A Desire for Love: Considerations on Sexuality and Sexual Education of People With Intellectual Disability in Poland

Sexualidade e Bem‐Estar nas Pessoas com Deficiência Intelectual Moderada: Estudo Tranversal

Introdução: A deficiência intelectual (DI) tem sido negligenciada ao longo dos tempos, ganhando notoriedade nos últimos anos através de estudos que visam melhorar a qualidade de vida destas pessoas. A sexualidade é um dospontos que mereceu atenção, pela falta de conhecimentos existente, pelas poucas experiências positivas e sentimentos negativos em relação à sexualidade das pessoas com DI. A grande expansão deste tema ocorreu quando surgiram casos de VIH e frequentes abusos sexuais, nestas pessoas. Pretendemos com este estudo identificar as associações entre indicadores de sexualidade e bem‐estar das pessoas com DI, bem como avaliar os níveis de conhecimento, experiência, necessidades e atitudes relacionadas à sexualidade, e a vulnerabilidade ao abuso sexual em situações de coação sexual. Material e Métodos: O estudo envolveu 86 pessoas com DI moderada (49 homens e 37 mulheres), com idade igual ou superior a 18 anos, não institucionalizadas, da zona Norte de Portugal. Os instrumentos utilizados foram o Sexuality Knowledge, Experience and Needs Scale for People with Intellectual Disability (SexKen‐ID), que avalia questões relacionadas com a sexualidade, e o Personal Wellbeing Index – Intellectual Disability (PWI‐ID), que avalia o bem‐ ‐estar pessoal. Resultados: Os resultados sugerem que as pessoas com DI apresentam níveis baixos de conhecimento, de experiência, necessidades elevadas e sentimentos negativos face à sexualidade. No que diz respeito a situações de abuso sexual, indicaram uma baixa capacidade de responder de forma assertiva. Não foram encontradas correlações estatisticamente significativas entre a sexualidade e o bem‐estar das pessoas com DI. Conclusão: A falta de conhecimentos em sexualidade deixa as pessoas com DI mais vulneráveis, motivo pelo qual é crucial implementar programas de promoção do bem‐estar e educação sexual, a fim de normalizar a expressão da sexualidade e aprimorar a capacidade para gerir sentimentos e lidar com situações de abuso sexual.

Analysis of the Differential Efficacy of the Reduced Version Over the Extended Version of an Affective-Sexual Education Program for Adults with Intellectual Disabilities

Recently, with the increase in demand, multiple intervention proposals aimed at improving the sexual health of people with intellectual disabilities have emerged. Among them is the SALUDIVERSEX program, which takes a positive approach to sexuality. It has an extended version, consisting of 16 sessions and whose efficacy has already been proven, and a reduced version of 10 sessions. Thus, the present study aimed to test the differential efficacy of the two versions. A total of 208 participants (103 women and 105 men) aged between 19 and 67 years (M = 37.23, SD = 10.66) completed a battery of instruments before and after the intervention. Statistical analyses showed that users who participated in the reduced version of the program presented a significantly higher rate of improvement in their sexual behaviors compared to those who participated in the extended version (Sexual response: β₁₀ = - 0.46 ± 0.19, p = .034; Sex practices: β₁₀ = - 0.52 ± 0.23, p = .037; Use condoms: β₁₀ = - 1.56 ± 0.59, p = .017), as well as a significantly higher decrease in the risk of suffering sexual abuse (β₁₀ = 3.95 ± 0.64, p < .001). However, no statistically significant differences in sexuality knowledge were obtained with respect to the improvement between the two versions (β₁₀ = - 0.09 ± 1.21, p = .94). Meanwhile, the professionals who applied the program found that those who participated in the reduced version, although they presented a significantly greater increase in their knowledge about privacy (β₁₀ = - 0.48 ± 0.08, p < .001), did not improve their concerns about their inappropriate sexual behaviors as much as the users of the extended version (β₁₀ = - 1.35 ± 0.21, p < .001). Thus, although both versions were effective, the reduced version seems to do so to a greater extent and in a shorter time, which makes it the more recommendable option.

Two pictorial tools for assessing the attitudes of Taiwanese male high school students with intellectual disabilities toward sexually offensive behavior

The purpose of this study was to develop two pictorial tools for assessing the attitudes of Taiwanese male senior high school students with intellectual disabilities toward sexually offensive behavior, focusing on cognitive distortion and victim empathy. A total of 181 male high school students at special education schools participated in this study. The validity and reliability were examined using exploratory factor analysis and Cronbach's alpha coefficient. For the cognitive distortion scale, 18 items grouped into three factors, rationalization, denial, and victim blaming, and explained 69.72% of the variance; for the victim empathy scale, 12 items grouped into two factors, the victim's feelings when the offensive behavior is perpetrated by another, and the victim's feelings when the offensive behavior is perpetrated by oneself, and explained 68.00% of the variance. The reliability was .96 for the cognitive distortion scale and .93 for the victim empathy scale. In conclusion, the two scales developed in this research were found to be reliable and valid tools for evaluating male students' attitudes toward sexually offensive behavior, and can also be used as reference material for courses in sex education.

Opinions of special education teachers on inappropriate sexual behaviors in adolescents with intellectual disabilities

Inappropriate sexual behaviors may be observed in individuals with intellectual disabilities (ID), especially during adolescence. There are several undesired consequences of exhibiting such behaviors in public spaces, such as schools. The competencies and attitudes of special education teachers, who are responsible for the education of individuals with ID, are of significant influence. This study was conducted to investigate the views of special education teachers working with adolescents with ID on inappropriate sexual behaviors exhibited in educational settings. Accordingly, semi-structured interviews were conducted with 12 special education teachers. The phenomenological research design, one of the qualitative research methods, and thematic analysis were used in this study. Five themes were identified after the analysis of the findings of the study, namely, common behaviors, teacher attitudes, teacher competencies, teacher interventions, and educational content. The findings were discussed on the basis of the relevant studies in the literature and a number of conclusions were reached. Accordingly, the inappropriate sexual behaviors that special education teachers encounter the most frequently are masturbation, undressing, and touching, and when these behaviors are exhibited aggressively, teachers have difficulty in intervening. Participants regard themselves to be incompetent in terms of sexual education and consider relevant educational content inadequate.

Determination of sexual developmental characteristics of adolescents with intellectual disabilities

This cross-sectional study was carried out in order to determine the opinions of mothers on sexual development in children with intellectual disabilities. The sampling of this study included mothers of children aged 10-19 years with moderate and severe intellectual disabilities. Of the mothers, 45.7% stated that they felt incapable of providing sexual education to their adolescent children with disabilities and 97.6% stated that they had received no information on this subject themselves. Based on the mothers' opinions, the mean score for the sexual development of adolescent children was 11.33 ± 16.18. In the sub-dimensions of sexual arousal (20.97 ± 5.71), sexual harassment (12.22 ± 3.13), sexual satisfaction (15.79 ± 3.85) and sharing sexual issues (12.74 ± 2.67) the mean score of the scale was found to be high. The knowledge levels of the mothers concerning the sexual development of their children with intellectual disabilities were found to be low, and they required education on this issue.

Attitudes towards sexuality and related caregiver support of people with intellectual disabilities: A systematic review on the perspectives of people with intellectual disabilities

BACKGROUND

Sexual health remains at risk for people with an intellectual disability. Attitudes towards sexuality, its support and education have an important role in promoting sexual health. The current review aims to provide an overview of the current research on supportive and restrictive attitudes towards sexuality and its support of people with intellectual disabilities themselves.

METHOD

A systematic review was conducted, searching across eight databases. The quality of the studies was assessed with the Mixed-Method Appraisal Tool.

RESULTS

Six themes emerged from the data: sexual behaviour, sexual identity, intimate relationships, barriers to sexual expression, sex education and support by caregivers. Supportive and restrictive attitudes were reported throughout.

CONCLUSIONS

Attitudes regarding sexuality of people with intellectual disabilities are heterogeneous and people with intellectual disabilities seem to be able to express their sexual desires, needs and attitudes. Findings allow for improved individual support and in-depth research questions.

Introducing sexual dysfunction in mental care

Introduction: People with any psychiatric disorder tend to have difficulties in responding sexually. However,sexual dysfunction (SD) is usually under-recognized, even the tightly hormonal and neuronal common connexions through the brain-sex axis. Multiple sources of resistance to SD assessment and intervention persist. Areas covered: The present review aims to underline the feasibility to introduce SD evaluation in patients with any psychiatric disorders, evaluating the potential mutual benefits of their management. Expert opinion: Women and men living with mental disorders frequently display sexual difficulties; however, some of them consider sexuality as a relevant parameter of their quality of life. In fact, SD as a side effect is a frequent reason for stopping the intake of medication. What is more, a holistic approach integrating sexual function could foster a better understanding of mental pathologies due to a common origin of pathogenesis. This could improve care quality, in keeping with the global tendency toward the development of personalized medicine. Consistently, the integration of SD assessment is highly recommended in mental health, all the more so when a psychotropic drug is prescribed. An expected consequence would be a reconstruction of the healthcare professional's consideration for the sexuality of people experiencing mental disorders.

[Sexual health and intellectual disability: a narrative literature review and its implications for nursing practice.]

Issues associated with affectivity and sexuality in the context of intellectual disability have recently been the subject of various interdisciplinary discussions in academia. In nursing, interventions in sexual health are supported with hesitation and those issues constitute a marginal field of nursing research. A narrative literature review was realized in order to establish a portrait of the knowledge produced on this topic in the last decade. This paper illustrates three specific research areas recently developed, namely issues related to sexual autonomy, contextual factors positively or negatively contributing to emotional and sexual life, and the experiences of people identified as having an intellectual disability in this regard. On the basis of these results, different issues related to sexuality and intellectual disability are discussed, including those associated with the negotiation process of affective and sexual life, parenthood as a mediator of emotional and sexual expression, and the inclusiveness issues of sexual diversity in health interventions. Implications for nursing are finally discussed in light of the recent development of its role in sexual health.

Sexuality, intellectual disability, and human rights legislation

Sexuality constitutes a central feature of what it is to be human, yet health practitioners, families, and caregivers frequently perceive romantic and sexually intimate relationships among persons with intellectual disabilities to be inappropriate tending to regard such individuals as either ‘asexual’ or ‘hyper-sexed’. A number of myths, stereotypes, and prejudices intersect in a manner that has deleterious consequences for persons with intellectual disabilities. This article reviews the literature on sexuality and barriers to sexual expression among persons with intellectual disabilities. Relevant legislative frameworks and human rights issues, in particular, the tensions between protecting persons with intellectual disabilities from exploitation, and the promotion of sexual autonomy also receive consideration. In addition, the article explores issues relating to competency to consent to sexual acts and concludes with a synthesis of the current knowledge.

An update on sexual function and dysfunction in women

Sexual function of women can be affected by many factors resulting in female sexual dysfunction (FSD). Sexual dysfunction is a common problem among women of all ages and has negative effects not only on their quality of lives but also on the sexual function and quality of life of their partners. It can also affect mental health of the entire family and society. Regarding the multidimensional nature of female sexual dysfunction and considering its consequences, this condition needs to be recognised in its early stages in order to prevent future consequences and impacts. This article discusses biopsychosocial aspect of female sexual function, classifications and risk factors of female sexual dysfunction and investigates current approaches to identify and treat this problem.

Sexual dysfunction and sexual quality of life among the physically challenged in the Kumasi metropolis, Ghana

Background

Despite the fact that the physically disabled have difficulties in many aspects of their lives, including sexuality, society often ignores these needs or assume that they have no such needs. This cross-sectional study therefore seeks to determine the prevalence of sexual dysfunction (SD) and its impact on the quality of life among persons with physical disability residing in the Kumasi metropolis, Ghana.

Method

This study was conducted among 235 persons with physical disability dwelling in communities within the Kumasi metropolis, Ghana between September 2011 and April 2012. All participants were evaluated by using a semi-structured questionnaire, the Golombok Rust Inventory of Sexual Satisfaction (GRISS) questionnaire and the Sexual Quality of Life questionnaire (SQoL). Self-designed semi-structured questionnaire was also administered to each consented study participant for socio-demographic information.

Results

The response rates were 72% and 63.6% for male and female respectively. The age range of the male was 19–74 years with 61.1% being married whilst the age range of the female was 20–66 years with 54.3% being married. 30% and 7.1% of the male and female respectively consumed alcohol beverage. The mean Sexual quality of life (SQoL) score was slightly higher in the females (57.7 ± 15.8), ranging from 25.6 to 97.8. Univariate analysis of the male data showed that the only significant factor that tends to increase the male SD was alcohol (OR: 24.6; CI: 1.4 - 14.9; p = 0.0071). The prevalence of SD was higher among the female populace (65.7%) compared to the 64.4% for the male populace though very closely comparable. Except for non-communication (NC) and anorgasmia (impotence in males), all other areas of difficulty had higher percentages in males than females.

Conclusion

The prevalence of sexual dysfunction among the physically challenged is comparable to prevalence rates in the able male and female population. This could impact significantly on their self-esteem and quality of life via avoidance, impotence and vaginismus thereby causing emotional distress leading to relationship problems. Alcohol increases the risk of developing SD by five-fold in physically challenged men.