Intended for healthcare professionals

Clinical Review ABC of sexual health

Sexual problems of disabled patients

BMJ 1999; 318 doi: (Published 20 February 1999) Cite this as: BMJ 1999;318:518
  1. Clive Glass,
  2. Bakulesh Soni

    Almost 4% of the UK population have some form of physical, sensory, or intellectual impairment—almost 2.5 million people. Many of these disabling conditions can produce sexual problems of desire, arousal, orgasm, or sexual pain in men and women. Sexual difficulties may arise from direct trauma to the genital area (due to either accident or disease), damage to the nervous system (such as spinal cord injury), or as an indirect consequence of a non-sexual illness (cancer of any organ may not directly affect sexual abilities but can cause fatigue and reduce the desire or ability to engage in sexual activity).

    The two main points for consideration are how disabling conditions affect sexual function and behaviour and which sexual difficulties most commonly arise.

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    Effects of disability on sexual function

    Women who undergo radical mastectomy or a disfiguring trauma often report concerns about their femininity and self image such as feelings of lowered self worth or the fear that men will find them less attractive. Similarly, young men with erectile dysfunction often avoid meeting potential partners because of their embarrassment over their inability to perform.

    “Sexuality” describes how people express their view of what is sexual. That awareness is the result of all the physical, emotional, intellectual, and social factors that have influenced their development up to that point in their life. Defining sexuality as wider than just physical functionis particularly important for people with disabilities. A person who is not able to use part of his or her body still has an equal right to full sexual expression.

    Key questions in cases of disability

    Present condition

    • Has the person congenital or acquired disability?

    • Is the disability static or deteriorating?

    • Is the disability observable by other people?

    Effect of condition on sexuality

    • Does the disability effect sexual function or sexuality?

    • Does the disability impair cognitive or intellectual ability?

    • Are there associated iatrogenic factors?

    • Is fertility …

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