Many aspects of Autism Spectrum Disorder (ASD) still remain unexplored. One of these aspects is sexuality of individuals with ASD.
Recent research has started to shed some light on the questions that arise when sexuality of individuals with ASD is observed. The following is an overview of the most recent research, focused on hypersexual and paraphilic behavior in women and men with high-functioning autism spectrum disorder (Schöttle, Briken, Tüscher, and Turner, 2017).
What is ASD?
Autism, or Autism Spectrum Disorder, refers to a range of conditions characterized by challenges with social skills, repetitive behaviors, speech and nonverbal communication, as well as by unique strengths and differences. Accordingly, there is not one type of ASD but many types, caused by different combinations of genetic and environmental influences. Hence, the term “spectrum” was introduced into the terminology. This term reflects the wide variation in challenges and strengths possessed by each person with ASD.
When it comes to ASD’s prevalence, the 2018 National Autism Spectrum Disorder Surveillance System (NASS) Report estimated it as 1 in 66 children in Canada. This includes 1 in 42 boys and 1 in 189 girls. Based on this, it is assumed that the male-to-female-ratio is between 3 and 4 to 1, and there exist particular gender differences in ASD when it comes to its presentation.
Sexuality in Autism
As it was mentioned previously, individuals with ASD, among other things, significantly struggle with appropriate social functioning. These struggles, more specifically social interaction and communication deficits and difficulties in seeing the perspective of others and intuitively understanding nonverbal social cues, constitute hidden barriers to the development and maintenance of romantic and sexual relationships. Due to these disturbances, sexuality-related problems can arise, especially at the start of adolescence. Adolescence presents a time when individuals with ASD start to struggle with keeping up with increasing social expectations. Hence, challenges of forming and maintaining romantic and sexual relationships become particularly apparent.
In addition to challenges in forming and maintaining romantic and sexual relationships, which arise from deficits in social and communication skills and the difficulties in understanding nonverbal or subtle interactional cues and with empathy, individuals with ASD often do not receive sexual education that takes their behavioral peculiarities into consideration, and they also seem less likely to get information on sexuality from social sources. This factor may have an especially strong effect on the severity of challenges individuals with ASD experience.
Another factor affecting the severity of challenges individuals with ASD are intense restricted and repetitive interests, which may be non-sexual in childhood but can transform into and result in sexualized and sexual behaviors in adulthood. In addition to this, any sensory sensitivities can lead to overreaction or underreaction to sensory stimuli in the context of sexual experience. Therefore, for example, some individuals with ASD may experience soft physical touches as something unpleasant, while some of them may experience the same touches as something arousing and reach orgasm.
When everything is taken into account, the ASD symptomatology, limited sexual knowledge, and challenges in forming and maintaining romantic relationships can result in individuals with ASD developing challenging or problematic sexual behaviors, such as hypersexual and paraphilic behaviors, and even sexual offending.
So far, not many studies have addressed these hypersexual or paraphilic behaviors in individuals with ASD. However, the ones that did primarily focused on males and, in most cases, cognitively impaired ASD individuals. These studies indicated that ASD individuals frequently show behaviors such as excessive masturbation, exhibitionistic behaviors, pedophilic fantasies or behaviors, fetishistic fantasies or behaviors, sadomasochism, or other forms of paraphilias.
Gender Differences and Sexuality
When it comes to gender differences, it seems that female individuals with ASD experience fewer challenges in forming and maintaining romantic and sexual relationships. More women that man with ASD report being in a relationship, even though men report higher desire to be in a dyadic relationship than women. One possible explanation for this is the ability of female individuals with ASD who often all on more advanced strategies that lessen their disturbances in social functioning. Therefore, for an example, female individuals with ASD will often imitate social skills of their non-ASD peers, leading to less social impairment. However, it is important to note that this seems to be true mostly for highly ‘functioning female individuals with ASD, as cognitive delays have a significant detrimental impact on their compensatory strategies.
Addressing the Issues
When it comes to addressing potential issues that individuals with ASD can face when it comes to the area of sexuality, the journey seems very complex.
The first step in addressing the issues is obtaining an appropriate diagnosis, as due to wide variation in challenges and strengths possessed by each person with ASD, ASD can end up undiagnosed.
Once the ASD diagnosis is made, appropriate and timely psychoeducational interventions are needed to help individuals with ASD learn about their sexuality and how appropriately address it. This is often best achieved through consultations with professionals, skilled in this area of concern. Often, appropriate and ongoing psychiatric consultation is needed as it can provide some assistance to individuals with ASD in managing their sexual urges, as well as giving them more control over how the fulfill these urges.
Schöttle, D., Briken, P., Tüscher, O., and Turner, D. (2017). Sexuality in autism: hypersexual and paraphilic behavior in women and men with high-functioning autism spectrum disorder
Sexuality in autism: hypersexual and paraphilic behavior in women and men with high-functioning autism spectrum disorder. Dialogues Clin Neurosci, 19(4): 381–393.