Sexual and Reproductive Health Service Utilization and Sexuality for Teens on the Autism Spectrum.

OBJECTIVES: Health care providers and educators play critical roles in supporting healthy sexuality development for youth with autism spectrum disorder. There is limited information about the sexual behavior of these youth, especially girls, and about their access to sexuality education or health care services. METHODS: This study addressed these gaps by surveying parents of youth with autism aged 12-18 years (N = 298, 52.7% boys) with a range of intellectual functioning. RESULTS: According to parent report, most youth experienced sexual attraction and were interested in relationships, including same-sex attraction or relationships (13.2%). Girls were more likely than boys to have had a romantic relationship and less likely to have experienced school or legal consequences for sexual behavior. Around one-fifth of youth had engaged in a socially inappropriate sexual behavior, whereas 6.4% had a known sexual abuse history and 14.5% were bullied by peers for lack of sexual knowledge. Almost 40% received no sex education in school or in the community, including 60.9% of youth with parent-reported intelligence quotient under 70. Some parents consulted with school personnel (36.4%) or health care providers (55.9%) about sexuality issues, whereas 19.5% reported taking no action aside from talking to their child about sexuality. Utilization models including predisposing, enabling, and needs-related factors were applied to parent consultation with providers and use of school-based sexuality education programming. CONCLUSION: The results suggest unmet needs for sexual and reproductive health services, particularly among youth who are younger, those who have co-occurring intellectual disability, or those who are homeschooled or who attend private, charter, or therapeutic versus public schools.

Family Sexuality Communication: Parent Report for Autistic Young Adults Versus a Comparison Group.

Families are a critical context for healthy sexuality development. This study characterized family sexuality communication for autistic adults (age 18-30) without intellectual disability (n = 117) versus a neurotypical comparison group (n = 319). Parent-reported number of sexuality topics covered did not significantly differ by gender or autism/comparison group. Parents of autistic adults who covered few or no topics (31%) reported higher religiosity, lower comfort and self-efficacy, and were less likely to say that the adult expressed attraction or desire for relationships. Parents of autistic adults were more likely than comparison parents to perceive their young person as being uninterested or not ready to learn about sexuality topics. These results suggest that families of autistic people require support to convey sexuality-related knowledge and values.

Family Sexuality Communication for Adolescent Girls on the Autism Spectrum.

Families are critical for supporting healthy sexuality and relationship development for youth with autism. The objective of this study was to describe family sexuality communication for adolescent girls with autism. Participants were 141 parents of autistic daughters who completed an online survey about sexuality development. Most parents relied on discussion alone rather than visual supports or skills-based teaching techniques. Intellectual functioning, child age, race/ethnicity, and whether youth expressed sexual interest in others affected family sexuality communication. We discuss how most parents covered important basics, but many did not cover more nuanced relationship or sexual health topics during family sexuality communication. Few used enhanced instructional techniques (e.g., visual supports, social stories), suggesting potential utilization barriers such as a lack of affordable and available resources. There is a need for research accounting for diverse racial/ethnic backgrounds, sexual orientations including asexuality/demisexuality, and for transgender and gender diverse youth.

The Impacts of Sexual Arousal and Its Suppression on Executive Functioning.

Suppression of certain types of reflexive emotional responses is thought to temporarily deplete executive functions (EF), as evidenced by poorer performance on measures of EF, but does not deplete other, lower-order cognitive processes. This study examined whether similar decrements in performance on EF tests would occur following suppression of sexual arousal. A sample of 44 male college students underwent baseline cognitive assessment (EF and lower-order cognitive processes), followed by experimental manipulation consisting of exposure to sexually explicit audiovisual stimuli. Sexual arousal was monitored using penile plethysmography. In this study, 21 participants were assigned to a suppression condition and were instructed to suppress sexual arousal during the video, while 23 were assigned to an arousal condition and were instructed to allow themselves to become aroused. Following experimental manipulation, cognition was reassessed. Unexpectedly, results showed EF decrements in the arousal group but not in the suppression group. As expected, only EF was affected by experimental manipulation, with no group differences in lower-order cognitive processes. Thus, the findings suggest that sexual arousal is associated with temporary decrements in EF performance, at least among young, primarily White, male college students. The results contribute to understanding why sexually charged situations are sometimes associated with poor decisions or unsafe/reckless sexual practices.

Parent Expectations and Preparatory Activities as Adolescents with ASD Transition to Adulthood.

Community stakeholders, researchers, and providers are increasingly focused on individual, family, and systemic factors that contribute to positive outcomes for adults on the autism spectrum. Parent expectations for their youth's future are associated with adult outcomes (e.g., employment, school success, independence), yet the mechanism for this effect remains unclear. This study investigated how expectations were related to parent transition-related activities in a sample of 298 parents of adolescents on the autism spectrum (48% female adolescents), stratified by parent-reported IQ (average or above, borderline, or below 70). Parent expectations for the future predicted engagement in some activities intended to enhance adult outcomes when controlling for IQ, gender, age, and household income. The results have implications for how providers discuss expectations and support families in preparing for adulthood.

Sexting by High School Students.

In the last 8 years, several studies have documented that many adolescents acknowledge having exchanged sexually explicit cell phone pictures of themselves, a behavior termed sexting. Differences across studies in how sexting was defined, recruitment strategies, and cohort have resulted in sometimes significant differences in as basic a metric as what percentage of adolescents have sent, received, or forwarded such sexts. The psychosocial and even legal risks associated with sexting by minors are significantly serious that accurate estimates of its prevalence, including over time, are important to ascertain. In the present study, students (N = 656) from a single private high school were surveyed regarding their participation in sexting. Students at this same school were similarly surveyed four years earlier. In this second survey, reported rates of sending (males 15.8%; females 13.6%) and receiving (males 40.5%; females 30.6%) sexually explicit cell phone pictures (revealing genitals or buttocks of either sex or female breasts) were generally similar to those reported at the same school 4 years earlier. Rates of forwarding sexts (males 12.2%; females 7.6%) were much lower than those previously acknowledged at this school. Correlates of sexting in this study were similar to those reported previously. Overall, our findings suggest that sexting by adolescents (with the exception of forwarding) remains a fairly common behavior, despite its risks.

Sexual Behavior, Definitions of Sex, and the Role of Self-Partner Context Among Lesbian, Gay, and Bisexual Adults.

Prior research has examined how heterosexual individuals define sex; however, these studies have rarely focused on sexual minority individuals or included a full range of applicable sexual behaviors. Participants were recruited from a local Pride Festival across two years. Study 1 (N = 329) was primarily descriptive and examined which physically intimate behaviors lesbian, gay, and bisexual (LGB) participants included in their definitions of sex and the behaviors in which they had previously engaged. Study 2 (N = 393) utilized a between-subjects design to assess differences in definitions of sex when judging one's own behavior compared with that of a partner outside of the relationship. The behaviors in which participants were most likely to have engaged were manual-genital (82%) and oral-genital stimulation (79%). Regarding definitions of sex, a clear "gold standard" emerged for men, with 90% endorsing penile-anal intercourse as sex. No equally clear standard existed for women. Participants who were asked to consider their partner's behavior outside of their relationship were more likely to endorse the behavior as "having sex" than participants asked to consider their own behavior. This study addressed a major limitation of prior research by investigating definitions of sex among a community sample of LGB adults, with implications for provision of health care and sexual agreements between same-sex couples.

Quality of Life Following Prostatectomy as a Function of Surgery Type and Degree of Nerve Sparing.

OBJECTIVES: To compare robotic-assisted laparoscopic prostatectomy with conventional retropubic radical prostatectomy in maintaining pre-surgery levels of urinary and sexual functioning and to evaluate the efficacy of nerve sparing in prostatectomies in protecting urinary functioning. MATERIAL AND METHODS: Patients (n = 385) receiving both surgical procedures were surveyed prior to surgery. Multiple measures, including the Expanded Prostate Cancer Index Composite, the Sexual Health Inventory for Men, and the International Prostate Symptom Score, assessed sexual and urinary function at an average of 12 months post-surgery. RESULTS: Across multiple measures, while controlling for pre-surgical sexual functioning, robotic-assisted surgery did not offer an advantage in maintaining sexual or urinary function an average of a year following the prostatectomy. Bilateral nerve sparing offered a strong and reliable advantage in the maintenance of sexual function, but not so regarding urinary function. CONCLUSION: While robotic-assisted prostatectomies may offer a number of medical advantages over open procedures, we found no significant effect on important quality of life outcomes associated with the technique.

Assessing Sexual Interest in Adolescents Who Have Sexually Offended.

Adolescents who have sexually offended have unique treatment needs. For mental health professionals to adequately address these unique needs, further research is necessary. To that end, we explored the assessment of sexual interest (which may play an integral role in understanding potential for sexual reoffending) in a sample of 103 male adolescents who have sexually offended. We compared results from a physiological assessment (MONARCH 21 penile plethysmography [PPG]) and an actuarial assessment (Screening Scale for Pedophilic Interest [SSPI]), plus data from an unobstrusive assessment (Affinity, a viewing time measure) in a smaller subsample of 16 male adolescents. One finding that has particular relevance for clinical assessment is that the SSPI may have limited utility with adolescents. We also found evidence for some overlap between data from PPG and viewing time assessments, although whether or not PPG data are ipsatized may affect relationships with other assessment modalities.

Parental romantic expectations and parent-child sexuality communication in autism spectrum disorders.

This study examined the relationship between core symptoms of autism spectrum disorder, parental romantic expectations, and parental provision of sexuality and relationship education in an online sample of 190 parents of youth 12-18 years of age with a parent-reported diagnosis of autism spectrum disorder. Regression analyses were conducted separately for youth with autism spectrum disorder + parent-reported average or above IQ and youth with autism spectrum disorder + parent-reported below average IQ. For youth with autism spectrum disorder + parent-reported average or above IQ, autism spectrum disorder severity predicted parental romantic expectations, but not parental provision of sexuality and relationship education. For youth with autism spectrum disorder + parent-reported below average IQ, parental romantic expectations mediated the relationship between autism spectrum disorder severity and parent provision of sexuality and relationship education. This supports the importance of carefully considering intellectual functioning in autism spectrum disorder sexuality research and suggests that acknowledging and addressing parent expectations may be important for parent-focused sexuality and relationship education interventions.

Beholder and Beheld: A Multilevel Model of Perceived Sexual Appeal.

When individuals (observers) assess how appealing they find sexual stimuli (targets), which factors matter and to whom? The present study examined how observer and target characteristics interact and impact perceived sexual appeal. Participants were 302 men (206 heterosexual, 96 gay) and 289 women (196 heterosexual, 93 lesbian) between the ages of 18 and 67 years, who viewed 34 photographs of targets of their preferred gender and rated each target for sexual appeal, masculinity-femininity, and estimated age. Participants also rated their own masculinity-femininity. A baseline model indicated that roughly 30 % of the variance in sexual appeal ratings was at the observer level (between observers) and 70 % of the variance was at the target level (within observers). In the final model, five characteristics of the participant observers (gender, sexual orientation, age, race/ethnicity, and self-described masculinity-femininity) and six characteristics of the target photographs (gender, whether the photographs were taken from heterosexual versus gay/lesbian media, race/ethnicity, perceived masculinity-femininity, and estimated age) were independently and interactively related to observer ratings of target sexual appeal. Observers displayed preferences for similar targets in terms of race/ethnicity and masculinity-femininity, while also displaying a general preference for target youth. Variation in the strength of these preferences occurred according to observers' own gender, race/ethnicity, masculinity-femininity, and sexual orientation.

An Experimental Study of Men's and Women's Personal Ads.

Personal ads have long served as a potentially rich source of information for social scientists regarding what women and men appear to be looking for in a partner and what they believe potential partners are looking for in them. Almost every study of this type has content analyzed existing personal ads in print media or, more recently, on the Internet. Many of the limits of this research approach were addressed in a study by Strassberg and Holty (2003) utilizing an experimental research design. Contrary to theory, prior research, and prediction, the most popular female seeking male (FSM) ad in that study was one in which the woman described herself as "financially independent, successful [and] ambitious," producing over 50 % more responses than the next most popular ad, describing the writer as "very attractive and slim." The present study replicated the Strassberg and Holty methodology, placing the same fictitious MSF and FSM personal ads using far more accessible Internet personal ad sites. Contrary to the previous finding, but consistent with evolutionary theories and social psychological experiments (e.g., Townsend & Wasserman, 1998), ads that presented the woman as attractive and the man as financially successful elicited the most interest.

How do heterosexual undergraduate students define having sex? A new approach to an old question.

This study examined how people define having sex utilizing a new approach to this area of research. A total of 267 men and 327 women rated their degree of confidence that engaging in each of 21 physically intimate behaviors (e.g., penile-vaginal intercourse) counted as "having sex" and then qualitatively explained their reasoning. Separate ratings were made for each behavior when engaged in by the respondent and by his or her partner with someone else. Results showed that, as in previous studies, for both sexes, some behaviors (e.g., penile-vaginal intercourse) were far more confidently rated (i.e., "definitely sex") than were others (e.g., oral-genital stimulation). Further, both men and women were significantly more certain that a behavior counted as "having sex" when considering their partner's behavior outside the relationship than when they considered their own behavior. Finally, the order in which the two scenarios (i.e., self versus partner) was presented significantly affected participants' certainty. Qualitative results, paired with quantitative findings, suggest that individuals consider a variety of contextual factors when making these definitional decisions. The methodological and sexual health implications of these results are discussed.

Gender-Specificity in Sexual Interest in Bisexual Men and Women.

The present study assessed the gender-specificity of sexual interest of bisexually-identified men and women, compared to gay men and lesbian women. Utilizing viewing time as a measure of sexual interest, self-identified bisexual men (N = 50) and women (N = 54) rated the sexual appeal of sexually provocative pictures while the amount of time spent viewing each picture was inconspicuously measured. As hypothesized, bisexual men and women demonstrated a pattern of sexual interest that was significantly less gender-specific than that of a gay/lesbian sample. That is, bisexual men and women (1) viewed other-sex pictures significantly longer than gay men/lesbian women viewed other-sex pictures and (2) rated other sex pictures significantly more sexually appealing than gay men/lesbians rated other-sex pictures. Additionally, the difference in viewing times and appeal ratings between male and female sexual stimuli for bisexuals was significantly less than the difference evidenced by gay men and lesbians. These findings suggest that self-identified bisexual men and women demonstrate a truly bisexual pattern of sexual interest, characterized by greater other-sex attraction and less gender-specificity than is true for gay men and lesbians.

Addressing sexuality in youth with autism spectrum disorders: current pediatric practices and barriers.

OBJECTIVE: Research on adolescents and young adults with autism spectrum disorders (ASDs) has focused on promoting independence and optimizing quality of life, yet the areas of sexual development and sexuality has been largely neglected. The American Academy of Pediatrics encourages pediatricians to address sexuality issues in youth with disabilities to foster healthy development and minimize negative consequences. However, it is unclear to what extent pediatricians address sexuality issues in this population. METHODS: Two hundred three pediatricians who regularly care for youth with ASD completed an online survey about their experiences in providing sexuality-related care to families and youth with ASD. RESULTS: Respondents discussed an average of 10.9 of 26 sexuality topics with all families at least once during routine visits. Experience in caring for youth with ASD correlated positively with the number of sexuality-related topics discussed and with self-reported comfort discussing sexuality with parents of youth with ASD. The most common barriers to providing comprehensive sexuality-related care to youth with ASD included logistical barriers, pediatrician and parent discomfort, lack of training, and absence of information and materials to help pediatricians address sexuality in this population. CONCLUSIONS: Although most pediatricians acknowledged the importance of addressing sexuality-related issues with youth with ASD and their families, several important sexuality-related topics were rarely discussed due to a variety of perceived barriers. Implications and recommendations are discussed.

Understanding processing speed weaknesses among pedophilic child molesters: response style vs. neuropathology.

Research shows that pedophilic (PED) child molesters exhibit slower performance speed and greater performance accuracy when compared to nonpedophilic (N-PED) child molesters or other criminal and noncriminal controls. The purpose of the present study was to examine whether these differences reflect a slow/deliberate response style among PEDS (as we have previously hypothesized; Eastvold, Suchy, & Strassberg, 2011; Suchy, Whittaker, Strassberg, & Eastvold, 2009a, 2009b), or a fundamental neuropathological weakness in processing speed. Data came from a larger study examining neurocognition among sex offenders. Processing speed in three different domains (motor speed, visual-perceptual speed, and visual-motor integration) was examined in 20 phallometrically identified PEDs, 20 N-PEDs, and 20 nonsexual offenders, using both clinical (Finger Tapping, Symbol Search, Digit Symbol Coding) and experimental measures (Inspection Time Task [ITT]). The ITT assessed speed of visual-perceptual processing independent of response speed. On clinical measures, PEDs exhibited slower visual perception [F(2, 57) = 5.24, p = .008] and visual-motor integration [F(2, 57) = 5.02, p = .010] than the other groups, with no differences for simple motor speed. On the ITT, PEDs performed less accurately than the other groups [F(2, 57) = 3.95, p = .025], clearly indicating that slow processing speed cannot be explained by a deliberate response style. Group differences persisted after controlling for other potential confounds (age, estimate IQ, working memory, ethnicity, and substance use). PEDs' slower performance is due to a fundamental neurocognitive weakness, rather than a slow/deliberate response style. These results are consistent with Cantor et al.'s (2008) work identifying white matter abnormalities among PEDs and provide further support for a neurodevelopmental etiology of pedophilia.

Sexting by high school students: an exploratory and descriptive study.

Recently, a phenomenon known as sexting, defined here as the transfer of sexually explicit photos via cell phone, has received substantial attention in the U.S. national media. To determine the current and potential future impact of sexting, more information about the behavior and the attitudes and beliefs surrounding it must be gathered, particularly as it relates to sexting by minors. The present study was designed to provide preliminary information about this phenomenon. Participants were 606 high school students (representing 98 % of the available student body) recruited from a single private high school in the southwestern U.S. Nearly 20 % of all participants reported they had ever sent a sexually explicit image of themselves via cell phone while almost twice as many reported that they had ever received a sexually explicit picture via cell phone and, of these, over 25 % indicated that they had forwarded such a picture to others. Of those reporting having sent a sexually explicit cell phone picture, over a third did so despite believing that there could be serious legal and other consequences attached to the behavior. Given the potential legal and psychological risks associated with sexting, it is important for adolescents, parents, school administrators, and even legislators and law enforcement to understand this behavior.

Psychopathy among pedophilic and nonpedophilic child molesters.

OBJECTIVE: Among men who commit sexual offenses against children, at least 2 distinct groups can be identified on the basis of the age of the primary targets of their sexual interest; pedophiles and nonpedophiles. METHOD: In the present report, across 2 independent samples of both types of child molesters as well as controls, a total of 104 men (53 pedophilic and 51 nonpedophilic) who had sexually offended against a child age 13 or younger were compared to each other (and to 49 non-sex offender controls) on psychopathy as assessed by the Psychopathic Personality Inventory (PPI). RESULTS: In both samples of child molesters, the nonpedophiles scored as significantly more psychopathic than the pedophiles. CONCLUSIONS: These results provide further evidence of the importance of distinguishing between these groups of offenders.

The latent structure of Multiphasic Sex Inventory-assessed pedophilic interest.

The Multiphasic Sex Inventory (MSI; Nichols & Molinder, 1984) is a self-report measure frequently used in the assessment of sex offenders. Scores on the MSI are often used to assess levels of pedophilic interest. However, the question of whether men with pedophilia represent a unique group distinguished by their sexual interests, or whether they are high-scorers on a continuum of sexual interest in children among men who sexually offend against children remains unanswered. Because no existing evidence points conclusively to pedophilia having either a categorical or continuous latent structure, it is unresolved whether MSI scores should be treated as a continuous measure of severity or whether a cut score should be used to categorize individuals as members of a pedophilic taxon. In the present study, the authors used 3 taxometric procedures to analyze the latent structure of pedophilic interest in a sample of 371 convicted child sex offenders. The results converged to indicate that pedophilic interest (as measured by the MSI) is dimensional. The implications of these findings for the assessment of pedophilic interest are discussed.

Category-specificity in sexual interest in gay men and lesbians.

The present study assessed the category-specificity of sexual interest of gay men and lesbians toward an understanding of the possible interaction of sex and sexual orientation that may exist in this phenomenon. Utilizing viewing time as a measure of sexual interest, we had participants (N = 99) rate the sexual appeal of sexually provocative pictures while the amount of time spent viewing each picture was inconspicuously measured. As hypothesized, same-sex oriented individuals demonstrated a category-specific pattern of sexual interest. That is, gay men and lesbians (1) viewed preferred sex pictures (i.e., of same sex) significantly longer than nonpreferred sex pictures (i.e., of opposite sex) and (2) rated preferred sex pictures as significantly more sexually appealing than nonpreferred sex pictures. Additionally, the difference in viewing times between preferred and nonpreferred sexual stimuli was not significantly different for gay men and lesbians, suggesting that lesbians are as category-specific as gay men. The implications of these findings are discussed.