The politics surrounding facilitated masturbation for people with varied disabilities are contentious. While much research has been done to examine the effects of training, education, and interventions on problematic masturbation practices, little literature exists addressing the need to support positive masturbation skills. Further, literature addressing the adaptation of sexual aides for people with mobility and dexterity concerns exists only in the form of case studies. With the rise of support for sexual pleasure as a fundamental human right, more information needs to be made available about the potential for integrating current sexual aide technology with adaptive design technology. This article addresses some of the underlying concerns around pleasure as a human right, summarizes previous literature regarding masturbation problems, offers suggestions for changes that can be made in care systems to support pleasure and provides a very short overview of some current sex aides that could be adapted to facilitate masturbation for people with mobility and dexterity concerns.
In the 2007 publication, Sexual Health for the Millennium, The World Association for Sexual Health asserts, “Sexual health is more than just the absence of disease. The right to sexual pleasure should be universally recognized and promoted” . Further, they extend this ideal to specific groups that have historically received education and training focused on negative sexual rights, focusing on youth and people with disabilities. According to The Arc and the American Association on Intellectual and Developmental Disabilities, “People with intellectual disabilities and/or developmental disabilities (IDD), like all people, have inherent sexual rights. These rights and needs must be affirmed, defended, and respected .” This article, informed by the above statements and many like it, continues under the assumption that sexual pleasure is a fundamental human right and an important facet of sexual health.
The sexuality of people with disabilities has been problematized and strictly regulated. From the use of compulsory sterilization during the eugenics movement in the United State and England to contemporary movements to keep people with profound impairments physically small and prevent sexual maturation, people with disabilities, particularly those with IDD have faced systematic societal oppression and degrading stereotypes regarding their sexuality [3, 4].
Beyond the overarching attitudes about sexuality, masturbation in particular seems to be a particularly difficult issue within care communities. Historically, problematic masturbation practices, such as masturbating in public or excessively, were treated using Electroconvulsive Shock Therapy (ECT). During the period of exposes and lawsuits brought about in the 1970s, the method changed from ECT to the use of lemon juice, sprayed onto the tongue, as a deterrent, citing that it was a more humane method of discouraging inappropriate masturbation . While general human rights informed policies no longer support the use of punishment as a behavioral modification technique, masturbation is discouraged in different ways, unofficial ways .
Research supports that masturbation is among one of the most accepted forms of sexual expression that people with disabilities engage in . This acceptance reaches broadly across all types of stakeholders; family, professional staff, specialized care providers, and frontline staff . However, most of the literature surrounding masturbation and people with disabilities focuses on stakeholder support or lack thereof of masturbatory practices and how to manage “problem” masturbation behaviors. There are few offerings relating to the actual mechanics of masturbatory behaviors of service users or offerings for frontline staff who want to learn the best ways to address masturbation in care settings.
For ease and continuity, a common lexicon must be established. In this article, the term service users will be used to refer to any people with physical, intellectual or developmental disabilities that require support from care agencies. This term is chosen specifically not only because it is broad enough to encompass the needs of many people who may need assistance in facilitating masturbation practices, but also to remind the reader and all who work in the care field that people who require assistance are, in fact, consumers and therefore have a say in what kind of service they pay for. In certain sections, a particular type of disability may be acknowledged by name, specifically when discussing aspects of education and training or mobility and dexterity concerns.
Masturbation will refer to autoerotic acts performed for sexual pleasure. This article does not address additional sexual activities that may also include masturbation with partners. To delineate the larger society from services users, the article will use typical or identify the category of person being discussed. Some examples of categories are family members, professional staff, etc.
Finally, the use of the terms appropriate and inappropriate will refer to actions that fall within the societal norms being discussed. Generally speaking, appropriate actions happen in the “right” place and at the “right” time as deemed by the greater community. Inappropriate actions are things that are potentially harmful to self or others and/or are illegal.