Talking to young people with cognitive disabilities about sex

Education about sex and sexuality is important for all children and teenagers. Young people with an intellectual disability have the same range of sexual thoughts, attitudes, feelings, desires and fantasies as young people without disabilities. Yet, they often have fewer opportunities to engage in age-appropriate sexual activity than others of the same age.

When people with an intellectual disability express their sexuality, it is often seen as a ‘problem’. Sex education is sometimes withheld, even though people with an intellectual disability experience sexually transmissible infections (STIs), unplanned pregnancy and sexual abuse at higher rates than the rest of the population.

It is important that all young people are educated about sex and given the chance to explore, enjoy and express their sexuality in positive and healthy ways. Sex education also provides the opportunity to learn protective behaviours.

Sexual development

Most young people with an intellectual disability begin puberty at the same age as other young people and experience the same physical and hormonal changes. A young person with an intellectual disability, however, may need more education and support to understand and manage these changes.

Young people with higher care needs may need extra education and support to express their sexuality in positive ways. For example, it may be important to explain the concepts of ‘public’ and ‘private’ and to make it clear which behaviours are appropriate in different places.

Increased risk of sexual harm

People with an intellectual disability experience all forms of abuse, including sexual abuse, at higher rates than the rest of the population. Without adequate sex education and an understanding of protective behaviours, they may also be at increased risk of STIs and unplanned pregnancy.

Some of the reasons for this increased risk include:

• Lack of knowledge about sexual issues
• Misinformation about sex from peers, rather than books or other reliable sources
• Lack of intellectual ability to understand the changes happening to their bodies
• Misplaced trust in others due to increased dependence on others for assistance
• A tendency to be overly compliant, particularly those children requiring a high level of support
• Lack of assertiveness training or skills
• An overprotected lifestyle and limited social contact.

Sex education may be discouraged by some parents and carers

Some common reasons are given for not educating young people with an intellectual disability about sexuality:

• There is a misconception that young people with an intellectual disability don’t need sex education because they will always remain ‘child-like’ and therefore non-sexual.
• Some parents fear a young person with sexual knowledge will be more likely to experiment with sex and have an unplanned pregnancy, contract an STI or ‘get into trouble’ in some way. The underlying hope is that a young person who doesn’t know about sex will have no desire to express their sexuality. In fact, the reverse is true.
• Some parents find it difficult to discuss sex, and this can be more difficult if the young person has a disability.
• The parents may have tried to talk to their child about sex, but weren’t able to express the information in a way the young person could understand. Failed attempts may cause the parents to give up.

Common learning difficulties

It can be hard to explain the physical, emotional and social aspects of sex to a young person with an intellectual disability.

Some common learning difficulties include:

• Learning at a slower rate
• Communication issues
• Limited literacy skills
• Difficulties with abstract thinking and comprehension
• Trouble relating the ideas to their own life experience.

Aspects of sex education

Ideally, sex education should include information about:

• Self-esteem
• Building the social skills to develop and maintain relationships
• Public and private body parts, places and behaviours
• Different types of relationships
• Personal safety – protective behaviours
• Coping with relationship difficulties or rejection
• Sex and relationships, including marriage and parenting
• The changes of puberty, both physical and emotional
• Menstruation
• The physical mechanics of sex, including reproduction
• Appropriate and inappropriate expressions of sexuality
• Sexually transmissible infections
• Safer sex
• Contraception
• Masturbation
• Same-sex attraction.

The benefits of sex education

Some of the documented benefits of sex education for young people with an intellectual disability include:

• Increased social skills
• Improved assertiveness
• Greater independence
• An ability to take greater responsibility for their sexuality
• Reduced risk of sexual abuse, STIs and unintended pregnancy
• The language to report an incidence of abuse
• Changes to behaviour, such as adopting more acceptable expressions of sexuality
• Healthier choices
• Less chance of risk-taking behaviours.

The right time to introduce sex education

Suggestions include:

• A child is never too young to learn proper names for body parts, including genitals, or about ‘public’ and ‘private’
• Parents should look out for times when the young person expresses interest or curiosity in sex – for example, if they see actors kissing in a movie on television and start asking questions
• Sex education is an ongoing process, not a single lecture. Young people should be given basic information first and then other topics should be introduced as they mature.

Where to get help

• Your GP (doctor)
• Sexual Health Victoria (SHV). To book an appointment call SHV Melbourne CBD Clinic: (03) 9660 4700 or call SHV Box Hill Clinic: (03) 9257 0100 or (free call): 1800 013 952. These services are youth friendly.
• Yooralla Community Learning and Living Centre Tel. (03) 9916 5800
• Scope Victoria Tel. (03) 9843 3000
• Disability Intake and Response Service Tel. 1800 783 783
• Merri Health provides relationship and sexual health education for people with intellectual disabilities and those on the autism spectrum. Tel: 1300 637 744