Together in the shower

In Diaconia's facilities, spontaneous sexual practices often occurred between clients. Clients may start undressing each other, showing their private parts. And as one of the managers, Václava Bláhová, says: "We were balancing how to approach this." The question was whether to restrict such displays more severely or whether to tolerate them.  

On the one hand, the clients' right to self-fulfilment is at stake. That includes eroticism and sex. The desires and needs of adults with intellectual disabilities are not fundamentally different from those of the so-called healthy part of the population. On the other side of the scale was the fact that clients with mental handicaps do not have the usual conventions. They can frighten society with their spontaneous sexual behaviour.

Diaconia West agreed that nothing would be banned, but that at the same time the sexual life of the clients needs some rules that everyone can understand. "That's why we started working with Mr Eisner, who is one of the leading experts on this issue in the Czech Republic," says Ms Bláhová. Petr Eisner has been working on the topic for twenty-five years; he has also received training in working with sexuality from Dutch colleagues. He regularly trains social service workers, provides sex education, awareness-raising and helps solve specific cases. He has been working with Diaconia West for three years.

In each of its five facilities for people with mental disabilities, Diaconia has appointed a so-called intimate confidant. One of them, for example, is Jiřina Urválková, who has had experience with the sexual behaviour of people with mental disabilities from her family. "I have dealt with these things with my adult autistic son, so I am sympathetic to the sexuality of our clients," she says.  

Above all, intimate confidants need to be good observers: they need to know their clients' behaviour well and recognise when it is appropriate to open up the issue of sexuality with them. At the same time, they cannot always rely on ordinary language, because some clients find it difficult to understand and do not speak it themselves. Education is then mainly done through visual demonstrations. Step by step, the clients learn to understand the value of their own bodies over various illustrations. For example, they discuss with them how to touch other people appropriately. In this way, they gradually begin to learn the boundary before which expressions of physical proximity are generally acceptable, and what already belongs to the sphere of intimacy.

The intimate confidant tries to direct sexual activities, especially self-satisfaction, into safe and private spaces. She also introduces clients to contraceptive methods. "Cooperation with the families of our clients is essential," says Václava Bláhová.

I Jiřina Urválková, the intimate confidante, recalls how she had to gain the trust of the parents on the issue of their adult children's sexuality. They discuss topics that everyone naturally feels shy about. "For example, when the parents did not explain to their son that women menstruate, he saw blood on his female partner, who did not know how to change her own menstrual device. He was terribly frightened and thought his girlfriend was dying," Jiřina Urválková recalls. "So we are trying to be preventive so that such situations do not arise," she adds.  

The so-called "protocol of sexuality" is used by the parents to give them a basic introduction to how the clients at Diaconia West approach sex and eroticism. Through it, guardians and parents learn that Diaconia West provides education on sexuality, what behaviour is acceptable and what is not in Diaconia's facilities. "We meet with parents regularly over this topic. They are our partners in this and it works well," adds Jiřina Urválková.

Expressions of sexuality in practice 

Sexuality is not just an "act", but also everything that goes with it - behaviour, rules of hygiene, cohabitation in a partnership. For some people, a display of affection is enough for full satisfaction - when they can say, "You're my girlfriend." On the other hand, there are people who need the sexual act itself. Practitioners then need to be able to distinguish which group of clients they are working with: "We've had a client take off our colleague's socks. No one saw the sexual subtext at first, more like a joke. But for the client, it was on that scale. "We work with a set of 25 images from the invitation to the date to the intercourse itself," explains Jiřina Urválková. "These pictures are given to both partners and each puts them in a line to describe how far they would like to go in intimacy. One partner wants to go to the kiss on the cheek and the other wants to make love. It is then up to me, the intimate confidant, to correct this so that one partner is not unhappy in the relationship."

Date in Františkovy Lázně 

Natálie and Honza are clients of one of Diaconia's day care centres. They are dating each other. "For me, it means liking someone, going for coffee with them, going out together in nature," says Natálie, who describes how her relationship with Honza started gradually. "In the beginning, we didn't know if we could touch each other. So we wrote to each other, called each other, held hands. Now we kiss and hug each other, but only at night, when nobody sees us. We want privacy." Honza's mother admits that the couple's first sleepover together in her apartment was a challenge. At the same time, she knew it was an important step in their relationship and organised a few days' holiday for the couple in love. She drove them to Františkovy Lázně directly to the hotel and arranged everything with the staff in advance. She created a safe environment and understanding surroundings for the couple.  

"I'm glad that now Natálie and I are rubbing each other's backs in the shower and telling each other that we love each other," adds Honza, holding Natálie's hand. He was relieved when he found out that Natálie liked his touches, because at first he wasn't sure if he was allowed these intimacies. However, he was able to consult with the staff at the residential home, who were supportive of both partners. They are planning to live together and believe they can achieve this with the help of the family and Diaconia staff.

Anita Stulíková