Sexual Issues in Cerebral Palsy: A Narrative Clinical Review

Abstract

Sexuality in individuals with cerebral palsy (CP) remains underexplored despite its central role in identity, intimacy and quality of life. Different types of CP, i.e., spastic, dyskinetic, ataxic and mixed shape sexual development variably through motor limitations, altered sensation and co-occurring intellectual or developmental disabilities. Greater motor severity often reduces sexual independence, influencing positioning, privacy and reliance on caregivers, thereby complicating sexual identity formation. Early brain injury may disrupt normative psychosexual development, affect impulse regulation and alter sexual taxonomy in the presence of cognitive impairment. As a visible disability, CP can adversely impact sexual self-esteem and perceived attractiveness, particularly when assistive devices are used. Physical factors such as muscle contractures, scoliosis, spasticity, dystonia and pelvic floor dysfunction may limit positioning, cause pain during intercourse or impair performance. Male sexual dysfunction, including erectile difficulties and female sexual dysfunction are reported but underdiagnosed. Anti-epileptic medications may further reduce libido or sexual responsiveness, while botulinum toxin interventions raise emerging questions regarding sexual function. Menstrual challenges, sensory processing differences and fertility concerns add further complexity. Individuals with CP face heightened vulnerability to sexual abuse and barriers to disclosure, underscoring the importance of assessing capacity for sexual consent. Societal stigma, parental overprotection and inadequate sex education hinder healthy sexual expression, dating experiences and marital satisfaction. There is a critical need for comprehensive sexual rehabilitation models integrating medical, psychological and social perspectives. Future research in sexual medicine must prioritise evidence-based interventions, inclusive education and rights-based frameworks to address sexuality in CP across the lifespan.