Sex and Relationship Education for Individuals with Disabilities: A Review of the Literature Through an Ecological Systems Lens

Abstract

Despite advances toward disability inclusion, high-quality sex and relationship education (SRE) is often inaccessible for disabled communities. Confounding this issue, each individual’s experience of SRE is shaped by aspects within their environment, such as societal contexts, cultural factors, policy frameworks at the national and local levels, and the attitudes of parents and educators. This informal review of the literature synthesizes historical and contemporary literature—focusing primarily on individuals with intellectual disabilities and autism—to explore the multifaceted barriers and opportunities for effective SRE. We have situated the literature within Bronfenbrenner’s ecological systems theory to illuminate how interactions among and within the environment shape individual experiences with SRE. The literature outlines several barriers to successful SRE programs for the disabled community, including pervasive misconceptions about the sexual and relational needs of disabled individuals, inadequate training for educators, and limited empirical evidence underpinning best practices. Our paper underscores the need for comprehensive, evidence-based curricula that align with the desires of the disabled community, are accessible to people with disabilities and their communities, and employ a variety of instructional methods to support learning across the life course, beginning in adolescence. We conclude by outlining future directions for research and practical solutions for curriculum development, emphasizing the importance of addressing these multi-layered challenges to enhance SRE for disabled people and their communities. Approaching and conceptualizing the literature within a systems framework and through our shared perspectives and experiences is noteworthy, as our review provides a descriptive and unique lens to understanding SRE influences on people with disabilities nationally and internationally.

1. Introduction

Relationships and sexuality are fundamental aspects of human life; however, people with disabilities often do not have access to sex and relationship education (SRE), severely limiting their ability to explore this facet of life with safety and success [1,2]. A 2012 survey, for example, found that less than half of students with disabilities receiving special education services at school took part in sex education, a rate significantly lower than that of the general population [3]. Like their non-disabled peers, many disabled individuals seek knowledge about sex from informal sources when formal education falls short [4]. However, while typically developing students often rely on peers to fill the gap, students with disabilities are more likely to turn to media sources such as television, magazines, or the internet [1]. Unfortunately, this reliance on informal, often inaccurate, sources puts individuals with disabilities at greater risk of victimization and participation in unsafe sexual situations [4].

Recently, researchers have sought to address this urgent issue by designing SRE curricula to meet the needs of people with disabilities; however, there is little consensus about the length, content, or method of instruction that is most effective [2,5]. Corrective feedback and visual/multimedia support have been identified as promising methods for increasing participants’ knowledge of and attitudes toward sexuality [6]. However, descriptions of SRE interventions, both nationally and internationally, have rarely provided sufficient detail about why specific methods were selected or how they were implemented, making it difficult to assess their efficacy [5]. For example, in a review of 40 international studies, Sala and colleagues (2019) found dramatic variability in the content, delivery, and quality of SRE offered to the disability community [6]. While many SRE programs centered on improving positive, short-term outcomes, such as increased knowledge and greater safety awareness, they often lacked valid outcome measures, sound theoretical framing, and proper ethical grounding (consent, privacy, dignity).

Furthermore, the scope of existing curricula is often limited, with the majority of SRE programs created for adults with disabilities and focusing on learning basic human anatomy, hygiene, and developing self-protection skills [1,6]. Specifically, there tends to be an over-emphasis on the biological aspects of human sexuality, such as human reproduction. However, there is an under-emphasis on the social aspects of human relationships and sexuality, such as the joy of meaningful relationships, practicing communication skills, gender diversity, and other topics that were once deemed “irrelevant” for people with disabilities [1,7]. There also tends to be an over-emphasis on safety and how to say “no” to potential predators, with little information about how to pursue healthy and meaningful relationships, how to gain consent, and how to behave with a romantic partner in socially expected ways [2]. A limited focus on application and generalization of learned skills further complicates this.

Yet above and beyond these limitations lies the discomfort that caregivers and educators have expressed about initiating and facilitating conversations centered on sexuality and relationships with people who have disabilities. Discomfort is heightened when professionals are tasked with facilitating sexual and gender diversity [8]. This current state of disability-inclusive SRE is unsurprising given the history of disability and sexuality in the United States (US); For centuries, people with disabilities have been robbed of their sexual autonomy and choice [2,9]. Yet, policymakers have been slow to address the inadequacy of current sex education laws. As of 2024, only three states in the US explicitly required sexual education programs to be accessible to people with disabilities [10]. How these mandates are applied in real-world settings remains unclear.

This inaccessibility of SRE puts individuals with disabilities at heightened risk for sexual abuse and exploitation, with the prevalence varying based on the type of disability [8]. For instance, individuals on the autism spectrum are two to three times more likely to experience unwanted sexual contact, coercion, and rape [4]. People with intellectual disability (ID) are at even higher risk of victimization, with rates of sexual abuse up to seven times that of the non-disabled population [11]. SRE is critical because it acts as a protecting mechanism, such that with knowledge about sexuality, people with disabilities are less vulnerable to negative sexual experiences and more empowered to engage in positive decision making [2].

The Present Paper

The present paper provides a synthesis of the current literature base on SRE, highlighting the wants and needs of individuals with disabilities, the perspectives of caregivers and educators, and the institutional factors that influence SRE. See Table 1 for an overview of the literature. Here, we define SRE as a holistic approach to sex education designed to encourage the development of healthy relationships, enriching romantic experiences, and socially expected sexual expression. We use the term “disability” to refer to the broad range of neurodivergence that exists among individuals with IDs and those on the autism spectrum. While we recognize that significant variation within and between these populations exists [12] much of the SRE literature-base has centered on ID and/or autism, as these two populations often face similar vulnerabilities to sexual exploitation and barriers to accessing SREs [6,8].

We have situated the literature within the lens of Bronfenbrenner’s ecological systems theory [13,14] to illustrate how individuals’ experiences are shaped by interactions between different aspects of their environment. We end with a discussion on concrete SRE curriculum recommendations that promote learner agency and critical understanding of romance, relationships and sexuality. Finally, we recognize the influence and importance of our diverse perspectives and experiences, in both how we have approached and conceptualized the current literature base. We provide a brief description of our positionalities here to highlight our shared lens as a community including educators, people with disabilities, undergraduate and graduate students, researchers, and clinicians. Our shared knowledge bridges academic fields in early childhood education, human development, speech language pathology, developmental and clinical psychology, genetics and education. The first author is a parent, educator and emerging scholar with a profoundly rooted interest in dynamic systems theory. The second author identifies as a person with a disability and has years of experience working with students with intellectual and developmental disabilities. The third author grew up with a neurodivergent sibling and hopes to promote inclusion in STEM fields. The fourth author identifies as a person with a disability and is a recent graduate of a 4-year residential, inclusive university program for individuals with intellectual disabilities. The fifth author is a researcher and educator who specializes in inclusive practices for autistic individuals. The sixth author is a cisgender female who is married to a woman. She was a special education teacher before becoming a clinical psychologist who specializes in supporting neurodivergent individuals develop safe and meaningful relationships.

2. Theoretical Frameworks

We have conceptualized the literature on SRE programs for individuals with disabilities and grounded our ideas within Bronfenbrenner’s ecological systems theory [14]. This framework provides a comprehensive lens for understanding the multiple layers of influence that shape individual experience. The ecological systems theory highlights the dynamic and transactional interplay between individuals and their environments [15,16]. Specifically, the theory proposes that experience is shaped by interactions within nested systems, ranging from immediate environments, such as families and schools, to broader societal contexts such as political climate and policy [14].

We acknowledge the ecological interdependence between and within the systems, and by doing so, we highlight the complexity involved in sexuality and dating for people with disabilities and the need for translatable education programs that address these interdependent layers of the system. Individuals are situated at the core of the system, such that one’s genetic make-up, personal histories and background, and traits and characteristics influence and are influenced by the surrounding systems. Hence, we have organized our review of the literature starting with the outermost systems (chronosystem and macrosystem) in order to end with a focus on the individual and individual preference and choice. See Figure 1.

2.1. Chronosystem and Macrosystem Influences: Historical Events, Cultural Attitudes, Policy

The outer levels of the ecological systems theory are the chronosystem, which includes historical influences and major events in an individual’s life, and the macrosystem, including societal attitudes and policies. To understand the complexity involved within these systems, we begin with the movements and policies that have historically driven society’s views and biases about disability within the US, beginning in the 1880s, with the eugenics movement that linked disability to criminality and sexual deviance [3]. Proponents of eugenics advocated isolating disabled people in institutions, both to limit this perceived criminal impulse and to prevent people with disabilities from reproducing. In 1927, the Supreme Court went as far as to uphold the forced sterilization of disabled individuals, codifying these harmful social biases into law [17] with the goal to eliminate the “feebleminded” from society [18]. As of 2022, as many as 31 states still allow forced sterilizations, with the most recent laws passed in 2019 in Iowa and Nevada [19]. Indeed, 17 states still legally permit sterilization of disabled children, only 3 explicitly prohibit it, and 11 states plus Washington, D.C. have no clear laws on sterilization of minors.

Today, a heightened awareness about issues of autonomy, consent, and human rights has led to significant progress in advocating for the rights of individuals with disabilities. For example, while it was not ratified, the US signed the 2009 United Nations Convention on the Rights of Persons with Disabilities, signaling support for the universal right to comprehensive SRE [20,21]. However, the US has no federal law regarding who should receive sex education, at what age it must begin, or what material should be covered. SRE policies, therefore, vary from state to state, district to district, and even from school to school [22]. As of 2023, schools in 38 states and Washington, D.C. are required to implement some sex education [23]. Thirty-nine (39) states require that when sex education is provided, abstinence must be included in the curriculum. In 29 states, abstinence must be the focus of the curriculum, while only 21 states require instruction on other contraceptive methods. Ten (10) states mandate that the curriculum be inclusive of LGBTQ+ identities, while four states discourage or outright prohibit discussion of LGBTQ+ people and relationships. Comprehensive SRE that is developmentally appropriate, evidence-based, inclusive, and empowering is limited overall [3].

Inconsistent access to SRE for people with disabilities has also been documented internationally, with sociocultural values influencing not only what is taught but whether SRE is offered world-wide [24,25]. This has led to significant global disparities in access to and comprehensiveness of SRE [6]. Saleh and Dillenburger (2025), for example, found that caregiver perspectives and attitudes are often influenced by cultural taboos and societal norms, creating barriers to SRE and resulting in underfunded programs staffed by professionals with limited specialized training [25]. In countries that tend to hold more traditional values, SRE is often limited to biological aspects of human sexuality and safety, such as hygiene, privacy, and abuse prevention [24]. Culturally conservative SRE programs are often restricted to single-gender classes and exclude topics like masturbation, while more liberal sociopolitical contexts have focused on topics like relationships, contraception, and gender identity.

Today’s modern era and rapid rise of social media and other online forums also present a host of unique challenges for people with disabilities, giving people access to unregulated information and giving predators another avenue to exploit disabled individuals [26,27]. People who are seeking to make romantic connections have endless access to each other on various online forums. For instance, a simple google search of “How do I find a girlfriend” will provide the searcher with thousands of links that range from cartoon explanations to pornography sites. The growing use of dating applications like Tinder, Bumble and Hinge has created new avenues for social connection and interaction which, at surface level, can be viewed as a positive way for historically isolated populations to connect; however, these dating services remain underregulated and can expose those with disabilities to increased risk of being manipulated or coerced into sexual activities without fully understanding the implications.

2.2. Exosystem and Mesosystem Influences: Responsibility for Teaching Relationships and Sexuality

There is currently limited training for both caregivers and educators in addressing sexuality and dating with disabled individuals. This may be due, in part, to the ambiguity regarding who feels responsible for delivering sexual education to disabled individuals. The research literature most commonly identifies educators and caregivers; however, both have shown to have their own reservations about delivering SRE. Educators, including general and special educators, have reported feeling unprepared to teach SRE, feeling that their expertise is too far removed from sexual education to be successful mentors [28,29,30]. Studies have suggested that teacher preparation in relation to SRE is overall ‘inadequate’ and often confounded with limitations related to school settings, such as limited curricular time and resources [31].

Studies have also suggested that educators often do not feel confident in their abilities to successfully teach sexual education, and at times, feel some resistance from caregivers [28,31]. Caregivers too often feel uncomfortable with addressing SRE topics with their children. And so begins the passing of responsibility, with educators suggesting that occupational therapists, who have training in daily living activities, may be better equipped to teach SRE content [30,32]. Yet occupational therapists have expressed feelings of concern about their knowledgebase for addressing SRE with people with disabilities [32]. Caregivers have turned to healthcare professionals for guidance, yet healthcare professionals have reported not feeling knowledgeable on SRE topics [33]. Shared responsibility of SRE content delivery between caregivers and educators has shown some promise for reducing discomfort around SRE content [34]. Frank and Sandman (2019), for example, reported that families felt more confident in providing SRE to their children after receiving basic training and participating in on-going communication with educators [35]. Caregivers have also reported feeling more comfortable when educators act as a liaison to facilitate delivery of SRE with their children [36].

2.3. Microsystem Influences: Perceptions of Caregivers and Educators

Misconceptions about disabilities and the relevance of SREs for individuals with disabilities is threaded throughout the systems [9]. Stakeholders, including educators and caregivers, often carry implicit biases that skew their perceptions of disabled individuals’ needs, wants and desires, creating a discrepancy or mismatch between what an individual wants and what others want for them [7]. Negative ideas, attitudes and biases are further exaggerated when stakeholders avoid SRE topics or withhold people with disabilities from access to SRE curricula. Educators, for example, have viewed developmentally appropriate sexual behavior as disruptive, responding by eliminating the ‘problematic behavior’ or implementing rules and regulations rather than viewing sexuality as part of the human condition and educating the individual [2,37]. Implementing this type of rule-based education without a more holistic approach leaves people with disabilities feeling unsure of how to navigate relationships and sexuality or who to turn to when they have questions [31].

Caregivers have indicated that SRE may not be appropriate for their children [35,37], reporting that topics centered on sexuality and dating ‘did not apply’ or that it was not possible for their child to have a ‘safe sexual relationship’ [1]. Caregiver feelings of uncertainty often begin during the onset of puberty and may extend into adulthood [37]. Bornman and Rathbone (2016) found that caregivers did not feel SRE topics would be useful for their adult children with disabilities, and therefore, did not permit their children to participate in SRE programs [36]. In fact, limited parental consent was a primary barrier within their study. This has been found across studies; People with disabilities need permission from their caregivers yet are often ‘discouraged’ or ‘forbidden’ to participate in SRE [2,38].

Caregivers often fear SRE for their disabled children, and in response, shelter them from education in an effort to keep them safe [31]. However, caregiver sheltering along with societal perceptions that people with disabilities ‘lack sexual desire’ or are ‘incapable of understanding or participating in sexual relationships’ prevent SRE programs being made available to them [1,7]. Yet, limiting opportunities for education makes individuals with disabilities more vulnerable or susceptible to manipulation, coercion, or abuse by others [39], highlighting the critical importance of providing adequate information and instruction to caregivers and the community.

Another key microsystem is the individual’s social network composed of one’s peers. Social networks can have profound influence on how individuals with disabilities express sexuality and form relationships, yet social opportunities are often limited or structured for people with disabilities [38]. Simply including students with disabilities in traditionally non-disabled social spaces is important [37]. People with disabilities have reported feeling safe discussing SRE topics with their peers [38]. They also learn from their peers’ experiences with relationships and dating, such as having a girlfriend, or expressing feelings of a crush. Notably, in executing the PEERS^® program, Rose and colleagues (2021) documented an improvement in social skill knowledge in college-age individuals with disabilities when facilitating guided interactions with their peers [40]. These individuals also participated in an inclusive post-secondary education (IPSE) program during the study, which facilitated additional social opportunities with their undergraduate peers.

2.4. The Role of the Individual: Experience, Preference, and Voice

At the center of the ecological systems theory is the individual. Individuals with disabilities have unique perspectives, needs, and experiences that significantly influence their understanding and approach to relationships and sexual health. Yet traditional SRE programs often overlook individual experience or preference, which potentially leads to gaps in knowledge and skills that are crucial for navigating relationships safely and confidently. People with IDs, for example, have identified friendship development, marriage, and safe intimacy as three topics of interest they would like to learn about [2]. Yet SRE curricula heavily focuses on biological information and safety rather than sexuality, sexual orientation and other content that align with individuals’ interests and lived experiences [6]. Although this information is important, focusing solely on safety may give people with disabilities a one-dimensional idea of sex and relationships as something to be feared. Many education programs also do not include information about online relationships, which is a form of relating that many people with disabilities prefer [8].

Furthermore, Graff and colleagues (2019) noted that programs designed with input from a diverse group of stakeholders, including self-advocates, were more effective and better received. In their curriculum, Positive Choices, individuals with disabilities reported that they would like more information on healthy, romantic partners, establishing relationships, menstruation, types of abuse, health care, and taking care of a baby [7]. People with IDs highlighted the use of video and discussions with peers where experiences and opinions can be shared as two preferred methods of instruction [2], and many people were also interested in receiving relationship coaching [1]. Similarly, Pedgrift & Sparapani (2022) found that nearly 90% of adults with disabilities who were interviewed reported they were interested in having a romantic relationship, and they reported that looking at photos and videos were useful when talking about various relationship topics [8].

Cheak-Zamora and colleagues (2019) further demonstrated the importance of including individual experience as a foundational component in SREs for individuals with disabilities. In their qualitative study using thematic analysis, the authors found that adolescents and young adults on the autism spectrum expressed a strong interest in relationships, but at the same time, experienced confusion, frustration, and limited confidence about knowledge of social relationships and sexual norms [41]. The participants, for example, expressed ideas about an ‘ideal partner,’ yet these expectations were often left unmet within actual relationships. This gap between desire and reality underscores the need for SREs that are tailored to the specific experiences of individuals with disabilities, incorporating their personal perspectives and providing practical, relatable guidance [42]. Including individual experiences in SREs would allow for the development of programs that not only address basic sexual health topics but also offer social skills training and realistic relationship modeling. By doing so, education becomes more directly relevant, and lesson application becomes integrated into the individual’s lived experience. This empowers people with disabilities to better practice autonomous management of their sexual and relationship experiences, reducing their vulnerability to exploitation and abuse [2].

3. Summary and Key Points

Viewing the literature base through Bronfenbrenner’s ecological systems theory, our review shows how multiple interacting systems—ranging from broader political contexts to individual lived experiences—shape the experiences of SRE for people with disabilities. A system approach to understanding SRE for people with disabilities highlights the need for transformative change in how education is approached, as SREs are currently designed and developed within a multilayered system that is steeped in biases, beliefs, and historical marginalization. We believe there is need for an interconnected approach to SRE design and delivery that addresses the nested systems holistically as well as research that considers the various ecological levels, rather than focusing solely on individual or classroom-based programs.

Starting with the outermost layer, there is a need to address stigma around disability in an effort to change societal views about sexuality in people with disabilities—that they are not aware of their sexuality, not capable or disinterested in forming relationships, and in need of protection [1,29,43]. We, as a society, need to recognize the past and become aware of implicit biases that communities and individuals carry with them in the present, as negative attitudes and actions often stem from misunderstanding of disability and sexuality. This points to improving broad community awareness and a deeper understanding of disabilities from an asset lens in which people with disabilities are viewed as capable beings with rights and autonomy. Sexuality is important as it contributes to a positive self-view [1,9]; hence, every human should have the right to access SRE and opportunities to build meaningful and lasting relationships.

Studies have begun to explore the perspectives of people with disabilities [1], yet there remains a need for comprehensive and ongoing training for caregivers and professionals delivering SREs. This would entail community-based, collaborative training for caregivers, educators, and service providers that includes depth and breadth of relationship and sexuality topics that align with the needs and lived experiences of the disabled community. Acknowledging and addressing community attitudes and feelings of uncertainty or discomfort, facilitating conversations with caregivers and educators centered around sheltering people with disabilities and risks associated with vulnerability, and transparent communication between educators, caregivers, and people with disabilities are critical components to positive change and successful SRE [1].

Listening and learning from the perspectives and experiences of people with disabilities is a critical step toward positioning people with disabilities as competent and capable members within the community with voice and choice. Design of SRE should consider limitations outlined within the current literature and include the desires and perspectives of the community as well as topics of interest to the disability community, such as understanding gender identity and developing safe and healthy relationships [2]. There is an emerging body of literature that has included people with disabilities in the design and development of SRE. Hughes and colleagues (2020), for example, developed The Safety Class, a comprehensive curriculum focusing on interpersonal violence prevention, using a participatory research design in partnership with the disability community [44]. The development of the Social-Sexual Education (SSE) project was also heavily influenced by individual feedback from adults with disabilities, with a goal to empower people with disabilities to be their own decision-makers [8]. Programs such as these are important to ensure that SRE content is tailored to align with individual needs, interests, and experiences, while giving people with disabilities agency and control over their personal goals [1].

Finally, people with disabilities exhibit varying levels of SRE knowledge and skills, have different experiences, and need different degrees of support. For example, the severity of autism features may vary within and across autistic populations, as may communication and adaptive skills in those with IDs. Studies have documented sex differences related to SRE learning as well as views and experiences regarding sexuality, with females exhibiting more difficulty with decision making and understanding abuse concepts relative to males [2]. SRE is further complicated because of these individual differences that are observed within and across the disability community and needs to be designed flexibly to align with the individual strengths and needs of specific populations [1,2]. Kohn and colleagues (2023), for example, suggested a need to focus on communication within educational programs designed for autistic learners who show communication differences, teaching topics such as how to interact with a romantic partner, communicating interest, and understanding and conveying one’s intentions [42].

Gkogkos and colleagues (2019) illustrate the importance of flexible design in their culturally bridging case study of a 15-year-old adolescent on the spectrum [45]. The participant showed initial gains in sexual health and hygiene while participating in a highly structured behavioral-based SRE program yet began displaying ‘inappropriate sexual behavior’ shortly following the end of the program. While the highly structured pedagogy and empirically validated measures toward SRE goals offers some insight into what a scientifically grounded SRE curricula might look like, it also demonstrates a critical limitation: sexuality is a fundamentally unique and highly personal human experience. The rigidity of overly structured SRE curricula may overlook individual differences in needs, values, and preferences. This study underscores the importance of personalized curricula that is responsive to each learner’s developmental profile, cultural context, and lived experience. Finally, including a range of innovative teaching methods is also critical to promote inclusion, understanding, and accessibility of content. This might include technology-enhanced learning opportunities, use of video modeling, social narratives and scripts, and peer-to-peer education opportunities [2].

Table 1. Over of Current Challenges, Supporting Evidence, and Practical Solutions Outlined in the Literature.

Challenge Outlined in the Literature	Supporting Evidence	Emerging Literature, Practical Solutions, and Future Directions	Supporting Studies
1. There are misconceptions about disabilities, disabled individuals’ needs and desires, and the relevance of SREs for individuals with disabilities.	Educators and caregivers often carry implicit biases that skew their perceptions of disabled individuals. Sociocultural values and sociopolitical contexts influence whether SRE is offered and how and what is taught. Societal beliefs that people with disabilities ‘lack sexual desire’ or are ‘incapable of understanding or taking part in sexual relationships’ influence access to SRE. There are minimal or no requirements for people with disabilities to receive SRE within or outside school settings.	There is a need to: Address stigma around disability. Recognize and remove implicit biases about sexuality in people with disabilities. Understand disability through an asset-based lens, viewing people with disabilities as capable and sexual beings with rights, interests, and autonomy. View sexuality as important for a positive self-view.	*[9] [37] *[2] *[1] [7] *[25] [29] *[43] [42]
2. Caregivers often feel uncomfortable initiating and facilitating conversations centered on sexuality and relationships.	Caregivers have turned to healthcare professionals for guidance. Caregivers have indicated that SRE may not be appropriate or useful for their children. Caregivers often do not give permission for their child to participate in SRE programs. Caregivers often shelter their disabled children from education in an effort to keep them safe. Studies have found that shared responsibility of SRE content delivery between caregivers and educators reduces caregiver discomfort.	Researchers have begun developing programs to help empower families with SRE delivery. There is a need to: Acknowledge and address attitudes and feelings of uncertainty or discomfort. Facilitate conversations with caregivers centered on problems with sheltering people with disabilities. Develop comprehensive and ongoing collaborative training with and for caregivers, educators, and service providers that includes depth and breadth of relationship and sexuality topics.	*[33] *[36] [37] [35] *[1] *[38] *[31] *[34]
3. There is limited training for educators in addressing sexuality and dating with disabled individuals.	There is ambiguity about who feels responsible for delivering sexual education. Educators often feel they do not have the expertise to teach SRE or provide mentorship to their disabled students. Teacher preparation does not exist, or it is limited or inadequate. There is often limited curricular time and resources for SRE. Educators have felt some resistance from caregivers.	There is a need to: Include relationship development and sexuality topics within educational curriculum; embed SRE instructional time and resources into the school day. Better prepare general and special educators as well as school specialists in SRE instruction. Improve communication between educational teams, outlining student goals and aims centered around sexuality and relationship development. Improve communication between caregivers and educators about the importance of SRE.	[28] [30] [29] *[31] [35] *[36] [7]
4. SRE curricula content often does not align with individuals’ interests, desires, and lived experiences.	There is often an over-emphasis on the biological aspects of human sexuality within SRE programs and an under-emphasis on social aspects of human relationships and sexuality. Individuals with disabilities have unique perspectives, needs, and experiences that significantly influence their understanding and approach to relationships and sexual health. There is a mismatch between what an individual wants and what others want for them.	Studies are starting to include people with disabilities in the design and development of SRE and develop tailored SRE curricula. There is a need to: Listen to and learn from the perspectives and experiences of people with disabilities. Co-develop SRE content to align with the needs, desires, interests, perspectives, and experiences of the disability community.	*[6] *[24] *[1] [7] *[2] [8] [40]
5. Rigid or highly structured SRE may overlook individual differences and focus on extinguishing problematic behavior rather than supporting human development.	People with disabilities show varying levels of SRE knowledge and skills, have different experiences, and need different degrees of support. Implementing rigid, rule-based instruction without a more holistic approach leaves people with disabilities feeling unsure of how to navigate relationships and sexuality. Educators have viewed developmentally appropriate sexual behavior as disruptive or problematic rather than as part of the human condition.	There is a need to: Develop person-centered programs that are adaptable to individual needs and strengths and responsive to cultural contexts and lived experiences. Ensure that people with disabilities have agency and control over their personal goals. Focus on application and generalization of learned skills.	*[31] *[2] [37] *[1] [42] *[45]
6. High-quality SRE is often inaccessible to people with disabilities.	Studies have documented that people with disabilities feel safe discussing SRE topics with their peers and learn from their peers’ experiences with relationships and dating, yet people with disabilities often have limited access to connect with peers and participate in socially rich learning opportunities. People with disabilities often seek information about sex and relationships from unreliable, unregulated, and often, inaccurate media sources and online forums. Studies have documented vast variability in the content, delivery, and quality of SRE offered to the disability community.	There is a need to: Promote opportunities for people with disabilities to discuss content with peers, social skills training and relationship modeling and coaching, and peer-to-peer education opportunities. Promote inclusion, understanding, and accessibility of content through a range of teaching methods and tools, such as using technology, video modeling, social narratives and scripts, and pictures. Provide clear, practical, relatable guidance and feedback and information about on-line safety.	*[26] [40] *[38] *[5] *[4] *[6] *[1] [37]

Note: * indicates international representation.

Table 1. Over of Current Challenges, Supporting Evidence, and Practical Solutions Outlined in the Literature.

Challenge Outlined in the Literature	Supporting Evidence	Emerging Literature, Practical Solutions, and Future Directions	Supporting Studies
1. There are misconceptions about disabilities, disabled individuals’ needs and desires, and the relevance of SREs for individuals with disabilities.	Educators and caregivers often carry implicit biases that skew their perceptions of disabled individuals. Sociocultural values and sociopolitical contexts influence whether SRE is offered and how and what is taught. Societal beliefs that people with disabilities ‘lack sexual desire’ or are ‘incapable of understanding or taking part in sexual relationships’ influence access to SRE. There are minimal or no requirements for people with disabilities to receive SRE within or outside school settings.	There is a need to: Address stigma around disability. Recognize and remove implicit biases about sexuality in people with disabilities. Understand disability through an asset-based lens, viewing people with disabilities as capable and sexual beings with rights, interests, and autonomy. View sexuality as important for a positive self-view.	*[9] [37] *[2] *[1] [7] *[25] [29] *[43] [42]
2. Caregivers often feel uncomfortable initiating and facilitating conversations centered on sexuality and relationships.	Caregivers have turned to healthcare professionals for guidance. Caregivers have indicated that SRE may not be appropriate or useful for their children. Caregivers often do not give permission for their child to participate in SRE programs. Caregivers often shelter their disabled children from education in an effort to keep them safe. Studies have found that shared responsibility of SRE content delivery between caregivers and educators reduces caregiver discomfort.	Researchers have begun developing programs to help empower families with SRE delivery. There is a need to: Acknowledge and address attitudes and feelings of uncertainty or discomfort. Facilitate conversations with caregivers centered on problems with sheltering people with disabilities. Develop comprehensive and ongoing collaborative training with and for caregivers, educators, and service providers that includes depth and breadth of relationship and sexuality topics.	*[33] *[36] [37] [35] *[1] *[38] *[31] *[34]
3. There is limited training for educators in addressing sexuality and dating with disabled individuals.	There is ambiguity about who feels responsible for delivering sexual education. Educators often feel they do not have the expertise to teach SRE or provide mentorship to their disabled students. Teacher preparation does not exist, or it is limited or inadequate. There is often limited curricular time and resources for SRE. Educators have felt some resistance from caregivers.	There is a need to: Include relationship development and sexuality topics within educational curriculum; embed SRE instructional time and resources into the school day. Better prepare general and special educators as well as school specialists in SRE instruction. Improve communication between educational teams, outlining student goals and aims centered around sexuality and relationship development. Improve communication between caregivers and educators about the importance of SRE.	[28] [30] [29] *[31] [35] *[36] [7]
4. SRE curricula content often does not align with individuals’ interests, desires, and lived experiences.	There is often an over-emphasis on the biological aspects of human sexuality within SRE programs and an under-emphasis on social aspects of human relationships and sexuality. Individuals with disabilities have unique perspectives, needs, and experiences that significantly influence their understanding and approach to relationships and sexual health. There is a mismatch between what an individual wants and what others want for them.	Studies are starting to include people with disabilities in the design and development of SRE and develop tailored SRE curricula. There is a need to: Listen to and learn from the perspectives and experiences of people with disabilities. Co-develop SRE content to align with the needs, desires, interests, perspectives, and experiences of the disability community.	*[6] *[24] *[1] [7] *[2] [8] [40]
5. Rigid or highly structured SRE may overlook individual differences and focus on extinguishing problematic behavior rather than supporting human development.	People with disabilities show varying levels of SRE knowledge and skills, have different experiences, and need different degrees of support. Implementing rigid, rule-based instruction without a more holistic approach leaves people with disabilities feeling unsure of how to navigate relationships and sexuality. Educators have viewed developmentally appropriate sexual behavior as disruptive or problematic rather than as part of the human condition.	There is a need to: Develop person-centered programs that are adaptable to individual needs and strengths and responsive to cultural contexts and lived experiences. Ensure that people with disabilities have agency and control over their personal goals. Focus on application and generalization of learned skills.	*[31] *[2] [37] *[1] [42] *[45]
6. High-quality SRE is often inaccessible to people with disabilities.	Studies have documented that people with disabilities feel safe discussing SRE topics with their peers and learn from their peers’ experiences with relationships and dating, yet people with disabilities often have limited access to connect with peers and participate in socially rich learning opportunities. People with disabilities often seek information about sex and relationships from unreliable, unregulated, and often, inaccurate media sources and online forums. Studies have documented vast variability in the content, delivery, and quality of SRE offered to the disability community.	There is a need to: Promote opportunities for people with disabilities to discuss content with peers, social skills training and relationship modeling and coaching, and peer-to-peer education opportunities. Promote inclusion, understanding, and accessibility of content through a range of teaching methods and tools, such as using technology, video modeling, social narratives and scripts, and pictures. Provide clear, practical, relatable guidance and feedback and information about on-line safety.	*[26] [40] *[38] *[5] *[4] *[6] *[1] [37]

Note: * indicates international representation.

Limitations and Areas for Future Research and Directions

We reviewed literature published between 2013 and 2025 using the following databases: Google Scholar, Educational Resources Information Center (ERIC), APA PsycInfo, and the UC Davis Library. Our review centered on SRE for people with disabilities, including autism and intellectual disability. Search terms included, but were not limited to, “sex education disability,” “relationship education disability,” “SRE disability,” “autism dating education,” “autism relationship education”, “intellectual disability relationship education,” and “sexual health disability.” Additional literature was also gathered through a careful review of citations featured in articles identified from these database searches. Our goal was to gain an understanding of the current literature base centered around SRE for people with disabilities, highlighting the multiple layers of influence that shape individual experience of SRE for people with disabilities. Our paper includes both national and international representation of SRE for people with disabilities; however, it is not a formal literature review. Rather, we provide a descriptive look at the literature base through a unique lens. Readers should be cautioned that our paper may not provide an exhaustive list of all studies centered on SRE between this timeframe.

The current literature points to several areas needing change, including widespread misconceptions about the sexual and relational needs of people with disabilities, inadequate training for caregivers and educators, and limited empirical evidence of best practices. Key recommendations include developing empirically validated, person-specific programs that are adaptable to individual needs, providing specialized training for educators, designing instruction guided by the disabled community, and promoting collaboration among caregivers, professionals, and people with disabilities. There is also need for longitudinal studies to assess long-term outcomes of SRE programs, particularly their impact on autonomy, relationship safety, and well-being. Understanding the effective components of SRE programs, including program length, content, and method, is also needed. By considering each of these areas within ecological systems, we can create more inclusive and responsive sexual health education programs that not only meet the needs of disabled individuals but also contribute to a more equitable and compassionate society for all.