Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review Article
  • Published:

The role of metaverse on sexual health of people with disabilities: narrative review

International Journal of Impotence Research (2023)Cite this article

Subjects

Abstract

Metaverse is the implementation of an Internet-based hypothetical meta-universe, which should facilitate an immersive experience in meeting people, working, shopping and other leisure activities. Immersive reality makes it possible to feel involved in a virtual environment using the mechanism of the “embodied simulations”, i.e., the capacity to evoke a sense of presence in a specific reality, whether real or imagined. The growing interest in the metaverse suggests exploring how this new kind of communicative space could be used to provide and guarantee sexual entertainment and/or education for people with disabilities. Through a thematic analysis, we aimed to define the theoretical framework and analyze scientific literature on this subject. Our purpose is to provide a comprehensive picture of the use of metaverse as a tool for sexuality, and of the possible benefits of such technologies for people with disabilities. To this end, we have also discussed a major topic, related to the Sexual Assistants, examining how their possible application can be implemented within the context of augmented reality. Our study further explores the importance of the metaverse in sexual education. Finally, we addressed the issue of cyber security as well as possible threats and negative consequences linked to metaverse misuse.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: The “Metaverse Roadmap” includes the definition of four types of metaverse.

Similar content being viewed by others

References

  1. Stephenson N. Snow Crash. New York: Bantam Books; 1993.

  2. Smart JM, Cascio J, Paffendorf J. Metaverse roadmap overview. Pathways to the 3D web. A cross industry public foresight project. 2007.

  3. Rahaman T. Into the Metaverse – Perspectives on a New Reality. Med Ref Serv Q. 2022;41:330–7.

    Article  PubMed  Google Scholar 

  4. Riva G, Wiederhold BK, Mantovani F. Neuroscience of Virtual Reality: From Virtual Exposure to Embodied Medicine. Cyberpsychol Behav Soc Netw. 2019;22:82–96.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Park JY, Lee K, Chung DR. Public interest in the digital transformation accelerated by the COVID-19 pandemic and perception of its future impact. Korean J Intern Med. 2022;37:1223–33.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Lamba S, Obedin-Maliver J, Mayo J, Flentje A, Lubensky ME, Dastur Z, et al. Self-Reported Barriers to Care Among Sexual and Gender Minority People With Disabilities: Findings From The PRIDE Study, 2019-2020. Am J Public Health. 2023;113:1009–18.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Franco DG, Cardoso J, Neto I. Attitudes Towards Affectivity and Sexuality of People with Intellectual Disability. Sex Disabil. 2012;30:261–87.

    Article  Google Scholar 

  8. Oloidi EO, Northway R, Prince J. ‘People with intellectual disabilities living in the communities is bad enough let alone…having sex’: Exploring societal influence on social care workers’ attitudes, beliefs and behaviours towards support for personal and sexual relationship needs. J Appl Res Intellect Disabil. 2022;35:1037–48.

    Article  PubMed  Google Scholar 

  9. Jannini EA. SM = SM: The Interface of Systems Medicine and Sexual Medicine for Facing Non-Communicable Diseases in a Gender-Dependent Manner. Sex Med Rev. 2017;5:349–64.

    Article  PubMed  Google Scholar 

  10. Limoncin E, Galli D, Ciocca G, Gravina GL, Carosa E, Mollaioli D, et al. The Psychosexual Profile of Sexual Assistants: An Internet-Based Explorative Study. PLoS One. 2014;9:e98413.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Döring N, Mohseni MR, Walter R. Design, Use, and Effects of Sex Dolls and Sex Robots: Scoping Review. J Med Internet Res. 2020;22:e18551.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Cox-George C, Bewley S. I, Sex Robot: the health implications of the sex robot industry. BMJ Sex Reprod Health. 2018;44:161–4.

    Article  PubMed  Google Scholar 

  13. Fosch-Villaronga E, Poulsen A. Sex care robots. Paladyn. 2020;11:1–18.

    Google Scholar 

  14. Ferguson CJ, Hartley RD. The pleasure is momentary…the expense damnable? Aggress Violent Behav. 2009;14:323–9.

    Article  Google Scholar 

  15. Evans L. Virtual Reality Pornography: a Review of Health-Related Opportunities and Challenges. Curr Sex Health Rep. 2022;15:26–35.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Dekker A, Wenzlaff F, Biedermann SV, Briken P, Fuss J. VR. Porn as “Empathy Machine”? Perception of Self and Others in Virtual Reality Pornography. J Sex Res. 2021;58:273–8.

    Article  PubMed  Google Scholar 

  17. Di Lorenzo G, Longo L, Jannini TB, Niolu C, Rossi R, Siracusano A. Oxytocin in the prevention and the treatment of post-traumatic stress disorder: A systematic review of randomized controlled trials. Giornale Italiano di Psicopatologia. 2020;26:107–18.

  18. Milani S, Jabs F, Brown NB, Zdaniuk B, Kingstone A, Brotto LA. Virtual Reality Erotica: Exploring General Presence, Sexual Presence, Sexual Arousal, and Sexual Desire in Women. Arch Sex Behav. 2022;51:565–76.

    Article  PubMed  Google Scholar 

  19. Slater M. Place illusion and plausibility can lead to realistic behaviour in immersive virtual environments. Philos Trans R Soc B. 2009;364:3549–57.

    Article  Google Scholar 

  20. Cheung JCW, Ni M, Tam AYC, Chan TTC, Cheung AKY, Tsang OYH, et al. Virtual reality based multiple life skill training for intellectual disability: A multicenter randomized controlled trial. Eng Regen. 2022;3:121–30.

    Google Scholar 

  21. Jung M, Sim S, Kim J, Kim K. Impact of Personalized Avatars and Motion Synchrony on Embodiment and Users’ Subjective Experience: Empirical Study. JMIR Serious Games. 2022;10:e40119.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Mello M, Fusaro M, Tieri G, Aglioti SM. Wearing same- and opposite-sex virtual bodies and seeing them caressed in intimate areas. Q J Exp Psychol. 2022;75:461–74.

    Article  Google Scholar 

  23. Shahzad HF, Rustam F, Flores ES, Luís Vidal Mazón J, de la Torre Diez I, Ashraf I. A Review of Image Processing Techniques for Deepfakes. Sensors. 2022;22:4556.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Balasubramanian SB, Jagadeesh Kannan R, Prabu P, Venkatachalam K, Trojovský P. Deep fake detection using cascaded deep sparse auto-encoder for effective feature selection. PeerJ Comput Sci. 2022;8:e1040.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Boháček M, Farid H. Protecting world leaders against deep fakes using facial, gestural, and vocal mannerisms. Proc Natl Acad Sci. 2022;119:e2216035119.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Su Z, Cheshmehzangi A, McDonnell D, Bentle BL, da Veiga CP, Xiang YT. Facial recognition law in China. J Med Ethics. 2022;48:1058–9. https://doi.org/10.1136/medethics-2022-108130.

    Article  PubMed  Google Scholar 

  27. Kikerpill K. Choose your stars and studs: the rise of deepfake designer porn. Porn Stud. 2020;7:352–6.

    Article  Google Scholar 

  28. Wasterlund M. The emergence of deepfake technology: a review. Technol Innov Manag Rev. 2019;9:39–52.

  29. van Minnen A, ter Heide FJJ, Koolstra T, de Jongh A, Karaoglu S, Gevers T. Initial development of perpetrator confrontation using deepfake technology in victims with sexual violence-related PTSD and moral injury. Front Psychiatry. 2022;13:882957.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Yang HC, Rahmanti AR, Huang CW, Li YCJ. How Can Research on Artificial Empathy Be Enhanced by Applying Deepfakes? J Med Internet Res. 2022;24:e29506.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Skarbez R, Neyret S, Brooks FP, Slater M, Whitton MC. A Psychophysical Experiment Regarding Components of the Plausibility Illusion. IEEE Trans Vis Comput Graph. 2017;23:1369–78.

    Article  PubMed  Google Scholar 

  32. Vahle NM, Tomasik MJ. Younger and Older Adults’ Cognitive and Physical Functioning in a Virtual Reality Age Manipulation. Front Aging. 2022;3:851687.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Kye B, Han N, Kim E, Park Y, Jo S. Educational applications of metaverse: possibilities and limitations. J Educ Eval Health Prof. 2021;18:32.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Carvalho Nascimento EC, da Silva E, Siqueira-Batista R. The “Use” of Sex Robots: A Bioethical Issue. Asian Bioeth Rev. 2018;10:231–40.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Massa N, Bisconti P, Nardi D. The Psychological Implications of Companion Robots: A Theoretical Framework and an Experimental Setup. Int J Soc Robot. 2022;28;1–14

  36. Limoncin E, Carta R, Gravina GL, Carosa E, Ciocca G, Di Sante S, et al. The sexual attraction toward disabilities: a preliminary internet-based study. Int J Impot Res. 2014;26:51–4.

    Article  CAS  PubMed  Google Scholar 

  37. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. APA; 2013.

  38. Mora C. Devotismo (atracción hacia las personas con discapacidad) y su relación con otras parafilias. Interam J Psychol. 2018;52:153–61.

  39. Peta C. Deafening silence on a vital issue: The World Health Organization has ignored the sexuality of persons with disabilities. Afr J Disabil. 2018;7:474.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Mannino G, Giunta S, La Fiura G. Psychodynamics of the Sexual Assistance for Individuals with Disability. Sex Disabil. 2017;35:495–506.

    Article  Google Scholar 

  41. Gammino GR, Faccio E, Cipolletta S. Sexual Assistance in Italy: An Explorative Study on the Opinions of People with Disabilities and Would-Be Assistants. Sex Disabil. 2016;34:157–70.

    Article  Google Scholar 

  42. Sevène A. Fonction sexuelle et handicap physique. Presse Med. 2014;43:1116–9.

    Article  PubMed  Google Scholar 

  43. Senese VP, Nasti C, Mottola F, Sergi I, Massaro R, Gnisci A. The Relationship Between Loneliness and Psychological Adjustment: Validation of the Italian Version of the Interpersonal Acceptance–Rejection Loneliness Scale. Front Psychol. 2021;12:655410.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Gilmore L, Cuskelly M. Vulnerability to Loneliness in People with Intellectual Disability: An Explanatory Model. J Policy Pr Intellect Disabil. 2014;11:192–9.

    Article  Google Scholar 

  45. Gallup GG & FDA. The Science of Sex Appeal: An Evolutionary Perspective. Rev Gen Psychol. 2010;14:240–50.

  46. Toto GA, Limone P. From Resistance to Digital Technologies in the Context of the Reaction to Distance Learning in the School Context during COVID-19. Educ Sci. 2021;11:163.

    Article  Google Scholar 

  47. Suh W, Ahn S. Utilizing the Metaverse for Learner-Centered Constructivist Education in the Post-Pandemic Era: An Analysis of Elementary School Students. J Intell. 2022;10:17.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Fromberger P, Jordan K, Müller JL. Virtual reality applications for diagnosis, risk assessment and therapy of child abusers. Behav Sci Law. 2018;36:235–44.

    Article  PubMed  Google Scholar 

  49. Wu L, Chen KB. Examining the Effects of Gender Transfer in Virtual Reality on Implicit Gender Bias. Hum Factors. 2022. 10.1177/00187208221145264.

  50. Ventura S, Cardenas G, Miragall M, Riva G, Baños R. How Does It Feel to Be a Woman Victim of Sexual Harassment? The Effect of 360°-Video-Based Virtual Reality on Empathy and Related Variables. Cyberpsychol Behav Soc Netw. 2021;24:258–66.

    Article  PubMed  Google Scholar 

  51. Neyret S, Navarro X, Beacco A, Oliva R, Bourdin P, Valenzuela J, et al. An Embodied Perspective as a Victim of Sexual Harassment in Virtual Reality Reduces Action Conformity in a Later Milgram Obedience Scenario. Sci Rep. 2020;10:6207.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. van Meggelen M, Morina N, van der Heiden C, Brinkman WP, Yocarini IE, Tielman ML, et al. A randomized controlled trial to pilot the efficacy of a computer-based intervention with elements of virtual reality and limited therapist assistance for the treatment of post-traumatic stress disorder. Front Digit Health. 2022;4:974668.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Loranger C, Bouchard S. Validating a Virtual Environment for Sexual Assault Victims. J Trauma Stress. 2017;30:157–65.

    Article  PubMed  Google Scholar 

  54. Kelson JN, Ridout B, Steinbeck K, Campbell AJ. The Use of Virtual Reality for Managing Psychological Distress in Adolescents: Systematic Review. Cyberpsychol Behav Soc Netw. 2021;24:633–41.

    Article  PubMed  Google Scholar 

  55. Majeed‐Ariss R, Rodriguez PM, White C. The disproportionately high prevalence of learning disabilities amongst adults attending Saint Marys Sexual Assault Referral Centre. J Appl Res Intellect Disabil. 2020;33:595–603.

    Article  PubMed  Google Scholar 

  56. Hershkowitz I, Lamb ME, Horowitz D. Victimization of children with disabilities. Am J Orthopsychiatr. 2007;77:629–35.

    Article  Google Scholar 

  57. Burns PA, Klukas E, Sims-Gomillia C, Omondi A, Bender M, Poteat T. As Much As I Can – Utilizing Immersive Theatre to Reduce HIV-Related Stigma and Discrimination Toward Black Sexual Minority Men. Community Health Equity Research & Policy. 2022. https://doi.org/10.1177/0272684X221115920.

  58. Lafortune D, Dion L, Renaud P. Virtual Reality and Sex Therapy: Future Directions for Clinical Research. J Sex Marital Ther. 2020;46:1–17.

    Article  PubMed  Google Scholar 

  59. Xue J, Hu R, Zhang W, Zhao Y, Zhang B, Liu N, et al. Virtual Reality or Augmented Reality as a Tool for Studying Bystander Behaviors in Interpersonal Violence: Scoping Review. J Med Internet Res. 2021;23:e25322.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Hadley W, Houck C, Brown LK, Spitalnick JS, Ferrer M, Barker D. Moving Beyond Role-Play: Evaluating the Use of Virtual Reality to Teach Emotion Regulation for the Prevention of Adolescent Risk Behavior Within a Randomized Pilot Trial. J Pediatr Psychol. 2019;44:425–35.

    Article  PubMed  Google Scholar 

  61. Ciocca G, Di Stefano R, Collazzoni A, Jannini TB, Di Lorenzo G, Jannini EA, et al. Sexual Dysfunctions and Problematic Sexuality in Personality Disorders and Pathological Personality Traits: A Systematic Review. Curr Psychiatry Rep. 2023;25:93–103.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Ilyina IA, Eltikova EA, Uvarova KA, Chelysheva SD. Metaverse - Death to Offline Communication or Empowerment of Interaction? In: 2022 Communication Strategies in Digital Society Seminar (ComSDS). IEEE; 2022. p. 117–9.

  63. Gorman TE, Gentile DA, Green CS. Problem Gaming: A Short Primer. Am J Play. 2018;10:309–27.

    PubMed  PubMed Central  Google Scholar 

  64. Sansone A, Sansone M, Proietti M, Ciocca G, Lenzi A, Jannini EA, et al. Relationship Between Use of Videogames and Sexual Health in Adult Males. J Sex Med. 2017;14:898–903.

    Article  PubMed  Google Scholar 

  65. Gil-Llario MD, Díaz-Rodríguez I, Morell-Mengual V, Gil-Juliá B, Ballester-Arnal R. Sexual Health in Spanish People with Intellectual Disability: the Impact of the Lockdown due to COVID-19. Sex Res Soc Policy. 2022;19:1217–27.

    Article  Google Scholar 

  66. Gao M, Geng B, Jannini TB, Wu J, Wang Y, Zhang Y, et al. Thalamocortical Dysconnectivity In Lifelong Premature Ejaculation: A Functional MRI Study. Urology. 2022;159:133–8.

    Article  PubMed  Google Scholar 

  67. Brown M, McCann E. Sexuality issues and the voices of adults with intellectual disabilities: A systematic review of the literature. Res Dev Disabil. 2018;74:124–38.

    Article  PubMed  Google Scholar 

  68. Wiederhold BK. Sexual Harassment in the Metaverse. Cyberpsychol Behav Soc Netw. 2022;25:479–80.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We are grateful to Sarah Janke Peart for reviewing the English language of the manuscript. AS and EAJ are partially supported by the PRIN 2017S9KTNE_002 grant and by the #NEXTGENERATIONEU (NGEU) grant funded by the Ministry of University and Research (MUR), National Recovery and Resilience Plan (NRRP), project MNESYS (PE0000006) – A Multiscale integrated approach to the study of the nervous system in health and disease (DN. 1553 11.10.2022).

Author information

Authors and Affiliations

  1. Dept. of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy

    Erika Limoncin, Benedetta Gaudio & Giacomo Ciocca

  2. Section of Endocrinology and Medical Sexology (ENDOSEX), University of Rome Tor Vergata, Rome, Italy

    Andrea Sansone & Emmanuele A. Jannini

  3. Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy

    Tommaso B. Jannini

  4. Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy

    Daniele Mollaioli

Authors
  1. Erika Limoncin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Benedetta Gaudio
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Andrea Sansone
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tommaso B. Jannini
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Giacomo Ciocca
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Daniele Mollaioli
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Emmanuele A. Jannini
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

EL and BG made the literature search, selected the papers, and wrote the manuscript. Revision of the manuscript has been made by AS, TBJ, GC and DM. The final revision of the manuscript has been made by EAJ. All the authors accepted the final version of the manuscript.

Corresponding author

Correspondence to Erika Limoncin.

Ethics declarations

Competing interests

All the authors, except from EAJ, declared to have no conflict of interest.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Limoncin, E., Gaudio, B., Sansone, A. et al. The role of metaverse on sexual health of people with disabilities: narrative review. Int J Impot Res (2023). https://doi.org/10.1038/s41443-023-00807-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1038/s41443-023-00807-0

Search

Advanced search

Quick links