New insights into the sexual health and activity of autistic adults and adolescents

New research published this autumn in Autism Research, the official journal of the International Society of Autism Research, reveals significant differences in sexual orientation and activity between autistic and non-autistic people across the lifespan. As the largest study on the sexuality of autistic adolescents and adults, these results may have important implications on sex education and healthcare in the autistic community.

Using an anonymous, self-reported survey, researchers collected data about demographics, autistic traits, lifestyle information and medical history from a sample of 2,386 individuals (including 1,183 autistic individuals). The sample primarily consisted of females, white individuals, UK residents and those without intellectual disability, and participants ranged in age from 16 to 90 years, with an average age of 40.

Overall, the results show that while the vast majority of both autistic and non-autistic respondents reported having been sexually active, people with autism were less likely than non-autistics to report having ever engaged in sexual activity—and this is particularly true of autistic men.

However, while autistic adolescents and adults are less likely to engage in sexual activity than non-autistic adults, they are more likely to have diverse sexual orientations. People with autism were 8.1 times less likely to identify as heterosexual and 7.6 times more likely to identify as asexual or “other” compared to non-autistic people.

In particular, autistic males were more likely to identify as bisexual compared to non-autistic males, while autistic females were more likely to identify as homosexual compared to non-autistic females. Older autistic adults were also more likely to identify as bisexual compared to older non-autistic adults, whereas younger autistic adults are more likely to identify as homosexual compared to non-autistic peers of similar age.

Comparing males and females with autism reveals additional complexity. While there were no significant differences in the average age of sexual activity onset between autistic and non-autistic groups, autistic females report greater sexual diversity than autistic males and were more likely to engage in sexual activity at a younger age (18.02 in females versus 19.44 in males).

Interestingly, these differences do not affect sexual health outcomes. Autistic and non-autistic groups did not differ in their risk of contracting a sexually transmitted infection (STI).

These findings may have important clinical implications for people with autism, particularly relating to sexual health screenings, sexual education and mental health support. Because autistic individuals are more likely to identify as LGBTQA+, they are more vulnerable to inadequate healthcare and worse mental and physical health. Improving sexual education and delivering regular sexual health screenings for autistic adolescents and adults across the spectrum should remain a priority. Practitioners providing these screenings should ensure that they use language that is inclusive of all genders and sexualities and actively support autistic individuals who may be at increased risk of stress and discrimination due to their intersectional identities.