Sexual Risk Profiles for Male and Female Adults on the Autism Spectrum

Background:

Many adults with ASD are interested and engage in sex and relationships. However, research suggests they have lower sexual knowledge than neurotypical adults and learn about sex from questionable sources. For adults with ASD, lower sexual knowledge has been linked to higher probability of past sexual victimization, and with higher incidence of engaging in inappropriate courtship and/or sexual behavior. Beyond this, little is known about the sexual risk profiles of adults with ASD, including potential gender differences, complicating the provision of effective sex education and healthcare.

Objectives:

1. Examine gender differences in sexual orientation, prevalence of sexual activity, and relationships.
2. Investigate risks, including (a) sexual behavior and provision of sexual healthcare (e.g., STI testing), (b) technology-mediated sexual behaviors (e.g., sexting, online dating, viewing sexually explicit material or SEM), and (c) sexual victimization.

Methods:

Adults with formal ASD diagnoses (N=216, M age=22.5, SD=3.17), recruited from a national database, completed an anonymous online survey about sexuality, relationships, health, and the Autism Spectrum Quotient (AQ). 32% of the participants identified as female (n=70), 5.5% as transgender (n=12), and 62.6% as male (n=137, 62.6%). Analyses included Pearson Chi Squares and logistic or linear regression models.

Results:

1. As expected, women were more likely than men to identify as LGB (30% vs. 11%) or asexual (20% vs. 11%, p=.001). Controlling for age and AQ score, women were 2.5 times more likely to report current relationship of >3 months duration (40% vs. 14% of men, p<.001) and rated romantic relationships as a more important priority (p<.01). Women were also more likely to report history of intercourse (53% vs. 25%, p<.001).
2. Sexual health: Among participants with history of partnered sexual behavior (n=94, 44%), few reported STI diagnosis (3%), yet only 52% had been tested due to anxiety (“too scared”) or simple lack of knowledge. Only 41% reported using a condom at last intercourse for reasons including embarrassment and committed relationships. Technology-related risks: Participants engaged in normative technology-mediated behaviors, including sexting photos (25% vs. ~50% in neurotypical samples) and online dating (35%). While common, these carry risks easily addressed through education (e.g., 42% of participants who sexted did so as minors). While 92% of online daters reported positive experiences, some (n=9) experienced sexual coercion or assault. Similar to neurotypical samples, most participants (76%) had used SEM. Most reported no problems associated with SEM, but 13% of users reported SEM caused misunderstandings about sex and 26% found it difficult to stop using SEM. Sexual victimization: 8% of participants had first sexual contact ≤ age 14, and 16% reported unwanted first sexual contact (no gender difference; p=.07).

Conclusions:

Young adults with ASD are less likely to report history of partnered sexual behavior compared to neurotypical adults, yet are affected by various sexual health risks. These findings demonstrate the importance of healthcare providers, schools, and parents collaborating to provide evidence-based sex and relationship education that targets these specific risks and accessible healthcare. Finally, these gender differences suggest that sex research with male-only samples may not generalize to women.