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Davies, A.; Brass, J.; Martins Mendonca, V.; O’leary, S.; Bryan, M.; Neustifter, R. Comprehensive Sexuality Education for Students with Disabilities. Encyclopedia. Available online: https://encyclopedia.pub/entry/50745 (accessed on 02 July 2024).
Davies A, Brass J, Martins Mendonca V, O’leary S, Bryan M, Neustifter R. Comprehensive Sexuality Education for Students with Disabilities. Encyclopedia. Available at: https://encyclopedia.pub/entry/50745. Accessed July 02, 2024.
Davies, Adam, Justin Brass, Victoria Martins Mendonca, Samantha O’leary, Malissa Bryan, Ruth Neustifter. "Comprehensive Sexuality Education for Students with Disabilities" Encyclopedia, https://encyclopedia.pub/entry/50745 (accessed July 02, 2024).
Davies, A., Brass, J., Martins Mendonca, V., O’leary, S., Bryan, M., & Neustifter, R. (2023, October 24). Comprehensive Sexuality Education for Students with Disabilities. In Encyclopedia. https://encyclopedia.pub/entry/50745
Davies, Adam, et al. "Comprehensive Sexuality Education for Students with Disabilities." Encyclopedia. Web. 24 October, 2023.
Comprehensive Sexuality Education for Students with Disabilities
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This entry is adapted from the peer-reviewed paper 10.3390/sexes4040034

Comprehensive sexuality education (CSE) is an important framework utilized worldwide to provide students and young people with accurate, affirming, and socially conscious sexuality education.

comprehensive sexuality education curriculum disability education

1. Introduction

Comprehensive sexuality education (CSE) serves as a foundational pillar in fostering informed, responsible, and inclusive attitudes towards sexuality and relationships [1]. However, the integration of intersectional considerations, particularly concerning students with disabilities, remains an underexplored domain.
The primary objectives are as follows:
  • To understand the current landscape of CSE for students with disabilities in Ontario, Canada.
  • To highlight the intersectional challenges faced by students with disabilities while considering factors like race, ethnicity, gender, and other social identities.
  • To propose recommendations for a more inclusive and comprehensive CSE curriculum.
The global discourse on CSE has witnessed a significant evolution, with countries and international organizations progressively recognizing its importance. Organizations, such as the United Nations Educational, Scientific, and Cultural Organization, have been instrumental in framing guidelines for diverse educational settings [2]. However, a closer examination of the literature reveals a glaring omission: the specific needs of students with disabilities in school and educational settings.
While disability is acknowledged as a pivotal aspect of identity and well-being [3], its intersection with sexuality education is often overlooked. The Canadian context, in particular, presents a limited exploration of this nexus [4]. The majority of the existing literature on sexuality education for students with disabilities addresses students with intellectual disabilities, with a focus on their social and emotional needs [5]. This limited focus fails to capture the diverse challenges faced by students with varied disabilities and intersecting identities [6][7][8].
Globally, research on CSE has been conducted in regions such as South Africa [9][10], China [11], and Malaysia [12], among other nations [13][14]. Yet, the emphasis on intersectionality, especially concerning students with disabilities, remains sparse. A recent scoping review identified limited research catering to students with “mild” disabilities, indicating a gap in tailored education for students with disabilities within inclusive settings [15]. Furthermore, the literature scarcely addresses the confluence of 2SLGBTQIA+ identities with disability, leaving a significant portion of the student population underserved. Moreover, many teachers report feeling unprepared to address gender and sexuality in their classroom interactions with students with disabilities [16].
Intersectionality, as conceptualized by Kimberlé Crenshaw, underscores the interconnected nature of social identities [1][7]. In the realm of CSE, this translates to understanding how intersecting identities, from race, gender, and sexual orientation to disability shape an individual’s experiences and needs. The current conversations on CSE, while expansive, often fail to address the intersections of disability with other identities. For instance, a student with a disability who also identifies as part of the 2SLGBTQIA+ community may face compounded challenges that are unaddressed in a curriculum that views these identities in isolation.

2. Mental Health and Sexuality Education: Historical Perspectives, Contemporary Challenges, and the Need for Holistic Integration in Ontario’s Curriculum

The Ontario Health and Physical Education curriculum has recently integrated discussions on mental health and well-being as pivotal components of health education [17][18]. The term “mental health” is a complex construct, with interpretations varying across diverse sociocultural and political contexts [19]. Researchers acknowledge the fluidity of the term “mental health” and emphasize the distinction and intersectionality in relation to sociocultural and political constructions “mental health” and “mental illness.” For instance, an individual diagnosed with a mental health condition can still experience positive self-worth and well-being [20]. Contemporary curriculum documents in Ontario address topics like mental health literacy, socio-emotional development, and potential suicidal ideation among students [21]. However, these documents lack in-depth guidance for educators on discussing suicidality in an affirming, non-pathologizing manner. They also overlook the intricate relationship between mental well-being, sexuality, and dual diagnoses, such as the coexistence of mental health conditions with Autism [22].
Historically, during its formative stages in the early twentieth century, mental health was closely linked with sexuality education, albeit through a pathologized and medicalized perspective [21]. Subsequent curriculum revisions in Canada and the U.S. pivoted towards topics like sexually transmitted infections and sexuality, primarily from an abstinence standpoint. Still, further discussion is needed within sexuality education on the nexus between mental well-being and human sexuality [22][23][24]. The sexuality of individuals with a mental illness such as schizophrenia can be impacted by hospitalizations and a lack of privacy in home life and medical care, as well as societal prejudice and beliefs that individuals who experience psychosis should not have an active sexuality [25]. Still, the prevailing literature around mental illness and sexuality education primarily focuses on in-patient mental health service users, emphasizing the impact of psychiatric medications on sexual functioning [26][27][28].
For students diagnosed with mental health conditions or those with mental disabilities, there is a noticeable gap in the literature exploring the interplay between their sexual health needs and mental well-being. However, some scholars advocate for the BETTER model in contexts involving individuals with mental health variations, emphasizing its potential in facilitating discussions on sexuality and its intricate relationship with mental health [29]. This approach, which encourages open dialogues on sexuality, its significance, resource provision, tailored conversations, education on safe sexual practices, and documentation, can be invaluable for educators, especially when engaging with students with mental health variations [29]. Educators must be acutely aware of the complexities involved in delivering sexuality education to students with diverse mental health backgrounds, including those with potentially traumatic experiences related to sexuality [30].
Recent Canadian research underscores the importance of addressing mental health as an integral aspect of sexuality and health education, advocating for a comprehensive approach to well-being [30][31]. A prominent challenge for individuals with mental health conditions is the potential ostracization in interpersonal, romantic, and sexual relationships upon disclosing their mental health challenges [32]. Discussions should also encompass the interplay between mental distress and sexual decision making, emotional regulation during intimate moments, condom usage, and libido fluctuations [32]. Moreover, symptoms of psychosis can profoundly influence body perception, impacting an individual’s self-concept and relationship with their body [33]. Educators must prioritize these specific intersections when discussing topics of mental health, well-being, and self-image in sexuality education sessions.
In the broader context of sexuality education research, it is widely acknowledged that mental health is intricately connected with one’s sexuality, and emotional and mental well-being are intertwined with sexuality [34]. Positive self-esteem and self-concept are crucial discussions within sexuality education, allowing students to reflect on their strengths, interests, passions, and values [31]. Teachers often grapple with mental health literacy, encompassing knowledge and understanding of mental health, wellness, and psychological disabilities, and how to assist students in expressing their feelings and discussing various emotions and emotional states [35][36][37]. It is imperative that these conversations are integrated with open discussions on sex; sexuality; and emotional, romantic, and sexual emotions and feelings.
There is an important need for nuanced and supportive conversations about mental health as it pertains to the intersections of race, gender, sexual orientation, and disability, with self-harm and suicidality often being described as a result of systemic oppression and navigating societal stigmatization and devaluation [38]. As such, while educators address mental health in health and sexuality education classes, it is important to discuss social determinants of health and the structural and systemic inequalities that exacerbate feelings of loneliness and isolation in marginalized communities and individuals [39][40]. Moreover, instead of associating ideal mental health with heterosexuality, able-bodiedness, or cisnormativity, educators can seek to create affirmative classrooms that do not strive to normalize students or perpetuate stigma upon marginalized communities [39]. Therefore, sexuality education can be a place of identity development [5] whereby positive representations of marginalized communities, such as 2SLGBTQIA and disability communities, as well as their intersections, can be celebrated [39]. By acknowledging the stress and trauma that marginalized communities often experience [40], mental health can be approached through a frame that seeks to address systemic oppression and discuss mental health challenges as a natural reaction to societal exclusion [41] while offering resources for students to engage with on their own or with their families.

3. Physical Disabilities in Sexuality Education: Addressing Stigma, Barriers, and the Need for Inclusive Pedagogies in Ontario

Within the realm of physical disability, this encompasses students with auditory, visual, mobility, and/or health conditions, which may manifest as permanent or episodic [42]. The Ontario curriculum’s approach to sexuality education for students with physical disabilities remains notably deficient, perpetuating assumptions of asexuality and societal prejudices surrounding the sexual rights and needs of individuals with physical disabilities [4][43]. Such omissions hinder students’ understanding of informed consent, discussions on healthy relationships, sexual safety, pleasure, and importantly, conversations surrounding bodily autonomy [42].
A nuanced pedagogical approach tailored to the needs of students with physical disabilities is imperative within a CSE framework. Curricula that robustly challenge misconceptions of inherent asexuality or incapacity for intimate relationships align with studies that highlight minimal differences in sexual behavior between adolescents with and without physical disabilities [44][45]. While students with physical disabilities exhibit comparable rates of sexual activity and contraception use, they may encounter distinct pubertal or hormonal challenges, yet such intricacies are glaringly absent from the curriculum [46][47][48]. This oversight is particularly concerning when discussing hormonal contraceptive use due to potential contraindications with other medications or specific medical needs. Emphasizing the significance of seeking medical guidance during these discussions is crucial.
The literature indicates similar statistics regarding sexual orientation for students with and without physical disabilities [45]. Therefore, it is essential to address sexuality in a manner that positively represents and understands 2SLGBTQIA identities and sexualities, especially in the context of individuals with physical disabilities. Discussions surrounding the sexual development of students with physical disabilities, albeit limited, indicate the pervasive influence of societal stigmatization and medical trauma [46]. This highlights the urgency for CSE to adopt a trauma-informed pedagogical approach. Such approaches are vital for students with physical disabilities, facilitating discussions around safety, boundaries, and the potential for touch without consent under medical interventions [47]. Distinguishing between medical intervention and sexual intimacy, while emphasizing consent and bodily autonomy, is paramount. For teachers and educators, engaging in open conversations with students with physical disabilities about how to have open conversations with family members about sexuality can alleviate anxiety and stress about discussing sexuality with parental figures [49]. It is necessary for future researchers and policymakers to also acknowledge the social barriers and stigma that students with physical disabilities experience in schools and their interests in learning both sex and sexuality and everyday socialization and developing friendships and self-esteem [49].
Attitudinal barriers persist in sexuality education, particularly concerning misconceptions about asexuality and the perceived ineptitude of these students, implicitly suggesting the redundancy of discussing sexual well-being for youth with physical disabilities [17][18]. Such gaps curtail opportunities for representation and positive self-regard and hinder sexual agency among youth [49]. Beyond attitudinal barriers, physical challenges, such as student absenteeism due to health reasons [48] and the inaccessibility of physical education classes for some students [50][51], also pose significant obstacles. Addressing barriers for students with sensory needs, like those who are d/Deaf, hard of hearing, or blind/low vision, through augmentative communication devices can enhance their participation in CSE. Beyond assistive technology, specialized training, including collaboration with d/Deaf advocates and information on sexual consent and communication for d/Deaf communities, can further dismantle barriers for these students.

4. Intellectual Disabilities and Sexuality Education in Ontario: Bridging Gaps, Challenging Stigmas, and Crafting Inclusive Pedagogies

Intellectual disabilities (IDs), within the context of sexuality education in Ontario, Canada, encompass a spectrum of disorders marked by impairments within cognitive capacities and adaptive behaviors [51][52]. These impairments can impact a student’s ability to understand, assimilate, and apply knowledge related to sexuality education. In the Ontario educational landscape, students with IDs often necessitate tailored pedagogical strategies to ensure that they receive comprehensive, relevant, and effective sexuality education [5]. This underscores the need for precise, inclusive definitions and methodologies tailored to their unique educational needs, aiming to equip students with Autism with the knowledge and skills for informed, safe, and positive sexual interactions [5].
Sexuality education is pivotal for holistic development, and its importance is accentuated for students with IDs [52]. While Ontario has made commendable progress in refining its curriculum for inclusivity [17][18], a thorough examination of the literature indicates persistent challenges faced by students with ID, such as a lack of individualized instruction, the need for social stories and situational examples to develop social–emotional skills, and explicit conversations about their own and others’ sexual consent [5]. The broader discourse on sexual health education for youth with Autism and other disabilities highlights issues of stigma, de-sexualization, and a lack of individualized instruction, thereby obstructing their sexual health and well-being [52][53].
Research in Ontario underscores the universal significance of sexuality education [54]. Yet, a glaring gap persists in addressing the nuanced needs of students with ID [52]. These students often struggle with understanding concepts like bodily autonomy, consent, and relationship complexities [5]. The intersections of disability, sexuality, and gender further intensify their experiences, leading to feelings of marginalization in romantic and sexual contexts [55]. While the Ontario curriculum encompasses these themes, the pedagogical approaches may not always resonate with the learning needs of students with ID [5], resulting in exclusionary practices due to a lack of educator training and readiness [5].
The challenge lies not in the absence of sexuality education but in its adaptability and inclusivity for students with ID [5][52]. The current curriculum and methodologies in Ontario often overlook the voices and experiences of students with disabilities [4][5], indicating the inadequacy of a one-size-fits-all pedagogical approach. Recognizing that students with ID deserve tailored curriculum planning is paramount. It is essential to develop a curriculum attuned to their cognitive skills, ensuring that concepts are accessible and comprehensible. Educators must receive specialized training to effectively teach students with ID, understanding the intricacies of intellectual disabilities and employing resonant teaching strategies. Collaborations between educators, caregivers, and field experts can foster a holistic educational experience, addressing challenges faced by youth with Autism and other disabilities, such as societal stigma and fetishization. Establishing feedback mechanisms involving students with ID and their caregivers can further refine the sexuality education program, ensuring continuous adaptability and improvement.
Future research should prioritize understanding the needs and challenges of students with ID in Ontario, such as conversations about romantic and sexual scripts [53]. Collaborative endeavors between educators, caregivers, and field experts can lay the foundation for a more inclusive curriculum [56]. Such forms of collaboration can involve the discussions of social stories and situational examples that parents can discuss with their children at home and bring to school for further questioning and engagement. Such situational examples can engage with conversations of romantic relationships, dating, personal boundaries, and consent, for example [5]. Investigating the efficacy of diverse teaching strategies, curating disability-affirming resources, and evaluating caregiver involvement can offer invaluable insights [51].

5. 2SLGBTQIA and Disability: Navigating the Dual Realms of Ableism and Queerphobia in Healthcare and Society

The confluence of 2SLGBTQIA+ identities with disability unveils a complex tapestry of challenges stemming from both ableism and queerphobia [57]. Individually, these groups have navigated systemic discrimination both historically and currently. However, their intersections can magnify adversities, particularly in healthcare systems that are ill-equipped to address their nuanced needs [58][59]. Societal stigmas, especially those tethered to discrimination directed towards disability, can exacerbate feelings of marginalization and undesirability, especially in the realms of romantic and sexual relationships [42].
Contemporary academic discourses delve into the multifaceted experiences of these intersecting groups. The challenges they face are not monolithic but are shaped by the nature of the disability, the sociopolitical milieu, and the cultural contexts in which they exist [58][59]. For instance, a person with a mobility disability identifying as queer might face different societal challenges than someone with a cognitive disability identifying as transgender. Such intricacies underscore the importance of a nuanced understanding and approach to support these communities [57][58][59].
Despite the myriad of challenges, there is remarkable resilience evident within these communities. Numerous organizations and advocacy groups champion the rights and well-being of individuals at this intersection, striving for inclusivity, representation, and equity [60]. Their efforts highlight the imperative to educate healthcare providers about the unique sexual health needs of individuals with disabilities, especially those who also identify within the 2SLGBTQIA+ spectrum [42].

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Contributors MDPI registered users' name will be linked to their SciProfiles pages. To register with us, please refer to https://encyclopedia.pub/register :
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Justin Brass
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Malissa Bryan
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Ruth Neustifter
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