Sexual health is a vital aspect of overall well-being, yet it remains a challenging topic, especially for individuals with disabilities. Building on our previous discussion in “Let’s Talk about Sex: Empowering Intimacy through AT,” this blog shifts the focus towards safe sex practices and reproductive health for individuals with disabilities. While our earlier blog explored how assistive technology (AT) can enhance intimacy through communication, positioning, and physical comfort, this installment will delve deeper into the critical aspects of sexual health and wellness. The following discussion will address barriers to sexual health education, the role of AT in promoting safe sex practices, independence and privacy, and better understanding reproductive health needs.
Written by Michelle Rosado, Ability Tools Program Coordinator II, utilizing content curated by herself, Amora Stahl, CA AT, Ability Tools, Scout Merry, MO AT and Thomas DiAgostino, PA AT, TechOWL.
It’s essential to approach this topic with sensitivity and respect, as it involves deeply personal aspects of relationships and individual well-being. Reader discretion is advised as we explore these intimate topics.
Barriers to Sexual Health Education
A significant barrier to sexual health for individuals with disabilities is the lack of inclusive sexual education. Traditional programs often overlook unique needs, leaving people without essential knowledge about their bodies, sexual rights, and safe practices. This gap is worsened by myths and misconceptions, such as the belief that individuals with disabilities are asexual. Inclusive sexual education is crucial for empowering individuals with disabilities to make informed decisions and respect their dignity of risk—the right to make choices and take risks to enhance their quality of life. For more information, visit the Self Determination/Dignity of Risk Fact Sheet.
Sexual Health and Wellness
Assistive technology (AT) improves sexual health and wellness for individuals with disabilities. These technologies include devices designed to ensure safe sex practices, promote independence, and support reproductive health. Devices like medication reminder apps like Medisafe, MyTherapy or devices like smart pill dispensers, Time Cap, provide notifications and reminders to take medications, including birth control. They also track medication adherence and can alert a designated contact if a dose is missed. Smartwatches like CADEX, Apple Watch, Fitbit and Smartphone reminders and voice assistants Siri, Google Assistant, and Amazon Alexa can set daily alerts, while automated pill dispensers ensure adherence to contraceptive regimens without assistance. Additionally, apps provide discreet access to sexual health information for private exploration. For more examples of AT solutions supporting reproductive journeys, visit our blog, “NavigATing Menstrual Cycles and Beyond.”
Understanding Contraceptive Options
There are two types of contraceptive methods: Hormonal and Barrier. Condoms (male or female) are the most effective for preventing both pregnancy and sexually transmitted infections (STIs), while hormonal methods and IUDs are highly effective for pregnancy prevention but do not protect against STIs. Let’s break down each of these options for a better understanding.
Hormonal Methods (Estrogen, Progestin, or Both)
- Prevent pregnancy
- Reduce menstrual bleeding
- Less painful periods of shorter duration
The Pill (Estrogen, Progestin, or Both)
- Description: A daily oral contraceptive.
- Effectiveness: Highly effective when taken consistently.
- Considerations:
- Increased risk of blood clots for women with disabilities.
- May cause weight gain, complicating transfers.
- Interactions with other medications may reduce effectiveness.
- Used to manage menstruation.
- Higher risk of blood clots for menopausal women taking estrogen.
Patch
- Description: A weekly hormone-delivering skin patch.
- Effectiveness: Highly effective with correct use.
- Considerations:
- Assistance may be needed for women with limited hand use.
- Not recommended for those with coronary artery disease, migraines, or high blood pressure.
Progestin-Only Contraceptives (Mini Pill, Implant, Depo Shot)
- Description: Hormonal contraceptives containing only progestin.
- Effectiveness: Highly effective with proper use.
- Considerations:
- May cause weight gain, complicating transfers.
- Risk of bone mineral density loss, compounding osteoporosis risk from immobility.
Emergency Contraception
- Description: Pills taken after unprotected sex to prevent pregnancy.
- Effectiveness: Most effective within 3-5 days of unprotected sex.
- Considerations: Should be used as an emergency method, not regularly.
Barrier Methods
Male or External Condom
- Description: Thin film cover placed over an erect penis.
- Effectiveness: Only method effective against both pregnancy and many STIs.
- Considerations:
- Alternatives for latex allergies: lambskin (no STI protection) and plastic.
Female or Internal Condom
- Description: Thin pouch with flexible rings, made of non-latex rubber.
- Effectiveness: Prevents pregnancy, less effective than male condoms for STIs.
- Considerations:
- Assistance may be needed for insertion by women with hand limitations.
Intrauterine Device (IUD)
- Description: T-shaped plastic device with copper or hormones, inserted into the uterus by a healthcare provider.
- Effectiveness: Highly effective at preventing pregnancy.
- Considerations:
- Not recommended for women with spinal cord injuries, lupus, or other disabilities due to severe bleeding risk, device displacement, autonomic dysreflexia, and possible weight gain.
Cervical Cap and Diaphragms
- Description: Prescribed silicone cup that covers the cervix, used with spermicide to prevent pregnancy.
- Effectiveness: Effective with correct use.
- Considerations:
- Difficult insertion and removal for women with mobility impairments.
- Comparison with diaphragms:
- Shape: Cervical caps look like a sailor’s hat, while diaphragms are dome-shaped.
- Size: Cervical caps are smaller.
- Fit: Diaphragms cover the cervix and surrounding area; cervical caps fit snugly on the cervix.
- Ease of Use: Diaphragms may be easier to insert and remove.
- Duration: Cervical caps can stay in place longer (up to two days), diaphragms must be removed every 24 hours.
- Effectiveness: Diaphragms are slightly more effective.
- Availability: Diaphragms require fitting at clinics; cervical caps need a prescription and can be purchased online.
Vaginal Ring
- Description: Small, flexible plastic ring inserted into the vagina.
- Effectiveness: Prevents pregnancy by releasing synthetic estrogen and progestin.
- Considerations: Easy to use and maintain with regular replacement as prescribed.
Applicators
Many people with disabilities may have limited use of their hands or arms and can find it difficult to use some barrier methods of contraception or even tampons. Here are a few different options for applicators that may help:
- TINA – Tampon Applicator: Allows insertion of tampons with one hand and no independent finger strength, great for women with limited dexterity.
- EcoBlossom: Menstrual Cup applicator for easy insertion.
- Medintim Diaphragm Applicators: The insertion rod has two sides: one for inserting and one for removing the diaphragm.
- The One Handed Condom Wrapper: Originally designed for people with hemiplegia, it requires a simple finger-clicking action to open.
Educational Resources
Promoting inclusive sexual health is essential for the well-being of individuals with disabilities. Utilizing assistive technologies can enhance intimacy, communication, and overall sexual health. If you would like to continue the conversation you can check out these additional resources:
Videos – Sexuality, Consent, & Relationships
- Ability Tools AT & Sexuality w/TechOWL PA and Missouri AT webinar
- Sexuality and People with Developmental Disabilities (4 Videos)
- Sex Ed for People with IDD (Full Series)
- Tea Consent (Clean)
- Consent for Kids (Animated)
- Amaze.org
- Picture This Documentary
Resource Hubs – Sexuality & Consent
