Autism and Sex Therapy: A Growing Need for Neurodiverse Populations

People who are neurodivergent and/or have a diagnosis of autism benefit from individualized care and education in sex therapy. As we know, there is a broad spectrum when it comes to autism. Two people with an autism diagnosis won’t express themselves in the same way. In an interview with the New York Times about the Netflix show “Love on the Spectrum”, Professional Counselor and Sexologist Jodi Rodgers said, “The presentation of autism is so diverse, it will be very different for every single person.” As sexuality challenges arise for those with autism, there is a growing demand for sex therapists, sexuality counselors, sex educators, and sex coaches who are knowledgeable in this area. 

Challenges in Sexuality for those with Autism

People who are autistic or neurodivergent have a history of not being seen as sexual beings. Caregivers as well as the general population tend to infantilize people with neurodiversity, autism, and disabilities. In doing this, they do a great disservice to the individual.

“While autism can influence how you communicate and interact with others, it doesn’t prevent you from developing sexually, or from finding mutually fulfilling relationships that involve intimacy and sex.” (How Does Autism Affect Sex and Intimacy?) As a result, these individuals are given little to no education about sexuality while living in a body that grows continually more sexual. The desire to have relationships and sexual experiences is there, but with no context, experience, or knowledge of what to do. 

In the Psych Central article, How Does Autism Affect Sex and Intimacy? the author identifies five sexuality challenges for people with autism. 

Communication about sex

• • Challenges communicating with potential romantic partners, caregivers, and friends about their sexual needs and desires, as well as general relationship concerns.

Hypersexuality

• • Preoccupation with sex, sexual fantasies, or the need to compulsively engage in sexual activities. It’s important to note a point brought up in the interview with Nicholas Maio Aether about Autism and Sex Therapy. Since people with autism are often infantilized, when they start to display any sexual behavior, it can be seen as “hypersexuality”.
  • “People who are in residential care settings or have to be staffed and supported are oftentimes looked at through a really unfair lens. And that lens I think is a lens that if they are seen as nonsexual and when they start to have ANY sexuality, they’re seen as hypersexual. They’re infantilized and then punished for acting like adults. I think that is something that really does need to be addressed. I think one of the things that saddens me is that these individuals don’t have access to sex therapy. Most therapists don’t have experience with such a heavily impacted population.” (Nicholas Maio Aether: Autism and Sex Therapy)

Limited or negative sexual experiences

• • Lack of education and experience with sexual relationships, or negative experiences because of the other challenges listed here 

Educational barriers 

• • Trouble understanding traditional classroom curriculum about sexuality, or being left out of the conversation or educational content
  • “Indeed, it has been shown that young adults and adolescents with ASD know much less about sex than peers without disabilities. As a consequence, a lack of sex education makes this population more vulnerable to unplanned pregnancy and sexually transmitted disease, and they are more likely to be sexually abused”. (Sexual Coach in Autism: A Growing Need)

Increased gender dysmorphia 

• • “In a 2021 study, researchers looked at autistic people’s experiences with gender dysphoria. They found study participants were highly attuned to feelings of distress caused by physically not matching their gender identities, and that autism helped them truly understand their gender identity.” (How Does Autism Affect Sex and Intimacy?)

Neurodiverse and Autistic Couples in Sex Therapy

In addition to these individual challenges, neurodiverse couples or couples with autism face other challenges that can be addressed in sex therapy. Communication with romantic partners can be a challenge for anyone in a relationship. With the additional communication barriers and brain diversity of those with autism, romantic communication and discussions about intimacy may have better outcomes if a person is working with a sex therapist. 

“In neurodiverse relationships, partners’ brains are wired differently, which impacts beliefs, thoughts, and opinions. These differences in neurodevelopment can result in varying needs in intimacy and sex within a partnership. For many, intimacy tends to refer to an emotional closeness and connectedness between partners. Sex within a partnership is one way of cultivating intimacy. It often involves sexual contact or an exploration of physical sexuality, which varies greatly from person to person based on preferences, desires, and sexual identity.” (A Brief Guide to Discussing Intimacy and Sex in Neurodiverse Couples Therapy)

Sex Therapy with Neurodiverse and Autistic People

In a recent Linkedin Audio interview titled Autism and Sex Therapy, Nicholas Maio-Aether, MAMFT, MSPSY, LBA, CSC, BCBA, spoke about some of the unique challenges for people with autism when it comes to sex therapy. Nicholas is the co-founder of Empowered: A Center for Sexuality, LLC. Nicholas is a Certified Professional Member of the American Association for Sex Educators, Counselors, and Therapists (AASECT). 

At ​Empowered: A Center for Sexuality, LLC, the mission is “to provide the utmost in socially-valid, comprehensive sexuality education and therapy, support, and sexual behavior interventions for individuals with and without disabilities, so all may lead healthy, safe, fulfilling lives, empowered by the knowledge that we are all, as human beings, capable of intimacy alone or with a willing and educated partner”.

Working with Combination Partners: When one partner is neurotypical

In the Autism and Sex Therapy interview, Nicholas talks about his experiences providing sex therapy to couples. He states, ”I also work with couples where one person has an autism diagnosis and one person is neurotypical…In working with these couples, a large part is helping the partner who is neurotypical understand more about autism, some psychoeducation built in, helping the autistic person let go of any hang-ups or shame they might feel about their autism, or the impact it’s had on them or their relationship.” (Nicholas Maio Aether: Autism and Sex Therapy)

This combination of education and sex therapy benefits both partners during the session. This may be the first time that either partner has received education about autism or neurodivergence in a safe space. When both partners have an opportunity to learn and speak with a knowledgeable professional, they are going to have better outcomes from sex therapy. This is why working with a clinician who understands autism and neurodivergence in combination with sex therapy is so important. 

Sensory Concerns Addressed in Sex Therapy for Autistic and Neurodivergent Individuals 

Addressing sensory concerns is an integral part of sex therapy with autistic or neurodivergent couples. Nicholas talks about what it feels like when one partner is having a negative sensory experience, and how important it is to validate and acknowledge that. 

“I like to equate it [a negative sensory experience] to: most neurotypical people do have a sensory reaction to fingernails on a chalkboard. And I want to note, if that’s what you’re experiencing when your partner is kissing you, or that’s what you’re experiencing when your partner touches your back lightly…you wouldn’t be down to just ‘buck up kiddo’ and keep going, would you?” (Nicholas Maio Aether: Autism and Sex Therapy)

Unfortunately, it is common to have sensory experiences misunderstood or dismissed when seeing a practitioner who is not knowledgeable about autism or neurodivergence. This analogy of nails on a chalkboard gives neurotypical individuals a small reference of what it feels like to have a negative sensory experience. A sex therapist who is knowledgeable in autism and neurodivergence will understand the need to address this important part of a person’s sexual life. 

What does intimacy look like for autistic and neurodivergent couples?

Intimacy looks different for every couple. There are some standard ideas of what intimacy in a relationship should look like. Deep conversations, gazing into each other’s eyes, and the physical intimacy of sex come to mind as some common intimacy themes. Does intimacy look different for couples who are autistic or neurodivergent? 

According to Nicholas Maio Aether, intimacy for autistic and neurodivergent people can look different than it does for neurotypical people, and there’s no right or wrong way to feel intimate with your partner. 

“Intimacy for autistic people can look a lot different, and there’s no right or wrong way to eat this Reece’s. You can have intimacy that is side-by-side gaming, you can have intimacy where one person is gaming and one person is on their phone, but they’re like physically snuggling maybe. There’s just lots of different intimacy. Certainly playing a game together can be incredibly intimate for neurodivergent folks. This is a great way to bond. I don’t have to talk, I don’t have to look you in the eyes, I don’t have to do any of that…Intimacy can also look like physical intimacy and sex.” (Nicholas Maio Aether: Autism and Sex Therapy)

When it comes to intimacy, no couple needs to fit into the model of what traditional intimacy looks like. It is beneficial for sex therapists who work with individuals and couples who are autistic or neurodivergent that intimacy can look nontraditional and that’s ok. A therapist without this knowledge may not understand how gaming could be a form of intimacy, and that misunderstanding is disruptive to the therapeutic process. 

The growing need for sex therapy and sex coaching for autistic individuals and couples 

More and more people are discovering that they are autistic or neurodivergent. As this number of people increases, the need for knowledgeable sex therapists, sex coaches, and sexuality counselors will increase as well. Having a knowledgeable and affirming therapist can make all of the difference when it comes to sex and intimacy. 

Many counselors are trained in couples therapy, but not in sexuality issues. Even less counselors specialize in working with people with autism or neurodivergence. We need more education and more inclusion. The time has come to include autistic and neurodivergent people in the conversation about sex. They have been left out for far too long. 

At Respark Therapy, we’re here to help you create healthy relationships, find pleasure, and spark joy. To explore more about sex and marriage counseling, connect with our Care Team at: care@respark.co or call (512)-537-0922.

By Michelle Melville-Kashon 

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