Sexuality and Gender Issues in Individuals with Autism Spectrum Disorder

Key points

Sexual behavior

Sexual behavior involves a wide range of behaviors and activities with sexual or romantic intent.⁹ Used to express and experience one’s sexuality toward oneself or a partner, such behaviors include, but are not limited to, masturbation, kissing, oral sex, and sexual intercourse.¹⁰ Studies investigating sexual behaviors within ASD consistently show that most individuals engage in solitary sexual behaviors. Masturbation is the most commonly reported form of sexual behavior, observed by caregivers

Sexual victimization

Studies investigating sexual experiences within ASD have identified an increased risk of sexual victimization and abuse.^23,40,41 Much of the literature documenting cases of sexual victimization has been drawn from child and adolescent samples.^40,42 Within all reviewed studies, significantly higher rates of sexual abuse (16.6%)⁴⁰ and coercive sexual victimization⁴² have been observed among youth with ASD than among the broader population (11.5%⁴³). Among adults, those with ASD are between two

Sexual orientation

Sexual orientation is a multidimensional construct comprising the domains of sexual identity, sexual interests, sexual attraction, and sexual contact.^9,22 Each domain is distinct from one another. Each influences an individual’s underlying sexual preference toward others.¹⁸ There is a considerable body of research citing a higher prevalence of nonheterosexual orientations in ASD than in the general population.^2,12,29,60, 61, 62

Initial observations of this increased prevalence were drawn from

Gender identity

There is evidence that individuals with ASD present with more diverse gender identities than the broader population. Gender identity refers to the self-identified gender conception of oneself,⁶³ the breadth of gender nouns is considerably greater than male, female, or transgender (see Ref.⁶⁴ for a listing). When there is incongruence between an individuals’ gender identity and biologic sex, an individual may identify along a spectrum of a gender identity.^65,66 An individual’s gender identity is

Gender and sexual diversity: underlying explanations

Various hypotheses have been proposed to explain the increased gender and sexual diversity among individuals with autism. Neurobiologic theories point to the influence of increased exposure to fetal testosterone, and its links with autistic traits, and neural masculinization.⁸⁶ Prenatal exposure to testosterone has been associated with an increased development of male-based traits, behaviors, and sexual preferences, particularly in females with ASD.^83,86 However, the fetal testosterone theory

Clinical implications

It is important to recognize that impairments in the social and communication domains of functioning, together with a lack of sexually appropriate education, and a desire for a romantic or sexual relationship are contributing to the range of problematic sexual behaviors identified in this review. Not all individuals with ASD express problematic sexual behaviors. The identified challenges experienced by individuals with ASD reflect the inherent need for developmentally appropriate sexual

Disclosure

The authors have nothing to disclose.