Adapting and Facilitating Masturbation
Before describing techniques and suggestions for facilitating masturbation, it is important to place parameters on the discussion. Facilitating masturbation is not the same as masturbating a service user, standing by to observe, or providing intrusive assistance in the sex act itself. As said in the beginning, masturbation was being used to describe a solitary, autoerotic act. Having named the things that do not fall under the purview of facilitating masturbation, it is important to discuss some of the practices that do fall into this category. It is also important to note that the following suggestions would ideally involve someone with knowledge of human sexuality and a broad understanding of disability related concerns.
Many have written about the necessary steps to facilitate masturbation. The first step in the process of providing assistance is always to provide an assessment and accompany any action with an educational element. An important aspect of education surrounding masturbation is to build in follow continued reinforcement and use neutral reminders when a service user has made a discrimination error that leads to inappropriate masturbation .
In practice, experts agree that not only establishing, but respecting privacy is paramount in facilitating masturbation. This can take many forms: knocking on the bedroom door and waiting for a response before opening (and creating systems for people who do not speak to indicate an answer); allowing for a longer amount of time in the shower unattended; installing a dividing curtain in a shared room. [5, 11]. By delineating private spaces and times that are private, frontline staff can concretely assist a service user to avoid future discrimination errors. In this ongoing learning, however, it is important to also discuss contextually private zones and activities (e.g. one may disrobe in a doctor’s office, but it is not an appropriate place to masturbate; bathrooms that have stalls are regarded as public places, so, although one is engaging in a private activity by using the toilet, this is not a private place for masturbatory purposes) .
Assisting the service user to find stimulating sexual images or materials to assist in fantasy development is also important when facilitating masturbation [6, 11]. This can prove difficult for a number of reasons. Service users generally have limited income options, making the purchase of adult magazines difficult and can potentially be embarrassing for a service user. Pornographic videos are also difficult to access due to financial restrictions, and, although stimulating, they may not create realistic ideals or expectations about bodies or sex acts. Additionally, some service users may not read, so the easier to procure erotica may also be inaccessible. Finally, not all service users have internet access, and if they do, their computer may be located in a public area of the home. Finding ways to facilitate the acquisition of stimulating material requires some creativity and risk taking on the part of stakeholders.
A part of facilitating masturbation is to address the potentially harmful masturbatory practices. Because we have established the importance of creating privacy, this is where the need to be cognizant of behavior and health patterns is particularly important. Szollos and McCabe found that stakeholders, particularly frontline staff, overestimate the amount of sexual knowledge and skill that the service users they support have. For example, if staff assume a service user is going into to their room to masturbate, but is attempting to accomplish the task by striking their genitals because it causes sensation, staff members would not know this is the practice the person is engaging in and may only see signs of trauma to the genitals when assisting with personal care.
When facilitating masturbation it is important to gain an understanding of the current practices and mechanics being used. This is a particularly important time to enlist someone who is specifically trained to do this type of assessment and education. It is also important to remain neutral if a service user is engaging in a behavior that is potentially physically harmful that provides them pleasure. Staff should avoid the dichotomous language of good and bad  and neutrally reaffirm that masturbation is ok but that some aspects of how the person is performing masturbation are potentially harmful, furthering the option for replacement behaviors.
To offer a personal example from working in a group home, a male service user was inserting objects anally. The objects ranged from bars of soap to action figures to videogame controllers. There are a number of concerns in this situation; physical integrity of the anus and rectum, hygiene, the potential for one of those items to enter the rectum and require medical intervention. The substitute behavior suggested was to assist the service user to purchase a sexual aide designed for anal insertion, lube to make insertion easier (there was speculation that the soap was being used for that purpose), and education—for both him and the staff about the best ways to use, clean, and store the aide.
As shown in the above example, the use of commercial sexual aides can be a beneficial tool in facilitating masturbation. Unfortunately, not all masturbation facilitations requires a lone butt plug to solve the problem. Supporting the service user to find an enticing and functional sexual aide system requires knowledge about adaptive design and some niche knowledge about sexual aides. One of the things that is also important to know about in this aspect of facilitating masturbation is the chemical composition of sexual aides and safety measures that may need to be taken when using certain types of toys. This is particularly relevant for service users who may be on stipends or have limited incomes.
For people with mobility and dexterity concerns, an evaluation of physical capacity, as well as an examination of current adaptive aides are paramount in finding a solution to adapt masturbatory aides . For people who have sexual functioning concerns, this may involve a conversation surrounding what satisfactory masturbation looks like for them with their current state of sexual functioning [Pat Carney, Personal Communication].
In 1982, DeWolfe and Livingston identified the need for more mechanical sexual aides to be developed that foster independence and provide sexual gratification . Fortunately, in the past two decades many advances have been made in both the arenas of sexual aides and adaptive technology. Currently, there are a number of commercially available items that answer some mobility concerns by including remote controls. An entire genre of vibrators that respond to music exist. Ergonomics have started being taken into consideration in sexual aide design, as well as different textures, shapes, and sensations. There is even a new vibrator that can be controlled by a phone app from across the world.
In adaptive technology, Adaptive and Augmentative Communication devices have moved far beyond the image on a button that spits out a phrase recorded in someone else’s voice. Trigger switches can be made to accommodate almost any type of available movement. There is even some crossover in the two realms between slings, splints, and harnesses. With the use of the right sexual aides, frontline staff would generally be limited to set up of the device/positioning and clean up when the service user is done . This has been found by some care staff to be no more, if not less, intrusive than having to assist with bathroom related care [personal communication].
The following are products that have great potential for adaptation and/or represent novel concepts in sexual aides.*
The PULSE from Hot Octopuss
The PULSE from Hot Octopuss  is a vibrator designed for the penis using the technology found in erectile dysfunction treatments. The aide has an oscillation plate that, when placed against the frenulum of a flaccid or erect penis will, according the website and many online reviewers, produce an orgasm. A benefit of the PULSE is that because it can be placed on a flaccid penis, the potential discomfort of having to apply a sexual aide mid-masturbation. The Pulse is designed to encase the penile shaft with flexible silicone wings, helping to keep the aide in place throughout masturbation. This is ideal for people with extremely limited mobility and those who lack the manual dexterity to masturbate manually.
The Minna Ola
The Minna Ola  is a slightly curved cylindrical vibrator that, rather than having a dial or buttons to control the intensity of the vibrations, uses an air filled, pressure sensitive pad to control speed. The vibrations could be used for clitoral or penile stimulation. There are two potential adaptations for the air pad function that would be beneficial for people with mobility issues. First, the aide could be used in conjunction with a splint to allow a user to use the pressure pad against the body (particularly for clitoral use, the pad could be pressed against the mons pubis). There is also potential, by merit of the pressure sensitivity, to use the Ola with a breath controlled switch.
Products from OhMiBod
OhMiBod  is a company that creates vibrators that connect to mp3 players and other sound sources via a 3.5 mm sound jack. Because of this capability, there is potential for a service user to connect the device with particularly stimulating songs (or potentially audiobooks) and have the vibrator act in combination with those other stimuli. The OhMiBod line of products could also to be connected to an existing AAC device, giving control of the sounds and sensations to the user.
There are many options for additionally adapted sexual aides. The ubiquitous Hitachi Magic Wand  comes with numerous attachments and may only require balancing on a pillow. Items like the LayaSpot  could be used in conjunction with a weighted blanked for vibratory sensation and pressure on the vulva. The La Palma, a hand harness from Spareparts , when used with a curved dildo or strapless strap-ons, like the Fun Factory Share  can be used for insertion by a service user who does not have the flexibility to reach the desired orifice with traditional aides.
The discussion around facilitating masturbation is the discussion about the right to pleasure. If we, the stakeholders and advocates, don’t discuss pleasure as a part of human rights and care provision, we reinforce stereotypes of services users as sub human and invalidate sexuality as an important part of all human identities. Mitch Tepper, who is consistently at the forefront of disability and sexuality activism and education, says, “When we do not include a discourse of pleasure we perpetuate our asexual and victimization status. We do nothing to alleviate what I see as endemic low sexual self-esteem among the many people with disabilities and illness who participate in my research or who come to me for help” . Service users are already singled out as ideal victims for abuse. It is our responsibility to help work against that notion by supporting increased bodily autonomy and self-esteem by facilitating the right to pleasure.
*The Author is not affiliated with any of the listed products or their parent companies and did not receive compensation for including them in this work.