Editing Sexual intercourse (section)

===Disabilities and other complications===
{{main| Sexuality and disability}}

Obstacles that those with [[disabilities]] face with regard to engaging in sexual intercourse include pain, [[Depression (mood)|depression]], fatigue, [[negative body image]], stiffness, functional impairment, anxiety, reduced [[libido]], hormonal imbalance, and drug treatment or side effects. Sexual functioning has been regularly identified as a neglected area of the quality of life in patients with [[rheumatoid arthritis]].<ref name="Tristano2014">{{cite journal|last1=Tristano|first1=Antonio G|title=Impact of rheumatoid arthritis on sexual function|journal=World Journal of Orthopedics|volume=5|issue=2|pages=107–11|year=2014|issn=2218-5836|doi=10.5312/wjo.v5.i2.107|pmid=24829873|pmc=4017303 |doi-access=free }}</ref> For those that must take opioids for pain control, sexual intercourse can become more difficult.<ref name="DeyoVon Korff2015">{{cite journal|last1=Deyo|first1=R. A.|last2=Von Korff|first2=M.|last3=Duhrkoop|first3=D.|title=Opioids for low back pain|journal=BMJ|volume=350|issue= |year=2015|pages=g6380|issn=1756-1833|doi=10.1136/bmj.g6380|pmid=25561513|pmc=6882374}}</ref> Having a [[stroke]] can also largely impact on the ability to engage in sexual intercourse.<ref name="HersonPalmateer2012">{{cite journal|last1=Herson|first1=Paco S.|last2=Palmateer|first2=Julie|last3=Hurn|first3=Patricia D.|title=Biological Sex and Mechanisms of Ischemic Brain Injury|journal=Translational Stroke Research|volume=4|issue=4|year=2012|pages=413–419|issn=1868-4483|doi=10.1007/s12975-012-0238-x|pmc=3733393|pmid=23930140}}</ref> Although disability-related pain, including as a result of [[cancer]], and mobility impairment can hamper sexual intercourse, in many cases, the most significant impediments to sexual intercourse for individuals with a disability are psychological.<ref name="Falvo">{{cite book |author=Donna Falvo| title = Medical and Psychosocial Aspects of Chronic Illness and Disability | publisher =[[Jones & Bartlett Publishers]]|page=367|year = 2013|access-date=December 7, 2014| isbn = 978-1-4496-9442-5 |url =https://books.google.com/books?id=SdM6FsykfWAC&pg=PA367}}</ref> In particular, people who have a disability can find sexual intercourse daunting due to issues involving their [[self-concept]] as a sexual being, or a partner's discomfort or perceived discomfort.<ref name="Falvo"/> Temporary difficulties can arise with [[alcohol and sex]], as alcohol can initially increase interest through disinhibition but decrease capacity with greater intake; however, disinhibition can vary depending on the culture.<ref name="WHO Risks">{{cite book|title=Alcohol Use and Sexual Risk Behaviour: A Cross-cultural Study in Eight Countries|publisher=[[World Health Organization]]|year=2005|pages=135 pages|access-date = March 30, 2013 |isbn = 978-92-4-156289-8| url =https://books.google.com/books?id=fZ1eBPIIr48C }}</ref><ref name="Aggleton">{{cite book |author=Peter Aggleton |author2=Andrew Ball |author3=Purnima Mane |author3-link=Purnima Mane | title = Sex, Drugs and Young People: International Perspectives | publisher =[[Routledge]]|pages=130–133|year = 2013|access-date=December 7, 2014| isbn = 978-1-134-33309-7 |url = https://books.google.com/books?id=dWknAAAAQBAJ&pg=PA130}}</ref>

People with [[mental disabilities]] also are subject to challenges in participating in sexual intercourse. This can include the lack of a knowledgeable healthcare provider trained and experienced in counseling those with [[intellectual disabilities]] on sexual intercourse. Those with intellectual disabilities may have hesitations regarding the discussion of the topic of sex, a lack of sexual knowledge and limited opportunities for sex education.<ref>{{cite journal |last1=Medina-Rico |first1=Mauricio |last2=López-Ramos |first2=Hugo |last3=Quiñonez |first3=Andrés |title=Sexuality in People with Intellectual Disability: Review of Literature |journal=Sexuality and Disability |date=September 1, 2018 |volume=36 |issue=3 |pages=231–248 |doi=10.1007/s11195-017-9508-6 |s2cid=255009541 |url=https://link.springer.com/article/10.1007/s11195-017-9508-6 |language=en |issn=1573-6717}}</ref> In addition there are other barriers such as a higher prevalence of sexual abuse and assault. These crimes often remain underreported. There remains a lack of "dialogue around this population's human right to consensual sexual expression, undertreatment of menstrual disorders, and legal and systemic barriers". Women with intellectual disability may lack sexual health care and sex education. They may not recognize sexual abuse. Consensual sexual intercourse is not always an option for some. Those with intellectual disability may have limited knowledge and access to contraception, screening for sexually transmitted infections and cervical cancer.<ref name="GreenwoodWilkinson2013">{{cite journal|last1=Greenwood|first1=Nechama W.|last2=Wilkinson|first2=Joanne|title=Sexual and Reproductive Health Care for Women with Intellectual Disabilities: A Primary Care Perspective|journal=International Journal of Family Medicine|volume=2013|year=2013|pages=1–8|issn=2090-2042|doi=10.1155/2013/642472|pmid=24455249|pmc=3876698|doi-access=free}}</ref>