The Challenges of Having Sex as a Little Person

A sexologist helps people with dwarfism overcome their bodies' obstacles to sex and intimacy.
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Dr. Marylou Naccarato was an agent for the Internal Revenue Service for decades before she became a clinical sexologist. “As a former IRS agent of 23 years,” she quips, “people ask, ‘How did you shift from working in the tax field to sexology?’ I always reply, ‘Well if you think about it, I haven’t really changed professions. It’s all about whether or not you’re gonna get screwed.’” Standing at 3’10” with a rare type of dwarfism called Kniest, Naccarato has become something of a pioneer in the Little People of America community. She was a speaker at their conference earlier this month in San Diego where she broke through conservative boundaries to talk the ins and outs of sex, intimacy, and lovemaking with the various limitations that may come with life as a person of short stature.

Born and raised in Los Angeles to a Sicilian Catholic father and a Moroccan Jewish mother, Naccarato found herself in the sex counseling and education field by accident. Although she was working for the IRS, she had always wanted to be a social worker, until one night when she watched a program on sexual health on a cable network. “They were talking about the Kama Sutra," she recalls. "The narrator was explaining that in this particular male-female intercourse position, if the man was standing and the woman was on her back on the edge of the bed, it would be less pressure on his lower back."

“When I saw the program it [piqued] my curiosity,” she says. Married to an average-sized man at the time, Naccarato and her husband adapted their sex lives because she had issues with her hip—like most Little People do—leading to issues with straddling.” Most of us will have hip implants and knee implants for mobility due to bone degeneration,” she explains. They adapted a side-by-side position to cope with her pain. “So when I saw the program on TV I thought, ‘Wow, I wonder what other people are doing in our community because no one is talking about it.’”

What followed was a series of phone calls to her close friends asking what they were doing in bed. To her surprise, everyone was having challenges and all were excited to talk about it. This was 10 years ago. She started with Little People of America, an umbrella organization that provides support to people of short stature, from information on scholarships and medical procedures to artist’s funds and specially designed kitchen appliances. LPA gave her permission to develop a workshop at the conference in 2004 in San Francisco. “Had it been in the Midwest I may have had more difficulty getting approved,” she says.

She conducted a lot of research, including phone and in-person interviews with Little People asking about their sexuality. She couldn’t find real, helpful information in libraries, bookstores, or online: “I thought, well I am going to have to create content myself.” Naccarato hired an illustrator to draw up a manual with 17 alternative sexual positions that would make sex not only easier, but more pleasurable for Little People. She called it, “Heighten Your Sensuality & Intimacy: Innovative Techniques for the LP Body,” a resource manual used in conjunction with her workshops. It addressed everything from living with a disability, chronic illness, and injury, to LQBTQ topics, to explicit details of techniques, sexual positions, and even personal hygiene. In addition, it tackled the broad topics of intimacy and sensuality, body image issues, safe sex resources, and even topics like how to kiss, how to have non-intercourse sex, and how to simply embrace or caress another.

“I put together a booklet with all kinds of sexuality information that I thought was helpful and it was about intimacy and sexuality and how to cherish yourself and your partner and how to bridge that gap,” she explains. “And it included terminology, words people weren’t using in their language. Genital words—vagina, penis, orgasm, all of these things.”

She quit her job at the IRS and has since become something of a sex education mogul. She is a board certified clinical sexologist, has a doctorate from the Institute for Advanced Study of Human Sexuality, and certification as a sexuality educator from the American Association of Sexuality Educators, Counselors, & Therapists, where she was a speaker last month. She also serves on the board of the American College of Sexologists, was recently featured on Playboy Radio, and is a sex and disability blogger for sex-positive pioneer Betty Dodson’s website

Naccarato is the first in her field to extensively study the sexual needs specific to the Little People community on the physical, emotional, and psychosocial level. “She is really a true pioneer in her own right,” says Dr. Patti Britton, a mentor to Naccarato and the co-founder of Sex Coach U. “She is the first person I know of in the Little People community who has had the courage and the wherewithal to design and implement programs and materials designed specifically for the Little People community around their specific sexual needs.”

Naccarato’s doctoral studies showed that among other issues, 20 percent of Little People have trouble reaching their genitals with their own hands without using assistive devices. “There are tools,” she explains. “Dressing sticks, bottom wipers—there are tools to help in their everyday routine to help manage all of this. That is another [question I asked] when they couldn’t reach their genitals—‘How did you manage your sexuality as an adult?’ There was a gap that may occur in that development where some maturity is not had.” Sixty-seven percent of the Little People in Naccarato’s studies who could not reach their genitals felt that sex was very important. “This is so critical,” Naccarato explains, “because it tells me that Little People do want more satisfaction in their sex life even if they are physically limited, and are receptive to change and education.”

According to the Little People of America website, there are roughly 200 types of medical dwarfism. A Little Person is usually 2’8” to 4’8” in height, but it varies. On average, they are 4 feet tall with a wide range of difficulty in medical conditions.

“When I speak regarding Little People,” Naccarato says, “there are Little People who don’t consider themselves disabled because they don’t have any really strong physical limitation—but most Little People do. There is a variety, a spectrum.” Some have no medical limitations—they are just short. And some have more difficulty than others. Typical issues that affect sex and sexuality include arms that are too short to reach and touch one’s genitals, hip rotation limitations that prevent the possibility of straddling, and severe spinal stenosis that can often result in paralysis from the waist down.

“I have been involved with Little People of America since I was 9 years old and I have attended numerous conferences and workshops,” Naccarato says. “[I’ve heard] everything under the sun about how we can better our lives and how we can help each other understand adaptive tips and things, but no one talks about sex. They will talk about marriage, they will talk about relationships, or parenting, or adopting, or having children—medical aspects, social aspects.”

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Merissa Nathan Gerson is a freelance writer and sex educator based in the Bay Area.

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