Autism and Sex: How the Condition Affects Sexual and Mental Health

Autism spectrum disorder (ASD), more commonly known as autism, is a common neurological and developmental disorder that affects more than 5.4 million adults in the United States.

Because autism is a spectrum disorder, it presents differently in each person, ranging in symptoms and severity. This broad range means every person with autism has their strengths and challenges.

Autism is widely discussed but not often as it relates to sexual health, despite that being one of the most important aspects of overall health and wellness. We talked to experts about the relationship between pregnancy and children born with autism, as well as overall sexual health and mental health.

Autism and pregnancy

ASD has no single cause. The condition is considered multifactorial, meaning that several factors can increase one's risk of having the condition. One of the biggest factors lies in your genes, which are estimated to contribute to 40 percent to 80 percent of ASD cases.

Beyond genes, however, are environmental factors in pregnancy. These include advanced parental age, maternal nutrition and health, premature birth, and exposure to chemicals, according to Julian Lagoy, M.D., a psychiatrist with Mindpath Health in San Jose, California.

Typically, the term "advanced age" in pregnancy refers to pregnant women ages 35 and older. However, researchers believe advanced paternal age also plays a role in autism risk. A 2006 study published in the journal JAMA Psychiatry suggested that the offspring of men ages 40 and older were 5.75 times more likely to have autism. The same research indicated no difference related to maternal age.

Similar findings published in 2016 suggested the risk for autism may increase with larger age disparities between the parents.

"The highest ASD risk was evident among couples characterized by fathers older than [about] 45 years, independent of maternal age; fathers 35 to 44 years with mothers at least 10 years younger; mothers 30 to 39 years old with fathers at least 10 years younger," according to the article in Molecular Psychiatry.

Maternal nutrition and health are other crucial factors in ASD.

"I believe it is important to optimize nutrition and the intestinal microbiome, vitamin D, zinc and iron levels, thyroid hormones, sleep, and B vitamin metabolism (through a genetics test) as soon as possible, even during pregnancy or lactation," said David Berger, M.D., a pediatrician and the founder of Wholistic Pediatrics & Family Care in Tampa, Florida. "No time is too late to make an impact."

Berger published an article in 2012 that explored the connection between nutrition, environmental exposures and ASD risk. In it, he suggested that maternal deficiencies in vitamin D, iron (without anemia) and folate may increase the risk of autism.

He also discussed the connection between heavy metal exposure and ASD risk, referencing rates of autism from 1998 to 2000 in Texas. These findings indicated that for every 1,000 pounds of environmentally released mercury, there was a 61 percent increase in the rate of children with autism. Berger recommended that women perform baseline heavy metal urine testing before getting pregnant to assess risk better.

"When you are pregnant you always want to make sure you are getting regular checkups with your physician, avoid smoking and toxins, consider changing your medications that are safe for pregnancy, and avoid stress in order to decrease the risk of autism," Lagoy said.

Autism and sexual health

Some people with ASD may find it challenging to develop or engage in romantic relationships while others may have no problem. Autism and physical affection can be a difficult combination. Common symptoms of autism include difficulty communicating or interacting socially and unusual moods or reactions—both of which can make romantic relationships demanding.

Of course, many autistic people have no problems dating or engaging in romantic or sexual relationships.

Autistic people may suffer developmental and neurological delays, but no evidence has been found to suggest delays in sexual development. A 2021 study indicated that adolescents with autism reported similar sexual interests to their non-autistic peers.

That same study also found that autistic young people reported a need for more sexual education programs, asking for more concrete guidance. Some people with autism struggle with social cues and social interactions. More explicit instruction and education might help solve those issues before they occur, giving people with autism more confidence moving forward in relationships.

The risk of sexual dysfunction may be heightened in people with autism, according to a 2019 study published in the Journal of Clinical Medicine. The study's findings suggested that both men and women with ASD reported lower levels of sexual and relationship satisfaction. The findings also indicated that men with ASD experience more problems with erectile function than their non-autistic counterparts. Women with ASD reported lower sexual excitement and more sexual pain problems.

Note that this study relied on self-reporting, which can lead to inaccuracies or incomplete data.

Mental health and autism

Just like non-autistic people, people with ASD can experience a wide variety of mental health problems. Social isolation or feelings of being misunderstood may contribute to depression or anxiety. People with autism need to take care of their mental health by seeking therapy or medication when necessary.

"There is considerable comorbidity with people who have autism and anxiety, depression, panic disorders and ADHD," Berger said. "These can be as debilitating as their autism."

People with autism are four times more likely to experience depression, according to a 2018 meta-analysis. These results indicate a need for individuals with ASD to undergo regular mental health screenings and take close notice of their mental and emotional state.

"A full mental health assessment is appropriate for all people with autism," Berger said. "They should be offered all treatments and services that are given to people without autism."

People with ASD can take certain steps to mitigate some of the stress they might experience from social situations.

"Learning to know when things are getting overwhelming and particular triggers are really useful in managing mental health and good for self-care," said Hester Grainger, a co-founder of Perfectly Autistic, a neurodiversity consultancy in the United Kingdom.

Grainger said ASD patients take some time to unwind and "un-people."

"It's self-care to get into the habit of unwinding and de-compressing when you've been with a lot of people or in a setting that isn't comfortable with you," she said.

Related conditions

Depression isn't the only condition people with ADS are at risk of developing. More than half of autistic people have more diagnosed conditions, according to a 2018 article published in the Journal of Autism and Developmental Disorders.

One of the major comorbidities is gastrointestinal distress.

"There seems to be a GI component to autism," Berger said. "Many of the patients I see have either chronic constipation or loose stool."

It's unclear why people with ADS experience higher rates of GI issues, but one study suggested that higher levels of a specific bacteria subgroup may play a role.

People with autism are also at higher risk of experiencing sleep problems, attention deficit-hyperactivity disorder (ADHD), epilepsy, obsessive-compulsive disorder (OCD) and anxiety.

Certain genetic conditions are related as well. Fragile X syndrome is one of the leading genetic causes of ASD, with about 1 in 3 individuals with Fragile X syndrome also diagnosed with autism.

Fragile X syndrome occurs due to mutations in the FMR1 gene. The connection between Fragile X syndrome and autism isn't fully understood, but scientists believe it lies in the FMRP protein, which suffers production rates due to the FMR1 gene mutation.

Understanding autism

Autism is a spectrum disorder, which means that every autistic individual has a unique experience, with varied challenges and strong suits. Just like non-autistic people, individuals on the spectrum can suffer from mental health issues and sexual dysfunctions—and they can be treated.