Sex Education for Individuals with I/DD

Sexual Education is known to be a vital part of education that many people with disabilities do not receive. The National Council on Independent Living (NCIL) developed an excellent series of youtube videos aimed to help close this gap. The sex ed for individuals with I/DD project is a 10 part video series that can be seen on youtube. The project contains videos that discuss a range of important sexual information from healthy relationships and consent to how to use a condom. The videos also contain self advocates. Understanding that individuals with disabilities are sexual beings and informing such individuals on all sexual topics is extremely important. The NCIL’s video series is an amazing resource. Linked below is the introduction video to the series. The videos can also be accessed though the Nation Council on Independent Living youtube channel.

NCIL Sex Education for Individuals with I/DD Project video one

Accessible Lingerie

In a world of increasing accessibility, more and more clothing brands have begun producing products with accessible modifications. Unfortunately, undergarments and lingerie are important categories often forgotten. Individuals with disabilities are sexual beings and have the right to feel confident in their own bodies just as able-bodied individuals, and accessible underwear is a major factor in this.

In order to shine a light on these hidden categories, it is important to understand what accessible undergarments aim to do. Accessible underwear provides clothing that can be used by individuals with disabilities; Understanding that not everyone can use common closures or typical underwear styles. Accessible lingerie is also a growing category.

Slick Chicks, a growing adaptive underwear business, is a prime example of a company combatting this issue and empowering individuals with disabilities. The company sells a variety of accessible underwear and includes many images and videos to show just how easy it is to use their garments. They are specialized for women who may be in wheelchairs or have limited mobility but can be used to improve the accessibility of underwear for many individuals.

Another excellent resource is Devovere, an Etsy shop, aiming to provide lingerie that is made for you. Through custom orders an individual can request front-facing closures or adjusters, velcro closings rather than clips or buttons, extra fastenings, and more for no extra price. The owner of the company identifies as disabled and has set out to make inclusive clothing.

https://www.etsy.com/shop/DevovereOnline

https://slickchicksonline.com

AUCD: Sex Talk for Self-Advocates

The Association of University Centers on Disabilities has created an incredible resource for self-advocates to gain sexual information and advice through a webinar series. The first episode of Sex Talk for Self-Advocates contains a panel of sexual educators answering questions about relationships and sexuality posed by self-advocates. Important questions such as “How do you know if someone is your boyfriend or girlfriend? What exactly does consent mean? How to be gay?” are discussed. The webinar series can be accessed through the AUCD website, linked below, or by going to AUCD network’s youtube channel. The presentation slides containing information from the video can also be found on the AUCD website. Sex Talk for Self Advocates is a great free resource that contains informed speakers and spreads sexual education to a diverse group of individuals.

The link to AUCD network is attached above, containing a preview of the webpage.

Wait, What: A Comic Book Guide to Relationships, Bodies, and Growing Up

The recently released comic book, “Wait, What: A Comic Book Guide to Relationships, Bodies, and Growing Up” by Heather Corinna and Isabelle Rotman gives insight to a sexuality, gender, and related issues in an inclusive and fun format. From the publishers:

“Join friends Malia, Rico, Max, Sam and Alexis as they talk about all the weird and exciting parts of growing up! This supportive group of friends are guides for some tricky subjects. Using comics, activities and examples, they give encouragement and context for new and confusing feelings and experiences.

Inclusive of different kinds of genders, sexualities, and other identities, they talk about important topics like:

– Bodies, including puberty, body parts and body image
– Sexual and gender identity
– Gender roles and stereotypes
– Crushes, relationships, and sexual feelings
– Boundaries and consent
– The media and cultural messages, specifically around bodies and sex
– How to be sensitive, kind, accepting, and mature
– Where to look for more information, support and help

A fun and easy-to-read guide from expert sex educators that gives readers a good basis and an age-appropriate start with sex, bodies and relationships education! The perfect complement to any school curriculum.”

Sexuality and Disability: A Guide for Women with Disabilities

Sexuality and Disability is a free blog dedicated to providing a resource for women with disabilities. The blog answers questions pertaining to sex, the body, relationships, and more in a safe and open discussion. The welcome statement of the website encompasses this;

“Our site starts with the premise that people with disabilities are sexual beings – just like anyone else. sexualityanddisability.org is constructed as a bunch of questions a woman with a disability might have – about her body, about the mechanics and dynamics of having sex, about the complexities of being in an intimate relationship or having children, about unvoiced fears or experiences of encountering abuse in some form.”

Sexuality and Disability also includes an award-winning section that appeals to many individuals with disabilities that contains stories from the point of view of an individual with a disability and gives an in depth and realistic view on sexual topics.

Image depicts the webpage described in the post, Sexuality and Disability.

High School Human Sexuality 101 Week 2- Anatomy

FemaleReproductiveSystem_Lateral_250w

Anatomy and Reproduction were the topics for week 2. We started off the session with a game called “Parts and Post-it Notes” to talk about body parts with the participants. To play this game we had a giant piece of paper with the outline of a body on it. We gave the participants post-it notes to write down the body parts that they knew and asked them to place them on the outline of the body.

After this activity, the participants were told that for the rest of the class they would be focusing on body parts related to reproduction (another way to refer to sex organs or private parts). The participants were then directed to the next activity where they practiced saying terminology related to reproduction out loud and recording their responses to how saying the words made them feel.

When the participants finished the terminology activity, we spit them into two groups to start the fruit anatomical model of reproductive organs using fruit. The participants were shown a picture of the parts of the body and were giving tooth picks and flash cards to label the fruit parts and their functions. This activity was great for the participants to learn the vocabulary in a little abstract and safe way! For a more concrete example of reproduction, we used the “Miracle of Life” video to explain the process.

We ended this session by having the participants briefly summarize that they learned during the session.

For more information on anatomy view our Human Sexuality 101 Week 2- AnatomyEXPLAINING ANATOMYYOUTUBE EDUCATIONAL RESOURCES: HEALTHCHANNEL, SEXPLANATIONS, AND CSPHADULT HUMAN SEXUALITY WEEK 2- ANTATOMY & REPRODUCTION posts

This Week’s Materials

Week 2 Lesson Plan

Week 2 Slides

Parent Letter

Worksheets

Anatomy labels

High School Human Sexuality 101 Week 3: Body Image Lesson Plan

IMG_20120718_152104This lesson plan revolved around teaching what body image means, understanding that people feel differently about their bodies, and that people change how they feel about their bodies over time.  After doing several knowledge based activities, we moved to exploring how the students felt about their own bodies.

There was one theme that was really relevant for the student we were working with.  She was really interested in her perception of self and others perception of her.   In her self-portrait, she focused on the things that make her her; most of these were things you couldn’t see.

We also read body stories.  Each had a picture of a body.  Just seeing the images was really moving.  We were planning mostly for girls, but I included a story that might be more appropriate for a male audience.  The young woman chose to read the story about the women who was the most traditionally beautiful (not really a big surprise).  This was a story about a woman with chronic illness.  Serendipitously, the body story resonated concepts that this student was working through.

Materials

Lesson Plan

Slides

Parent Letter

Body Stories (all female) from This is Who I Am by Rosanne Olson (her website is http://bodyimagebook.com)

Body Story (male)

Dove Clip

Sexual Violence: How to Protect and Prevent

Here are some resources about sexual violence, including crisis hotline information:

Sexual Violence and Disabilities Resources:

Sexual Abuse of Children with Autism: Factors that Increase Risk and Interfere with Recognition of Abuse: A free-to-access report on sexual abuse and children with ASD.

People with Intellectual Disabilities and Sexual Violence: A brief report on signs of sexual violence involving people with intellectual disability.

Guardianship, Sexual Assault, and Rape Kit Rights: A previous post of ours which highlights policy changes involving issues with guardians, sexual assault, and the right to release a rape kit.

Promoting Justice: An Essential Resource Guide for Responding to Abuse Against Children with Disabilities: This guide discusses abuse and neglect toward children with many types of disabilities, including neurodevelopmental, physical, sensory, brain injury, and mental health disabilities.

General Sexual Violence Resources:

Rape, Abuse, and Incest National Network: General resource about rape, abuse, and incest. There’s a lot of information, but not all of it is specific to people with intellectual disability.

The National Child Traumatic Stress Network: Parenting resources on sexual abuse in English and Spanish.

The National Domestic Violence Hotline: A great resource on domestic violence and abuse issues, along with contact information for hotlines and other related services.

You Are in Charge of Your Body: A video series aimed at young children to identify and understand sexual abuse and how to communicate these incidents to adults. It also teaches children to take charge of their bodies.

Sexual violence comes in many forms and it can be difficult to distinguish them. Here’s a basic guide on how to classify types of sexual violence.

Sexual Harassment: Giving someone unwanted sexual attention. This can include touching someone’s body without their explicit permission, asking for sexual acts, and catcalling, which is an unwelcome, sexually charged comment.

Rape: Forced vaginal, anal, or oral sexual intercourse. Rape lacks clear consent. Rape can occur by strangers or people you know, even a partner. Sometimes, power is used to coerce a person into sexual intercourse. In these case, usually a person declines sexual advances and is then guilted into intercourse.

Statutory Rape: Sexual intercourse with a person who is a minor or not at the age of consent (which varies by state and country). Get more information on statutory rape and the age of consent here.

Incest: Sexual acts between people who are related. This can be siblings, parent-child, uncles/aunts and nephews/nieces.

Domestic Violence: Violence between two people in an intimate partnership. This includes threats and acts of violence (i.e. battery).

Stalking: When a person repeatedly follows, watches, or harasses someone for a long period of time. This can include excessive phone calls (i.e. five phone calls in one hours) and giving gifts.

So, how can we prevent sexual violence and protect ourselves and others against it?

Understanding sexual violence: By understanding the types of sexual violence, it can be easier to identify and understand how it can affect yourself and others.

Speak out if something doesn’t feel right: If you are feeling that you have been part of a sexual act that did not make you feel good or that you did not want to do, telling someone you trust or contacting a sexual assault survivor’s line can help clarify the situation.

Teach consent as a mandatory step in all sexual situations: Consent is a fancy way of saying “yes, I would like this to happen.” By giving consent, you are allowing another person to touch your body. You can tell them what you are and are not comfortable with (i.e. “I do not want to do vaginal sex, only oral”). Understanding that consent can change at anytime during the interaction is also important and can be overlooked. It’s okay to say “stop, I don’t want to have sex anymore.”

Here’s a quick video about consent, including examples of what consent looks like.

Intimacy Activity

This activity can be used to teach about different intimate activities, either alone or with a partner. All of the actions come in a word list form and in a visual form. The activity includes a continuum worksheet in which  activities can be classified as “less intimate” and “more intimate”.

One way to use this activity is to teach what sex is.  We often assume that people understand what sex is, but people have difficulty with understanding sex even when it is explained.  First list the acts of intimacy in a continuum and then discuss “where sex starts” or “which activities are sex and which ones are not.  This is more difficult than it seems.  For example, it is not uncommon for students to start with thinking that “kissing above the waist over the clothes” is sex. When we teach this activity, we encourage students to express their own understanding of what is more or less intimate but because the concept of a spectrum is difficult, we guide them at the anchors of what is the most inmate and least intimate.  By seeing sex in the context of different sexual activities it helps fill in some of the gaps.

Instead of a continuum you could use categories- the categories we use help reinforce the idea of a continuum as well.  There is also a list of different levels of intimacy that can be used to classify these activities. Using the activity in this way is consistent with the concept of postponement- postponing intercourse until a relationship is more serious of formalized.

Sometimes when people see all the different acts of intimacy  they are surprised but it is important to be inclusive of all different forms of sexual expression.  We also don’t use all the different acts with every group, but we’ve given you a pretty comprehensive list that you can tailor to meet your student or child’s needs.

Download the intimacy activity intimacy activity pictures or with just words.

Levels of Intimacy

Levels of Intimacy

YouTube Educational Resources: Healthchannel, Sexplanations, and CSPH

YouTube has a lost of great sexuality education resources but it can be hard to find among all of the “not safe for work” content.  Here’s a few channels and videos that might be useful.  One of the most difficult tasks sex educators report is explaining intimate acts.  This can be uncomfortable and difficult so I’ve tried to focus on these difficult to teach topics.  The videos may not be the best fit for the person/people you’re working with, but they can give you an idea where to start.  The channels also have great resources for expanding your own education on sexuality topics.


 

The Center for Sexual Pleasure and Health (CSPH) has a lot of great videos.  Is one of my favorite cites.  In addition to having direct information they also have videos for parents (“Use Your Words” videos).

Healthchannel is a YouTube channel with short videos on a variety of health care issues including sexual health resources including a few I’ve listed below.  The videos aren’t prefect.  They don’t feature animations with people with disabilities and focus on heterosexual couples, but they give very precise, clear information.

Sexplanations is another YouTube channel.  They have mini episodes on human sexuality topics from shared sexual behavior to STDs to anatomy.  Again the videos aren’t perfect.  They move a little too quickly than I would like, but I’ve selected a few I think could be helpful.  They could also be good to expand your own understanding of various topics.

 

Affirming Sexual Expression- Accessible Sex Toys

I’m just going to be honest. I think sex shops can be a little creepy.  It really pushes my comfort zone to support someone purchasing sex toys not because I’m uncomfortable with the individual I’m working with’s sexual expression- I’m uncomfortable the sexual of expression of general patrons of the store.  Usually the line between sexual exploitation and sexual affirmation is a nice, clear, thick, black line. But in a sex store it’s gets blurrier and it can be difficult to navigate.  It pushes me to think about my own biases, but at the same time I don’t think all sex shops affirm sexuality equally.

comeasyouare2That’s part of the reason I was so glad to stumble upon “Come As You Are”.  The other reason is because they actually know things about serving people with disabilities.  “Come As You Are” is a sex shop located in Canada (great for Torantoins, but less than great for Illinoisians).  They have a wonderful website, are knowledgeable about people with all different abilities, and are responsive to questions.  If you know of place that is safe and accessible or at least responsive to the needs of individuals with disabilities, please share.

The store was featured in this video which I found to be very enlightening in regards to things to consider when supporting someone with purchasing a sex toy.  For one, I wasn’t really aware of some of the options out there.   The video also goes into several was to match ability needs with sex toy functioning.  I will warn you that streaming quality is not that great, but the content is excellent.


Another thing to think about is the use of wedges and ramps for sexual exploration and sexual expression.  The Liberator is probably the most popular line of sexual furniture.  They look just like the wedges used in the exercise room of our day program (except the ads all have beautiful scantily clad women on them).  Using tools for sexual positioning may be the only way some individuals can participate in intercourse or other sexual activities.  The how to use videos on their website are more erotic than instructional.  There are videos online geared toward instruction.  They are explicit, but the participants are fully clothed throughout.  Click here for the male positioning and here for female positioning.

Communicating About Sexuality Adaptively

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It can be a little overwhelming to start thinking about communicating pictorially about human sexuality topics, but there are some supports available.

Many of you already use Board Maker (computer software that helps make visual supports and PECS).  They have a “Communicating About Sexuality” add on that is very useful and only costs $15.00 (but you have to already have Board Maker).

If you would like some guidelines on how to approach augmentative and alternative communication (AAC) in regards to sexuality Speak Up has resources that you may find useful.  Speak Up is a group dedicated to preventing sexual abuse/victimization among people who use alternative communication.  They have guidelines, suggestions for communication displays, and information about building sexual vocabulary.  This group surveyed individuals who use AAC and found that ACC users say they need:

  • People who recognize that they are sexual
  • Information about sexuality
  • Vocabulary to communicate about sexuality
  • People to communicate with about sexuality
  • Accessible resources and services

Sounds pretty darn reasonable to me.

 

The Ultimate Guide to Sex and Disability

the guideThis book by Miriam Kaufman, Cory Silverberg, and Fran Odette is eye opening.  It’s written by people with disabilities for people with disabilities and focuses on the joys of sexual intimacy.  As a typically developing person, it challenged a lot of my assumptions about sex and made me think about new things.  Chapters include: Myths About Disability and Sex; Desire and Self-Esteem; Sexual Anatomy and Sexual Response; Communication; Sex with Ourselves; Sex with Others; Oral Sex, Penetration and Positioning; Sex Toys, Books, and Videos; Yoga and Tantric Sex; S/M; Sexual Health; Sexual Violence and Sexuality; Resources; and Glossary of Gender and Sex Terms.   I want to share two passages with you.

Sex and Spontaneity

“We’re taught that sex is suppose to be spontaneous, something that just comes naturally (like ‘true love’).  This belief is damaging to everyone, but is a real problem for people living with disabilities, because any amount of planning makes sex not spontaneous.  Believing in this myth pretty much ensures a lously sex life.
While sex has many meanings, at its heart sex is a process of communication.  Whether we are flirting from across a crowded room, giving someone head for the first time, or making love while listening to a piece of music that totally turns us on, being sexual is being in contact with ourselves and our surroundings.  The idea that this process can happen without thinking, talking, or planning is ridiculous.
Maybe we are willing to buy into the myth of sexual spontaneity because talking about our desires is difficult.  It’s risky, and makes us feel exposed and vulnerable, and often vulnerability is equated with weakness.”

This made me think a lot about the way I teach reproduction and sexual intimacy.  I tend to focus a lot sexual behavior, but not as much on the planning and communication that comprises that behavior.  Also, I do a lot of role playing, planning out what you’re going to say in advance, and scripting.  I’ve never really done that around negotiating intimacy.

Privacy

“If we were taught anything about sex at all when we were younger, many of us learned that sex was something private, inappropriate to talk about or do in front of others.  Privacy becomes a requirement for sexuality.
From someone living in an institution, or using attendant services, or needing the assistance of someone else to facilitate communication, privacy is a completely different reality.  The definition of privacy changes when you have no lock on your door, or when you request private time at a specific hours knowing that it will probably be written down in a log-book.  This myth is one of those ‘no-win situations,’ because we’re told that real sex is a private matter and, guess what, you can’t have that kind of privacy.”

This passage really challenged me to think about how I teach privacy and how I teach about relationship types.  I think sometimes I might ignore that what a lot of people think of as privacy and the individual I am working with reality of privacy are two disparate things.

I do wish this book focused a little more on people with intellectual disability and was written at lower reading level.  I do think people with ID/DD could read it with support, especially sections.  Much of the book is testimonies by people with disabilities and I think these passages could be great teaching tools.  There are also suggested exercises- one of the exercises was about looking at your body.  I teach antimony all the time, but I don’t think I’ve ever said, “when you’re at home, alone in your bedroom, look at and feel your body and check out the parts we’ve been talking about, you can even use a mirror.”

Facilitated Sex

What is facilitated sex?  This brief video explains what facilitated sexual activity is and some of the considerations.

Dr. Mitchel Tepper is an expert in the area of sexual health, disabilities, and medical conditions with a specific focus on physical disabilities.  His website can connect you with a lot of great information (I especially like his blog).

Some things to keep in mind about facilitated sex…

  • Facilitated sex is a continuum.  Dr. Sarah Earle suggests it might include providing sex education, fostering an environment that allows intimacy, the procurement of sexual goods,  and arranging for paid-for sexual services.
  • Many individuals with disabilities would be unable to participate in many parts of sexual expression without some level of facilitation.
  • It’s not that abuse and victimization aren’t concerns- they are!  It is also important to consider how to support individuals with exploring sexual pleasure and sexual facilitation is part of that picture.

Sexual Health- Pelvic Exams

Many women with development disabilities are under anesthesia during pelvic exams or don’t get them at all (or as recommended).  However, educating about pelvic exams may be an important part of teaching sexual health.  I’ve included the link to a video that may help.

This is a brief video that goes through the basic procedure of a woman having a pelvic exam.  This could also be a good video for teaching about female anatomy.  It has a lot of technical terminology but it also moves nice and slow.