops, PWD become less withdrawn, depressed, and lonely (Vash & Crewe, 2004). As noted by
Orange (2009), this lonliness or depression is frequently a symptom of feeling frustrated. The person is less likely to socialize,
becomes more anxious, and withdraws from potential social contacts, making it less probable she or he will develop social relationships. Through effective rehabilitation counseling, an individual will have increased self-esteem thereby enhancing opportunities for development of social relationships.

Rehabilitation Professionals,
Sexuality, and Disability

Many counselors are implicitly or explicitly aware of the


social issues restricting the sexuality of PWD. These problems
increase ones vulnerability. Reduced prospects to form sexual
and marital relationships are a threat to the natural instinct of all
human beings to find acceptable partners and establish families
(Brodwin & Chen, 2000). Although professionals who provide
services for PWD may realize the diminished possibilities that
their clients will achieve sexual and marital relationships, they
often are reluctant to acknowledge and discuss these subjects
(Kroll & Klein, 1995; Orange, 2009).

Whereas many people are raised in families in which sex is


not openly discussed, those entering health professions such as
nursing, social work, counseling, and other rehabilitation-related
fields are taught to address the total person, including sexuality.
Many rehabilitation professionals have little knowledge, understanding, and sensitivity in this area, thereby limiting their ability
to assist clients with these issues (Northcott & Chad, 2000).
Rehabilitation professionals are not exempt from societys negative attitudes. It is essential for staff training programs to provide
professionals with opportunities to examine their attitudes, values,
and beliefs related to sexuality and disability.
For counselors to initiate meaningful dialogue regarding sexuality, an atmosphere of safety and trust is necessary. Discussions
can occur with a shared, precise, and accurate language (Burling,
Tarvydas, & Maki, 1994). Nurses and counselors are in an excellent position to establish a trusting relationship necessary for giving information about sexual functions because of their frequent
and lengthy contact with PWD. Nurses may be able to assist these
individuals and help them realize that sexual enjoyment is always
possible in alternative ways. Sexuality is a vital part of holistic
rehabilitation; one needs to recognize the impact of specific disabilities and illnesses related to sexual functioning, and be comfortable when discussing these issues (Orange, 2009).
There are various facets of disability which inhibit an individuals sexuality (Miller et al., 2009). Each person has distinct
views, values, and lifestyle. Experiences of disability are unique,
although symptoms across disabilities can be similar. Adjustment
to disability will occur in different ways and extents; each person
will adjust at her or his own pace, in their own individualized
manner. To help facilitate adjustment, the rehabilitation counselor
needs to make an accurate, unbiased evaluation. The counselors
emotional support, knowledge of sexuality and disability, and
expressions of validation enhance the clients sense of health and
well-being (Best, 1992; Cole, 1988).
As stated by Orange (2009), positive self-esteem assists
PWD to maintain and enhance their feelings and beliefs about
themselves. Research (Davidson & Moore, 2005; Ivey, Ivey, &
Gluckstern, 2006) indicated that almost every aspect of life,
including happiness, success, relationships, achievements, creativity, and sexuality are dependent on positive self-esteem. With
this, an individual becomes more effective, productive, and
responsive to others in a healthy and affirmative manner.

Defined in a narrow way, sexuality involves the expression of


our sexual urges. Yet, it is much greater than this. It is also how
we feel about ourselves, how we present ourselves to others, and
how we fill our various roles in society (Person, 1989).

Conclusion
With training and confidence, rehabilitation professionals can
become more comfortable with sexual and social issues confronted by individuals adjusting to disabilities. If society accepts that
sexual expression is a natural and essential part of human existence, then perceptions that deny sexuality for PWD refute a basic
right of expression. Perceiving persons living with disabilities as
non-sexual creates barriers for both rehabilitation professionals
who may be influenced by these views and for PWD in terms of
gaining access to information and acceptance as sexual beings.

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