CHAPTER 7: SEXUALITY

Sexual health is often overlooked in individuals with intellectual disabilities. They are very vulnerable to sexual abuse and may not understand what consenting to sexual activity means. They may not know how to express their sexuality. Sex education programs often include important discussions of normal expressions of sexuality such as masturbation, relationships, contraception, sexually transmitted diseases, and safe sex practices. These kinds of topics must also be part of the everyday conversations that take place between intellectually disabled individuals and the people in their lives. When individuals with intellectual disabilities are parents, they need a network of people around them and opportunities to learn about children’s development and showing appropriate affection to children.

Establishing boundaries in relationships can create safe psychological spaces. When individuals with an intellectual disability express their sexuality in inappropriate ways, their behaviour needs to be addressed just as it would be with non-disabled individuals. Open demonstrations of sexuality may be linked to mental illnesses and must be reported and discussed with other staff and health professionals. In some instances, the behaviour must be reported to police. Caregivers can model respectful behaviour that shows the difference between private and public actions. This is an important way for individuals with intellectual disability to learn about setting boundaries. Resources are available, such as picture cards and the Circle of Relationships activity.

Inappropriate expressions of sexuality are very serious. Whether they are open or violent, they can traumatize victims and leave offenders facing lifelong consequences. Different professional groups do not all agree on the best treatment approaches. Some view sexually violent behaviours that hurt others and interfere with quality of life for others as challenging. Others view these behaviours as sexual offending. Treatment approaches that view the behaviour as challenging will try to find out why individuals act this way, what the behaviour means, and how it meets an otherwise unmet need. When caregivers are involved, they will admit that the behaviour is unacceptable and hurts others as well as themselves. They will also recognize that the behaviour is occurring for a reason and they will guide individuals toward meeting their needs with more acceptable behaviours.

Treatment approaches that view the behaviour as sexual offending will not focus on what the behaviour means. Here, when caregivers are involved, they will still admit that the behaviour is unacceptable and hurts others as well as themselves. However, they will pay more attention to strategies that prevent the behaviour from re-occurring and to protecting all the people in the community that the individual interacts with.

Although views about treatment approaches are different and each individual is unique, inappropriate expressions of sexuality must all be reported, discussed, and addressed as a team.