Preventing pregnancy

Birth control allows people to have sex without getting pregnant. Condoms are a common type of birth control. 

Everyone has the right to choose their own birth control method. To make these choices, people need clear, easy-to-understand information about:

• How reproduction works.
• Why birth control is important.
• The different types of birth control you can use.

Ask your client if they know how to avoid pregnancy. Talk about how condoms can help. Explain that a doctor or sexual health nurse can help them explore other ways to prevent getting pregnant. Many women use birth control that lasts for a long time but can be removed if and when you want.

If your client does not know the basics of reproduction, find appropriate resources to share with them. For example, Family Planning NSW has developed a plain English fact sheet about birth control options. You can access it here (external link). 

Some people with disabilities might struggle to get birth control because they can't talk openly about their sex life with family or supporters. They might also have limited options because:

• Some medications don't work well with certain types of birth control.
• Some types of birth control can cause bleeding, which can be hard for some people to deal with.
• Having devices inserted might be tricky for some people. They can get help by having the procedure done while they're asleep or under anaesthesia.
• Some people have trouble remembering to take birth control pills regularly. They can get help by having someone set up reminders or supervise them.
• Using condoms might be difficult for some people with cognitive disabilities or physical limitations.
• Some people with disabilities have sensory issues with the smell or feel of sex. It can impact the pleasure they experience. Fragrance-free products, like fragrance-free condoms, are available.

Emergency birth control can prevent pregnancy after unprotected sex, like if a pill is missed or a condom breaks. It's available at pharmacies without a prescription. It should be taken as soon as possible, ideally within 24 hours, but it can still work up to 3 days later. It's less effective the longer you wait.

In most states in Australia, it's legal for any woman to choose to end a pregnancy. We call the procedure an abortion or termination. Everyone has the right to get support and counselling about abortion. Help your client to find the services they need.

STIs and safer sex

STIs are sexually transmissible infections—infections spread through sexual contact.

Safer sex is a simple conversation. Explain to your client that most STIs spread through skin-on-skin contact. They can use a condom (male or female) or dental dam to be safer. Show pictures to explain how it works. 

There is a right and wrong way to use condoms. Make sure your client follows the instructions. Talk them through the process. Use pictures or props. If they are worried about losing sensation, suggest they use a single drop of lubricant inside the condom. If a sexual partner doesn't want to talk about safer sex or practice safer sex, they may not be a safe person. It can be a sign of coercive behaviour. Look out for signs like this. Talk about them with your client.

If your client tells you they have sex without protection, don't respond with shame. They can have an STI test. It will be free or cheap. If they have an STI, they can get treatment from a doctor or sexual health nurse. You could help them make an appointment.

Sexual health checks

People with disabilities should be able to get sexual health checks with a doctor or a nurse. It could be to:

• Learn about menstrual hygiene.
• Test for STIs.
• Get regular screenings to help prevent cervical cancer. If it's hard for them, they can talk about other options.
• Take part in immunisation programs. For example, they could get the HPV vaccine, which helps prevent cervical cancer.
• Know how their breasts should look and feel and seeing a doctor if they notice anything strange.
• Get a mammogram if they're over 40 to check for breast cancer. They can talk to a doctor for more information.
• Understand the importance of seeing a doctor if they notice anything unusual with their testicles. Prostates should be checked, too.

Sexual hygiene 

Sexual hygiene means keeping the sexual parts of your body clean to feel good, promote health and prevent disease. People with disabilities should learn about sexual hygiene in a way that suits their specific needs and abilities. 

Everyone should learn basic personal hygiene practices, like:

• Regular bathing or showering 
• How to clean genital areas
• Wearing clean clothing. 

This will keep your client clean and help prevent infections. It will also help your client feel confident and sexy when dating and having sex.

You may need to provide instructions using diagrams to help a client learn how to clean their genitals properly. Remind your client not to use soap on their internal private parts. 

Depending on physical limitations, clients may need help with personal hygiene. It could include:

• Assistive devices 
• Help from supporters
• Different ways to bathe or groom.

A shower chair with a hole in the seat, a detachable shower head, or a bidet can be useful tools for cleaning genitals. Soap-free wet wipes may also help.

Some people with disabilities may have issues with bladder or bowel control. This is known as incontinence. It's important for clients to learn proper techniques for managing incontinence.

They might need to:

• Use protective garments such as disposable pads or nappies
• Empty catheters or colostomy bags 
• Keep skin clean to prevent irritation and infection. 

Your client may want advice about options for managing incontinence issues when they have sex. A specialist like an incontinence nurse or sexologist could help.

A lot of people feel embarrassed to talk about these types of issues. You may have to be proactive about bringing it up gently.

People who menstruate should learn about menstrual hygiene, like:

• Using appropriate hygiene products such as period undies, pads or tampons.
• Changing these products regularly.
• Looking after discomfort or skin irritation. 

It is safe and acceptable to have sex during a period, it’s just a little messier! Consider having a conversation about how to clean up, including doing the laundry after sex. If a carer or supporter does the laundry, it is polite to let them know so they can wear gloves.

Sometimes people can get an infection in the urinary tract after having sex. It is called a urinary tract infection or UTI. Sexual activity can introduce bacteria into the urinary tract. It increases the risk of UTIs, particularly in people with vulvas.

Sometimes, urinating straight after sex can help prevent UTIs. A doctor or pharmacist can help anyone deal with a UTI. The faster it's dealt with, the easier it is to get rid of.