Sexuality in ASD: The Female Profile

Background:  Current understandings of sexual development and sexuality of females with High-Functioning Autism (HFA) are limited, and drawn only from few clinical anecdotes and qualitative case reports. Recent systematic reviews and meta-analyses suggest that females with HFA report poorer overall levels of sexual functioning and experience more sex-related problems and harassment than males with HFA and TD counterparts.

Objectives:  The objective of this study was to quantitatively investigate sex differences in sexual development and sexuality in males and females with HFA, in order to confirm qualitative accounts that suggest poorer sexual and romantic functioning for females in this group.

Methods:

Participants consisted of 232 individuals with HFA (97 males; 134 Females; 1 unreported [M = 25 years]) and 227 non-clinical controls (66 males; 161 females [M = 27 years]). Demographic information, self-reported levels of personal wellbeing, and sexual and romantic functioning were assessed using the SBS-III a 236-item online questionnaire that measures a range of social, sexual and romantic domains across 14 subscales.

Results:

While controlling for age, analyses confirmed the hypotheses that females with HFA would report poorer levels of overall sexual and romantic functioning and adverse sexual experiences across a range of sexuality domains than males with HFA.

Males with HFA reported overall greater engagement in a range of sexual behaviours, and thus a greater level of sexual experiences than females with HFA F(1, 209)=11.41, p<.001, =.05. Females however, were found to be more subject to a range of negative and adverse sexual experiences than males with HFA, where they reported greater instances of being victims of unwanted sexual advances F(1, 209)=25.84, p<.001, =.01, and engagement in sexual behaviours with others that they either did not want to F(1, 209)=15.95, p <.001, =.07, or regretted doing so following the event F(1, 209)=14.53, p <.001, =.07.

While there were no significant differences in the level of engagement in sexual behaviours between females with HFA and TD females, females that met diagnosis reported less interest in sex and sexual behaviours F(1, 283)=7.20 p <.01, =.03, fewer reported experiences of any form of sexual attraction to another person F(1, 283)=6.46, p <.05, =.02, and greater instances of bullying or victimisation due to having less sexual knowledge and experiences than other same aged peers than TD females F(1, 283)=8.82, p <.001, =.03.

Analyses revealed that males with HFA reported greater instances of both casual romantic experiences (dating, courting) F(1, 220)=6.05, p<.05, =.03; and being previously or currently involved in a romantic relationship F(1, 220)=8.26, p <.01, =.04.

Conclusions:

The data confirm existing qualitative case reports that suggest females with HFA are subject to a range of adverse experiences in their pursuit of a healthy sexual development and sexual life. While results are preliminary, they warrant the importance of further investigation in order to identify the sex-specific challenges and concerns that are unique to females on the spectrum, and urgency in developing targeted sex education programs and services that meet the needs of this diagnostic group.