Attitudes Towards Affectivity and Sexuality of People With Intellectual Disability

Sex Disabil (2012) 30:261287
DOI 10.1007/s11195-012-9260-x
ORIGINAL PAPER
Attitudes Towards Affectivity and Sexuality of People

with Intellectual Disability
Daniela G. Franco Jorge Cardoso Isabel Neto
Published online: 17 February 2012

Springer Science+Business Media, LLC 2012
Abstract The acceptance of sexuality and its manifestations has changed in recent
decades to being considered a normal feature of the identity of each individual. However,
the person with intellectual disability have not benefited from this change in attitude. Their
sexuality remains shrouded in myths and prejudices. The study population consisted of 454
students from the University of Beira Interior, from the Medicine, Psychology and
Architecture majors. The data was collected using a questionnaire specifically drafted for
this research. Most surveyed students consider sexuality an important part of life for every
human being. From the responses to the questionnaire, psychology students were those
with a more positive attitude towards sexuality and affectivity of the individual with
intellectual disability, but the variability of the distribution of student responses from the
three majors did not differ significantly. A positive attitude is characteristic of those who
have acquired sufficient knowledge, females and of those who have frequent contact with
individuals with intellectual disability.
Keywords
Sexuality Intellectual disability Attitudes Affectivity Portugal
Introduction
Sexuality is an attribute of every human being; it is not something a person has, it is a
characteristic that is built according to laws, customs, rules and changes in time and space.
D. G. Franco (&)
Faculdade Ciencias da Saude, Universidade da Beira Interior, Rua dos Teixos,
Lote 22 Bairro Sao Salvador, 6200-698 Teixoso, Covilha, Portugal
e-mail: danielagouveiafranco@gmail.com
D. G. Franco
Centro Hospitalar Tondela-Viseu, Viseu, Portugal
J. Cardoso
Instituto Superior de Ciencias da Saude Egas Moniz, Almada, Portugal
I. Neto
Faculdade Ciencias da Saude, Universidade da Beira Interior, Covilha, Portugal
123
262
Sex Disabil (2012) 30:261287
The concept of sexuality has long been closely related with the genital aspects, and its
expression related only to marriage, regulated by moral and religious precepts.
Carrera [1] says that thanks to social and cultural revolutions that have occurred over
the twentieth century, sexuality is no longer understood as merely biological, but became
inseparable from the basic identity of a person.
Despite the fact that expressions of sexuality have become more accepted in the
general population, when it comes to the individual with intellectual disability this issue
still finds resistance. Their sexuality is a victim of different reactions in a society with
low tolerance to differences and surrounded by controversy, myths, beliefs and prejudices [2].
The understanding of their disability as an intellectual limitation, which generates
changes in the development of emotional and social maturity keeps the individual with
intellectual disability in a child-like status [2]. They are seen by most people as being
sexless [35] and by others as being sexually primitive, wild and incomplete [6, 7] whose
emotional and sexual fulfillment should be denied.
Adolescents with intellectual disabilities have the same problems as other young people,
most of which have a normal development of physical and psychological characteristics.
Any socially inappropriate sexual behavior is not due to the disability itself but to a nonexistent sex education [8].
Felix and Marques [9] argue that if we ban the opportunity of the population with
disability from expressing their sexuality, we are preventing satisfying basic needs for their
growth and development as individuals.
Health professionals take a more tolerant attitude towards the fundamental rights of
citizens with disabilities when they are stated as general principles. However, everything
becomes more complex when the person with disability makes more specific and
objective requirements [10]. The WHO acknowledges that the attitudes of health professionals can be a major obstacle to their role as educators and counselors on the topic of
sexuality. [11]
In a 1993 study, which evaluated the degree of knowledge about sexuality among
medical and engineering, students found that both had similar levels of knowledge [12].
This finding emphasizes the need to carry out further studies on the attitudes and behaviors
of the general population or specific groups, such as medical students or psychology
professionals and health care and education providers who, as citizens and leading figures
in life of the individual with intellectual disability, have a duty to understand, accept and
promote their welfare and, thus, their right to sexuality.
The purpose of this study involves assessing the attitudes of medical and psychology
students about affectivity and sexuality of young people with intellectual disabilities.
To this end it is proposed to:
evaluate whether the sex of the respondent or the frequency of their contact with people
with intellectual disability influences their attitude towards their sexuality and
affection;
assess how the academic skills and knowledge acquired over medical and psychology
courses influence attitudes towards sexuality and affectivity of the individual with
intellectual disability;
evaluate whether students who choose an academic course of medicine and psychology
already have a more positive attitude in what concerns affectivity and sexuality of
young people with intellectual disabilities.
123
Sex Disabil (2012) 30:261287
263
Materials and Methods

This comparative study [1316], is aimed at medicine, psychology and architecture students of Universidad da Beira Interior (University of Beira InteriorUBI). Medicine and
psychology students have, as future health professionals, a strong position to deal with
human beings as a whole and, as such, do not neglect their sexuality. Therefore, an
assessment of their attitudes towards this issue and the understanding of how their education was crucial to this process is of utmost importance. Architecture students were
picked as a control group, since those choosing a majors on medicine and psychology have,
from the outset, a more positive attitude than those who did not make this choice.
A questionnaire was used to collect information with 22 items originally drafted for the
present study. The present work had as starting point two other scales already used in other
works: one devised by Dr. Antonio Martins, Psychologist, graduated from the Faculty of
Psychology and Educational Sciences, University of Lisbon, in its original version with 17
questions [10]; and another developed and used by Dr. Maria de Lurdes Pereira Ramos, in her
master thesis entitled Sexuality in Diversityattitudes of parents and coaches face the
Affectivity and Sexuality in Young with intellectual disability [17]. The Likert Scale
response options were: strongly disagree, disagree, neither agree or disagree, agree, and
strongly agree [18] (Annexes 1 and 2). As for the variables, we considered the attitudes to
affection and sexuality of the person with intellectual disability as the dependent variable and
the variables of gender, knowledge acquired (measured by year curriculum for medical
students and by now they must have not attended Introduction to Psychology of Human
Sexuality (IPSH) for Psychology) course and frequent contact with individuals with
intellectual disability ([29 per month), as independent. It should also be noted that when
applying the questionnaire respondents were asked to take into account only the mild to
moderate intellectual disabilities to facilitate and standardize the evaluation of their attitudes.
In this study, a subject that accepts the person with intellectual disability as a sexual
being with same right to express sexuality is considered positive (or liberal). On the other
hand, a subject that does not accept it is considered negative (or a conservative).
Statistical Methods
Statistical analysis was performed using the SPSS 17.0 for Microsoft Windows.
The tests used were:
Fishers exact test

KruskalWallis test
Fridman test
Method of multiple comparison of means of orders
Results
Questionnaires were obtained with the cooperation of 454 UBI students from the previously mentioned departments. From the medical school, of a group of 159 students in first
year and 140 in sixth, a sample, respectively, of 152 and 114 students was obtained. Of the
189 psychology and 343 architecture students, 109 and 78 pupils, respectively, answered
the questionnaires (Table 1).
123
123
193
95
41
319
Medicine
Psychology
Architecture
Total
70.3
51.9
87.2
72.6
135
38
14
73
29.7
48.1
12.8
27.4
409
72
97
240
90.1
91.1
89.0
90.2
1824 years
Male
Female
Age
Gender
Table 1 Sample Characterization
45
12
26
9.9
8.9
11.0
9.8
[24 years
175
24
54
107
Yes
38.5
30.4
49.5
40.2
Frequent contact
279
55
55
159
No
61.5
69.6
51.5
59.8
166
52
114
Yes
36.6
47.7
54.1
Knowledge
288
79
57
152
No
63.4
100
52.3
45.9
264
Sex Disabil (2012) 30:261287
Sex Disabil (2012) 30:261287
265
Table 2 shows that for the variable Year Course, statistical significance was
achieved in questions 3, 58, 1012 and 21. When asked, medical students displayed an
indisputably positive attitude with regards to the difficulty of approaching the topic of
sexuality, the right of the individuals with intellectual disability to have sexual and
emotional life and the importance of sex education for these individuals (questions 3, 7, 8
and 21, respectively).
However, on issues that reflect more specific behavior in the theme of sexuality
(questions 11 and 12), the attitude demonstrated by the sixth-year students was more
positive than those of the first-year. In question 11, 76.3% of 6th year students disagreed
with the statement while only 56.6% attending 1st year followed suit. And in question
12, the former group is 63.2% while the latter is 40.8%. Question 6, in which the
problem of the capacity of the persons with intellectual disability to control their
impulses was approached; there is a disagreement between the two groups. While 48.3%
of sixth-year students think that they are capable of doing so, only 19.7% of first-year
students agree.
In the same table, for the variable gender, statistical significance was achieved in
questions 11, 15, 18, 20 and 21. When asked if youth with intellectual disabilities should be
allowed to marry, 41.1% of male students and 40.9% females agreed. However, when
questioned about their competence to care for a child, attitudes become more negative with
only 13.7% of men and 11.4% of women agreeing with this statement.
In Table 3, for the variable It must attended or not discipline IPSH significance was
obtained in questions 2, 4, 5, 11, 19 and 21.
By questioning the psychology students if they recognize the various roles of sexuality (question 2), both student groups, who have attended the course referred to be
able to do so and those who have not, appeared to be unanimous in showing a positive
attitude. And in both groups, although with some percentage differences between their
responses, show a positive attitude when asked about the emotional immaturity of the
individual with intellectual disability on the possibility of them having children, or
about the importance of sex education for these individuals (issues 4, 19 and 21,
respectively).
In the same table for the variable Frequent contact with intellectual disability, there
was statistical significance in questions 2, 12, 17 and 21. From questions 2 and 21, about
the general topic of sexuality, resulted that students from both groups (with and without
frequent contact with people with intellectual disability) are unanimous in expressing their
agreement with the statements.
In question 12, when asked whether the person with intellectual disability should not
have access to photographs of nude or semi-nude, 80% of those who have frequent contact
with persons with intellectual disability individuals disagree with this statement while only
57.4% of those who do not have such contact agreed. For question 17 there is an inverse
relationship, since when asked if the individual with intellectual disability are able to take
responsibility for their actions, only 14.8% of people living with individuals with intellectual disability often disagree with this assertion, while the value raises up to 40% for
those without this coexistence.
Finally, for the variable gender, statistical significance was achieved in questions
13, 79, 15, 18 and 21. When asked about the importance of sexuality in the life of every
human being and about their different functions (questions 1 and 2, respectively), both
female and male students were unanimous in taking a positive attitude. However, there
were significant percentage differences between gender, with women showing a more
positive attitude, when asked about their right to emotional and sexual life (questions 7 and
123
123
137
129
36
9. The issues of sexuality must be dealt at the home of the

person with intellectual disability
10. Television shows (soap operas and movies) have, with

respect to affectivity and sexuality, a harmful effect on
the individual with intellectual disability
36
6. The person with intellectual disability are unable to

control their sexual impulses
8. The individual intellectual disability are entitled to their

sexuality
87
5. When the individual with intellectual disability grab

people to kiss them that is just one manifestation of
tenderness
139
46
4. Under the terms of emotional relationships, a person with

intellectual disability is very childish
7. The individual with intellectual disability are entitled to

live their emotional life
36
148
2. Sexuality has several functions: affection,

communication, pleasure and reproduction
3. It is difficult to speak on the subject of affectivity and

sexuality because it is a very sensitive subject
143
23.7
84.9
90.1
91.5
23.7
57.2
30.3
22.4
97.4
94.1
40
30
36
66
26.3
0.7
19.7
5.9
23.7
43.4
1.3
15
102
102
108
19
44
20
34
112
109
Agree
Disagree
Agree
%
No
Yes
Year
1. Sexuality is one of the important dimensions of the life

of every human being
Questions
Table 2 Responses of medical students
13.2
89.5
89.5
94.7
16.7
39
17.5
29.8
98.2
95.6
47
55
19
42
60
Disagree
41.2
0.9
48.3
6.7
36.8
52.6
0.03
0.43
0.02
0.01
0.01
0.09
0.01
0.41
0.55
266
Sex Disabil (2012) 30:261287
48
17
5. When the individual with intellectual disability

grab people to kiss them that is just one
manifestation of tenderness
6. The person with intellectual disability are unable

to control their sexual impulses
95
93
18
8. The individual intellectual disability are entitled

to their sexuality
9. The issues of sexuality must be dealt at the home

of the person with intellectual disability
10. Television shows (soap operas and movies)

have, with respect to affectivity and sexuality, a
harmful effect on the individual with intellectual
disability
100
25
4. Under the terms of emotional relationships, a

person with intellectual disability is very childish
7. The individual with intellectual disability are

entitled to live their emotional life
25
104

3. It is difficult to speak on the subject of affectivity

and sexuality because it is a very sensitive subject
100
16.8
87.0
88.8
93.5
15.9
44.9
23.4
23.4
97.2
93.5
33
42
16
35
54
20.8
87
39.3
15
32.7
23.4
0.93
47
138
144
147
38
83
41
43
156
152
Agree
Disagree
Agree
%
No
Yes
Frequent contact
1. Sexuality is one of the important dimensions of

the life of every human being
Questions
Table 2 continued
29.6
87.4
90.6
92.5
23.9
52.2
25.8
27.0
98.1
95.6
33
43
12
43
72
Disagree
20.8
0.63
0.63
27
7.5
27
45.3
0.63
0.76
0.05
0.88
0.88
0.11
0.33
0.62
0.87
0.21
0.55
Sex Disabil (2012) 30:261287

267
123
123
69
69
13
16
35
13
67
65
59
22


4. Under the terms of emotional relationships, a person with

intellectual disability is very childish

tenderness

7. The individual with intellectual disability are entitled to

8. The individual intellectual disability are entitled to their

sexuality
9. The issues of sexuality must be dealt at the home of the

person with intellectual disability
10. Television shows (soap operas and movies) have, with

respect to affectivity and sexuality, a harmful effect on
the individual with intellectual disability
30.1
80.8
89
91.8
17.8
47.9
21.0
17.85
94.5
94.5
17
18
17
35
23.3
24.7
9.6
23.3
47.9
34
172
174
180
42
92
50
55
191
183
Agree
Disagree
Agree
%
Female
Male
Gender
1. Sexuality is one of the important dimensions of the life

of every human being
Questions
Table 2 continued
17.6
89.1
90.2
93.3
21.8
47.7
25.9
28.5
99
94.8
65
67
21
61
91
Disagree
33.7
1.6
0.5
0.5
34.7
10.9
31.6
47.2
1.0
0.83
0.77
0.2
0.15
0.07
0.46
0.97
0.13
0.1
0.28
268
Sex Disabil (2012) 30:261287
22. Society in general has preconceived ideas about the

sexuality of the young with intellectual disability
21. It is important that young people with intellectual

disabilities have information in the context of sex
education
131
132
18
104
18. Young people with intellectual disability should be

allowed to marry
20. The individual with intellectual disability are competent

to care for a child
30
17. The person with intellectual disability are capable of

taking responsibility for their own actions
62
49
16. The individual with intellectually disability are capable

of making decisions about your own life
19. The person with intellectual disability must be able to

have kids
19
133
11
13. When the person with intellectual disability are found

masturbating, they should be promptly reprimanded
15. Regarding situation 13, parents should talk to them and

introduce rules to guide them
15
12. The person with intellectual disability should not have

access to magazines or newspapers with photographs of
nude or semi-nude
14. In the previous situation, the best attitude is to ignore
19
86.2
86.8
11.8
40.9
68.4
19.7
32.3
87.5
12.5
7.2
9.9
12.5
59
22
49
28
80
99
62
86
0.7
2.0
38.8
14.5
2.6
32.2
18.4
3.3
52.6
65.1
40.8
56.6
14
47
90
35
40
97
13
102
106
Agree
Disagree
Agree
%
Sixth
First
Year of course
11. When the individual with intellectual disability express,

verbally or in attitudes, interest in these scenes that you
see on television, they should be reprimanded
Questions
Table 2 continued
89.5
93.0
12.3
41.2
78.9
30.7
35.1
85.1
11.4
3.5
7.0
4.4
41
15
37
28
65
84
72
87
Disagree
3.5
0.9
36
13.2
0.9
32.5
24.6
1.3
57.0
73.7
63.2
76.3
0.06
0.00
0.53
0.65
0.27
0.12
0.16
0.1
0.67
0.15
0.03
0.01
Sex Disabil (2012) 30:261287

269
123
123
8
95
34
26
78
39
14
95
91



allowed to marry

have kids

to care for a child

education




nude or semi-nude
85.0
88.8
13.1
36.4
72.9
24.3
31.8
88.8
7.5
5.6
4.7
7.5
41
17
33
19
24
18
16
2.8
1.9
38.3
15.9
0.93
30.8
17.8
3.7
15.1
5.7
11.3
10.1
142
143
18
70
116
39
55
135
81
112
76
103
Agree
Disagree
Agree
%
No
Yes
Frequent contact

Questions
Table 2 continued
89.3
89.9
11.3
44. 0
73.0
24.5
34.6
84.9
51.0
70.4
47.8
64.8
59
20
53
37
24
18
16
Disagree
1.3
1.3
37.1
12.6
2.5
33.3
23.3
7.9
15.1
5.7
11.3
10.1
0.12
0.97
0.77
0.77
0.85
0.58
0.8
0.56
0.28
0.73
0.26
0.97
270
Sex Disabil (2012) 30:261287
18
46
30
10
57


allowed to marry

have kids

to care for a child

education
60
28


37
58
48


34

nude or semi-nude
39
82.2
78.1
13.7
41.1
63.0
24.7
38.4
79.5
50.7
65.75
46.6
53.4
33
11
26
14
1.4
2.7
45.2
15.1
4.1
35.6
19.2
4.1
9.6
2.7
9.6
9.6
25
13
16
17
173
181
22
79
148
47
61
172
Agree
Disagree
Agree
%
Female
Male
Gender

Questions
Table 2 continued
89.6
93.8
11.4
40.9
76.7
24.4
31.6
89.1
13.0
6.7
8.3
8.8
57
26
60
42
108
135
100
134
Disagree
2.1
1.0
29.5
13.5
1.0
31.0
21.8
2.1
56.0
70.0
51.8
69.4
0.01
0.00
0.00
0.06
0.02
0.11
0.09
0.02
0.33
0.06
0.36
0.03
Sex Disabil (2012) 30:261287

271
123
272
Sex Disabil (2012) 30:261287
Table 3 Responses of psychology

Questions
Attended the course IPSH

Yes
No
Agree
Disagree
Agree
Disagree
1. Sexuality is one of the important dimensions of

the life of every human being
52
100
56
98.25

52
100
57
100
3. It is difficult to speak on the subject of

affectivity and sexuality because it is a very
sensitive subject
19
36.5
19
36.5
12
21.1
32
56.1
0.09

person with intellectual disability is very childish
13.5
29
55.8
8.8
24
42.1
0.04

grab people to kiss them that is just one
manifestation of tenderness
28
53.9
10
19.2
19
33.3
14.0
0.03
6. The person with intellectual disability are unable

5.8
24
46.2
10.5
24
42.1
0.52
7. The person with intellectual disability are

52
100
54
94.7

entitled to their sexuality
51
98
53
93.0
9. The issues of sexuality must be dealt at the home

of individual with intellectual disability
45
86.5
1.9
53
93.0

have, with respect to affectivity and sexuality, a
harmful effect on the individual with intellectual
disability
15.3
16
30.8
12.3
22
38.6
0.85
11. When the person with intellectual disability

express, verbally or in attitudes, interest in these
scenes that you see on television, they should be
reprimanded
3.9
47
90.4
3.5
40
70.2
0.02
12. The individual with intellectual disability

should not have access to magazines or
newspapers with photographs of nude or seminude
40
76.9
7.0
35
61.4
0.16

are found masturbating, they should be promptly
reprimanded
48
92.3
46
80.7
0.23
14. In the previous situation, the best attitude is to

ignore
13.5
27
51.9
5.3
25
43.9
0.24
15. Regarding situation 13, parents should talk to

them and introduce rules to guide them
46
88.5
1.9
49
86.0
5.3
0.61

capable of making decisions about your own life
23
44.2
11.5
15
26.3
15
26.3
0.14

capable of taking responsibility for their own
actions
15
28.8
13
25
14
24.6
17
29.8
0.9
18. Young people with intellectual disability

should be allowed to marry
46
88.5
48
84.2
1.8
0.06
123
1.9
%
1.8
0.07
0.02
0.34
1.8
0.24
0.42
Sex Disabil (2012) 30:261287
273
Table 3 continued
Questions
Attended the course IPSH

Yes
No
Agree
Disagree
Agree
Disagree
19. The person with intellectual disability must be

able to have kids
26
50.0
7.7
35
61.4
3.5
0.05

competent to care for a child
15.4
10
19.2
15
26.3
10
17.5
0.37
21. It is important that young people with

intellectual disabilities have information in the
context of sex education
51
98.1
1.9
53
93.0
0.03
22. Society in general has preconceived ideas about

the sexuality of the young with intellectual
disability
50
96.2
1.9
55
96.5
0.94
Questions
Frequent contact
Yes
No
Agree
Disagree
Agree
Disagree
1. Sexuality is one of the important dimensions

of the life of every human being
53
98.1
55
100
0.34

54
100
55
100
0.01

affectivity and sexuality because it is a very
sensitive subject
16
29.6
25
46.3
15
27.3
26
47.3
0.24

person with intellectual disability is very
childish
13.0
28
51.9
9.9
25
45.5
0.24
5. When the individual with intellectual

disability grab people to kiss them that is just
one manifestation of tenderness
21
38.9
12
22.2
26
47.3
11.0
0.22

unable to control their sexual impulses
14.5
21
38.9
1.8
27
49.1
0.13

51
98.1
55
100
0.28

50
92.6
54
98.2
0.58
9. The issues of sexuality must be dealt at the

home of individual with intellectual disability
47
87.0
51
92.7
1.8
0.33

have, with respect to affectivity and sexuality,
a harmful effect on the individual with
intellectual disability
14.8
13
12.7
25
45.5
0.17
1.9
24.1
123
274
Sex Disabil (2012) 30:261287
Table 3 continued
Questions
Frequent contact
Yes
No
Agree
Disagree
Agree
Disagree
11. When the person with intellectual disability

express, verbally or in attitudes, interest in these
scenes that you see on television, they should be
reprimanded
3.7
41
75.9
3.6
46
83.6
0.12
12. The individual with intellectual disability should

not have access to magazines or newspapers with
photographs of nude or semi-nude
3.7
31
57.4
3.6
44
80.0
0.05

are found masturbating, they should be promptly
reprimanded
43
79.6
51
92.7
0.09

ignore
10.9
22
40.7
7.3
30
54.5
0.16
15. Regarding situation 13, parents should talk to

them and introduce rules to guide them
45
83.3
3.7
49
89.1
3.6
0.4

22
40.7
11.1
16
29.1
15
27.3
0.2

capable of taking responsibility for their own
actions
15
27.8
14.8
14
25.5
22
40
0.05
18. Young people with intellectual disability should

be allowed to marry
45
83.3
1.9
49
89.1
1.8
0.75
19. The person with intellectual disability must be

able to have kids
26
48.1
7.4
35
63.6
3.6
0.29

competent to care for a child
12
22.2
11
20.4
11
20
16.4
0.74

intellectual disabilities have information in the
context of sex education
49
94.2
1.9
55
100
22. Society in general has preconceived ideas about

the sexuality of the young with intellectual
disability
53
98.1
52
94.5
Questions
0.03
1.8
Gender
Male
Female
Agree
Disagree
Agree
Disagree
1. Sexuality is one of the important

dimensions of the life of every human
being
14
100
94

14
100
95

affectivity and sexuality because it is a
very sensitive subject
123
0.66
21.4
10
71.4
28
%
99.0
100
29.5
%
0.9
0
41
0.04
0.00
43.2
0.00
Sex Disabil (2012) 30:261287
275
Table 3 continued
Questions
Gender
Male
Female
Agree
Disagree
Agree
Disagree
35.7
12
12.6
48
50.5
0.36
4. Under the terms of emotional

relationships, a person with intellectual
disability is very childish

disability grab people to kiss them that is
just one manifestation of tenderness
28.6
14.3
43
45.3
16
16.8
0.73

unable to control their sexual impulses
7.1
42.9
8.4
42
44.2
0.92

11
78.6

10
71.4
9. The issues of sexuality must be dealt at

the home of individual with intellectual
disability
11
78.6
10. Television shows (soap operas and

movies) have, with respect to affectivity
and sexuality, a harmful effect on the
individual with intellectual disability
7.1
11. When the person with intellectual

disability express, verbally or in attitudes,
interest in these scenes that you see on
television, they should be reprimanded
12. The individual with intellectual

disability should not have access to
magazines or newspapers with

disability are found masturbating, they
should be promptly reprimanded
7.1
95
100
0.00
95
100
0.00
87
91.6
1.1
0.02
21.4
14
14.8
35
36.8
0.74
64.3
4.2
78
82.1
0.36
57.1
3.2
67
70.5
0.13
11
78.6
83
87.4
0.12
14. In the previous situation, the best attitude

is to ignore
57.1
9.5
44
46.3
0.88
15. Regarding situation 13, parents should

talk to them and introduce rules to guide
them
11
78.6
14.3
83
87.4
2.1
0.04
16. The person with intellectual disability

are capable of making decisions about
your own life
7.1
21.4
37
38.9
18
18.9
0.16

disability are capable of taking
responsibility for their own actions
7.1
42.8
28
29.5
24
25.3
0.24
18. Young people with intellectual disability

57.1
7.1
86
90.5
1.8
0.00
19. The person with intellectual disability

must be able to have kids
35.7
56
58.9
6.3
0.3
7.1
123
276
Sex Disabil (2012) 30:261287
Table 3 continued
Questions
Gender
Male
Female
Agree
Disagree
Agree
Disagree
14.3
21
22.1
18
18.9
0.97

disability are competent to care for a child
14.3

intellectual disabilities have information in
the context of sex education
11
78.6
93
97.9
1.1
0.00
22. Society in general has preconceived

ideas about the sexuality of the young with
intellectual disability
14
91
95.8
1.1
0.16
100
8), the approach to the issue of sexuality at home to the individual with intellectual
disability (question 9), the possibility of marriage (question 18) and the importance of sex
education for these individuals (question 21). A more positive attitude in males was seen in
the third question in which we asked students about the difficulty resulting from discussing
sexuality.
In Table 4 the distributions of the average of responses from medical and psychology
students was compared by applying the MannWhitneys test. In Medical School it was
found that for the variable year curriculum, students in the sixth year had a much more
positive attitude towards people with intellectual disability than pupils from first grade to
the questions 47, 12, 21 and 22.
Concerning the variable gender, from the answers to questions 15, 18, 20 and 21 it
was resulted that it were female students who took a more positive attitude in the face of
affectivity and sexuality of young people with intellectual disabilities.
While psychology students, that answered questions 1, 2, 11, 16, 18 and 21 and who had
attended the subject IPSH, showed a more positive attitude than those who had not
attended it. The opposite was found in question 3. Regarding the variable frequent contact
with the individuals with intellectual disability, resulted that students who do not have
this contact had a more positive attitude on questions 2, 10, 12, 19 and 21 than those who
have it.
Finally, with regard to gender, similarities are perceivable with what happens in medical
school, since women have shown a much more positive attitude than men on questions 1, 2,
9, 15, 17, 18 and 21.
In order to establish comparisons between the attitudes of students of medicine, psychology and architecture, KruskalWallis was used. This test determined whether there
were differences in the distribution of the median response among the students of the three
majors.
However, for statistically significant matters, it did not establish any hierarchy of
attitudes between the majors, i.e. to determine which of them had a more negative attitude
and which had a more positive one. This had been achieved by using the method of
multiple comparisons, which allowed comparison between majors (Medicine vs. Architecture, Medicine vs. Psychology and Psychology vs. Architecture).
123
Sex Disabil (2012) 30:261287
277
In Table 5 the variation in attitudes of students in different majors throughout the

questionnaire may be observed by applying the Friedman test. There is no significant
difference in attitude among students to the various questions. It was in questions 1, 2, 7, 9,
21 and 22 that students, regardless of their major, demonstrated a more positive attitude,
while facing questions 35, 10, 16, 17, 19 and 20 they seemed to present a more negative
one.
Discussion/Conclusion
Human sexuality is an area where, to a very large extent, aspects of biological, psychological and socio-cultural significance are intertwined and possess such influence that is
determinant to attitudes and behaviors [19].
When comparing the variability of attitudes among students of three majors with
regards to affectivity and sexuality of young people with intellectual disabilities, it was
possible to gather that, when asked about the importance of sexuality in the life of every
human being and to admit they had different roles in this a positive attitude. But when
asked about the difficulty of tackling this issue, the attitude becomes less positive, with
123
123
11. When the person with intellectual disability express,

verbally or in attitudes, interest in these scenes that
you see on television, they should be reprimanded
10. Television shows (soap operas and movies) have,

with respect to affectivity and sexuality, a harmful
effect on the intellectually disabled
9. The issues of sexuality must be dealt at the home of

the people with intellectual disabilities
8. The person with intellectual disability are entitled to

their sexuality

6. The individual with intellectual disability are unable

5. When the person with intellectual disability grab

tenderness
4. Under the terms of emotional relationships, a person

with intellectual disabilities very childish


1. Sexuality is one of the important dimensions of the

life of every human being
Questions
125.45
144.23
128.43
140.26
121.26
149.82
119.48
152.19
Sixth
First
Sixth
First
Sixth
First
Sixth
148.18
Sixth
First
122.49
First
156.01
149.87
Sixth
116.62
121.22
First
Sixth
148.25
First
122.44
Sixth
135.72
First
131.84
Sixth
139.24
First
129.2
Sixth
138.11
First
130.04
Sixth
Mean Rank
First
Year of course
Medicine
Table 4 Compare responses between medical and psychology students
0.00
0.01
0.17
0.29
0.02
0.00
0.00
0.04
0.67
0.17
0.31
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Contact
135.66
132.05
140.23
128.07
140.77
128.61
134.95
132.53
137.93
130.52
143.29
126.92
140.8
128.59
136.55
131.45
139.19
129.67
140.55
128.76
137.86
130.57
Mean Rank
0.69
0.21
0.17
0.78
0.38
0.07
0.17
0.57
0.3
0.11
0.37
Female
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
Male
Gender
138.68
119.82
136.3
126.1
137.17
123.79
132.07
137.28
136.77
124.85
135.28
128.78
136.34
126
136.1
126.62
131.84
137.9
134.78
130.1
133.53
133.41
Mean Rank
0.06
0.3
0.16
0.58
0.2
0.51
0.29
0.34
0.55
0.56
0.99
278
Sex Disabil (2012) 30:261287

sexuality of the young intellectually disabled

education
20. The person with intellectual disability are competent

to care for a child
19. The individual with intellectual disability must be

able to have kids
18. Young people with an intellectually disability


16. The intellectually disabled are capable of making

decisions about your own life
15. Regarding situation 13, parents should talk to them

and introduce rules to gui de them

ignore
13. When the person with intellectual disability are

found masturbating, they should be promptly
reprimanded
12. The individual with intellectual disability should not

have access to magazines or newspapers with
Questions
Table 4 continued
145.86
Sixth
145.84
152.99
Sixth
124.24
118.88
First
Sixth
136.06
First
131.58
Sixth
135.91
First
131.69
Sixth
141.51
First
127.49
Sixth
139.99
Sixth
128.63
First
133.37
First
133.6
Sixth
140
Sixth
First
128.63
First
139.42
124.23
First
129.06
151.53
Sixth
Sixth
119.98
First
First
Mean Rank
Year of course
Medicine
0.01
0.00
0.61
0.64
0.11
0.21
0.98
0.19
0.25
0.15
0.00
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Contact
139.48
129.48
134.7
132.69
135.54
132.13
128.23
137.04
131.56
134.81
135.87
131.9
134.57
132.78
136.96
131.17
144.5
126.09
134.02
133.15
139.7
129.33
Mean Rank
0.25
0.82
0.7
0.33
0.72
0.66
0.84
0.5
0.04
0.92
0.25
Female
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
Male
Gender
136.02
126.84
144.11
105.45
139.42
117.85
134.85
129.93
139.39
117.92
136.49
125.58
132.36
136.51
139.09
118.72
135.55
128.08
132.78
135.41
135.57
128.03
Mean Rank
0.34
0.00
0.03
0.62
0.03
0.27
0.68
0.03
0.45
0.79
0.45
Sex Disabil (2012) 30:261287

279
123
123


effect on the intellectually disabled

the people with intellectual disabilities

their sexuality

6. The individual with intellectual disability are unable

5. When the person with intellectual disability grab

tenderness

with intellectual disabilities is very childish
3. It is difficult to s peak on the subject of affectivity

and sexuality because it is a very sensitive subject


Questions
Table 4 continued
57.12
52.67
49.67
60.85
Yes
No
Yes
Yes
No
54.61
55.43
No
52.13
58.14
Yes
Yes
No
52.91
57.29
No
53.61
Yes
56.53
No
Yes
58.14
51.56
Yes
No
50.79
59.62
No
60.44
49.04
Yes
Yes
No
49.14
61.42
No
48.44
62.19
Yes
Mean Rank
No
Attended discipline
Psychology
0.05
0.42
0.88
0.22
0.34
0.6
0.25
0.12
0.05
0.01
0.00
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Contact
53.63
56.35
49.24
60.65
51.89
58.05
51.96
57.98
53.03
56.94
50.31
59.6
57.95
52.1
54.51
55.48
55.68
54.34
46.75
63.1
52.21
57.74
Mean Rank
0.63
0.04
0.25
0.22
0.39
0.09
0.3
0.87
0.82
0.00
0.24
Female
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
Male
Gender
56.28
46.32
55.69
50.29
57.82
35.86
56.53
44.64
56.23
46.68
55.19
53.68
54.03
61.57
55.64
50.68
54.42
58.93
58.51
31.18
57.83
35.79
Mean Rank
0.23
0.52
0.00
0.1
0.16
0.86
0.37
0.56
0.61
0.00
0.00
280
Sex Disabil (2012) 30:261287

sexuality of the young intellectually disabled

education

to care for a child
19. The individual with intellectual disability must be

able to have kids
18. Young people with an intellectually disability


16. The intellectually disabled are capable of making

decisions about your own life

and introduce rules to gui de them

ignore

reprimanded
12. The individual with intellectual disability should not

Questions
Table 4 continued
54.27
55.27
Yes
Yes
49.95
60.54
No
No
56.93
52.88
Yes
Yes
No
55.75
54.18
No
49.59
60.93
Yes
Yes
No
53.32
56.84
No
48.96
61.63
Yes
Yes
No
52.92
57.28
No
54.75
Yes
55.27
No
Yes
51.91
58.38
Yes
No
50.28
60.17
No
Mean Rank
Attended discipline
Psychology
0.92
0.04
0.45
0.79
0.04
0.54
0.03
0.42
0.93
0.24
0.08
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Contact
57.68
52.37
48.96
60.93
53.55
56.43
49.24
60.65
51.4
58.54
60.07
50.02
60.29
49.81
56.26
53.76
52.5
57.45
53.28
56.69
48.56
61.32
Mean Rank
0.32
0.02
0.59
0.05
0.19
0.08
0.06
0.64
0.38
0.53
0.03
Female
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
Male
Gender
56.77
43
57.91
35.25
55.05
54.64
56.65
43.79
58.25
32.93
57.11
40.71
56.9
42.11
57.13
40.57
53.97
62
56.88
42.21
56.98
41.54
Mean Rank
0.08
0.04
0.96
0.13
0.00
0.05
0.08
0.04
0.34
0.07
0.07
Sex Disabil (2012) 30:261287

281
123
282
Sex Disabil (2012) 30:261287
Table 5 Variability of students attitudes

Questions
General
Mean
rank
Medicine
Mean
rank
Psychology
Mean rank
Architecture
Mean rank

16.91
17.11
16.95
16.91

17.44
17.99
16.63
17.44

8.68
9.12
8.3
8.68

with intellectual disabilities is very childish
7.69
9.05

tenderness
4.96
5.11
4.7
4.96

7.76
7.79
7.96
7.76

16.61
16.55
17.22
16.61
8. The individual with intellectual disability are entitled

to their sexuality
16.01
16
16.49
16.01

individual with intellectual disability
14.82
14.96
15.24
14.82
7.74
8.09
7.53
7.74

12.04
12.14
12.47
12.04
12. The person with intellectual disability should not

photographs of nude or
11
10.42
11.72
11

reprimanded
12.43
12.27
13.5
12.43

ignore
10.12
10.43
8.92
10.12

and introduce rules to guide them
13.89
14.46
12.92
13.89

7.88
7.79
7.04
7.88

6.5
6.57
5.85
6.5

allowed to marry
13.22
12.94
12.94
13.22
19. The person with intellectual disability must be able

to have kids
10.2
9.34
10.26
10.2

effect on the individual with intellectual disability

to care for a child
6.11
5.42
5.91
6.11

education
15.78
15.79
15.89
15.78
123
Sex Disabil (2012) 30:261287
283
Table 5 continued
Questions
General
Mean
rank
Medicine
Mean
rank
Psychology
Mean rank
Architecture
Mean rank

14.9
15.02
15.53
14.9
0.00
0.00
0.00
0.00
particular emphasis on female students. Thus, it is illustrated that in the society we live in,
the topic of sexuality is still surrounded by prejudice and discrimination. [2]
On the issues mentioned, the most positive attitude was demonstrated by the students of
psychology, while the least positive was taken by the architecture students. According to
Albuquerque and Ramos, the social attitudes, shaped by prejudice, and also by ignorance,
are reflected in a set of behaviors that deny some of the most elementary rights of persons
with disabilities, especially with regard to their sexual and emotional aspect [20].
By analyzing the variability of students attitudes, the questionnaire showed that when
asked about the right of the person with intellectual disability to their emotional and sex
life, all students show a more positive attitude than the one described by the authors
mentioned above. But when asked about the most objective demonstration of interest and
curiosity about the issue of sexuality (questions 1012), their approach becomes much less
positive. It is the psychology students who take a more positive attitude while a less
positive perspective is held by the architecture students. When we ask medicine and
psychology students about more objective aspects of this theme, there are differences
between those who have already acquired knowledge and those who have not yet done so.
The attitude was more positive in the latter group.
In that same issue, considering only the psychology major students, regarding the
variable frequent contact with the individual with intellectual disability, those with more
frequent contact demonstrate a more negative attitude. This shows that despite the social
and cultural changes that have occurred in relation to the topic of sexuality, making it (at
least in theory) a legitimate right of all human beings, there are still no real changes
happening in attitude for the group surveyed. The manifestations of sexuality are only to be
considered normal and socially acceptable to the beautiful, the young, capable, healthy,
and free of any disability.
Sexuality is also acceptable for people as long as it does not involve their grandparents,
parents, children or siblings. Accepting the sexuality of those who are close to them is to
accept their own condition of being sexual, and it seems that they are still far from being
able to do so.
Felix and Marques argue that the ban is affective-sexual behaviors to the population
with disabilities; we are preventing them from satisfying basic needs for their growth and
development as individuals. One of those needs is sexuality and this does not necessarily
mean intercourse. It implies rather that we want, that we value. We feel important and
useful because we have someone to share projects and anxieties. [9]
Glat [21] says that teenagers with learning disabilities have the same problems as other
young people, most of them have normal development of physical and psychological
characteristics, and finally they receive little information about the functioning of [their]
body. So when they take on a far from normal sexual behavior, it usually arises from the
way the individuals with intellectual disability have been treated and not due to disability.
123
284
Sex Disabil (2012) 30:261287
[22] Another author also states that the needs and emotions of the persons with intellectual disability are equal to those of others. The perspective that they have higher or
lower sex drives lacks biological foundation. [23] These are the two major contradictory
myths that accompany their. According to one of them, they are described as a sexual
beings, as children lacking sexual urges and desires who need to be protected and monitored for any social contact to develop. According to the other, they are perceived as
being hypersexual without any control of their impulses that must be caught and punished
[2, 2428].
Comparing the different attitudes of the participants in the study reveals that when
asked about the childishness of the individuals with intellectual disability in emotional
relationships and on their ability to control impulses, students of the three majors showed a
negative attitude. The less negative attitude was found among the psychology students.
When asked about their emotional maturity, students of medicine and psychology who
have already acquired knowledge regarding the mentality of the person with intellectual
disability reflect a more positive attitude than those who have not acquired it. A similar
phenomenon is manifested with the medical students when asked about the ability of
person with intellectual disability control their impulses. One can infer that the degree of
knowledge of students seems to be a determining factor in them, causing a more positive
attitude in the face of affectivity and sexuality of the individual with intellectual disability.
Some researchers observed in their studies greater acceptance of the practice of
masturbation, thus reflecting a more liberal attitude in that area and people with intellectual
disabilities are part of the group that benefited from this change [29]. However, although
the majority of the individuals who have mildly to moderately intellectual disability are
aware of the concept of masturbation [30], and the prevalence of this practice in this
population is high at 97% for those with an IQ over 50 and 80% for those of a lower IQ
than 50 [31], the practice remains shrouded in controversy and discrimination. And this
situation is illustrated by the fact that when the individual with intellectual disability are
caught either by parents or other caregivers in situations perceived as socially inappropriate, such as masturbation, they are severely reprimanded [32].
By analyzing the different distributions of responses from the students of medicine,
psychology and architecture regarding issues related to the masturbatory practices of the
person with intellectual disabilities, one can observe a moderately positive attitude on the
part of the three student groups. Hierarchically, again, psychology students were those who
had the most positive attitude while the architecture students had the least.
Caregivers and society in general have been made aware to the right of the individual
with intellectual disability has to live a normal life. They have the right to live in society
and the right to relate to whoever they want and however they wish. [33] Some recent
studies have also shown that relationships are [] important aspects of life for the
individual with intellectual disability [34]. In addition to those fundamental rights
subjects are able often to make decisions about how to organize their lives and consider
more appropriate taking into account their capabilities. While this capability exists, it
exists also for the affective-sexual area. Suppress this fact; it will not make it disappear. By
doing so, we become asexual people creating distress and often more anger and aggression.
More importantly, we are limited human beings [35].
And it is on these issues of responsibility, ability to marry and have children, and the
ability of the person with intellectual disability to care for a child that those surveyed
showed a less positive attitude. Even medicine and psychology students followed this
pattern. This shows a society that insists on considering the person with intellectual disability as individuals unable to hold themselves to any kind of responsibility.
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Sex Disabil (2012) 30:261287
285
When asked about the possibility of marrying an individual with intellectual disability,
medicine students demonstrate a positive attitude. However, when asked about this persons ability to take care of a child, the attitude changes, becoming more negative. On both
issues we notice a much more positive attitude in female students. Psychology students
reflected a positive attitude about the ability of the person with intellectual disability being
able to have children. A similar attitude was noticeable with women who previously had a
more positive attitude to marriage. And the more positive attitude of women regarding
marriage reflects a belief that already exists.
Regarding the variable frequent contact with individual with intellectual disability
the Psychology students are, from those who do not have this frequent contact, the ones
who had a more positive attitude to the possibility of what individual with intellectual
disability will experience. Those individuals who live closest to people with intellectual
disabilities tend to infantilize them and more vehemently tend to deny their right to
expression of sexuality.
What would happen if sex education programs were presented to the individual with
intellectual disability? Would they have sex at the first opportunity? Would men become
hypersexual without any control over their impulses? How about women? Would they start
to breed compulsively? [36]. The person with intellectual disability need sex education
more than anything else because they have no opportunity to learn and build their sexuality
from friends, books or from watching behaviors [2, 8, 3639]. They also need to be trained
in social skills, particularly in how to show affection and love in a socially acceptable way
and also learn to defend and protect themselves from sexually transmitted diseases,
unwanted pregnancies and sexual abuse [2, 8, 3639].
According to the questionnaire, when subjects were asked about the importance of sex
education for the individual with intellectual disability, students of the three majors adopt a
very positive attitude. This attitude is more evident with the psychology students and less
with the architecture students. We also observed that as far as the medicine and psychology
majors, knowledge and females variables go more positive attitudes were registered.
It also appears that the psychology students with frequent contact with the individual with
intellectual disability show a more negative attitude to the importance of sex education
than those without such contact.
A common belief about the sexuality of the person with intellectual disability is that
professionals who work with them, both in terms of rehabilitation or the different types of
therapy and follow-up, have a more tolerant and understanding spirit. This belief has been
refuted by several previous studies [26, 40]. However, it is necessary to take into account
that these professionals have little academic training to achieve and deal with the sexuality
of their patients [11, 41, 42]. The WHO even acknowledges that the attitudes of health
professionals can be a major obstacle to their role as educators and counselors on the topic
of sexuality [11].
Another interesting fact emerges from a study by Silveira in 1993 [12], which evaluated
the degree of knowledge about sexuality among medical and engineering students and it
was found that both have similar levels of knowledge at the end of their academic studies.
This finding is quite surprising, as health professionals should be trained to assist individuals in a holistic manner, including tending to their sexuality.
One can therefore conclude that the vast majority of students surveyed consider sexuality an important part of the life of every human being and recognize their many
functions, but they lack training to be better able to deal with this issue.
From the responses to the questionnaire, psychology students were those with a more
positive attitude towards sexuality and affectivity of the individual with intellectual
123
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Sex Disabil (2012) 30:261287
disability, but the variability of the distribution of student responses from the three majors
did not differ significantly. A positive attitude is characteristic of those who have acquired
sufficient knowledge, females and of those who have frequent contact with individuals
with intellectual disability.
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