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Frequently Asked Questions

  1. My seventeen year old daughter with mild learning disabilities is in her final year at school. She is going out after school and meeting up with boys from school. How can I ensure she doesn't get pregnant when she denies she is having sex, and won't talk about it?

    Your daughter needs to have serious safer sex education so that she is know show to keep herself protected from sexually transmitted diseases, as well as from getting pregnant. It will also give her the power to say "no" as well as "yes", and understand what she is saying "yes" and "no" to. It will protect her from abuse. Your daughter needs to absolutely understand the importance of insisting on safer sex at all times with any boy/s she has sex with. Boys will want to have unsafe sex with her so she needs to know how to have safe sex and insist on condoms.

    If she won't talk to you, ask her school to organise some sex education, or bring in an expert to spend time with the teenagers. That way, the boys will learn as well. It is important that this education includes feelings and the social aspects. Image in Action provides an education service in London and the South East. Staff can get trained by the FPA or other agencies - see Resources.

    If the school is unwilling, you could perhaps find a professional counsellor to have a session with your daughter. We have a list of counsellors on this website. Spend time reassuring your daughter that you do believe what she says, create an environment where she feels she feels totally accepted, in the hope she'll welcome your caring and non-judgmental advice. The FPA book "Talking Together About Growing Up" (Scott and Kerr-Edwards 1999) might help.

  2. My client, who has moderate learning disabilities, keeps exposing himself, and the police are giving him one last chance.

    Not knowing all the dynamics of this situation, what we say to health care professionals is that perhaps they need to be doing two things:

    1. find an exciting new club where he may find a sexual relationship - this would provide him with some hope. Social clubs for people with learning disabilities are listed on this site.
    2. look at the behaviour of your client to see if there are patterns to when this unacceptable behaviour is happening, which might indicate what brings it on. It could be boredom or attention-seeking. Has he had good sex education about masturbation? He needs positive reinforcement that masturbation in a private place is OK. Discuss the situation with him, emphasising the potential consequences of it happening again. Perhaps use Sheila Hollins book "Going to Court". Increase the level of supervision to reduce the risks and try to improve the quality of his life. If there is a Community Learning Disability Team in the locality, get him a referral, as they may have trained experts in this area.

    This advice incorporates Jonathan Beebee's "Improve and Care framework" which can be seen on www.nursing-standard.co.uk/archives/ldp_pdfs/ldpvo16-10p1015.pdf which is based on the following principles:

    • masturbation is a normal and healthy expression of sexuality
    • all human behaviours communicate something
    • the least restrictive and most beneficial intervention for the person should be used

    Respond provide support and counselling for people with learning disabilities who have such problems and we suggest you call their helpline on 0808 808 0700 (also textphone). Also see their Help Site www.respond.org.uk

  3. Following a workshop on the subject, some of the women in our residential home are showing an interest in finding boyfriends. However, they say they have been put off sex by the behaviour of the men in our home, and they are not interested in the men in the home.

    Perhaps you (or a professional from outside) could do more workshops, perhaps dividing the women and the men. The women may know little about their bodies need encouragement to help them see that sex can be pleasurable. They need to gain enough self esteem to enjoy their own bodies, and take an active role in sexual encounters. The men need to look at the behaviour which is off-putting to women, and how to improve it, perhaps using roleplay. The rest of their workshop could be similar to the women's.

    People usually look outside the immediate vicinity to find partners and it is quite normal for people in the home to discard each other. Plus, it is sometimes better people in the same residential home don't form relationships because what happens when they split up? If possible, find a club or social group where the residents can make new friends and perhaps meet potential partners. Hopefully, you can provide the transport for them to get there and back safely. See our List of Clubs. Alternatively, hold a social gathering and invite people from other homes to come along. Look in our list at some of the schemes clubs use to provide social skills and STI-HIV prevention training. Again, the Community Learning Disability team might help, and a multi-agency plan may be the best way forward.

  4. How can we provide sex education to a client who has profound learning disabilities, has no speech and is blind? We feel it would benefit the client no end, as they are expressing severe sexual frustration.

    You need to be absolutely certain of the client's wishes first and again, the Community Learning Disability team might help, and a multi-agency plan may be the best way forward, to establish and demonstrate that the client is truly providing informed consent, otherwise be against the adult protection policy, and be illegal. Some health care professionals decide to use a sex worker, once they have agreed that informed consent has been given. A good sex worker could teach masturbation techniques and help them learn about the body of the opposite gender. Contrary to popular opinion, sex workers, like gay men and disabled people, are ordinary people like you and me, and most sex worker take their work seriously. Phone the numbers in the ads in your local paper or look at to find someone who is sympathetic with your requirements and once a price has been agreed, arrange a visit. The visit should be discussed at length and everything done to ensure no abuse takes place. For more about using a sex worker, see below.

  5. One of our residents goes out cruising, comes back to the home and has unprotected sex with male residents, and then jumps on the female residents, having anal sex with them. We live in terror of him spreading HIV throughout the home, but he refuses to get tested.

    This is a very common issue and you are right to be worried. Services are responsible for protecting people from risks but also for safeguarding their rights to sexual expression, so you need to work with him about his responsibilities to others regarding safer sex. You need to establish HIV and risk management guidelines. It is true that having an HIV test is something that individuals must consent to, and people with learning disabilities should enjoy the right to have sex and take risks, just like everybody else. However, the other residents have rights too - and this includes the right to stay healthy. So, first you need to work on an intensive programme to educate all the residents on safer sex. Practicing safer sex can be very difficult if the sexual partner is more able or more powerful than you, and this needs to be addressed. Residents should be given the option of having themselves tested for STIs. If things don't improve, i.e. the residents continue to have unprotected sex with your cruiser, more drastic measures will need to be taken to separate him from the rest.

  6. My client is becoming violent. He is a 55 year old heterosexual man with mild learning disabilities who has never had sex. We have established that he very much wants to have sex, and suspect this would improve his behaviour, but how can we make this happen?

    Your hypothesis that his aggression is linked to sex needs to be checked out by someone by looking at the pattern of behaviour. If he is in agreement, you could help him attend social groups so that he might find a partner, and/or discuss with him using a sex worker to have sex with him. Best use a member of staff who feels comfortable with the situation, and this person should themselves be supported. A local sex worker can be found by looking in the local paper or local LOOT under massage or sauna or adult fun. Phone around to find the most responsible-sounding woman and explain the situation, to see if she is willing to take on your client.

    Clients with learning disabilities need to understand that the sex worker is not a girlfriend and will go away after the sex. Because sex is normally a two-way activity, it is best if you try to re-create this situation. This can be done either by him making the payment himself, or gives her something of value which he has made or collected, in return for her services. Payment must be agreed in advance - you are paying for her time and travel time will be included if she is to visit. Your client may agree to pay out of his personal allowances, but it may be prudent to prevent him handing over a large tip which some unscrupulous sex workers may try to get out of him. If funds need to come from his care budget, it might be best to think of a pseudonym. This is acceptable practice in the world of sex work and officialdom.

    With regard to the law, it is not illegal to buy or sell sex. Since you are not charging for this service, it is not illegal for you to make the arrangements. However, the laws on prostitution are largely misunderstood and sex work often frowned on. The laws surrounding consent are currently ambiguous. The trend has been to label anything that is not clear as abusive, so you need to be sure your client has consented to everything that happens.

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