سلامت جنسی افراد مبتلا به ناتوانی ذهنی: رویکرد اکوسیستم

The goal of this article is to propose a state of knowledge on the situation of people with an intellectual disability regarding their sexual health from factors that facilitate or obstruct it. Definitions of sexual health and disability suggest an ecosystem approach, which considers both personal and environmental factors that may have an impact on sexual life. A literature review confirms the role of intellectual restrictions and social configurations on the sexual health of people with an intellectual disability.

People with an intellectual disability have restrictions regarding cognitive functioning and adaptive behaviour that affect their conceptual and social skills, and their sexuality. Before the 1970s, people with an intellectual disability were seen as asexual beings who were not interested in sexuality. The fear of a suffered or committed aggression as well as an unwanted pregnancy gave grounds to prohibit sexuality. These people were considered unable to assume their sexual life. This perception has changed since the last four decades. For example, in 2008 the American Association on Intellectual and Developmental Disabilities adopted a policy on sexuality recognizing the right of people with intellectual disabilities to live their sexuality (AAIDD, 2008). If their sexual needs were denied or solved by sterilization, they are now recognized and sexual health services are looking into it. People with an intellectual disability need support to prevent unwanted pregnancies, sexual abuse and sexually transmitted infections. Their intellectual restrictions make them vulnerable to these dangers. An increasing body of literature is studying these issues. Indeed, Gascon et al. (2010) examined the themes in the scientific literature from 1990 to 2007 that focused on adolescents with mental retardation and found that sexual life is in fifth position on a list of twenty-one. Many people with an intellectual disability do not receive the necessary attention regarding sexual health (Servais, 2006). Consequently, they are subject to obstacles from their environment that oppose interventions to promote sexual health. Whether it is in terms of family, school or community, many obstacles can hinder sexual education initiatives. Thus, it becomes imperative to establish the state of knowledge on the situation of people with an intellectual disability and their sexual health in order to determine the factors that facilitate and obstruct it. This inventory could inspire service providers in the development of intervention projects with families, schools, social and health institutions, and community organizations. To carry out this work, definitions of sexual health, handicap and intellectual disability will be initially presented, to then adopt and implement a theoretical model that will be used to document the determinants of sexual health of people with an intellectual disability.

The ecosystem approach provides an insight to better understand the sexual life conditions of people with an intellectual disability. This instrument uncovers the factors that influence the changes in their sexuality and their involvement in sexual activities, such as positive social representations, actions for social rights, as well as the permissive attitudes of parents and professionals. This knowledge can provide families, schools and the community with measures to put in place in order to promote the sexual well-being of people with an intellectual disability. It is important that the different social actors act and cooperate for the prevention and the promotion of sexual health for people with an intellectual disability in the context of specific measures, as well as harmonized and coordinated programs.