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Sexual Health and Disability

Leo Orange, Oxnard College

Sexual health is having the ability to communicate, enjoy, and embrace your sexuality.  Understanding your sexuality means understanding that you are a sexual human being no matter what others may think about you.  As long as your desire to love and be loved is true, you will have the opportunity to enjoy a healthy sexual relationship with another person. 

It requires a positive and respectful approach to your sexuality and sexual relationships, and an understanding that sexuality is a natural part of life that involves more than sexual behavior.  Sexual health is a state of mental, physical, and social well-being in relation to one’s sexuality.  It is a significant part of our emotional and physical health and can shape a person’s thoughts, relationships, and experience with others.  Being sexually healthy means recognizing and respecting the sexual rights we all share.  All of us have the right to love and be loved by who they chose to share life.

Sexuality refers to the expression of sexual sensation and related intimacy between human beings and the expression of identity through sex.  Sexuality comprises a broad range of behaviors and processes, including those that are biological, psychosocial, emotional, spiritual or religious, cultural, and political.  Beginning with how we see ourselves, it extends to influence and encompass our relationships with others (Best, 1993).

Sexuality goes above and beyond intercourse.  It is also about feelings and attractions.  The most widely recognized labels people use to identify their sexuality are as follows (LGBTQIA.):

Heterosexual: Attracted mostly to people of the opposite sex or gender.

Lesbian: Attracted mostly to people of the same sex or gender (usually used by women).

Gay: Attracted mostly to people of the same sex or gender (usually used by males).

Bisexual: Attracted to both men and women.

Transsexual: Identify as a member of the sex opposite to that assigned at birth and desire to live as such.

Questioning: Uncertain and still exploring one’s sexuality or gender.

Intersexual: Being of any of several variations in sex or gender characteristics. 

Asexual: Without sexual feelings or associations.   

As of June 26, 2015, same-sex marriage is legally recognized in the United States. The recognition of people of non-traditional identities as members of society is a first step in the process of integration or allowing all people to express themselves sexually.  Increased access to information and educational material is integral to affirming this process.  Because sexuality is both physiological and psychological, so too are the societal obstacles that people with disabilities encounter in regards to sexual expression.  From a psychological perspective, sexuality involves expressions of intimacy, affection, caring, and love. Although recent laws have officially recognized members of non-traditional sexual identities, they do nothing for people with disabilities, who are still largely thought of as non-sexual (Brodwin & Orange, Orange, in press).

Social Components of Sexuality

One of the major difficulties facing the study of sexuality and disability has been the tendency to view disability strictly from a clinical or biological perspective rather than a social one.  Although there has been much discussion about social issues in the literature on disability, most have been limited to exploring the impacts of particular physical impairments on sexuality.  Since the concept of disability encompasses social as well as physical components, there is a need to devote increased attention to the social problems that may affect sexual relationships involving people with disabilities.

Beauty and strength are perceived as integral, beneficial components of life in American culture.  At the interpersonal level, persons who are physically attractive are evaluated on the basis of their sexuality.  A physical disability thus leads to the categorization of a person as abnormal.  When it is used to discredit an individual in this stereotypical manner, it becomes a source of stigmatization.

Pervasive social norms reinforce taboos against sexual contact and interaction with people who have disabilities (Brodwin & Orange, in press).  Often, physical attractiveness alone is considered paramount in the development of relationships.  This emphasis may reflect traditional values that are attached to physical strength, power, beauty, and grace.  There is a coexisting significance to the terms the whole body, or the body beautiful, and the narcissistic anxiety that is easily aroused in many people who are plagued by doubts about their own supposed physical flaws or defects.

Sexual Identity

        Sexual identity is at the core of one’s sexuality.  As with other aspects of identity, including gender, age, and ability, sexual identity involves self-perception and expression.  Like age, sexual identity is not static, but may change over time.

Sexual behaviors, like dating, often involve physical skills that are beyond the capacity of people with major disabilities.  As a result, the person with a disability and the non-disabled individual in a relationship may face negative feelings and attitudes from others, including parents and friends who regard the relationship as inappropriate or inadvisable.  Those who are able to overcome the effect of adverse attitudes and taboos against physical contact between persons with and without disabilities must still confront the handicaps resulting from ambiguous social values and dating norms.  Social customs, perhaps more than physical differences, are powerful deterrents to these relationships.

Many professionals are implicitly or explicitly aware of the social problems restricting the sexuality of people with disabilities; these problems increase vulnerability.  Reduced prospects for forming sexual and marital relationships poses a serious threat to the natural instinct of all human beings to find love and establish stability.  Although professionals who work with people with disabilities may be cognizant of the reduced probability that their clients will achieve sexual and marital relationships, they often appear reluctant to acknowledge and discuss these subjects.


            Body image encompasses perceptions and attitudes about one’s physical appearance (Wiederman, 2012).  The role of body-image and attitudes in human sexual functioning include one’s appearance-related thoughts, emotions, and behaviors.  Specifically, body dissatisfaction and excessive psychological investment in one’s physical appearance may lead to physical self-consciousness and avoiding body exposure during sexual relations, which in turn may impair sexual desire, enjoyment, and performance.

Most body image research has focused on eating disturbances among women (Cash & Smolak, 2012).  Clearly, body image has implications for other facets of psychosocial functioning in both sexes and can influence one’s interest in and experiences during sexual activities.  Wiederman (2012) found that body dissatisfaction may inhibit sexual behavior and interfere with the quality of sexual experiences.

Western civilization has historically defined its standard of beauty and health by the image of an impeccable and physically fit body (Orange, in press).  Persons with disabilities may feel unattractive, or even less worthy of sexual partnerships, because they cannot live up to the idealized image.  If the disability was acquired later in life, the person may remember how they used to look and feel unattractive by comparison.  Talking with others who have overcome their body image problems may be helpful.  


One of the most difficult accomplishments in life is being courageous enough to take chances with love, as it requires not only loving oneself but caring for another person.  Self-esteem helps people with disabilities maintain positive attitudes.  Research indicates that almost every aspect of our lives including personal happiness, success, relationships, achievements, creativity, and sexuality are dependent upon positive self-esteem (Ivey, Ivey, & Zalaquett, 2018).  With positive self-esteem, a person is more effective, productive, and responsive to others in healthy and affirmative ways.

Pebdani’s (2013) study of 312 Master’s students in CORE-accredited rehabilitation counselor education programs reported that rehabilitation counseling students had negative attitudes toward sex and disability, and low levels of comfort if they were asked to discuss sexuality with perspective clients.  This researcher concluded that these issues need to be a part of rehabilitation counselor training programs to increase students’ knowledge and comfort level needed to discuss sexuality with clients.

Anxiety due to disability may cause an individual to withdraw and, as a result, lead to depression and loneliness.  This loneliness or depression is often a symptom of frustration.  If the frustrated individual is unable to socialize, he or she may become anxious and withdrawn.  Increased loneliness, anxiety, and depression can make it problematic for people with disabilities to recognize their role in society.

Multicultural Perspectives

Culture encompasses the socially transmitted behavior patterns characteristic of a community or population (Ivey et al., 2018).  People with disabilities have developed a culture as a result of characteristics that are part of the environment in which they live (Orange, 1995).  Counselors may attempt to understand these characteristics, which are often viewed as peculiarities, without seeing their own cultural biases.  This is true of sexuality and disability.  With regard to sexuality, people with disabilities are seen as needing to be corrected to fit into the dominant, non-disabled culture.  Professional services always reflect the dominant culture.

To provide appropriate services when counseling ethnic minorities about issues related to sexuality and disability, counselors need to understand both the meaning of disability in their lives and the cultural context within which they live.  Ideas about sexuality are part of a larger culturally-based belief system.  All cultures have shared ideas of what makes people sexy, appealing, and helps them maintain health through time (Orange & Brodwin, 2005b).  These beliefs help people understand their sexuality and make sense of the world around them.  All cultures have beliefs about the appropriate type of sexuality; cultural and ethnic beliefs describe how people view what is sexually desirable.  Defining sexuality from a multicultural perspective is particularly important for people with disabilities.  Counselors need the understanding that people are all sexual beings, young or old, married or single, heterosexual, lesbian, gay, bisexual, transsexual, questioning, intersexual, or asexual.  As people change, their sexuality changes which remains a lifelong process no matter what the disability, culture, ethnic background, or sexual orientation.

Heterosexual relationships are not the sole form of interpersonal attraction.  As more people are feeling comfortable acknowledging their sexual orientation, these relationships have gained wider acknowledgement and acceptance.  With the gradual subsidence of homophobia over the last several decades, individuals with disabilities with same sex gender orientations are becoming less intimidated from expressing their true sexuality.


Sexuality is a form of communication, a way of expressing part of one’s personality to another individual.  The way people present themselves largely depends on how they see and feel about themselves.  Sexuality is a very intimate area of an individual’s personal life and is usually shared among a few people who care and respect one another.  Relationships are developed between people sharing their experience and insights concerning their sexuality and learning to appreciate each other for who they truly are as unique human beings.

Learning to appreciate one’s sexuality is a lifelong process that takes courage and understanding, with or without a disability. Learn to enjoy your sexuality and remember it always starts with a smile.


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Brodwin, M. G., & Orange, L. M. (in press). Attitudes toward disability. In J. D. Andrew & C. W. Faubion (Eds.), Rehabilitation services: An introduction for the human services professional (4th ed.). Linn Creek, MO: Aspen Professional Services.

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