Comparing Physical Intimacy and Romantic Relationships of Autistic and Non-autistic Adults: A Qualitative Analysis

Abstract

Participants (n = 57) included two groups: autistic (n = 31; mean age 32.29 years (SD = 9.07) and non-autistic (n = 26; mean age 33.1 years (SD = 11.51) individuals as reported previously (Sala et al., 2020a , b ). All autistic individuals reported a formal diagnosis. Demographic information was collected to characterise the sample, such as age, gender, assigned sex at birth, sexual orientation, educational attainment, religion, and employment; full details are provided in Sala et al. ( 2020a , b ). Throughout we use labels to describe gender identification and sexual orientation when providing examples of participants’ comments. These terms are those they ascribed to themselves, and if interpreted simply, these terms may appear to indicate some contradiction to their statement. Participants in both groups completed an online survey (see Appendix). To screen for autism related traits, the 50-item Autism Spectrum Quotient was used (AQ; Baron-Cohen et al., 2001 ). The AQ is a self-report screening tool for individuals 16 years and over. Items are rated on a 4-point Likert scale from 1 (definitely agree) to 4 (definitely disagree), then scores of 0 and 1 are coded as 0 with scores of 2 and 3 coded as 1, resulting in a total score (0–50). Higher scores indicate more autism characteristics. A cut-off of ≥ 32 is recommended by the authors of the AQ, identifying 80% of those diagnosed with autism at a 2% false positive rate, (sensitivity = 0.95, specificity = 0.52). The survey also included an open-ended qualitative questionnaire on experiences of romantic and sexual intimacy designed for this study. Participants were first asked the following question: “Have you ever been in a romantic relationship/s lasting at least one month?”, to which they answered either, “yes, currently”; “yes, in the past”, or “no, never”. Participants were then presented a series of questions about their perspectives on, and experiences of, emotional and physical intimacy in romantic relationships, depending on their experience or lack thereof. Examples of questions are “What does physical intimacy mean for you?”, “Are you comfortable and satisfied with the amount and type of physical intimacy in your romantic relationships?”, “If so, what helps you feel this way?”, “If not, what are the barriers to feeling comfortable and satisfied with the physical intimacy in your relationship?” (For a full list of questions please see Sala et al., 2020a , b ). Prior to data collection, ethical approval was obtained from the overseeing university (DUHREC 2017 − 354), consistent with the Declaration of Helsinki and the National Statement on Ethical Conduct in Human research outlined by the National Health and Medical Research Council of the Government of Australia. Participants were recruited by advertising on social media, via social connection, and through international support groups for autistic individuals and their allies. Individuals were invited to participate in an online survey, then presented with a plain language statement describing the study and indicated their consent by selecting “accept”. Demographic information were collected first; those identifying as autistic reported details regarding their ASD diagnosis, and all participants were asked about other diagnosed mental or physical health conditions. Following this, all participants were directed to the open-ended survey before completing the AQ. As outlined in Sala et al. ( 2020a , b ), an online survey was selected for data collection as this mode of communication has been positively promoted by autistic self-advocates and other researchers because it removes the complexity of navigating non-verbal communication (Benford & Standen, 2009 ; Davidson, 2008 ). Data analysis followed the procedure for thematic analysis outlined by Braun and Clarke ( 2006 ): reading the data repetitively to familiarise; generating initial codes; grouping codes into themes; reviewing themes; defining and naming themes; and producing the report. Data were imported into NVivo 12 software package to facilitate analysis, and during initial stages, 15% of the autistic participants’ data were randomly selected and read by a colleague familiar with phenomenological methods in order to discuss and verify the themes emerging in initial coding. During thematic definition, 15% of data were given to a separate blind reviewer for thematic coding to verify the interpretations made by the first author. The rate of agreement between reviewers was 93%, with all disagreements resolved. While knowledge of prior literature on autism and sexuality aided interpretation, data were coded at the descriptive level (Willig, 2012 ), generating themes which closely reflected the data, focusing on what was stated explicitly by participants in their written responses, drawing on semantic meaning rather than applying theoretical frameworks to interpret underlying meanings. Therefore, an inductive rather than deductive approach was used (Boyzantis, 1998 ; Willig, 2012 ). Autistic and non-autistic participants’ data were coded separately; points of similarity and difference between the groups were addressed in later stages of analysis. As reported in Sala et al. ( 2020a , b ), odds ratio and chi-square analysis were used to compare demographic information of the ASD and N-A participants. Although not all of these differences were statistically significant, autistic participants were more likely to be non-binary gender, non-heterosexual, in non-monogamous relationships, have no prior relationship experience, and be currently unemployed and not studying compared to control participants. Three themes emerged in relationship to physical intimacy; these were comfort and bonding, love and sex are different, and sensory sensitivity. Similarities and differences between autistic and non-autistic participants within each theme are summarised in Table 1 and discussed below. Physical intimacy was described as important by most participants across both groups (70% of autistic participants, and 100% of non-autistic participants [ z = 3.05, p = .001]). Most participants’ responses indicated that without some form of physical intimacy, their romantic relationships may struggle, or may feel too similar to a friendship. However, not all participants rated sexual intercourse as the most important type of physical affection. Rather, many participants emphasised physical intimacy that reinforces a sense of attachment, such as “hugs or cuddling”, or other tangible connections that “feels comforting and safe and connected” (36, female, heterosexual, N-A). Some participants highlighted sex was an important peak experience to solidify the bonding within the relationship, a “physical expression of love and belonging” (57, female, bisexual, N-A), and makes them feel “desired and wanted” by their partner (24, male, heterosexual, N-A). However most described regular physical affection (that was less overtly sexual) as being those physical acts that provided them with the greatest sense of reassurance, “skin to skin contact helps me build trust and emotionally bond” (27, male, heterosexual, ASD). This included cuddling, touch, physical proximity, sitting together, and sleeping in the same bed. Some of these acts were described as exclusive and not shared with others, which “makes it particularly special” (36, female, heterosexual, N-A). It adversely affects my mood and my feelings about my relationship if I don’t get to sleep next to my partner for a prolonged period of time. Ultimately humans are animals and we relate to one another physically. (39, male, heterosexual, N-A). Some participants also described physical affection as part of intimacy in their non-romantic relationships, “I enjoy physical intimacy with anyone I feel comfortable sharing the experience with and it does not necessarily feel romantic to me…” (30, female, asexual, ASD). Hugs, holding hands and physical proximity were also referenced as forms of bonding learnt within the family context and sometimes shared with friends or pets, which creates intimacy with no sexual potency attached to it. If I want comfort from him in that way and he says yes then it’s nice, and if he’s not feeling it then I’ll cuddle my pet or engage in one of my interests or something as a way of self-soothing. (24, female, bisexual, ASD). ASD. While many autistic participants were interested in and enjoyed engaging in sexual acts with lovers or partners, there were several people in the autistic group who identified as asexual, while nobody in the non-autistic group identified this way. This may contribute to the slightly greater variability in what autistic participants found comforting or enjoyable, and tendency to focus on acts such as cuddling and non-sexual physical contact as a form of intimacy and comfort. Not all autistic participants felt that physical intimacy was an important part of their romantic relationships. We live in a long-distance relationship, which also means that we see each other rarely. So [physical intimacy] can’t play a big role in the relationship to begin with and I don’t mind that. My partner does [mind], and wants way more physical intimacy. (27, agender AFAB, demisexual, ASD). N-A. Amongst the non-autistic group, none of the participants identified as asexual, and sexual acts were generally referenced as part of their romantic relationships. A stronger sense of sex providing comfort or acting as a “bonding kind of activity” (29, male, heterosexual N-A) came through in the N-A data, though N-A participants also emphasized non-sexual touch and proximity. Taken together, all of the non-autistic participants felt that physical intimacy is an important part of romantic relationships; whereas physical intimacy was less important to autistic participants. I often feel the most intimate with people I am physically intimate with, I show my trust and vulnerability in sexual ways. Having connected sex builds intimacy for me in a way that is quite different from friendships. (27, female, queer, N-A). Sex was described by some participants in both groups as a symbol of connection and bonding, with some going so far as to say they need a “strong emotional bond to a potential sexual partner” (27, agender, demisexual, ASD) to feel sexual desire, and emphasized the exclusivity of sexual contact with their partner. However, another subset of participants emphasized that sexual desire can exist outside of monogamous romantic relationships, and that sex can be separate to love. The notion of romance feels dishonest to me … pretending I’m in love with every girl I’m attracted to is an insult to their intelligence … if I ever had the chance, I would be hypersexual (27, male, heterosexual, ASD). Some participants in both groups talked about having mismatched libidos or different views on the importance of sex compared to their partners. Some described difficulties related to this, and a desire to engage in sexual intercourse with people outside of the relationship. Some participants in both groups also had explicitly consensual non-monogamous romantic relationships, wherein they had committed romantic partnerships with people they loved and usually lived with, but engaged in casual sex with people outside of the relationship. I wasn’t previously [sexually satisfied] … so I started seeing other people more regularly rather than put that resentment/dissatisfaction on my partner too much. I have a very high sex drive … (28, femme, bisexual, N-A). In my current relationships my partner and I have the option to sleep with other people from time to time, and it seems to help, although it can obviously be complicated (39, male, heterosexual, N-A) The desire and drive for sexual and physical intimacy that is separate to loving, ongoing affiliative relationships may be stronger in some people than others. [I] would like more sex but not necessarily with my partner, who I love and never want to be without … (33, non-binary, heterosexual, ASD). ASD. There was diversity in responses amongst the autistic group. As some participants in this group were asexual and/or experienced gender dysphoria, there were notions of love and romance that were considered separate to sex, and some participants expressed very little or no interest in having sex even if they would like a partner in future, “I could never satisfy a relationship that requires sex or excessive touching” (25, genderflux demi-male, unknown sexual orientation, ASD). For the participants who were not asexual, there were still some who expressed that sex is of lesser importance in their relationships for various reasons, “currently, non-sexual physical intimacy is important with both my wife and girlfriend, mostly because I’m too disable[d] to [have] sex” (38, queer male, ASD). In contrast again, there were some autistic participants who expressed interest in sex, not necessarily within the context of a romantic relationship. N-A. Amongst the non-autistic group, some participants were in non-monogamous relationships as described above, wherein having their sexual needs being met by people outside their loving committed relationships was acceptable and was treated differently to their primary intimate relationship. These participants did not tend to equate this kind of sexual intimacy as being representative of love or commitment. Some participants also indicated that sexual contact is not the most important part of their relationships, and sex itself doesn’t define whether or not a relationship is romantic/intimate. Mismatches in the desired amount of sexual intimacy was also common, and most participants described this as something they navigate. I’ve gotten to the point in my relationship where [sex] not the main issue, it’s just kind of a nice addition to the relationship (20, female, demisexual, N-A). This theme was specific to autistic participants, many of whom discussed their experiences of sensory overload or hyposensitivity in relation to physical intimacy. It is important to note that not all autistic participants described sensory processing issues in relation to physical intimacy, therefore it must not be assumed that this phenomenon affects all autistic people. For the participants who described sensory issues, many discussed feeling overwhelmed by too much physical touch, even having “an aversion to touch” (25, genderflux demi-male, unknown sexual orientation, ASD). Some participants described how they can tolerate a certain amount or type of touch, but “a lot of cuddling can startle or tickle” (26, female, heterosexual, ASD), as well as feeling “touched out” over the course of the day, which can reduce the desire to engage in physical intimacy with a partner. For participants whose partners were also autistic, there were descriptions of how each person’s sensory needs needed to factor into the relationship. [It] took me ages to be okay with even touching other people, but now I’m fine with touching my boyfriend but not really anyone else. I prefer touching my cheek to his instead of kissing, he likes that too … (24, female, bisexual, ASD). I do not like to be touched, so just cuddling is pretty intimate in our relationship … if physical touch is initiated by surprise, I can get annoyed … (29, female, bisexual, ASD). Some participants reflected on the challenges that can arise as a result of hypo- or hyper-sensitivity to touch. Current or previous challenges in communicating and navigating their needs around physical touch with partners and others was described as a barrier for seeking future relationships or engaging in sexual acts. Telling [a sexual partner] they need to use a tool/toy/vibrator if they want me to have an orgasm because I am hyposensitive to touch… seems to always turn into them trying to prove me wrong … (30, female, asexual, ASD). I thoroughly enjoy kissing and cuddling and very intense foreplay … with a trusted partner, but am not all that interested in penetrative sex … barriers to comfort are sensory overload and my partner’s potential feelings of rejection if I need to take a break [during sex] … (44, “primarily male”, pansexual/queer, ASD). There were some physically and psychologically adverse experiences outlined by some participants, such as the impact of gender dysphoria, pain, and negative healthcare experiences, on reduced desire for physical intimacy. I have some physical issues that I’m trying to work out and get diagnosed. Because I have pain often during sex, unfortunately we mostly only do [other sexual practices] for example, rather than [non-penetrative sex]… (26, female, heterosexual, ASD).

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