Sexual Esteem, Sexual Satisfaction, and Sexual Behavior Among ...

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Archives of Sexual Behavior, Vol. 32, No. 4, August 2003, pp. 359–369 ( C 2003)
Sexual Esteem, Sexual Satisfaction, and Sexual Behavior
Among People With Physical Disability
Marita P. McCabe, Ph.D.1,2 and George Taleporos, B.A.(Hons.), G.Dip.(Ed. Psych.)1
Received December 17, 2001; revisions received November 26, 2002 and March 17, 2003; accepted March 23,
2003
This study investigated the association between the severity and duration of physical disability and
sexual esteem, sexual depression, sexual satisfaction, and the frequency of sexual behavior. A total of
1,196 participants completed the study. There were 748 participants (367 males, 381 females) who
had a physical disability and 448 participants (171 males, 277 females) who were able-bodied. The
age range of participants was 18–69 years, with a mean age of 36.39 years (SD = 10.41). The results
demonstrated that people with more severe physical impairments experienced significantly lower lev-
els of sexual esteem and sexual satisfaction and significantly higher levels of sexual depression than
people who had mild impairments or who did not report having a physical impairment. The study also
found that people with more severe physical disabilities engaged in mutual sexual activity significantly
less frequently. Women with physical disabilities had significantly more positive feelings about their
sexuality and significantly more frequent mutual sexual experiences than their male counterparts. For
people with physical disabilities, the frequency of oral sex and nude cuddling were significant predic-
tors of sexual satisfaction in men, while the frequency of deep kissing predicted sexual satisfaction
in women. Furthermore, the viewing of erotica was significantly related to sexual dissatisfaction in
men. Finally, it was found that people who had experienced their physical impairment for a longer
period of time reported significantly more positive feelings about their sexuality. Implications of these
findings are discussed and suggestions are made for future research.
KEY WORDS: physical disability; sexual esteem; sexual satisfaction; sexual behavior.
INTRODUCTION
duced sensation, sexual pleasure, and orgasm (e.g.,
McCabe, McDonald, Deeks, Vowels, & Cobain, 1996;
The aim of this study was to examine the sexual be-
Sipski, 1991). These problems in sexual response can have
havior, sexual esteem, and sexual satisfaction of people
an impact on sexual behavior, sexual esteem (confidence
with a broad range of physical disabilities with varying
in experiencing sexuality in a satisfying and enjoyable
levels of both severity and duration. Physical disability is
way), and sexual satisfaction, at least for some individu-
defined as a condition where a person experiences signif-
als (Donelson, 1998; Nosek et al., 1996). There has been
icant deviation or loss in their body function or structure
no large-scale study that has examined a large range of sex-
that results in limitations in the physical activity (World
ual responses among people with physical disability, and
Health Organization, 2001). Some conditions that result
compared these findings to a nondisabled control group.
in physical disability, such as spinal cord injuries and mul-
There are also many practical and social barriers
tiple sclerosis, can result in difficulty achieving and main-
that impede the sexual expression of people with phys-
taining an erection, impaired vaginal lubrication, and re-
ical disabilities. For example, reduced mobility has been
reported as interfering with sexual expression in people
with physical impairments (Taleporos, 2001). Some peo-
1School of Psychology, Deakin University, Melbourne, Australia.
2
ple with physical disability may also risk spontaneous
To whom correspondence should be addressed at the School of Psy-
chology, Deakin University, 221 Burwood Highway, Burwood, Victoria
bladder and bowel emptying during sexual activity (Teal
3125, Australia; e-mail: maritam@deakin.edu.au.
& Athelstan, 1975). People with disabilities that cause
359
0004-0002/03/0800-0359/0 C 2003 Plenum Publishing Corporation

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McCabe and Taleporos
physical weakness, such as spinal muscular atrophy and
A number of studies have suggested, however, that
other neuromuscular conditions, may not have sufficient
physical disability does not have a significant impact on
motor strength to masturbate to orgasm or to sufficiently
sexual behavior. For example, White, Rintala, Hart, and
pleasure a sexual partner (Taleporos, 2001). Dependence
Fuhrer’s (1993) sample of 40 spinal cord injured women
on others for care can also seriously restrict an individual’s
revealed that 83% had engaged in physical relationships
opportunities to freely express their sexuality, because of
postinjury and 65% had within the preceding 12 months
a lack of privacy and overprotective parents or caregivers
(physical relationships did not necessarily involve inter-
(Bach & Bardach, 1997; Knight, 1983; Taleporos, 2001).
course). This figure of 65% is only slightly lower than
For those people with physical disabilities who reside in
the figure of 72% that had been reported among women
supported accommodation, social isolation and a lack of
in the general population (Smith, Hamilton, & Granger,
privacy can also present limitations in sexual expression
1990); however, spinal cord injury is an acquired disabil-
(Daniels, 1978). The impact of these social and practical
ity and these women may have already been in a sexual
barriers to sexual expression and sexual esteem requires
relationship prior to the injury. It may therefore not be
further investigation.
necessary for them to establish a new sexual relationship
A number of studies have suggested that people with
after becoming physically disabled.
physical disabilities have more limited sexual and roman-
Despite some conflicting findings, the weight of ev-
tic lives. For example, MacDougall and Morin’s survey of
idence indicates that it is likely that the sexual behavior,
the sexual attitudes and self-reported behavior of 45 con-
sexual esteem, and sexual satisfaction of people with phys-
genitally disabled adults revealed that nearly all of the par-
ical disability will be limited. Some authors have argued
ticipants were unmarried (MacDougall & Morin, 1979).
that physical disability poses more difficulties for the sex-
Further, nearly half of the participants had never had an
ual adjustment of men, highlighting how the loss of ability
intimate sexual experience with another person. Rintala
for a “normal” sexual performance can have a devastat-
et al. (1997) also found that women with physical disabil-
ing, emasculating effect because of the strong association
ities were less satisfied than were an able-bodied control
between masculinity and sexual performance (Drench,
group with their dating frequency, they perceived more
1992; Erikson & Erikson, 1992; Teal & Athelstan, 1975;
constraints in attracting partners, and they also perceived
Tepper, 1997, 1999). Other authors have highlighted the
more societal and personal barriers to their dating. Nosek
difficulties that are specific to disabled women. Tilley
et al. (1996) found that although severity of disability was
(1996) emphasized the pressure that women experience
not significantly related to level of sexual activity, women
to have the “perfect” body and to fit into their gender role,
with physical disabilities had lower levels of sexual ac-
which is “ . . . defined by a traditional, heterosexual mar-
tivity and sexual satisfaction compared to women without
riage complete with children and probably a job” (p. 140).
disabilities.
Chenoweth (1993) concluded that women with disabilities
Research
by
Taleporos
and
McCabe
(2001)
face a “double strike”: being a woman and being disabled.
suggested that people with physical disabilities struggled
This study aimed to investigate aspects of the sexu-
with many social and sexual barriers that were associated
ality of people with physical disability. The novel aspects
with having a physical impairment. This appeared to lead
of this study were that it included people with a range of
to lower sexual esteem in may participants. Donelson’s
disabilities, a large sample was recruited to participate, it
study of spinal cord injured people found that partici-
included a comparative group of nondisabled respondents,
pants with a more severe injury were more likely to have
it investigated the role of severity and duration of disability
lower levels of sexual esteem (Donelson, 1998). Similarly,
on sexuality, it examined the responses of both men and
Silvers (1997) found that people with disabilities reported
women, and it examined a broad range of sexual behav-
lower sexual esteem and higher sexual depression (nega-
iors. It was predicted that participants with more severe
tive mood state due to sexual functioning) than persons
physical disabilities (both in terms of self-rated severity
without disabilities. Physical disability appears to lead
as well as functional abilities), would have less frequent
to increased feelings of negativity in many individuals,
sexual activity and lower levels of sexual esteem and sex-
including a belief that they are less sexually desirable
ual satisfaction. It was further predicted that people who
than an able-bodied person and that having a disabil-
had experienced their impairment for a longer period of
ity seriously limits their sexual expression (Taleporos,
time would have adjusted to the associated barriers and so
2001; Taleporos & McCabe, 2001, 2002a). Mona,
would report higher levels of sexual esteem and sexual sat-
Gardos, and Brown (1994) suggested that sexual
isfaction and lower levels of sexual depression, although
esteem warranted special attention in people with
their sexual frequency was expected to be the same as par-
disabilities.
ticipants who had experienced their disability for a shorter

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period of time. Comparison was made with an able-bodied
“Sexuality and Disability Research.” A short message was
population of men and women, and it was predicted that
posted to these lists explaining the nature of the research
people with physical disabilities would demonstrate lower
and directing readers to the plain language statement and
levels of sexual esteem, sexual satisfaction, and sexual ac-
the online survey. This message was subsequently posted
tivity but higher levels of sexual depression, than people
in other areas of the World Wide Web, including disability-
who were able-bodied.
related
“Yahoo!
Clubs,”
and
disability-related
websites, such as “Cando.com” and “Disabled Persons
International.
METHOD
The survey for people without disabilities was
launched several months later. The website was posted on
Participants
the same disability related lists, clubs, and bulletin boards
mentioned above and readers were asked to pass the in-
Participants were recruited from the International
formation on to their able-bodied friends and colleagues.
Conference on Sexuality, Disability, and Culture held in
A printed version of the survey was also publicized and
San Francisco (n = 35 people with physical disability,
made available.
n = 11 people without a physical disability) and over the
Internet by accessing several disability sites (n = 713 peo-
Demographic Variables
ple with a physical disability, n = 437 people without
a physical disability). A total of 1,196 participants took
Demographic questions sought information on the
part in this study, with a mean age of 36.39 years (SD =
participants’ gender, age, relationship status, sexual ori-
10.41; range 18–69). There were 748 participants (367
entation, country of origin, and level of education. The
men, 381 women) who identified as having a physical dis-
questionnaire for people with disabilities also asked what
ability and 448 participants (171 men, 277 women) who
the participants’disability was called.
identified as not having a physical disability.
Sexual Variables
Procedure and Measures
1. Sexual esteem and sexual depression were measured
Participants completed an anonymous and confiden-
with a short form of the Sexual Esteem and Sexual
tial questionnaire. The questionnaire took between 10 and
Depression subscales in Snell and Papini’s (Snell &
30 min to complete. The online version was completed and
Papini, 1989) Multidimensional Sexual Self-Concept
returned online, and the printed version was returned in a
Questionnaire (Wiederman & Allgeier, 1993). The sub-
reply paid envelope. People without disability completed
scales contained five items each and participants were
the sections on demographic characteristics and scales 1–
asked to respond on a 5-point Likert scale from (1)
3 from the sexual variables. People with physical disabil-
strongly agree to (5) strongly disagree. Examples of
ity completed these measures as well as scales 4 and 5
items in the two subscales are “I derive a sense of self-
from the sexual variables and the measures of physical
pride from the way I handle my own sexual needs and
disability.
desires” for the Sexual Esteem subscale, and “I am de-
The printed version of the disability survey was
pressed about the sexual aspects of my life” for the
launched in San Francisco at the International Conference
Sexual Depression subscale. Snell (1998) reported an
on Sexuality, Disability, and Culture in 2000 via an audio-
α of .78 for the Sexual Esteem subscale and .72 for
visual poster presentation. This is a conference where both
the Sexual Depression subscale. This study obtained α
people with physical disability as well as able-bodied peo-
of .92 for the Sexual Esteem subscale and .87 for the
ple present research papers and personal perspectives on
Sexual Depression subscale.
issues related to sexuality and disability. Delegates at the
2. A Sexual Frequency Scale asked participants to indi-
conference were asked to take copies of the plain language
cate whether they had engaged in a list of six sexual
statement and survey to distribute them among people
activities on a 5-point scale (never, one time, 2–5 times,
with disabilities and disability organizations in their local
6–20 times, or 20+ times) over the past 6 months.
area.
Scores for each item ranged from 1 to 5. The items
The online version of the disability survey was dis-
fell into either the “solo” category (masturbation by
tributed via several disability-related e-mail lists. They
yourself, viewing erotic movies/magazines) or “mutual
included “OZADVOCACY,” “Disability Research,” and
sexual activity” category (deep kissing, nude cuddling,

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McCabe and Taleporos
oral sex, sexual intercourse) and separate totals were
3. Duration of disability was measured using a question
obtained for both of these categories.
that asked: “For how long has your disability interfered
3. Sexual satisfaction was measured using a single item
with your ability to walk?” Responses were made on a
that asked, “Looking back over the past 6 months, how
6-point scale with the following options: My disability
sexually satisfied do you feel overall?” The possible
does not affect my ability to walk; Less than a year; 1–3
responses ranged from 1 (extremely dissatisfied) to 5
years; 4–10 years; 11–18 years; and over 19 years. All
(extremely satisfied).
respondents who chose My disability does not affect
4. Physical disability specific attractiveness to others was
my ability to walk were removed from the analysis and
measured using the relevant subscale of the Physical
the remaining responses were merged into one of two
Disability Sexual and Body Esteem (PDSBE) scale that
groups, those who had experienced their physical dis-
contained three items with a 5-point Likert scale from 1
ability for more than 10 years (n = 434) and those who
(strongly agree) to 5 (strongly disagree) (Taleporos &
had experienced their physical disability for 10 years
McCabe, 2002b). The subscale’s internal consistency
or less (n = 224).
in this study was .80. The scale has been subject to
exploratory and confirmatory factor analysis and has a
test–retest score of .78 (Taleporos & McCabe, 2002b).
RESULTS
An example of a scale item is “It is hard to find a sexual
partner when you have a disability.”
The demographic characteristics of the sample are
5. Physical disability specific sexual esteem was mea-
summarized in Table I. The two groups of participants
sured using the relevant subscale of the PDSBE scale
evidenced some differences in their demographic char-
that contained four items with a 5-point Likert scale
acteristics. Chi-square tests were calculated to determine
ranging from 1 (strongly agree) to 5 (strongly disagree)
differences between the disabled and nondisabled group.
(Taleporos & McCabe, 2002b). An example of a scale
These results showed significant differences in the rela-
item is “I envy people with ‘normal’ bodies.” The sub-
tionship status (χ2 = 53.47, p < .001) and educational
scale’s internal consistency in this study was .81. The
levels (χ2 = 116.10, p < .001) of the two groups. The
scale has been subject to both exploratory and confir-
sample with physical disability had more single people
matory factor analyses and has a test–retest score of
and had less formal education. Thus, these two variables
.80 (Taleporos & McCabe, 2002b).
were included as covariates in subsequent MANCOVA
analyses. The physical disability group was also domi-
Disability Variables
nated by people from the United States, whereas the sam-
ple without physical disability had a larger proportion of
1. Severity of disability was measured subjectively by a
Australians. The two samples were similar in age (see
question that asked participants “How severe is your
Table I).
disability?” Responses were reported on a 3-point scale
The nature, duration, and severity of physical disabil-
with the following options: mild, moderate, and severe,
ity are summarized in Table II. The most common type of
and responses to this scale allowed respondents to be
physical disability in this sample was spinal cord injury.
classified as mild (n = 135), moderate (n = 389), or
Most of the respondents had experienced their disability
severely (n = 224) disabled.
for more than 18 years, and there was a broad spread of
2. Severity of disability was measured objectively by a
the severity of the disability from mild to severe.
measure that asked participants “In the previous 2 days,
Table III shows the five measures of sexual behavior
please indicate if you were “able” or “not able” to
as a function of sex and disability status (none, mild, mod-
complete the following tasks without assistance.” The
erate, severe). A 2 (sex) × 4 (disability status) MANCOVA
tasks were: getting dressed; brushing teeth; bathing/
(with relationship status and education as covariates) re-
showering; and getting out of bed. The need for assis-
vealed main effects for sex,
F (5, 1108) = 24.26,
tance was defined as low if participants did not require
p < .001, and disability, F(15, 3330) = 9.06, p < .001.
assistance with any of these tasks, and 62% (n = 460)
The interaction effect for severity of disability and sex was
fitted this category. The need for assistance was de-
not significant, F (15, 3330) < 1.
fined as high if participants required assistance with
Univariate tests showed that there was a significant
one or more of these tasks, and 37% (n = 274)
effect of disability on sexual esteem, F (3, 1112) = 35.63,
fitted this category. A number of respondents 1%
p < .001, sexual satisfaction, F(3, 1112) = 41.85, p <
(n = 14) did not provide information on these
.001, sexual depression, F(3, 1112) = 56.54, p < .001,
questions.
mutual sexual activity, F (3, 1112) = 29.69, p < .001, and

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Table I.
Demographic Characteristics of Disabled and Control
Table II. Nature, Duration, and Severity of Disability
Population
(n = 748)
Disabled group Control group
Number
%
(n = 748)
(n = 448)
Nature of physical disability
n
%
n
%
Spinal cord injury
172
23
Cerebral palsy
90
12
Gender
Acquired brain injury
90
12
Male
367
49 171
38
Multiple sclerosis
52
7
Female
381
51 277
62
Spina bifida
52
7
Age
Spinal muscular atrophy
45
6
Mean (SD; range)
37.73
35.83
Muscular dystrophy
37
5
(10.34, 18–69) (10.49, 18–64)
Amputation
37
5
Partner status
Polio myetitis
30
4
No partner
351
47 134
30
Achondroplasia
30
4
Partner lived separately
120
16
81
18
Arthrogryposis
22
3
Defacto
75
10
99
22
Osteogenesis imperfecta
15
2
Married
202
27 134
30
Arthritis
15
2
Sexual orientation
Filromyalia
7
1
Exclusively heterosexual
531
71 269
60
Duration of physical disability
Mainly heterosexual
97
13
81
18
Not affected ability to walk
90
12
Bisexual
45
6
31
7
<1 year
15
2
Mainly homosexual
30
4
18
4
Between 1 and 3 years
75
10
Exclusively homosexual
45
6
49
11
Between 4 and 10 years
135
18
Place of residence
Between 11 and 18 years
97
13
United States of America
553
74 166
37
>18 years
336
45
Australia
75
10 175
39
United Kingdom
45
6
54
12
Severe
224
30
Canada
45
6
27
6
Moderate
389
52
New Zealand
15
2
13
3
Mild
135
18
Other
15
2
13
3
Assistance to dress
224
30
Education
Assistance to bathe
239
32
Completed graduate studies
120
16 183
41
Assistance to get out of bed
195
26
Completed University degree
262
35 139
31
Assistance to brush teeth
90
12
Completed secondary school
321
43
93
21
No completed secondary school
45
6
13
3
and solo sexual activity, F (1, 1112) = 98.54, p < .001.
solo sexual activity, F (3, 1112) = 35.63, p < .001. There
Females were significantly more sexually satisfied than
were significant differences between none (no disability)
males, had significantly more frequent mutual sexual ac-
and the mild, moderate, and severe groups for all vari-
tivity but less frequent solo sexual activity.
ables except solo sexual activity, with the disabled groups
In order to determine the magnitude of the effects
demonstrating lower levels of sexual esteem, sexual sat-
outlined in the analyses above, effect sizes (Cohen’s d)
isfaction, and mutual sexual activity, but higher levels of
were calculated to compare the nondisabled group with
sexual depression. The mild and severe groups were also
each of the disabled groups, as well as comparing the
significantly different on all measures except solo sexual
disabled groups with each other, on each of the sexual
activity, with the severe group obtaining lower scores on
variables (see Table IV). There were large effect sizes
sexual esteem, sexual satisfaction, and mutual sexual ac-
between no disability and each of the disability groups in
tivity, and higher scores on sexual depression. The mild
sexual esteem, sexual depression, sexual satisfaction, and
and moderate groups were significantly different on mu-
mutual sexual activity, but not solo sexual activity.
tual sexual activity and sexual satisfaction, with the mod-
Participants with physical activity were divided into
erate group obtaining lower scores on both mutual sexual
two groups using an objective measure of disability. The
activity and sexual satisfaction.
group with a high need for assistance (n = 274) could not
The univariate tests also revealed sex differences in
perform one or more of four daily tasks (getting dressed,
levels of sexual satisfaction, F (1, 1112) = 4.12, p <
brushing teeth, showering/bathing, or getting out of bed)
.05, mutual sexual activity, F(1, 1112) = 8.16, p < .01,
while the group labeled as having a low need for assistance

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Table III. Mean Scores for Sexual Esteem, Sexual Depression, Sexual Satisfaction, and the Frequency of Sexual
Behaviour by Severity of Disability
Severity of disability
None
Mild
Moderate
Severe
Total
Sexual esteem
Male
20.08 (3.78)
17.53 (5.45)
16.79 (4.83)
16.36 (5.64)
17.84 (5.04)
Female
19.50 (4.24)
17.85 (4.73)
16.97 (5.54)
15.35 (5.88)
17.90 (5.21)
Total
19.72a (4.08)
17.72bc (5.02)
16.89b (5.21)
15.91bd (5.76)
17.87 (5.13)
Sexual depression
Male
11.95 (4.97)
15.17 (5.86)
16.69 (5.40)
17.41 (5.68)
15.13 (5.84)
Female
11.95 (4.93)
14.39 (5.72)
15.58 (5.78)
16.77 (5.92)
14.07 (5.77)
Total
11.95a (4.94)
14.72bc (5.77)
16.10b (5.62)
17.12bd (5.79)
14.54 (5.82)
Sexual satisfaction
Male
4.68 (1.65)
3.87 (2.06)
3.24 (1.94)
3.03 (2.06)
3.73a (2.01)
Female
4.78 (1.75)
4.22 (2.19)
3.69 (2.03)
3.35 (2.12)
4.16b (2.03)
Total
4.74a (1.71)
4.07bce (2.13)
3.48bf (2.00)
3.18bd (2.09)
3.97 (2.03)
Mutual sexual activity
Male
10.56 (5.21)
7.89 (6.27)
6.17 (5.76)
6.79 (5.86)
7.91a (5.96)
Female
10.60 (5.29)
9.68 (5.82)
8.22 (5.73)
6.98 (5.94)
9.21b (5.75)
Total
10.58a (5.25)
8.91bce (6.06)
7.26bf (5.83)
6.87bd (5.88)
8.63 (5.88)
Solo sexual activity
Male
5.54 (2.28)
5.29 (2.80)
5.18 (2.52)
4.36 (2.57)
5.12a (2.52)
Female
3.61 (2.09)
3.82 (2.44)
3.21 (2.50)
2.87 (2.67)
3.40b (2.37)
Total
4.35 (2.36)
4.44 (2.69)
4.12 (2.69)
3.70 (2.71)
4.16 (2.58)
Note. The superscripts indicate the groups that are significantly different from one another. Values represent mean
(SD).
could perform all of these tasks (n = 460). Table V shows
cific sexual esteem, and the frequency of mutual and solo
the means and SDs for the two groups on sexual esteem,
sexual behavior.
sexual depression, sexual satisfaction, physical disability
A 2 (sex) × 2 (disability level) MANOVA revealed
specific attractiveness to others, physical disability spe-
main effects for sex, F (7, 660) = 16.54, p < .001, and
Table IV. Effect Sizes for Contrasts Between Different Levels of Disability and Sexual Variables
Contrasts between different levels of disability
Sexuality variables
None/mild
None/moderate
None/severe
Mild/moderate
Mild/severe
Moderate/severe
Sexual esteem
Male
0.67
0.87
0.98
0.15
0.24
0.14
Female
0.39
0.60
0.98
0.17
0.45
0.16
Total
0.49
0.70
0.93
0.16
0.35
0.15
Sexual depression
Male
0.65
0.95
1.10
0.27
0.41
−0.28
Female
0.50
0.74
0.98
0.20
0.41
−0.20
Total
0.56
0.84
1.05
0.24
0.43
−0.24
Sexual satisfaction
Male
0.49
0.87
1.00
0.32
0.43
0.32
Female
0.32
0.62
0.81
0.25
0.42
0.26
Total
0.39
0.74
0.92
0.29
0.45
0.29
Mutual sexual activity
Male
0.51
0.84
0.72
0.29
0.19
0.30
Female
0.17
0.45
0.68
0.25
0.47
0.25
Total
0.32
0.63
0.71
0.28
0.35
0.28
Solo sexual activity
Male
0.11
0.16
0.52
0.04
0.37
0.05
Female
0.10
0.19
0.36
0.24
0.38
0.24
Total
0.04
0.10
0.28
0.12
0.27
0.12

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Table V. Mean Scores for Sexual Esteem, Sexual Depression, Sexual Satisfaction, and the Frequency of Behavior by Objective Level of Disability
and Years Since Onset
Need for disability
Onset
Low (n = 460) High (n = 274) Total (n = 734) ≤10 Years (n = 224) >10 Years (n = 434)
Total (n = 748)
Sexual esteem
(range: 5–25)
Male
17.25 (5.01)
15.82(5.44)
16.69 (5.22)
16.59 (5.18)
16.59 (5.19)
16.59 (5.18)
Female
17.46 (5.41)
15.25 (5.50)
16.68 (5.54)
15.81 (5.88)
16.98 (5.40)
16.52 (5.62)
Total
17.36 (5.22)
15.54 (5.47)
16.69 (5.38)
16.15 (5.59)
16.77 (5.29)
16.56 (5.40)
Sexual depression
(range: 5–25)
Male
16.23 (5.43)
17.43 (5.68)
16.70 (5.55)
16.97 (5.56)
16.79 (5.63)
16.84 (5.60)
Female
15.05 (5.68)
16.75 (6.06)
15.64 (5.86)
17.07 (5.38)
15.14 (6.06)
15.89 (5.87)
Total
15.60 (5.59)
17.10 (5.87)
16.15 (5.73)
17.03 (5.45)
16.00 (5.89)
16.36 (5.76)
Sexual satisfaction
(range: 1–5)
Male
3.36 (1.95)
3.11 (2.07)
3.26 (2.00)
3.11 (2.08)
3.27 (1.99)
3.22 (2.02)
Female
3.92 (2.07)
3.28 (2.09)
3.69 (2.10)
3.22 (2.00)
3.87 (2.14)
3.62 (2.11)
Total
3.65 (2.03)
3.19 (2.08)
3.48 (2.06)
3.17 (2.03)
3.55 (2.08)
3.42 (2.07)
Mutual sexual activity
(range 3–15)
Male
7.30 (6.03)
5.67 (5.58)
6.66 (5.90)
6.56 (6.03)
6.34 (5.81)
6.41 (5.87)
Female
8.82 (5.76)
6.98 (5.95)
8.16 (5.89)
7.93 (5.66)
7.89 (6.03)
7.91 (5.89)
Total
8.10 (5.93)
6.31 (5.79)
7.43 (5.94)
7.31 (5.86)
7.08 (5.96)
7.16 (5.92)
Solo sexual activity
(range: 2–10)
Male
5.05 (2.62)
4.68 (2.55)
4.90 (2.60)
4.37 (2.61)
4.96 (2.59)
4.78 (2.60)
Female
3.40 (2.54)
2.98 (2.50)
3.25 (2.53)
2.97 (2.50)
3.27 (2.58)
3.15 (2.55)
Total
4.18 (2.70)
3.85 (2.66)
4.06 (2.69)
3.59 (2.63)
4.15 (2.71)
3.96 (2.70)
PDSBE sexual esteem
(range: 4–20)
Male
10.79 (4.55)
9.55 (4.21)
10.30 (4.45)
9.24 (4.48)
10.41 (4.26)
10.05 (4.36)
Female
12.44 (4.61)
10.39 (4.82)
11.70 (4.78)
10.55 (4.43)
11.94 (4.74)
11.41 (4.66)
Total
11.66 (4.65)
9.96 (4.53)
11.02 (4.67)
9.97 (4.49)
11.13 (4.55)
10.73 (4.56)
PDSBE attractiveness to
others (range: 3–15)
Male
6.44 (2.98)
5.76 (3.10)
6.17 (3.04)
6.39 (3.04)
6.01 (3.13)
6.13 (3.10)
Female
7.62 (3.34)
6.50 (2.95)
7.22 (3.25)
7.30 (3.15)
6.82 (3.20)
7.01 (3.18)
Total
7.06 (3.23)
6.12 (3.05)
6.71 (3.19)
6.90 (3.13)
6.40 (3.18)
6.57 (3.17)
disability level, F (7, 660) = 5.44, p < .001. The interac-
The univariate tests also showed significant sex dif-
tion effect between sex and disability level was not signif-
ferences in levels of sexual depression, F (1, 666) = 3.92,
icant, F (7, 660) < 1. Univariate tests showed that there
p < .05, sexual satisfaction, F(1,666) = 5.19, p < .05,
was a significant effect of disability on sexual esteem,
physical disability specific sexual esteem, F (1, 666) =
F (1, 666) = 20.63, p < .001, sexual satisfaction, F(1,
10.15,
p < .01, perceived attractiveness to others,
666) = 6.68, p < .01, physical disability specific sexual
F (1, 666) = 12.67, p < .001, mutual sexual activity, F(1,
esteem, F (1, 666) = 21.21, p < .001, physical disability
666) = 12.36, p < .001, and solo sexual activity, F(1,
specific perceived attractiveness to others, F (1, 666) =
666) = 68.79, p < .001. Men had significantly higher
13.87, p < .001, sexual depression, F(1, 666) = 11.07,
levels of sexual depression, and significantly lower levels
p < .001, and mutual sexual activity, F(1, 666) = 16.10,
of sexual satisfaction, physical disability, specific sexual
p < .001. Participants who needed assistance with at least
esteem, and perceived attractiveness to others. In contrast,
one daily task reported significantly lower levels of sex-
females had significantly more frequent mutual sexual ac-
ual esteem, sexual satisfaction, physical disability specific
tivity but less frequent solo sexual activity.
sexual esteem, physical disability specific perceived at-
Mean scores on the sexual variables were compared
tractiveness to others, higher levels of sexual depression,
between participants who had experienced difficulty walk-
and less frequent mutual sexual activity.
ing for 10 years or less and those who had experienced

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McCabe and Taleporos
difficulty walking for more than 10 years. The period of
ipants who had experienced their disability for 10 years or
10 years was chosen, as this would seem to be an ade-
less, a higher percentage (67%) fell into the low support
quate length of time after the onset of the disability for
category compared to 54% of people falling into the low
the person to have acknowledged the fact that they have a
support category who had their disability for more than
disability.
10 years. A significant chi-square goodness-of-fit statistic
Table V shows the means and SDs for the two groups.
was computed, χ2 = 10.41, p < .001.
A 2 (sex) × 2 (disability duration) MANOVA, with age
To examine the relationship between sexual satisfac-
covaried, revealed main effects for sex, F (7, 587) = 13.32,
tion and the frequency of deep kissing, nude cuddling, sex-
p < .001, and disability duration, F(7, 587) = 6.16, p <
ual intercourse, viewing erotic movies or magazines, and
.001. The interaction effect between sex and disability
lone masturbation in men and women with physical dis-
duration was not significant, F (7, 587) < 1.
abilities, these behaviors were entered into separate mul-
Univariate tests revealed that there was a significant
tiple regression equations for both men and women with
effect
of
disability
duration
on
sexual
esteem,
physical disabilities, with sexual satisfaction as the de-
F (1,
593)
= 4.02, p < .05, sexual satisfaction,
pendent variable. In men, F (6, 348) = 31.41, p < .001,
F (1, 593) = 5.98, p < .01, physical disability specific
with 35% of the variance in sexual satisfaction being pre-
sexual esteem, F (1, 593) = 10.62, p < .001, sexual de-
dicted by the frequency of these sexual behaviors. How-
pression, F (1, 593) = 5.09, p < .05, physical disability
ever, only three of these behaviors were significant pre-
specific perceived attractiveness to others, F (1, 593) =
dictors of sexual satisfaction. The frequency of oral
3.82, p < .05, and solo sexual activity, F(1, 593) = 4.08,
sex was the strongest predictor of sexual satisfaction,
p < .05. Participants who had experienced difficulty
β = .28 (p < .001), followed by nude cuddling,
walking for more than 10 years had significantly higher
β = .22 (p < .05), and viewing erotica, β = −.15 (p <
levels of sexual esteem, sexual satisfaction, physical dis-
.01). In women, F(6, 357) = 31.19, p < .001, with 34%
ability, specific sexual esteem, and more frequent solo
of the variance in sexual satisfaction being predicted by
sexual activity and significantly lower levels of sexual
the frequency of these sexual behaviors. However, only
depression and of physical disability specific perceived
deep kissing was a significant predictor of women’s sex-
attractiveness to others.
ual satisfaction, β = .24 ( p < .001).
The univariate tests also showed a significant sex dif-
In order to determine the relative contribution of dis-
ference in levels of mutual sexual activity, F (1, 593) =
ability on sexual response, a composite measure of sexual
8.89, p < .05, solo sexual activity, F(1, 593) = 25.68,
functioning was created for the physically disabled group.
p < .001, physical disability specific sexual esteem, F(1,
This involved converting scores on all the measures of
593) = 12.21, p < .001, and physical disability specific
sexual functioning for the physically disabled group (sex-
perceived attractiveness to others, F (1, 593) = 6.81, p <
ual esteem, sexual depression, sexual satisfaction, mutual
.01. Females demonstrated significantly more frequent
sexual activity, solo sexual activity, PDSBE sexual es-
mutual sexual activity and less frequent solo sexual ac-
teem, PDSBE attractiveness to others) into z scores, and
tivity, but significantly higher levels of physical disability
summing these scores to obtain a total. A standard mul-
specific sexual esteem and physical disability specific per-
tiple regression analysis was then conducted, with gen-
ceived attractiveness to others.
der, perceived severity of disability, objective measure of
In order to determine if the improvement in sexual
disability severity (support needs), and age at onset of
adjustment among participants who had experienced their
disability as the independent variables, and the composite
physical disability for more than 10 years was the result
sexuality variable as the dependent variable. The results in-
of a lessening in the severity of disability, two separate
dicted that sexuality was significantly predicted by the in-
analyses were conducted. Firstly, an ANOVA was used to
dependent variables, F (4, 584) = 9.68, p < .001, R2 =
compare the mean scores on the perceived severity of the
.06. All variables contributed significant unique variance
disability for the two groups. Overall, participants who
to the composite measure of sexuality (gender, β = .09,
had experienced their disability for 10 years or less per-
p < .05; severity of disability, β = −.09, p < .05; ob-
ceived that they had a slightly less severe physical dis-
jective disability, β = −.16, p < .001; age of onset, β =
ability (M = 1.15) compared to participants who had ex-
.11, p < .01).
perienced their physical disability for more than 10 years
(M = 2.24). However, this difference was not significant,
F (1, 649) = 2.69, p > .05. Secondly, to use an objective
DISCUSSION
measure of disability severity, the percentages of people
in the high or low need for assistance categories were
The current study found that people with more severe
compared between the two duration groups. Of the partic-
physical impairments had lower levels of sexual esteem

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and sexual satisfaction and higher levels of sexual depres-
may use erotica as a sexual outlet when other, more satis-
sion than people who experienced mild impairments or the
fying outlets, are not available to them. Interestingly, the
able-bodied population. The study also found that people
frequency of sexual intercourse did not predict sexual sat-
with a severe physical disability engaged in mutual sexual
isfaction in either gender. This challenges the emphasis
activity less frequently.
placed by researchers and clinicians on the achievement
These findings support the qualitative data from pre-
of coitus (Rivas & Chancellor, 1997), and suggests that for
vious studies that have demonstrated that people with
people with physical disability, other types of sexual ac-
physical disabilities commonly believe that they are less
tivities may be more closely related to sexual satisfaction.
sexually desirable than able-bodied people and that their
These data suggest that it is important to affirm nonpene-
disability seriously limits their sexual life (Taleporos,
trative sexual behaviors as healthy and valid expressions
2001; Taleporos & McCabe, 2001, 2002a). The results are
of the individual’s or couple’s sexuality, whereas recog-
also consistent with the proposal that people with physi-
nizing that men may have a stronger need than women
cal disabilities experience difficulties in their sexual lives
for genitally focused activities such as oral sex or nude
(Bach & Bardach, 1997; Crabtree, 1997; Donelson, 1998;
cuddling.
Earle, 1999; Gill, 1996; Knight, 1983; Saad, 1997; Tepper,
Although previous studies have discussed the dif-
1997). In the present study, both high subjective and ob-
ficulties of sexual adjustment at the onset of physical
jective measures of disability predicted low levels of sexu-
disability (Alexander, Sipski, & Findley, 1993; Drench,
ality among the disabled population. Low levels of sexual
1992), this study demonstrated that people who had ex-
esteem and low sexual satisfaction in people with severe
perienced their physical impairment for a longer period
physical disabilities are also consistent with the previous
of time reported more positive feelings about their sex-
studies that have found that the romantic lives of people
uality, even though their physical impairment may have
with physical disabilities were limited or less active than
become more severe. In fact, the regression analysis that
those of able-bodied people (MacDougall & Morin, 1979;
examined the impact of the disability measures on a com-
Nosek et al., 1996; Page et al., 1987; Rintala et al., 1997;
posite measure of sexuality demonstrated that the longer
Romeo, Wanlass, & Arenas, 1993), although their sexual
the person had experienced the disability, the more posi-
needs were high (McCabe, Cummins, & Deeks, 2000).
tive their level of sexuality. It would appear that there is
The current study did not separate the participants
an adjustment process that takes place as people accept
with physical disability into different disability groups,
and overcome the new sexual barriers that are put before
but instead examined the sexuality of respondents accord-
them. It is possible that during this time individuals meet
ing to both subjective and objective levels of functional
sexual partners who accept their physical difference, and
impairment. It was anticipated that this would provide a
that this sense of acceptance is subsequently internalized
more meaningful and accurate representation of the sexu-
by the person with the physical disability. They may also
ality of people with physical disability, since people with
learn to express and experience their sexuality in a more
the same disability (e.g., multiple sclerosis, cerebral palsy)
enjoyable way by learning new techniques that are suited
can vary substantially in their level of impairment. How-
to their physical limitations.
ever, future studies should also include an analysis of the
A novel aspect of this study was the use of the Internet
effect of different types of physical impairment (e.g., mo-
to obtain the sample and administer the survey. A positive
bility, congenital vs. acquired disability) on sexuality.
outcome of this was a large sample from across the English
Women reported more mutual sexual experiences,
speaking world. The success in obtaining such a broad-
higher sexual satisfaction, higher perceived attractiveness
based sample would suggest that the World Wide Web is
to others, higher sexual esteem, and lower levels of sexual
an efficient and effective tool for conducting research on
depression than their male counterparts. These empirical
people with physical disabilities. It is especially useful in
data support the assertions of Drench (1992), who stated
surveying participants with severe physical impairments
that sexual adjustment is easier for women because they
who are unable to complete a paper and pencil test or who
traditionally place more emphasis on interpersonal aspects
would find this physically taxing. Clearly, there may be
of sexuality, such as tenderness and emotional sharing, and
some biases with a sample dominated by Internet users,
so less focus is directed to their genital function. We found
and so it is essential to also publicize and provide a printed
that oral sex and nude cuddling appeared to be more impor-
version of the survey. However, as Internet technology
tant to men with physical disabilities, whereas deep kissing
becomes more widely available, this limitation will be
was more important to women, indicating that men were
less relevant.
more focused on genitally focused activity than women.
There may also have been some bias in the respon-
Furthermore, since the viewing of erotica was related to
dents who were drawn from the International Conferences
sexual dissatisfaction in men, it would appear that men
on Sexuality, Disability, and Culture, as these respondents

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McCabe and Taleporos
may be more vocal and active in their defense of the rights
MacDougall, J., & Morin, S. (1979). Sexual attitudes and self-reported
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