This supplementary information is presented as submitted by the corresponding author. It has not been copy-edited by NTvG.
People with intellectual disability (ID) are known to have an increased risk of unwanted pregnancy, sexually transmitted disease, or sexual abuse. In most special secondary schools additional sex education is provided to empower these youths.
The purpose of this study was to obtain information to improve quality of medical consultations concerning sexuality and contraceptives by mildly disabled youngsters.
This qualitative study was based on 28 semi-structured interviews with youngsters with a mild ID.
In four special needs secondary schools all 57 youths were selected as possible candidates for the interview according to their age. Pupils with a known history of sexual abuse were excluded. The interviews were recorded. The text was labeled and analysed using Atlas.ti .
The teachers excluded 17 pupils. Reasons for exclusion were a history of sexual abuse (8), too difficult (2), insufficient verbal skills for the interview (3), suspected emotional discomfort (2), expected objections by parents (1), poor attendance in school (1). Of the remaining 40, pupils 28 agreed to the interview (13 male, 15 female; age 15-18 years, average IQ 58). The four schools were located across the Netherlands and varied from small towns to urban areas. 19 of the participants had been going out with someone, five had sexual experience (intercourse). Eleven youngsters used contraceptives. Knowledge of contraceptives regarding condoms and oral contraceptives was sufficient, knowledge of other types of contraceptives was minimal. Youths who were dating knew more about contraceptives. Twelve youngsters appeared vulnerable due to lack of self-protecting skills. Those interviewed appreciated the sex education received at school. Besides the sex education in school they were informed about sexual topics by their parents, their peers, from books, television and internet. “Mutual respect”, “no one-night-stands” and among the moslim participants “no sex before marriage” were frequently mentioned moral values. Most participants enjoyed talking about sex and had trusted supporting relatives or teachers available for consultation. Verbal skills appeared poor for understanding questions and expressing feelings or opinions. Doctors were not frequently reported as a source of information.
Participants stated their right to choose contraceptive methods and were optimistic about their future self-supporting family life.
The participants showed marked interest and willingness to talk about their experiences, in addition to their needs for adequate sex education. Limited verbal skills influence the effect of sex education. These youngsters are vulnerable because of a lack knowledge and understanding and their limited social skills. As their interest in dating develops they become more open for sex education, but meanwhile they are already at risk for unwanted or abusive sexual interactions. Although sex education is primary a task of parents and schools, doctors can have an important additional role in supplying necessary information and recognizing problems. Doctors can contribute to the empowerment of youngster with ID by inquiring about sex education, dating, sexual activity and offering repeated sex education and information about contraceptives. The use of explicit and simple terminology can be helpful. The availability of easy-to-read booklets or other materials could support the general physician. Consultation by people with an intellectual disability usually requires extra time.