Maneuvering romantic and sexual relationships can be difficult for anyone, but it is an important part of human life. The difficulties become even greater when other factors are thrown in, such as physical and/or mental disabilities, which often times make romantic and sexual relationships seem impossible. However, it is important that society de-stigmatizes the idea of people with disabilities having relationships, because it only adds to the added difficulties that they experience trying to maneuver their dating and sexual activity. Understanding the reasons why people with disabilities may struggle in their dating and sexual life will aid in breaking the stigmas, and help them to live as normally as possible with their disabilities. This paper will answer the following questions: How do the dating and sexual experiences of people with disabilities differ from those without disabilities? How do people with disabilities feel about these differences? How do their disabilities, and cognitions surrounding them, affect their dating and sexual lives?
Heller, Gambino, Church, Lindsay, Kaufman, and McPherson conducted the following study to learn more about sexuality of people living with disabilities, specifically Spina Bifida, and to discover how the disability factors into their sexual relationships. Their theory was that sexual relationships would be more difficult because the disability is something that must be discussed before engaging in sexual activity. Their second theory was that the need to discuss the disability may actually lead to more satisfying sexual encounters because the couple will immediately be more open to discussing sex more intimately.
The Heller et.al (2016) study, “Sexuality and Relationships in Young People with Spina Bifida and Their Partners” used a sample of adolescents aged 16-25, who were collected from a pediatric rehab center in Toronto, Canada. Inclusion criteria were a Spina Bifida diagnosis, an ability to speak English, and the ability to do a one-on-one interview. The participants were recruited via a mailed information letter. Data was collected from in person and telephone interviews. The interviewer asked the participant about their sexual and romantic relationships during a 27-85 minute long interview. The interview was 56 minutes on average, and participants were asked questions such as “have you thought about how you would bring up your spina bifida when talking about sex or other sexual activity?” and “What is/was a priority for you when discussing sex with someone you’re interested in?”
Heller et.al (2016) found that there were three factors that were most important for the participants in relation to their sexual activity: importance of disclosure, worries around disclosure, and confidence after disclosure. They concluded that many of the participants felt that their disability did in fact affect their romantic and sexual relationships, and they were most worried about how and when to disclose their disability. They were also very worried about the consequences of disclosing their disability in respect to their partner’s view of them sexually.
Some limitations of the study are that they did not screen for the participants that had not actually been in a romantic or sexual relationship. This meant that they were not going off of actual experience, but just cognitions and predictions of how the participant felt they might be in a romantic or sexual relationship.
The study “Romantic attachment in individuals with physical disabilities” was conducted in 2007 by Hwang, Johnston, and Smith. They attempted to look more closely at the attachment styles of people with physical disabilities that were also in relationships. Their hypothesis was that there is a higher risk for people with disabilities to experience insecure attachment styles, because they did not have as close of a bond to their mothers as infants due to their physical disability.
Hwang, Johnston, and Smith (2007) recruited 100 individuals with physical disabilities, ages ranging from 20-50 years old. 50 of the participants had congenital disabilities, and the other 50 had physical disabilities that were developed at the age of 16, but no later than the age of 18. This was to ensure that participants had their disabilities for at least two years, and were no longer psychologically or physically adjusting to the disability. Participants were recruited from doctor offices for the disabled, independent living centers, Internet ads, and referrals.
Attachment styles were measured based off of the Experience in Close Relationship Scale, which is a 36-item scale where intimate relationships are evaluated in relation to anxiety and avoidance within the relationships.
Analysis showed that the results did not actually support one of the hypotheses that people with disabilities had different attachment styles in their intimate relationships than those that do not have physical disabilities. However, the authors do claim that the results support different theories surrounding attachment styles, specifically that attachment styles are based much more off of internal characteristics rather than physical, such as a physical disability.
Some of the limitations of the study were that it was based off of a self-report scale, which means that there is a possibility of human error and bias from the participants. Also, the recruitment style of mailed letters and referrals could mean that the participants were not necessarily representative of the population of individuals with disabilities in relationships.
Rintala, Howland, Nosek, et. al conducted a study called “Sexuality and Disability” in 1997 that wanted to answer the following questions: “What are the differences in dating for women with and without disabilities?” and “What variables are associated with dating outcomes for women with disabilities?”
Rintala et. al (1997) worked specifically on this study, that was actually a component of a larger scale study. They interviewed 31 women with physical disabilities and surveyed 940 women, more than half of who had physical disabilities and the remainder had some other form of a disability. They looked at five different variables: “sense of self, sexuality information, relationships (family, friends, dating), societal and environmental barriers and abuse, and health and sexual functioning” (Rintala et. al, 1997). They developed a questionnaire of 311 items and 1011 variables based on the previously mentioned five groups. They then used the 10-item Rosenberg self-esteem scale and the RANDSF-36 physical functioning scale to determine the extent of their physical disability.
Inclusion criteria were women with a physical disability, 18 years or older, with no cognitive or mental impairments. They recruited from ten centers for independent living and had quotas for race and ethnicity. They also asked for the age of onset for the physical disability, to control for participants that had congenital disabilities versus an onset later in life.
The participants were mailed the questionnaires with return envelopes. A total of 1060 women were mailed, with a cash incentive of $10 for returned questionnaires. Out of the 1060 women mailed, 506 with physical disabilities responded. The responses were then coded and entered into a database.
Rintala et. al (1997) found that 58% of women with disabilities that responded were not in relationships. They also found that women with disabilities were significantly “more dissatisfied with their dating frequency, perceived more constraints on attracting partners, and perceived more societal and personal barriers to dating.” The implications of this are that women with disabilities who have these perceptions may, in fact, confirm a self-fulfilling prophesy of not attempting to date because they assume that they will be rejected due to their disabilities.
One of the limitations of this study was that all of the participants were women, so the results cannot be assumed to be correct for any other gender. Another limitation is that the questionnaire was all self-report, meaning that there could be some bias in answers from the participants.
Study number four, titled “Relationship status and quality moderate daily pain-related changes in physical disability, affect, and cognitions in women with chronic pain,” was conducted in 2013 by Taylor, Davis, and Zautra. They hypothesized that women in relationships that had chronic pain would have healthier cognitions surrounding their pain, and more effective coping mechanisms for their pain. They further hypothesized that better quality of relationships would indicate less reports of pain.
Taylor, Davis, and Zautra recruited participants from Phoenix out of physicians’ offices, ads, senior citizen groups, and mailings to members of the Arthritis Foundation for their longitudinal study. Inclusion criteria for participants were: a pain rating above 20 on a scale of 1-100, diagnosis of osteoarthritis, or diagnosis of fibromyalgia. They were excluded is they had a diagnosed autoimmune disorder if they completed 6 or fewer days of the diary entries (part of the methods). Participants were first interviewed on the phone for eligibility, then given a home visit by a researcher that would assess the participants painful areas and range of motion, and help the participant complete a questionnaire about partner relations. Participants were also asked to fill out 30 days of diary entries about “physical pain symptoms, functional health, pain cognitions and coping strategies, interpersonal events, and affects” for the day they were journaling about. 37 participants adequately followed the study method to be included in the analysis.
Variables measured were if the participants were in a relationship, as well as the different stages of relationship they may be in (widowed, together, separated, living together, single). Also measured were: “satisfaction with spouse, pain, affect, pain catastrophizing, pain coping, and physical disability” (Taylor, Davis, & Zautra 2013).
Results and analysis showed that participants who lived with their spouse or partner showed better functioning and cognitions for the measured variables, allowing the researchers to assume that their hypothesis was supported. However, they could not determine the exact mechanisms for these results. Participants that were living with their partners, yet had low relationship satisfaction, actually reported higher pain and pain related symptoms than those who were single and living alone.
One of the limitations of this study is that the participants were all women, and they were primarily white.
The study “Personal and environmental factors contributing to participation in romantic relationships and sexual activity of young adults with cerebral palsy” was conducted in 2012 by Wiegrink, Stam, Ketelaar, Cohen-Kettenis and Roebroeck. The authors were aiming to look at the factors between romantic and sexual relationships of young adults with cerebral palsy.
For this study, there were 74 participants that were aged 20-25 years, with 46 men and 28 women. Questionnaires were mailed and completed, and 74 were returned adequately filled out to be included in the analysis.
The authors found that more women with cerebral palsy were in romantic or sexual relationships than men, and that there was a correlation between the age and the severity of the cerebral palsy for predicting sexual activity levels. Participants that were younger and had higher physical functionality reported higher sexual activity. They also found that participants that were more open to discussing their disability with their partners also had higher reports of sexual activity, similar to what some of the previously mentioned studies found.
Wiegerink et. al (2012) concluded that individuals with cerebral palsy were more affected by the interpersonal aspect of the disability rather than the physical aspect. Therefore, fi they had more discussions about sex in respect to their physical disability, they were more likely to feel comfortable with being intimate with their partners despite their disability.
One of the limitations of this study was that the sample size was relatively small, and so the study cannot be considered to have external validity.
Conclusion
The literature around romantic and sexual relationships for people with physical disabilities all has a similar, overarching conclusion. The disability seems to have a significant effect on their cognitions about their relationship, however it is based more on internal anxiety surrounding discussions of the disability rather than the actual physicality of it.
The internal anxiety of discussing their disability could come from a variety of reasons. One could be that there are so many stigmas around people with physical disabilities in today’s society. This could stem from a lack of education around physical disabilities, leading people to become uncomfortable in the presence of the physically disabled. This, in turn, could also stem from underrepresentation of physical disabilities in many areas of social life. Therefore, the implications of these findings are that society needs to create a better and more comfortable atmosphere for people living with physical disabilities, who are a significant portion of the population.
This could also lead to a possibility for more informed treatment for individuals, as well as couples, that are in therapy for problems related to their physical disabilities and/or romantic and sexual relationships.
Overall, there should be more education regarding the psychology effects of physical disabilities, so that our society and the caretakers of our society, including psychologists and doctors, can be better prepared to provide care for this portion of the population.
