Myth-busting Monday: People that are disabled or ill, acutely or chronically, are not interested in sex.
And our healthcare system perpetuates this myth. Our “western” medical system did not develop in a bubble, but was heavily influenced by religious and social norms of the 19th century, leading to certain expectations, approved sexual behaviors (ie for procreation), and heteronormativity. Those that fell out of the expectations (ie not white, cis gender, male, heterosexual, able bodied, young/middle age) were marginalized and experienced barriers to their care and navigation of the health care system. Further, the tendancy of our medical system is to utilize a biomedical lens when considering a medical condition, an “issue in the tissue” approach that fails to engage the whole person but also creates binaries and hierarchies of medical “need”. For example, if someone suffered a heart attack, the focus is on cardiac recovery, and sexual health is not considered important and therefore, rarely addressed. Studies show that medical providers often do not engage in discussion with their clients about sexual health, not only because sexual health is not given priority based on the biomedical lens and our social influence and moralizing of sexuality for procreation, but because of lack of education on the professional’s end, discomfort of the professional (either their own or fear of making their clients uncomfortable), and/or institutional silencing or lack of support to cover these topics with patients. But silencing, practitioner or institution-induced, does not make sexuality go away – instead it makes sexuality vulnerable to misunderstanding or even shame. This, when the World Health Organization recognizes sexuality and sexual health as being integral components of being human.
We can do better.
And I am trying. As a physical therapist, I was asked by patients while working in the hospital setting about sexuality and did not know what professionals could help with these questions. It was later that I realized with training, I could, and I currently work as a sexuality educator and counselor. When people consider physical therapists for sexual health, they often think of pelvic floor related issues, but physical therapists, and allied healthcare practitioners in general, can offer so much more. From recognizing that sexuality is a component of health and can be incorporated into health and wellness goals, that being a trauma-informed practitioner is critical when navigating sensitive topics, that demonstrating and modeling sex positivity frees us as individuals but also our clients and our culture, and that modalities we utilize already (such as exercise, nutrition, education, stress management) have carryover into sexual well-being. Further, by discussing sexuality with our clients that are living with an illness, injury, or disability, we can provide resources for these individuals that they might not have access to elsewhere (ex. bed mobility tips for your client recovering from a stroke that can be utilized for positioning during sexual encounters) and the verbalization and illumination of sexuality helps erase some of the cultural shame and ableist assumptions surrounding the topic.
If you are an allied healthcare practitioner interested in sexology and sexual health, please do pursue reputable trainings that will offer current, evidence based curricula and challenge your personal biases. See the American Association of Sexuality Educators, Counselors, and Therapists, AASECT, for resources and referrals.
Injury, illness, aging, and/or disability do not make sexuality disappear or even lessen the importance of sexuality from a wellness perspective (note to the reader, you can be asexual and still regard your sexuality as important). For some, exploring sexuality following illness/injury/aging/disability can allow for resilience, connection to self and others, even some form of healing. If you are living with an injury, illness, or disability that you feel limits your sexuality (expression, self-esteem, mobility, etc), please do seek a trained professional to help with your needs and know that your sexual well-being deserves recognition as a legitimate health and wellness concern.
Happy myth-busting, community. Thanks for doing this liberating work of self-education so that we can build ourselves a more holistic and inclusive world.
Suggested resources for professionals and clients:
Sexual Health Alliance (where I am completing my training – love them!!!) https://sexualhealthalliance.com/
Disability After Dark https://podcasts.apple.com/us/podcast/disability-after-dark/id1151890990 (Support Andrew on Patreon https://www.patreon.com/disabilityafterdark/posts )
Handi Book of Love, Lust, & Disability https://www.sheboptheshop.com/the-handi-book-of-love-lust-disability.html
Kaufman M et al. Ultimate Guide to Sex and Disability: For All of Us Who Live with Disabilities, Chronic Pain, and Illness.
Moser, C. Health Care Without Shame: a handbook for the sexually diverse and their caregivers
Written by Dr. Allison Mitch, PT (DPT), CHEK practitioner, RYT500, sexuality counselor and educator; copyright protected, please cite accordingly. I am a physical therapist that specializes in post-rehab return to fitness, as well as general fitness and well-being for all bodies, genders, and sexualities.
The image associated with this post is mine.
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