Sex and Disability: Tips, Tools, and Conversations that Matter

Sex and Disability

It goes without saying that all people, including those with disabilities, deserve to have fulfilling sexual experiences. However, there are many misconceptions about what sex among people with disabilities looks like. 

Let’s be clear: People with disabilities have sex, a libido, may be into any number of kinks, can be members of the LGBTQI community, and engage in various relationship structures. Folks who have disabilities may express any and every note of sexuality that exists.

In this guide, we’ll myth-bust common falsehoods around sex in the disability community, and also share tips and tools to enhance sexual encounters more. Whether you have a disability or you’re in a relationship with someone who does, we have you covered.

Mental vs. Physical Disabilities and Sex

The disability community, which the World Health Organization estimates to include more than 1 billion people worldwide, is diverse, encompassing people who live with a wide range of physical and mental conditions.

Put simply, physical disabilities affect the body while mental (or intellectual or cognitive) disabilities affect the mind.

Having a physical or mental disability doesn’t necessarily impact your sexuality or desire for sexual pleasure. But it can impact the sexual activities you’re capable of performing.

For example, a person with a spinal cord injury may benefit from exploring different sex positions to accommodate limited mobility. Or, they might experience erectile dysfunction (ED) and require prescription medication to obtain an erection. (Research has shown that around 75 percent of men who have spinal cord injuries experience ED, and 95 percent may have ejaculatory problems.)

If a person has a learning disability or a condition like Down syndrome or Fragile X syndrome, both of which are associated with intellectual disability, they may need access to tailored resources on consent and safe sex due to a historical gap in sex education. Research shows that young adults and adolescents with intellectual and developmental disabilities know much less about sex than peers without disabilities.

People who are neurodiverse may also benefit from extra support in navigating sexual relationships. For example, studies show that most adolescents and young adults with autism desire sexual intimacy and romantic relationships, but tend to have less sexual knowledge and experience than peers without autism.

Myths and Misconceptions Around Sex in the Disability Community

Here are just a few of the myths and misconceptions around sex in the disability community that need to end once and for all.

• People with disabilities don’t have sexual desires. Some people perceive folks with disabilities as perpetual children with no desire for sexual partners. This is entirely untrue. However, some research has concluded that while people with disabilities have the same sexual needs and desires as anyone else, their body image, sexual self-esteem, and sexual satisfaction may be lower. This can be due to the limitations of a disability itself or because there are limited resources available that model leading a more satisfying sex life.

• People with disabilities don’t experience sexual assault. According to the Centers for Disease Control and Preventino (CDC), women with a disability have a higher risk of experiencing rape than women without. And nearly one in four male victims of sexual violence other than rape have a disability.

• For people with disabilities, sex isn’t kinky. For some people with disabilities, exploring kinks and fetishes can be an empowering component of their sexual lives. 

• People with paralysis don’t experience sexual pleasure. While sexual dysfunctions are common among people with spinal cord injuries and paralysis, sexual pleasure isn’t an impossibility. Research shows that men with spinal cord injuries may still be able to experience sexual pleasure by focusing on other sensitive parts of the body (like erogenous zones) or through medication, surgery, or treatments like penile vibratory stimulation.

• People with disabilities shouldn’t or can’t have kids. The ability to conceive and have healthy children often isn’t impacted by a disability. Furthermore, people with disabilities can possess the same desire to have kids and ability to care for them as any other members of the general population.

• People with disabilities are only attracted to others in the disability community. While sharing a disability can be a source of connection for partners, it’s not the only possible basis for a fulfilling relationship. People with disabilities can be attracted to anyone and vice versa..

Explore What Feels Good in Your Body

No two people experience their disability in the same way. What feels good in your body may not feel as great for someone else.

The best way to find out what works for you is to experiment with self-pleasure and masturbation.

One caveat to keep in mind is that self-pleasure isn’t limited to genital stimulation. If your disability prevents you from stimulating your genitals, some alternative ways to explore sexuality include:

• Sexual fantasy

• Sex toys

• Stimulating all of your erogenous zones (like nipples, inner thighs, armpits, or belly button)

• Experimenting with different types of tactile stimulation (vibration, an ice cube, hot wax)

• Listening to ASMR playlists

• Tuning in to sexy podcasts or erotica

• Trying a massage

How Do People in Wheelchairs Have Sex?

Wondering how to have sex in a wheelchair? Whether you have paralysis or any other condition that has you using a wheelchair (or you’re dating someone who uses a wheelchair), you should know that limited mobility doesn’t have to limit your sexual activities.

Here are some sex positions to try that are accessible for people who have limited mobility:

• Reverse cowgirl/cowboy. This is easily the most convenient sex position for people in wheelchairs if the penetrating partner is the one sitting. To perform the reverse cowgirl/cowboy, the receiving partner straddles the penetrating partner while facing the other way. Facing the other way allows the receiving partner to prop their feet up on the wheelchair while controlling the depth of penetration and rocking movement. The penetrating partner can caress their partner with their free hands or a sex toy while enjoying the view. You can also perform this face-to-face for more intimacy.

• Oral. The person in the wheelchair can orally pleasure their partner without leaving their chair by pulling their chair up close to the edge of the bed. The receiving partner then lies down on their back, spreads their legs, and rests them over their partner’s shoulders, bringing their genitals as close as possible to their partner’s mouth.

• Modified missionary. In modified missionary, the partner with limited mobility sits on the edge of the bed, propped up on a cushion or pillows if needed. The other partner stands on the ground between their legs, facing their partner, and lifts their partner’s legs to rest on their shoulders, bringing the genitals together.

• Modified doggy style. Regular doggy style requires the receiving partner to be on hands and knees while the penetrating partner penetrates from behind. If the receiving partner isn’t able to access this position, they can lie on their stomach in this modified version with a pillow under their hips, propping the genitals high enough for the penetrating partner to enter. If the penetrating partner isn’t able to access the traditional doggy-style position, they can remain in their wheelchair and bring it up close to the edge of the bed. The receiving partner will lower themselves on the penetrating partner while resting their arms and upper body on the bed.

Of course, these are just a few sex positions to consider. Finding the correct position for you and your partner takes creativity, experimentation, and patience.

How Do People With Paralysis Have Sex?

As previously noted, many men with spinal cord injuries, which are often associated with paralysis, struggle with erectile dysfunction and ejaculation. The degree of sexual dysfunction varies widely among individuals depending on the level and severity of the injury.

For instance, studies show that in men with spinal cord injuries above T10 (referring to the 10th thoracic vertebra), reflexogenic arousal—triggered by physical touch—still works because the reflex pathways in the spinal cord are intact. However, psychogenic arousal—triggered by mental or visual stimulation—is lost because the connection between the brain and the spinal cord at T10-L2 is disrupted.

No matter your specific situation, you should work with your healthcare provider to navigate sex with disability. They can help you understand any limitations and also discover what’s still on the menu.

While the sex positions mentioned above may not work as well for individuals with paralysis of any form including paraplegia, here are some tools and techniques your provider may suggest:

• Oral ED medication. Prescription medications like Viagra® (sildenafil) and Cialis® (tadalafil) have helped many men with paralysis obtain erections by encouraging blood flow to the penis. In one study of 41 patients with spinal cord injuries, 93 percent of participants had a positive response to sildenafil treatment and were able to become hard enough for sexual intercourse.

• Alprostadil. Alprostadil, a prostaglandin E1 agonist, is a Food and Drug Administration (FDA)-approved intracavernous injection that increases blood flow to the penis. It may also be available as a urethral suppository. Studies show a link between intracavernous injections of alprostadil and similar medications and improved erections in patients with spinal cord injuries.

• Vacuum erection devices (VEDs). VEDs, or penis pumps, improve erections by pulling blood into the penile tissues. While this option may work for some men with spinal cord injuries, studies suggest that VEDs are more likely to cause complications compared to oral ED medication and intracavernous drug injections.

• Penile implants. Also known as a penile prosthesis, penile implants consist of bendable rods or inflatables that are inserted into the penis to help maintain erections. The study mentioned above also found that penile implants were linked to more complications than ED medications and intracavernous injections.

• Vibration. Penile vibratory stimulation is a medical procedure in which a vibrator is applied to the penis to stimulate ejaculation. Across 3,700 trials of men with spinal cord injuries, 86 percent of those whose injury was at or above T10 were able to ejaculate due to vibratory stimulation. 

• Cock rings. Wearing a cock ring at the root of the penis can improve circulation to help you get and maintain a harder erection. For even more stimulation, you can try a vibrating cock ring to combine the sensations of vibration and constriction.

How Do People with Chronic Pain Have Sex?

Chronic pain can significantly impact a person’s quality of life, and may compromise both their mental health and ability to have satisfying sex. Some research has concluded that 50 to 78 percent of people with chronic pain struggle with sexual difficulties.

But there are tactics that can help:

• Plan sex. Sex doesn’t always have to be spontaneous. You can plan for sex by taking pain medication, warming up with a hot bath, or even stretching beforehand. Just as important is planning pain management after sex (like hot or cold packs) if sex tends to trigger painful episodes.

• Take time on foreplay. There’s no need to rush into sex. Ease in gradually with an extensive yet relaxing foreplay session, which may or may not end in penetrative sex. This can include kissing, massage, mutual masturbation, or oral sex. By removing the pressure of needing to have penetrative sex, you can focus on the buildup of one pleasurable sensation to the next.

• Use props. From cushions to sex swings and beyond, there are numerous props and toys you can incorporate into the bedroom to make sex more comfortable and put fewer demands on your body.

Communicate. If something isn’t working, say so. Openly discussing what works and what hurts is essential for finding a sex life that feels good to both of you. It can also help you avoid exacerbating pain.

Consult an Expert

If you have a disability, perhaps you didn’t receive enough information about sex from your medical care team or family members while growing up. Fortunately, there are now many resources available including specialized experts.

They include:

• Sex therapists. A sex therapist can provide you with tailored sex education and counseling to help you understand your sexuality and sexual capabilities. This person can also work with couples to confront obstacles and discuss strategies for maintaining sexual connection.

• Dating coaches. A dating or intimacy coach can help you build confidence in navigating the dating world.

• Sex surrogates. Not to be confused with sex work, a sex surrogate provides therapeutic support in a clinical setting to clients with disabilities who are experiencing sexual issues. They help clients overcome sexual difficulties through structured exercises that may include sexual touch. Sex surrogates often work in conjunction with sex therapists to address the sexual needs of the client.

Think Beyond Penetrative Sex

If penetrative sex is not possible due to physical limitations, it doesn’t mean sexual intimacy is off the table.

Some non-penetrative sex ideas to consider include:

• Kissing

• Mutual masturbation

• Oral sex

• Roleplay and fantasy

• Erotic massage

• Bondage

• Temperature play

• Tickling

• Spanking

Practice Safe Sex

People with intellectual and developmental disabilities have an increased risk of sexually transmitted infections (STIs), partly due to limited sexual health education.

To practice safe sex, be sure to always wear condoms, regularly test for STIs, and don’t be afraid to ask your sexual partner about their own STI testing history. If you use sex toys, make sure you know how to clean them properly, practice good hygiene, and use condoms on sex toys if you plan on sharing them.

Avoid Injuries

If you have limited sensitivity due to your disability, it’s possible to injure yourself during sex without knowing it.

To stay safe, do the following:

• Communicate your boundaries with your partner

• Use lube during sex

• Don’t put yourself in unsafe sex positions

• Monitor your body for signs of discomfort

• Stop if something doesn’t feel right

Next Steps for People With Disabilities in Sexual Relationships

Whether you have a disability or are in a relationship with someone who does, the immediate next step is to acknowledge, accept, and discuss your needs, desires, and boundaries with your partner. Remember:

• Sexuality and disability aren’t mutually exclusive. People with disabilities  can experience the same range of sexual desires and needs as anyone. It’s possible that a person’s disability may introduce the need for a sex modification or medical intervention. But this doesn’t negate any desire for sexual pleasure or romantic relationships.

• Adaptation and exploration support better sex: Individuals with disabilities can explore a variety of sexual experiences and positions tailored to their unique physical abilities. Be willing to try new things, use props, and think beyond penetrative sex.

• Tools and resources are available. Having access to tools like vibrators and medications may enhance disabled sex. Consulting sex therapists, intimacy coaches, and other professionals can help individuals and couples navigate the complexities of disability and sexuality, as these folks offer personalized strategies for improving sexual satisfaction.

If you think you could use more support for sexual dysfunction related to your disability, such as erectile dysfunction, get advice from a healthcare professional today.