Autistic Narratives of Sensory Features, Sexuality, and Relationships

Abstract

Background:

Research about the experience of sexuality and intimacy for autistic people has largely excluded the potential influences of autistic sensory features, which are highly common. The aim of this study was to explore how autistic sensory features influence autistic people's experiences of sexuality and relationships, including the impact of low and high neurological threshold sensory patterns and regarding specific sensory modalities.

Methods:

Utilizing a qualitative approach, we explored autistic people's perspectives about the influences of sensory features on their experiences of sexuality and relationships through existing publicly available narratives (5 books and 13 online forums containing messages from 72 unique usernames) and responses to an open-ended survey question (N = 49). We used deductive coding based on Dunn's model of sensory processing, as well as inductive coding to identify additional themes about autistic sensory features and sexuality.

Results:

Our findings indicated that sexual and relationship experiences were related to both sensory sensitivity and sensation seeking (i.e., low and high threshold sensory patterns) across several sensory modalities, including touch, sight, sound, and smell. Sensory features influenced autistic people's sexual and relationship experiences in both positive and negative ways. Examined narratives revealed adaptations and strategies used by autistic people to enhance or enable engagement in sexual activity as well as implications for their sexual identity.

Conclusions:

Sensory features and their impact on the sexuality and relationship experiences of autistic people should be considered in clinical practice and educational programming. More research is needed to further understand the impact of autistic sensory features on experiences of sexuality and relationships, and to develop effective strategies to promote safe and satisfying engagement, when desired.

Lay summary

Why was this study done?

Autistic people often respond to sensations differently than other people, including being more sensitive to sensations and/or wanting more intense sensations (called “autistic sensory features” in this study). Many aspects of sexuality and relationships involve sensory input. However, we do not know much about how autistic sensory features influence sexuality and relationships for autistic people.

What was the purpose of this study?

The purpose of this study was to explore how autistic sensory features influence autistic people's experiences of sexuality and relationships.

What did the researchers do?

For this study, we used two different sources of data. The first was existing publicly available things written by autistic people, including books and posts on online forums. The second was answers provided on a survey question asking about autistic sensory features and sexuality. Overall, we looked at things written by over 120 autistic people. We reviewed all the information to explore what kinds of sensory responses (e.g., sensitivities and sensation seeking) and sensory modalities (e.g., touches, sights, sounds, and smells) they wrote about. We also looked more generally to see how autistic people described the ways that autistic sensory features influenced their sexuality and relationship experiences.

What were the results of the study?

Our findings show that in the information we accessed, autistic people did write about how sensory features influence their sexual and relationship experiences. Some people who have sensory sensitivities described confusion, distress, and frustration with sexual experiences. Despite wanting to participate, people with sensitivities described negative reactions to many of the sights, sounds, smells, and textures that were involved in dating and sexual activities. Other people indicated that they avoided sexual activity because of their sensory features. However, we also found that some autistic people seek out more intense sensations in their sexual activities, and others that enjoy intimacy that promotes calming and self-regulation. People wrote about strategies they use in response to their autistic sensory features, such as communication with partners and the use of substances to dull sensations.

What do these findings add to what was already known?

There has not been much published research on this topic, so this study is a starting place. In books, as well as in online discussion boards, autistic people have been discussing the importance of sensory features to their sexuality and relationships. We accessed that information, and used theory and clinical experience to analyze their writings and help identify what other research is needed.

What are potential weaknesses in the study?

We used text already written by autistic people and responses on one survey question for this study. Therefore, we may not have gained a complete understanding of the ways that autistic sensory features influence sexuality and relationship experiences.

How will these findings help autistic adults now or in the future?

This study contributes to greater understanding of how autistic traits affect sexuality and relationships for autistic people. That information can be used to develop effective education and resources for autistic people, families, and service providers.

Introduction

Sexuality is a central aspect of humanity across the lifespan, encompassing sexual behaviors, gender identities, sexual orientation, eroticism, pleasure, intimacy, and reproduction.¹ Despite stigma about disabled people's sexuality,^2,3 sexuality and intimate relationships are a positive and important part of life for many autistic people. Studies show that most autistic people experience sexual feelings and have satisfying sexual relationships, although some may not want or have partners.^4–14 However, there is limited research on how autistic traits affect sexual and intimate experiences and ways to support autistic people to achieve satisfaction in their sexual and romantic relationships.

Prior research on how autistic traits affect autism and sexuality has primarily focused on the impacts of communication and social interaction differences.^13–16 For example, some autistic people report difficulty forming partnerships due to social communication challenges.^4,15 Autistic research participants also report anxiety related to social expectations of being in a relationship, and uncertainty about how to sexually satisfy their partner.¹⁵ Some also report less common sexual interests and sexual sensory fascinations that may impact sexual relationships.^7,17 However, there is a lack of research about how autistic features related to sensory processing affect sexuality.

Autistic people commonly experience sensory differences.^18,19 Dunn's model of sensory processing posits that individuals can have low and/or high neurological thresholds.²⁰ A low threshold can present as being highly sensitive to sensory input (i.e., threshold is surpassed with a relatively low amount of stimuli).²⁰ A high threshold may present as a diminished response to sensory input and/or seeking out more intense sensations (i.e., more stimuli is needed for it to register).²⁰ Evidence suggests autistic people may experience both high and low thresholds and that they can differ across sensory modalities (i.e., visual, tactile, auditory, olfactory, gustatory, vestibular, and proprioceptive).²¹ These autistic sensory features are known to affect daily activities for autistic children (e.g., eating, grooming, and learning),^22–25 yet the effect of these features on autistic adults' daily lives is relatively unexplored.¹⁹ Despite the fact that sensation is an important component of sexuality, there has been little attempt to understand how autistic sensory features and sexuality intersect.

Study purpose

Our purpose was to explore autistic people's perceptions of how sensory features affect their sexual and relationship experiences. We examined the following research questions:

• 1.In what ways do sensory response patterns (i.e., high and low threshold) across different sensory modalities (e.g., tactile and auditory) influence sexuality and relationships for autistic people?
• 2.More generally, how do sensory features affect autistic people's experiences of sexuality and relationships?

Methods

Data sources

Existing narratives

One source of data we used was existing narratives. The University of Utah Institutional Review Board (IRB) determined we would not require ethical review. We conducted an internet search in January to March of 2018 to yield English-language, autistic first-person accounts of sexuality and relationship experiences. We searched Google, the University of Utah library database, and Reddit and Wrong Planet web forums. Search terms included “autism AND sex,” “autism AND sexuality,” “autism AND sex AND sensory.” We reviewed available information to ensure authors identified as autistic. We then reviewed identified sources to determine if the narrative contained discussion of sensory experiences and sexuality. The final data set included text from 5 books and 13 online forums containing messages from 72 unique usernames (Table 1). If a source contained both first-person accounts by autistic author(s) and quotes from other autistic people they interviewed, we included both in our analysis. We followed ethical research guidelines and do not report any potentially identifying information about online forum participants.

Table 1.

Sources of Existing Narratives

Title/name	Author/year	Type	Description
The Autism Spectrum Guide to Sexuality and Relationships: Understand Yourself and Make Choices That Are Right for You	Emma Goodall (2016)	Book	Advice and assistance with sexuality and relationships by compiling both personal information and narratives from interviews with autistic people
Love, Sex and Long-Term Relationships: What People with Asperger Syndrome Really Want	Sarah Hendrickx (2008)	Book	Describes love and relationships for autistic people, and includes both autobiographical information as well as descriptions of personal accounts of other autistic adults
Sex, Sexuality, and the Autism Spectrum	Wenn Lawson (2004)	Book	Discusses relationships and sexuality for autistic people, including advice and personal anecdotes
Autistics' Guide to Dating: A Book by Autistics, for Autistics and Those Who Love Them or Who Are In Love With Them	Emilia Ramey and JodyRamey (2008)	Book	Describes sexuality and relationships for autistic people, including anecdotes from their experiences helping other couples
Look Me in the Eye: My life With Asperger's	John Robison (2007)	Book	Autobiography describing his life and relationships
Wrong Planet		Online community	Online community for autistic people with forums on various topics
Reddit		Website/online community	Online discussion forums on a wide range of topics, web content review, and informational articles about a variety of subjects

Survey study

As part of a larger survey (N = 232) on autism and sexual satisfaction, we asked a subset of participants (N = 78) about sensory experiences and sexuality. The University of Utah IRB approved this study. We recruited participants between July 2016 to December 2017 from the Interactive Autism Network and the Children's Hospital of Philadelphia Center for Autism Research registry. Eligible individuals were aged 18–40 years and self-reported a formal autism diagnosis. Table 2 presents descriptive information about survey participants. We recruited participants through email, asking them to take part in a study about sexuality and relationships. Although not initially part of the survey, we added sensory questions to the web-based questionnaire toward the end of the recruitment period, by which point we were emphasizing recruitment of women, transgender, and nonbinary autistic adults.

Table 2.

Survey Participant Characteristics (N = 78)

Characteristic	Mean (SD) or percent
Age in years, mean (SD)	28.23 (6.88)
Gender (%)
Male	30.8
Female	59.0
Other (transgender, not specified)	10.3
Race/ethnicitya (%)
White/Caucasian	87.2
Hispanic/Latinx	3.8
Black/African American	2.6
Native American/Alaskan	1.3
Multiracial	5.1
Living situation (%)
With parents or other relatives	47.4
With a romantic partner	24.4
Alone or in a college dorm	19.3
In a group home	2.6
Other not listed	6.4
Postsecondary outcomesa (%)
Full-time school, volunteer or paid	51.3
Part-time school or work	25.6
Neither working or attending school	23.1
Working and attending school	15.4
Relationship statusa (%)
Single	53.9
Dating casually	11.5
Dating seriously	14.1
Married	16.7
Divorced	3.8
Long-term relationship >3 months duration	32.1
Cohabiting with romantic partner	25.6

^a Indicates result categories were not mutually exclusive.

SD, standard deviation.

To collect the data included in this study, we presented participants with an open-ended question: “How have sensory interests or sensitivities affected your sexual or romantic experiences?” We analyzed responses from 49 participants who provided a free-text response to the question.

Data analysis

We analyzed text segments from the identified narratives and the survey responses to identify semantic themes.^26,27 We used deductive and inductive analyses to address the first and second research questions, respectively. For the first research question, we began with preconceived codes based on existing literature about sensory response patterns and modalities. We used Dunn's²⁰ theory to code segments of data that aligned with low and high neurological threshold patterns and sensory modalities (Table 3). For the second research question, we focused on uncovering additional themes in the data regarding how sensory experiences affected sexuality and relationships.

Table 3.

Sensory Response Patterns and Modalities: Qualitative Codes and Examples

Code	Description	Example quote
Low Neurological Threshold	Indication that the autistic person is highly sensitive to sensory input during sexual or romantic experiences	“I am unfortunately sensitive to the sounds of repetitive squeaking sounds”
High Neurological Threshold	Indication that a great deal of sensory input is needed for the autistic person's sensory needs to be met during sexual or romantic experiences	“I am not particularly sensitive so I need more friction to achieve orgasm”
Tactile	Sensory experiences related to touch sensations during sexual or romantic experiences	“I'm very sensitive to touch, which usually heightens my sexual experiences”
Auditory	Sensory experiences related to sound during sexual or romantic experiences	“High-pitched electronic sounds (from anything like smoke detectors to adult toys) can be extremely painful”
Visual	Sensory experiences related to sight during sexual or romantic experiences	“If a light bulb is turned on and catches my eye, it is like my eyeball is being burned”
Gustatory	Sensory experiences related to taste during sexual or romantic experiences	“Kissing and sex sometimes involves too much texture, bodily smells, tastes, heat and intimacy that I get overloaded and frightened” [emphasis added]
Olfactory	Sensory experiences related to smell during sexual or romantic experiences	“I don't always like the odour of body fluids”
Proprioceptive	Sensory experiences related to pressure or body position during sexual or romantic experiences	“I prefer a firm touch. I like to be held tightly and sometimes bound”

We took several steps to promote trustworthiness.²⁸ The first author coded all of the data and documented the analysis process using a reflexivity journal and audit trail. The second author acted as an additional analyst by reviewing the coded data, discussing emerging findings, finalizing the codes, and inspecting the audit trail. The team used “analyst triangulation” to encourage a thorough examination of the data and robust results.²⁸ Both analysts are occupational therapists with extensive training and experience related to autistic sensory features. The second author also examined the data for confirming/disconfirming evidence,²⁸ which was integrated into the results as appropriate. Verbatim quotes further promote trustworthiness.²⁸

Results

Sensory response patterns and modalities related to sexuality and relationships

Our results indicate that sensory response patterns across several different sensory modalities influence sexuality and relationships for autistic people in a variety of ways. We have separated our results by high and low thresholds.

Low threshold sensory experiences

Narratives about sexual activity often referenced heightened sensitivity with a negative reaction to several types of sensory input. Tactile input was the most common modality. A woman interviewed by Hendrickx²⁹ described her experience of pain when touched lightly, stating, “I do not like light touch. Light touch almost hurts” (p. 59). An online forum participant wrote about how all touch was unpleasant: “A lot the time I just don't like to be touched at all. Anywhere. Instead of Oooo….someone's touching me, it's more like ARGH!! SOMEONE'S TOUCHING ME! The shocking feeling tends to override any good feelings.” Excessive ticklishness was also noted by survey respondents, including a sexually active respondent who described feeling ticklish during “all the wrong moments,” and by a not-yet-sexually active participant as a concern for desired future sexual encounters. Lawson³⁰ described: “Some touch I liked and some I didn't. His body pressing up against mine was difficult for me to handle at times” (p. 69).

The data also revealed how low threshold responses to other sensory modalities affected sexual and relationship experiences. In Goodall,³¹ one woman described her sensitivity to light during sex:

If a light bulb is turned on and catches my eye, it is like my eyeball is being burned […]*…I have found that shouting ‘Ah, my eye ball is burning!’ ends any passion and sexual interest in the person I am with! (p.154)

Sounds could also cause pain or distraction from sexual experiences, for example: “High-pitched electronic sounds (from anything like smoke detectors to adult toys) can be extremely painful to the point where it's not just a turn-off, it's debilitating.” A man interviewed by Hendrickx²⁹ reported, “I am unfortunately sensitive to the sounds of repetitive squeaking sounds, primarily those emitted from a squeaky bed being sexed upon” (p. 57). Describing an olfactory experience, another man interviewed by Hendrickx²⁹ stated, “I don't always like the odour of body fluids” (p. 57). Lastly, low threshold experiences could occur in response to multisensory stimuli. An online forum participant stated, “I am hypersensitive with all my senses. Kissing and sex sometimes involves too much texture, bodily smells, tastes, heat and intimacy that I get overloaded and frightened.”

Participants also described low threshold experiences as interfering with meeting new intimate partners. One survey respondent described:

I don't like going to public places because of the lights, noise, other people being around, but that is usually how to meet someone new. Plus I would not want to be in a relationship with someone who likes to be in noisy, crowded, bright places […]. So I am stuck at home wanting to be with someone else who is also stuck at home.

Lawson³⁰ also described this difficulty: “If all my attention is needed to process the act of just being in a pub or club, then it might mean I won't notice the other important aspects of relating to others” (p. 57).

For people in relationships, some narratives suggested low threshold experiences can interfere with daily interactions with partners. One woman interviewed by Goodall³¹ expressed difficulty allowing her partner to cook her preferred meals, stating “I hate the smell of it all […]…if my partner does cook for me, I have to stay out of the kitchen” (p. 219). A man interviewed by Goodall³¹ described how fabric sensitivity affected his relationship:

We spent about six months together […]…He was wearing wool sweaters and I find wool really itchy and, urgggh, just being near it is horrid. (p.184)

Although touch was described as being associated with negative experiences, some described their heightened awareness of touch stimuli as positive. A survey respondent wrote, “I'm very sensitive to touch, which usually heightens my sexual experiences.” Another wrote, “It seems I get turned on quicker and more often from just a touch.”

High threshold sensory experiences

Although much less frequent, some narratives described experiences aligned with diminished responses to sensory stimuli. In an interview with Hendrickx,²⁹ a man indicated: “I am not particularly sensitive so I need more friction to achieve orgasm” (p. 61). Others described seeking out more intense sensations. In an interview with Hendrickx,²⁹ two interviewees indicated seeking out both firm touch and rough stimulations, such as hitting and biting. In an example of how different sensory patterns can coexist for the same person, a survey respondent wrote, “I typically require more support when I climax during sex either through light bondage or otherwise being pinned down. My partner also cannot lightly touch me without me feeling pain.”

Other narratives suggested that participants sought physical sensation for calming and self-regulation purposes. In Goodall,³¹ one woman said:

I orgasm very easily and my partner finds it fun to try to ensure that I have a really big intense orgasms, as this seems to be something that can really help me to self-regulate and be calmer in our day to day life. (p. 234)

Another woman interviewed by Goodall³¹ described how she often sought sex for calming, “I went through this highly sexualized phase […]…because I just loved the way orgasms made me feel and connected me to myself and centered me. It was like the best self-regulation strategy I had found” (p. 108). Seeking nonsexual physical contact could also be soothing. Robison³² discussed the calming effects of being with his partner: “I am always calmer and more relaxed in a pile, being petted […]…I feel safe sleeping in a pile” (p. 257).

Other influences of autistic sensory features on sexuality and relationships

Sexual identity

Autistic people described connecting aspects of their sexual identity to their sensory experiences. One woman in an online forum described telling her friends about her need for rough stimulation (hitting) and deep pressure for calming, and subsequently understanding that she is “mildly masochistic.”

Sensory features were sometimes impactful enough that they reduced libido or willingness to engage in sexual activity. One forum participant indicated that her sexual motivation was reduced and she noticed herself “having more issues with sensory overload.” Another discussed how her sensory overload caused her first relationship to end, affecting her self-esteem, and leading her to write: “no man has been willing to wait for me to be comfortable enough […]…to have sex with him.”

In online forums, people wrote that it was difficult to determine whether they are asexual or, rather, so overwhelmed by the social and sensory challenges associated with sexual experiences that they became disinterested in partnered sexual activity. One woman expressed distress about partnered sexual activity as a means to seek sensory input: “I was thinking….I go along with sex becuz [sic] it gives me the freedom to get what I really want, which is texture/sensory input….but…sometimes I get really mad after having sex and I can't explain why, except everything feels wrong.” Whether sensory features were connected with asexuality differed among survey respondents. Although some participants wrote responses such as “I do not engage in sexual or romantic activities because of my sensory issues” (emphasis added), others clearly distinguished these (e.g., “They haven't [affected my sexuality] because I've never had interest in having a romantic or sexual experiences,” and “They have not. I'm just asexual.”).

Adaptations and strategies

A wide range of adaptations used in response to autistic sensory features were described. Many people's narratives indicated that they avoided sexual contact with another person, and instead chose other avenues for sexual gratification. For example, one forum participant described fulfilling his sexual needs in ways that did not involve touch by another person: “I am resigning myself to virtual sex and to masturbation….less complicated for me.” Another forum participant reported engaging in alternative activities that still allowed them to avoid sexual touch, saying, “I get sensory overload if I get too much skin-to-skin contact […]…so not really interested much in sex at all. I do kink,^† however, as it requires neither skin contact nor actual sex.”

Other personal narratives described the use of a variety of strategies to tolerate or enjoy sexual activity despite sensory features. The most commonly discussed strategy was communication with one's partner, and other strategies were often identified as being implemented alongside communication. For example, a forum participant stated that she had “been educating my partner about what NOT to do. I think it is working.” Ramey and Ramey,³³ an autistic couple, provided advice from their personal relationship: “the most important thing is to talk about what you did after you have finished and in the days that follow each encounter” (p. 85). This type of communication can be difficult, however, as a survey respondent explained:

There are specific things that are too overwhelming or distracting for me, but when I ask that we avoid or limit those things, it always offends the other person because they feel personally criticized.

Another survey respondent described that even when a partner is supportive, it can be frustrating and exhausting to communicate during sex, concluding: “I tend to prefer solo activity rather than with a partner to avoid unpleasant sensations.”

Substances (topical or ingested) were used to dull sensations or make sexual activity more tolerable or enjoyable. A forum participant provided insight into the use of gels, saying, “I have experience with lidocaine-based numbing gels….It numbed painful sensations, but still allowed for the pleasurable ones.” Some also discussed the use of drugs or alcohol. For example, a forum participant stated, “Only when I am drunk do I feel comfortable being touched or touching others.”

Many people also described desensitization as a strategy for low threshold experiences, particularly with touch. Many people suggested self-touch and masturbation as a starting point. One woman interviewed by Goodall³¹ stated “By experimenting with different touches on different parts of my body […]…I figured out that I really enjoy having my lower abdomen stroked” (p. 226). The use of hand-over-hand touch was also suggested by a forum participant providing advice, saying, “Could you start by taking his hand and demonstrating how lightly you need to be touched?”

Other types of adaptations included changing the situation in various ways. For example, a forum participant suggested starting with sexual text messages or photos instead of touch. A female forum participant described using a pillow to block out other senses: “Sounds silly, but if my eyes and ears aren't covered to block out noise and sound, I can't handle it.” Having control over the situation was described as being important: “I mean that I need to initiate […]…if I am ready for touch I am less bothered by it.” Others described changing or controlling the environment. Goodall³¹ described how one man manages his smell aversion:

I am sensitive to smells and I just can't have sex in a bed that is not clean […]…The best way to manage this and still have any kind of sex life is to only have sex in my house in my bed. (p.154)

Discussion

Findings of this study suggested that sensory features are one factor that can have a meaningful impact on sexual and relationship experiences of autistic people. Because of our methods, we do not know the extent to which our findings generalize to a broader group of autistic adults; however, we identified evidence suggesting meaningful impact of sensory features on sexual and relationship experiences for some autistic adults. We also must clarify that we do not suggest that sensory experiences uniquely affect autistic people, as our focus was only on understanding autistic narratives of sexuality. There is a large body of sexuality research that explores aspects of sexuality connected to sensory experiences—distinct from autistic sensory features—including sensitivity and pain, as well as sexual sensation seeking,³⁴ suggesting that sensory experiences also relate to sexual preferences in the general population.

Through reviewing text provided by autistic people, we found evidence that sexual and relationship experiences were influenced by both low and high neurological threshold responses across sensory modalities, including touch, sight, sound, and smell. Negative responses associated with a low neurological threshold—particularly in response to touch—were the most pronounced in the data we examined. Those experiencing a low threshold highlighted their confusion, distress, and frustration with sexual experiences and their own sensory responses. Despite their desire for sexual activity, people described noxious reactions to the sights, sounds, smells and tactile sensations of sex, intimacy, and romantic activities. For some, this extended beyond sexual experiences to satisfaction with dating and cohabitation experiences.

To manage low threshold responses, many narratives suggested what may be considered both adaptive and potentially maladaptive strategies for reducing unpleasant input while still engaging in sexual activity. A common adaptive strategy was communicating with partners about needs and experiences. Sexual communication is related to positive outcomes in the general population, and couples' communication skills affect relationships and sexual satisfaction (i.e., sexual and orgasm frequency).^35,36 Couples may also experience sexuality communication differently than talking about other issues.^37,38 Research also suggests that there is a link between communication and sexuality for autistic adults. For example, Byers et al. found that the intensity of self-reported social and communication challenges was associated with level of sexual anxiety and satisfaction.⁴ Autistic people themselves have also discussed how communication enables intimacy.³⁹ Consistent with this, self-disclosure to partners about sensory needs and preferences was noted consistently throughout the narratives, emphasizing how communication facilitates meaningful enjoyable sexual activity.⁴⁰ Future research could study how various aspects of a relationship (e.g., trust and communication) affect sensory comfort and satisfaction among autistic people.

Another strategy autistic people suggested was the use of products such as numbing gels to decrease sensation. Relatedly, autistic participants in a study by Barnett and Maticka-Tyndale⁴¹ reported using items such as gloves and blankets to decrease sensation during sexual experiences. Additional research could inform evidence-based recommendations for the use of these types of strategies for autistic people experiencing sensitivities related to sexuality.

In contrast to purely adaptive strategies such as communication, some people described approaches to reduce or avoid sensory stimuli that could pose health and/or social risks. For example, evidence suggests that people use alcohol, marijuana, and other drugs during sexual activity because they heighten sensation or remove anxiety or inhibitions.^42,43 However, the use of drugs to enhance or decrease sensation could lead to negative health outcomes (e.g., addiction). In addition, drug use is associated with lower odds of condom use^44,45 and higher risk of adverse outcomes such as sexual assault.^46–48 Other autistic people in this study described avoiding sexual activity due to their sensory features. Byers et al. previously suggested that autistic sensory features may lead some autistic people to pursue solitary instead of partnered sexual activity.^4,10 Abstaining from sexual activity is a legitimate personal choice. However, a person who avoids sex with partners due to sensory features even though they desire intimate connection could experience loneliness and distress. Based on these narratives, it is imperative to develop strategies and solutions for sensory features that minimize social and health risks.

Although we found evidence for autistic sensory features posing a barrier, it is notable that some autistic people described positive experiences. Most discussions related to sensation seeking described individual preferences for increased pressure or more intense sensations such as biting or hitting. The desire for intense sexual sensations is not uncommon.^49,50 Despite this, some people in this study expressed concern about their preferences, possibly due to stigma associated with bondage, domination, and sadomasochism.⁵¹ Finally, some people in this study described seeking out increased touch and intimacy as adaptive strategies that promote calming and self-regulation.

Comprehensive sexuality education, including the potential effects of sensory features, is an important part of meeting the needs of autistic people. A recent systematic review of sexuality education literature found that programs for autistic people focused on biological mechanisms and safety more than personal aspects of sexuality such as how sensory features affect sexual experiences.⁵² Information about the impact of sensory features on sexuality should be integrated into comprehensive educational opportunities for autistic people and their loved ones.

Limitations

This study used existing data rather than a prospective design. Biases may have affected the data and we likely did not access a complete picture of autistic sensory features and sexuality. In particular, online forums tend to be avenues to seek advice and help. Thus, the narratives may over-represent people that experience extremes either in autistic sensory features or in their emotional responses to sensory features. People who experience little effect of sensory features on sexuality or who have neutral or mild emotions about such effects may be less likely to seek advice or discussion. However, the consistencies and patterns we observed in the books, online forums, and survey results suggest that there are commonalities among autistic people.

Another limitation is the high proportion of women in the study, including from the survey as well as among the authors of the existing narratives, where known. A high rate of female response in adult autism surveys is not uncommon; however, we acknowledge that this may skew the results. The sample was also disproportionately White, and the results may not represent the experiences of people from other racial/ethnic backgrounds. Future research should focus on expanding understanding of the sexual and romantic experiences of a more diverse and representative group of autistic people.

Conclusion

This study offers preliminary evidence that autistic sensory features have an impact on sexuality and relationships for some autistic people. Results suggest sensory response patterns can influence experiences for autistic people in both positive and negative directions. Further research is needed to directly assess how autistic people's sensory features affect their experience of sexuality and relationships, and on effective strategies to promote safe and satisfying engagement, when desired.

Authorship Confirmation Statement

S.G. developed the idea for the project, conducted data collection (existing narratives portion), conducted data analysis, and wrote the article. A.V.K. developed the idea for the project, assisted with data analysis, and edited the article. L.G.H. developed the idea for the project, conducted data collection (survey portion), and edited the article. All authors have reviewed and approved of the article. This article has been submitted solely to this journal and is not published, in press, or submitted elsewhere.

Author Disclosure Statement

No competing financial interests exist.

Funding Information

The survey was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under UJ2MC31073: Maternal and Child Health-Autism Transitions Research Project.