Gender identity, sexual orientation and adverse sexual experiences in autistic females

Merrilyn Hooley,Mark A. Stokes,Grace I. Hancock,Laura A. Pecora,Tony Attwood,David H. Demmer,Gary B. Mesibov

doi:10.1186/s13229-020-00363-0

Abstract

BackgroundThere is growing recognition that autistic females present with more diverse gender and sexual identities than their non-autistic counterparts. Likewise, autistic females are also at an increased risk of adverse sexual experiences. As higher rates of sexual victimisation are observed in individuals with diverse sexual identities in the broader population, rates of negative sexual experiences among autistic females remain unclear. This study aimed to investigate the representation of gender and sexual diversity within autistic females and examine their rates of regretted, and unwanted, sexual encounters among females with a transgender gender identity and non-heterosexual sexual orientation.MethodsTwo hundred and ninety-five females completed the Sexual Behaviour Scale-III (SBS-III) online. Self-reported gender identity and sexual orientation were compared between 134 autistic (Mage= 26.2 years, SD = 8.7) and 161 non-autistic females (Mage = 22.0 years, SD = 4.6). Differences in the prevalence of negative sexual experiences were compared across diagnosis and each gender identity and sexual orientation label.ResultsAutistic females were more likely to identify with a transgender gender identity (p < .05) and non-heterosexual sexual orientation (p < .007) compared to non-autistic females. Autistic homosexual females were more likely to have experienced a range of negative sexual experiences than autistic heterosexual females (OR ≥ 3.29; p < .01) and were more likely to have experienced unwanted sexual experiences than non-autistic females regardless of sexual orientation (OR ≥ 2.38; p < .05). There were no differences in rates of negative sexual experiences between autistic bisexual and both autistic heterosexual and non-autistic bisexual females. Non-autistic bisexual females (OR = 0.24; p = .018) presented with a reduced risk of regretted sexual experiences than non-autistic heterosexual peers. There were no differences in negative sexual experiences across gender identity in the autistic sample.LimitationsThe use of fixed format response items may have restricted participants’ abilities to provide rich responses pertaining to their sexual identities and nature of negative sexual experiences. The small number of participants who identified as transgender (n = 40) limits the reliability of results pertaining to sexual experiences across gender identity. Moreover, although multiple recruitment methods were used in this study, non-representative may bias estimates of prevalence rates. Thus, the data may not be representative of the broader population.ConclusionsResults indicate that autistic females present with greater diversity in their sexual identities than individuals without autism, with those with a homosexual sexual orientation being at greater risk of experiencing adverse sexual encounters. Findings suggest the importance of increased clinical attention to this diversity and the need to provide support to facilitate the development of a healthy sexual identity and reduce the risks identified in this study.

Highlights

There is growing recognition that autistic females present with more diverse gender and sexual identities than their non-autistic counterparts
Results indicate that autistic females present with greater diversity in their sexual identities than individuals without autism, with those with a homosexual sexual orientation being at greater risk of experiencing adverse sexual encounters
Findings suggest the importance of increased clinical attention to this diversity and the need to provide support to facilitate the development of a healthy sexual identity and reduce the risks identified in this study

Summary

Introduction

There is growing recognition that autistic females present with more diverse gender and sexual identities than their non-autistic counterparts. There appears to be greater variability in gender identity than found in the wider population Studies proposing this link have identified an increased prevalence of gender variance in autism. A relationship between gender dysphoria (GD) and autism has been suggested, where both a higher representation of GD in autistic groups irrespective of sex, as well as an increased number of autistic symptoms in adults with GD, are common observations within current literature [3,4,5]. Sex differences have been observed, where the co-occurrence of elevated rates of gender variance in autistic groups [6], as well as greater clinically significant autism symptoms in adult GD samples [7,8,9], is reported in individuals assigned female at birth than individuals assigned as male. Studies investigating the relationship between autistic traits and GD in child samples have found comparable levels of autism symptoms between boys and girls with GD [10, 11]

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