Leading Practice Guidelines

Sexual Health

Type: Wellbeing

Guideline: The organization acknowledges that sexuality is an essential part of anyone’s health, well-being, and identity. Loving relationships, which include sexual expression, are an integral component of a person’s physical, emotional and mental well-being.

All individuals with intellectual disabilities have the same inalienable rights to life, liberty, and the pursuit of happiness as all other individuals. This includes the right to responsibly engage in interpersonal relationships, which include sexual expressions, where there is mutual consent.

Each person is supported on an individual basis and in a sensitive and appropriate way to gain knowledge, skills and information about sexual health and expression.

What does this look like?

The organization has policies and practices that give proactive guidance and direction to staff on how to support people to express their sexuality in healthy and positive ways. These include the following important aspects:

• Promote and protect the rights of people specifically the right to self-determination concerning relationships, sexual expressions and sexual health.
• Mutual sexual expression, which is private and between consenting adults, is a healthy and pleasurable expression of affection, bonding, and sexuality. Heterosexual, bisexual and homosexual expressions are matters of individual choice and will be equally supported.
• Inappropriate sexual behaviour may be due to a lack of knowledge or experience, an expression of medical condition or lack of any other meaningful activity. The organization supports the person to explore the root of the behaviour, understand the options for alternative ways to gain the same result and ensures the person is informed of any potential social or legal consequences of their actions. The organization seeks additional resources and expertise as needed to support the person.
• Masturbation is a normal, healthy expression of sexuality. At times, masturbation may not in itself be a sexual act. It may be a form of sensory stimulation that is readily accessible and usually pleasurable. Masturbation at the appropriate time and place can be acceptable behaviour. Masturbation will be supported when expressed in a way which does not intrude on others and does not inflict self-harm.
• When a person with an intellectual disability becomes sexually active their parents or other support people may be anxious.
• This anxiety about the risks and the vulnerability of the person may or may not be warranted. Each situation needs to be assessed on its own merits.
• People need to be able to interact with others that they encounter day-to-day, and to be free to form close friendships or love relationships that they choose. Friendships and romantic relationships are a matter of personal preference. Staff will respect the personal choices and will only intervene when it is necessary for the person’s safety. Heterosexual, bisexual and homosexual relationships will be supported equally.
• Some adults with intellectual disabilities may need support in recognizing opportunities and in developing skills and knowledge which enable them to develop loving relationships.
• The organization will help people understand the difference between public and private and reinforce that most sexual expression should occur in a personal, private space. Where appropriate to the scope of service, the organization will ensure that people have access to private space of their own.
• Any documentation in a Support Plan concerning sexual matters will be limited to issues of health, safety, and life quality. All communication and documentation will be: respectful of the person’s dignity and self-determination, treated as confidential in nature, and stored and accessed only by those that need to be aware of this information. The organization avoids stigmatizing labels or terms for sexual behaviour.

People with intellectual disabilities have the same range of sexual desires and expressions as the rest of the community, however they may have had limited life experiences or social opportunities to learn about sexuality. The organization provides age and developmentally appropriate support and education that may include:

• Sexual rights & responsibilities
• Sexual health and development;
  • Proper names for body parts
• Safe and healthy relationships;
  • Social skills needed to develop and maintain healthy romantic relationships
  • How to sense or understand their feelings
• Socially acceptable rules of sexual behaviour
  • Public vs private spaces
  • Consent – saying no, importance of getting a clear yes
• Prevention & Recognition of sexual abuse and exploitation –
  • Knowing when they don’t feel safe
• Birth control and pregnancy prevention;
• Prevention of STDs and HIV/AIDS
  • Risks, means of transmission, and recommended precautions.

Education will be delivered in an accessible and personalized manner. If this includes group education, then strategies will be considered on how to continue support for skills learned outside of the class.

The organization considers recruiting people who received education and demonstrated leadership skills to be trained and hired as self-advocate peer mentors.

The organization trains staff to be able to support people in healthy expressions of sexuality. Training should include:

• The myths and stereotypes about the sexuality of people with developmental disabilities
• Social and cultural barriers to sexual expression
• Promotion of positive attitudes towards appropriate sexual expression
• Proactive guidance to ensure that they take reasonable measures to provide protection while supporting residents in expressing, consenting and enhancing sexuality.
• Available resources such as printed information, audio-visual resources, trained staff, therapists and community resources
• Information about the specific needs of people they support regarding sexual expression and health.

How would you know this is happening? (Evidence)

What you see in systems:

• Respectful Support Plan documentation is available
• Policies related to supporting sexual health
• Training Content and records

What you see in actions:

• People feel well supported and respected in the area of sexual expression.
• Staff talk in a positive, respectful manner and are aware of expectations, strategies and resources available to support people in the area of sexuality.