Learning Outcomes

• Discuss the way that acute and chronic illnesses and disabilities may interact with sexuality and analyze the ways sexuality may be impacted by other identities as well from an intersectional perspective.

• Identify various types of chronic illness (multiple sclerosis, diabetes, heart disease, cancer, arthritis, stroke) and disability (spinal cord injury, cerebral palsy, blindness and deafness, mental disabilities) on sexual desire and expression.
• Explain how additional marginalized identities may further impact body image for those living in the United States and identify techniques to develop a positive counter narrative and healthy self-esteem.

Introduction

While this may be the end of our journey together, each of us is just beginning our exploration into human sexuality and the complexities of human existence. The topics in this course are jumping-off points for further inquiry. We will undergo changes across our lifespans and the people around us will experience shifts as well. From a systems perspective, a change in us creates movement in the lives of others and vice versa. We are unique individuals yet we are also interconnected with each other and our surroundings. Throughout the term, we have taken a clinical approach in which we seek ways to educate and uplift our communities, and it is fitting to end now on ourselves. We cannot help and support others if we are exhausted and emotionally taxed. By focusing on our own sexual wellbeing and reclaiming our bodies, we can best be there for others.

Ability

Ability is not something we either have or don’t have. This is a concept that lies in perception and is constantly in flux as we cope with pain, emotional distress, sickness, and accidents. We could also be born with neurodivergent or physical differences that give us insight into the way society is often created without flexibility in mind as we develop techniques to navigate and live our lives to the fullest. Being differently-abled or disabled exist on visible to invisible continuums and are experienced in ways that are psychological and physical.

Sexuality connects with ability in profound ways that can be beneficial to explore. While people who are differently-abled or disabled are clumped together under these umbrella terms, the reality of peoples’ experiences is vast and multidimensional. What is known is that mainstream media effectively erases the experiences of individuals who are differently-abled or disabled and reduces representation for individuals to see people like themselves engaged in relationships and exploring their sexuality.

Psychological Health

Looking at sexuality as it connects with mental health is vitally important because people who are coping with anxiety, depression, bipolar disorder, ADHD, trauma, schizophrenia, substance dependence, etc. may experience changes in their self-perception related to the status or severity of current flare-ups of their symptomatology. Sexual risk-taking behavior, relationship distress, taking medication (prescribed or self-medicating), and body image are interwoven with mental health status and sexual functioning. Some symptoms can either increase (i.e. manic episode) or decrease (i.e. depressive episode) sexual desire or responsiveness, or increase risk-taking behaviors. Medications often have sexual side-effects that can be addressed by changing medications (by discussing this with a psychiatrist) or seeking substance use treatment. People who are neurodivergent or experience cognitive impairments are sometimes desexualized by caregivers, teachers, and healthcare workers which opens them up to engaging in risky behaviors because they do not have access to much-needed information regarding their bodies, boundaries, and consent (Manoj & Suja, 2018; Grove et al., 2018). Thus, education, resources, and support tailored to each individuals’ experiences related to their psychological abilities are necessary.

Providing individuals with the tools to understand their mental health diagnoses and how this connects with their sexuality can be empowering. Mental health symptoms can also make people feel uncomfortable and uneasy within their minds and bodies (dysphoria). For instance, normalizing and validating the way that hypervigilance and trauma reminders can interfere with relationship intimacy and sexual engagement and developing methods to cope with the underlying trauma will benefit sexual functioning. Treating people holistically and recognizing that sexual difficulties are often a surface-level symptom for other interconnected struggles are important.

Physical Health and Pain

Being differently-abled or disabled physically can be something people experience across their lifespan or this can be developed at some point in time. People may also be able to fully heal or some may have residual symptoms. Illnesses can be acute (sudden) or chronic (over a long period). These experiences may be visible (wheelchair, cane, hearing aid, hair loss, etc.) while others may be invisible (pain levels, fatigue, etc.). Some examples of physical health concerns are cardiovascular diseases, cancer, autoimmune diseases, diabetes, multiple sclerosis, cerebral palsy, experiencing visual or auditory differences, spinal cord injuries (paraplegia and quadriplegia), etc. All of these can impact desire and cause sexual difficulties. The relationship with one’s own body and self-perception shift throughout different stages of illness, pain, frustration, and acceptance. Relationships with others change as lovers may also become caregivers and feelings of weakness or relying on others can cause strains in this dynamic. Reframing roles and letting go of labels allows for greater possibilities. Loss of a body part due to a surgery or injury can cause specific self-image alterations, challenge feelings of attractiveness and self-worth, and cause people to question aspects of their femininity and/or masculinity.

Grief and Self-Acceptance

When grief is discussed, it is usually in the context of a loved one or pet dying. However, any loss can cause a grieving process and mental health and physical health concerns can sometimes be accompanied by grief as one adjusts to a new normal or as they make sense of their diagnosis. Here are some educational resources on this process and ways to cope.

• Finding Acceptance: Psychological Stages of Chronic Illness
• APA (2013): Coping with a Diagnosis of Chronic Illness
• Stages of Grief

Intersectionality

This has been a recurring theme throughout this course because our lived experiences are based on the ways our multiple identities come together and our wellbeing is heavily influenced by the way in which these identities are marginalized or privileged by society. These identities are social constructs and are not based in reality yet power structures and social hierarchies cause them to manifest and influence our lives in very real ways. Race, ethnicity, financial resources (class), education, religion, spirituality, age, gender, immigration status, language, acculturation, etc. are interwoven with our body image and sexuality based on the society we are living in. The impact of colonization and the meaning and value placed on these social constructs by society are then internalized or rejected. Borders and nations are not real to birds and butterflies yet they dictate our movement and way of being in this world. How can we work to develop positive perspectives around our identities while also recognizing and not minimizing or ignoring the flaws in society? What does it mean to decolonize our body image?

Resources to Call Out and Combat Patriarchy, Colonization, and Self-Doubt

• An Introduction to Feminism and Cross-Cultural Body Image in the United States (Darnell, 2018)
• Body Image Experiences Among Asian American Women: A Qualitative Intersectionality Framework (Brady, 2016)
• Opara, I., & Santos, N. (2019). A conceptual framework exploring social media, eating disorders, and body dissatisfaction among latina adolescents. Hispanic Journal of Behavioral Sciences, 41(3), 363–377.
• Colonizing Black Female Bodies Within Patriarchal Capitalism: Feminist and Human Rights Perspectives (Benard, 2016)
• Tabaac, A., Perrin, P. B., & Benotsch, E. G. (2018). Discrimination, mental health, and body image among transgender and gender-non-binary individuals: Constructing a multiple mediational path model. Journal of gay & lesbian social services, 30(1), 1–16.
• Is Beauty in the Eyes of the Colonizer? (NPR Code Switch, 2019)

Body Image

Our bodies are just vessels that carry us through this life, yet society places labels upon our flesh that politicize, marginalize, and dehumanize us. The stretch marks, scars, cellulite, acne, muscles, fat, curves, and birthmarks are devoid of meaning except the meaning we ascribe to them. Fitness magazines, airbrushed images of celebrities, CGI movies, and music videos are sold to us as reality which causes a warped perception about what actual human bodies look like naked and clothed. If beauty is in the eye of the beholder, how can we hold ourselves more closely with compassion and look upon ourselves with a fresh perspective that is cleansed of falsehoods? Moving forward, how can intersecting identities be used as sources of sexual strength that collide to undo stigma and shame?

Techniques

“Beauty ideal internalization” and the frequency of social comparisons are correlated with body image (Alleva et al., 2015, p. 11). Cognitive Behavioral Therapy techniques have shown promise to improve body image by recognizing and challenging cognitive distortion and by implementing perception checking and reality testing methods (Alleva et al., 2015). Restructuring of thoughts, changing the language used to describe the body from judgmental to neutral phrases, revisiting times of feeling self-conscious or uncomfortable and creating a new narrative, and improving media literacy and media resistance strategies were some of the techniques that Alleva et al. (2015) found to be effective in their meta-analysis of previous research studies conducted.

Implementation

Utilizing this knowledge, try out some of these methods and make notes about how you feel about yourself throughout the process.

• Take a look at your social media accounts (TikTok, Instagram, YouTube, Twitter, Facebook, etc.) and unfollow people or products that make you feel bad about your body. Increase your media literacy by reminding yourself that what is shown is not reality. Be more selective about what you watch and expose yourself to, and pay attention to the way the media impacts your thoughts, feelings, and behaviors. Choose media that uplifts and supports you. Resist media that is judgmental and negative.
• When you see images of people who have attributes you desire or see something that makes you feel self-conscious about the way you look, reality check your experiences by asking yourself Socratic Questions.
• Recognize common thinking errors related to our body image.
• Reality check and restructure our cognitions by putting thoughts on trial and challenging negative thoughts.

Conclusion

This chapter explores the interplay between ability, intersectionality, body image, and sexuality. We’ve seen how physical and mental health, along with various intersecting identities, profoundly impact our sexual experiences and self-perception. We highlight the importance of recognizing ability as a fluid concept and understanding how societal norms and media representations can shape our views of our bodies and sexuality. By examining these issues through an intersectional lens, we gain a more nuanced understanding of the diverse experiences individuals face. There’s a need for inclusive, comprehensive sexual education and resources that address the needs of people with different abilities and identities. Furthermore, we can all aim to improve body image and reclaim our bodies, encouraging a journey of self-acceptance and empowerment.

As we conclude this exploration of human sexuality, we are reminded that sexuality is a fundamental aspect of the human experience, diverse and unique to each individual. By fostering understanding, challenging societal norms, and promoting self-acceptance, we can work towards a more inclusive and affirming approach to sexuality and body image for all.

Resources

• The Body is Not an Apology: Radical Self-Love for Everybody and Every Body
• Seaman (2018): A Guide to Reclaiming Sexual Health
• Dissertation by Espinoza (2013): The Erotic Intelligence of Plants: A Heuristic Inquiry of Women’s Sexual/Spiritual Experiences with Sacred Amazonian Plant Teachers
• Savage, L. E. (2014). Reclaiming women’s sexuality: The intersection of Shamanic practices and sex therapy. Sexual & Relationship Therapy, 29(1), 121–131. https://doi-org.libproxy.pcc.edu/10.1080/14681994.2013.861061

Licenses & Attributions

Henry, O. (2019, November 25). Reclaiming sexual identity through carnival [Video]. TEDxPortofSpain. https://www.youtube.com/watch?v=uFn98nZnhCo. License: All Rights Reserved. License Terms: Standard YouTube license.

Additional References

Alleva, J. M., Sheeran, P., Webb, T. L., Martijn, C., & Miles, E. (2015). A meta-analytic review of stand-alone interventions to improve body image. PloS one, 10(9), e0139177. https://doi.org/10.1371/journal.pone.0139177. Retrieved from

Grove, L., Morrison-Beedy, D., Kirby, R., & Hess, J. (2018). The birds, bees, and special needs: Making evidence-based sex education accessible for adolescents with intellectual disabilities. Sexuality & Disability, 36(4), 313–329. https://doi-org.libproxy.pcc.edu/10.1007/s11195-018-9547-7

Manoj, M. P., & Suja, M. K. (2018). Correction to: Sexuality and reproductive health in young people with disability: A systematic review of issues and challenges. Sexuality & Disability, 36(2), 207–216. https://doi.org/10.1007/s11195-018-9523-2