Enhancing Sexual Health Education for Autistic Youth: A Scoping Review of Barriers, Gaps, and Solutions

Abstract

Autistic adolescents are often excluded from comprehensive sexuality education (CSE) by schools, parents, and healthcare providers, despite growing recognition of their sexual agency. This scoping review examined 42 U.S.- based studies to identify thematic categories that highlight the recurring challenges and opportunities in providing sexuality education for autistic adolescents. Five themes emerged: (1) pervasive misconceptions about autism and sexuality; (2) inadequate access to formal sexual education; (3) parental and clinician discomfort or lack of preparedness to address sexual health; (4) heightened vulnerability to sexual exploitation and adverse health outcomes; and (5) recommendations for inclusive, affirming, and developmentally responsive curricula. Findings highlight how autistic adolescents often receive fragmented, reactive instruction that prioritizes behavior management rather than proactive skill-building in consent, boundaries, and healthy relationships. Evidence suggests that tailored approaches incorporating visual supports, concrete language, and LGBTQ+ inclusivity improve accessibility and relevance. Addressing these gaps requires proper CSE training for autistic adolescents’ family members, teachers, and clinicians to enhance communication, strengthen mutual understanding, and foster more supportive, informed relationships across all parties involved. This review contributes to the growing body of literature that calls for CSE that empowers autistic adolescents to make informed decisions and promotes equitable sexual health outcomes.

Introduction

Autistic adolescents have historically been underserved in the domain of comprehensive sexuality education CSE, despite growing recognition of their sexual agency and rights (SIECUS: Sex Ed for Social Change, 2021). This phenomenon encompasses the systematic exclusion of autistic youth from CSE, persistent misconceptions about their sexual agency, and limited adaptation of curricula to address their cognitive, sensory, and communicative needs (SIECUS: Sex Ed for Social Change, 2021). Previous research has documented how autistic adolescents often encounter fragmented or delayed education, leading to confusion about boundaries, consent, and relationships, and increased vulnerability to sexual exploitation and health risks (Ballan & Freyer, 2017; Barnett & Maticka-Tyndale, 2015; Cheak-Zamora et al., 2019; Graham Holmes et al., 2020). These studies highlight that autistic youth frequently articulate a desire for sexuality education that is explicit, concrete, and socially contextualized, yet their voices remain underrepresented in formal curricula and policy discussions (Strnadová et al., 2022; Sullivan & Caterino, 2008). By centering this phenomenon, the present scoping review synthesizes evidence on the barriers, gaps, and recommendations for inclusive sexual health education tailored to autistic adolescents.

While CSE has been increasingly emphasized as a universal right, autistic youth are frequently excluded from its development and delivery (Strnadová et al., 2022; Sullivan & Caterino, 2008). When instruction is provided, it is commonly misaligned with their cognitive, sensory, and communicative needs. As a result, they receive less CSE than their non-autistic peers (Herrick & Datti, 2022; Strnadová et al., 2022). In some instances, autistic adolescents learn CSE alongside non-autistic classmates; however, in these instances, these students have noted their difficulty in understanding abstract concepts such as dating, sexual autonomy, and the perception of abusive behavior, due to the “one-size-fits-all” curriculum used for all students (Barnett & Maticka-Tyndale, 2015). Prior studies have found that inadequate education on body knowledge, privacy, and consent during early childhood contributes to sexual health disparities in adolescence, emphasizing the importance of CSE that reflects the developmental needs of autistic youth (Solomon et al., 2019).

Comprehensive sexuality education encompasses more than disease prevention and includes teaching about identity, relationships, consent, boundaries, communication, and self-determination (Albert Sekhar et al., 2024; ACOG, 2024). CSE is an integral part of promoting sexual health, establishing healthy relationships, having safe sex, recognizing signs of sexual abuse and victimization, and feeling secure in one’s own body (Goldfarb & Lieberman, 2021; Pediatrics AAP, 2024; Schneider & Hirsch, 2020). Without proper CSE to guide their journeys through adolescence, such as experiencing sexual desires and romantic attraction for the first time, autistic adolescents lack guidance and support that can ensure their sexual health and well-being beyond disease prevention (Schneider & Hirsch, 2020). As a result, there is a significant disparity in knowledge and understanding regarding sexual education topics, confusion about how to approach sexual and romantic relationships, and increased rates of sexual manipulation and abuse (Ballan & Freyer, 2017; Herrick & Datti, 2022; Maggio et al., 2022). These factors elevate autistic individuals’ vulnerability to sexually transmitted infections (STIs) and HIV, which is a consequence of ableism, presumptions, stigmatization, and exclusion (Botha et al., 2022; James et al., 2024; Turnock et al., 2022). While HIV and STI prevention are critical aspects of CSE, they represent only one dimension of the broader educational needs of autistic youth.

Sexual education for autistic persons is often reactive, addressing behaviors deemed inappropriate, such as public masturbation, only after they occur, rather than proactive guidance to understand and manage their sexual development in healthy, private, and socially appropriate ways (Ballan & Freyer, 2017). This reactive approach reflects a broader pattern in which sexual health education is framed as a behavioral management rather than a rights-based, development necessity. By focusing primarily on correction rather than prevention or empowerment, these interventions miss the opportunity to support autistic individuals in developing autonomy, understanding consent, and forming healthy intimate and sexual relationships. Proactive sexual education includes prioritizing students’ communication, understanding, and rewarding appropriate social/sexual behavior prior to an unwanted incident occurring (Ballan & Freyer, 2017). However, efforts to provide proactive sexual education are often impeded by preconceived notions that autistic individuals lack desire or are incapable of understanding social and sexual norms, further hindering their access to comprehensive and affirming sex education, sexual agency, and engagement in sexual healthcare (Solomon et al., 2019). Without comprehensive education on expressing their sexuality, including boundaries, the distinction between private and public space, and healthy ways to explore their bodies to enhance their overall well-being, autistic persons will lack the skills and resources to mitigate potential risks such as unintended pregnancies, STI/HIV transmission, and sexual exploitation (Ballan & Freyer, 2017).

Research indicates that sexual education programs for autistic individuals are still in their early stages of development, limited by policies and their application to diverse populations, including autistic youth and young adults (Solomon et al., 2019). Previous reviews on autism and sexuality have focused on narrower aspects such as sexual knowledge (Maggio et al., 2022), sexual behaviors and outcomes (Byers et al., 2013a), or safety and abuse prevention (Brown-Lavoie et al., 2014). Others have targeted autistic adults rather than adolescents (Solomon et al., 2019), focused exclusively on interventions (Ngo et al., 2025), or emphasized parental or clinical perspectives without entirely centering on youth experiences (Strnadová et al., 2022). It is critical to address these disparities and ensure that all people, regardless of intellectual or developmental ability, have access to adequate sexual health care and education.

Foundational work by Travers and Tincani (2010) outlined critical issues and decision-making guidelines for sexuality education among individuals with autism spectrum disorders. Their framework emphasized core content areas such as distinguishing public versus private behaviors, understanding consent, and personal safety, while advocating for instructional strategies tailored to autistic learners, including visual supports, social stories, and role-play. Importantly, they highlighted the significant risks associated with omitting sexuality education for autistic youth, including increased vulnerability to exploitation and social misunderstanding. While this early work provided essential guidance for program design, it pre-dated contemporary movements toward disability-inclusive comprehensive sexuality education.

Our review builds on this foundation by examining how more recent U.S.-based curricula and interventions (post-2010) incorporate these principles into inclusive and developmentally responsive sexuality education frameworks for autistic adolescents. This scoping review aims to provide a comprehensive synthesis of the literature on sexual and relationship education within comprehensive sexuality education (CSE) for autistic adolescents in the United States, encompassing access, content, delivery, inclusion, and intersectionality within a developmental, rights-based, and public health framework. This review builds on but diverges from earlier global and adult-focused analyses by identifying gaps, assessing inclusivity, and proposing responsive educational solutions tailored to autistic youth. Mapping existing knowledge, identifying barriers, and proposing solutions serves as a critical resource for educators, healthcare providers, and policymakers aiming to improve sexual health outcomes for autistic adolescents.

Methods

The purpose of this scoping review was to (1) describe characteristics (e.g., study design, focus) of studies that have focused on sexual education among autistic individuals, (2) categorize the significant findings of those studies, (3) identify research gaps needed to enhance comprehensive sex education for autistic adolescents in the United States, and (4) define future directions for research in this area. This scoping study followed the Reviewers’ Manual for Scoping Reviews developed by the Joanna Briggs Institute (Peters et al., 2015). The review process includes the following steps: (1) identifying and aligning research questions and objectives; (2) identifying relevant studies by developing inclusion and exclusion criteria that align with research questions; (3) searching, selecting, and extracting studies to be used in the review; (4) charting the data; and (5) collating, summarizing, and reporting findings by the objectives and research questions. No registered protocol was used; instead, the PRISMA-SCR guidelines were employed. Consistent with recommendations from Bottema-Beutel et al. (2021), this review intentionally avoids ableist language and adopts identity-first terminology (e.g., autistic adolescents) to align with preferences expressed by many within the autism community.

Search strategy

Pilot searches were performed across multiple databases before finalizing the databases and search criteria listed below. The search strategy was conducted in June 2023 and consisted of the following databases: ERIC, PubMed, CINAHL, and PsychInfo. We used the search terms: “sex education AND autism,” “adolescents AND autism AND sexuality,” “autism AND sexual abuse,” “autism AND sex education AND parents,” and “autism AND sex education AND clinicians.” Two authors screened all titles and abstracts, as well as full-text articles, and completed data extraction. A separate meeting was held to determine the status of conflicting reviews. This search was limited to academic journals and peer-reviewed articles published between 2010 and 2024.

Study selection

With these search terms, we gathered 1,956 abstracts. The inclusion criteria for studies were to be published after 2010, conducted in the United States, or, if conducted online, to have at least 30% of the participants be from the United States, autistic participants, and/or their parents or providers. The research team selected 2010 as the starting point to align with a period of heightened public health and educational discourse regarding inclusive sexual health education and disability rights, rather than in response to a specific policy or legal change(The United Nations, 2006; Travers & Tincani, 2010). This timeframe reflects the increasing recommendations from advocacy organizations, researchers, and public health bodies to incorporate disability-inclusive frameworks into sexuality education (The United Nations, 2006; Travers & Tincani, 2010). While no single policy shift defines this year, the growing emphasis on inclusion during this period provided a meaningful context for examining the literature (Travers & Tincani, 2010). While 2010 marked the emergence of this focus, no peer-reviewed, U.S.-based studies meeting our inclusion criteria were identified from 2010 or 2011; thus, the first included study was published in 2012. Focusing on U.S.-based studies allowed us to synthesize findings with a shared educational and public health framework, thereby enhancing the relevance and applicability of the results to domestic policy and practice. Table 1 outlines the criteria for inclusion and exclusion. After applying these criteria to the gathered abstracts, 1,914 records were excluded. Following a full-text review, 42 studies remained (see Figure 1).

Table 1.

Inclusion criteria for studies assessed.

	Inclusion Criteria
Publication Type	Journal articles
Language	English
Country	United States or, if conducted online with other countries, then at least 30% of participants from the United States.
Time Period	Published after 2010
Focus	Focused on the sexual education and practices of autistic individuals. As well as, the perspectives from parents and clinicians on sex education within this population.

Figure 1.

PRISMA Flowchart of Studies Reviewed.

Note: This figure demonstrates the process of reviewing studies based on our inclusion and exclusion criteria. In total, 1,956 studies were screened using our search terms in ERIC, PubMed, CINAHL, and PsychInfo. However, 1,914 were excluded because they did not meet our inclusion criteria.

The data were gathered and organized into an extraction table, which included information on the study design, population (including inclusion criteria and sample size), measurements used, and the results obtained. Due to the scarcity of research in this field and the need to get a comprehensive understanding of sexual education for autistic adolescents, we did not set any restrictions on the study design or particular outcomes for this scoping review. All studies that met our inclusion criteria were included, regardless of the technique or assessed result. The study’s evidence summary consists of both quantitative analyses and qualitative evaluations. The authors classified the qualitative data into three categories: enhanced, unaltered, or reduced. The assessment of bias was conducted in accordance with the Cochrane recommendations (Higgins et al., 2022).

Mapping study topic and analysis

An inductive thematic analysis was employed to synthesize findings from the reviewed studies, allowing themes to emerge from the data following Braun and Clarke (2006) established framework for reflexive thematic analysis. This approach enabled a nuanced understanding of the barriers, gaps, and opportunities in CSE for autistic adolescents. Two researchers independently reviewed the studies and engaged in open coding to ensure reliability and rigor. The included studies were systematically reviewed to extract key information, including study design, population characteristics, intervention details, and main findings. The analysis allowed the identification of five categories related to the objectives of the sexual health interventions. These remaining studies were then categorized into the following: sex education, sexuality, parents’ sexual education, clinician sex education, and sexual abuse. A data extraction table was used to organize the information and facilitate the identification of patterns across studies. This process ensured a comprehensive overview of the scope and nature of existing research on sex education for autistic adolescents. Using an open coding approach, researchers coded relevant text segments and labeled them based on recurring concepts within the studies. Codes reflected critical aspects of sex education for autistic youth, including misconceptions about autism spectrum disorder and sexuality, gaps in formal sexual education, barriers to parental and clinician engagement, sexual abuse and manipulation, and recommendations for inclusive education. The codes were then grouped into higher categories through constant comparison and memo writing, culminating in five core themes that aligned with the review’s research questions. This process enhanced the credibility of the findings and allowed for reflexive interpretation of the data. The emerging themes were synthesized into a narrative summary to contextualize the findings within broader discussions of health disparities, disability rights, and education policy. The analysis highlighted systemic barriers that limit autistic adolescents’ access to comprehensive and inclusive sex education, underscoring the need for policy reforms, parental involvement, and clinician training. The study findings contribute to ongoing efforts to enhance sexual health education and promote the sexual agency and well-being of autistic youth.

Results

Studies characteristics

Table 2 shows that the studies in the sample used the following methods: randomized control trial (n = 1), intervention with pre-exposure and post-exposure assessments (n = 6), qualitative studies (n = 5), cross-sectional (n = 25), case study (n = 1), retrospective study (n = 1), and a mixed method (n = 3). Fifteen of the studies conducted recruited parents of adolescents with autism. Nineteen of the studies recruited autistic adults who were 18 years of age or older. Ten of the studies included non-autistic participants in the sample. Three of the studies recruited healthcare providers and educators. The articles covered key areas related to sex education and sexual health, such as sex education delivery, dating and relationship dynamics, parent-child sex communication, concerns about sexual expression, sexual diversity, and sexual abuse and violence. Table 3 provides an overview of essential sexual health topics, including their definitions and relevant academic references.

Table 2.

Characteristics of the articles (n = 42).

		n(%)
Data Range	2012–2016	15(36)
	2017–2020	14 (33)
	2021–2024	13(31)
Study Design	Cross-sectional	25 (60)
	Case-Control	1 (2)
	Pre-experimental(Pre/post test)	6 (14)
	Qualitative	5 (12)
	Mixed-methods	3 (7)
	RCT	1 (2)
	Retrospective Cohort	1 (2)
Population	ASD Child	1 (2)
	ASD Adolescent/Young Adult (age13–24)	10 (24)
	ASD adults	17 (40)
	Parents/ Caregivers only	9 (21)
	Both Parent and Child	1 (2)
	Healthcare Provider (HCP) only	1 (2)
	Multiple Key Populations*	3 (7)
Study Focus
Major Themes	Misconceptions ASD Sexuality	15 (36)
	Lack of formal CSE	2 (5)
	Missed Opportunities	11 (26)
	Consequences of Inadequate SE	6 (14)
	Recommendations for SE interventions	8 (19)
Sexual Health Topics	Sex Education Delivery	9 (21)
	Dating/Relationship Dynamics	8 (19)
	Parent Child Sex Communication	11 (26)
	Concerns about Sexual Expression	2 (5)
	Sexual Diversity (LGBTQIA+)	4 (10)
	Sexual Abuse/Violence	8 (19)

^*Studies with multiple key populations included the following participants: family and school professionals (n = 1); parents, ASD youth, & educators, HCP (n = 1); school professionals, ASD youth, HCP, & parents (n = 1).

Table 3.

Definitions and references for key sexual health topics.

Sexual Health Topics	Definition	References
Sex Education Delivery (n = 9)	Sex education delivery refers to the methods, settings, and approaches used to provide information about human sexuality, reproductive health, relationships, consent, and safe sex practices. This can occur in formal settings such as schools, community organizations, and healthcare facilities, or informal through parents, digital platforms, social media, and peer education. Effective delivery methods can include comprehensive, abstinence-only, or medically accurate, evidence-based curricula tailored to different populations’ needs.	Barnard-Brak et al., 2014; Crehan et al., 2022; Crehan et al., 2023; Curtiss & Ebata, 2016; Hannah & Stagg, 2016; Klett & Turan, 2012; Schmidt et al., 2020; Stein et al., 2018; Weir et al., 2021
Dating/Relationship Dynamics (n = 8)	Dating and relationship dynamics encompass the behaviors, communication patterns, power structures, and emotional interactions between individuals in romantic or sexual relationships. These dynamics can be influenced by cultural norms, personal experiences, social expectations, and factors such as gender roles, power imbalances, emotional intelligence, and conflict resolution skills.	Byers et al., 2013a; Byers et al., 2013b; Cheak-Zamora et al., 2019; Crehan et al., 2024; Gray et al., 2021; Kohn et al., 2023; McMahon et al., 2021; Pedgrift & Sparapani, 2022
Parent-Child Sex Communication (n = 11)	Parent-child sex communication refers to discussions between parents (or guardians) and their children about topics related to sex, relationships, sexual health, consent, and values surrounding sexuality. The nature and effectiveness of these conversations can be shaped by cultural beliefs, parental comfort levels, openness, and the child’s developmental stage. Research suggests that open and positive communication about sexual health can contribute to safer sexual behaviors and healthier attitudes toward sex.	Ballan, 2012; Corona et al., 2016; Hartmann et al., 2019; Holmes et al., 2016; Holmes et al., 2019; Graham Holmes et al., 2020; Kenny et al., 2013; Kenny et al., 2021; Lehan Mackin et al., 2016; Pugliese et al., 2020; Rooks-Ellis et al., 2020
Concerns about Sexual Expression (n = 2)	Concerns about sexual expression involve personal, societal, and cultural apprehensions related to how individuals experience and express their sexuality, including desires, identities, orientations, and behaviors. These concerns can be influenced by stigma, religious beliefs, societal norms, mental health, and experiences of discrimination or trauma. Barriers to healthy sexual expression can affect psychological well-being and access to appropriate sexual health resources.	Cividini-Motta et al., 2020; Penwell Barnett & Maticka-Tyndale, 2015
Sexual Diversity (LGBTQIA+) (n = 4)	Sexual diversity refers to the spectrum of sexual orientations, identities, and expressions beyond heterosexuality and cisnormativity. It includes lesbian, gay, bisexual, transgender, queer, and other identities (LGBTQIA+), recognizing the varied ways individuals experience attraction, gender identity, and sexual behaviors. Understanding and supporting sexual diversity involves acknowledging the unique social, health, and legal challenges faced by LGBTQIA+ individuals, as well as advocating for inclusivity, equity, and rights.	Bush et al., 2021; Hillier et al., 2020; Lewis et al., 2021; Ronis et al., 2021
Sexual Abuse/Violence (n = 8)	Sexual abuse and violence encompass any unwanted or non-consensual sexual activity, including sexual harassment, assault, exploitation, and coercion. This can occur in various contexts, including intimate relationships, institutions, workplaces, and online spaces. Sexual violence has significant physical, emotional, and psychological consequences and disproportionately affects marginalized groups. Prevention and response efforts involve education, legal protections, survivor-centered support services, and societal efforts to address power imbalances and cultural norms that enable violence.	Brenner et al., 2018; Brown et al., 2017; Brown-Lavoie et al., 2014; Kildahl et al., 2020; Libster et al., 2024; Pecora et al., 2019; Sutton et al., 2013; Bleil Walters et al., 2013

The reviewed studies revealed five key themes influencing access to CSE for autistic individuals. First, pervasive misconceptions, such as the belief that autistic individuals are asexual or uninterested in relationships, contribute to their exclusion from sex education (n = 15). Second, autistic youth often receive significantly less structured sex education compared to non-autistic peers, contributing to knowledge deficits in areas such as consent, boundaries, and healthy relationships (n = 2). Third, parents and healthcare providers expressed discomfort or lacked the knowledge to discuss sex education effectively, further limiting autistic adolescents’ access to accurate and inclusive information (n = 11). Fourth, the absence of CSE is linked to increased vulnerability to sexual exploitation, unintended pregnancies, and STI/HIV (n = 6). Finally, studies recommend the use of adaptive teaching strategies, including visual supports, LGBTQ+ inclusivity, and culturally sensitive approaches, to improve the accessibility and effectiveness of sex education programs for autistic youth (n = 8). The sections below provide a more detailed examination of each of these themes.

Misconceptions about autistic individuals’ sexuality and sexual development

Sexual knowledge

Several articles reported inadequate sexual knowledge among autistic adolescents (Barnett & Maticka-Tyndale, 2015; Brown-Lavoie et al., 2014; Cheak-Zamora et al., 2019; Hannah & Stagg, 2016). Autistic participants reported obtaining knowledge regarding STIs, contraception, and reproductive health from fewer social sources, such as parents, teachers, or friends (Crehan et al., 2022). As a result, they understood these topics less than their non-autistic counterparts (Brown-Lavoie et al., 2014). Autistic individuals have noted a lack of education on proper social interactions, social etiquette, and physical interactions relevant to dating and courtship (Barnett & Maticka-Tyndale, 2015; Cheak-Zamora et al., 2019; Hannah & Stagg, 2016; Kohn et al., 2023). Those who did receive sex education in schools emphasized that social concepts should have been explicitly taught, such as courtship, healthy relationships, and signs of abuse, as opposed to vague generalizations that were typically not fully understood (Barnett & Maticka-Tyndale, 2015). For example, one autistic participant in Barnett and Maticka-Tyndale (2015) stated, “I think autistic people should be given more specifics, instead of the vague generalizations (‘when you love somebody…’) that sex ed sometimes devolves into. I like specificity” (Barnett & Maticka-Tyndale, 2015). Additionally, in Hannah and Stagg (2016) one autistic participant stated similarly, “Because I have very concrete, black and white thinking… it didn’t quite fit. And it caused me a lot of sort of emotional problems” (Hannah & Stagg, 2016). In Kohn and colleagues’ study (2023), the autistic and non-autistic participants demonstrated comparable levels of sexual knowledge; however, autistic participants demonstrated distinct differences in pragmatic and social communication abilities when defining concepts related to sexual anatomy and health, which may influence how they interpret, engage with, and apply content presented in formal sex education settings in real-world application. These abilities were measured by participants’ sociocultural competency, vulgarity, and mechanical language when asked to define key sexual autonomy and sexual health terminology using a sexual vocabulary test (Kohn et al., 2023). These differences may reflect not only reduced access to formal CSE but also limited opportunities for informal learning through peer and family conversations and the need for instructional approaches that align with diverse communicative and cognitive profiles.

Sexual interest

Despite the common misconception that autistic adolescents are not interested in engaging in sexual behaviors, research reveals that this is not accurate (Cheak-Zamora et al., 2019; Corona et al., 2016; Pecora et al., 2019). Several studies showed that autistic adolescents had sexual interests comparable to non-autistic youth (Cheak-Zamora et al., 2019; Corona et al., 2016; Pecora et al., 2019). Cheak-Zamora et al. (2019) reported that 19 out of 27 autistic participants were interested in being in a relationship and were frustrated by their lack of success (Cheak-Zamora et al., 2019). Interestingly, when assessing the dating habits of autistic youth, it was found that those with more autistic traits were more likely to pursue relationships with partners who display rudeness, emotional distance, and idiosyncratic behaviors (McMahon et al., 2021). Additionally, Corona et al. (2016) reported that 75% of the parent participants were aware that their child desired a romantic relationship. Still, they did not know how to initiate a romantic relationship appropriately (Corona et al., 2016).

Sexual experiences

Regarding sexual experiences, some studies showed that autistic participants were less likely to engage in sexual activity than non-autistic youth but that there was still a significant portion of those who were having sex or masturbating (Byers et al., 2013a, 2013b; Pecora et al., 2019; Weir et al., 2021). Weir et al. (2021) compared the sexual activities of autistic individuals to non-autistic individuals. They found no significant difference .in STI rates or age of sexual activity onset (Weir et al., 2021). Pecora et al. (2019) found that autistic females had no significant difference in sexual interest or sexual experiences between autistic and non-autistic females (Pecora et al., 2019). Other studies reported moderate sexual satisfaction, moderate sexual self-esteem, and participants who engaged in affectionate activities at least once a week and genitally focused behaviors between 1 and 2 times a month, including masturbation and self-pleasure (Byers et al., 2013a, 2013b).

A common difficulty with sexual experiences among autistic participants was hypersensitivity, a heightened sensation of touch, sound, or odor (Barnett & Maticka-Tyndale, 2015; Gray et al., 2021; Lewis et al., 2021). Several participants detailed how difficult it was to engage in sexual activities, how to mediate their hypersensitivity, and the difficulty of meeting someone at social events because of their low sensory thresholds (Gray et al., 2021). To overcome this obstacle, these participants highlighted the importance of communication with their partner, desensitization with lidocaine or alcohol, and incorporating self-pleasure and self-touch (Barnett & Maticka-Tyndale, 2015; Gray et al., 2021). Participants employed a specific method in their relationships called “literal declaration,” characterized by direct disclosure of feelings and intentions, which facilitated effective communication when they were overstimulated (Barnett & Maticka-Tyndale, 2015).

Lack of formal sexual education

Formal CSE refers to structured instruction in settings like schools, youth centers, churches, or other community-based locations. Two studies that met the inclusion criteria concentrated on the current CSE curriculum in schools among autistic adolescents with intellectual and developmental disabilities (IDD). In a national study analyzing predictors of access to sexual education in public schools, 43% of participants with IDD had CSE compared to 57% of participants who did not have an IDD (Barnard-Brak et al., 2014). Additionally, 84% of participants with more severe IDD did not receive CSE (Barnard-Brak et al., 2014). The significant predictors of not receiving CSE identified in this study were, most notably, a lack of communication skills, low social skills, and physical limitations (Barnard-Brak et al., 2014).

To address the lack of CSE delivered in schools, Curtiss and Ebata assessed the different sources that adolescents with autism have for CSE (social workers, special educators, nurses, parents, and therapists), and their willingness to educate this population about sex and relationships (Curtiss & Ebata, 2016). Among the 43 participants, only 21.8% were currently teaching human sexuality to autistic adolescents, and 38% were planning on teaching in the future or did not plan on teaching (Curtiss & Ebata, 2016). Despite these numbers, the participants agreed that everyone needs sex education and that there are unique challenges that autistic adolescents experience (Curtiss & Ebata, 2016). This research also included an intervention that provided sex education material to autistic adolescents via email or Facebook. This research emphasizes the need to explicitly target specialists who should educate autistic teens about CSE (Curtiss & Ebata, 2016). Autistic adolescents are significantly less likely to receive sexual education from schools, parents, and clinicians and more likely to report knowledge from the internet, TV/movies, radio, or porn (Barnett & Maticka-Tyndale, 2015; Brown-Lavoie et al., 2014; Cheak-Zamora et al., 2019; Crehan et al., 2023; Hartmann et al., 2019).

Barriers to parental and clinician engagement

Parents sex education

In the studies reviewed, it was found that the majority of parents with autistic adolescents were less likely to engage in conversations regarding sexuality and sexual education (Graham Holmes et al., 2020; Holmes et al., 2016; 2019; Lehan Mackin et al., 2016; Schmidt et al., 2020). Despite some parents noting that they are the primary source of sexual education for their children, they rely on other sources, such as teachers or clinicians, to discuss sexual and relationship topics (Crehan et al., 2023; Lehan Mackin et al., 2016). For the parents who did educate their children on sex and sexual activity, it was found that more topics were commonly ignored compared to parents with non-autistic children (Graham Holmes et al., 2020; Holmes et al., 2019). For example, one online study assessed family communication with autistic daughters and found that topics commonly discussed were privacy, abuse, hygiene, and menstruation, but the topics ignored were relationships, sexual health, and sexuality (Graham Holmes et al., 2020; Holmes et al., 2019). For parents who had already begun sexual education for their child or who were planning on doing it in the future, the majority supported CSE from themselves, teachers, or clinicians (Stein et al., 2018).

Graham Holmes and colleagues examined how parents teach their autistic children about sexuality (Graham Holmes et al., 2020). However, these strategies did not use visual aids, social narratives, or skill-focused guidance, which are often employed as instructional techniques for children with autism (Graham Holmes et al., 2020). The reasons why several parents noted not teaching their child these sexuality topics included thinking that their child was “not ready” because the parent had low expectations of their child to engage in sexual or romantic relationships or because the parent themselves had limited knowledge on such topics (Ballan, 2012); Graham Holmes et al., 2020; Holmes et al., 2016; Holmes et al., 2019; (Kenny et al., 2021); Lehan Mackin et al., 2016; Schmidt et al., 2020). Despite these beliefs, several parents in these studies acknowledged that their child was knowingly engaging in sexual behavior or had admitted to desiring one in the future (Corona et al., 2016). Some parents even acknowledged the consequences of their child not having adequate sexual education, including being a victim of abuse or conducting inappropriate sexual behavior (Graham Holmes et al., 2020; Lehan Mackin et al., 2016). Hartmann et al. (2019) found inadequate knowledge among parents of their children’s sexual behaviors and sexual victimization, with only 54% of parents of autistic adolescents reporting their child’s sexual abuse, despite 62% of the adolescents themselves reporting being victims (Hartmann et al., 2019).

Clinicians sexual education

There was only one study that fit our inclusion criteria that focused on the impact of clinicians on autistic sexual education, a retrospective analysis of healthcare providers’ failure to detect signs of abuse in an autistic patient. Unfortunately, these healthcare providers attributed several of the patient’s post-traumatic stress disorder (PTSD) symptoms (discomfort, agitation, apathy, anxiety) to symptoms of his autism (Kildahl et al., 2020). The patient displayed signs of depression and sexual victimization, such as leaving images and texts relating to suicide for the staff to find (Kildahl et al., 2020). The providers admitted to a lack of knowledge of how to distinguish these two diagnoses and failed to ask the proper sexual victimization questions (Kildahl et al., 2020). In another study, Cheak-Zamora et al. (2019) explored the sexual and relationship experiences of autistic adolescents and young adults. They found that only 4 of 27 participants experienced their doctor discussing sexuality and sexual practices with them (Cheak-Zamora et al., 2019). Additionally, an epidemiological study revealed substantial disparities in HIV care engagement, such as HIV testing and accessing HIV-related treatment for people with intellectual and developmental impairments, including autism (James et al., 2024). The research revealed a common misunderstanding that people with intellectual impairments are asexual and, hence, do not need HIV testing or education, indicating that autistic individuals with co-occurring intellectual and developmental disabilities have more detrimental health and social outcomes, highlighting the need for more inclusive HIV testing, treatment, and education programs (James et al., 2024). These researchers also highlighted that it is probable that physicians are not adequately trained to work with people with disabilities, leading to these outcomes (James et al., 2024).

LGBTQ inclusion

Overall, autistic youth identified as LGBTQ+ more than non-autistic youth in the research examined (Barnett & Maticka-Tyndale, 2015; Bush et al., 2021; Ronis et al., 2021; Weir et al., 2021). When asked to reflect on their sexual identity and their autism, participants described a common experience of others conflating the two identities, claiming that their autism had caused others to be confused about their sexual identity (Hillier et al., 2020; Lewis et al., 2021). Participants in the study conducted by Lewis et al. (2021) reported a sense of shame that was associated with their sexuality, autism, or the intersection of both identities (Lewis et al., 2021). Both studies indicated that autistic individuals were viewed stereotypically within the LGBTQ+ community (Hillier et al., 2020; Lewis et al., 2021). However, these participants found it challenging to identify a mental and sexual health professional who viewed autism and sexuality as distinct matters and navigating the absence of resources for LGBTQ autistic people (Hillier et al., 2020). This gap leaves LGBTQ+ autistic youth with limited access to affirming and tailored resources, underscoring the need for sex education and health services that are both neurodiversity-affirming and LGBTQ+-inclusive.

Promotion of healthy relationships

Sexual abuse

Autistic individuals, specifically women, are at a significantly higher risk of being sexually victimized compared to non-autistic individuals (Brown et al., 2017; Brown-Lavoie et al., 2014; Pecora et al., 2019). A 2014 study found that 78% of autistic participants reported being victims of sexual abuse, compared to only 47% of the non-autistic participants (Brown-Lavoie et al., 2014). Pecora et al. (2019) found that autistic females were twice as likely to report sexual victimization compared to non-autistic females and that non-autistic females were 1.5 times more likely to be sexually victimized compared to autistic males (Pecora et al., 2019). Brown et al. (2017) found higher rates of unwanted sexual contact among disabled students (including autistic students), with 61.5% identifying as autistic women and 23.1% as nonbinary (Brown et al., 2017). Interestingly, Libster et al. (2024) discovered that autistic individuals with co-occurring attention-deficit hyperactivity disorder (ADHD) had a significantly increased risk compared to those who were only autistic and those who were neither autistic nor had ADHD (Libster et al., 2024).

Brenner et al. (2018) reported that increased sexual abuse among autistic adolescents correlated with increased rates of PTSD, loss of general interest, temper tantrums, and intrusive thoughts (Brenner et al., 2018). A study of male autistic and non-autistic adolescents in the Juvenile Court Sexual Offenders Program found higher rates of emotional abuse and neglect among autistic adolescents and higher rates of depression (Bleil Walters et al., 2013). Additionally, Sutton et al. (2013) assessed adolescents in a sexual offender program. They found that 60% were classified as autistic and that non-autistic adolescents were more likely to have experienced sexual trauma in childhood (Sutton et al., 2013).

Discussion

The findings of this review highlight critical gaps in CSE for autistic adolescents, emphasizing the misconceptions, systemic barriers, and missed opportunities that contribute to disparities in sexual health knowledge and adverse outcomes. It also highlights an important nuance that autistic youth may demonstrate comparable levels of factual sexual knowledge to their non-autistic peers (Kohn et al., 2023). However, their understanding and application of that knowledge diverge in terms of differences in pragmatic language skills and social communication. Findings indicate that autistic adolescents often experience a lack of access to formal sexual education that actively supports social-cognitive development, despite having similar desires for sexual intimacy to their non-autistic counterparts. This absence stems from societal misconceptions that they are uninterested in or incapable of engaging in sexual or romantic relationships. These common myths have led to the exclusion of autistic youth from school-based CSE programs, as well as a reluctance among parents and clinicians to engage in sexual health discussions that go beyond the biological aspects of sex and encompass a comprehensive understanding of human relationships that include desire and intimacy. The consequences of these omissions are significant, as they place autistic adolescents at increased vulnerability to sexual exploitation, unintended pregnancies, and STI/HIV transmission. By recognizing that knowledge acquisition does not always translate into functional social or relational competence, this review reinforces the importance of designing CSE that is both cognitively and socially accessible for autistic youth.

To target the inadequate CSE for autistic adolescents in schools, several changes can be made. Sex education for autistic learners must incorporate explicit instruction on social scripts, literal communication strategies, and real-world scenarios to facilitate comprehension and application. In Barnett and Maticka-Tyndale (2015), autistic participants recommended that the future of CSE for autistic students included how to make sex enjoyable, using traditional sexual education vocabulary words (penis, vagina, breasts) alongside “slang words” for body parts and sexual activities, education about alternative sexual activities, and a distinction between real-life sexual activities and sex scenes in porn or movies. Sexual education and healthcare should use culturally appropriate and affirming language, including medically accurate and colloquial terms for anatomy and sexual practices, to foster inclusive, pleasure-centered discussions and promote autonomy, especially for individuals with diverse needs and capacities (Bond & Radix, 2024). Other recommendations include having improved CSE training for teachers of autistic students so that they can feel more prepared to initiate these critical topics with their students (Curtiss & Ebata, 2016). Curtiss and Ebata (2016) found that providing teachers with low-intensity workshops and online resources made they feel more prepared and engaged with CSE topics (Curtiss & Ebata, 2016). An additional point emphasized in several studies was the provision of tools to help students identify signs of abuse and victimization (Hannah & Stagg, 2016; Pecora et al., 2019). One method that was explained in Ballan and Freyer (2017) was Social Stories (Ballan & Freyer, 2017). A Social Story describes a situation, concept, or skill using sentences that explicitly state appropriate behavioral responses and reinforce how the student would incorporate what they learned in real life. These researchers emphasize how Social Stories can be used to help autistic adolescents navigate puberty but can also be used as a proactive strategy to prevent abuse in this population (Ballan & Freyer, 2017).

Parental involvement in sexual education remains a critical yet underutilized component in ensuring autistic adolescents receive accurate and appropriate information. Research examining the role of parents in providing CSE to autistic youth indicates that most parents refrain from engaging in these discussions (Graham Holmes et al., 2020; Holmes et al., 2016; Holmes et al., 2019; Lehan Mackin et al., 2016; Schmidt et al., 2020). This reluctance is primarily attributed to the belief that their child is not developmentally ready for such conversations, low parental expectations regarding their child’s likelihood of engaging in sexual or romantic relationships, or a lack of parental knowledge on the subject (Graham Holmes et al., 2020; Holmes et al., 2019). These factors contribute to significant gaps in sexual health education, limiting autistic adolescents’ access to essential information on relationships, consent, and sexual well-being (Graham Holmes et al., 2020). However, when parents were provided with tools to incorporate different learning styles into their child’s education, parents demonstrated increased confidence (Lehan Mackin et al., 2016). Therefore, some interventions have been developed to educate parents and caregivers, ensuring they are comfortable and competent in discussing various topics related to sexual health education. Parent-mediated CSE programs and structured curricula, such as the Supporting Teens with Autism on Relationships (STAR) program, have been effective in enhancing both parental engagement and youth understanding of sexuality (Pugliese et al., 2020). The STAR program demonstrated promising outcomes in increasing knowledge about puberty, hygiene, social behaviors, dating, sexual health, and abuse prevention through the use of visual diagrams, concrete language, and structured content delivery (Pugliese et al., 2020). In another study, parents received a 60-minute intervention that resulted in significant changes in their attitudes and beliefs, level of communication, and competence in teaching sexuality topics following participation (Rooks-Ellis et al., 2020). In both studies, parents reported being more understanding, comfortable, and competent in integrating sexual education into their households (Pugliese et al., 2020; Rooks-Ellis et al., 2020).

Clinicians also play an essential role in providing sexual health education, yet findings indicate that healthcare providers frequently overlook discussions on sexuality with autistic patients (Kildahl et al., 2020). Long-term, developmentally appropriate, and culturally responsive sexual education can promote healthy lifestyles and enrich conversations between patients with disabilities and their parents/caregivers (Houtrow et al., 2021). The lack of formal training on how to address sexual health concerns among autistic individuals may contribute to missed opportunities for education, intervention, and recognizing signs of abuse. Increasing provider training on autism and sexual health, incorporating trauma-informed care practices, and ensuring that clinical environments are accessible and inclusive are crucial steps toward improving sexual health outcomes for this population. “The Real Talk Provider Toolkit”, created by the Autistic Self Advocacy Network (ASAN) and the National Council on Independent Living (NCIL), and “The Clinician’s Guide to Sexuality and Autism: A Guide to Sex Education for Individuals with Autism Spectrum Disorders” both offer practical advice for clinicians on how to improve accessibility, access, and attitudes surrounding sexual health care for autistic individuals (Autistic Self Advocacy Network, 2024; Cauchi et al., 2023). By utilizing these resources and strategies, providers can improve the quality of sexual health care for autistic patients.

Furthermore, this review highlights the unique intersectionality between autism and LGBTQ+ identities. Autistic individuals are more likely than their non-autistic peers to identify as LGBTQ+, yet they often lack access to inclusive and affirming sexual education (Drew et al., 2024; Herrick & Datti, 2022; Jordan, 2024; Sullivan & Caterino, 2008). Many participants in the reviewed studies reported that their autism was perceived as a source of confusion regarding their sexual orientation or gender identity (Hillier et al., 2020; Lewis et al., 2021). The absence of targeted educational resources for LGBTQ+ autistic youth contributes to feelings of isolation and limits their ability to explore and express their identities safely (Herrick & Datti, 2022; Jordan, 2024; Ngo et al., 2025). Future interventions must prioritize LGBTQ+ inclusivity and provide affirming spaces for autistic adolescents to receive accurate, nonjudgmental, and identity-affirming sexual education by involving autistic individuals in the development process (Strnadová et al., 2022). To improve outcomes, sex education should be inclusive, accessible, and tailored to the needs of autistic learners, incorporating visual aids, personalized learning, and technology (Barnett & Maticka-Tyndale, 2015; Ngo et al., 2025). Additionally, education should address sensory and communication challenges, practice non-autistic sociosexual norms, and prioritize safety and self-determination (Barnett & Maticka-Tyndale, 2015; Strnadová et al., 2022).

Limitations

While this scoping review provides valuable insights into the state of sexual education for autistic adolescents, several limitations should be acknowledged. First, the studies included in this review were primarily conducted in English-speaking regions, which limits the generalizability of the findings to non-English-speaking populations. Second, the hetero-geneity of study designs and methodologies prevented direct comparisons across interventions, making it difficult to assess the relative effectiveness of various educational approaches. Third, the term “Asperger’s Syndrome” was not included in the search strategy. This decision was made in alignment with current diagnostic standards, as “Asperger’s Syndrome” has been subsumed under the broader category of Autism Spectrum Disorder in the DSM-5 (American Psychiatric Association, 2013). The authors acknowledge that their omission may have inadvertently excluded older studies or those using legacy diagnostic terms still standard in some research. Lastly, the potential underrepresentation of intersectional perspectives in the included studies, particularly regarding how race, ethnicity, gender, and socioeconomic status influence autism diagnosis, treatment, and support (Miller et al., 2022; Weiss et al., 2024). While recent research highlights these disparities, the lack of diverse participant samples and limited focus on marginalized autistic populations, such as Black autistic women and girls, may restrict the generalizability of findings and hinder the development of truly inclusive interventions (Lovelace et al., 2022). Future research should aim to address these limitations by conducting longitudinal studies, incorporating diverse cultural perspectives, and evaluating the efficacy of targeted interventions in improving sexual health outcomes for autistic youth.

Conclusion

This review highlights a critical need for comprehensive sexuality education (CSE) curricula that are inclusive of autistic adolescents and responsive to their diverse learning styles. Findings from the included studies emphasized the importance of addressing persistent misconceptions about autistic individuals’ sexuality as well as gaps in formal education and informal guidance from parents and clinicians. Rather than assuming a one-size-fits-all model, CSE should promote sexual agency, account for differences between cognitive development, and ensure access to content on consent, boundaries, communication, and healthy relationships. Evidence suggests that insufficient sex education contributes to increasing vulnerability to sexual victimization, insecurity, and confusion among autistic youth. Regardless of their cognitive support needs, autistic youth require affirming and developmentally appropriate instruction and guidance that supports skill-building in sexual communication and self-advocacy. To address these disparities, stakeholders, including parents, schools, and healthcare providers, should collaborate in implementing proactive, tailored sexual education interventions. Our findings suggest that enhancing sexual education for individuals with autism involves creating an inclusive and accessible learning environment that meets their unique needs. To meet these needs, policy changes are necessary to mandate the inclusion of autistic adolescents in school-based sexual health programs and to ensure that such curricula are accessible and adaptable to autistic learners. Given that many autistic students are educated in mainstream classrooms, the inclusive curricula should be flexible and differentiated to support a range of cognitive, sensory, and communication profiles in a shared setting. Autism-specific adaptations, such as visual supports, concrete language, explicit instruction on social norms, and sensory-sensitive delivery, may be essential for effective learning among autistic students, particularly when general curricula fail to meet their needs or assume shared social knowledge. The question is not whether sex education should be autism-specific or inclusive, but how to design inclusive curricula using universal design for learning principles that ensure accessibility for autistic students while keeping them connected with their peers.

Data availability statement

Data is available upon request.