Sexual Experiences and Health Outcomes from Adolescence to Early Adulthood in Populations with Physical Disabilities

Although a large amount of research over the last half century has focused on changes in adolescent sexual behavior, relatively little is known about what characterizes optimal sexual development through the life course. Populations with disabilities have been particularly understudied for various reasons, including historical restrictions on sexual behaviors for eugenic purposes and unfounded assumptions of asexuality or hypersexuality. Past research shows that adolescents with disabilities have less sexual knowledge than non-disabled peers, are at increased risk for pregnancy and sexually transmitted infections or diseases (STI/STD), and are more vulnerable to sexual violence and abuse, indicating a need for more information to protect this population. It is therefore crucial to understand sexual patterns and health outcomes of populations with disabilities in order to develop better support for sexual health. Accordingly, this dissertation used the Life Course perspective to understand longitudinal patterns of sexual development in populations with physical disabilities in the United States (U.S.) from adolescence into adulthood. I used data from the National Longitudinal Study of Adolescent to Adult Health (Add Health) to: 1) identify sexual patterns of people with physical disabilities from adolescence to adulthood, and 2) determine health outcomes associated with these sexual patterns. Results demonstrate significant differences in sexual patterns and health outcomes for populations with physical disabilities through adulthood. Regarding sexual patterns, populations with severe disabilities progressed more slowly to first vaginal sex, oral sex, and first sexual experience, and had fewer lifetime sexual partners compared to non-disabled peers. In general, earlier timing and more sexual partners were associated with greater odds of STI/STDs and unintended pregnancy, and lower romantic relationship quality in adulthood. Associations also varied by biological sex, race/ethnicity, and sexual orientation. Most notably, female and Non-Hispanic (NH) Black populations with mild disabilities were more likely to experience negative sexual health outcomes. These results fill gaps in the literature by providing important information regarding sexual patterns and health outcomes in this notably understudied population. Such evidence can inform future research, practice, and policies that support understanding, healthy sexual development, and the provision of more focused sexuality education to populations with physical disabilities.Doctor of Philosoph