Sex and disability: time to treat all women as individualsBMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j3454 (Published 19 July 2017) Cite this as: BMJ 2017;358:j3454
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Health workers, patients and relatives share a very confused view about sexuality and disabilities. If we consider sexuality and mental health patients, we find a strong fear of supporting women's reproductive right when they are taking neuroleptic treatment. The fear is about their capacity to have "safe parental responsibility". There are inside this fear several motifs. The first is "the patient is now in a good status, when pregnant does she need a change of medicaments... will she get a relapse of psychosis ?" The second is about the parental responsability of women with a child. Furthermore is a long history of denial of sterilisation (https://en.wikipedia.org/wiki/Compulsory_sterilization). When we speak about sexuality and disability or autism storm clouds gather because all these questions are extended.
The small experience of the mental health dept. in Ambito sociale XXIV of Marche Region since 1998 is that we have had several patients whith succesful pregnancies because they have followed regular neuroleptic treatment and been involved in a therapeutic relationship including with a GP and their families. This enlarged therapeutical team works with the patients, and when they decide with their partners to get pregnant, it is not always formal but substantive for all.
The second point is the sexuality of patients when they live in a sheltered facility. It is a good topic of actual debate with the team of sheltered house Don Rino Vallorani in Comunanza (ATS XXIV Mrche Region). A personal view is that the sexuality of patients cannot be forced and is a freedom and awareness of sharing affection. The role of the psychotherapeutic and educational team of this sheltered house is to ensure efforts to help patients to develop awareness and freedom also in this expression of personal life. And it is a complicated long way considering sexual abuse which has commonly been experienced by patients.
Competing interests: No competing interests