Abstract Sexuality is one of the most important aspects of human life that relates to sex, one's identification, sexual role, sexual preferences, eroticism, pleasure and intimacy. It fulfils such functions as procreative, hedonistic and relationship-building as well as constitutes an integral part of human's personality.
The sexuality of people with intellectual disability is a special case - both from medical, pedagogical, psychological and ethical point of view.
Little available research shows that it may become a significant factor that modifies their psychological and sexual functioning. The basic poll involved altogether people with mild intellectual disability.
The work was carried out in 11 schools and special institutions of three provinces in Poland: Their age was of importance as in that life period one can observe the formation of first partner relationships with the clear aim of establishing a family.
It is accompanied by a quick development of sexual desire and taking up various forms of sexual activity.
People with intellectual disability don't form a homogenous group as regards their psychological and sexual development. In this group, one can observe both different forms of clinical mental handicap which definitely affects the whole process of sexual development. The sexual development is delayed by an average period of 3 years. The people with intellectual disability take up mostly autoerotic behaviour whereas partner relationships wthin that group are more seldom.
The phenomenon of sexuality of people with higher degree of intellectual disability is an issue that needs further constant analysis. The research has also made it possible to detect what kind of sexual behaviour people with intellectual disability undertake and the value of sexuality for such people.
The article deals also with some important dilemmas connected with sexual education and what factors trigger off incorrect sexual reaction including their lack in the above mentioned group. Intellectual disability, Severe and moderate intellectual disability, Sexuality of people with intellectual disability, Sexuality, Sexual experiences, Poland Introduction The sexuality of people with intellectual disability has recently become the topic of professional discussion and public debate.
The normalization rule introduced into society made it necessary to understand and accept an intellectually disabled person as a sexual person. Unfortunately there is still a lack of knowledge on people with higher degree of intellectual disability.
Due to limited research in this field it is difficult to achieve any general conclusion as to the knowledge and sexual activity of people with HDID. The analysis of studies available in literature gives only a general perspective on this issue. The presented studies are related to three areas: The studies have been preceded by pilot studies 2 aimed at determining the scale of the studied problem, proper research procedure as well as verifying adopted research tools.
The pilot studies gave several pieces of interesting data: Low levels of sexual awareness sometimes become the reason for taking risky sexual behavior. The interest in sexual life among intellectually disabled people is high; however the knowledge on sex, contraception, social and biological sex roles is very low.
Every seventh woman and every fifth man showed negative feelings towards masturbation. Sexual activity is low. Intellectually disabled people were unable to clearly determine what the skill to sexually satisfy a partner is. The present work concentrates on presenting the knowledge of the people questioned on private body parts, fertilization, pregnancy, childbirth and contraception.
Various forms of sexual behavior practiced by people with HDID have also been described as well as the evaluation of the sexual development of the group in question. The work formulates three basic research problems: What is the level of sexual development of the tested people with a higher degree of intellectual disability?
What is the level of knowledge of the tested people with a higher degree of intellectual disability on the following subjects: What forms of sexual activities are taken up by people with a higher degree of intellectual disability? Whether and with what frequency are masturbation activities taken up? Whether and with what frequency are petting activities conducted? Whether and at what age does their sexual life start?
Method In the applied research project, the presented material was based on genuine source input—real comments, but described not as individual examples but as a more or less typical common sexual experiences of a group of people with HDID. The input material for such a definition of the issue was provided by the research work with people with a higher degree of ID. The first method used was an interview with a nurse and a doctor in order to estimate sexual development of participants according to J.
The next method used was an interview questionnaire DSMN, [ 1 ]. Interview Questionnaire The research work made use, primarily of the technique of a standard interview in the form of a guided conversation with people with HDID.
It was prepared according to a precise described sample that comprised a set of questions, their correct sequence as well as the manner of asking them. It was also exceptionally important to provide similar interview circumstances for all the people interviewed. These circumstances were very important for the material collected to be compared and then generalized. As the character of the conducted research was connected with exceptionally sensitive and personal areas, which are usually hidden and not easily shared, it was necessary to put the prepared interview questionnaire and poll to a wide range of consultations.
The interview questionnaire was first discussed by psychologists and psychotherapists as well as a psychiatric doctor. Their remarks concerned mainly the applied inventory of notions and consequently their suggestions were contained in the interview questionnaire and elaborated on in such a way as to ensure that they met the criteria of correctness as regards questions asked and applied terminology.
It should be emphasized that the results achieved during the research work with youths with a higher degree of ID were later discussed with their teachers in charge and teachers who had direct contact with them. All suggestions and remarks by these teachers were noted and then taken into account while elaborating the results.
The interview comprised of three stages. Stage 1 was to establish good contact with the person being interviewed. The questions concerned their general physical and mental state mood as well as their interests. The aim of that stage was to create an atmosphere of safety and trust. The next stage, called the main one, consisted of conducting the interview according to previously prepared questions. Stage 3—was the stage of ending, summarizing the interview results, explicating potential misunderstandings and a small talk to finish the whole procedure.
The research work made use of the following testing tools: An interview questionnaire from a school nurse destined to evaluate sexual development, an interview questionnaire to evaluate the sexual experiences of the youths with HDID DSMN. There were two versions of the questionnaire, one for men and one for women. The present work presents only the results obtained from parts I and II of the interview questionnaire i. The interview questionnaire had two versions, a version for men and for women and was supplemented by charts that contained notions connected with human sexuality.
The charts presented objects, activities and features as well as names of presented notions. All the pictures on the charts were schematic and simplified in form. The part concerning knowledge was categorized into 3-scale answers, giving an opportunity to describe the level as low, medium or high. In this manuscript there was presented only the level of knowledge on private body parts, fertilization, pregnancy, child delivery and contarception.
The study subjects were tasked to indicate, in the picture of a man, testicles, penis and pubic hair and in the picture of a woman—breasts, vagina and pubic hair. The score was referred to as a middle when the study subjects named 2 attributes, and too low—when they were unable to indicate any or just one. Knowledge on Insemination It was found that the tested group could achieve high level of knowledge on physiology of insemination if they could respond to 3 asked questions whether a woman can become pregnant through kissing, hugging or touching with a man with their clothes on as well as to explain correctly how the process of insemination takes place.
Average results were scored when they could do the same with 1—2 such problems and the tested people had difficulties in explaining the idea of insemination, whereas low score was ascribed when none of the above problems was correctly answered and no explanation of insemination given.
Knowledge on Pregnancy As regards physiology of pregnancy, high score was reserved for the tested people who could determine the time necessary for a full development of an inseminated egg into a human being. Average results were scored by those who, in spite of not giving correct response, were aware that the development of an inseminated egg is a long-lasting process.
Low score reflecting very little knowledge on physiology of pregnancy was obtained when the tested people had no idea of pregnancy and could not respond whether it takes long or short time for an inseminated egg to develop into a human being. Knowledge on Giving Birth In the questions concerning physiology of giving birth, the tested people could score high if they could explain that a woman gives birth to a child through her procreative tracts; average score when they had difficulties in precise explanation of the phenomenon of birth and low score when no explanation was given at all.
Knowledge on Contraception As regards knowledge on contraception, the tested group could score high when named 3 contraceptions methods, average with two and low when no contraception methods were named. Many of those under study have openly discussed sexual experience. The presented study results are illustrated with several selected sentences in their original wording, expressed by the people under study.
The atmosphere of these conversations is difficult to precisely depict, e. A lot of non-verbal information often accompanied words. The expressions have been selected in such a way as to present, as wide as possible, the different opinions of the people under study on the described issue.
According to these factors, the sexual ages of the people concerned were determined. The level of development of secondary sexual attributes features appearing during each stage of adolescence differentiating an adult from a child such as different sexual tracts and copulative organs, puberty hair P , hair in the armpit A , development of genitals X , breast increase Y , facial hair were also settled. The test made use of a simplified model of describing sexual development among the tested group and was applied taking account of possibly the most precise and complete interview with a doctor or a nurse.
As a result of the above, their sexual development was described according to a modified J. The Bioethical Committee controls, among others: A clinical study cannot start without the consent of a bioethical committee. The people to be examined were selected according to formal certificates 5 stating their ID level and the core research work concentrated on people with a higher degree of ID. The basic research work comprised people altogether and was carried out in 11 schools and special institutions in three Polish provinces: The respondents qualified to take part in the research constituted a uniform group—homogenous as regards their age of 18—25 as well as an IQ level that was average for the people with a higher degree of ID.
Their age was of importance, as in that life period one can observe the creation of first partner relationships with the aim of establishing a family.