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Ask the Mental Health Expert Archives 2001-2004

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Sexuality for a Mental Retardee

Q. I need to know if there is any way to explain and teach about human sexuality to a young man with mild to moderate mental retardation? At the age of 23 he seems to have discovered sex and it appears that his fascination is with other males. Can it be a stage of development - a curiosity - or is it actually an expression of his own sexuality? He has had no opportunities for sexual experiences and because of recent behaviors is becoming more isolated since he does not have appropriate social behaviors surrounding this issue. I need help understanding what is happening to him. He is in counseling - but his counselor has not been able to find out if there is any information about this issue.

A. There certainly are ways to provide useful sexual education to those with intellectual handicaps. The question is: what are your priorities? So far as I know, there is no reason why someone with mental retardation can't experience the same rich and complicated sexual feelings as those with a normal IQ experience. Thus, it's quite possible that this young man is simply curious about other males, or that he is expressing a long-developing homosexual orientation.

I'm not sure what your professional position is, with respect to this young man-but I'm not convinced that you need to concern yourself, right now, with such subtleties of sexual orientation. It sounds as if the most pressing issue is this young man's inappropriate social behaviors and resulting isolation. You don't say what these behaviors are--unwelcome touching of other males? exposing himself? masturbating? etc.--but I would suggest focusing on helping him control and reduce these behaviors, perhaps via a combination of educative and behavioral-modification techniques. (A behavioral psychologist would be an excellent consultant).

It would also be important to teach this individual basic safe sex techniques, so that he does not expose himself or others to increased risk of HIV, or other sexually-transmitted diseases. After these top priority issues are dealt with, you might then focus on helping this young man accept his sexual orientation, if he clearly expresses feelings of shame or guilt about his preferences. Alternatively, these issues could be pursued with his counselor.

If you or the counselor want to pursue some of the literature in this area, here are some sources: McCabe et al, (Res Dev Disabil 1999 Jul-Aug 20:241-54), describe some psychometric tests for determining sexual knowledge, feelings, and needs of people with intellectual disabilities; Abramson et al (Am J Ment Retard 1988 93:328-34) outline some of the educational and legal issues surrounding sexual expression in mentally retarded individuals; Pincus covers sexuality in the mentally retarded from the physician's standpoint (Am Fam Physician 1988;37:319-23); and Huntley and Benner (Ment Retard 1993;31:215-20) present recommendations aimed at increasing professionals' ability to provide sex education and counseling for mentally retarded individuals.

Finally, while I have not reviewed or read this book, you may be interested in Sex and the Mentally Handicapped : A Guide for Parents and Carers by Michael Craft, which is apparently out-of-print. You may also learn some important tips from the American Assocation on Mental Retardation website (http://161.58.153.187/index.shtml). Good luck with this challenging individual.

April 2001

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