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Emotional needs usually have more relevance to people with physical disabilities who are very aware and sensitive about their sexuality. People with mental handicap may be less sensitive to other people’s approval or disapproval, although of course the situation is even more complicated when physical and mental handicap coexist in the same patient.

One area of difficulty for the doctor may be that of inappropriate behaviour, which tends to occur in people with mental handicap who are disinhibited, or in people who have suffered head injury, stroke or neurological disease. The question of what is inappropriate behaviour needs exploring, as does the question of ‘inappropriate for whom’? While there are some activities we would all consider inappropriate, such as masturbating or having intercourse in public, other activities are a matter of opinion. A nonjudgemental exploration of the problem is necessary, as well as practical advice tailored to the specific situation. If the person has not been educated into what is acceptable social or sexual behaviour, it is very difficult for him to behave appropriately. The unease for both patient and doctor is made worse by society’s attitude that sex is for the young, beautiful and athletic, in whom, for instance, considerable public petting is acceptable. But people with disabilities, mental or physical, do not fit that image, and both they and others may feel more self-conscious. These attitudes can also affect the doctor/patient relationship.

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