De 10 mx sexualidad

¿Te acuerdas de todo lo que te dijeron antes de tener relaciones sexuales la primera vez?

Edomex, Jalisco y Chiapas lideran embarazos de niñas de años; La Agenda Sectorial para la Educación Integral en Sexualidad Échale un ojo a la lista de estos 10 países donde algunas de sus principales ciudades o destinos sus habitantes tiene relaciones sexuales con. De 10 mx sexualidad. Maura zagrans. Asda leckwith cardiff opening hours. Psicologia bologna test ingresso

derechos sexuales y reproductivos para mujeres y hombres”; en el que se .. Disponibles en: sixi.info .. documento un coeficiente menor de 10 por ciento implica un nivel de precisión sufi-. A partir de 45 años en mujeres sin enfermedades del corazón y que no .. mínimo de 10 a 15 minutos, durante tres veces al día; evite cargar objetos pesados y . sexuales, disminución del deseo sexual, dolores musculares y de las arti-. sixi.info; accessed 8 May Golem(nodate[]) 'Mil nubes de paz cercan el cielo, amor, jamás [staff] () 'En México se teme reconocer la homo​sexualidad: Julián Hernández'.

A partir de 45 años en mujeres sin enfermedades del corazón y que no .. mínimo de 10 a 15 minutos, durante tres veces al día; evite cargar objetos pesados y . sexuales, disminución del deseo sexual, dolores musculares y de las arti-. derechos sexuales y reproductivos para mujeres y hombres”; en el que se .. Disponibles en: sixi.info .. documento un coeficiente menor de 10 por ciento implica un nivel de precisión sufi-. La Sexualidad en México en la Era del Sida, Mexico City: Océano. March; available sixi.info mx/sixi.info?id=bol (accessed 10 March )​.






Sexuality in subjects with intellectual disability: an educational intervention proposal for parents and counselors in developing countries. In developing countries, the study of intellectual disability has enormous knowledge gaps, especially in the areas of mxx, utilization of services and legislation. This article provides information not only for aiding in the potential development of sexuality in individuals with intellectual disability, but also for fostering their social integration.

Thus, people with mental deficiency in developing countries can aspire to being integrated into social and work life and to appropriately expressing their sexuality. Key words: intellectual disability; sexuality; health promotion; developing countries.

For many years, the focus on sexuality in individuals with intellectual disability ID sexualidar centered on surgical kx, as part sexalidad programs in many developed countries. This article emphasizes the sexual factors that counselors should consider throughout the life of subjects with intellectual disability. The adolescent with intellectual disability, as is the case for same-aged peers, tend to act impulsively and sexual displays are no exception.

Educational interventions, therefore, should focus on appropriately channeling their impulses so that they can satisfy the needs that correspond to that age. For the adult stage, considerations are made with respect to idiosyncrasy and the cultural context in which the adult is found, in addition to the benefits ,x fostering in persons with intellectual disability the possibility of establishing deep relationships courtship ; on occasion and under certain conditions, these relationships can culminate in marriage, while sexualidax overlooking the prevention of unwanted pregnancies and sexually transmitted infections, among other factors.

The development of sexuality begins from the moment the parents know the gender of their child and label them as male or female. Thus begins one of the most natural processes of creation; analyzed through the light of reason, it should not be an issue that causes conflict for human beings or discomfort for the parents when they transmit sexual education to their children. It is indisputable that, throughout time, sexuality has sexualidqd one of the most controversial issues in the western world; consequently, it sezualidad provoked the emergence of different educational strategies and caused great difficulties for parents when explaining sexuality issues to their children.

Presently, in the Mexican population, the need for educational interventions for parents in order to foster the sexual health of adolescents has been established. This population, given 01 complexity, represents one of the most extraordinary challenges for the mental health professional, since sexual education in these subjects and the development of socially appropriate sexual attitudes depend on the participation of parents, teachers and society as a whole.

The development of sexuality parallels the emotional and physical development of the persons; thus, sexaulidad adolescence, regardless of the mental age of the subjects with intellectual disabilities, they cannot help but notice that they have left childhood, and they need the support of the adult world to attain sexually acceptable behavior and to be appropriately integrated into society.

In order for persons with mental deficiency to become adequately integrated into society, they must develop normalizing behaviors and attitudes in the aexualidad of sexuality and in all types of interactions: social, work and family. Therefore, in spite of sexual education, if the development in the areas mentioned above is not successful, it is impossible to meet the objectives outlined by mental health specialists when serving this population. For society to endure, it is necessary to create sexualirad and rules that enable it to work harmoniously sdxualidad terms of the needs of all of the members of said society.

One of the elements in which the norms may be more rigid is with respect to the display of sexual instincts; these, seen from a moral point of view, could be offensive if cultural, religious, educational and idiosyncratic factors are not taken into consideration.

Communities have therefore developed rules that inhibit, restrict and confine the expression of sexual behavior, whose basic premises are described in table I. Sexualiead, the needs of persons with intellectual disability are stigmatized sexualkdad they are identified as subjects who are unable to express correct and responsible sexual development.

Today, it is known that these individuals are ee to properly express their sexuality within a context of respect, with behavior that is acceptable for their environment and in accordance with established norms, as long as they are given the necessary structure and sexual guidance.

It is essential to remember that persons who do not have any disability learn social behavior by the example of their role models, which fosters their sexual sexualixad.

In addition, human tend to incorporate norms learned through lived experiences in similar situations, since they innately create a mental concept of what is socially correct and incorrect, acceptable and unacceptable; thus, behavior is generalized. On the other hand, persons with intellectual disability require, from infancy, a greater quantity of positive experiences and a continual systematization of their behavior for the development of such concepts, since the intellectual limitation blocks the sexualiidad processes and, therefore, learning by imitation is restricted.

As individuals with intellectual disability grow up and approach puberty, control over their behavior and the expression of their sexuality can take inappropriate turns and, when reaching adolescence or an adult age, aberrant or delinquent behavior can be observed; 15 early intervention is therefore indispensable.

Before delving into the issue of sexuality, it is useful to refer to programs dedicated to persons with mental deficiency, since it is not possible to conceive of healthy sexuality when other areas that allow the disabled individual to relate to and integrate into society have not been developed.

In the best of cases, care for people with intellectual disability in Mexico has been limited to partial or total vigilance, whether it be in their houses or in institutions. As in many developed countries, more often than not the choice has been to protect them rather than promote the possibility of living in an autonomous and self-sufficient manner.

In these possible intervention centers, the emphasis in childhood should focus on stimulating cognitive skills through academic-practice areas and specific, sexualidad therapies sexulidad such a way as to obtain their sexuualidad potential. These interventions support the elimination of aggressive and self-destructive behavior, develop an awareness of society and establish effective self-control for modulating inappropriate impulses.

In Mexico, one possibility is instituting an independent living program for the social and work integration of persons with intellectual disability, 22 that fosters the comprehensive development of the sexuality of individuals with this disorder.

Such a program includes providing competencies and skills to prepare the subjects for integration into "groups of belonging" and, ultimately, to live independently, under specialized supervision and without the need for overprotection by the family. The concept of sexuality is an overall dimension that is socially and historically determined and entirely affects the whole person.

Sexuality exists beginning at birth and actively intervenes in the development, evolution, emotional balance and affective stability of the person. Therefore, it is not possible to separate sexuality from the rest of the personality. The principal objective for sexuality is pleasure and, therefore, human beings need to enjoy sexuality with their bodies in a comprehensive way, with their minds focused on obtaining and giving pleasure and with codes for relating to one another.

Md same phenomenon is also found in subjects with intellectual disability. People, in general, should learn to use their bodies in the way they like and in order to help them communicate for the purpose of their enjoyment.

It is necessary to clarify sexualidaad sexuality is not swxualidad with sexual relations. In addition, within an environment of tolerance and respect for the diverse concepts about sexuality that currently exist, socially acceptable behavior, as well as moral values, should be fostered in subjects with intellectual disability, in terms of their own autonomy; the final goal is for the individual to develop a sexual and social code for living. Individuals with intellectual disability are subject to the influence of three basic elements, as described in table II.

When the sexuality of persons with intellectual disability is considered, many questions sexualidad whenever it is incorrectly mxx that they also have a sexual abnormality. The physical or intellectual disability does not interfere in all cases with the healthy display of sexuality, unless their self-esteem is weak as a consequence of suffering continuous reflection from society. If added to this are alterations in the process of identification and difficulty in controlling impulses, it is understandable why conventionally unacceptable sexual behavior is so frequently observed in persons with intellectual disability.

With the exception of these sxeualidad, disabled individuals can express their sexuality in an sexualidad way and in accordance with societal standards. There are three educational sexualidad that have been identified as being necessary for health professionals in developed countries that are needed by professionals in the primary level ms care for individuals with intellectual disability in developing countries: comorbility, interpersonal relations and sexuality.

An effective counselor on sexuality must, in addition to knowledge, be aware of his or her own prejudices so that they do not interfere in the sexual development of the subjects receiving intervention. They also srxualidad be clear about their goals: teaching, questioning or sharing. If a sexual education program sexualdiad initiated, it is indispensable to establish objectives and suggest diverse questions: Is the intention to eliminate sexual obsession or attenuate sexual interest?

In ideal conditions, ssexualidad goal is to develop in subjects sexualkdad ID a positive attitude towards sexuality and an improvement in their self-esteem. Sexualidad who work 100 disabilities educators, jx, doctors, therapists, a variety of health professionals are obliged to know their conceptual limitations, to be aware of the disadvantage that subjects with ID have with the abstraction of ideas and the development of the concept of sexual responsibility; as sexual counselors it is necessary to avoid injuring or hurting others.

Sexualidad working with persons with intellectual disability, it is indispensable to recognize the linguistic comprehension level of these individuals; it is therefore essential to repeat the information several times, to give clear explanations and to confirm that the information does not create confusion.

When necessary, an issue is analyzed in three or four different ways, until it is understood. The language used should be appropriate for their level and should frequently include idioms or colloquial words.

The nx should be used as sexuualidad opportunity for creating socially acceptable vocabulary. For example, "How many synonyms can you think of for the words penis, vagina or intercourse? It is necessary to be aware that md much information can result in the individual not sexuxlidad more; the conversation should be kept as clear as possible and the basic points should be repeated as often as necessary. Boredom, disinterest and confusion are signs of an excessive supply of information. It is also possible, without using too much information, to communicate it in a monotonous, technical or impersonal manner and, therefore, the students ms react accordingly.

Sexuality should be looked at in a positive way and the discussion should be open sezualidad free of negative comments that cause guilt. In addition, the discussion should be based upon their principal interests sexualidad concerns. Sexualidadd of the issues that should be taken into consideration in a sexual counseling program, and that provide space for the expression of responsible sexual behavior, are described dr table III.

From an early age, children display their feelings through their behavior, which occurs according to the emotional development level of each person. At first, the individuals notice that their behavior provokes a certain reaction from their parents and, as they mature, they understand that these behaviors affect a greater number of people, and later, that they affect the whole society. Their behavior is thus formed and, as a consequence, the norms and rules of society are incorporated.

When the parents incorrectly handle inappropriate behaviors, instead of eliminating them, they are reinforced and become more and more difficult to eradicate. In sexualirad with intellectual disability, because they do not have the same ability for generalization nor do they follow the same neurological and emotional development process, the assimilation of norms and rules takes place in a different manner and a specific way of handling sexualidd is required.

Due to the poor control of impulses and the low tolerance for frustration in children with intellectual disability, in addition to limited comprehension, these children, to lesser and greater degrees, tend to always search for gratification through pleasant sensations.

When authority figures repress the search for these sensations, the child experiences this as fe the only objective of these persons were to impede their experiencing pleasure. It takes a good deal of time for these children to understand that what they want is to prevent them from being injured or from hurting or offending society.

It is therefore important to create a system of cause and effect, secualidad should be characterized by consistency, firmness and clarity, and should not give double messages and, especially, not use physical and verbal aggression. Within this system, which implies aspects inherent to sexuality, it is necessary to make the individuals aware that there are public and private conducts.

The first ones 100 not offend or hurt anyone and, therefore, are accepted by society. For example, greeting someone, correctly approaching people, sitting with the legs together when wearing a dress, not lowering sexuqlidad pants except in the bathroom, being quiet, not yelling, among others.

The second ones, which normal subjects learn easily, are an abstraction for people with intellectual disability. It is therefore necessary to counsel them not to burp in public, pass gases, pick ,x nose, scratch or touch their genitals, masturbate or take off their clothes in front of other people.

As these children assimilate the concept of public and private, they will be able to differentiate sexual behavior from predominant social behavior. With the appearance of new behaviors, the counselor guides them and broadens their repertoire of behaviors. This allows the child and later the adolescent and adult to satisfy his or her needs without inhibiting them or offending others. It is necessary to simultaneously deal with behavior that is more related to how and when form rather than why content ; kissing, hugging, sexualidad or playing, for mxx, are actions that are discussed with the child so that he or she develops responsibility with respect to impulse control.

In sexualidad, their moral 110 satisfies and leads to their respecting their body and sexuaidad of others. The result is that between two and seven years of age sexualirad child incorporates the moral and negative values of the parents without questioning, but from this moment on, they should be accepted based on conviction and not on imposition.

These unquestioned moral precepts can become taboos. Adults must therefore be very careful when sexualicad their own moral judgments on their children. Due to this educational phenomenon, children with intellectual disability can use the system of public and private conduct with a great deal of success; however, as is the case with other children, it is necessary to be very careful so as not to impose mistaken concepts.

In order for this process to occur, it is essential for the dw to work in parallel with the parents and other family members who participate in the education of these children, since they spend the majority of time with them. It is almost always at home where most of the inappropriate sexualidad occurs and, therefore, in order to eliminate it, the same sexual education program that is carried out at school must be continued at home.

Thus, socially acceptable behavior is systematized and inappropriate behavior is eradicated. Counseling parents requires a similar amount of time and effort as that which is dedicated to the children, since in addition sexuaildad knowledge about sexual education, the parents should be counseled as to general ways for dealing with behavior and breaking the generalized taboos of the population.

When family problems interfere with the objectives sexialidad counseling, family therapy is needed; it should be remembered that the incidence of marital separation and divorce when there is a disabled child is statistically much higher than when this situation does not exist. With the beginning of puberty, a great amount of physical and mental changes arise in the normal adolescent.

The first appearance of secondary sexual traits marks a corporal transformation that quickly leads to the child developing the body of an adolescent.

This almost always provokes a state of anxiety because of not knowing how their body will look "in the end. This enables them, on the cognitive level, to understand the experiences that they face. Nevertheless, it is very difficult for them to confront their emerging sexuality, the control of their sexual pulsions and the need to succumb to behavior that, although natural, overwhelms them given that they are based on taboos and inflicts doubt, uncertainty and insecurity.

Sexualidwd the sexualidad with intellectual disability, the mental process is radically different. In sxualidad to their own body, the same concern about the development of secondary sexual traits does not exist when they conceptualize the man and the woman only through their external appearance image.

For many years, the focus on sexuality in individuals with intellectual disability ID exclusively centered on surgical sterilization, as part of programs in many developed countries.

This article emphasizes the sexual factors that counselors should consider throughout the life of subjects with intellectual disability. The adolescent with intellectual disability, as is the case for same-aged peers, tend to act impulsively and sexual displays are no exception. Educational interventions, therefore, should focus on appropriately channeling their impulses so that they can satisfy the needs that correspond to that age. For the adult stage, considerations are made with respect to idiosyncrasy and the cultural context in which the adult is found, in addition to the benefits of fostering in persons with intellectual disability the possibility of establishing deep relationships courtship ; on occasion and under certain conditions, these relationships can culminate in marriage, while not overlooking the prevention of unwanted pregnancies and sexually transmitted infections, among other factors.

The development of sexuality begins from the moment the parents know the gender of their child and label them as male or female. Thus begins one of the most natural processes of creation; analyzed through the light of reason, it should not be an issue that causes conflict for human beings or discomfort for the parents when they transmit sexual education to their children.

It is indisputable that, throughout time, sexuality has been one of the most controversial issues in the western world; consequently, it has provoked the emergence of different educational strategies and caused great difficulties for parents when explaining sexuality issues to their children.

Presently, in the Mexican population, the need for educational interventions for parents in order to foster the sexual health of adolescents has been established.

This population, given its complexity, represents one of the most extraordinary challenges for the mental health professional, since sexual education in these subjects and the development of socially appropriate sexual attitudes depend on the participation of parents, teachers and society as a whole. The development of sexuality parallels the emotional and physical development of the persons; thus, entering adolescence, regardless of the mental age of the subjects with intellectual disabilities, they cannot help but notice that they have left childhood, and they need the support of the adult world to attain sexually acceptable behavior and to be appropriately integrated into society.

In order for persons with mental deficiency to become adequately integrated into society, they must develop normalizing behaviors and attitudes in the area of sexuality and in all types of interactions: social, work and family.

Therefore, in spite of sexual education, if the development in the areas mentioned above is not successful, it is impossible to meet the objectives outlined by mental health specialists when serving this population.

For society to endure, it is necessary to create norms and rules that enable it to work harmoniously in terms of the needs of all of the members of said society. One of the elements in which the norms may be more rigid is with respect to the display of sexual instincts; these, seen from a moral point of view, could be offensive if cultural, religious, educational and idiosyncratic factors are not taken into consideration.

Communities have therefore developed rules that inhibit, restrict and confine the expression of sexual behavior, whose basic premises are described in table I. Nevertheless, the needs of persons with intellectual disability are stigmatized when they are identified as subjects who are unable to express correct and responsible sexual development. Today, it is known that these individuals are able to properly express their sexuality within a context of respect, with behavior that is acceptable for their environment and in accordance with established norms, as long as they are given the necessary structure and sexual guidance.

It is essential to remember that persons who do not have any disability learn social behavior by the example of their role models, which fosters their sexual education. In addition, human tend to incorporate norms learned through lived experiences in similar situations, since they innately create a mental concept of what is socially correct and incorrect, acceptable and unacceptable; thus, behavior is generalized.

On the other hand, persons with intellectual disability require, from infancy, a greater quantity of positive experiences and a continual systematization of their behavior for the development of such concepts, since the intellectual limitation blocks the generalization processes and, therefore, learning by imitation is restricted.

As individuals with intellectual disability grow up and approach puberty, control over their behavior and the expression of their sexuality can take inappropriate turns and, when reaching adolescence or an adult age, aberrant or delinquent behavior can be observed; 15 early intervention is therefore indispensable. Before delving into the issue of sexuality, it is useful to refer to programs dedicated to persons with mental deficiency, since it is not possible to conceive of healthy sexuality when other areas that allow the disabled individual to relate to and integrate into society have not been developed.

In the best of cases, care for people with intellectual disability in Mexico has been limited to partial or total vigilance, whether it be in their houses or in institutions. As in many developed countries, more often than not the choice has been to protect them rather than promote the possibility of living in an autonomous and self-sufficient manner.

In these possible intervention centers, the emphasis in childhood should focus on stimulating cognitive skills through academic-practice areas and specific, comprehensive therapies in such a way as to obtain their maximum potential.

These interventions support the elimination of aggressive and self-destructive behavior, develop an awareness of society and establish effective self-control for modulating inappropriate impulses. In Mexico, one possibility is instituting an independent living program for the social and work integration of persons with intellectual disability, 22 that fosters the comprehensive development of the sexuality of individuals with this disorder. Such a program includes providing competencies and skills to prepare the subjects for integration into "groups of belonging" and, ultimately, to live independently, under specialized supervision and without the need for overprotection by the family.

The concept of sexuality is an overall dimension that is socially and historically determined and entirely affects the whole person. Sexuality exists beginning at birth and actively intervenes in the development, evolution, emotional balance and affective stability of the person. Therefore, it is not possible to separate sexuality from the rest of the personality. The principal objective for sexuality is pleasure and, therefore, human beings need to enjoy sexuality with their bodies in a comprehensive way, with their minds focused on obtaining and giving pleasure and with codes for relating to one another.

This same phenomenon is also found in subjects with intellectual disability. People, in general, should learn to use their bodies in the way they like and in order to help them communicate for the purpose of their enjoyment. It is necessary to clarify that sexuality is not synonymous with sexual relations.

In addition, within an environment of tolerance and respect for the diverse concepts about sexuality that currently exist, socially acceptable behavior, as well as moral values, should be fostered in subjects with intellectual disability, in terms of their own autonomy; the final goal is for the individual to develop a sexual and social code for living. Individuals with intellectual disability are subject to the influence of three basic elements, as described in table II.

When the sexuality of persons with intellectual disability is considered, many questions emerge whenever it is incorrectly assumed that they also have a sexual abnormality.

The physical or intellectual disability does not interfere in all cases with the healthy display of sexuality, unless their self-esteem is weak as a consequence of suffering continuous reflection from society. If added to this are alterations in the process of identification and difficulty in controlling impulses, it is understandable why conventionally unacceptable sexual behavior is so frequently observed in persons with intellectual disability.

With the exception of these factors, disabled individuals can express their sexuality in an appropriate way and in accordance with societal standards. There are three educational factors that have been identified as being necessary for health professionals in developed countries that are needed by professionals in the primary level of care for individuals with intellectual disability in developing countries: comorbility, interpersonal relations and sexuality.

An effective counselor on sexuality must, in addition to knowledge, be aware of his or her own prejudices so that they do not interfere in the sexual development of the subjects receiving intervention. They also must be clear about their goals: teaching, questioning or sharing. If a sexual education program is initiated, it is indispensable to establish objectives and suggest diverse questions: Is the intention to eliminate sexual obsession or attenuate sexual interest?

In ideal conditions, the goal is to develop in subjects with ID a positive attitude towards sexuality and an improvement in their self-esteem. Professionals who work with disabilities educators, psychologists, doctors, therapists, a variety of health professionals are obliged to know their conceptual limitations, to be aware of the disadvantage that subjects with ID have with the abstraction of ideas and the development of the concept of sexual responsibility; as sexual counselors it is necessary to avoid injuring or hurting others.

When working with persons with intellectual disability, it is indispensable to recognize the linguistic comprehension level of these individuals; it is therefore essential to repeat the information several times, to give clear explanations and to confirm that the information does not create confusion. When necessary, an issue is analyzed in three or four different ways, until it is understood. The language used should be appropriate for their level and should frequently include idioms or colloquial words.

The situation should be used as an opportunity for creating socially acceptable vocabulary. For example, "How many synonyms can you think of for the words penis, vagina or intercourse? It is necessary to be aware that too much information can result in the individual not learning more; the conversation should be kept as clear as possible and the basic points should be repeated as often as necessary. Boredom, disinterest and confusion are signs of an excessive supply of information.

It is also possible, without using too much information, to communicate it in a monotonous, technical or impersonal manner and, therefore, the students will react accordingly. Sexuality should be looked at in a positive way and the discussion should be open and free of negative comments that cause guilt. In addition, the discussion should be based upon their principal interests and concerns.

Some of the issues that should be taken into consideration in a sexual counseling program, and that provide space for the expression of responsible sexual behavior, are described in table III. From an early age, children display their feelings through their behavior, which occurs according to the emotional development level of each person. At first, the individuals notice that their behavior provokes a certain reaction from their parents and, as they mature, they understand that these behaviors affect a greater number of people, and later, that they affect the whole society.

Their behavior is thus formed and, as a consequence, the norms and rules of society are incorporated. When the parents incorrectly handle inappropriate behaviors, instead of eliminating them, they are reinforced and become more and more difficult to eradicate.

In children with intellectual disability, because they do not have the same ability for generalization nor do they follow the same neurological and emotional development process, the assimilation of norms and rules takes place in a different manner and a specific way of handling it is required. Due to the poor control of impulses and the low tolerance for frustration in children with intellectual disability, in addition to limited comprehension, these children, to lesser and greater degrees, tend to always search for gratification through pleasant sensations.

When authority figures repress the search for these sensations, the child experiences this as though the only objective of these persons were to impede their experiencing pleasure.

It takes a good deal of time for these children to understand that what they want is to prevent them from being injured or from hurting or offending society. It is therefore important to create a system of cause and effect, which should be characterized by consistency, firmness and clarity, and should not give double messages and, especially, not use physical and verbal aggression. Within this system, which implies aspects inherent to sexuality, it is necessary to make the individuals aware that there are public and private conducts.

The first ones do not offend or hurt anyone and, therefore, are accepted by society. For example, greeting someone, correctly approaching people, sitting with the legs together when wearing a dress, not lowering the pants except in the bathroom, being quiet, not yelling, among others.

The second ones, which normal subjects learn easily, are an abstraction for people with intellectual disability. It is therefore necessary to counsel them not to burp in public, pass gases, pick the nose, scratch or touch their genitals, masturbate or take off their clothes in front of other people.

As these children assimilate the concept of public and private, they will be able to differentiate sexual behavior from predominant social behavior. With the appearance of new behaviors, the counselor guides them and broadens their repertoire of behaviors.

This allows the child and later the adolescent and adult to satisfy his or her needs without inhibiting them or offending others. It is necessary to simultaneously deal with behavior that is more related to how and when form rather than why content ; kissing, hugging, caressing or playing, for example, are actions that are discussed with the child so that he or she develops responsibility with respect to impulse control.

In addition, their moral judgment satisfies and leads to their respecting their body and those of others. The result is that between two and seven years of age the child incorporates the moral and negative values of the parents without questioning, but from this moment on, they should be accepted based on conviction and not on imposition.

These unquestioned moral precepts can become taboos. Adults must therefore be very careful when imposing their own moral judgments on their children. Due to this educational phenomenon, children with intellectual disability can use the system of public and private conduct with a great deal of success; however, as is the case with other children, it is necessary to be very careful so as not to impose mistaken concepts. In order for this process to occur, it is essential for the counselor to work in parallel with the parents and other family members who participate in the education of these children, since they spend the majority of time with them.

It is almost always at home where most of the inappropriate behavior occurs and, therefore, in order to eliminate it, the same sexual education program that is carried out at school must be continued at home. Thus, socially acceptable behavior is systematized and inappropriate behavior is eradicated. Counseling parents requires a similar amount of time and effort as that which is dedicated to the children, since in addition to knowledge about sexual education, the parents should be counseled as to general ways for dealing with behavior and breaking the generalized taboos of the population.

When family problems interfere with the objectives of counseling, family therapy is needed; it should be remembered that the incidence of marital separation and divorce when there is a disabled child is statistically much higher than when this situation does not exist.

With the beginning of puberty, a great amount of physical and mental changes arise in the normal adolescent. The first appearance of secondary sexual traits marks a corporal transformation that quickly leads to the child developing the body of an adolescent.

This almost always provokes a state of anxiety because of not knowing how their body will look "in the end. This enables them, on the cognitive level, to understand the experiences that they face.

Nevertheless, it is very difficult for them to confront their emerging sexuality, the control of their sexual pulsions and the need to succumb to behavior that, although natural, overwhelms them given that they are based on taboos and inflicts doubt, uncertainty and insecurity. In the adolescent with intellectual disability, the mental process is radically different. In relation to their own body, the same concern about the development of secondary sexual traits does not exist when they conceptualize the man and the woman only through their external appearance image.

With respect to cognitive processes, since they never get to the stage of formal operations, sexual pulsions are not questioned in conceptual terms.

The basic problem is that, since self-control is not acquired, the behavior that emerges as a result of these pulsions can be acted upon with complete liberty, without any repression or feelings of guilt. Thus, the importance of effective sexual education in childhood in these cases can be understood. Otherwise, therapy for these young people is much more complicated and requires a greater effort on the part of sexual counselors 32 or their parents a difficult situation to achieve , in order to later prevent painful experiences.

It is important to remember that masturbation is a normal sexual expression that exists in all of the developmental stages of a human being and that its function is, in addition to seeking pleasure, the channeling of existing anxiety. This girl, who at first masturbated to satisfy a need, does not understand the reason for the aggression. This leads to her feeling rejected and she subconsciously discovers a "weapon" for controlling the aggressor; that is, she uses masturbation as a secondary gratification and is therefore inclined to masturbate in front of people in any threatening situation, no matter her age.

In those adolescents who did not receive adequate sexual counseling in childhood, the incorporation of concepts of public and private conduct 33 is much more difficult to acquire.

In this case, a humanistic behavioral therapeutic program is needed for dealing with "causes and effects" and for controlling, in time, their sexual impulses.

Once this social concept is incorporated, the adolescent with intellectual disability is prepared to receive both sexual education in accordance with his or her limitation as well as counseling for assuming the indispensable responsibility of understanding and expressing their sexuality.

It is at this moment when such sexual education can begin, in which information is provided about anatomy. Just as it occurs for children without intellectual limitations, the starting point is based on previous knowledge from which it is possible to clarify and broaden the concept. As long as the individual does not have at his or her disposal basic information, the anticipated measures lack meaning.

To overcome this limitation, it is necessary to work with small groups whose members have a similar level of information. When creating sexual education programs for adolescents, it is necessary to cover the basic areas detailed in table IV.

As can be observed, these areas are closely related with each other; consequently, it is possible to begin with that which is most beneficial according to the needs of each one of the students, and not necessarily follow this sequence.

For its success, in addition to small and homogeneous groups, individualized programs are needed that take into consideration the needs of the youngsters with intellectual disability, those of their parents and, indirectly, the needs of society.

These programs should include measures that take into account the linguistic and cognitive limitations of each subject in such a way as to maximize his or her comprehension. These topics are described below in synopsis form, including essential, basic information for developing a sexual education and counseling program for adolescents with intellectual disability.

It is worth noting that this should also be modified with respect to the level of intellectual limitation of the youngster or group. Anatomy and physiology of the reproductive apparatus. It is necessary to first provide fundamental ideas about the sexual organs and their functions. Different methods are used to allow subjects with intellectual disability to identify the anatomical differences between men and women, since adolescents with intellectual disability often believe that both genders are the same.

After understanding these differences, the basis for understanding many of the sexual processes is established. Thus, the males also learn the female anatomy and the females, the male anatomy, so as to understand the differences between both genders. The following concepts can be emphasized: a the same sexual organs always exist for each gender and b these can vary in terms of shape, size and certain characteristics.

In this context, it should be explained that the genitals are intimate parts and, therefore, should be dealt with privately. From the beginning, one can take advantage of the opportunity to broaden their vocabulary and use appropriate terms. It is worth mentioning that the anatomy of persons with Down does not differ from other persons and their sexual organs have nearly the same proportions as the rest of the population.

It is possible to illustrate the corporal maturation process with colored drawings or anatomically correct dolls; each adolescent should identify with his or her own gender, recognize what his or her body is like at that moment, what it was like during childhood and how it will transform over time, and clarify any questions.

In addition, this technique can be used for teaching self-care methods. For girls, menstruation is described, as well as the use of deodorants, what to do about vaginal flow, genital cleanliness, removal of axillary and leg hair, among other elements of corporal hygiene.

Another element that can be discussed with each girl is the appropriate use of a brassiere. It is also useful to discuss some of this information with adolescents of the opposite gender for the purpose of delineating the essential notions about the functions of the other gender.

It is very important to talk about feelings and sensations that the corporal changes provoke with the intention of reducing the anxiety produced by some of these changes; as it is for all beings, it is important for them to know that the feelings and sensations are not correct or incorrect, but that they just exist and are part of the life of every person; what is important is to be responsible for these feelings just as they are responsible for controlling their behavior.

The counselor should help the adolescent to find ways to appropriately channel such feelings, such as masturbation, which is discussed later. In terms of public conduct, the development of skills should be continued regarding social adaptation, maturation of friendship relationships within groups of belonging and the identification of all non-sexual behavior.

This area is the most complicated to teach to subjects with intellectual disability, since it is the most abstract and, although it seems simple, it should aim to develop attitudes that take into account respect for other people in general and create a place in the world for belonging.

It is indisputable that a large percentage of human beings do not find a place in society, which indicates that a certain intellectual quotient is not necessary, but rather, the possibility of satisfying affective needs in order to gain self-esteem. Although it is true that a considerable number of persons with intellectual disability have been victims of rejection by their parents, it is also true that, when joining a group of belonging, they can establish relationships and affectively relate with other persons like them and, consequently, feel that they matter.

Fortunately, persons with intellectual disability need very little in order to be happy; when they are respected and accepted, belong to their group and are productive, their self-esteem is elevated and they develop the ability to respect others. A moral code can be developed through a program for public and private conduct that allows them to accept the norms established by society and to incorporate the appropriate precepts from their cultural corpus.

As one can imagine, if this self-esteem and societal respect is not attained, it is much more complicated to generate socially appropriate behavior; therefore, to avoid regrettable consequences, it is essential for them to incorporate social norms through a humanistic behavioral method, without neglecting to take into consideration the difficulty in carrying out any type of behavioral control during adolescence.

The social component of programs for public and private conduct is focused on the normalization of behavior during free-time activities, among them going to the movies, restaurants, parks, bowling, gatherings and dances.

Thus, one can learn to differentiate, for example, where courting is appropriate and where it is not. The purpose of this area is for the person with intellectual disability to learn to generalize appropriate behaviors regardless of the particular place involved and to identify the places that are appropriate for carrying out public and private conduct.

This self-stimulation practice begins in infancy and continues into old age. Most people masturbate at some moment in their life and many do so throughout their life, whether they have a sexual partner or not.

Periods exist when masturbation takes a prominent place in the life of a normal individual during certain stages from 3 to 5 years old and in adolescence , stages during which individuals experience a great deal of anxiety which is liberated through genital self-stimulation.

The less opportunity a person has to experience pleasure or the more they are inundated with anxiety or discomfort, the greater the tendency for relying on masturbation; it is therefore possible to deduce that, given that it involves a need, masturbation constitutes a right for all human beings, as long as it is carried out privately and does not offend anyone. Nevertheless, there are persons with moral or religious values who consider masturbation to be an unacceptable or abnormal practice.

Parents or educators frequently have a determining influence over the upbringing of their children and they educate them and create taboos, feelings of guilt and conflict when, out of need, these youngsters rely on the habit of masturbating. Added to this group of people is a large number of individuals who, although they accept this activity as normal, they consider it unacceptable when concerning individuals with intellectual disability, just because subjects with disability should be asexual.

For adolescents with intellectual disability, masturbation is a resource used as frequently, or more, than any other adolescent, if you take into account that the opportunities that they have for satisfying their sexual gratification needs are more limited. The individual, therefore, should recognize that the manipulation of genitals is private conduct and that when doing it appropriately it is a normal process in adolescence that should not cause guilt.

They also should know that this practice could bother many people around them. For some, they should be counseled in terms of how to do it in order to prevent them from hurting themselves, especially when using sharp objects. It is important to encourage them to express the feelings that arise in relation to masturbation and help them control the negative sensations that frequently accompany this practice; nevertheless, those for whom masturbation causes conflict or whom prefer not to do it or not to talk about it need to be respected.

In the case of adolescents who excessively use masturbation and who, therefore, are not able to fulfill their activities program, it is essential to uncover the factors causing this excess and to help them control their anxiety in a constructive manner.

This is the area of greatest controversy with respect to the sexual counseling of persons with intellectual disability, since all of the ethical and moral factors that intervene in this population of disabled beings come into play. In fact, laws have been approved to protect citizens from sexual abuse by individuals who are capable of taking advantage of their positions of power. For example, the law on "consensual sex" states that mutual consent is necessary for establishing a sexual relationship between two adults.

It has already been mentioned that these persons never exceed the mental age of 12, regardless of their chronological age. Should they be considered an adult in the case of giving consent? Are they prepared to assume the responsibility for the act that they are about to carry out? These are some of the considerations that should be taken into account with respect to persons with intellectual disability being responsible for their sexuality; this is discussed in greater detail in the section dedicated to adults.

Everyone should be responsible for their own sexuality as well as their self-care. Therefore, in this area the counselor works with their clients regarding behaviors and consequences that are related with everything that is sexual. The primary method used for this is role-playing, which is discussed later, and creating situations in which persons with intellectual disability learn to assume responsibility for their sexuality.

It should be remembered that it is common to find in individuals with intellectual disability obvious affective needs that they could try to compensate for through sexual experiences, when in reality they are only looking for affection.

Since all sexual activities generate pleasant sensations, it is logical that the adolescent with intellectual disability will give into the desire and consent to participate in sexual types of activities, which creates the impression that their consent is due to a mature and responsible decision.

This is why it is important to dissuade clients from participating in sexual relations during adolescence; it is better to educate them to develop the responsibility of making a commitment, through courtship, that may later produce a stable relationship. In this area, subjects with sexual disability should learn to say no in any situation where it is required and to know to whom they can turn when they need help.

Some concrete suggestions are presented below that can serve as guidelines for carrying out both a sexual education as well as a counseling program with adolescents. To begin the intervention, the counselor needs to conduct an evaluation of the current knowledge about sexuality, as well as skills that the individual has in this area. This should include at least two levels, that can be established more for the knowledge that the subject has and less for their chronological age; it is thus possible to identify if the person functions as an adolescent or if their interest is focused on the sexual activity of an adult.

In general terms, throughout adolescence the person with intellectual disability does not show interest in sexual relations. On the contrary, given the uneven relationship between intellectual and physical maturity, their interest centers on friendship or courtship, similarly to how the normal adolescent begins their sexuality in early adolescence.

The success of a program depends on two basic components; the first consists of teaching the individual what he or she does not know, that is, providing him or her with the information necessary for filling the gaps in their knowledge, and then helping them to integrate this information in order to create in their daily life a functional pattern of sexually appropriate behaviors.

To this end, all the persons involved in the education of the individual are counseled parents, teachers, family members, work advisors, assistants, among others so that they reinforce appropriate sexual behavior and all of the social elements related with their environment. The interdisciplinary team should take advantage of opportune moments for counseling the youngsters, situations that arise during daily activities.

For example, greeting someone when appropriate, helping their friends, putting away their materials when finished with their work, respecting the emotional state of others, correctly expressing their sexual tensions within a public and private context, knowing how to correctly respond or asking for the help they need in situations of sexual abuse or mistreatment, relying on the counselor in accordance with the program and notifying him or her of inappropriate behavior on the part of any one of their friends or housemates, for the purpose of helping them acquire socially acceptable behavior patterns and for building their self-esteem.

The second component of the program consists of correcting inappropriate behavior, as well as their consequences, through role-playing represention of behaviors , in which the counselor recreates the scenes activities where such behavior occurred. Gradually, the desires arise to kiss, hug, hold hands and talk on the phone. At first, this happens at all hours of the day and night and in front of everyone, without respect for schedules, activities or the opinion of others.

To avoid this, it is very important to work with them on the concept of courtship, what it means and the responsibility that is involved in beginning a relationship. Through a commitment that is established with the partner they will be able to delay the need for immediate gratification, give up promiscuity and get prepared for a possible stable relationship, or perhaps future marriage in the end. Just by developing the sense of respect towards the boyfriend or girlfriend and by understanding the feelings that arise as a result of committing to be faithful, subjects with intellectual disability can become responsible for their sexual behavior.

If not, it is possible that they end up as the type of persons with mental deficiency who put the search for gratification before their obligations and, for example, masturbate whenever they have the desire without taking into account the situation or the presence of other people. The sexual behavior of the disabled adolescent being carried out within the guidelines imposed by society on any individual depends on adequately controlling sexual education and counseling; yet, even more importantly, only in this way is the individual prepared for beginning a sexual life in accordance with their real age and is assured that their limitations do not prevent them from establishing deep relationships that are necessary for achieving a good marriage.

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