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Your sexuality, or sexual orientation, is basically a way to describe the feelings you have for someone you fancy or are attracted to. The most common definitions are as follows:

- Heterosexual/Straight: a person physically and emotionally attracted to someone of the opposite sex, so a male attracted to a female and a female attracted to a male.
- Gay: a male physically and emotionally attracted to another male or a female physically and emotionally attracted to another female (more commonly used in males).
- Lesbian: a female physically and emotionally attracted to another female.
- Homosexual (gay/lesbian): People who are homosexual are attracted to the same sex. Homosexual men are often called gay and homosexual women are often called lesbians but can also be called gay.
- Bisexual/Bi: People who are bisexual are attracted to both males and females.
- Pansexual: People who are attracted to other people regardless of their sex or gender identity. Asexual/Ace: People who are asexual or ace don’t feel sexually attracted to anyone and feel no desire to have sex.

Gender and sex are often two terms that are used interchangeably and people can get confused about the differences between them. The reason for this is that for many people, their gender and sex are the same, so it can be difficult for some people to separate them and understand that they are actually individual things.

When we look at gender, it actually has nothing to do with our sexual or reproductive organs. The World Health Organisation (WHO) defines gender as the socially constructed characteristics of women and men – such as norms, roles, behaviours and relationships of and between groups of women and men. These attributes are more about masculinity and femininity than male or female and when individuals or groups do not “fit” established gender norms they often face stigma, discrimination or social exclusion – all of which adversely affect health. It is important to be sensitive to different identities that do not necessarily fit into binary male or female sex categories. Feelings around gender identity can be permanent or can change and be expressed differently at different times.

When attending any sexual health clinics in Lanarkshire, it is extremely helpful if you are able to be honest and disclose your gender identity to the health professionals at your appointment. We understand not everyone is comfortable discussing this, but your information will be treated sensitively and confidentially and it is important so that staff can provide you with the correct care and advice.

There is no single measure of what is normal in sexual activity – it varies from person to person. You have to decide what has been normal for you throughout your own life and consider any changes based on that. Growing older may well affect the quantity of sex you experience, but it does not necessarily have to affect the quality. You can expect to slow down in most physical activities you undertake as you get older, and sex is not any different. The desire for sex may also decline due to hormonal changes in both men and women.

In men, more prolonged manual or oral stimulation may be needed to attain an erection which itself is not as rigid as before. Orgasm may be less frequent and less intense. Ejaculation may be less forceful and the period of time before another erection is possible is likely to be longer. In women, dryness may make penetration or stimulation of the vagina more difficult, more irritating or even painful. This can usually be easily resolved by the use of a lubricant. Following the menopause, with vaginal shrinkage, women may even find sex more intense or pleasurable. The lack of anxiety about becoming pregnant may even contribute towards greater sexual enjoyment. It is important to remember however that although pregnancy is no longer possible, protection is still required against STIs, especially for individuals entering into a new relationship or with different partners.

A few other things can be taken into consideration to improve your sex life in later years. Routine can lead to boredom, which in turn can lead to a lack of arousal. Experimenting may intensify stimulation, and this can be as simple as changing the location or time at which sex usually takes place. The use of erotic materials or sex toys might also introduce an element of novelty and enhance arousal.

You may choose not to engage in any sexual activity at all, at any age, and this is your right. You may simply engage in masturbation or a variety of activities with any number of partners of either sex. Today in our modern society, there is a much more open and relaxed attitude to sex than there has ever been. You have a greater freedom of choice now than probably at any other time. You have the right to make your own choices as long as you and any other partners are happy and consent to any of the sexual activities you choose.

Our interest in sex varies from person to person and changes from time to time. It is normal for us to experience highs and lows in our sex drive at various points in our lives.

The word 'arousal' is used to describe the physiological changes that occur when we are sexually stimulated. Arousal is noticeable in the man when he gets an erection. When a woman is aroused there is increased blood flow to the genitals resulting in vaginal wall thickening, lubrication and swelling of the clitoris. In both men and women, heart rate and breathing quicken and there is a feeling of being “turned on”. Without this arousal, sexual activity is possible but tends to be less enjoyable, and achieving orgasm will be difficult.

Many things can cause a problem with sexual desire or stimulation, any illness, for instance, can have a knock-on effect on sexual ability at all ages. As you grow older you become more prone to those illnesses, including; heart disease, stroke, dementia, Parkinson’s disease, prostate problems and mental health issues such as anxiety and depression. It is illnesses like these which can have a detrimental effect on your sexual capability. Some illnesses can be treated more successfully than others, but the treatments themselves can have an adverse effect on sexual function. You should not automatically accept a poorer sex life as a result however if you do not want to. There are many treatments for sexual difficulties which can restore sexual capacity, although it may feel embarrassing, speak to your GP or staff at a local sexual health clinic confidentially for support and advice.

People with a disability experience the same sexual needs, feelings and desires as any other individual. Disability does not prevent sexual maturity or remove sexual feelings, desires or curiosity.

Body image has a strong impact on an individual’s and societies perceptions of sexual relationships. Talking about sex/sexuality and people with a physical disability is often seen as inappropriate. When sexuality and physical disability is discussed, it is often in purely functional terms, like fertility and capacity to physically perform sexual activities. It commonly leaves out all the wider aspects of sexuality: feelings, affection, emotional and physical needs and desires and same-sex relationships. Sexuality brings with it a multitude of complex issues with its highs and lows, pitfalls and pleasures. These affect everyone, with or without a disability.

This is not to say, however, that the individual impact of a disability should be ignored. Whether it is lifelong or acquired, disability or illness can potentially affect any aspect of sexuality. Questions about having children, sustaining relationships or being able to enjoy sex can be raised. Some disabilities may cause a loss of fertility, but this does not mean a loss of sexual function. If the sexual function is reduced, it may be possible to increase it again. A loss of sensation in the genitals does not mean that sexual pleasure is no longer possible.

Keeping the discussion open about sexuality and acknowledging sexual needs and preferences allows disabled people to adapt to their own unique circumstances and both explore and enjoy their own sexual identity. Each disability affects each individual differently and responding to this in a sexual way will involve a high degree of personal consideration. This may involve experimentation with a variety of sexual activities or a variety of positions to achieve pleasure and comfort. Some people use sex-toys (vibrators etc.), additional lubricants or concentrate more on non-penetrative activities.

An essential part of fulfilling sexuality is communication. Openness between sexual partners can create the right environment to develop particular ways of giving and receiving sexual pleasure. Telling each other what you like and don’t like, and not criticising, builds a greater understanding of needs and desires. Guide your partner(s) and be guided by them. Safer sex is equally important for disabled and non-disabled people. Please refer to this website for more info: Disability Now

It is essential to recognise and acknowledge that learning-disabled people also experience the same needs, feelings and desires associated with sexuality. It is also essential that this sexuality is given the freedom to express itself, and not be shut away for mistakenly being deemed inappropriate. A learning disability should not prevent any person from channelling their needs and feelings into means of expression that allows them to enjoy their sexuality and get pleasure and enjoyment from intimate relationships.

Education about sex and sexuality has often been completely denied to learning-disabled people. This not only denies the basic right of expression but creates a number of unnecessary difficulties. Sexual development and the management of feelings that come along with it can be stressful for anyone. If no help is given to understand what is happening, physically and emotionally, then this stress is greatly increased. In addition to this, if the only messages that are given consist of phrases like “don’t do that, it’s bad” or “don’t touch yourself there”, then further confusion and frustration can build up. We should all be given the opportunity to learn about our own bodies and what we like or dislike.

Appropriate sexual behaviour and the difference between private and public behaviour are important areas that need to be fully supported with positive messages and learning. There is a misconception that learning-disabled people can have an uncontrollable sexual drive, and present some kind of danger as a result. If no proper education is available then there is no opportunity to develop the kind of behaviour that is considered publicly acceptable. It is important for educators, particularly those involved in education programmes with disability workers or disabled people, to understand community attitudes towards disability and sexuality, and the impact of these views upon disabled people themselves.

Without good education and support, learning-disabled people can be very vulnerable to abuse, exploitation, or negative consequences of their actions. This education needs to be consistent in the various settings someone might be, and consistent between different people who might carry out a support role – family and carers, care workers, supported education or employment workers, and counsellors. NHS Lanarkshire’s Adult Learning Disability Service has created a website for people with a learning disability and health professionals.

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