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Disabled Sex 9/11/2019 DISABLED SEX Kim Austin-Baker Barbara Hill, OTRL Americans with Disabilities To empower people with disabilities to make 2015 Census Data 38 million Americans living with informed decisions regarding their sexual and disability 18.5 million with Cognitive reproductive health and to provide a better and/or Ambulatory Disabilities between ages 18 and 65. understanding of the need for sexual education and All of which are sexual beings! resources as related to the disabled community. Disabled Population Cognitive or Ambulatory 1 9/11/2019 Yes, disabled people can and do have sex, relationships and Today’s Topics families! Health Dating, Functionality Services & Sex Intimacy & & Sex Aides Education Relationships Fertility, Sexual Abuse Pregnancy & & Consent Birth 2014 STUDY BY DYER & NAIR Change and Awareness is 97% of professionals Necessary to believed that the topic Enhance & of relationships and intimacy should be Promote Full-Life discussed, but only 36% Recovery actually addressed these issues with their following clients. Traumatic Injury 2 9/11/2019 “ Sexual Abuse & ” Consent Sexual consent is actively agreeing to participate in a sexual activity Both people must agree to sex before being sexual — every single time — with someone. for it to be consensual. 3 9/11/2019 “A person is guilty of criminal sexual The term “sexual assault” means any conduct if the person engages in sexual unwanted, non- penetration or contact and the actor knows consensual sexual contact of any kind or has reason to know that the victim is (including kissing) mentally incapable, mentally obtained through the incapacitated, or physically helpless”. use of force, threat of force, intimidation, or RAINN 2019 coercion Unwanted, non-consensual sexual contact that includes penetration (i.e. vaginal or anal penetration, oral sex, and genital touching) obtained through the use of force, threat of force, intimidation, or coercion. 4 9/11/2019 According to 2017 Bureau of Justice’s Who can people with Persons with disabilities are twice more disabilities turn to, talk likely to be sexually assaulted than people without a disability. with in private and 18% of all rapes and sexual assaults express themselves are reported to be committed by freely without fear of This Photo by Unknow n Author is licensed under strangers, which means that most of CC BY-SA-NC these crimes are committed by backlash? someone the victim knows, is close with or related to. The sexual well-being of people with disabilities is SEXUAL HEALTH extremely important and it’s SERVICESSERVICESSERVICES time we expressed that need! 5 9/11/2019 Life After TBI Care needs to be managed by a team of healthcare professionals to oversee the physical and TBI is known to cause Changes to sexual changes in thinking, behavior after TBI could psychological needs of their behavior and body include erectile problems, function which alters the reduced libido, the inability patients. way a person experiences to orgasm, and the and expresses their reduction in frequency of sexuality. sex. This Photo by Unknown Author is licensed under CC BY-ND Everyone is entitled to express their sexuality, ACCESS TO receive appropriate important information HEALTH regarding their sexual health and receive proper guidance. SERVICES 6 9/11/2019 Dating, Intimacy & Relationships (S)EXPLORING DISABILITY Sexuality is one of the most complex aspects of life but, the sexual lives of people with disabilities have been DATING, INTIMACY & disregarded and stigmatized. As a result, sexuality as a form RELATIONSHIPS of pleasure and an expression of love is not taken into account or even recognized for individuals with disabilities. Dating, Intimacy & Relationships Fertility, Pregnancy and Birth Research has shown that TBI and SCI MEN WOMEN survivors report significant changes that Fertility Pregnancy and Birth impact relationships which can include Erectile problems Assessable doctors’ offices behavioral and emotional changes, Reduced libido Birth control options dwindle cognitive and physical changes, significantly because of hormones difficulties communicating, role changes Inability to orgasm and other ingredients included in pills, patches, injections or from significant other to caregiver and Reduction in implanted devices. changes in self-esteem, as well as, self- frequency of sex identity. Women with disabilities often need specialists to handle their pregnancy and birth. 7 9/11/2019 The Disabled Body: Functionality and Pleasure The Disabled Sexual expression is influenced by cognitive and emotional Body: processes and is dependent on functioning anatomical and physiological systems, in other FUNCTIONALITY AND words, our brains control our PLEASURE sexual organs and responses. The Disabled Body: Functionality and Pleasure Before resuming sex with a You may need to change your partner, boyfriend, girlfriend or same old lovemaking style and spouse, talk about it with your experiment with other sexual doctor or therapist and be activities which can include oral sex and mutual guided by their advice. masturbation. Make sure you are clear and To increase intimacy, talk with your mate about your concentrate on boosting the expectations, fears and romance in your relationship by feelings, including consent. offering lots of affection, Communication is key! complementing and saying nice things to each other and From a Survivor’s Perspective Remember to not put too celebrating big and small much pressure on yourself, occasions. to a Therapist’s Perspective focus on pleasure and not technique 8 9/11/2019 KEY DEFINITIONS The Role of the Therapist World Health Organization: Sexual health: Sexuality is an integral “…a state of physical, emotional, mental and social well- part of the human being in relation to sexuality; it is not merely the absence of experience and disease, dysfunction or infirmity. Sexual health requires a contributes to an positive and respectful approach to sexuality and sexual individual’s quality of relationships, as well as, the possibility of having pleasurable life, satisfaction and and safe sexual experiences, free of coercion, discrimination overall health. and violence. For sexual health to be attained and (Crooks & Bauer, 2013) maintained, the sexual rights of all persons must be respected, protected and fulfilled” Multi-Disciplinary Approach SERC SEXUALITY RESOURCE EDUCATION CENTRE MB 9 9/11/2019 Occupational Therapy Framework Defines: Who Should be Addressing Sexuality? Physiatrists Primary Care Physicians Sexual Activity as an Urologists, Gynecologists, “Activity of Daily Living” Endocrinologists Behavioral Health (Psychologist / Managing Intimate Relationships as an Psychiatrists) “Instrumental Activity of Daily Living” OT / PT / Speech Language Pathology Nurses AOTA, 2014; Estes 2014 Social Workers Fertility Specialists Certified Sex Counselors or Therapists Why An Interdisciplinary Therapy Team? Research Findings Improved quality of life (Sale et al., 2012) May mitigate depression, anxiety, & self-esteem issues My Adv ise to other disabled people would be, (Hough et al. & Barbonetti et al., 2012) concentrate on things your disability doesn’t prev ent you doing well, and don’t regret the Avoid general health symptoms associated with sexual things it interferes with. Don’t be disabled in spirit, dysfunction (Khak et al. 2016) as well as physically. Improved knowledge --- Stephen Hawking Provision of support Reduce feelings of isolation Reduce unevenness of services provided 10 9/11/2019 Physical / Sensory Barriers Motor Function (paralysis, spasticity, coordination) Direct and Indirect Injury Medical Complications Effects Medication and Side Effects Fatigue Sensory Tolerance and Changes Impacting Sexuality and Various Levels of Pain Wellness Bowel / Bladder Challenges Seizures Endocrine Abnormalities Leading to Fluctuating Hormone Levels and Effects Goldwin, 2015 Cognitive Barriers Emotional and Behavioral Barriers Attention Personality Changes Memory Adjustment and Loss Depression Awareness Anxiety Language and Communication Difficulties with Perception and Expression of Emotions Decreased Initiation Apathy Disinhibition Impulsivity Lability Regulation of Behaviors and Emotions Self Esteem Planning and Time Management Goldwin, 2015 Goldwin, 2015 11 9/11/2019 Predictors of Lower Sexual Social Barriers Functioning Greater injury severity measured by Post Traumatic Self-Esteem Amnesia duration Decreased Social Contact Lower Levels of Independence with ADLs Relationship Changes Mood/Psychological Adjustment Role Status Higher Levels of Depression Socioeconomic Status Lower Self-Esteem Shorter time post injury Transportation Obstacles Age and Age of Injury (Younger adults fare best 24-49 Residential Obstacles Goldwin, 2015 years old) Stolwyk et al., 2013 Staff Barriers to the Provision of Sexuality in Rehabilitation Challenges / False Levels of Staff Discomfort Beliefs Perception of Expertise Elsewhere Therapist’s Perspective Client Readiness Staff Attitudes Eglseder, K.L. 2017 12 9/11/2019 Modeling and Authentic Activity Building Scaffolding Coaching / Reflection Principal Community / Reflection Reflection Phase / Introduction & Extensive Literature Data Collection Data Analysis via Reflection via Guided Discussion Reviews via Interviews Guided Discussion Guided Discussion Technique of Research • Personal Bias • Group • Themes Discussion • Enhance Identified • Discussion of Outcome • Beliefs Comfort • Member Therapist
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