Consumer sexuality may be a challenging subject for clinical professionals working with people with developmental disabilities. Persons with disabilities often need more help in understanding bodily changes and the emotions and drives that accompany these changes. Adequate knowledge and understanding of their bodies and of the choices available to them will help protect people both from exploitation and from unwittingly offending others.
Appropriate education and counseling, including information about the right to refuse sexual advances, is the best protection from sexual exploitation. Frequently, clinical professionals are called upon to provide guidance on sexuality issues to persons with developmental disabilities, their families, and caregivers as a component of clinical practice. Some family members or care givers may be reluctant to discuss sexuality issues as (1) they deny consumers' sexuality, (2) they report not knowing what to say or how to say it, or (3) they fear that talking about sexuality will promote sexual behavior. The Arc of the United States has chronicled research noting that a lack of knowledge and education poses a greater risk of potential exploitation. Education should be provided to consumers, family members, and caregivers. Two goals of sexuality education should be:
- To help the consumer learn to be assertive in protecting the privacy of their own bodies; and
- To learn to report violations to trusted adults.
Sexual information should be stated concretely, unambiguously, and repeatedly to consumers. Most importantly, it must be tailored to the specific level of understanding of each consumer. Recommendations for clinicians who are called upon to provide information on sexuality include:
- Base the amount and level of information on what each consumer can understand. Establish how much the consumer knows and supplement it accordingly. Work with family members and caregivers who may be unsure of their ability to gauge how much the consumer can understand to present sexual information to the consumer on an individual basis.
- Ensure that education, healthcare and support regarding sexuality is tailored to meet the needs of each consumer.
- If the consumer needs additional supports, involve a counselor or therapist as needed. Discuss any additional needs with the Service Coordinator from the Regional Center who will know what resources are available and how to arrange for the services needed.
- Respect the values and concerns of both the consumer and their family.
- Use pictures or other training materials to illustrate, especially for people who have limited receptive language skills.
Strategies to Decrease the Risk of Sexual Exploitation
In order to decrease the risk of sexual exploitation, objectives of sexuality education for consumers with developmental disabilities should include the following:
- Teaching how to express physical affection in a manner that is appropriate to the chronological age of the consumer. Discuss how to express physical affection that conforms to family and societal standards.
- Discouraging inappropriate displays of affection, such as hugging strangers.
- Expressing clear expectations that their behavior conforms to family and societal standards for privacy and personal modesty.
- Teaching the difference between acceptable behaviors in a private setting and those acceptable in public.
- Teaching the right to refuse to be touched at any time, to refuse unwanted sexual advances, and to report when they have been touched inappropriately.
- Encouraging consumers to discuss their questions and concerns about sexuality, and other sexually related issues such as menstruation for females and nocturnal emissions for males, with people they trust.
- Teaching them that prostitution (trading sex for money, gifts, etc.) is both illegal and dangerous.
- Teaching them that just because someone says something nice to them, that is no reason for having sex with them.
- Teaching them that if you have sex with a stranger, there is a good possibility they have had sex with others. This increases the risk of getting a disease, such as HIV.
Symptoms of Sexual Exploitation
It is important to be able to recognize when sexual abuse or sexual exploitation has occurred. Some common symptoms exhibited by people who have been victims of sexual exploitation include:
- Bleeding, bruising, infection, scarring or irritation of the genitals, rectum, mouth or breasts. Genital pain or itching. Difficulty walking or sitting.
- Torn, stained or bloody underclothing.
- New fears. Sudden avoidance or fear of certain people, places, genders, or situations. Fear of strangers or strange situations. Fear of being alone .
- Social or emotional withdrawal. Depression. Unprovoked crying spells.
- Sexually transmitted diseases.
- Changes in personal hygiene. Taking an excessive number of baths. Urinating or defecating in clothing.
- Resistance to physical examination.
- Sexually inappropriate behaviors. Compulsive masturbation. Promiscuity. Hints about sexual activity. New or detailed understanding of sexual behavior.
- Changes in sleep patterns. Sleep disturbances. Nocturnal Enuresis. Nightmares.
- Fantasies dealing with victimization or violence.
- Clinging to a significant adult.
- Running away.
- Loss of appetite. Weight gain or loss.
- Ongoing or unexplained medical problems like stomach pains and headaches.
- Refusal to participate in school, work, or social activities. Changes in work performance.
- Significant behavioral changes. Acting out, attention seeking, aggression. Self-destructive behavior.
- Substance abuse.
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