Disability and sexuality: making space for a private conversation
What About Sex?
By Victoria Chipperfield · Originally published 22 July 2015
Original article
Victoria Chipperfield trained and worked as a nurse for fifteen years, later completing qualifications in community work and working as an advocate and case manager.
When I first offered to write this piece for Clickability I had all sorts of ideas – sex and sexuality are big topics!
I hope this will open up real conversations for people with disabilities, partners, carers and workers in the sector.
Working as a case manager several years ago, I was approached by a young woman’s parents about her behaviour. They recognised that she was sexually frustrated and it was becoming an issue for her male friends who felt overwhelmed by her advances.
I remember feeling annoyed. I was working so hard on trying to secure funding for “Important Things, Immediate Things” like therapy, transport, rehabilitation and an air conditioner. There were report deadlines to meet, funding submissions to write and meetings to organise. Besides, I had no idea what they thought I could do about it!
Sure, I’d organised funding for male clients to access “Personal Massages” (sex workers) on a regular basis. I had even dropped off the fee to the brothel prior to the service, so it wasn’t that I had any issues around sexuality but I had no idea if a similar service existed for women or even if it was appropriate. Sexual issues for women were only ever discussed in terms of risk as they were perceived as vulnerable to abuse and to be protected.
[Clickability update, October 2026:
The current NDIS support rules exclude sexual services and sex work. This historical account is not permission to claim those costs from a plan.
]
Terms such as “inappropriate sexualised behaviours” and “behaviours of concern” required extensive behavioural or systems intervention and the issues addressed “deviant or perverse behaviours”.
These attitudes probably shouldn’t be surprising really. There is no mention of the reproductive system in any of the intake or rehabilitation review documents used by workers and certainly no inclusion of sex and sexuality!
This now seems quite shocking.
In purely medical terms the exclusion of the reproductive system has significant issues for basic and important health aspects for women such as menstruation, pap smears and breast checks and, for men, prostate screening.
Unintentionally, it also diminishes people with support needs or a disability to being “asexual”.
For people who acquire a disability while in relationships, the lack of discussion on sexuality has an impact on the person and their partner. Often the partner is retagged as a “Carer” and is also expected to relinquish any personal needs and become “Asexual”.
All of this is, of course, nonsense.
Decades ago working in residential care, I had been well aware of young men with Cerebral Palsy picking up women at the local pub and bringing them back to their unit for the night. We also provided support to a married couple with Cerebral Palsy (yes, they shared a unit, a bed and were sexually active).
So how did sex and sexuality become such an issue for people with disabilities, partners and workers? More importantly, how do we change it?
Undoubtedly concerns around legal liability and duty of care have played a part as Australian society become more litigious. Reported cases of people with disabilities being sexually assaulted by workers has added to organisation’s conservative policies.
While these issues must be addressed in the same way that is expected in the wider community, it should not be used to ignore a fundamental aspect of being human.
The realisation that “Important Things, Immediate Things” were not report writing and therapy but rather enabling people to be acknowledge and supported to be people first and that those priorities included really fundamental aspects such as sexuality.
Intellectual Disability, Multiple Sclerosis, Acquired Brain Injury or a myriad of other injuries, illness or disabilities (including ageing) do not change the fundamental fact that human beings are, by our very nature, sexual beings.
[Clickability update, October 2026:
People’s experiences differ, including asexual identities and people who do not want sexual activity. Respectful support follows the person’s own wishes, without assuming a universal need. The Commission’s rights standards address autonomy, intimacy and sexual expression.
]
By denying basic human needs, we deny a person’s humanity and make it a pathology instead of a normal aspect of life. Sex and sexuality are, as recognised in “Maslow’s Hierarchy of need”, a fundamental aspect of being human in line with food and shelter.
Sex and sexuality issues are as complex and diverse as human beings but an integral aspect of being human. Most people want the same things: meaningful relationships, intimacy and the opportunity for personal sexual expression.
There is no “one right” answer to address any these aspects but there are options. While the options may fulfill some (or all) of these needs at different times of a person’s life, it is essential that the “person-centred practice” is, indeed, person-centred and that people who access support services and the providers of services themselves, feel able to have the conversations to acknowledge and address all aspects of being a person including sex and sexuality.
Clickability editorial update: October 2026
Choose what you want to discuss and with whom
You can ask for a private conversation about relationships or sexual health, choose a trusted person to attend, or decline the discussion. Explain any communication or physical access you need. Clinical questions belong with an appropriate health professional; ask separately which costs are covered by health services, personal funds or eligible disability support.
Make consent and boundaries part of ordinary practice
Speak directly with the participant using their preferred communication. A family concern does not substitute for the person’s wishes. Offer privacy, accessible information and appropriate referrals. Workers must maintain professional boundaries and act on safeguarding concerns; respecting intimacy never authorises sexual contact between a worker and a participant. The NDIS Code of Conduct sets relevant expectations.
Questions readers ask
Does the NDIS fund sex work?
No. Sexual services and sex work are excluded from NDIS supports. Official guidance
Must I discuss sexuality with my support worker?
You choose what to share. Ask for suitable privacy and professional support when you want it. Official guidance
Choose support that respects your boundaries
Tell Clickability the everyday assistance you need, then ask potential providers how they protect privacy and communicate about personal preferences.
