Background: Autistic adolescents have long been positioned at the margins of sexuality research, often treated as asexual or assumed incapable of meaningful sexual participation by clinicians, educators, and families. Accumulating evidence challenges this framing in each of its dimensions. Sexual interest, behaviour, identity diversity, and vulnerability to sexual harm are all well documented in autistic adolescent populations, yet adequate clinical and educational responses remain lacking. Objectives: This narrative review examines the current evidence on sexuality in autistic adolescents, with particular attention to sexual development, sexual and gender identity diversity, the role of social cognition and sensory processing in intimate experience, educational gaps, sexual victimisation, and the state of clinical and educational practice. Methods: A narrative review of peer-reviewed literature published between 2005 and 2025 was conducted across PubMed, PsycINFO, and Scopus, using terms encompassing autism spectrum disorder (ASD), sexuality, sexual development, gender identity, sexual education, and sexual victimisation in adolescent and young adult samples. Priority was given to empirical studies, systematic reviews, and meta-analyses; qualitative research was included where it substantially extended quantitative findings. Findings: Autistic adolescents experience pubertal development on timelines broadly comparable to neurotypical peers, but navigate sexuality within a social environment rarely calibrated to their needs. Rates of non-heterosexual identity and gender incongruence are consistently elevated across multiple independent samples. Core autistic characteristics, differences in social cognition, sensory processing, and communication style, shape the experience of intimate relationships in ways that existing support systems seldom acknowledge. Sexual victimisation occurs at substantially higher rates than in the general population. Formal sex education consistently fails to meet the needs of autistic learners. Interpretation: Autistic adolescents are sexual beings who deserve education, clinical support, and safeguarding adapted to their profile. The framing of autism as incompatible with sexual selfhood must be abandoned in both research and practice. Priority areas include the development and evaluation of ASD-adapted sex education programmes, routine sexuality assessment in clinical encounters with autistic young people, and targeted safeguarding approaches that address the specific mechanisms of vulnerability operating in this population.
Giulia Suzzi (Sat,) studied this question.
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