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Further Information : Sexual Advocacy for Disabled People

Disabled people have the same sexual needs as everybody else, but those who are unable to run their lives without physical and/or practical support are often denied sexual expression, with more attention being paid to potential risks than the individual's rights. This attitude is now changing.

It is no more difficult to support sexual expression than to support any other part of daily life, so long as communication is clear, and attitudes and stigma do not get in the way. A good way forward on this is to use our Values Workshop in this Tool Kit with all members of your practice, so that everyone can work together.

Obviously, care staff must not engage in sexual activities with clients. Nor should a residential home or college hire sex workers for individuals (although they may hire a striptease artist to perform). In fact, officially facilitating sexual expression will actually result in members of staff no longer breaking the rules by privately offering sexual services, perhaps for money.

There have been many assumptions made that UK laws make it legally risky to support disabled people in enjoying sexuality and intimate relationships in any way they wish. In fact, duty of care includes care to ensure the individual can safely enjoy sexual expression. Human Rights are central to any support or intervention. So rather than it being illegal to support sexual expression, it is illegal to deny that support. The rights of the individual take priority over the risks.

The first step is communication. Before open discussion can happen, a disabled person needs to be assured that confidences won't be broken, their privacy won't be invaded any more than necessary, and their sexual preferences will be respected.

Initial discussion is best done at a time specifically set aside, with the member of staff most comfortable in doing so, and to whom the client feels most comfortable talking. If there is no such member of staff, then the disabiled person can be asked if you should bring an expert (e.g. a sex therapist) in to discuss his or her needs.

In order that the initial discussion is relaxed, it’s useful to have a two-way swap of self disclosure: both client and professional need to ensure that they are not making assumptions about the other.

For example, the client needs to confirm their sexual orientation (gay, straight or bi) and that they have, or do not have, sexual desires. The care worker needs to check with the client how much their view matches the reality of the situation, and come to mutual understanding and agreement. Otherwise dangerous assumptions may be made (for example assuming that because a client is gay he is threateningly promiscuous, or because a client is Christian she is prudish or uninterested in sex).

“Where there is Silence, Confusion, Fear, Harassment and Abuse can flourish.”
Once trust and mutual understanding are gained, the care worker can ask what the client's sexual needs are. Some clients may be certain of their needs, whilst others, having no experience perhaps, may be unclear in themselves.
Here is the list of of possible needs a client might have; this is based on the list compiled for the Sexuality and Access Project in Canada by two authors of the renowned Ultimate Guide to Disability, Cory Silverberg and Fran Odette (1):
Going out to clubs to flirt, dance and socialise
Going out on a date
Going to an event in a lesbian, gay, bisexual transgendered or queer community
Positioning for sex with a partner
Positioning for solo sexual activities (e.g. masturbation)
Going to workshops or trade fairs about sex
Purchasing resources about sex (e.g. books, DVDs websites)
Purchasing a sex toy
Using a sex toy
Renting/purchasing erotica/pornography
Watching or reading erotica/pornography
Going into online dating or chat rooms
Going to a strip pub
Dressing up as a form of sexual expression (e.g. leather, lingerie)
Finding, calling or arranging for a sex worker/escort
Helping with vocabulary, supporting to find someone to talk to, and opportunities to communicate about sexuality and intimacy (and facilitating that communication).

We could add:
Joining the Outsiders Club and other peer support networks
Visiting a sex therapist or counsellor
Preparing for and experiencing the visit of a sex worker/escort; this may include deciding what will be wanted from that visit so that the sex worker understands and agrees in advance.
Preparing for and experiencing a visit to a sex worker/escort

The client should be reassured that it's OK to be shy or extrovert. It's OK to feel private and inhibited talking about sex, or open and frank about it. It's OK to make mistakes and OK to get upset when things go wrong.

Often, the clients' sexual needs battle with their sexual guilt. Guilt may result from institutionalisation, from religious views or from parents’ wishing to keep their disabled son or daughter as child-like. If a client were not disabled, they might have more easily found a partner and not need to use some of the services above.

One way to help them feel more comfortable with their current level of experience, is to point out that they – like everyone - are on a journey of discovery and self education, to find out who they are sexually, what they want from sex, how to gain sexual confidence, and what they really want in life. They need to understand that everyone, disabled or not, evolves sexually throughout their lives.

Many a disabled person — particularly ones with short life expectancy — say they don't want to die a virgin, and that they are actively seeking seek a good experience with a sex worker. An example of this was written up in an article which appeared in the Guardian.

The care worker must tell the client that normally everything is discussed with the team practice, but for intimate, sexual matters you would like to obtain their permission. Any desire for secrecy must be declared and agreed in advance. Although everything must go in writing, this can not necessarily be in with their practice notes, available to all, except if legal issues emerge.

Where there are issues of capacity to consent, the whole team have to decide what is in the best interest of the client, and all decisions, plus how they were reached, are documented. Then the laws on duty of care dictate that they can legally proceed.

In some cases, where more detailed discussion is required, or where getting involved with intimate sexual details may have a negative effect on the relationship between client and support staff, it mght be preferable to hire in a professional Sexual Advocate who will talk to the client in depth and help them more forward. Support staff need to initiate an discussion with the client, asking how they feel about bringing in a trained expert. Advocates are listed in the Resources.

1 Sexuality and Access Project ebookbrowse.com/sexuality-and-access-survey-summary-pdf
2 http://www.guardian.co.uk/society/2007/jan/15/health.socialcare
3 Specialist sex workers can be found on www.TLC-Trust.org.uk and www.Para-Doxies.co.uk