Care work and sexuality

A woman's leg, wearing a black boot.  (Photo: Ich-und-Du/
The sexuality of people in need of care is only too rarely accepted, and even less a subject of discussions. (Ich-und-Du/

People with disabilities, who often have a greater need for care, equally possess sexual needs. This reality is becoming gradually more acknowledged by society as well as in care work.

In our society, sexuality is becoming less of a taboo. However, there are still areas where it is still not much of an issue, such as in nursing or care work. Indeed, the care of severely disabled people, whether in a home or ambulant, whether as a relative or as a foreigner, involves close physical contacts, at times almost intimate.

According to the Society for medical intensive care (Gesellschaft für medizinische Intensivpflege, Germany), "care and sexual work have much in common". Because the disabled person needs to be washed, dressed up or carried, many physical contacts can take place. Furthermore, people with a severe disability often do not have the same possibilities to live their sexuality - partly because of their motor constraints, but also because of social reservations and difficulties to find a partner.

Less possibilities for a fulfilled sexuality

At the same time, sexual needs, which can be aroused as a result of unintentional contacts during care work, are often repressed or can also, in rare situations, lead to an assault. Some care workers report that, in cases of severe dementia or mental disability, they have seen patients satisfy themselves in front of their own eyes. This can create a grey zone, an uneasy area for the care workers, which however is not sufficiently addressed among the people concerned.

Especially for adults caring for their own parents, their sexuality is often from the outset a taboo. Such needs and events are most usually not talked about. Even professional care workers barely know how to address the issue.

A message scribbled on a wall: "Sex is a life necessity". (Photo: Rolf van Melis/
Openly addressing the issue can help the people involved in care work to avoid uneasy situations. (Rolf van Melis/

Care work is not sexual work

We are witnessing a gradual change, which has been initiated, among others, by the Convention on the Rights of Persons with Disabilities. The Convention states that people with a disability have a right to sexual self-determination. Most care workers agree that this autonomy needs to be respected and preserved.

The question is much more about how to achieve this. Of course, a care worker does not have the task to help a disabled patient to fulfil his or her sexual needs. However, he does have the responsibility to help a severely disabled patient to achieve self-determination as well as to show how to address the issue, so thatthe borders between care work and sexuality are no more blurred.

Openness and respectful language

Therefore, people in need of care and care workers should be able to speak and communicate openly about sexuality and discuss about the possibilities. In doing so, it is essential to pay attention to an appropriate language and to respect the private sphere. The Society for medical intensive care has issued a list of advice for care workers. Sexuality does not need to mean a dead-end road for people with disabilities - there is a way out.
For example, it is essential to respect the privacy of a person in need of care, by first asking to come in, or not to disturb at pre-arranged times. Also, the possibility to use sex aids should be discussed with the person herself. There is also the alternative, for people with disabilities, to ask for a sexual assistance, even when certain institutions and especially many relatives cannot easily accept it.

Schooling and counselling in the care work

Currently, nursing education addresses the issue of sexual needs of people in need of care, and care workers, especially those involved in residential care, are required to participate in further education programs on this theme. For relatives who are in charge of care work, there would certainly be a need for seminars on how to cope with sexuality in the care of severely disabled people.

Text: Thomas Mitterhuber - 06/2013
Translation: MyH - 06/2013