Disability and Illness

This section deals primarily with contraception-related issues that affect women and men with different physical disabilities or illnesses. Factors associated with contraception must always be considered within the broader context of sexual, social and interpersonal relationships.

Young people and adults with a physical disability or illness often want to know how their condition might affect various aspects of their sexuality including forming and maintaining sexual relationships, sexual arousal and orgasm, fertility, mobility to engage in sexual activity, or the effects of medications on sexual functioning. These and other such issues encompass three categories of factors that can contribute to sexual difficulties or dysfunctions for heterosexual, gay or bisexual people with a disability or illness (Sanders, Foley, LaRocca, & Zemon, 2000).

Primary effects, attributable to the direct effect of neurological or other impairments on sexual response and desire;

Secondary effects, associated with the indirect impact of the condition on factors that can affect sexual activity or relationships (e.g. fatigue, mobility, bowel or bladder function, pain, reduced sensation);

Tertiary effects, arising from the person’s emotional reaction to the condition, to their treatment by others, or to societal experiences linked to work, relationships, income and other such factors. These effects can influence self-image, mood, communication, and self-confidence as a sexual person or sexual partner.

Issues associated with each of these categories can overlap and be mutually reinforcing. Such effects are encountered in a variety of health conditions seen by physicians and other health professionals. Raising these topics during routine visits can help to identify concerns that would otherwise go unaddressed. Unpublished studies of family physicians and obstetricians and gynaecologists who began practice in the mid 1990s suggest that only a small percentage of physicians would routinely assess such primary, secondary and tertiary issues during routine care of patients with common medical conditions known to have sexual sequelae. In contrast, less sensitive topics such as contraception and STI prevention are more likely to be raised with patients during routine care.

Contraception and contraceptive practices are important considerations for youth and adults of reproductive age who have a physical disability or illness. Questions about the contraceptive implications of such conditions are common among teens (see Kaufman, 1995). The topic is also important for adults with a disability or illness. The following sections for women and men thus focuses on contraceptive and reproductive issues associated with a selection of disabilities and health conditions. The broader sexual implications of the different conditions are mentioned when they have implications for fertility or contraception, but are otherwise not covered here.