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Supporting People with Learning Difficulties
in their sexuality
Sex and Learning Difficulties
Teaching Materials
Sex and Learning Difficulties
In recent years, major changes have taken place in the way we think about people with a
learning disability, and in our approaches to their needs and those of their families. We
now recognise that adults with a learning disability should be acknowledged as real adults
whose individual requirements need to be met without undue segregation.
Generally, everybody involved with the care of people with learning difficulties is ldeally
trained in this area, without exception. However, still those people with learning difficulties
are still abused and many left without full access to sexual expression.
One aspect of adulthood which most of us take for granted is the right to be sexually
active. There are two contradictory myths which contribute to people with a learning
disability not being included in this right:
People with a learning disability remain forever childlike and “innocent”, whatever
their actual age. We do not associate sexual expression with childhood; by
extension, we do not see it as appropriate for people labelled as having a learning
disability to express themselves sexually.
People with a learning disability may have very strong sexual drives and appetites,
but this may be accompanied by very poor self control, so that they can be a danger
both to themselves and to other members of society.
Neither of these ideas is helpful to people with a learning disability or to their parents and
All human beings are sexual beings. Sexuality is not an optional extra. Everyone has
sexual needs, feelings and drives. The question here is: How can we help people with
learning disabilities to channel their needs, feelings and drives to get pleasure and
enjoyment from their close personal relationships, and provide them with protection from
other encounters which are exploitative?
Learning about sexuality is a life-long and often haphazard process. Babies learn, from
birth onwards, about the bodily pleasure of being warm, being cuddled, being tickled and
interacted with. We learn from watching the ways in which our parents show affection to
each other; we learn from spoken and unspoken messages about private parts; also from
films, advertisements and soap operas on TV.
Sadly, it is often the case that youngsters with learning disabilities only get a very negative
form of sex education — “Don’t do that, it’s not nice!” “Stop touching yourself down there;
that’s bad!”
Not giving them any positive formal or sensible sex education does not mean that they
don’t pick up many enticing ideas — but they need more sex education than most young
people, in order to protect them from people who seek them out in order to exploit their
Ignorance is definitely not bliss. Not knowing how to behave or the consequences of
sexual activity, not knowing the difference between public and private behaviour, not
knowing you “own” your body and can say “no” to touches you do not like, leaves people
with a learning disability very vulnerable to getting into trouble, to abuse, or to exploitation.
Proper sex education is therefore a particularly important factor in helping people protect
themselves from abuse.
Children with a learning disability grow up. Although puberty may be slightly delayed for
those with profound or multiple disabilities, they go through the same process as any other
child: boys’ voices start to break, body hair starts to grow, girls begin their periods, boys
start to have wet dreams, mood swings become more extreme. All that is the biological
process of puberty, which cannot be stopped, even if sometimes parents would want it to!
However, adolescence is a social process whereby the youngster develops a personal
understanding of his or her adult social and sexual identity. Frequently we deny that period
of adolescence, and then adult status, to people with a learning disability. We cannot stop
their physical maturity, but often with the best of intentions, we stop or curtail their sociosexual development. The result is a person who is physically an adult, but who has the
social status of a child.
What is the alternative, given that the people we are concerned with do have varying
degrees of difficulty in learning and in understanding?
Broadly-based sex education at all levels
Access to counselling where necessary (for individuals and their families or carers)
Social skills training about appropriate behaviour
Consistency of response between home/residential unit and school/college/day
Social opportunities to enable people to make and maintain friendships and
Education and practical help to protect vulnerable people from sexual exploitation
by strangers on public transport and when out and about
Environments in which people with a learning disability are treated with dignity and
Sex education, in the context of social education and health education, is increasingly
being provided in ~ schools, on special needs courses in FE colleges, and in Day Centres.
Youngsters and adults with a learning disability can gain a great deal of individual and
social satisfaction from close personal and sexual relationships and in this they are no
different from anyone else. They may, however, need specific counselling on issues
relating to communication, contraception or parenting.
Care should be taken to ensure that there is liaison between home and educational or
work settings. Inconsistent responses only serve to confuse and make learning about
appropriate behaviour more difficult. For example, open masturbation is a frequent source
of worry to parents or staff. Masturbation is an extremely common human behaviour and is
not harmful — in fact it can help to relieve the tensions which spring from sexual feelings.
But persistent masturbation in public will get the individual into trouble. Careful and
consistent teaching and training is needed to make it quite clear that this is an activity
which should take place only in private.
Surveys have shown that people with a learning disability tend to lead very restricted lives,
only going out socially with members of their own family, or attending clubs where they mix
only with those from the same Day Centre. Those who venture out into the big wide world
face rejection and exploitation. If this is true for the person or people with a learning
disability that you know, try to consider how their social and leisure opportunities could be
safely extended.
Groups and clubs are at last starting up. People First is a network of groups around the
country run by and for people with learning disabilities, providing opportunities to socialise,
train and campaign.
To sum up, the vast majority of individuals with a learning disability develop normally
as sexual beings. They may need more help to understand the bodily and emotional
changes that occur as they grow up, but if we deny them the right to be sexual and
to make and break relationships their lives are much poorer. Difficulties can occur
when this happens and help should be sought from a qualified source. More
expertise and literature aimed at people with learning disabilities is required and we
are currently working on gathering this together.
The main dating club in Britain is Stars in the Sky and if there's no branch in your
area then type the words “disco, learning disabilities” and your local town into
google to find out what's available locally. Examples of the type of club you might
find are called Beautiful Octopus, Squidz Club, Funky Flamingo and Bubble
People First is a network of groups around the country run by and for people with
learning disabilities, providing opportunities to socialise, train and campaign.
Teaching Materials
Resources are kept up-to-date on
More resources can be found on
Living you Life— sex education and personal development resource for special
educational needs now up dated and revised by Brook
Talking together...about sex and relationships by Lesley Kerr-Edwards and
Lorna Scott 2003 fpa
Sex Education Forum leaflets
Respond London-based organisation working around abuse and learning
You and I a social skills programme for people with developmental disabilities
National Institute for People with Learning Disabilities, New York
Holding on Letting Go by John Drury, Lynn Hutchinson and Jon Wright 2000
Souvenir Press
Books Beyond Words a series of picture books produced by the Royal College of
Psychiatrists and St Georges Hospital Medical School for adults and adolescents
who cannot read or who have difficulty reading. Titles cover a wide range of
subjects, including falling in love, personal hygiene and health, and sexual abuse.
Suitable for 7 year olds and above
Downs Syndrome Scotland
The Council for Disabled Children
Elfrida Society
Secret loves, hidden lives? — exploring issues for people with learning difficulties
who are gay, lesbian or bisexual by David Abbott and Joyce Howarth. Policy Press
Speaking Up published a booklet Sex and Sexuality in 2006 by people with
learning difficulties.
The Sexuality & Sexual Rights of People with Learning Disabilities by Paul
Cambridge 1996 BILD
Sexual Health and Relationships —a review of resources for people with learning
disabilities 2005 Health Scotland
DVD called You, your Body and Sex deals with masturbation and privacy, is
animated and usefully explicit.
Sex 1998 BILD
Love Is...Highland Learning Disabilities and Relationships Group
Let's Talk About Sex — Growing Up, Changing Bodies, Sex and Sexual Health
2001 Walker Books
Cloth Sex Education Models Jane Fraser has updated her cloth models which she
sells for sex education for young people with learning disabilities.
PLD Frequently Asked Questions
My seventeen year old daughter with mild learning disabilities is in her final
year at school. She is going out after school and meeting up with boys from
school. How can I ensure she doesn't get pregnant when she denies she is
having sex, and won't talk about it?
Your daughter needs to have serious safer sex education so that she knows how to
keep herself protected from Sexually Transmitted Diseases , as well as from getting
pregnant. It will also give her the power to say "no" as well as "yes", and understand
what she is saying "yes" and "no" to. It will protect her from abuse. Your daughter
needs to absolutely understand the importance of insisting on safer sex at all times
with any boy/s she has sex with. Boys will want to have unsafe sex with her so she
needs to know how to have safe sex and insist on condoms.
If she won't talk to you, ask her school to organize some sex education, or bring in
an expert to spend time with the teenagers. That way, the boys will learn as well. It
is important that this education includes feelings and the social aspects. Image in
Action provides an education service in London and the South East. Staff can get
trained by the or other agencies — see Resources.
If the school is unwilling, you could perhaps find a professional counsellor to have a
session with your daughter. Spend time reassuring your daughter that you do
believe what she says, create an environment where she feels she feels totally
accepted, in the hope she'll welcome your caring and non-judgemental advice.
The FPA book "Talking Together About Growing Up" (Scott and Kerr-Edwards 1999)
might help.
My client, who has moderate learning disabilities, keeps exposing himself,
and the police are giving him one last chance.
Not knowing all the dynamics of this situation, what we say to health care
professionals is that perhaps they need to be doing two things:
Find an exciting new club where he may find a sexual relationship - this
would provide him with some hope. Social clubs for people with learning disabilities are
listed here.
Look at the behaviour of your client to see if there are patterns to when this unacceptable
behaviour is happening, which might indicate what brings it on. It could be boredom or
attention-seeking. Has he had good sex education about Masturbation ? He needs positive
reinforcement that Masturbation in a private place is OK. Discuss the situation with him,
emphasising the potential consequences of it happening again. If there is a Community
Learning Disability Team in the locality, get him a referral, as they may have trained
experts in this area.
Respond provide support and counselling for people with learning disabilities who have
such problems and we suggest you call their helpline on 0808 808 0700 (also textphone).
Also see their Help Site
Following a workshop on the subject, some of the women in our residential
home are showing an interest in finding boyfriends. However, they say they
have been put off sex by the behaviour of the men in our home, and they are
not interested in the men in the home.
Perhaps you (or a professional from outside) could do more workshops, perhaps
dividing the women and the men. The women may know little about their bodies
need encouragement to help them see that sex can be pleasurable. They need to
gain enough self esteem to enjoy their own bodies, and take an active role in sexual
encounters. The men need to look at the behaviour which is off-putting to women,
and how to improve it, perhaps using roleplay. The rest of their workshop could be
similar to the women's.
People usually look outside the immediate vicinity to find partners and it is quite
normal for people in the home to discard each other. Plus, it is sometimes better
people in the same residential home don't form relationships because what happens
when they split up? If possible, find a club or social group where the residents can
make new friends and perhaps meet potential partners. Hopefully, you can provide
the transport for them to get there and back safely. See our List of Clubs.
Alternatively, hold a social gathering and invite people from other homes to come
along. There are various schemes clubs use to provide social skills and STIHIV prevention training. Again, the Community Learning Disability team might help,
and a multi-agency plan may be the best way forward.
How can we provide sex education to a client who has profound learning
disabilities, has no speech and is blind? We feel it would benefit the client no
end, as they are expressing severe sexual frustration.
You need to be absolutely certain of the client's wishes first and again, the
Community Learning Disability team might help, and a multi-agency plan may be
the best way forward, to establish and demonstrate that the client is truly providing
informed consent, otherwise be against the adult protection policy, and be illegal.
Some health care professionals decide to use a sex worker, once they have agreed
that informed consent has been given. A good sex worker could
teach Masturbation techniques and help them learn about the body of the opposite
gender. Contrary to popular opinion, sex workers, like gay men and disabled
people, are ordinary people like you and me, and most sex worker take their work
seriously. See below.
One of our residents goes out cruising, comes back to the home and has
unprotected sex with male residents, and then jumps on the female residents,
having anal sex with them. We live in terror of him spreading HIV throughout
the home, but he refuses to get tested.
This is a very common issue and you are right to be worried. Services are
responsible for protecting people from risks but also for safeguarding their rights to
sexual expression, so you need to work with him about his responsibilities to others
regarding safer sex. You need to establish HIV and risk management guidelines. It
is true that having an HIV test is something that individuals must consent to, and
people with learning disabilities should enjoy the right to have sex and take risks,
just like everybody else. However, the other residents have rights too - and this
includes the right to stay healthy. So, first you need to work on an intensive
programme to educate all the residents on safer sex. Practicing safer sex can be
very difficult if the sexual partner is more able or more powerful than you, and this
needs to be addressed. Residents should be given the option of having themselves
tested for STIs. If things don't improve, i.e. the residents continue to have
unprotected sex with your cruiser, more drastic measures will need to be taken to
separate him from the rest.
My client is becoming violent. He is a 55 year old heterosexual man with mild
learning disabilities who has never had sex. We have established that he very
much wants to have sex, and suspect this would improve his behaviour, but
how can we make this happen?
Your hypothesis that his aggression is linked to sex needs to be checked out by
someone by looking at the pattern of behaviour. If he is in agreement, you could
help him attend social groups so that he might find a partner, and/or discuss with
him using a sex worker to have sex with him. Best use a member of staff who feels
comfortable with the situation, and this person should themselves be supported. A
local sex worker can be found by looking on
Clients with learning disabilities need to understand that the sex worker is not a
girlfriend and will go away after the sex. Because sex is normally a two-way activity,
it is best if you try to re-create this situation. This can be done by telling him to make
the payment himself, which gives him some notion that he is making a valuable
purchase like in a shop. He is paying for her time and travel time will be included if
she is to visit. Your client may agree to pay out of his personal allowances. If funds
need to come from his care budget, think carefully of the wording and take care.
With regard to the law, it is not illegal to buy or sell sex. Since you are not charging
for this service, it is not illegal for you to make the arrangements. However, the laws
on prostitution are largely misunderstood and sex work often frowned on. So long
as you and your team have discussed the fact that this is duty of care for the
wellbeing of your client, and decisions have been recorded, there should be no
illegalities surroundig consent.
What should we to do with a resident who is learning disabled and unable to
understand words, and masturbates regularly in front of everybody?
There is not an easy answer. If the resident has an understanding of a symbol vocabulary
e.g. wigit symbols or an understanding of Makaton or Signalong, then using very simple
language the client should be told that it's fine for him/her to masturbate but that s/he must
do this in a private space.
A one-off chat isn't usually enough, and so it would need to be worked on in a
variety of ways. They may have great difficulty understanding the concepts of
'public' and 'private', so much work is required with them around this using sign
language, symbols, role play and anatomically correct dolls. The DVD called 'You,
your Body and Sex' deals with masturbation and privacy; it is animated and usefully