Sexual Dysfunction

In this chapter, we consider how diagnostic criteria for sexual dysfunctions can be used with people who have intellectual disabilities (ID), considering that very little is known about the prevalence of sexual dysfunctions amongst this population. The existing literature suggests that a lack of socio-sexual knowledge, poor support systems, mental health problems, and psychotropic medications are likely to be prominent aetiological factors for the development of sexual dysfunction amongst people with ID. However, while people with ID experience atypical development within the cognitive, emotional and social domains, their physical and sexual development is sometimes typical. Clinicians need to be aware of the impact of this dysynchronous development.

Within this chapter, the relevant biological, genetic, and psycho-social factors, including developmental factors, are reviewed. People with ID may experience extreme negative reactions to normal sexual behaviour which results in concealment and for some, suppression of sexuality, or for others, antisocial behaviours. They are vulnerable to victimisation, including sexual harm, and may conform to the wishes of those around them. Clinicians need to conduct their assessment taking into account cognitive, developmental and psychosocial factors which may impact upon presentation and course, and need to remain involved whilst mainstream services are accessed.