Journal of Autism and Developmental Disorders

https://doi.org/10.1007/s10803-020-04565-6

BRIEF REPORT

Brief Report: Asexuality and Young Women on the Autism Spectrum

Hillary H. Bush1,2   · Lindsey W. Williams3 · Eva Mendes4

© Springer Science+Business Media, LLC, part of Springer Nature 2020

Abstract
Existing research suggests that people with Autism Spectrum Disorder (ASD) are more likely than those without ASD to
self-identify as asexual, or as being on the asexual spectrum. This study contributes to the literature by exploring aspects
of sexuality and well-being in a large, community-based sample of young women (18–30 years old) with ASD (N = 247)
and comparing the experiences of those with asexual spectrum identities and those with other sexual orientations (e.g., gay,
bisexual, heterosexual). In the present sample, asexual participants reported less sexual desire and fewer sexual behaviors
than those with other sexual orientations, but greater sexual satisfaction. Being on the asexual spectrum also was associated
with lower generalized anxiety symptoms. Clinical and research implications are discussed.

Keywords  Autism spectrum disorder · Asexuality · Human sexuality · Internalizing symptoms · Women

Introduction is not due solely to lack of a sexual partner, and lack of

Asexuality is often described as a stable pattern of not expe-
riencing sexual desire for other people (The Asexual Vis-
ibility & Education Network, n.d.). Lack of sexual behavior
Hillary H. Bush is a Staff Psychologist at the Learning and
Emotional Assessment Program, Department of Psychiatry,
Massachusetts General Hospital, and an Instructor of Psychology,
Part-Time, at Harvard Medical School. Lindsey W. Williams is
a Clinical Assistant Professor at University of North Carolina
TEACCH Autism Program, where she specializes in working with
adolescents and adults. Eva Mendes is a sought-after Asperger/
autism specialist, author of Marriage and Lasting Relationships
with Asperger’s Syndrome and Gender Identity, Sexuality and
Autism, psychotherapist and couples’ counselor in private practice
in the Boston area, who works with clients from around the
country and internationally via video conferencing.The original
research presented in this article was conducted as part of the first
author’s doctoral dissertation at the University of Massachusetts
Boston (UMB). The Society for the Psychological Study of Social
Issues (SPSSI) and the UMB Doctoral Dissertation Research
Grant Program are recognized for their financial support of this
work.
sexual desire is not associated with significant distress (as
it would in a sexual dysfunction disorder). When defined
narrowly, research suggests that about one percent of the
population identifies as asexual (e.g., Bogaert 2004); when
the definition is broadened, more people appear to be on
an asexual spectrum (Poston and Baumle 2010). Emerging
research suggests great diversity within asexuality, and many
people participating in asexual communities use language
(e.g., “gray ace”) to reflect this variability. For reasons not
yet fully understood, people with Autism Spectrum Disorder
(ASD) appear to be more likely than those without ASD to
be asexual (e.g., George and Stokes 2018; Gilmour et al.
2012; Ingudomnukul et al. 2007). Sexuality studies within
the ASD community also suggest greater sexual diversity
more generally, including lower percentages of individuals
identifying as heterosexual (Dewinter et al. 2017; Pecora
et al. 2016). Whether higher rates of asexuality among autis-
tic people are phenomenologically related, or whether they

3
* Hillary H. Bush TEACCH Autism Program, Psychiatry Department,
hbush@partners.org University of North Carolina Chapel Hill, 4301 Lake Boone
Trail #200, Raleigh, NC 27607, USA
1
Learning and Emotional Assessment Program, Department 4
Independent Practice, 50 Grove St., 2nd Floor, Arlington,
of Psychiatry, Massachusetts General Hospital, 151
MA 02476, USA
Merrimac St., 5th Floor, Boston, MA 02114, USA
2
Department of Psychiatry, Harvard Medical School, Boston,
USA

13
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are an artifact of overall higher sexual diversity within the
ASD population, is not well-understood (Chasin 2017).
Existing studies have shown that the sexualities of peo-
ple with ASD are healthy and widely diverse (e.g., Byers
and Nichols 2014; Byers et al. 2013). Previous studies have
identified some sexuality-related differences between people
with and without ASD. For instance, young women with
ASD report lower levels of sexual desire, fewer lifetime sex-
ual behaviors, and less sexual self-awareness compared to
young women without ASD (Bush 2019). Further, previous
studies have identified sexuality-related differences between
men and women with ASD. For instance, women with ASD
are more likely to be sexual minorities than men with ASD,
including asexual (Gilmour et al. 2012). However, asexuality
within the ASD community is only beginning to be explored.
As George and Stokes (2018) summarized, researchers have
posed theories about possible factors (e.g., lack of oppor-
tunity, sensory issues, social anxiety, hormonal anomalies)
that might contribute to increased frequency of asexual
identification within the ASD population; a drawback is
that many of these theories imply an underlying pathology
or deficit, when one may not exist (Brotto and Yule 2017).
Continued research into the experiences of asexuality within
the ASD population is especially needed to inform best clini-
cal practices (e.g., when and how to ask autistic clients about
sexual orientation, and how to affirm someone who identifies
as asexual) and sexuality education practices (e.g., how to
accurately and respectfully discuss asexuality when develop-
ing new curricula).
A main goal of the present study was to better understand
characteristics and experiences of asexual young women,
and those with nonbinary and more fluid gender identities,
with ASD. A secondary goal was to partially replicate the
findings of George and Stokes (2018), who in a study on
sexual orientation identified a sizeable minority of autistic
participants who identified as asexual, who in turn reported
fewer sexual behaviors and desires than individuals with
ASD and other sexual orientations. Replicating these find-
ings is important for acknowledging that while variability
exists within the asexual spectrum, some degree of stability
does too (i.e., consistently less desire and fewer behaviors
reported by people identifying as asexual), and that young
adults with ASD are capable reporters of their own sexu-
alities. Finally, this study expands the literature by exam-
ining internalizing symptoms (including depression, anxi-
ety, and social anxiety) in a substantial sample of asexual
young adults with ASD. Elevated rates of internalizing
symptoms have been well-documented in individuals with
ASD (e.g., Kuusikko et al. 2008; Lai et al. 2011). Research
on asexuality in the general population has found associa-
tions between asexuality and certain aspects of well-being,
including higher anxiety symptoms and suicidality (Yule
et al. 2013), though it is unknown if these patterns hold true
13
Journal of Autism and Developmental Disorders
for people who are both asexual and on the autism spectrum.
Contemporary research does not support asexuality being a
psychological or sexual disorder (Brotto and Yule 2017), nor
is asexuality experienced as a disorder by people in asexual
communities. Brotto and Yule (2017) highlighted the pos-
sibility that when asexual individuals experience elevated
internalizing symptoms, it may be related to stress and dis-
crimination encountered due to negative social impressions
of asexuality. In this study, we took an exploratory approach
to better understanding internalizing symptoms among
young women who are both autistic and asexual.
Research Aims
The present study sought to identify, in a sample of young
women and gender diverse individuals on the autism
spectrum, whether there are differences in demographics,
dimensions of sexuality (i.e., desire, behavior, satisfaction),
or internalizing symptoms (i.e., depressive, generalized
anxiety, or social anxiety symptoms) between those on the
asexual spectrum and those with other sexual orientations.
Based on previous asexuality studies among people with and
without ASD, we expected that participants on the asexual
spectrum would report less sexual desire and fewer sexual
behaviors. We took a more exploratory approach to examin-
ing the other variables named above.
Method
Participants
Participants in the present study took part in a larger, lon-
gitudinal study of sexuality and well-being among young
women with and without ASD (Bush 2019). Inclusion cri-
teria for the present study included: (1) identity as a woman,
or a more fluid, non-male gender identity (e.g., agender, non-
binary); (2) age 18 to 30 years, inclusive; (3) identity as hav-
ing ASD and a score of seven (clinical cutoff) or above on
the Autism-Spectrum Quotient (AQ-10; Allison et al. 2012);
(4) answer item about sexual orientation; (5) English lan-
guage proficiency; and (6) computer access and literacy. In
total, 247 participants were retained for analyses.
Mean participant age was 23.2  years (SD = 3.7). The
majority were White (89%). About half (51%) identi-
fied as cisgender women and the other half reported more
diverse gender identities. Besides cisgender, the most fre-
quently reported genders included agender, or without gen-
der (17%); genderqueer or non-binary, or not identifying
as exclusively masculine or feminine and/or not ascribing
to traditional gender roles, expectations, and stereotypes
(15%); “demigirl” or somewhat but not entirely feminine
Journal of Autism and Developmental Disorders
(7%); and genderfluid, or experiencing fluctuation in the
extent to which one identifies as masculine, feminine, or
other genders (4%). Approximately two-thirds (64%) had
a formal diagnosis of ASD or related disorder (e.g., Asper-
ger Syndrome). Participants were geographically diverse,
with the United States (56%), United Kingdom (11%), and
Canada (10%) most represented. More than half (55%) were
either full-time or part-time students; a minority held full-
time or part-time jobs (39%). Of note, 24% were neither stu-
dents nor employees. The vast majority (95%) had graduated
from high school, and about a third of participants (34%) had
earned a college degree or higher.
Procedure
All procedures were approved by the Institutional Review
Board (IRB) of the University of Massachusetts Boston,
where this research was conducted. Informed consent was
obtained from all individual participants included in the
study. Participants were recruited for the “Women’s Sex-
uality Study,” a study on sexuality and well-being among
18–30 year-old women, with and without ASD. While the
title of the study communicated its focus on women’s experi-
ences, those with more diverse gender identities (e.g., gen-
derqueer, gender nonconforming) were invited to participate
too. Participants in the present study were recruited from
ASD-specific advocacy and support organizations, univer-
sity and college disability service centers, and research and
clinical groups. The study also was shared on ASD message
boards and online communities.
Individuals who followed the link to the secure online
survey (hosted by PsychData) first answered several screen-
ing questions to verify eligibility. If participants met inclu-
sion criteria, they proceeded to the informed consent
form, and then to five true-or-false “quiz” items related to
informed consent. Upon successful completion of the quiz,
they could access the battery. Median completion time was
20 min. Participants did not receive monetary compensation.
Measures
Demographics
Participants were asked to answer demographic ques-
tions regarding ASD diagnostic status, age, race, ethnic-
ity, income, education level, employment status, housing
situation, relationship status, and other constructs. Gender
was assessed with an open-ended item: “ ‘Gender’ refers
to the socially constructed roles, behaviors, activities, and
attributes that a given society considers appropriate for men
and women. Examples of gender identity include ‘female,’
‘male,’ ‘genderqueer,’ etc. In your own words, what is your
gender identity?” Sexual orientation similarly was assessed
with an open-ended item: “In your own words, how would
you describe your sexual orientation? Examples might
include ‘straight,’ ‘lesbian,’ ‘bisexual,’ ‘queer,’ etc.” Par-
ticipants’ responses to each of these questions were con-
sensus coded into categories by coding teams. Participants
also provided information on sexual history (e.g., number of
lifetime sexual partners) using 10 questions from the Sexual
History Questionnaire (SHQ; Cupitt 1998).
Additional Measures
Several measures were used to collect information about
participants. A full list of measures with relevant details
is shown in Table 1. For all measures with a Likert scale,
higher numbers indicated higher levels of the construct
being measured.
Data Analyses
On two measures, scores were subsequently adapted for
analysis. For the Sexual Desire Inventory (SDI; Spector et al.
1998), item scores were converted to z scores and summed
to create a composite score. For the Sexual Experience
Questionnaire (SEQ; Trotter and Alderson 2007), responses
were dichotomized (“never” versus other frequencies) and
added to create a summary sexual behavior score, ranging
from 0 to 19. All continuous variables were assessed for
normality, skewness, and kurtosis. Further visual inspection
of frequency distributions suggested good symmetry and
approximate normality, excepting sexual behavior, which
showed bimodal distribution. Thus, nonparametric statistics
are presented for those data. Continuous data were screened
for univariate outliers; significant outliers were noted only
for number of lifetime sexual partners, for which median
numbers (not means) are reported. Missingness overall was
very low (< 1%) among key outcome variables; specifically,
missing item-level responses for two participants on the SDI
were managed with listwise deletion in the relevant analyses.
Chi-squared tests, t-tests, and nonparametric tests (where
warranted) were used to compare participants with and with-
out asexual spectrum identities across demographic, sexual-
ity-related, and internalizing symptom variables. Analyses
were performed using IBM SPSS Statistics 19.0.
Results
Rates of Asexuality in the Present Sample
Approximately one-third of participants (36%, n = 88)
broadly reported an asexual spectrum identity. While
most of these participants clearly identified themselves
as asexual (n = 59), others’ responses reflected a broader
13
 Journal of Autism and Developmental Disorders

asexual spectrum identity, as they identified as questioning

you have liked to engage in sexual activity

avoid doing things or speaking to people?

How often have you engaged in having sex

I feel content with the way my present sex

asexuality (n = 9), gray-asexual (i.e., rarely experiencing

Does fear of embarrassment cause you to

with more than one person at the same
During the last month, how often would
sexual desire, n = 7), demi-sexual (i.e., rarely experiencing

Feeling down, depressed, or hopeless

Feeling nervous, anxious, or on edge

sexual desire, and only in the context of deep emotional
connection, n = 7), or as otherwise on the asexual spectrum
(n = 6). In the following sections, this broad group (n = 88)
is referred to as the “asexual spectrum” sample or group.
Among participants who did not report an asexual spec-
with a partner?

trum identity, the most frequently reported sexual orienta-

Cronbach’s α Sample item

tions included bisexual (15% of total sample), pansexual

or polysexual (14%), queer (10%), and gay or lesbian (6%).
time?

life is
Few participants identified exclusively as heterosexual
(8%); while this rate was unexpectedly low in the present
sample, high rates of sexual minority identity have been
observed in other studies among young people with ASD
(e.g., George and Stokes 2018; Gilmour et al. 2012).
.88

.96

.87

4-Point Likert scale from 0 (not at all) to 3 .89

.91

.83
(nearly every day) over the past 2 weeks
4-point Likert scale: 0 (never) to 3 (many

5-Point Likert scale (very unsatisfied to

Asexuality and Demographic Correlates

(nearly every day) over past 2 weeks
8 point scale: 0 (never) to 7 (< 1 time/

4-Point Likert scale: 0 (not at all) to 3

5-Point Likert scale: 0 (not at all) to 4

day), or 9 point: 0 (no desire) to 8

(extremely) over the past week

Asexual spectrum participants were younger than those

with other sexual orientations [M age = 22.5 years versus
M age = 23.6 years, respectively, t(245) =  − 2.22, p = .03,
Cohen’s d = .29]. Asexual spectrum participants were
more likely to have a non-binary gender identity and to
(strong desire)

very satisfied)

live at home with their parents; they were less likely to

have a formal ASD diagnosis or to live with a romantic
times)
Scoring

partner (Table 2). No significant differences were observed

regarding race, student enrollment status, employment sta-
tus, living alone, living with roommates, or educational
were used in this

attainment.
5 of original 14
# of items

study

Asexuality and Dimensions of Sexuality

19

3
Generalized anxiety disorder scale (GAD-
Trotter and Alderson 2007) with 4 addi-

Relationship and Sexual History

Depressive symptoms Personal health questionnaire depression
Sexual experience questionnaire (SEQ;

tional items to measure low base-rate

(SSSW; Meston and Trapnell 2005);

Sexual desire inventory (SDI; Spector
Table 1  Measures used and Cronbach’s α in the current study

scale (PHQ-8; Kroenke et al. 2009)

Mini-social phobia inventory (MINI-

Sexual satisfaction scale for women

Asexual spectrum participants were more likely to be

single and less likely to be married or to have had con-
SPIN; Connor et al. 2001)

sensual sex with another person (Table 2). Among those

who had had sex with a partner, the median age of first
7; Spitzer et al. 2006)

sex was comparable for asexual spectrum participants and

contentment scale

those with other sexual orientations (17.9 years old versus

Measure name

et al. 1998)

16.9 years old, respectively), as was median number of

behavior

lifetime sexual partners (one versus three). Rates of being

in a relationship (18% versus 25%), multiple relationships/
polyamorous (5% versus 8%;), engaged (6% versus 1%), or
having another type of relationship status (8% versus 3%)
partnered and solo

Anxiety symptoms
Sexual satisfaction
sexual behaviors

also were comparable between groups. Among participants

and experiences
Range of lifetime
and interest for

in relationships, asexual spectrum participants reported a

Social anxiety
Sexual desire

shorter mean relationship length (2.60 years) than those

Construct

activity

with other sexual orientations (4.19 years).

13
Journal of Autism and Developmental Disorders

Table 2  Significant group Variable measured % Asexual % Other χ2(1, N = 247) p value Cramer’s ϕ
differences on dichotomous spectrum orientations
demographic and sexual history (n = 88)a (n = 159)
variables
Non-binary gender identity 59 44 5.14 .02 .14
Has formal ASD ­diagnosisb 55 69 4.80 .03 .14
Live with p­ arentsb 50 36 4.69 .03 .14
Live with romantic partner 8 32 18.34 < .001 − .27
Relationship status: single 66 45 9.67 < .01 .20
Relationship status: ­marriedb 2 13 8.02 .01 − .18
Have had consensual sex with 31 73 43.06 < .001 .42
a partner (any gender)

Cramer’s ϕ guide (Cohen 1988): ± .10 = small effect, ± .30 = medium effect, ± .50 = large effect

a
 When analyses were re-run with participants who specifically identified as asexual (n = 59), the difference
in rates of formal ASD diagnosis between the asexual and other orientations groups was no longer statisti-
cally significant. All other comparisons remained similarly significant
b
 Relations were no longer statistically significant when analyses were re-run only with cisgender women
participants (asexual spectrum n = 36, other sexual orientations n = 89, total n = 125)

Table 3  Descriptive statistics Variable (questionnaire) Na Mean SD Range Between-group difference

and between-group differences
for continuous sexuality-related Sexual desire (SDI)
and internalizing symptom
 Asexual spectrum 88 − 3.65 3.02 − 7 to 6 t(243) =  − 11.52, p < .001
variables
 Other orientations 157 1.34 3.63 − 7 to 9 Cohen’s d = 1.49
Sexual behavior (SEQ)
 Asexual spectrum 88 6.41 5.24 0 to 19 Mann–Whitney U = 2998, p < .001
 Other orientations 159 12.35 5.50 0 to 19
Sexual satisfaction (SSSW)
 Asexual spectrum 88 23.16 5.37 9 to 30 t(245) = 6.83, p < .001
 Other orientations 159 17.61 6.49 6 to 30 Cohen’s d = .93
Depression (PHQ-8)
 Asexual spectrum 88 10.95 6.10 0 to 24 n.s
 Other orientations 159 11.69 6.37 0 to 24
Anxiety (GAD-7)
 Asexual spectrum 88 9.18 5.95 0 to 21 t(245) =  − 2.15, p = .03
 Other orientations 159 10.86 5.83 0 to 21 Cohen’s d = .29
Social anxiety (MINI-SPIN)
 Asexual spectrum 88 7.60 3.41 0 to 12 n.s
 Other orientations 159 7.93 3.41 0 to 12

SDI sexual desire inventory (Spector et al. 1998), SEQ sexual experience questionnaire (Trotter and Alder-
son 2007), SSSW sexual satisfaction scale for women (Meston and Trapnell 2005), PHQ-8 personal health
questionnaire depression scale (Kroenke et  al. 2009), GAD-7 generalized anxiety disorder scale (Spitzer
et al. 2006), MINI-SPIN mini-social phobia inventory (Connor et al. 2001)
a
 When analyses were re-run with participants who specifically identified as asexual (n = 59), all compari-
sons between the asexual and other orientations groups remained similarly significant. When analyses were
re-run only with cisgender women participants (asexual spectrum n = 36, other sexual orientations n = 89,
total n = 125), all comparisons remained similarly significant

13

Sexual Desire
Consistent with expectations, asexual spectrum par-
ticipants reported significantly lower levels of over-
all desire for sexual activity (Table  3), includ-
ing lower desire for both partnered sexual activity
[Mann–Whitney U = 1752, n1 = 88, n2 = 158, p < .001] and
solo sexual activity [Mann–Whitney U = 3320, n 1 = 87,
n2 = 158, p < .001].
Sexual Behavior
Consistent with expectations, asexual spectrum participants
reported fewer lifetime sexual behaviors (Table 3). The
median number of sexual activities for asexual spectrum
participants was five, which was significantly fewer than
the 15 reported by participants with other sexual orienta-
tions (Mann–Whitney U = 2998, n1 = 88, n2 = 159, p < .001).
Among asexual spectrum participants, the most frequently
reported lifetime sexual activities were masturbating alone
(83%), looking at erotica or pornography (81%), having an
orgasm alone (62%), and deep kissing (46%); see Table 4 for
frequencies of all lifetime sexual behaviors.
Sexual Satisfaction
Both asexual spectrum participants and those with other
sexual orientations reported a range in their level of pre-
sent sexual satisfaction. Overall, however, asexual spectrum
participants reported significantly greater sexual satisfaction
(Table 3).
Asexuality and Internalizing Symptoms
Asexual spectrum participants reported significantly lower
generalized anxiety symptoms than participants with other
sexual orientations; however, reported levels of depressive
and social anxiety symptoms were comparable (Table 3).
Discussion
Consistent with previous studies (e.g., George and Stokes
2018; Gilmour et al. 2012; Ingudomnukul et al. 2007), a
sizeable minority of young women and gender diverse peo-
ple with ASD identified as being on the asexual spectrum,
and at rates higher than have been documented in the general
population (e.g., Bogaert 2004). While some researchers and
theorists have taken argument with asexuality as a sexual
orientation (which remains a highly debated issue; see Cha-
sin 2017), our findings—and those of other contemporary
ASD and sexuality researchers—show that individuals with
ASD are using “asexual” and related labels to describe
13
Journal of Autism and Developmental Disorders
themselves when asked about their sexual orientation. Still,
it is important not to make assumptions about any one indi-
vidual on the autism spectrum, and our findings suggest that
most young women with ASD do not have an asexual spec-
trum identity (although many do identify as sexual minori-
ties, including lesbian, gay, bisexual, queer, or pansexual).
In the present sample, identifying on the asexual spec-
trum was associated with many sexuality-related variables
in the anticipated directions, including being less likely to
have a current sexual partner, having fewer lifetime sexual
partners, experiencing less desire for partnered and solo
sexual activity, and fewer lifetime sexual behaviors. Over-
all, these findings are highly consistent with those of George
and Stokes (2018), who used similar research methods to
examine sexual orientation in a large ASD sample. Still,
it is important to note the variability that occurred within
the sexuality-related variables, which is consistent with the
diversity within the asexual population that other researchers
have emphasized (e.g., Brotto et al. 2010; Carrigan 2011;
Carrigan et al. 2013). Although not explored specifically in
the present study, the way that some participants described
their sexual orientation suggested asexual people vary in
their romantic orientation, or desire to have a close, lov-
ing, and emotional (though not sexual) relationship with
someone else. This further suggests that people use the
term “asexual” in slightly different ways (though no less
validly); therefore, it is important not to make assumptions
about what being on the asexual spectrum means to any one
person. Individuals may also consider sexual orientation and
romantic orientation to be separate constructs.
Finally, our results show how important it is not to patholo-
gize asexuality. In this study, participants who reported an
asexual spectrum identity reported greater sexual satisfaction
and lower generalized anxiety symptoms than those with other
sexual orientations. This fits into the larger literature, which
has deemed asexuality not to be a disorder (Brotto and Yule
2017). In the present sample, asexual participants may have
reported higher levels of sexual satisfaction because they
felt satisfied without having sex—or having solo sex only—
whereas participants with other sexual orientations, who
did desire sex with a partner, reported lower levels of sexual
satisfaction, perhaps because they faced barriers to having
the kind of sexual lives they wanted (e.g., availability of, and
opportunities to meet potential partners). However, observing
lower generalized anxiety symptoms within our asexual and
ASD sample was different from findings in the general popu-
lation, where asexual individuals have reported greater anxi-
ety symptoms (Yule et al. 2013). It is possible that ASD status
may moderate the relation between asexuality and anxiety.
Further, it may be that some individuals with ASD, who do
have sexual interests, face barriers to finding suitable sexual
partners and to having the sexual lives they desire (resulting
in lower sexual satisfaction and higher anxiety).
Journal of Autism and Developmental Disorders

Table 4  Differences in lifetime Activity % Asexual % Other orienta- Difference

sexual behaviors between
asexual spectrum (n = 88)
and other orientations groups
(n = 159)
Partnered sexual activity
 Deep kissing
 Touching another’s nipples
 Someone touching your nipples
 Touching another’s genitals
 Someone touching your genitals
 Performing oral sex
 Receiving oral sex
 Masturbating with a partner
 Orgasm with a partner
 Vaginal intercourse
Solo sexual activity
 Masturbating alone
 Orgasm alone
 Looking at pornography
Sexual activity with technology
 Phone/internet sex
 Sexting
Low base rate activity
 Anal intercourse
 Sex on a “one night stand”
 Group sex
 Bondage/S&M activity
spectrum tions
47 82 χ2 (1, N = 247) = 34.33***
Cramer’s ϕ =  − .37
34 72 χ2 (1, N = 247) = 34.16***
Cramer’s ϕ =  − .37
44 77 χ2 (1, N = 247) = 26.22***
Cramer’s ϕ =  − .33
39 75 χ2 (1, N = 247) = 31.50***
Cramer’s ϕ =  − .36
39 77 χ2 (1, N = 247) = 35.33***
Cramer’s ϕ =  − .38
33 69 χ2 (1, N = 247) = 29.12***
Cramer’s ϕ =  − .34
33 69 χ2 (1, N = 247) = 29.12***
Cramer’s ϕ =  − .34
18 54 χ2 (1, N = 247) = 29.17***
Cramer’s ϕ =  − .34
24 62 χ2 (1, N = 247) = 33.44***
Cramer’s ϕ =  − .37
27 63 χ2 (1, N = 247) = 28.75***
Cramer’s ϕ =  − .34
83 96 χ2 (1, N = 247) = 11.16**
Cramer’s ϕ =  − .21
61 87 χ2 (1, N = 247) = 22.52***
Cramer’s ϕ =  − .30
81 93 χ2 (1, N = 247) = 8.67**
Cramer’s ϕ =  − .19
23 55 χ2 (1, N = 247) = 24.50***
Cramer’s ϕ =  − .32
22 51 χ2 (1, N = 247) = 20.26***
Cramer’s ϕ =  − .29
8 40 χ2 (1, N = 247) = 28.85***
Cramer’s ϕ =  − .34
5 31 χ2 (1, N = 247) = 24.00***
Cramer’s ϕ =  − .31
5 26 χ2 (1, N = 247) = 17.88***
Cramer’s ϕ =  − .27
17 56 χ2 (1, N = 247) = 35.22***
Cramer’s ϕ =  − .38

Cramer’s ϕ guide (Cohen 1988): ± .10 = small effect, ± .30 = medium effect, ± .50 = large effect

When analyses were re-run with participants who specifically identified as asexual (n = 59), percentages
who endorsed each behavior shifted slightly downward, as anticipated. However, all comparisons between
groups remained similarly significant. When analyses were re-run only with cisgender women participants
(asexual spectrum n = 36, other sexual orientations n = 89, total n = 125), comparisons between the asexual
spectrum and other orientations groups remained similarly significant, except for looking at pornography
(which was comparable between groups at 81% and 91%, respectively)
*
 p < .05, **p < .01, ***p < .001

13

Strengths and Limitations
The current study is strengthened by is its large, community-
based sample of young women and gender diverse people
on the autism spectrum. By assessing identity-related vari-
ables (e.g., gender, sexual orientation) with open-ended sur-
vey items rather than forced-choice “checkbox” methods,
the resulting sample was found to be highly diverse. Our
study contributes to the existing literature by document-
ing asexuality in a subsample of the ASD population, but
it also moves the literature forward by examining internal-
izing symptoms in individuals with both ASD and asexual
spectrum identities.
The study also possesses potential limitations. While
globally diverse, participants were predominantly White;
current findings may not generalize to racial minorities with
ASD who may also experience other types of stress and dis-
crimination. Further, the relations between asexual and non-
asexual people observed in this study (where all participants
were autistic, and many were gender diverse and/or sexual
minorities) may not generalize to the greater, non-ASD
population (where the comparison group typically consists
primarily of cisgender and heterosexual participants). While
the study is strengthened by its inclusive approach to gen-
der, the fact that participants were not explicitly asked about
assigned sex at birth limits characterization of the present
sample. Current recruitment methods (e.g., indicating at the
point of recruitment that gender diverse individuals were
eligible to participate) likely resulted in a sample, while
diverse in sexual orientation and gender, that is not wholly
representative of all young people on the autism spectrum.
The online nature of this study precluded assessing cogni-
tive functioning or adaptive behavior, although participants
likely had average or higher intelligence to access and com-
plete the battery. Thus, our findings cannot be assumed to
generalize to young people who have ASD and concurrent
intellectual disabilities. Finally, romantic orientation was not
assessed separately from sexual orientation; there may be
meaningful differences between individuals who are both
asexual and aromantic, and those who are asexual but do
experience romantic desire.
Research and Clinical Implications,
and Future Directions
Self-reported research on the sexualities of people with ASD
is growing and should continue. When studying identity-
related variables, including gender and sexual orientation,
researchers are encouraged to use open-ended questions to
capture the diversity that exists within the population. Lon-
gitudinal research can help identify how sexual orientation
13
Journal of Autism and Developmental Disorders
(including asexual identity) develops and, for some, may
shift over time. While the current study contributes mean-
ingfully to the literature by focusing on the experiences
of women and gender diverse young people on the autism
spectrum—a subminority within a minority group—repli-
cating this research with men and with a range of ages will
help to better understand and support the sexualities of all
individuals with ASD.
Given the sizeable minority of people with ASD who
identify as being on the asexual spectrum, clinicians who
serve clients with ASD should be familiar with the basics of
asexuality and related terminology. Considering that most
clinicians are unlikely to be asexual themselves, it is impor-
tant that they understand and confront their own biases. For
instance, clinicians may assume that an individual with ASD
identifies as asexual because they lack insight or have not
matured into their sexuality; this could result in clients feel-
ing invalidated and distressed. When relevant for treatment,
we encourage clinicians to ask about sexual orientation in
an open-ended manner (leaving open the possibility of an
asexual identity), and to ask separately about romantic orien-
tation. Finally, when clinicians do encounter asexual clients,
it is important to ask follow-up questions and avoid making
assumptions given the diversity that exists within the asexual
spectrum and community.
All procedures performed in studies involving human
participants were in accordance with the ethical standards
of the institutional research committee and with the 1964
Helsinki declaration and its later amendments or comparable
ethical standards.
Author Contributions  HHB conceived the larger study from which the
current study is drawn, collected data, performed statistical analyses,
reviewed the literature, and drafted the manuscript. LWW and EM
reviewed the literature, helped to draft and edit the manuscript, and
developed ideas presented in the Introduction and Discussion. All
authors read and approved the final manuscript.
Compliance with Ethical Standards 
Conflict of interest  The authors declare that they have no conflict of
interest.
References
Allison, C., Auyeung, B., & Baron-Cohen, S. (2012). Toward brief “red
flags” for autism screening: The short autism spectrum quotient
and the short quantitative checklist for autism in toddlers in 1,000
cases and 3,000 controls. Journal of the American Academy of
Child and Adolescent Psychiatry, 51(2), 202–212.
Bogaert, A. F. (2004). Asexuality: Prevalence and associated factors
in a national probability sample. Journal of Sex Research, 41,
279–287.
Journal of Autism and Developmental Disorders
Brotto, L. A., Knudson, G., Inskip, J., Rhodes, K., & Erskine, Y.
(2010). Asexuality: A mixed-methods approach. Archives of
Sexual Behavior, 39, 599–618.
Brotto, L. A., & Yule, M. (2017). Asexuality: Sexual orientation,
paraphilia, sexual dysfunction, or none of the above? Archives of
Sexual Behavior, 46, 619–627.
Bush, H. H. (2019). Dimensions of sexuality among young women,
with and without autism, with predominantly sexual minority
identities. Sexuality and Disability, 37(2), 275–292.
Byers, E. S., & Nichols, S. (2014). Sexual satisfaction of high-func-
tioning adults with autism spectrum disorders. Sexuality and Dis-
ability, 32, 365–382.
Byers, E. S., Nichols, S., & Voyer, S. D. (2013). Challenging stereo-
types: Sexual functioning of single adults with high functioning
autism spectrum disorder. Journal of Autism and Developmental
Disorders, 43(11), 2617–2627.
Carrigan, M. (2011). There’s more to life than sex? Difference and
commonality within the asexual community. Sexualities, 14(4),
462–478.
Carrigan, M., Gupta, K., & Morrison, T. G. (2013). Asexuality special
theme issue editorial. Psychology & Sexuality, 4(2), 111–120.
Chasin, C. D. (2017). Considering asexuality as a sexual orientation
and implications for acquired female sexual arousal/interest dis-
order. Archives of Sexual Behavior, 46, 631–635.
Cohen, J. (1988). Statistical power analysis for the behavioral sciences
(2nd ed.). New York: Lawrence Erlbaum Associates.
Connor, K. M., Kobak, K. A., Churchill, L. E., Katzelnick, D., &
Davidson, J. R. (2001). Mini-SPIN: A brief screening assessment
for generalized social anxiety disorder. Depression and Anxiety,
14(2), 137–140.
Cupitt, C. (1998). Sexual history questionnaire. In C. M. Davis (Ed.),
Handbook of sexuality-related measures (pp. 106–108). Thousand
Oaks: Sage Publications.
Dewinter, J., De Graaf, H., & Begeer, S. (2017). Sexual orientation,
gender identity, and romantic relationships in adolescents and
adults with autism spectrum disorder. Journal of Autism and
Developmental Disorders, 47(9), 2927–2934.
Gilmour, L., Schalomon, P. M., & Smith, V. (2012). Sexuality in a
community based sample of adults with autism spectrum disorder.
Research in Autism Spectrum Disorders, 6, 313–318.
George, R., & Stokes, M. A. (2018). Sexual orientation in autism spec-
trum disorder. Autism Research, 11, 133–141.
Ingudomnukul, I., Baron-Cohen, S., Wheelwright, S., & Knickmeyer,
R. (2007). Elevated rates of testosterone-related disorders in
women with autism spectrum conditions. Hormones and Behav-
ior, 51(5), 597–604.
Kroenke, K., Strine, T. W., Spitzer, R. L., Williams, J. B., Berry, J.
T., & Mokdad, A. H. (2009). The PHQ-8 as a measure of current
depression in the general population. Journal of Affective Disor-
ders, 114(1–3), 163–173.
Kuusikko, S., Pollock-Wurman, R., Jussila, K., Carter, A. S., Mattila,
M., Ebieling, H.,… Moilanen, I. (2008). Social anxiety in high-
functioning children and adolescents with autism and Asperger
syndrome. Journal of Autism and Developmental Disorders, 38,
1697–1709
Lai, M., Lombardo, M. V., Pasco, G., Ruigrok, A. N. V., Wheelwright,
S.J., Sadek, S. A.,… Baron-Cohen, S. (2011). A behavioral com-
parison of male and female adults with high functioning autism
spectrum conditions. PLoS ONE, 6(6), e20835
Meston, C., & Trapnell, P. (2005). Development and validation of a
five-factor sexual satisfaction and distress scale for women: The
sexual satisfaction scale for women (SSS-W). The Journal of
Sexual Medicine, 2(1), 66–81.
Pecora, L. A., Mesibov, G. B., & Stokes, M. A. (2016). Sexuality in
high-functioning autism: A systematic review and meta-analy-
sis. Journal of Autism and Developmental Disorders, 46(11),
3519–3556.
Poston, D. L., & Baumle, A. (2010). Patterns of asexuality in the
United States. Demographic Research, 23(18), 509–530.
Spector, I. P., Carey, M. P., & Steinberg, L. (1998). Sexual desire inven-
tory. In C. M. Davis, W. L. Yarber, R. Bauserman, G. Schreer, &
E. L. Davis (Eds.), Handbook of sexuality-related measures (pp.
174–176). Thousand Oaks: Sage Publisher.
Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Lowe, B. (2006). A
brief measure for assessing generalized anxiety disorder. Archives
of Internal Medicine, 166, 1092–1097.
The Asexual Visibility & Education Network. (n.d.). Retrieved June 1,
2019, from https​://www.asexu​ality​.org/
Trotter, E. C., & Alderson, K. G. (2007). University students’ defini-
tions of having sex, sexual partner, and virginity loss: The influ-
ence of participant gender, sexual experience, and contextual
factors. The Canadian Journal of Human Sexuality, 16, 11–29.
Yule, M. A., Brotto, L. A., & Gorzalka, B. B. (2013). Mental health
and interpersonal functioning in self-identified asexual men and
women. Psychology & Sexuality, 4(2), 136–151.
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