Sexual Counseling and Autism

A recent blog written by Maureen Bennie of the Autism Awareness Centre, starts in the following fashion:

“Sexuality for those on the spectrum can be a heated topic. We have a hard-enough time talking about appropriate behavior and boundaries around sex and sexuality even as adults, let alone to children who might have issues around general appropriate behavior and boundaries to begin with. Common issues around inappropriate sexual behavior are: inappropriate touching of others, excessive masturbation, masturbating in public, dangerous forms of masturbation, masturbation that doesn’t result in climax increasing frustration, public nudity, discussion of inappropriate topics at inappropriate times, and a lack of knowledge on how to navigate sexual feelings and urges. So how do we deal with growing hormonal feelings and establish ground-rules for children on the spectrum?

I encourage our readers to read Maureen’s blog in its totality. This is a great essay promoting awareness of sexuality in autism while simultaneously providing practical advice for both parents and individuals in the spectrum.

Developing an interest in sex is normal and can be a very positive experience, but a difficult one in the case of autistic individuals.  There are many relationship guides on the internet focusing on autism.  I will not dwell on that aspect of counseling in this blog. Rather I will emphasize two important aspects for autistic individuals: sexual assault and sexually transmitted infections (STI).

People with disabilities are at a greater risk of sexual assault.  Sex counseling helps to mitigate that risk.  Please read my previous blog on sexual abuse and autism:.

Some behaviors indicative of sexual abuse include:

  • An increase in nightmares and/or other sleeping difficulties
  • Angry outbursts
  • Anxiety/Depression
  • Propensity to wander or run away (Note: See wondering prevention tips at https://www.autismspeaks.org/wandering-prevention-tips-our-community)
  • Refusal to change for gym or to participate in physical activities
  • Regressive behaviors depending on their age (e.g., return to thumb-sucking or bed-wetting)
  • Reluctance to be left alone with a particular person or people
  • Unusual and inappropriate sexual knowledge for the age of the child
  • Withdrawn behavior

The Committee on Child Abuse and Neglect from the American Academy of Pediatrics (AAP) encourages physicians, “…to routinely ask adolescents, including those with disabilities, about a history of sexual violence, dating violence, and sexual assault.”  Prompt and proper action by the physician diminishes the likelihood of future assaults, reduces the stigma, decreases long-term negative outcomes, and provides appropriate medical, psychological, and supportive care.

50% of adolescents have had sex by the time they are 16.  This figure increases to 75% by the time they are 19.  Average age of first sexual encounter is 16.  Individuals aged 15 to 24 account for 27% of the sexually active population and, moreover, account for 50% of the new STI in US each year. STIs are quite common in this population and if undiagnosed may lead to infertility.  From 16 to 18 years of age HIV requires an “opt out” screen by your physician (meaning that unless you opt out you will be screened).  After 18 this screening is based on sexual activity.

STD sgns

Screening recommendations for women under 25 are for annual chlamydia and gonorrhea. If at high risk it includes syphilis, trichomoniasis, HBV, and HCV.  For relationships involving men with men you have to screen based on site of intercourse -screening is recommended at least annually.  For genito-rectal intercourse we screen for chlamydia, and for genitorectal/pharyngyal intercourse examine for gonorrhea. In all of these cases we also do syphilis and HIV.

Confidentiality and State Law vary according to State.  In South Carolina sexual consent is 14 years, while health care consent is 16 years. Report to Law Enforcement are mandatory in all states for syphilis, gonorrhea, chlamydia and AIDS.  The state of South Carolina also requires reporting of HIV and Haemophilus ducrey (Chancroid).

References

Sexual abuse and autism

LGBT and autism: what does it means to be different?

Autism screening for potential health problems

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