Disability/Sexuality

Overview

Summary

Current barriers in sexual development for disabled people include lack of knowledge ("no one taught me"), lack of skills, negative social attitudes towards discussing sex, limited opportunities for social interaction as well as others that are disability-specific.

Key Statistics & Figures

Cultural sensibilities in Singapore might make it difficult to talk about sex, but it becomes almost taboo when it comes to the disabled. The disabled are often either seen as "asexual beings" or subjects of curiosity or ignorance.

Despite societal perception and understanding, different people with different disabilities present different strains of discussion:

• Sexuality education as a need tends to feature more when discussing individuals with cognitive impairments or intellectual and developmental disabilities, because they are at higher risk of displaying sexual behaviour that is misunderstood by others, or being the targets of sexual crime.
• In comparison, stigma and the lack of fulfillment of sexual desire might be a significant factor for individuals who are normatively cognate but who experience lack of access as a result of disability.
• Some disabilities, particularly those of the spinal cord, may lead to the individual facing issues with sexual performance. Men with spinal cord injuries may have difficulty achieving erection or ejaculation, while women may lack lubrication or be psychologically fearful of engaging in sex.
• Disabled people who acquired their impairment may face different issues compared to someone who was disabled through congenital impairment.
• Some disabled people may face minimal to no issues in comparison to others in society, such as an individual who is mildly hard-of-hearing but who uses a hearing aid.

Articulating the Ideal Outcome

PWDs experience sexual quality of life on an equitable basis with others in society

Theory of Change

Public acceptance of varying sexual needs of PWDs	↘
		PWDs have knowledge on appropriate sexual behaviour	↘
		PWDs have access to medical / social assistance to address sexual needs	→	PWDs experience sexual quality of life on an equitable basis with others in society
		PWDs are protected against sexual harassment & crimes	↗

Short-Term Outcomes(skills, knowledge, attitudes)		Mid-Term Outcomes(behaviours)		Long-Term Outcomes(impact)		Social Impact
Greater public consciousness of the varying sexual needs of persons with disabilities	→		→		→	Disabled people experience sexual quality of life on an equitable basis with others in society
Persons with disabilities have knowledge on appropriate sexual behaviour	→
Persons with disabilities have protection against sexual harassment and crime	→		→
		Disabled people can access medical assistance to resolve sexual problems

Areas of Needs

Public acceptance of the varying sexual needs of persons with disabilities

Resources	Gaps	Ideas
Educational courses AWWA offers two workshops for caregivers of persons with disability regarding understanding and supporting their sexual development. Courses are: Supporting Sexual Development of Adolescents with Special Needs and Understanding Sexuality Development in Persons with Disabilities SSI course: Managing Sexuality Issues of Adults with Intellectual Disabilities	"Trainings may not be sufficiently frequent." "Possibility of insufficient marketing and thus limited reach of the education programme." "Difficult to justify funding if there is no interest and difficult to generate interest with limited funding."
Creation of sexuality education curriculum In 2015, the Ministry of Education (MOE) has awarded a $24,000 tender to a company to develop a guide to help Sped schools design programmes in personal safety and relationships.	Students in public special education (Sped) schools lack guidance in sexuality education and relationships.  Lack of information if the guide is being used today  Thorough examination of the available literature resulted in the conclusion that formal, individualized, and specific sexual education for individuals with intellectual disabilities is lacking.

Persons with disabilities have knowledge on appropriate sexual behaviour

Resources	Gaps	Ideas
Sexuality education in Special Education (SPED) Schools, some examples: Pathlight School Metta School, in its Basic and Career Programmes MINDS	Not all Sped schools teach sexuality education, unlike mainstream schools which have an MOE-approved approach for it. Some school teachers may not know how to manage sexuality-related incidents in Sped students.

Persons with disabilities have protection against sexual harassment and crime

Resources	Gaps	Ideas
Potential upcoming legal revisions Singapore laws may be undergoing a revision that includes new provisions to protect vulnerable persons. “Two provisions spelt out punishments for bystanders who know of but fail to take steps to prevent the neglect or abuse of three types of victims: maids, young children and the mentally or physically infirm.”	The law alone may not be enough, especially if poorly enforced or if circumstances surrounding abuse are more complex. “Child protection specialists and foreign worker activists were also concerned about how the law might be enforced. Ms Serene Yeo, director of Big Love Child Protection Specialist Centre, noted that there are many limiting factors that prevent a person from reporting abuse, particularly in family settings. "What if they relied on (the abuser) for financial support, or what if the wife is on a dependant's pass? It's more complicated than just putting the law in place that will prevent abuse."

Disabled people can access medical and social assistance to resolve sexual problems

• Idea: Consider establishing an SDU-like association or agency that can support disabled people to have healthy romantic relationships and explore marriage, with support care officers to educate on sexuality matters, counsellors to deal with relationship issues, support group with other married couples/parents, financial support, and home visits if need be to help couples come up with living plans.

Resources	Gaps	Ideas
Tan Tock Seng Hospital's Complex Erectile Dysfunction Clinic One in 30 cases seen are patients with disabilities due mainly to spinal cord injuries.
Tan Tock Seng Hospital’s Sexual Wellness Service Provides support for sexual concerns including after disabling injuries	While some support is now available for people with disabilities, there is still some way to go in Singapore, when it comes to frank discussion about sex. The majority of healthcare professionals are ill-equipped to address the sensitive topic. Many individuals may also be reluctant to seek professional help due to the nature of the topic.Limited number of trained sexual therapists for the disabled	Would likely require more sweeping cultural changes to encourage open conversation and reduced stigmatisation of sex and our need for intimacy. Additionally, medical services would likely require a change in paradigm to acknowledge that patients are often concerned with more than just physical recovery but also psycho-social-sexual recovery.The healthcare system is currently still very medicalised. Most healthcare professionals do not proactively ask patients if they have any sexual concerns.