Silenced No More: A Review of Supporting Disabled People with Their Sexual Lives

Supporting Disabled People with Their Sexual Lives: A Clear Guide for Health and Social Care Professionals focuses on educating healthcare providers about the needs and barriers to sexuality for disabled people. This comprehensive volume encourages providers to openly address issues of sexuality with disabled clients. The author takes a positive approach toward disability and a clearly sexually affirmative perspective. The author includes a section on difficulties that providers may encounter in conducting sexual advocacy and promotion of sexual health. The volume includes analysis of the sexual health needs of individuals with disability, specific techniques and approaches to sexual expression, dating and partnership, the role of sexual services, and sexual diversity. Her chapter on sexuality and sex education with disabled youth is one of the most controversial areas of the many provocative topics covered. A co-author wrote a chapter on sex, disability, and human rights exploring the sexual rights of disabled people. The text is written in a very accessible, open narrative that varies from extremely detailed to quite concise. There is no serious or comprehensive discussion about concerns related to sexual abuse. Many statements presented are supported primarily by anecdotal data; while there is clearly a paucity of available empirical research on these topics, readers may question the evidence-base for many strategies presented. This book is a countercultural response to decades of overly conservative practices that have attempted to restrict and silence disabled sexuality. This is a helpful and useful tool for those seriously interested in enabling disabled people full participation in this important realm of life.     

Self-concept,sexual knowledge and attitudes,and parental support in the sexual adjustment of women with early- and late-onset physical disability

Three groups of college women were compared on the following dimensions: sexual experiences, sexual satisfaction, self-concept, sexual attitudes and knowledge, and parental support for sexual development. Groups were composed of women with late-onset physical disability, early-onset physical disability, and no disability. Measures utilized included an extension of the Sexual Interaction Inventory, the Tennessee Self-Concept Inventory, the Sexual Knowledge and Attitude Test, and questionnaires developed for this study. The early-onset group reported fewer current sexual experiences than did the nondisabled group. The early-onset group was dissatisfied with the frequency of sexual behavior to a greater degree than the nondisabled group. Also, both disabled groups believed that they could enjoy sexual experiences more than they did at present in contrast to the nondisabled group. There were no group differences for self-concept, though several aspects of self-concept contributed significantly to sexual adjustment for the disabled groups. No group differences were found for sexual knowledge and attitudes or parental support for sexual development, nor did these variables relate to sexual adjustment. Group differences in sexual adjustment are discussed in terms of functional, emotional, and social implications. Recommendations for further research include following the social development of women with lateonset conditions, comparing the social skills and cognitions of the two disabled groups, and assessing men who have established intimate relationships with disabled women.     

Sexual Behavior of Married Young Women: A Preliminary Study from North India

Background:

There are significant gaps in the scientific literature concerning female sexual behavior and attitudes surrounding sexuality, which have definitive implications on public health and clinical work.

Aim:

To study the sexual behavior of young married Indian women.

Materials and Methods:

The study group comprised 100 consecutive women attending the Department of Pediatrics for the care of noncritical children in a multispecialty, tertiary care teaching hospital setting in North India. Current levels of sexual functioning and satisfaction were assessed by using the Brief Index of Sexual Functioning for Women (BISF-W). All participants were also administered a translated and culturally adapted instrument called Sex Knowledge and Attitude Questionnaire-II (SKAQ-II).

Results:

Peno-vaginal sex continues to be considered the most desired and actually performed sexual activity for arousal and orgasm, followed by kissing and foreplay. Difficulties while performing sexual activity, in the form of physical problems, were faced by 17% of the participants. The participants displayed adequate sexual knowledge and favorable attitude towards sexuality as measured by SKAQ-II.

Conclusion:

The present study is a preliminary effort to understand the contemporary female sexual behavior, knowledge and attitude by employing standard instruments. Still further studies are required in this area.     

The Sex Knowledge and Attitude Test (SKAT)

The Sex Knowledge and Attitude Test (SKAT) was designed to measure knowledge, attitudes and degree of experience in a variety of sexual behaviors, and to be used as a teaching and research instrument. The SKAT has been administered to over 35,000 students, approximately two-thirds of whom have been medical students. SKAT has served two major objectives: to measure changes in knowledge and attitudes after a course or program in human sexuality and to demonstrate the deficiencies of medical and nursing education in preparing health professionals to aid patients with sexual problems. Additional types of research using the SKAT are suggested.     

An Analysis of the Attitudes of the General Public Towards the Sexuality of Individuals with Disabilities Through a Systematic Literature Review

Individuals with disabilities face many misconceptions regarding their sexuality, the most common of which are that they are either asexual or unable to control themselves sexually. These misconceptions are present in members of the general public, parents of individuals with disabilities, and professionals who work with individuals with disabilities. This systematic literature review explores the extant literature on attitudes of the general public towards the sexuality of individuals with disabilities. Thirty-four articles were included in this systematic review, representing attitudes towards individuals with physical disabilities, intellectual disabilities, and psychiatric disabilities. Results were coded into three main themes: People with Disabilities as Sexual Beings, Factors Influencing Societal Attitudes, and Factors Related to the Sexuality of People with Disabilities. Topics such as sexual rights, sexual behavior, relationships, partner factors, sexual orientation, sexual and reproductive health, parenting, and stigma are addressed. Also addressed are the nine measures of attitudes towards sexuality and disability utilized studies included in the systematic review.

     

A profile of sexually active male adolescent high school students in Lima, Peru

To document knowledge and attitudes regarding sexuality and sexual practices of male adolescent high school students in Lima, Peru, a self-administered, anonymous survey was completed by 991 male adolescents aged 12-19 as part of a School-Based Sex Education Intervention model. Questions concerned sociodemographic information; family characteristics; personal activities; knowledge and attitudes regarding sexuality; sexual experience; and contraceptive use. Knowledge related to sexuality was limited. Males tended to mainly discuss sexuality with their male peers (49.8%). Attitudes towards sexual activity and condom use were largely positive, although some males expressed ambivalent feelings towards the latter. Of the sample, 43% had ever had sex; age at first sexual intercourse was 13 years. While 88% of the sample would use condoms, 74% also gave reasons for not using them. Sexual activity was related to age, ever having repeated a grade, living with only one parent or in a mixed family, activities such as going to parties, use of alcohol, tobacco, and drugs, and viewing pornographic videos or magazines. Many male adolescents were at risk of causing an unintended pregnancy or acquiring an STD.     

Sexual Knowledge,Experience and Feelings Among People with Disability

The current study was designed to evaluate the sexual knowledge, experience, feelings and needs of people with intellectual disability or physical disability, and compare them to people from the general population. Sixty people with mild intellectual disability (28 males, 32 females, mean age=27.62 years), 60 people with physical disability (33 males, 27 females, mean age=28.65 years) and 100 people from the general population (40 males, 60 females, mean age=30.10 years) participated in the study. Each respondent completed the Sexual Knowledge, Experience and Needs Scale (SexKen). This scale assesses levels of knowledge, experience, feelings and needs in 12 different areas of sexuality. The results demonstrated that people with intellectual disability experienced lower levels of sexual knowledge and experience, more negative attitudes to sex and stronger sexual needs than people with physical disability, in all areas of sexuality. People with physical disability demonstrated these same trends when they were compared to people from the general population. An interpretation of these results as they relate to the sexuality of people with intellectual or physical disability is provided.     

The effects of a sexual issues discussion group on the sexual attitudes and behaviors of physically disabled college students

The purpose of this study was to measure the effects of a sexual issues discussion group on the sexual attitudes and behaviors of physically disabled college students. Research indicated that the disabled have more difficulty adjusting to college than do able-bodied students. Since sexual adjustment is an important component of total adjustment, it was hypothesized that this might be an important function of a college counselor working with disabled students. Twelve physically disabled students at ASU were the subjects for this study. It was determined that while there was no statistically significant difference on test instruments between the experimental and control groups, change was made in the direction of more liberal sexual attitudes and behaviors of the experimental group. Secondly, self-ratings on individual goals of the experimental group did show that participants progressed toward the goals which they had set for themselves prior to treatment. The major conclusion was that the size of the N was a contributing factor in the failure to denote a statistically significant difference between the two groups on the test instruments.This article is based on her dissertation study on sexuality and disability submitted to the University of Arizona in February, 1980.     

The effective use of group in sex education with people diagnosed as mildly developmentally disabled

Sex education with the developmentally disabled maintains a broad focus. This includes the promotion of knowledge, attitudes and skills. While there are many educational techniques which have proven effective in the transmission of knowledge, many programs still have difficulty enhancing attitudes and skills. This article supplements the traditional techniques of sex education with the developmentally disabled through inclusion of group treatment strategies. Techniques drawn from structured group treatment, the mainstream model of group work and group psychotherapy are used toward the goals of increasing sexual knowledge, attitudes and skills. Examples from the authors' clinical and educational practices are used to illustrate important points.     

Sexual climate and reported rape: A state-level analysis

Data on the US states are used to study two aspects of sexual climate: sexually liberal attitudes and sex magazine readership, and their relationship to reported rape. The two sexual climate measures are correlated (r =0.50), but each also seems to measure a different facet of sexual climate: tolerance for the sexual behavior of others in the case of the Sexual Liberalism Index, and perhaps sexuality per se in the case of sex magazine readership. States in the Northeast have the highest average sexual liberalism score, and states in the West have the highest average readership of sex magazines. The relationship between sexual climate and the incidence of reported rape was investigated using multiple regression. Results indicate no relationship between sexually liberal attitudes and rape, but that sex magazine readership, urbanization, poverty, and a high percentage of divorced men are each significantly associated with the incidence of reported rape. The findings are interpreted within a theoretical model that posits rape as a function of social disorganization and hypermasculine gender roles and sexuality. Paper presented at the 1985 annual meeting of the Society for the Study of Social Problems. This research is part of the State and Regional Indicators Archive and research program at the University of New Hampshire. A list of program publications and information on the availability of data can be obtained by writing to Murray A. Straus. We are indebted to the Graduate School of the University of New Hampshire, and to the National Institute of Mental Health (grant T23HM15161) for support of this research.     

Implicit Attitudes in Sexuality: Gender Differences

This study examined the role of gender in both implicit and explicit attitudes toward sexuality. Implicit attitudes are judgments or evaluations of social objects that are automatically activated, often without the individual's conscious awareness of the causation. In contrast, explicit attitudes are judgments or evaluations that are well established in awareness. As described in Oliver and Hyde's (1993) meta-analysis of self-report (explicit) data, women report greater negative attitudes toward sexuality than do men. In the current study, we used the Sexual Opinion Survey (SOS) developed by Fisher, Byrne, White, and Kelley (1988) to index explicit attitudes and the Implicit Association Test (IAT) developed by Greenwald, McGhee, and Schwartz (1998) to index implicit attitudes. Research has demonstrated that the IAT reveals attitudes that participants may be reluctant to express. Independent variables examined were participant gender, social acceptability of sexual words, and order of associated evaluations in the IAT (switching from positive to negative evaluations or the reverse). The IAT data revealed a significant Order × Gender interaction that showed that women had more negative implicit attitudes toward sexuality than did men. There was also a significant Order × Acceptability interaction, indicating that implicit attitudes were more strongly revealed when the sexual words used in the IAT were more socially unacceptable. As expected, on the SOS, women had more negative explicit attitudes toward sexuality. There was no significant correlation between explicit and implicit attitudes. These data suggest that at both automatic (implicit) and controlled (explicit) levels of attitudes, women harbor more negative feelings toward sex than do men. Portions of this article were presented as a poster at the meeting of the International Academy of Sex Research, Bloomington, Indiana, July 2003.     

Premarital sexual behavior among Chinese college students in the United States

Little is known about sexuality among Chinese in the U.S. There are reasons to believe that their sexual attitudes and behaviors would differ from those of Chinese in Asia as well as other groups in the U.S. This survey of ethnic Chinese college students in the U.S. examined the permissiveness of their attitudes toward premarital sex and their premarital sexual behavior with an eye toward their levels of acculturation. Over 60% approved of premarital sexual intercourse when the partners were in love or engaged. There was no significant gender difference in sexual permissiveness. Most of the men and women had engaged in kissing, necking, and petting, but most had not engaged in sexual intercourse. Gender differences were found in sexual experience: Chinese men were less experienced than Chinese women. Sexual permissiveness and experience were related to level of acculturation. Those who dated only Caucasians were more sexually experienced than those who dated only Chinese. Results are discussed in terms of differences in sexual attitudes and behaviors between Caucasian Americans and Chinese Americans and in terms of acculturation.The authors gratefully acknowledge the support by the American Psychological Association Minority Fellowship, and the National Research Center on Asian American Mental Health.     

Rehabilitation professionals and sexual counseling for spinal cord injured adults

The Michigan Rehabilitation Association (M.R.A.) and the Program in Human Sexuality of the University of Minnesota collaborated to produce a 1-day seminar on sexual function in spinal cord injury. Evaluation of the participants and the seminar showed that the program was beneficial for most and harmful for few. Questionnaire responses indicated that few M.R.A. members are currently doing sexual counseling but many see an opportunity to do so. A relationship appeared between those who have received some form of training in sexual counseling and those who are doing counseling with clients. It is postulated that frank and sincere discussion of sexuality may improve rapport between client and counselor. However, before such an interaction can comfortably take place, the counselor may gain from an opportunity to examine his or her own attitudes toward human sexuality and gather more information about the sexuality of physically disabled adults.This study was supported in part by Rehabilitation Research and Training Center Grant No. RT-2, Social and Rehabilitation Services, Department of Health, Education, and Welfare, Washington, D.C., the Bush Foundation, The Commonwealth Fund, and the University of Minnesota Medical School.     

Attitudes and behavior of college students relative to oral-genital sexuality

A survey was conducted to determine college students' attitudes toward and behavior relative to oral-genital sexuality. Information concerning attitude and behavior was elicited through the use of an equal-interval attitude scale and a behavior inventory. Responses from 91 students were analyzed. Results of the study indicated that more favorable attitudes toward oralgenital sexuality were expressed by students who had participated in the specific behavior and by students who had experienced sexual intercourse. Attitude toward receiving oral-genital contact was found to be dependent on church attendance. Men were more likely than women to have received oralgenital contact, and students who had participated in sexual intercourse were more likely to have both administered and received oral-genital contact. Receiving oral-genital contact was dependent on church attendance. Women were more likely than men to require love as a prerequisite for their participation in oral-genital contact.     

Sex knowledge,attitudes, and experience of Chinese medical students in Hong Kong

Sex knowledge, attitudes, and experience of 83 Chinese undergraduate medical students were assessed in their responses to the Sex Knowledge and Attitude Test. They were found to be relatively less knowledgeable especially in areas of social and cultural data-based knowledge and were less liberal especially in attitudes toward heterosexual relations and abortion. While increased knowledge tended to be associated with the repudiation of sexual myths, a general conservative outlook as assessed by the Wilson-Patterson Conservatism Scale was found to have the greatest influence on attitudes toward heterosexual relations, autoeroticism, and abortion. In contrast to the sexual practice of young Chinese of similar age based on another survey, the present sample of medical students was relatively heterosexually inexperienced. Implications for medical education with value reorientation are discussed.This study was supported by a research grant from the Chou's foundation.     

Family Life Education for Persons with Developmental Disabilities

Through the development and evaluation of the Family Life Education Trainer's Manual, the author sought to address the human sexuality needs of moderately and severely developmentally disabled people and to increase the comfort and confidence of parents, teachers, and service providers in their role as sex educators. Evaluation included various aspects of the manual as well as reviewers' attitudes toward the sexual behavior of developmentally disabled people. Teachers, parents, and service providers rated the manual in the good-to-excellent range regarding its potential effectiveness as a training tool. Although parents had the least liberal attitudes, they nevertheless viewed the manual as an effective tool. Readers expressed reservations about the level of the materials for the severely disabled.     

Religious correlates of male sexual behavior and contraceptive use

This study sought to determine whether males classified according to sexual behavior and contraceptive use could be distinguished on the basis of religiosity. Subjects included 245 single male college students ages 16-19 years, 129 of whom were identified as being currently sexually active. These sexually active males were classified into 4 groups based on consistency of contraceptive use: 1) always, 2) most of the time, 3) sometimes, and 4) never. The Faulkner and DeJong Religiosity in 5-D Scale was used to provide a measure of religiosity. Discriminant analysis indicated that a set of religiosity items can differentiate among groups differing in regard to sexual behavior, especially those from the ritualistic dimension. Males who had not participated in sexual intercourse during the preceding year indicated a greater degree of religious commitment than other males on all items selected. Attitude toward sex was the item most highly distinguishing among males in terms of consistency of contraceptive use. It is concluded that health educators should recognize the influence of religious convictions on sexual behavior and attitudes. The churches are in a positive to help their members develop decision making skills and positive attitudes toward sexuality. Questions for further research include: 1) is religiosity predictive of behavior or does religiosity change following a change in behavior, and 2) what are the implications of religious commitment in terms of educational programming in the area of sexuality?     

Sexual attitude and information questionnaire: Reliability and validity in a spinal cord injured population

There have been a number of sexual counseling programs for spinal cord injured individuals, but little attempt has been made to assess the impact of such programs. One reason for this has been the lack of reliable and valid assessment devices. The present paper attempted to evaluate the reliability and validity of the Sexual Attitude and Information Questionnaire (SAIQ) as a measure of specific sexual information and attitudes in spinal cord injured patients. Eleven recent onset and 23 remote onset spinal cord injured persons completed the SAIQ on one occasion. Twenty of these subjects (five with remote and 15 with recent onset) completed the SAIQ on two occasions, two or three weeks apart. Seven of the remote onset subjects also completed the Sexual Interaction Inventory. Statistical analysis indicated the SAIQ to have good reliability, internal consistency, and temporal stability. The validity of the SAIQ as a measure of specific sexual information and attitudes in SCI was evaluated and appears promising.This paper was supported in part by Grant #16P-56818 from the Rehabilitation Services Administration, Department of Health, Education and Welfare, to the Department of Rehabilitation Medicine, University of Washington School of Medicine.     

The Sexual Needs of the Handicapped

One of the basic needs of life to the handicapped, as well as to all individuals, is the understanding of one's own sexuality. Sex education can help handicapped individuals in finding sexual satisfaction and may foster self-responsibility, maturity and positive actions toward other rehabilitation goals. Traditionally, the teachings of sexuality to handicapped persons have run into objections resulting from society's negative attitude toward the handicapped and parental apprehension regarding the decision-making skills of their children in relation to acceptable and unacceptable sexual behaviors. However, the Education for All Handicapped Children Act of 1975 has provided a way for parents and health professionals to put pressure on local, state and federal programs to allocate funds for the development of a sound sex education program. As professionals in health education it is our challenge and responsibility to see that the sexual needs of the handicapped are not forgotten.