People with disabilities face many problems, some intrinsic to the disability, some the result of living in a world designed for those without disabilities, and some the result of prejudice. LGBT people have special reason to sympathize with the disabled, since there are inherent similarities between the difficulties faced by both minorities. Indeed, there is a significant overlap between the LGBT and disabled worlds, as disabilities are more common among LGBT people than among the general population. The converse is also true: disabled people are more likely to identify as a sexual minority than are abled people.

Statistics tell a tale. American Journal of Public Health (Jan. 2012) reports that “approximately 25 percent of heterosexual women” experience a disability, and the figure for both lesbians and bisexual women is 36 percent. It also reports that 22 percent of heterosexual men have a disability, versus 26 percent of gay men. Although the disparity is small between straight and gay men, it is unexpectedly large between these two groups and bisexual males, forty percent of whom have a disability.

What’s more, behaviors and difficulties associated with disability are higher among LGBT people. Notes the study: “The age-adjusted likelihoods of current smoking, frequent mental distress, and arthritis for both lesbians and women who are bisexual are notably higher than for heterosexual women.” Among males (adjusting for age), gay and bisexual men are more likely than straight men to be current smokers. They are also more apt to suffer from mental distress and poor physical health. Of course, one of the largest issues for gay and bisexual men is HIV-related disabilities. According to the Centers for Disease Control (CDC), more than 600,000 gay and bisexual American men have HIV. Although many of these men are asymptomatic, there are some who are disabled because of HIV-related ailments.

Disability should be of universal concern, since anyone can become disabled through accident, violent crime, or disease. The aging process is such that people often become disabled as senior citizens. Here again, the effect is stronger among sexual minorities. SAGE, a membership organization for older LGBT people, observes: “Recent studies have found that LGBT older adults experience higher rates of disability as compared to their heterosexual peers.” Equally troubling, research reveals that “many LGBT people delay care out of fear of discrimination from health providers.”

SAGE notes that a national survey found that 44 percent of LGBT seniors say their physical activities are limited by disabilities, and twenty percent say they use special equipment (canes, wheelchairs, special telephones, etc.) due to a health condition. The same survey found that, among senior citizens, 53 percent of lesbians, 51 percent of bisexual women, 41 percent of gay men, 54 percent of bisexual men, and 62 percent of transgendered people live with a disability.

Why are disabilities more common among LGBT people? Explanations for the greater prevalence among LGBT people include greater stress from living in a “heterocentric” world, from outright discrimination to the many micro-aggressions that one experiences over the course of a lifetime. A wealth of research suggests that both gay men and lesbians have a higher tendency to engage in risky behaviors, such as smoking, excessive drinking, and the use of recreational drugs. Other research has shown that LGBT people are disproportionately likely to be poor or barely managing financially, and all that this implies for access to health care and preventative maintenance.

As members of two marginalized groups (at least), disabled LGBT people can face special challenges in their quest for community. Event producer and disability campaigner A. J. Higginson notes: “Being disabled and a lesbian makes you a minority times two. Discrimination can come from different sources, even within the LGBT and disabled communities, the very places where you would expect to find support.” She quotes a lesbian complaining, “I feel I belong to two communities but don’t fit in either.” In Queer Crips: Disabled Gay Men and Their Stories (2004), co-editor John Killacky, who is partially paralyzed due to an operation that went wrong, recalled a disheartening experience at a (non-gay) conference of disabled artists: “A quadriplegic comic derisively parodied Siegfried and Roy and the audience roared.” In the same book, co-editor Bob Guter, born with limb deformities, maintains: “As queer crips, we’ve been isolated from society at large and even from one another, by underemployment, institutionalization, poverty, and internalized cripophobia.”

A powerful example of the overlap of cripophobia and homophobia is recalled in Queer Crips by George Steven Powell. Growing up in a household of religious extremism, he came to fear that his spina bifida was the result of his “sinful” gay desires. He writes that “it took years to free myself of all the guilt.” Dylan Orr observes that both LGBT and disabled people trigger a “fascination or discomfort-avoidance dynamic” in the majority population. The “discomfort-avoidance” manifests itself in the perception that disability renders people asexual; the fascination leads to the fetishizing of disabilities.

Comments Higginson: “If you’re a disabled woman, you’re assumed not to be able to—or even desire to—have sex.” She argues that there’s a paradox here because “able-bodied lesbians often say there is more to them than the people they have sex with” whereas “disabled women—lesbians and bisexuals included—are fighting for recognition of our sexuality.” She believes it can be a “continual struggle” to “find intimate partners and even learn to accept our sexual orientation and bodies.”

Lesbian producer and performer Julia Trahan asserts: “My sexuality never left me.” The beautifully brazen performer has cheerfully swung her dildo onstage and danced in her wheelchair. Judith Smith is another lesbian who dances in her wheelchair onstage. Founder and Director of AXIS Dance Company, she had been a champion horse rider before becoming disabled in 1977 at age seventeen. Not too long after becoming quadriplegic, she discovered a passion for dancing. AXIS was founded in 1987 as a dance company boasting both disabled and non-disabled dancers, a genre called physically integrated dance.

Smith also believes it is unlikely that her sexual orientation is recognized by many people—partly because of her disability. “Being disabled is part of the reason people don’t think of me as lesbian—although they would when I was with my ex-partner because she was very butch,” Smith explains. “I have long hair and present as fairly feminine. People see the disability before seeing that I might be lesbian.” Disability inevitably affects sexual expression, Smith continues. “Being disabled really limits the number of people who want to date you or be in a relationship with you.”

Even in the Bay Area, where she lives, homophobia and cripophobia are “not non-existent. I face a lot of prejudice as a disabled woman. People don’t consider you smart, don’t consider you successful, don’t consider you sexual. There are still a lot of buildings and events that are not accessible.” Nevertheless, she sees things going in the right direction: “I think we’re starting to see more disability represented in advertising and in the media. Our disabled veterans are getting visibility, our disabled athletes are getting visibility. But we’ve got a long way to go.”

When John Killacky became paralyzed in 1996, he found himself dismayed by the ignorance of therapists who could not “explain sexual functioning after spinal surgery through a queer lens.” When he asked a rehab therapist about his prospects for recovery of sexual function, the reply he got was: “I’m not gay. I don’t know.” Killacky was shown a short movie about sexuality after paralysis, but he found it most unhelpful. Not only was it completely heterosexual, but it included elements that he thought irrelevant and unbelievable. “The film started with a man in a wheelchair and a woman having a lovely dinner with wine,” he remembers. He found this scene jarring because alcohol and the medicines he was taking do not mix well, so drinking would have been “ill-advised.” The dinner scene was followed by one in which the lady puts the gentleman on the bed and pulls him on top of her. Protests Killacky: “Insertion and thrusting aren’t possible for me. I thought it was the wrong message. You have to find a new way: start with what you have and where you feel something.” Previously “quite phallocentric,” his paralysis meant he had to “reorient” himself. Killacky found that “the unconditional love of my husband has allowed new patterns to emerge: light massage and hugging are central to our relating.”

Similarly, Queer Crips contributor Steven Sendham, who became paralyzed after an accident, wrote: “I lack sensation in my penis and testicles. … But the hair—that’s something different! A light silk scarf or a cashmere sweater drawn slowly, ever so slowly, over the genitals creates exquisite sensations. … A light touch is an erotic promise made and delivered. … The light touch is the lewd touch.” Or another example: Samuel Lurie, a gay transman who trains healthcare providers in trans awareness, finds the “tremoring touch” of partner Eli Clare, a gay transman with cerebral palsy, erotically hot. “Sensually, for me, Eli’s cerebral palsy is literally a gift,” he states.

The counterpart to denying disabled people’s sexuality is the fetishization of disability. In Queer Crips, Guter interviews psychologist Alan Sable, who observes that “fetish” is a term “that says it’s unhealthy by definition.” However, he contends, “ability is a socially-approved fetish, with those having less of it tending to fetishize it in those who have more of it.” Sable believes the non-disabled fetishize the disabled because “it’s a way to care for someone” seen as “vulnerable.” There is also a stereotype of a disabled person as a “saint” who has “suffered a lot” and is therefore able to do something immensely positive for a partner.

While Sable counsels being open to such overtures from the able-bodied, it’s understandable that many disabled people find such fetishizing a turn-off. After all, people often fetishize racial and ethnic groups due to stereotypes about them. Many people on the receiving end of this interest would automatically rule out a relationship with someone attracted to them due to such stereotypes. Similarly, many disabled people might regard fetishizing as an offensive manifestation of bigotry.

When disability strikes one half of a previously abled couple, the relationship is truly tested. “When something like this happens, it’s very complex for the partner,” Killacky remarks. “When I became paralyzed, there was no group for people in Larry’s position. Society had sympathy for me but not for my husband.” Killacky directed a PBS documentary entitled Holding On that featured him and Connolly along with two heterosexual couples. The goal was “partly to focus on the partners of the disabled and what that is like for them.” In Holding On, Connolly says, “His disability is like a third character in the room with us.”

For everyone, life itself is full of complexity. For LGBT people who are disabled, that complexity is multiplied. For most people, enjoying their sexuality is vital to happiness, so it is vital that therapeutic workers, and society at large, adequately address the special needs, including the sexual ones, of LGBT people.

Previously published in The Gay and Lesbian Review.