Puberty and Sexuality for Teenagers with Disabilities

Oh, man. This is such a tough topic! Sexuality for kids with disabilities is definitely something that makes a lot of people uncomfortable. What many people don’t realize is that occupational therapists are very qualified to address sexuality. It’s an ADL right next to dressing, toileting, or feeding. However, being qualified to address it and feeling comfortable addressing it are two different things. It has definitely taken me some time to figure out how to best address issues of sex and disability, especially with a younger population. I wrote these tips with parents in mind, but I hope they are useful for OTs as well!

• Consider typical milestones.
  • Don’t assume that because a person has a disability that they’re not interested in sexuality! Most people are interested in sex, and this doesn’t change just due to the presence of a disability. 
  • It’s typical for most teenagers to start exploring their sexuality – disability or not. 
• Use a specific curriculum designed for students with disabilities.
  • This is a great place to start – try to choose a curriculum that addresses both biological aspects of sex (anatomy) as well as social (consent).
  • Carry this language through across contexts – both school and at home. This will help students generalize concepts. 
  • Curriculum Example
• Get comfortable with having frank conversations.
  • Talking about sex can be awkward! But your child is relying on you to help them understand this information.
  • Think of all the other places a child might get information about sex – friends, the internet, other media. Be proactive! Have these discussions before they learn information that is incorrect, outdated, or potentially harmful. 
  • Your child likely already has questions about sexuality even if they haven’t brought it up. Very often, parents need to be the one to start the conversation.
  • It may help to practice what you want to say to a partner or friend first.
• Use visuals.
  • Many students benefit from having visuals to learn, especially for a topic like this where they likely don’t see all the topics in real life. 
  • No cute clip-art here! Use real (scientific) pictures/video when appropriate, and detailed illustrations when not. 
• Teach anatomically correct terms.
  • First and foremost, this helps prevent sexual assault. Children need to be able to describe what’s happening to them to the best of their abilities. They can’t do this when they are using vague euphemisms for genitalia or sex. 
  • This also helps concrete thinkers learn appropriate norms, i.e. “It’s okay for me to touch a friend’s shoulder, but not their breast.”
• Use Social Stories.
  • In one research study, Social Stories were used successfully to help teenagers with autism learn to manage their periods.
  • Social Stories can also be used to teach appropriate behavior, such as where it is okay to be nude. 

• Teach and practice consent.
  • Especially for students who are not abstract thinkers, this needs to be very concrete and explicit. 
  • Model what consent looks like, i.e. asking before touching someone. You can practice this at home with a partner by modeling appropriate consent before both sexual (kissing) and non-sexual (shoulder patting) touch. 
  • Don’t force your child to hug people! When we do this, we teach our children that their bodies are not their own. We teach them that even though they may not to touch someone, if a person with authority tells them to, they have to do it. This sets up children to be more vulnerable to sexual assault. 

• Discuss masturbation with your child.
  • Teach appropriate norms, such as where masturbation should occur and where it shouldn’t. This is another great area to use a Social Story!
  • It’s important to make sure to not impart shame on your child, especially if they have already started masturbating in an inappropriate way, such as in public. Teach them that the act itself is not shameful, but it must be done in private. Be very explicit about what private means – typically at home, in your bedroom, with the door closed. 
  • If your child has a physical disability, they may not be able to masturbate manually, but could be successful with vibrators or other masturbation aids. This is another frank conversation that you may have to be the one to bring up. Other physical accommodations may be needed down the road if your child plans to have sex with other people. 
• Consider alternative menstrual hygiene strategies.
  • Pads can be very difficult for students with disabilities to learn to use, especially because many students require daily practice to become successful with a novel task like this. And hopefully, your child isn’t menstruating every day! But it does make it more challenging to become practiced with a task. 
  • Some students are more successful with period underwear. These specialized underwear collect menstrual blood in the same way that a pad would without the extra steps. Management is as simple as changing the pair of underwear 1-2x a day! After use, rinse the underwear off in the sink or shower and then wash as normal with the rest of the laundry. I’ve had many clients who were much more successful with these than any other type of period management. If your child can independently don/doff their underwear, they can manage their period!
  • You can also check in with your child’s doctor to see if they have any medications that might help, especially if your child has a very heavy or painful flow. 

I hope these tips were helpful to consider! Sex can be a very tricky topic to discuss, and adding disability into the mix doesn’t make it easier. But I promise, the more you practice, the more comfortable you become when bringing up conversations like these. My biggest piece of advice is to be proactive about this topic. As an OT, I often don’t get brought into these situations until something negative has happened. Many people don’t think of sex until their student is masturbating in class or touching others inappropriately. Heading off these behaviors with education before they even begin is the right approach to take. Do you have more questions? Let’s continue the discussion at my online group.

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