In order to investigate some of the myths surrounding disability, especially mental handicap, we need to examine some of the historical context of sexuality and disability. According to Clarke, Society’s present reluctance to “accept the rights of the mentally handicapped to enjoy a full sexual life are partly historical, attitudinal and ethical.” Historically the sexes were often segregated, and there were fears in the general population that if they were not, sexual expression would lead to procreation, the nation’s intelligence would be diluted and degeneracy would be a consequence. There were also some myths about the insatiable sexual appetite of learning disabled people, and fears about what they might get up to if allowed free expression of their sexuality.

One argument in favor of suppressing sexuality continues to be that it requires a degree of maturity and responsibility to pursue an active sex life, and that people with a mental handicap simply do not have this. Society therefore has the right to limit the possibilities of irresponsible sexual behavior and its consequences. Whilst acknowledging that carers often have to take responsibility for the consequences of unsafe sexual activity between their clients, we need to be aware of a certain hypocrisy in this, as this restriction does not apply to the rest of the rest of the population, who are by no means always responsible for the consequences of their sexual activity!

In Sweden, when accommodation for people with mental handicap changed from being segregated to mixed sex, it was found that aggressive behavior lessened and that there was more sexual expression, but sexual acts happened less often than had been expected, and penetrative intercourse was often not attempted. This may lead to the conclusion that it is the ability to accept and reciprocate loving feelings and some sexual expression of this rather than the sex act per se which is important.

It is worth mentioning here in addition, that people with a learning disability who have been injured or abused in childhood may have become intellectually impaired because of the trauma and real physical injury done to them. Any childhood abuse unresolved is likely to have repercussions in adult life, particularly in intimate relationships, whether the person has a learning disability or not. If a client flinches when approached, lashes out when confronted or can only tolerate small amounts of physical touch, the impact on their sexual development will be marked. Myths can also be a set of assumptions we make about people, based on their diagnosis. Sinason who with others has pioneered psychotherapeutic work with learning disabled children and adults, cites several cases where clients made great intellectual strides during the therapy, with improvement in communication, memory and concentration, once they had worked through the source of their trauma. In the case of eight-year-old Ali, Sinason describes how at first he spoke only in two word sentences, had no concentration, and could not recognize his name or write it. Born prematurely to parents with a moderate learning difficulty, Ali became violent and disruptive. He had, however, been the subject of serious sexual assaults by an older boy, and then been circumcised for religious reasons. As therapy progressed he began to speak in full sentences and to show in graphic detail what had been done to him.

Virginia Axline, in the classic tale of Dibs, relates how he had first been thought of as learning impaired, when he crept under tables and refused to speak. But Dibs was extremely intelligent and this became apparent as therapy went on. Many myths are founded on false assumptions.

Media-Promoted Myths

It seems to me that the media actively promotes the idea that sex between all but the young, fit and beautiful is somehow repellent and rather shameful, instead of a normal activity. While we see displays of sexual exhibitionism from celebrities on a regular basis, and view images of near naked young non-disabled people frequently via advertisements and so on, we do not see the private sex lives of older, or disabled people portrayed, except as curiosities. It is in this way that myths are created: if you see it or hear about it, it exists, if you don’t it doesn’t (or shouldn’t).

We are often resistant to the idea that older people, some very elderly, might engage in pleasurable sexual activities with one another. It seems prurient to inquire about the sexual lives of disabled people, and goes against the incest taboo to consider our parents’ sex lives. It’s private, faintly disgusting and not something we wish to consider. This, I believe, makes it difficult to deal objectively with the sexuality of some of our clients. We need to address this issue. There is a difference between giving permission for discussion of sexual matters by being matter of fact and open about it, and being intrusive or prying into peoples’ private affairs. We will look at this further in the book.

Many myths have grown up around disabled people and sexuality. Chipouras writes that these myths “can drastically and unnecessarily curtail the sexual expression of disabled people.” The myths he names are in italics, the comments mine.

Disabled People are A-Sexual.

Disabled people, like the rest of us, have differing sexual needs and experiences, but they are not a-sexual. Sexuality is part of the human condition.

Disabled People are Dependent and Childlike, So They Need to be Protected.

Being dependent and childlike is the prerogative of children, not adults, and while there will always be people with limited understanding and independence, we should foster as much self reliance and confidence as possible in our disabled young people.

Disability Breeds Disability.

True, there are certain genetic conditions where there is a likelihood of offspring inheriting the disorder, but most of these are known about and can be either guarded against or taken into account. In the main if we look at people damaged at birth, or having conditions such as multiple sclerosis, spinal cord injury or stroke we can see how little truth there is in this statement. It depends on the disability the person has and how fit their partner (who provides different genetic stock) may be. Couples may need good genetic counselling to make decisions about parenting, and they may choose to give birth to children like themselves.

Disabled People Should Stay With and Marry their Own Kind.

Disabled people marry different partners, who may or may not be disabled. This is their choice and their right. Many relationships start off with both parties fit and able-bodied, but if an illness or accident comes along the relationship has to accommodate changes. No one can foresee the future, but with an able/disabled couple, at least the disability is a given from the start.

Parents of Handicapped Children do not Want Sex Education for their Children.

Sex education is the right of every child. Parents are often grateful that their son or daughter is learning about their body and about sexual and social issues in a setting where their needs are taken into account.

Sexual Intercourse Culminates in Orgasm and is Essential for Sexual Satisfaction.

Sexual satisfaction can be gained in many ways. The mutual closeness and physical touch that is different from the touch of a carer may in itself be very satisfying, and one partner may experience great pleasure from giving a sexual experience to the other in a loving relationship, even if orgasm is not possible.

If a Disabled Person has a Sexual Problem it is Almost Always the Result of the Disability.

Disabled people have the same sexual problems as the rest of us – they experience impotence, premature or delayed ejaculation, problems with arousal and orgasm and lowered libido. Medication is sometimes responsible for these problems, so is chronic pain and exhaustion. Disability per se does not necessarily cause sexual problems; it is more likely to cause acute frustration. A sex therapist can assess this fully with medical assessment as needed. The main causes of sexual difficulties in the population as a whole are problems in the relationship, impotence caused by age and narrowing of the arteries, depression and the unresolved sexual abuse of one party. These factors are part of the work of the sex therapist in assessment.

If a Non-Disabled Person has a Sexual Relationship with a Disabled Individual, it’s because He/She Can’t Attract Anyone Else.

People with disabilities, especially if they are outgoing personalities with good self esteem, will always attract others. Non-disabled adults will respond to this.

While not wishing to blame the media for all the myths prevalent in our society, it does seem to me that the myths around sex, age, and physical attractiveness are all actively promoted in newspapers, on television and in popular magazines, so that there is very little room for any other reality to be included.

An interesting contrast to these myths is the list of myths provided by Keith Hawton in his standard work on sexual problems:

• A man always wants and is ready to have sex.
• Sex must only ever occur at the instigation of the man.
• Any woman who initiates sex is immoral
• Sex equals intercourse: anything else doesn’t really count
• When a man gets en erection it is bad for him not to use it to get an orgasm very soon.
• Sex should be always natural and spontaneous: thinking or talking about it spoils it.
• All physical contact must lead to intercourse
• Men should not express their feelings
• Any man ought to know how to give pleasure to any woman
• Sex is really good only when partners have orgasms simultaneously
• If people love each other they will know how to enjoy sex together
• Partners in a sexual relationship instinctively know what the other thinks or wants
• Masturbation is dirty or harmful
• Masturbation within a sexual relationship is wrong
• If a man loses his erection it means he doesn’t find his partner attractive
• It is wrong to have fantasies during intercourse
• A man cannot say “no” to sex/ a woman cannot say “no” to sex
• There are certain absolute, universal rules about what is normal in sex

It is useful to consider which of these myths we may still promote in our own lives, and also which ones we believe in respect of physically or intellectually impaired people.

If we look at the myth around sex being spontaneous and natural, many couples have found that the use of viagra, for example, takes away this spontaneity, as there is a window of opportunity for a limited period only. And does thinking about it and planning it really take away the enjoyment? Sometimes the anticipation is the best part! A couple who have arthritis, for example, may need to plan their sexual activity to coincide with the effect of any painkillers, in a place where the hip, or knee is comfortable and at a time when both are relaxed and happy. Is this wrong or less enjoyable? Older women sometimes have the idea that masturbation is harmful or wrong, and there may be a religious taboo that makes it a shameful or prohibited activity. This myth is quite prevalent. Carers who hold onto these beliefs in their own personal lives need to be aware that these will not necessarily apply to their clients.

Sexual experience is a learning opportunity also and people with disabilities have less opportunity than others to find out what their sexual likes and dislikes are. If they never find a partner they will forever wonder about this and the frustration they may feel will be hard to cope with, especially if there is no privacy to masturbate.

As in the general population, there will be impaired clients who have high sex drives, as well as those with no interest in sex at all, and a whole range of people in the middle, some of whom may have enjoyed a good sex life prior to becoming disabled but now with illness and medication have decided to live and love without it.

There are two outlooks: one says that providing opportunities for sexual expression for disabled people gives them a false sense of what is possible and breeds discontent, so taking the option away is kinder in the long run. The other view is that if we start from a point of realisation that we all start life with a sexual potential, and some people develop this fully while others never do, we leave the door open for this to happen if it is right for the client, and in providing sex education, an open forum to ask questions and opportunities to make and develop friendships, those of people who wish for sexual experience are enabled to find it. Time and again, disabled people have confounded their advisors and consultants and become sexual beings, married, given birth and undertaken enormous challenges. We may think we know what’s best for them, but we have no right to impose this on them, when perhaps the biggest myth we hold on to is that they cannot make decisions for themselves about this.