Caretakers, nurses, social- and health care assistants, physiotherapists as well as occupational therapists – anyone working to minimize the impact of the functional impairment of your clients or patients. Whether you work in day programs or respite care, residential care, nursing homes, hospitals, or in the client or patient’s own home, you get close to people with special needs.
Needs which may also be of a sexual nature, and which may lead to conflicts, frustrations and abuse, if suppressed and not dealt with. In fact, in Denmark professionals have a legal duty to clients or patients to address possible sexual needs:
“When due to disabilities people rely on advice or support in order to develop and have a sex life, both management and employees must prioritize working with the client’s sexuality.” Services Act, 2012
The law may be different in your country or municipality – but you also have a moral responsibility as a fellow human being.
It is equally important for you to have a working environment that feels safe and professionally competent.
Handisex host workshops, lectures, and seminars, and teach a wide range of topics in the area of sexuality and disability, so that you in every way can obtain the necessary knowledge and feel prepared to talk about and deal with the sexuality of your clients or patients in a professional and ethical manner.
Browse our list of most common topics requested by professionals, or if you find that your problem is not adequately addressed, feel free to call Asgerbo Persson at +45 30 13 18 11 and Kim Steimle at +45 22 63 60 42 or contact us at firstname.lastname@example.org
Our specialty is solving the problems that don’t fit into neat boxes.
“We had a very fruitful and inspiring field trip, where we got new ideas about how to work with sex education for people with intellectual disabilities. It was a good presentation with both the lecture, display of the tools and time for discussions. I can wholeheartedly recommend a visit or lecture by Asgerbo to gain in-depth knowledge and inspiration on how to address questions about sex and relationships in connection with disability. Johanna Karlsson, of the project “Sex For All” in RFSU Malmö, Sweden.
Sexuality and disability
If you work with people – either in the educational or in the health care realm – it is very likely that you also encounter their sexuality in one way or another. In our lectures and workshops we give you an understanding of the concept and nature of sexuality and why it has such a profound impact on us. We tailor the program to fit your specific occupation and need – which can be as diverse as the nature of sexuality itself.
In Denmark, approximately 250,000 people suffer from physical disability. This can range from multiple sclerosis, muscular dystrophy, and cerebral palsy to arthritis. In addition, 5000 people are victims of acquired brain damage each year, many to such an extent that it prevents them from living out their sexuality. The number of elderly people is also steadily increasing, and with the high life expectancy, they will presumably experience disability, which might reduce their ability to have an active sex life in one way or another. Add another 50,000 people with cognitive disability (formerly referred to as the retarded) and up to 50,000 people with autism, who often find it difficult to live out their sexuality or may express it in an inappropriate way and you have a major obstacle at hand.
In Europe it is estimated that 80 million people have to live with some kind of disability.
So we are not talking about a marginalized group, but about a considerable segment of the population.
Handisex teaches a wide range of professionals and students in sexuality and disability. The Joan Ørting School of Sexology, Aalborg University, SOSU schools, sexology conferences, and residential facilities and day programs, are some of the places that have benefited from our theoretical knowledge and practical experience.
Our job is to prepare you and your colleagues to handle your client’s sexuality in the best way possible. For many this comes as a surprise and can be quite difficult to deal with. Perhaps you are under the assumption that there are no sexual needs where you work – or at least no one ever talks about it. In that case we would like to help you remove the fig leaf and see the naked truth. In reality there are a number of unspoken beliefs and myths about the elderly, disabled and diseased.
- Common myths regarding the elderly, disabled and diseased include:
- They are asexual (they have no sexual desires or needs)
- They are unattractive (to us and to each other)
- They can’t have ‘real sex’
- They should not have sex with a ‘normal’, healthy, or younger person
- They have other more important things to worry about than sex
- They are too old to have sexual desires
- They have no need for sexual education or other information about sexuality
- They have no right to sexual privacy
- They do not need information about sexual boundaries and abuse
One of the most important tasks for Handisex is to break down these asexual attitudes and body-phobic myths, and we would like to help you do the same – regardless of what kind of people you are in contact with.
“Asgerbo’s teaching is at a high professional level, and as a teacher he exudes integrity and credibility. His theoretical knowledge combined with his practical experience makes him a unique and valuable teacher who also manages to convey his expertise in a sympathetic and relevant manner. Everyone who works with people should benefit from Asgerbo’s skills.” Joan Ørting, Founder of the Joan Ørting School of Sexology.
Talking about sex
”… And you know what the worst thing is? Every time I try to initiate a conversation about my sexual frustration, I am dismissed and the conversation redirects to what I think about my new shoes. It is humiliating and disgraceful.” Henrik age 28
Henrik is not the only one who feels frustrated because of negligence and inattention to sexual issues. In a Dutch study, 90 % of a group of adolescents with CP said that their biggest barrier to living out their sexuality was that no one ever talked to them about sex. Sex is one of the most natural things in the world, but talking about it can feel inconvenient and awkward. One of the reasons for that is the fact that we are facing our own sexuality when confronted with that of others. Another reason why it can difficult to discuss sexuality openly and without prejudices, is the fact that we still have a hard time accepting that the elderly, the sick and people different from ourselves can be just as sexual and aroused as “the rest of us”. This does not mean that we shouldn’t address it. In fact, as professionals we have a responsibility to help create a sex-positive environment. This means that we have to start by accepting that our clients or patients are sexual beings – and then be open and responsive to questions regarding sexual matters and to signals about sexual needs – whether internally or externally expressed.
In order to test, whether you have a culture in which both professionals and clients or patients can speak freely and openly about sex, consider the following questions:
- Are we open to dialogue when a client or patient contacts us with questions or problems related to sexuality?
- Do we participate in the dialogue trying to clarify the reason for the conversation? Do we follow up?
- Do we respond to signals that can be associated with sexual issues?
- Do we ask questions and try to identify the need further? Do we follow up?
- Do we respect everyone’s right to privacy as a condition of being able to have a love- and sex life?
- Are we in the client’s home on the client’s terms? Do we demonstrate the necessary discretion and respect, for example only entering someone’s home by appointment?
- Do we respect that different people have different sexual interests and needs?
- Do we have the necessary framework to ensure that an individual can get appropriate guidance and support to get to know his or her own sexuality and/or develop it – including getting to know his or her own and others’ boundaries?
- Are we open to general discussions about sexuality among our colleagues and ourselves?
- Do we provide employees with the necessary skills to carry out tasks related to sexuality, and do we recognize differences in our personal boundaries?
Yes, there are plenty of issues to address. So start with asking yourselves if you have the necessary knowledge and tools or if you need professional assistance and coaching in your plan for maintaining an open and sex-positive environment.
“Thank you, for an informative, inspiring and exciting day of sexuality. It was nice meeting an open-minded and well-prepared consultant with a humorous approach and dissemination of the material. You have opened our eyes and we feel much more competent in guiding our students when it comes to their relationships and sexuality.” UUC Maglemosen, Ballerup, 2014, multidisciplinary staff group
Legislation, obligations and responsibilities
Most often there is no specific law entitled “Disability and Sexuality”. Instead, when it comes to assist your clients, residents and patients in sexual matters, you most likely have to navigate through a labyrinth of service-, social-, and penal codes.
Naturally Handisex is not familiar with national laws and legislations around the world. But we can assist you in what to pay special attention, in order to create a sex positive and safe frame when it comes to working with sexuality.
In Denmark the authorities – such as social workers, caretakers and occupational therapists – are obliged to assess the needs of disabled, elderly and diseased. This also applies addressing sexual needs and addressing them accordingly. This does not mean that caretakers are required to involve themselves sexually – in fact is illegal to do so. However it might be a little complicated figuring out exactly where the boundaries are for whom and for what.
Roughly speaking one might say that the intention of legislations and the recommendations is to protect both the individual and the professionals. Depending on your level of interaction with the clients or patients and the environment in which you work, we strongly recommend you to get the relevant law material, to find out what you are obliged to do, what you are allowed to do, what you need to avoid and what is recommended that you do.
Typically relevant subjects to know about:
- What is allowed in assisting with sexuality
- Consent and permission
- The penal code and help with sexuality
- Individual rights and autonomy
- How to act upon abuse and sexual violence
The important thing is for you to have clearly defined boundaries and a solid frame in which to work – it creates a sense of security for both you as a professional and for the clients, patients or residents you are working for.
Assistance with assessment
Basically, assessment means finding out what the client or patient needs. This can be done in many ways. The simplest way is to be aware of the behavior and mood and simply ask about their potential needs.
However, this may be difficult if the individual is both physically and mentally unable to express directly what is going on, or in cases where there has not been established a sex-positive culture.
Often Handisex is contacted due to problems of inappropriate behavior or problems with boundaries. This is a sad trend, since it indicates that only the people who are causing trouble will receive the help they need as a last resort. Other, more tranquil, clients or patients must suffer in silence.
If it is a case of unacceptable or inappropriate behavior, it is important to be aware of the situations in which the behavior starts, how long it lasts, and whether the behavior is directed inwardly or toward others.
Determining whether the action is a reaction to unfulfilled sexual needs or rather a matter of general frustration requires a more thorough approach and knowledge of the clients or patients. Sexualized behavior does not necessarily relate to unresolved issues of sexuality, just as negative patterns of behavior may mask a lack of sexual satisfaction. An example from one of our assement jobs: a guy living in residential care had a habit of pulling down his pants in front of the staff and peeing in the corners, a possible indication of sexual frustration. But upon closer observation, it appeared that he did it every time he was scolded. Moreover, through dialogue, it became apparent that it was more about marking territory – you piss me off therefore I piss on you. Ultimately it was a result of lack of understanding and miscommunication rather than a question of sexual frustrations.
At other times, an individual seemingly not thriving in general is in fact rooted in undetected and suppressed sexual desire.
When Handisex identifies the possible sexual needs of clients, we find their level of sexuality and compare it with the individual client’s personality, disability, and behavior. Through dialogue with the contact person and taking into account the legal and ethical issues, we draw up a specific plan of action, which leads to improved quality of life for clients or patients and a better environment the for staff.
“Thank you, for your visit as an external consultant. You are a very positive person to work with. You are well prepared and a good listener and an excellent cooperating partner for our interdisciplinary team. You are very professional in the way you handle sexuality.” Mette Lynggaard, dept. Manager, Rehabilitation Center Strandgården, Nykøbing Mors.
Boundaries and abuse
One individual is requesting help with masturbation. Another is expecting you to call a prostitute. A third client is always firing off lewd comments at the staff and other residents slap your butt every time you walk by, all situations that can be difficult to handle and could very well be intruding your personal boundaries.
Where is the limit? What limit? Whose limit?
The same action can be perceived completely differently from one person to another. A dirty joke could easily be perceived as a lurid sexual harassment by one person and as merely a joke by another. When confronted with other people’s sexuality, it is inevitable that we, often unconsciously, encounter our own. Moreover, unconscious feelings can lead to involuntary actions and reactions that are neither beneficial to yourself, the client or patient nor the educational, caring and social work you do.
In order for you to be able to recognize the sexual needs of clients or patients, handle their frustrations, and take responsibility for providing legal and ethically motivated plans of action, it is necessary to work within certain ethics and boundaries – both on an organizational level and on a personal level.
Clear guidelines in a frame that both staff and the residents can live up to both combined with a clear awareness of one’s own sexuality and boundaries, allow for both professional care and tender caring – and reduces the risk of abuse and violations.
To begin with you can start by discussing the following issues:
- Which sexual behaviors are acceptable/unacceptable for us?
- Do we have clear guidelines for sexual behavior?
- What is allowed, what is forbidden?
- What are our rules for relationships between the staff and clients or patients?
- What can and will we, as professionals, help with when it comes to sexuality and how?
Use these questions as a guide to and as part of an actual sexuality policy. Nevertheless, the main thing is that you’ve initiated the process and that’s the first step.
Prevention of abuse
The dark side of sexual urges is expressed in behaviors that violate other’s boundaries and in worse cases end up in abuse and sexual assault.
There are no specific stats as to the number of abuse against people with disabilities, but all indications point to the fact that they have a higher risk of being sexually abused. However, professionals are at risk as well. In Denmark, according to the Union 3F, more than 13% of healthcare and social services workers have been sexually harassed during the last year. Moreover, the tendency is increasing. For the last ten years, sexual harassment among nurses has doubled, so that today more than 4,700 are exposed to harassment. Every year.
Once the damage is done, there are a number of established procedures you should follow and that you should know in any case. Therefore, it is recommended that you have prepared written guidelines that clearly outline how to respond, who does what, when and how in case, or suspicion, of abuse. Of course, prevention or minimizing the risk of it occurring at all is by far to be preferred.
One of the best ways to minimize the risk of abusive behavior is creating an environment of openness, dialogue and communication. If you create a culture where both residents and staff can talk openly about sex (link to “talking about sex”), you have already laid the foundation for a proactive approach towards possible abuse and offensive behavior
Another thing that reduces the risk while upgrading your ability to handle abuse, are clear guidelines for when and how sexual behavior is acceptable and unacceptable. These guidelines may be a short and precise description – preferably prepared with the involvement of the residents or clients you are working for – or could be part of your overall Policy on Sexuality.
These measures make it easier to be aware of signs of possible abuse. These may be non-verbal, psychological or physical signs of failure to thrive. It is important to state that these signs are indications – not proof of any wrongdoing.
Aside from the more obvious signs like STDs, pain or wounds around the genitals and other signs of physical violence, unexplained symptoms, such as stomachaches, headaches or recurrent urinary tract infections, can also be a signs of abuse.
In case of sudden aggressive or destructive behavior, excessive focus on sex and personal boundary violating actions, extra attention is also recommended. If a resident, who is normally happy and positive, seemingly inexplicably becomes anxious, depressed, helpless, passive, or withdraws from social interaction, reason to be concerned is likewise present.
A sexual policy is a common set of values and guidelines that you and your colleagues can use in your work with children and adults with disabilities. It is also an important tool in the prevention of sexual abuse (link: boundaries & abuse) and can be used to address sexual needs in a proper way.
The task of drafting a policy can be a very rewarding process in itself. It is a good opportunity to discuss sexuality and personal and common boundaries, not only in the staff group but also among the people in your care. The more you can involve the people for whom the policy is intended, the easier it will be to live up to the policies you develop.
In fact, the optimal solution is for the staff group to begin by making an overall sexual policy and then make a sexual policy developed by the residents, clients or patients. In doing so both dialogue and an open approach to sexuality are encouraged, while you in fact obtain an understanding and insight into the thoughts, feelings, and knowledge of the residents, clients or patients.
What are the benefits of making a sexual policy:
- A mutual ethical approach
- A mutual language about sex
- Knowledge of your own norms and boundaries and those of others
- Openness and recognition
- Articulation of a difficult and sensitive issue
- Increased security, happiness, and quality of life
- Prevention of repeated harassment and abuse
- Plan of action in case of sexual abuse
What should it contain?
Here are some of the topics most frequently included. But remember that it needs to make sense for you and this should not be considered a mandatory list:
- Common set of professional and ethical values
- Procedures to identify the needs of the individual clients or patients
- Procedures for sexual guidance and training
- Procedures for practical help with sex and masturbation
- Courses and training of staff
- External professional assistance
- Plan of action in case of abuse
- Confidentiality clause and consent
The most important thing is that the policy does not become a statement of intent looking great in some desk drawer, but that it is an actual practical plan in use. A working document tailored to the specific needs of you and your clients or patients and that it can be of actual use in daily life.
So start with the basics: Take each other’s hands, speak up, and grab a pen and paper.
“Varde municipality has benefited from Handisex’s professional knowledge about disability and sexuality, both in the preparation of the guide “Sexuality and people with disabilities” and at a seminar on the same topic. Their knowledge and many years’ experience on the subject were communicated in a professional and inspiring way, and their approach created a positive and open atmosphere.”/ Varde Kommune, Thorkild Sloth Pedersen, superintendent for seniors and disabled persons.