Blog 23 -Beyond the Myths: Sexuality, Autonomy, and Pleasure for People with Disabilities

Fabiola Ngamaleu Teumeni

Fabiola (she/her) is a third-year undergraduate student in psychology at the University of Montreal. Since February 2023, she has been a research assistant in Dr. Bőthe's Sexuality, Technology, and Addictions Laboratory. She wishes to pursue her doctoral studies in clinical psychology, and her main research interests focus on the intersectional perspective of compulsive sexual behaviors in older adults.

Sexuality is a multifaceted aspect of human life that encompasses identity, attraction, intimacy, relationships, bodily autonomy, pleasure, and self-expression (Giles et al., 2023). Yet, although approximately 16% of the global population lives with a significant disability, the sexuality of people with disabilities is often overlooked or discussed mainly through vulnerability and risk (Bolarinwa et al., 2024). Research with different groups of people with disabilities documents romantic and sexual desires, as well as their right to intimate citizenship: the ability to make choices concerning their bodies, feelings, identities, and relationships (Giles et al., 2023; Santinele Martino, 2022). However, ableist assumptions often undermine this right.

Despite the diversity of their experiences, people with disabilities are often portrayed through three contradictory stereotypes:

• Asexualization assumes that they have little or no interest in attraction, relationships, or pleasure (Pebdani & Tashjian, 2022).
• Infantilization treats adults with disabilities as perpetual children who cannot understand sexuality or make intimate decisions (Santinele Martino, 2022; Pebdani & Tashjian, 2022).
• Hypersexualization portrays some people, particularly those with intellectual disabilities, as sexually inappropriate or unable to control their behaviour (Giles et al., 2023; Santinele Martino, 2022; Pebdani & Tashjian, 2022).

 
These seemingly contradictory portrayals share an underlying assumption: that people with disabilities cannot direct their own sexual and relational lives. Sexuality is either considered absent or viewed as something that must be supervised and controlled by others (Bolarinwa et al., 2024; Santinele Martino, 2022). For example, in a qualitative study involving 46 adults with intellectual disabilities in Ontario, Canada, one 39-year-old participant with an intellectual disability reported being told by his mother that he was not ready for a romantic relationship, leading him to believe that he might only be ready around age 50 (Santinele Martino, 2022). Such experiences show how social assumptions can restrict access to relationships, information, and sexual autonomy.

These assumptions can shape the information, services, and opportunities available to people with disabilities.

• Asexualization may cause sexuality education or reproductive healthcare to be viewed as unnecessary (Giles et al., 2023; Pebdani & Tashjian, 2022).
• Infantilization can lead others to make intimate decisions on a person’s behalf (Pebdani & Tashjian, 2022).
• Hypersexualization beliefs may justify increased surveillance (Santinele Martino, 2022).

In these cases, efforts presented as protection can become forms of control (Giles et al., 2023; Santinele Martino, 2022). For example, in one study included in Giles et al.’s (2023) systematic review, a young woman with spina bifida seeking contraception described a doctor questioning why she needed birth control because she used a wheelchair. Such assumptions can limit access to appropriate healthcare, privacy, information, and opportunities for relationships.

When people with disabilities are included directly in research, their accounts challenge the idea that disability is incompatible with sexuality or relationships. Participants describe attraction, desire, affection, dating, companionship, pleasure, rejection, and breakups (Beato et al., 2024; Santinele Martino, 2022; Okotie & Jolly, 2024; Sologuren-García et al., 2023). At the same time, disability may shape how these experiences are navigated through sensory needs, communication differences, changes in mobility, inaccessible environments, or social stigma (Beato et al., 2024; Giles et al., 2023; Santinele Martino, 2022; Sologuren-García et al., 2023).
 
In a qualitative study of 22 autistic adolescents and adults in Portugal, participants reported different levels of romantic and sexual interest. Some found flirting and non-verbal communication difficult, while others described relationships built on shared interests, stability, and communication (Beato et al., 2024). Similarly, a qualitative study of seven adults with acquired motor disabilities in Peru found diverse experiences of sexuality: some connected intimacy with love, trust, and satisfaction, while others reduced or stopped sexual activity because of pain, rejection, depression, or environmental barriers (Sologuren-García et al., 2023). Together, these findings show that disability may influence sexuality without determining whether desire, intimacy, or relationships are present.

Sexuality education for people with disabilities often emphasizes anatomy, danger, and abuse prevention while overlooking dating, communication, sexual orientation, intimacy, and pleasure (Andreassen et al., 2024; Giles et al., 2023). Although safety is essential, education should also provide accessible and relevant information about consent, relationships, sexual health, and bodily autonomy (Andreassen et al., 2024).
 
Accessibility may involve direct language, visual or audio formats, sign-language interpretation, physically accessible spaces, or opportunities to practise communication skills (Andreassen et al., 2024). Most importantly, education should be developed with people with disabilities so that their questions and experiences shape what is taught (Andreassen et al., 2024; Giles et al., 2023).
 
Education cannot only be directed at people with disabilities. Families, caregivers, educators, and healthcare professionals also need support in recognizing sexual agency and distinguishing protection from unnecessary control (Andreassen et al., 2024; Giles et al., 2023). Public education is similarly needed to challenge assumptions about desirability and sexual decision-making (Pebdani & Tashjian, 2022).

Protecting people with disabilities from violence and exploitation remains essential. However, a risk-only approach can reinforce the idea that they are primarily vulnerable rather than capable of desire, choice, and pleasure (Giles et al., 2023; Okotie & Jolly, 2024; Parchomiuk, 2022). During a sexual and reproductive health training in Nigeria, one person with a spinal-cord injury reported wondering whether he could still have sex after his injury but feeling too ashamed to ask his doctors, leaving the concern unanswered for months (Okotie & Jolly, 2024).
 
A positive-sexuality approach expands the conversation to include intimacy, sexual self-esteem, relationships, autonomy, and pleasure alongside safety (Parchomiuk, 2022). It does not assume that everyone wants sex or experiences desire in the same way (Beato et al., 2024; Parchomiuk, 2022). Instead, it places people with disabilities at the centre, recognizing their right to define their own needs, boundaries, relationships, and experiences (Giles et al., 2023; Martino, 2022; Parchomiuk, 2022).

References
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Andreassen, K., Quain, J., & Castell, E. (2024). Stop leaving people with disability behind: Reviewing comprehensive sexuality education for people with disability. Health Education Journal, 83(8), 830–840. https://doi.org/10.1177/00178969241269656
Beato, A., Sarmento, M. R., & Correia, M. (2024). Experiencing intimate relationships and sexuality: A qualitative study with autistic adolescents and adults. Sexuality and Disability, 42(2), 439–457. https://doi.org/10.1007/s11195-024-09838-x
Bolarinwa, O. A., Odimegwu, C., & Adebisi, Y. A. (2024). Leaving no one behind: Addressing the sexuality of people with disabilities. International Journal for Equity in Health, 23, Article 129. https://doi.org/10.1186/s12939-024-02219-y
Giles, M. L., Juando-Prats, C., McPherson, A. C., & Gesink, D. (2023). “But, you’re in a wheelchair!”: A systematic review exploring the sexuality of youth with physical disabilities. Sexuality and Disability, 41(1), 141–171. https://doi.org/10.1007/s11195-022-09769-5
Okotie, E. S., & Jolly, S. (2024). Feeling “happy, loved, cherished, desired” and “hopeful for the future”: Disabled women in Nigeria talk about sex and pleasure. Sexuality and Disability, 42(1), 85–99. https://doi.org/10.1007/s11195-023-09830-x
Parchomiuk, M. (2022). Sexuality of people with intellectual disabilities: A proposal to use the positive sexuality model. Sexuality & Culture, 26(1), 418–448. https://doi.org/10.1007/s12119-021-09893-y
Pebdani, R. N., & Tashjian, A. (2022). An analysis of the attitudes of the general public towards the sexuality of individuals with disabilities through a systematic literature review. Sexuality and Disability, 40(1), 21–55. https://doi.org/10.1007/s11195-021-09700-4
Santinele Martino, A. (2022). The intersection of sexuality and intellectual disabilities: Shattering the taboo. In N. L. Fischer, L. Westbrook, & S. Seidman (Eds.), Introducing the new sexuality studies: Original essays (4th ed., pp. 460–469). Routledge. https://doi.org/10.4324/9781003163329-57
Sologuren-García, G., Linares, C. L., Flores, J. R., Mendoza-Mamani, K., Pilco, R. M., Escobar-Bermejo, G., Sotelo-Gonzales, S., & Palza-Portugal, G. (2023). Breaking the taboo: Qualitative analysis of the sexuality in people with acquired motor disability. BMC Psychology, 11, Article 380. https://doi.org/10.1186/s40359-023-01423-9