Sexual Problems and Attitudes Toward the Sexuality of Persons With ...

Sexuality and Disability, Vol. 20, No. 2, Summer 2002 ( 2002)
Sexual Problems and Attitudes Toward
the Sexuality of Persons With and Without
Disabilities in Thailand
Tavee Cheausuwantavee, M.Sc.1,2
The purposes of this descriptive study are to survey and compare the following
criteria: estimated prevalence of sexual problems, the development of love, and
attitudes toward sexuality between persons with and without disabilities. The
sample was 25 persons with disabilities and 76 persons without disabilities.
The questionnaires consisted of 35 questions and were distributed to the sam-
ple. Research results showed that sexual problems occurred in 36% of persons
with disabilities and in 12% of persons without. Both samples were not signifi-
cantly different as to the kinds of love they want. In contrast, both samples are
significantly different in their consideration for selecting lovers. Most attitudes
toward sexuality between persons with and without disabilities were not signifi-
cantly different. This is a good sign since it implies that there are more oppor-
tunities and possibilities for persons with and without disabilities to establish
love, to form attachment, and to marry if sexual education and appropriate
sexual communication are facilitated.
KEY WORDS: sexuality; attitude; disability; Thailand.
INTRODUCTION
Sexuality is an important part of being a human being. Psychoanalysts
such as Sigmund Freud viewed libido, or sexual energy, as the energy of all the
life instincts that serve the purpose of the survival of the individual and the
human race, growth, development and creativity (1). However, it’s not easy to
express as overt behaviors due to limitation and boundary of one’s own cultural
1Rehabilitation Counseling Program, Ratchasuda College, Mahidol University, Thailand.
2Address correspondence to: Tavee Cheausuwantavee, M.Sc., Ratchasuda College, Mahidol Univer-
sity, 4th Puthamonthon Road, Salaya, Puthamonthon, Nakornpatom Province, Thailand, 73170;
e-mail: tavee126
hotmail.com.
125
0146-1044/02/0600-0125/0
2002 Human Sciences Press, Inc.

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Cheausuwantavee
and moral dimensions. Particularly, the more sexuality comes up with disability,
the more sexuality cannot be expressed and more concerned (2,3). In general,
sexuality is still a taboo subject (4), and disability is an asexuality (4,5). Fur-
thermore, some researchers and writers say that sexuality and sexual needs are
dangerous and masculinity symbols of men, leading to sexual hazard and sexual
abuse to women and disabled persons (6).
If society and culture deny sexuality for persons with disabilities as a basic
right of expression, then the perceptions of persons with disabilities as non-
sexual can present a barrier to safe sex education—both for workers who may
be influenced by these views and for persons with disabilities themselves—in
terms of gaining access to information and acceptance as sexual beings. This
can lead to sexual problems, lack of sexual education, inappropriate attitudes
toward sexuality of persons with and without disabilities, making sexual prob-
lems difficult to resolve. This has taken place in Thailand, especially in persons
without disabilities. It has been reported recently that approximately 3 million
(4%) of Thai men have erectile dysfunction, but only 1% of those were treated
(7).
In many countries in Northern America and Europe, maintaining a healthy
sex life after disabilities, particularly spinal cord injury, is an important issue.
Over the past few years, much research has begun to be performed in these
areas. In the past, knowledge about the field of spinal cord injury was exclu-
sively focused on males and erectile dysfunction; treatment options were pri-
marily surgery, medication, and vacuum. Recent work has begun to illustrate
the impact of spinal cord injury on female sexuality. Moreover, recent gains in
the study of infertility after spinal cord injury have allowed professionals to
approach the care of newly injured patients with optimism for their potential in
sexual functioning (8) as well as their social, loving, and psychological con-
cerns (9).
Focusing on Thailand, the socialization process produces women who are
more submissive and less able to hold responsibility than men (10,11). The
traditional beliefs of Thai people view persons with disabilities as sinful per-
sons who should go to temple and do more positive to compensate for their sin,
and who become more sinful once they recognize sexuality. As a result, sexu-
ality must be driven from their mind. What little research regarding the sexu-
ality of persons with disabilities does exist, is generally not available. Most of
the research objectives were to survey and explore reproductive health, sexual
awareness, and styles among adolescent students and factory workers (10,11,
12). Although there was recent research to try to determine the prevalence of
sexual problems among Thai men, individuals with disabilities were excluded
(10). Therefore, the objectives of this pilot study are to survey and compare
sexual problems, knowledge, and attitudes toward sexuality between persons
with and without disabilities in order to enhance and formulate a more compre-

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Sexuality of Persons With and Without Disabilities in Thailand
127
hensive plan for preventive and progressive interventions for sexual problems
of all persons involved with these issues.
METHOD
Subjects
This pilot research was a descriptive study. Because sexuality is a sensitive
issue in Thailand, the sample had to share and ventilate their information inten-
tionally. He or she was selected by purposive sampling. The sample was partici-
pants in a one-day workshop, namely “Persons with Disabilities and Couple
Living,” conducted by The Association of Persons with Physical Disability of
Thailand, in Bangkok, Thailand. Participants were 25 persons with physical
disabilities (particularly polio and spinal cord injury) and 76 persons without
disabilities. Most of the sample worked in both public and private sectors in-
volving rehabilitation services.
Instrument
The instrument used in this study was the questionnaire constructed and
developed by the researcher relating to the above theoretical background
(13,14,15). It contained 35 questions concentrating on 3 areas:
1. general demographic information, for example, sex, age, education
level, types of their own disabilities, and their couple’s disabilities (6
questions)
2. knowledge of coping techniques for sexual problems or sexual dysfunc-
tions and perception of development of their love and attachment, for
example, consideration for selecting lovers, the kinds of love they want
(10 questions)
3. attitude toward sexuality (obtained reliability
0.75) obtained through
self-report and closed-ended questions with only agree or disagree as
possible answers (19 questions)
Procedure
The questionnaires were distributed to 120 participants during a one-day
workshop session and introduced by the workshop moderator, who had a spinal

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Cheausuwantavee
cord injury. Reinforcement was used in order to motivate the participants to
answer the questionnaires. Whenever participants completed and returned ques-
tionnaires, a label ticket was given, and they would get a reward, such as a gift
set, from researcher. Questionnaires were returned and collected from 101 par-
ticipants. The data were analyzed by using the SPSS PC 9.0 for Windows
program as frequency, percentages, and 2 test.
RESULTS
General Information
Of the 25 persons (100%) with physical disabilities, particularly polio and
spinal cord injury, 15 were women (60%), with a mean age of 31.8 years, 13
were single (50%), and 12 were married (48%). There were 7 couples (28%)
with disabilities and 5 couples (20%) without disabilities. Eighteen persons
(72%) had a secondary school (grade 12) educational level.
For 76 persons (100%) without disabilities, 66 were women (87%), with a
mean age of 35.8 years, 45 were single (59%), 31 married (41%). There were 5
couples (7%) with disabilities and 26 couples without disabilities (34%) and 14
no answer (18%).
Marital Problems, Sexual Problems, or Dysfunction and Its Solution
Of the 25 persons with disabilities, 40% had marital problems (such as the
lack of lover, inability to marry, broken family), 36% had sexual dysfunctions
including premature ejaculation, impotence, inability to control ejaculation in
vagina, and non-orgasm with intercourse. Meanwhile, only 11% of those who
had sexual dysfunction see professionals for treatment. Only 16% of persons
with disabilities had known helping resources.
Of the 76 persons without disabilities, 37% had marital problems, and 12%
had sexual dysfunctions similar to persons with disabilities. However, 32% had
known helping resources—more than persons with disabilities. However, only
11% of those who had sexual dysfunctions see professionals.
Kinds of Love and Consideration for Selecting Lovers
Both persons with disabilities and without disability were not significantly
different at 0.05 level as to the kinds of love they want (see Table 1). Intimate
love, commitment love, and the passion love were ranked first, second, and
third, respectively. In contrast, both samples were significantly different at 0.05

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Sexuality of Persons With and Without Disabilities in Thailand
129
Table 1. The Kinds of Favorite Love by Participant Status
Disability
Without Disability
(n
25)
(n
76)
Kinds of Favorite
Love**
Number
Percent
Number
Percent
Chi Sq.*
df
Passion
Yes
1
4.0
6
7.9
0.500
1
No
24
96.0
70
92.1
Intimacy
Yes
16
64.0
49
64.5
0.002
1
No
9
36.0
27
35.5
Commitment
Yes
8
32.0
16
21.1
1.244
1
No
17
68.0
60
78.9
*No significant difference at p
0.5.
**Could be chosen more than once.
in their consideration for selecting lovers; intimacy and physical attractiveness
were more emphasized by persons without disabilities than by persons with
disabilities (see Table 2). Furthermore, all consideration variables for selecting
lovers, including similarity, proximity, reciprocity, and physical attrac-
tiveness, were of less concern to persons with disabilities than to persons with-
out disabilities.
Table 2. Considerations for Selecting Lovers by Participant Status
Disability
Without Disability
(n
25)
(n
76)
Considerations for
Selecting Lovers**
Number
Percent
Number
Percent
Chi Sq.*
df
Proximity
Yes
14
13.9
61
60.4
5.058*
1
No
11
10.9
15
14.8
Similarity
Yes
21
20.8
69
68.3
0.894
1
No
4
4.0
7
6.9
Reciprocity
Yes
14
13.9
58
57.4
3.793
1
No
11
10.9
18
17.8
Physical Attractiveness
Yes
13
12.9
58
57.4
5.327*
1
No
12
11.9
18
17.8
*Significant difference at p
0.5.
**Could be chosen more than once.

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Cheausuwantavee
Attitudes Toward Sexuality
Some attitudes toward sexuality of persons with and without disabilities
were significantly different at 0.05. Attitudes concerning the right and equality
for sexual expression and openness of sexual communication were of more
concern to persons with disabilities. Sexual intercourse and its necessity to
maintain spouse attachment were of more concern to persons without disabil-
ities. As illustrated previously, however, most attitudes toward sexuality be-
tween persons with and without disabilities were not significantly different at
0.05 (see Table 3).
DISCUSSION
Based on the results of this study, sexual problems or sexual dysfunctions
and attitudes toward sexuality of persons with and without disabilities were
similar to and different from each other in variable issues. In terms of marital
Table 3. Some Attitudes Toward Sexuality Differing Between Persons
With and Without Disability
Disability
Without Disability
(n
25)
(n
76)
Attitudes Toward
Sexuality
Number
Percent
Number
Percent
Chi Sq.
df
Item 9
Agree
12
48.0
20
26.3
2.972*
1
Disagree
10
4.0
50
65.8
Item 10
Agree
6
24.0
27
35.5
0.520*
1
Disagree
16
64.0
49
64.5
Item 11
Agree
9
36.0
18
23.7
2.124*
1
Disagree
14
56.0
58
76.3
Item 12
Agree
0
0.0
46
60.5
1.850*
1
Disagree
22
88.0
70
92.1
Item 18
Agree
7
28.0
41
53.9
3.908*
1
Disagree
16
64.0
35
46.1
Notes: Items 9 and 10 are related to gender equality in sexuality. Items 11 and 12 are related to
sexual communication. Item 18 is related to effect of sexual dysfunction to couple life. The
number of participants of some items is less than 25 and 76 due to no answers.
*Significant difference at p
0.5.

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Sexuality of Persons With and Without Disabilities in Thailand
131
problems (such as the lack of lover, inability to marry, and broken family),
there were quite equal percentages in both samples (37–40%). But, sexual
problems or sexual dysfunctions occurred in quite different percentages of the
sample—36% of persons with disabilities and 12% of persons without disabil-
ities. This prevalence was higher than in the previous study, which reported that
sexual problems occurred among 4% of Thai people (7). Research methodology
may account for this different result. Further research that includes a representa-
tive sample needs to be done in order to confirm exact results. Most of the
participants who had sexual problems did not know how to cope with them
correctly. Only 1.9% of those go to see doctors or professionals. A possible
reason for this is a lack of a sexuality clinic and an inability to disclose their
sexual problems to others—even professionals. It is also an attitudinal barrier
in terms of sexual expression and sexual communication. For this reason, it is
important for professionals, including doctors, nurses, psychologists, educators,
counselors—particularly those involved in rehabilitation programs—to chal-
lenge and break down this barrier and for people with disabilities to become
trustful and comfortable with these professionals.
Persons with and without disabilities were not significantly different as to
the kinds of love they want. This result implies that love or intimacy is inte-
grated to each of us, and each human being has an unlimited potential for
sexual well being. In other words, intimacy is strongly associated with impor-
tance of quality of life of persons with disabilities (13,16). It is also supported
by “the triangle of love” (14); love is formulated integrally with passion, inti-
mate, and decision/commitment. Passion involves a state of intense longing for
union with the other and is also largely the expression of desires and needs—
such as for self-esteem, nurturance, affiliation, dominance, submission, and sex-
ual fulfillment. The intimate refers to those feelings in relationship that promote
closeness, bondedness, and connectedness. The decision/commitment consists
of two aspects, one short term and one long term: the decision to love a certain
other and the commitment to maintain that love, respectively. These two aspects
do not necessarily occur together. So, stable love must be combined appro-
priately with passion, intimate, and decision/commitment.
Persons with disabilities and those without differed significantly in their
consideration for selecting lovers. Normally, individuals know what is empha-
sized for selecting lovers. Proximity, similarity, reciprocity, and physical attrac-
tiveness are factors that influence them to become lovers. Persons with disabil-
ities are less concerned on all factors than persons without disabilities,
particularly by proximity and physical attractiveness. The next issue is why. As
discussed, there could be two reasons. First, considerations for selecting lovers
of persons with disabilities were other factors excluded above. Second, persons
with disabilities had negative attitudes toward love or marriage. Self-loving is a
basic and necessary step for individuals to establish relationship with others.

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Cheausuwantavee
Self-loving is not egocentricism, selfish, separated from colleague or parent-
hood, but it is self-awareness, maturity, self-esteem, and self-control in what-
ever he or she copes with (13). Guldin (17) said that disabled persons some-
times felt self-introjection with recognizing that their bodies did not fit the
cultural ideal. Perhaps because of this lack of self-loving and self-esteem, dis-
abled persons find it difficult to establish gratifying relationships and to love
others as a sexual being—even though they sometimes have opportunity or
financial and physical readiness to love or marry. Sexual pleasure is not only
important in making an individual feel alive, but can also enhance an intimate
relationship (21).
On attitudes toward sexuality between persons with and without disabil-
ities, each differed from the other in two issues. First, persons with disabilities
felt that having sexual intercourse was not important for their human being.
Nevertheless, they did not view it as a predictor of their own divorce problems.
Second, persons with disabilities were concerned about open sexual communi-
cation and gender equality of right to have sexual experience. Conversely, per-
sons without disabilities were less concerned with both issues. Ideally, open
sexual communication is important in promoting a relationship as well as in
understanding his or her couple’s sexual need (13); it is a good event for per-
sons with disabilities. Attitudes toward sexuality regarding gender equality of
right to have sexual experience and sexual expression, however, have been
controversial issues. Perceptions of society, tradition, moral complex, culture,
and context are routinely attributed to sexual behavior of individuals. For exam-
ple, feminist writers have frequently discussed the concept of male sexual need
and highlighted its dangerousness; they have also pointed out the way in which
this has been used to justify sexual coercion, such as rape, pornography, and
prostitution (19). Furthermore, society conventionally accepts standards of mas-
culinity as strength and independence (20) and also accepts standards of female
beauty and attractiveness. So, if individuals become disabled persons, they also
become deviant and inferior persons (21). In other words, persons with disabil-
ities, especially persons with intellectual disability, sometimes have been deter-
mined to be a sexual victim and a sexually abused group (22).
Even though persons with disabilities did not view sexuality as physical
attractiveness and sexual intercourse, they needed to express and share their
sexual behaviors and feelings to others more than did persons without disabil-
ities. This probably suggests that because of long-term sociocultural limitations
that obstruct opportunities for persons with disabilities to have sexual experi-
ences, obtain information and partake in activities (20), such limitations made
them suppress, and were therefore more likely to know about sexual informa-
tion and search for sexual intimacy than persons without disabilities (23). Since
society viewed persons with disabilities as an asexual group (4,5), it was not
necessary to let them know sexuality information. Eventually, this led to a bar-

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Sexuality of Persons With and Without Disabilities in Thailand
133
rier to safe sex education and an attitudinal gap between persons with disabil-
ities and those without, who are majority in society. This research result also
corresponded to a study by Earle (4) in which perceptions of sexuality and the
concept of sexual need between disabled persons and their personal assistants
were different. The former was sexual need, the latter was sexual want. In
addition, facilitated sex for persons with disabilities could not be accepted by
society, and it should be frankly discussed and negotiated in the future.
Despite the differences of a minority of attitudes toward sexuality between
persons with and without disabilities, the majority of such attitudes was likely
the same. Thus, it implies that if disabled persons can be educated adequately
and effectively with more sexual knowledge, and general persons in society can
accept psychological and physical differences of disabled persons, the develop-
ment of love and attachment between them will come up with and will promote
their interpersonal relations and self-assurance as well as positive self-esteem
(24,25). The percentage of those living with each other as a couple will eventu-
ally increase. Westgren and Livi (26) also recommended that a positive attitude
toward sexuality and good communicative skills seem to be of particular impor-
tance for a favorable outcome of sexual rehabilitation. Many researchers recom-
mended that it was necessary for professionals to assist persons with disabilities
to break down barriers of society attitude and express appropriate sexual behav-
iors as well as have access to sexual knowledge (27,28,29). Further studies
need to determine the prevalence of sexual problems of persons with and with-
out disabilities, based on representative participants as to their number and
types of disabilities. The present study results, however, may be useful in strat-
egy planning in order to cope with current sexual problems, enhance appropri-
ate attitudes, and change inappropriate attitudes toward sexuality of such partic-
ipants as rehabilitation workers, especially rehabilitation counselors in
Thailand.
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