THE HANDICAPPED AND DISABLED
As we have seen in two previous sections, the human sexual and reproductive functions can be physically and psychologically impaired (see "Some Physical Problems" and "Sexual Maladjustment"). It is also obvious that these functions can be indirectly affected by a great number of nonsexual injuries, disorders, disabilities, and diseases, indeed, the damage may well be compounded by ignorance and negative social attitudes. Thus, as a rule, physically or mentally handicapped persons find themselves confronted with special sexual problems of their own.
In our society the handicapped and disabled, such as amputees, paraplegics and quadriplegics, and the victims of cerebral palsy, may receive much valuable medical help, but very little support in developing their sexual interests. On the contrary, under the pretext of "protection", their families, friends, doctors, nurses, and teachers often deny them any opportunity to become sexually active or even explicitly discourage them. Many people simply assume that a serious physical or mental handicap precludes any hope for a rewarding sex life. However, this assumption is false. Except for extremely serious cases, in which the sheer need to survive requires all available energy, some form of sexual pleasure is always possible. The fact that this simple truth is not widely recognized only reflects the sensual poverty of our culture.
The situation is especially difficult for those handicapped or disabled persons who live in hospitals, convalescent or nursing homes, or similar institutions. In such places patients usually have very little privacy and little opportunity to meet other people from the outside. Living quarters are sexually segregated. In addition, the staff is often prudish and intolerant. Many doctors, in fact, do not know that their patients are capable of sexual enjoyment and thus never think of discussing the subject. Thus, the men and women in their care remain without guidance, and many possible sexual alternatives are left unexplored. Furthermore, many hospital administrations feel that they cannot permit any sexual activity on their premises, because this would bring them in conflict with the law, and, unfortunately, this concern may be justified. Conservative employees or relatives of patients who disapprove of nonmarital sex might bring suit against the institution. Finally, since many patients are incapable of coitus and therefore practice other forms of sexual intercourse, they may well be guilty of "sodomy" or "crimes against nature" as defined in many state penal codes. This is another reason why doctors may be reluctant to help their patients with necessary sexual experimentations. Needless to say, all of this applies not only to long-term, but also to short-term patients. Many people are hospitalized for only a few months or even weeks and, during that time, are needlessly deprived of sexual intercourse. Not every illness demands sexual abstinence, but virtually no hospital offers its patients an opportunity to become intimate with visiting spouses or lovers. On the other hand, in case of a serious illness, lovers may not even be allowed to visit at all, because they are not officially recognized "family members". Such a regulation is especially insensitive to homosexual patients.
Fortunately, in recent years a more humane and sophisticated approach has been gaining ground. Clinical sex research has shown that a great many of even severely handicapped persons can enjoy sex if they are willing to raise their sexual consciousness and to break out of conventional patterns. As it turns out, very often their partners are happy to go along with them. Indeed, in the meantime special explicit books and films have become available which demonstrate the sexual options open to the handicapped. When these materials are shown in a hospital, they not only help the patients and their families, but also educate the staff. As a result, some institutions have, in fact, changed their policies and now allow their patients to find sexual satisfaction either with other patients or with regular outside visitors.
Unusual problems are faced by the mentally handicapped, especially those who are institutionalized. Still, in principle, everything said above also applies to them. In the past, they were often treated as if they had no sexual interests or sexual rights. As children, the mentally "deficient" or "retarded" were given no sex education of any kind, as adolescents and adults they were forcibly prevented from engaging in any sexual activity and even routinely sterilized against their will. If they wanted to marry, the law would not permit it. However, it is now increasingly being recognized that such unfeeling rigidity is uncalled for. Mentally handicapped children, like all other children, need to learn about conception, contraception, and venereal disease. They also need love and physical affection and therefore should have the right to any sexual activity of their choosing, as long as it is consensual and private. The necessary privacy should be provided by their families or by the institutions to which they are confined. On the other hand, the mentally handicapped also have to be protected against sexual exploitation. This can be done by personal attention, appropriate institutional regulations, and sensible criminal laws. (Laws which define all sexual contact with the mentally handicapped as statutory rape end up victimizing those they are meant to protect.) Where sterilization seems desirable, informed consent should be obtained. Yet, as a matter of policy, the least restrictive alternative should always be preferred. As long as nobody else is harmed, all handicapped and disabled persons are entitled to full sexual fulfillment according to their abilities.