A free online resource developed to support the inclusion of autistic learners in Scottish Early Learning and Childcare settings, Primary and Secondary schools.

Sexual Health

‘’Children learn about sex from a very young age even if we don't talk with them about it. Many of the things they learn are incorrect, confusing and frightening. In a world where sex is used to sell cars and ice creams, and celebrities' private lives become everybody's business, we cannot afford not to talk to our children about sex and relationships if we're going to help them make sense of it all.’’ 

National Children's Bureau, Sex Education Forum 2003 

The information on this website aims to encourage schools to provide positive sexual health and relationships education, supporting links with parents and providing information to encourage them to talk more openly with their children.

Good sexual health and relationships education can help young people: 

  • With emotional development 
  • To explore their own beliefs and values 
  • To learn about positive relationships 
  • To cope with changes that puberty brings 
  • To recognise abuse 
  • To make choices and stay safe 
  • To learn boundaries and appropriate behaviour 
  • To delay the age young people first try out sexual activity 
  • To learn how to avoid unplanned pregnancy and sexually transmitted infections. 

Some people think that giving sexual health and relationships education to young people encourages young people to experiment with sex but research has shown it has quite the opposite effect. 

A range of materials can be found within Scotland's Relationships, Sexual Health and Parenthood website.

Children need to learn about their body parts, including private body parts and their correct names.

Apart from having a better understanding about their own body, how it feels, how they grow, how they move, the differences between boy’s and girl’s bodies, they can also identify:

  • If something is sore or feels out of the ordinary. 
  • When it is okay for someone to touch your private body parts, and when it is not okay 
  • Equally they can learn when it is okay/not okay to touch someone else’s body parts. 

Children should be learning about body parts from a very early age. If they learn ‘penis’ and ‘vagina’ at the same time as ‘hands, feet, head’ etc, children will not see these words as any different. They are not sexual or embarrassing to a child, they are just the correct biological terms. If children know the correct words it is easier for them to communicate that they are sore, or where someone has touched them. Children can still have ‘pet names’ for private body parts as long as they know the correct terms. If a child has limited vocabulary, or communication difficulties, too many words can be confusing. It is then better to just have the one correct name. 

Parents have the advantage of talking about body parts at bedtime and bathtime when they help their child get washed. Parents can also use clothes to discuss what to wear over body parts, including private body parts, and when it is okay to show someone your private body parts or be naked. Most young people have better learning experiences at home, looking at and touching their own bodies. 

All young people need to learn the correct names and differences in boys and girls before they can learn about puberty and body changes. 

It is important to discuss in advance with young people, the changes to their body that will take place during puberty and adolescence, especially those with autism who can find it difficult to deal with changes generally.  It can help reduce worries and anxieties if they are aware that these changes happen to everyone and if they have someone to talk to about the changes. 

Teaching about Body Parts as part of the Health and Wellbeing outcomes should be part of the curriculum for all students. 

For younger pupils, giant body outlines (drawn round a child) and names of the body parts for a girl, and body parts for a boy can be duplicated at home. 

For pupils who require more factual information, the BBC Science website provides some clear factual images and information about the human body, some of which is interactive.

Inappropriate touching/masturbation in public are issues for both boys and girls. It can be embarrassing for other people. It is also an offence to masturbate in public and can have serious consequences for the person involved. 

Most commonly, issues arise during puberty, but younger children also masturbate and adults who have not been taught about boundaries may masturbate in public. 

It is important for parents and school staff to take a lead in planning and delivering this aspect of the curriculum. Sometimes speech and language therapy and occupational therapy can be involved, especially if resources and input need to be more personalised. 

Frequent masturbation may be a sign of infection. A doctor may need to check this. 

Some young people are ashamed to talk about masturbation. Some even think it is against the law. Information about private touching should be taught to all students as part of Relationships, Sexual Health and Parenthood so they know it’s normal and okay. 

Input on this topic may have to be ongoing. A duplicate approach by home and school enhances learning and shortens the time it takes most young people to change behaviour.

Support approaches to consider

  • Social stories can help teach about appropriate behaviour 
  • OKAY/NOT OKAY chart. Pictures/ photos/symbols to show public places (not OKAY to masturbate) and private places at home (OKAY to masturbate) 
  • Consistent signs/symbols/responses from school staff and parents/family to say ‘that’s not appropriate’ when it occurs e.g. thumbs down, shake of head, Makaton ‘stop’ sign or ‘not here’ symbol
  • Allowing the young person private time at home to explore their bodies (bathtime, bedtime) and removing restrictive clothing/pads 
  • Diversionary tactics/ activities e.g. squeezy ball to keep hands busy 
  • Other sensory activities to bring pleasure- bubble bath, exercise, deep massage on arms and legs (occupational therapist may teach this). Also resources from occupational therapy such as vibrating cushions. 

Many young women are not taught about periods until they happen. This can lead to misunderstanding and a fear of bleeding to death. Some young women have sensory issues around sanitary wear. 

Girls cope better with their periods if they know what’s coming in advance. Before puberty (and periods) start, children should be taught that their body will change as they grow and they will bleed once a month. They need reassurance that this is nothing to worry about. 

Support approaches to consider

  • Introduce information about periods before they happen, around 8 or 9 years of age 
  • Parents, teachers and speech and language therapy may be involved in planning; the  NHS sexual health team can provide some resources
  • Social stories can be developed about how to manage a period 
  • The young person can carry their own instructions in their purse or bag to remind them when to change their sanitary wear
  • Keep a box in the toilet at home and one toilet at school with sanitary wear and the same instructions (take pad off, put in bin, put on another one, wash hands etc)
  • Trial and error test with variety of sanitary pads due to sensory issues. Some parents put the sanitary pad inside the gusset of the pants 
  • Social stories should be personalized depending on understanding 
  • Keep a diary or calendar to show when a girl has her period 
  • Support for as long as the young woman needs, usually a few months 
  • Some young women celebrate their period as a sign of growing up  - a cake/hot chocolate to celebrate and give it a positive slant.

Some young people need to learn about 
•    Private body parts (when it is okay to touch yourself, others) 
•    Private and public places and appropriate behaviour  
•    Sharing private information (e.g. telling the bus driver about having a period).

Input generally starts at home with very young children identifying private body parts. If children start to touch other people (particularly private body parts), this needs to be addressed by the school and parent in a co-ordinated way. Aspects of Private and Public need to be taught from early childhood through puberty and into young adulthood. Prior to puberty, children should learn who they can talk to about body changes and other private things. 

Some young people grow in to adults without this knowledge and some behaviours (exposing private body parts in public, touching other people’s private body parts without consent) can lead to being charged under the Sexual Offences Act.  

Teachers will teach about Body Parts and Public and Private in class as part of Relationships, Sexual Health and Parenthood. Parents have the advantage of talking about body parts, including private body parts, at bathtime and bedtime when they help their child get dressed and undressed. 

Children and young people must have some private time at home where they can do private things. They may need actual photographs of rooms they are familiar with (their own classroom, bedroom, bathroom) to identify Public and Private and appropriate behaviour. This information can be supported by a social story used at home and at school to provide consistency. 

A Relationships circle can be drawn and developed to help young people to map which people are in their lives, what their relationship is, and what would be appropriate or inappropriate behaviours with each person. From this they can identify eg ‘who can I tell about my period? Who can I talk to about having an erection?’ and the differences between public and private conversations.

Many young people are not taught about puberty until it happens. This can lead to fear, misunderstanding and sometimes harmful behaviour. 

Puberty can begin from age 9 upwards. Children should be taught the basics from an early stage, before puberty occurs. E.g.

‘When a boy starts to grow up his body will change. He will grow taller, he will get hair under his arms……sometimes his penis will go hard and stick out from his body…’ 

If this information is given early and repeated it may not seem as alarming when it does actually happen. 

Many young people with autism have a fear about changes generally, so changes to their body can cause a lot of anxiety if they are not prepared. Teachers and parents should work together to develop the young person’s understanding. Teachers can incorporate Puberty in to their Relationships, Sexual Health and Parenthood Education for all pupils. Parents can carry out one-to-one work, encourage their son/daughter to explore their own bodies in a safe environment (in their bedroom, in front of a mirror. At bedtime. At bathtime), and check understanding of topics being discussed in school. 

Intensive input may be required - from a few weeks to several months - in order to manage particular behaviours such as self harming or higher levels of anxiety about changes that are happening during puberty. 

*some young people relate better to realistic images of bodies and body parts rather than cartoons/line drawings.

Some young people may not be certain of their sexual orientation, or they may know that they are lesbian, gay or bisexual but worry about this. They may be transgender. Awareness of their sexual orientation usually starts during puberty and teenage years but can begin earlier. 

The need to provide information on this topic may arise because of specific circumstances e.g. two young men together touching one another intimately, teenage girls kissing and cuddling together in the classroom, a young man dressing in women’s clothing in his bedroom.

These young people may not have been taught that people can be lesbian, gay, bisexual or transgender.  Issues can include:  
•    Learning about sexual orientation  
•    Helping the young person to understand their emotions 
•    Checking that behaviour is consensual 
•    Understanding public and private behaviour 
  
Some one-to-one work is required with young people, especially to define public and private, e.g intimate behaviour between the two boys or two girls should be in a private place (and identifying where is an appropriate private place).

The implications of the young man going out in public in female clothes could have negative repercussions. Whilst he may, or may not be transgender, these are issues that could be explored over time with professional help sought if necessary. There is an option for him to seek further help from the local Sexual Health clinic, who could refer him to a specialist centre to discuss Transgender issues and the options. This would be a long-term process.    

LGBT Youth Scotland (Lesbian, Gay, Bisexual and Transgender Youth Scotland) can also help to support young people and their parents. 

General learning about Relationships, including same sex relationships, should continue as young people grow up, as part of the Relationships, Sexual Health and Parenthood curriculum. 

Some young people who require additional support, for whatever reason, are sometimes sheltered from the fact that same sex relationships exist. This information needs to be part of their learning about the people who make up their own community, and that different relationships are okay. Should a young person decide that they are lesbian, gay, bisexual or transgender, or are uncertain, they will then know that they do not need to be worried or frightened.

It is important to remember that many people with autism desire social interaction and relationships but may not have the skills to engage appropriately or have difficulty communicating effectively.  This can have significant implications for individuals trying to establish relationships and being able to read social cues, potentially creating opportunities for misinterpretation, confusion or elements of risk, particularly when navigating the challenges of forming relationships.


Support Approaches to consider

  • Talking openly and honestly 
  • Teaching social cues so pupils can interpret interactions 
  • Role play and acting out scenarios 
  • Comic strip conversations to help understand others’ perspectives
  • Clear boundaries and explicit rules 
  • Using visuals to support understanding 
  • Giving opportunities for peer interaction and practicing initiation/ conversation starters

It is normal for young people to be curious and want to find out more about sex and relationships.  The internet is a very accessible platform and it is typical that young people may access pornographic material or develop awareness through online sites.  This can pose potential problems as it can develop unrealistic expectations about body image, sex and relationships particularly for someone with difficulties with social interaction and awareness.

Young people also use social media and different communication apps to engage with the world around them and their friends.  This can be taken to another level through sexting or sharing sexually explicit images or content.  Although it can be seen as harmless, it is illegal to share explicit images of children and can pose potential risks such as emotional distress, blackmail or bullying. 

Many individuals with autism access a significant amount of screen time and can use the internet as a way to learn about the world.  Autistic learners may need more guidance and clear boundaries or supports around these areas.  They can be more vulnerable due to difficulties with social understanding and understanding between fantasy and reality. 

Support Approaches to consider

  • Talking openly about what is available
  • Being clear about fantasy and reality
  • Directing to more suitable online resources for developing understanding and awareness
  • Clarity about the law and rights and wrongs with online behaviour
  • Knowing about social cues and interpreting meaning when on line.
  • Use of social stories or visuals