Abstract Introduction Autism spectrum disorder (ASD) is a neurodevelopmental condition affecting 1-2% of the population. It is characterized by differences in social communication, sensory processing, and repetitive behaviors. Despite autistic adults engaging in sexual relationships, research on their sexual experiences is scarce and often focuses on deficits rather than lived experiences. Online communities provide unique insight into autistic perspectives on sexuality. Objective To examine how autistic adults discuss sexual experiences in online communities to identify themes that could inform clinical practice. Methods We identified autism-focused communities on Reddit for data collection. Preliminary exploratory analysis determined appropriate inclusion thresholds based on community size, posting frequency, and engagement patterns. For general autism communities (r/autism, r/AutismInWomen, r/evilautism, r/aspergers, r/aspergirls, r/AutisticAdults, r/AutismTranslated, r/AutisticPride), posts required ≥250 upvotes and sexuality-related keywords (e.g., sex, sexuality, intimacy, arousal); for sexuality-specific communities (r/SexOnTheSpectrum, r/AutismAfterDark), we included the top 20-30% of posts by upvotes without keyword requirements. We collected posts over 3 years, yielding 534 posts. Manual review excluded 446 posts not meeting relevance criteria, resulting in 88 posts for analysis. Each post included original content and top three comments. We qualitatively coded posts to identify recurring themes, iteratively refining codes into major thematic categories. Results Analysis of 88 posts identified six major themes. Sensory and Physical Experience was mentioned in 38.6% of posts, making it the most common theme. Sensory processing differences profoundly affected sexual activity. Posts described sensory sensitivities that caused overwhelm/shutdown. Others discussed sensory-seeking behaviors. Sexual Desire and Interest Variations was mentioned in 37.5% of posts. Experiences ranged from asexuality to hypersexuality. Many described fluctuating libido. Some prioritized special interests or routines over sex. Partner mismatches in desire levels caused relationship strain. Sexual Victimization and Targeting was mentioned in 30.7% of posts and was a significant concern. Discussions described being targeted due to social vulnerabilities. Romantic deception and difficulty recognizing manipulation were common. A striking paradox emerged: individuals experienced both hypersexualization (autistic traits fetishized) and desexualization (being infantilized or dismissed as nonsexual). Communication and Understanding Challenges was mentioned in 25.0% of posts. These involved difficulty with implicit sexual expectations. Many felt uncertain about how to initiate or proceed during intimate encounters. Reading partner cues was challenging. Kink and BDSM was mentioned in 13.6% of posts, often in relation to autistic traits. Preferences for clear structure, explicit communication, and predictable boundaries aligned with kink practices. Some connected kink to meeting sensory needs. Masking and Authenticity was mentioned in 11.4% of posts. This involved suppressing autistic traits during intimacy, including hiding stimming (repetitive self-stimulatory behaviors) and mimicking neurotypical sexual behavior, which led to exhaustion and reduced satisfaction. Conclusions Autistic adults' sexual experiences are shaped by sensory processing differences, diverse expressions of desire, and heightened vulnerability to victimization. Findings highlight the need for autism-informed sexual health services that address communication barriers, provide sensory accommodations, prioritize safety education, and validate diverse sexual expressions. Disclosure No
Pinto et al. (Mon,) studied this question.