Challenges for Sexual Education of Persons with Mental Disabilities In Slovakia, the sexuality of persons with mental disabilities as a taboo or marginalized concept is gradually becoming a less taboo topic, at least in professional circles. It's right this way. After all, sexuality is a natural part of human life and disability in no way reduces the right of individuals with mental disabilities to their sexual expression.

Despite the fact that sexuality is considered a basic human need and education in this area is a natural right of each of us, until now almost no attention has been paid to the sexual education of these persons. In this target category, we rarely encounter planned sexual education, it is usually not perceived as an important part of education. In the presented contribution, we therefore pay attention to the description of some of the problems that we perceive in the context of the mentioned component of education during its practical implementation (if it is implemented at all) for persons with mental disabilities. We are based on the analysis of relevant literature and our own research findings.

Sexual education and its introduction into the educational system has its genesis in Slovakia. However, we will limit ourselves only to the statement of E. Poliakova (2003), according to which, historically speaking, we belong to the countries that laid the foundations of sex education in Europe, scientifically and institutionally developed it. Despite the above, there is a great deal of conceptual ambiguity and inconsistency in this area. It can be documented, for example, by some of its older names: parenting education, marriage and parenting education, family education, preparation for marriage and parenthood, education for family life, etc.

Before 1989, the term parenting education was the most preferred term in professional literature and in official documents. However, he narrows the entire issue down to the relationship between parent and child, emphasizes problems related to raising children and the role of the parent at the expense of other topics dealing with sexuality and partner relationships. In the context of the issue we are looking at, most people with mental disabilities do not start a family and do not become parents. The terms marital and parental education and family education sound similarly misleading. Both emphasize the responsibility of the family, or parents for education, but they do not indicate that it is necessary to implement sex education in school, as well as where the family has completely failed - in the case of persons with severe mental disabilities, especially in social service homes.

Apart from the term sexual education, other terms are also used abroad. In the second half of the 70s, the term parenthood education (parenthood education) was often used, because it includes a broader scope than sex education. During this period, individual countries moved to more general names that were supposed to emphasize a broader approach to issues of intimate coexistence, especially from the point of view of ethics and morality, for example in Finland - Education for family life, Norway - Learning to live together, Human reproduction, Sweden - Education for sexual and human relationships, Poland - Preparation for family life.

In the 1980s, sexologists in particular began to point out that broader names (without the adjective sexual) allow attention to be paid mainly to psychological, social and ethical issues of partnership, marriage and parenthood, and only limited (or no) attention is paid to specific information about sexuality. The growing importance of this information was reflected in the return to the name sexual education, which until 1998 was officially used by the Ministry of Education of the Slovak Republic to designate the given field of education in our country as well. In the USA, a distinction is made between the names sex education, which is less complex, and sexuality education, which represents instruction about sexuality in its entirety (Šilerová, 2003).

In Slovakia, the concept of Education for marriage and parenthood is currently officially approved. This term replaced the previously used term sex education. The said change was prompted by a response among the lay and professional public after the Ministry of Education of the Slovak Republic approved the Sex Education curriculum in 1994.

Especially for people with mental disabilities, we come to a certain terminological contradiction regarding the concepts of sex education and education for marriage and parenthood. For a large number of the lay public, the noun sex itself and the adjective sexual, derived from it, arouse outrage. It is interesting that these negative feelings are amplified by the degree of religiosity of the population, so the term sex education, as we indicated above, is hardly passable in Slovakia. After the division of Czechoslovakia in 1993, the Society for Family Planning and Sexual Education was forced by the state authorities to rename it to the Society for Planned Parenthood and Parenting Education. Also in the Czech Republic, sex education is replaced by family education, even though it is obvious to everyone at first glance that it is not a synonym. This discrepancy then stands out much more in the education of sexual minorities, such as persons with mental disabilities. According to R. Uzlo (2009), there is no dispute that their sexual education is a complete necessity, while parenting education is quite problematic. This nomenclature paradox is then very clearly manifested in persons with more severe mental disabilities. The term education for marriage and parenthood cannot function as a substitute or even a "broader" term for this population group. For persons with mild mental disabilities, we could also consider the concept of education for marriage and parenthood, used in the general population. But what about persons with more severe mental disabilities? Persons of whom, we dare say, most will not marry and raise their children. In this regard, we consider sexual education to be a more appropriate name for the mentioned component of education. R. Uzel (2009) is of the same opinion, when he states that we cannot agree with the opinion that education for marriage and parenthood is superior to sexual education, which is part of it, for persons with mental disabilities. On the contrary, the Swedish model will be more valid for these persons, where education for marriage and parenthood is considered part of universal sexual education.

Some other challenges for sexuality education of people with intellectual disabilities

A still unresolved question in the field of sex education is whether it should be a separate subject (as it is, for example, in Great Britain) or part of the educational process (as it is, for example, in Sweden, Denmark, etc.). In Slovakia, we can illustrate the situation by the fact that the sexual education of persons with mental disabilities is part of the curriculum of other subjects, but it does not have its own curriculum. Sex education is not a separate subject. It is conceived as an interdisciplinary discipline. It should therefore be implemented in other teaching subjects. In special elementary schools, natural history and social studies are taught, but also in other subjects in the form of the so-called hidden curricula as well as in extracurricular educational activities of the classroom teacher. In a special elementary school, students with mental disabilities encounter sexual education in ethical education, religion, natural history, civics and practical subjects as well as cooking, sewing, etc. Of course, the biggest space is in classrooms and especially in ethical education. However, this is again optional and children (but more often their parents) choose between it and religion. As a result, there are regions where not a single student is taught ethical education at school, and instead of truthful information about sexuality, they hear that homosexuality is an original sin, masturbation is harmful to health, premarital sex is unacceptable, and any ethical abortion is equal to murder. We can therefore conclude that the implementation of sexual education for persons with mental disabilities is mostly practically zero.

On the other hand, the effectiveness of sex education requires systematicity, complexity and long-term inclusion in the educational process, especially with regard to students with mental disabilities. By systematic and long-term, we understand the inclusion of sex education from an early age to adulthood. Especially for persons with intellectual disabilities, this method is necessary because of the memory trace, which is lost faster in them than in intact children. By comprehensiveness we mean the inclusion of sex education in all types of schools, not excluding special schools, both for boys and girls, because so far this area of ​​education has focused mostly on girls. It is important that this area of ​​education is not neglected.

Another obstacle to the implementation of high-quality and professionally founded sex education in Slovakia is the fact that we do not have a clearly designated and trained teacher (pedagogue) of sex education. We have an insufficient number of educators prepared for this type of education. Current education is carried out mainly within the framework of postgraduate education of teachers of ethical and civic education at methodological centers, but rather as a marginal topic. In addition, teachers focused on this issue have the opportunity to participate in special trainings.

Another unresolved area is the issue of compulsory sex education. Is and should sexual education be compulsory? We must state that only a small part of teachers implement sexual education in practice. In this context, E. Poliaková (1996) states that, despite the fact that the issues of the quality and effectiveness of sex education are becoming particularly topical and urgent, the approach to their solution is unclear. Based on the results of research with sex education teachers and empirical knowledge, the author gives the following statements:

  1. The acceptance of sex education as a necessary part of the educational process in schools is very high.
  2. In the subjectively felt problems in sex education, deficiencies in the methodology prevail over deficiencies in the knowledge sphere and personality barriers.
  3. The most frequently perceived problem is insufficient cooperation between the family and the school and absolute abstinence from sexual education in the family.
  4. Problems with understanding the content and status of sexual education prevail.

Challenges towards sex education in social service homes

In the next part of the post, we will focus on the description of the problems we see in the field of sexual education in social service homes.

Based on the analysis of professional literature (Matulay, 1986; Tóthová, 2001; Novosad, 2002; Mandzáková, Hornák, 2009; Mandzáková, 2011 and others) and our research findings (Mandzáková, 2011), we can include the following in the problems of sexuality and the implementation of sex education in social service centers in Slovakia:

  • lack of intimacy and opportunities for bodily and feeling-sensual self-knowledge;
  • failure to ensure co-education;
  • lack of respect for clients' sexual needs and sexual rights;
  • sexual abuse by close people (employees of the social services home), or by persons of a higher mental level;
  • unplanned pregnancy and sexually transmitted diseases;
  • insufficient or missing sexual awareness and sexual education;
  • insufficient training in sexual matters;
  • absence of interdisciplinary cooperation.

In the following lines, we specify the mentioned problems and supplement them with our research findings.

Collective care is characterized by a lack of intimacy and opportunities for bodily and feeling-sensual self-knowledge. According to B. Bazalova (2009), the problem is that the state still supports and still prefers the life of people with mental disabilities in large facilities. Clients of welfare homes lack privacy, whether for masturbation or for couple sexual activities, unless the users of these facilities are lucky enough to be supported in these activities. L. Novosad (2002) draws attention to the generally known stimulus, cognitive, emotional and performance deprivation threatening persons with mental disabilities in facilities with permanent residence.

Based on the research carried out by us, it can be concluded that there are relatively large differences in the individual facilities, as regards the quality of the services provided. On the one hand, the Slovak Republic has modern facilities that offer their services to clients who live alone in a room, on the other hand there are large, sometimes uncoordinated facilities where the client lives with a dozen other clients. A key factor is the very unnaturalness of institutional education (e.g. in social service homes with full-day stay there is a lack of contact with the family, the risk of role confusion). Research has confirmed to us that in most institutional facilities there is still a lack of sufficient privacy for people with mental disabilities. This is related to the existence of the already mentioned large facilities (risk of isolation, abuse, the need to adapt to the regime, the needs of other residents, etc.). The majority of social service homes in Slovakia provide their services to more than 30 clients, which is a key threshold in terms of assessing the quality of the services provided. Although the findings of the majority of co-educational institutions' clients are positive, we are forced to mention that even in some co-educational institutions, individuals have limited contact with persons of the opposite sex.

Of the 28 social service centers that participated in the research, 82.14% (23) of the facilities provide their services to more than 30 clients (in one social service center). We present the limit of 30 clients considering that this is considered by European experts to be crucial from the point of view of assessing the quality of services. In an institution that has more than 30 residents, there is a higher probability that some of the basic human rights will be violated (Kozáková, 2005).

An important indicator of the quality of the provided residential service is also the number of clients occupying a common room. As part of our investigation, we determined the minimum and maximum number of clients occupying one room. A very gratifying finding is that 25% of the 28 facilities surveyed reported at least one user occupying one room. On the other hand, rather worrying information is that one device listed as a minimum number of 8 users living together in one room. The facts when determining the maximum number of clients occupying one room were alarming, where in one case 11 clients were listed as the maximum.

Co-education is not provided in social service homes. As for the healthy sexual development of persons with mental disabilities, it must often be pathological, especially in those facilities that are not co-educational. In our research, we noted a fairly well-known fact, namely the significant preponderance of women (76.45%) in the staff of social service homes, i.e. the lack of a male role model in these types of facilities. Clients with mental disabilities thus grow up in an environment where, apart from female staff, they have never seen a person of the opposite sex.

It is obvious that clients of social service homes do not have the same conditions as other individuals for the undisturbed development of their sexual life. I. Burdová (1988) calls this phenomenon an unhealthy "Love map", i.e. "Map of love" - which is what we imprint on the child's memory in the field of sexual development from an early age. As B. Bazalová (2009) adds, such conditions would deform even a person without a mental disability (e.g. prisons), not a person who has problems with logical judgment, evaluating situations, generalization, analysis, synthesis, communication, imagination, etc. According to K. Matulay (1986), the atmosphere in co-educational facilities is noticeably better than in facilities with clients of the same sex, as daily contact with the opposite sex helps them better adapt to the demands of living together.

A positive finding is that in the social service homes mapped by us, out of 28 facilities, only one facility was non-coeded. 298 clients placed in co-educational institutions and 68 clients placed in non-co-educational institutions were included in the comparison of sexual manifestations (Mandzáková, 2011). Even though the findings of the majority of co-educational institutions' clients are positive, we are forced to mention that even in some co-educational institutions, clients have limited contact with persons of the opposite sex.

Social service homes have little respect for the sexual needs and sexual rights of their clients. Loss of privacy is a regular tax for staying in a social service home. It is often a matter of being forced to endure a small space with clients whom one cannot choose. The feeling of loneliness is often perhaps the biggest problem of these persons. During the day during employment, they can usually find a friend in a sheltered workshop or in a day care center, but loneliness is often at risk during their free time (Matulay, 1986). Loneliness and isolation can be the cause of the lack of opportunities to have relationships with loving people. One must be aware of the importance and overall essence of human relationships. If we did not do this, we would ignore the perspective of understanding the individual as a whole.

The urgent solution to the situation in social service homes is all the more urgent because according to the Helsinki Declaration on Equality and Services for People with Mental Disabilities of July 11, 1996 (Preamble, Article 6): People with mental disabilities must have the right to live in the least restrictive environment providing privacy. Constitutions are in conflict with this principle, they are already modeled after, because they are based on the outdated principle of isolating people with disabilities.

The Declaration of the Rights of the Mentally Retarded also emphasizes that people with mental disabilities have the same rights as other citizens - that is, the right to sexual expression, to education and education in this area. In the context of law, it should be mentioned that even employees of social service homes often do not have sufficient rights in the area of ​​sexuality, many things are open to challenge, they would act contrary to the management and they would be threatened with dismissal or even criminal prosecution in the event of a problem (Bazalová, 2009). In this regard, it is necessary to emphasize that the area of ​​sexuality requires systematicity and clearly set rules in the given facility, so that there are no ambiguities.

Sexual abuse by loved ones, employees of social service homes, or by other persons of a higher mental level. We often encounter sexual abuse in social service homes, where abuse can also occur between clients. In many cases, facility employees abuse their power over clients to disproportionately punish, humiliate, or even sexually abuse them.

In our research to determine the prevalence of sexual abuse in 452 clients with mental disabilities placed in collective facilities, specifically in social service homes, we came to the results according to which the majority of professional employees did not encounter the mentioned problem among clients. Considering the majority, we could perceive this conclusion positively, but the value of 23.55% points to the presence of sexual abuse among clients with more severe mental disabilities (see Table 1).

Table 1 Presence of sexual abuse among clients in social service homes

Professional employees who encountered sexual abuse identified the perpetrator of sexual abuse as follows:

  • another client on a higher mental level,
  • client at a lower mental level,
  • another relative,
  • another foreign person.

In the answers, we also registered the worker of the social services home and even the parent of the client (see Table 2).

Table 2 Perpetrator of sexual abuse of clients in social service homes

The presented findings are evidence that there are many arguments in the literature for the claim that people with intellectual disabilities are exposed to a greater risk of sexual abuse and exploitation at the hands of workers, health professionals and family members than in the general population. At the same time, as stated by D. Štěrbová (2007), if we want to change the approach to people with mental disabilities and increase their quality of life, we need to uncover the problem of sexual abuse primarily by social service providers. For many clients, social service homes are their only home and they should feel at home there.

Unplanned pregnancy and sexually transmitted diseases. One of the consequences of not using contraception is undoubtedly an unplanned pregnancy. We present in the following part of the text what experiences professional employees in Slovakia have with unplanned pregnancy among clients of social service homes.

Table 3 Presence of unplanned pregnancy in social service homes

A positive finding is that the majority of professional employees did not encounter unplanned pregnancy in social service homes. Those who encountered this problem most often solved it by abortion, or by transferring the client to another device. However, even these cases can be prevented. We see effective prevention in sexual education and awareness of both professional employees and clients with mental disabilities.

Unplanned pregnancy is certainly not the only problem that can arise from the sexual activity of persons with mental disabilities. STDs are another potential problem that is often overlooked because (surgery) or contraception can give the false impression that 'there is no more danger'.

Sexual education and sexual education is minimal in these facilities. A problem in the area of sexuality of clients with mental disabilities is also the lack of information about the prevention and consequences of sexual activity. According to researches, only a small part of ordinary schools provides sex education (unless we consider a one-time lecture by an invited expert as sex education) (Weiss, Zvěřina, 2001). We were interested in what the situation is in social service homes in Slovakia.

Table 4 Implementation of sexual education in social service centers

As shown in Table 4, most facilities do not implement sex education. The reasons included the following: it is not necessary, there are no problems in this area, we have not dealt with it so far, he is not a qualified specialist, I do not know, severe mental disability, lack of specialist literature and seminars. In the event that sexual education is carried out in a social services home, there is an obvious preference for individual instruction or conversation with the client before other forms of sexual education implementation (see table 5).

Table 5 Forms of implementation of sexual education in social service centers

This confirms the statement of J. Walter (1994), according to which there is rarely a place for the implementation of sexual education at home and at school. We do not find space for the mentioned component of education even in the period of adulthood. It is no wonder that people with intellectual disabilities do not understand the connection between procreation and contraception.

Table 6 Presence of a sex education supervisor in social service homes

The data in Table 6 indicate that in most social service homes there is no senior worker who is responsible for solving sexual and partner problems. This finding is one of the arguments indicating the low level of implementation of sexual education in the social service centers mapped by us (if it is implemented at all).

Due to the interdisciplinarity of sexuality, which should be attended by a team of experts who care for a client with a mental disability, including family and other interested persons, it is necessary for the effective implementation of sexual education to appoint a person in the facility who would be entrusted with their coordination. In the homes of social services mapped by us, this fact is overlooked.

Another of the findings is that, apart from two facilities, no rules or guidelines have been drawn up in social service homes in Slovakia that would represent instructions on how to solve basic problems that occur in the field of sexual and partner relationships of clients with severe mental disabilities in the facility. Only one of the facilities has issued a guideline that is regularly checked and evaluated (see Table 7). According to Z. Kozáková (2005), it is important that social service centers have precise guidelines or agreements on how to solve basic problems that occur in this area. According to the author, they should also ensure that the behavior of employees in problematic situations is uniform, because that is the only way it can be effective. Abroad, this trend is a common and necessary condition for the successful implementation of sex education.

Table 7 Presence of guidelines for solving sexual problems in social service homes

Professional training in sexual issues is insufficient. A complicating factor in social service centers is apparently insufficient training of professional employees working with clients on how to react and correctly solve problems that arise and insufficient training of the clients themselves. Our research confirmed the negative assessment of client awareness by professional employees of social service homes. When asked about the need to expand the knowledge of clients with mental disabilities in the field of sexual education, a negative opinion about sexual education and awareness dominated among this target group of people. Despite the minimal awareness of clients in the field of sexual education, the majority stated that an increase in awareness is not necessary for this group of people (see table 8). Here, too, the negative attitude of professional employees towards the implementation of sexual education for clients with mental disabilities is reflected.

Table 8 Need to expand clients' knowledge in the field of sexual education and awareness

Table 9 Completion of professional training of professional employees in the field of sexuality and sexual education of persons with mental disabilities

We came to equally negative conclusions from the data presented in Table 9, which reflect that the majority of professional employees did not complete any professional training in the field of sexuality or sexual education of persons with mental disabilities. In cases where they completed it, it was mainly training, lectures during their studies, a seminar and a sex education course. The following were the reasons why the respondents did not complete the education: there was no opportunity, they are not organized, it is not available, it is not necessary, I was not sent, there was no proposal from the management - the employer, I do not know, and for financial reasons. Professional employees who completed the training evaluated it as rather beneficial, in which we see a positive trend pointing to the importance and justification of further education in the addressed area. The presented conclusions of the training of professional employees in the field of sexuality and sex education indicate the need to improve the situation by implementing continuous education with the provision of quality training to solve this complex issue of the life of people with mental disabilities.

On the basis of the research carried out by us, we can conclude that there are relatively large differences in the individual facilities, as regards the quality of the services provided. On the one hand, the Slovak Republic has modern facilities that offer their services to clients who live alone in a room, on the other hand there are large, sometimes uncoordinated facilities where the client lives with a dozen other clients. The institutional facility should open up to the surrounding society as much as possible, making maximum use of the social learning of clients directly "in the field". Contacts with the general population motivate clients for continuous development and education. Thanks to very important feedback, they learn faster and positive feedback is much more motivating than learning in a non-stimulating rigid environment in which the individual does not have the opportunity to use what he has learned.

At the end of this section, we present the obligations of a social service provider abroad. The development of a clear facility policy should guide professional staff to further education, ensure a thorough individual assessment of competence, and at the same time provide program participants with the education and training they need in the area of ​​sexuality, including personal protection and ensuring adequate supervision of the protection from harm of those who are unable to protect themselves - all of these are basic obligations of a social service provider abroad (Sweeney, 2007). Although all these precautions are taken carefully, incidents can occur. Facilities must create an environment that estimates the confrontation of facts while looking at the incident as an opportunity for critical introspection or for seeking outside help and for learning from these experiences that can prevent recurrences and enable better protection of persons with intellectual disabilities. All this may sound like a big challenge for social service providers in Slovakia. What keeps us optimistic is our work in monitoring sexuality education that should serve people with intellectual disabilities.

At the end of the post, we state that a successful sex life and everything related to it is today generally considered one of the basic human needs and all adults without distinction have the right to it. There is therefore no reason for people with mental disabilities around us to be disabled in the sexual area in addition to their primary disability. However, the analyzed problematic areas of the sexuality of persons with mental disabilities clearly say that we still cannot talk about their successful socialization or comprehensive support in this area.

Authors: PaedDr. Stanislava Lištiak Mandzáková, PhD., doc. PhDr. Dagmar Marková, PhD.* The contribution was created thanks to the support of grants: VEGA 2/0015/12 (2012-2015): Lifestyles, norms and their transgression: paths to personal satisfaction and social benefit. VEGA 1/0942/11: Improving the quality of life of clients with severe mental disabilities in social service homes in the area of ​​sexuality and partner relationships. APVV 0604-10: Sustainable reproduction in Slovakia: psycho-social investigation. *Literature

BAZALOVÁ, B. 2009. Autism, relationships and sexuality here and abroad. In: Sexuality of the mentally disabled - II. : collection of materials from the second national conference organized by Fr. with ORPHEUS. Prague: Center of daily services o.s. ORPHEUS, 2009, p. 45-56. ISBN 978-80-903519-7-4. BURDOVÁ, I. 1988. Course on the sexuality of persons with mental disabilities. Prague: Pragoversa, 1988. CHOVANEC, M., WEISS, P. 2011. Sexual behavior of secondary school students. In: Sexuology, 2011, vol. 11, no. 2. ISSN 1335-8820. KOZÁKOVÁ, Z. 2005. Safety education and sexual education of persons with mental disabilities. In: Domestic violence and the disabled: collection of materials from the national conference. Prague: HB Print, 2005. ISBN 80-903519-2-1. MANDZÁKOVÁ, S. 2011. Improving the quality of sexual and partner life of persons with severe mental disabilities. Prešov: PF PU in Prešov, 2011. ISBN 978-80-555-0455-1. MANDZÁKOVÁ, S., HORŇÁK, L. 2009. Sexual education and preparation for partnership of persons with mental disabilities. Prešov: PF PU in Prešov, 2009. ISBN 978-80-8068-935-3. MATULAY, K. 1986. Mental retardation. Martin: Osveta, 1986. NOVOSAD, L. 2002. Health disadvantage and the risk of sexual abuse or assault. In: Protection of the disabled from sexual abuse: Health education publication. Prague: Association of the Disabled in the Czech Republic, 2002. p. 20-24. POLIAKOVÁ, E. 1996. Notes on the process of sexual education. In: Poliaková, E. et al. Education for parenthood, marriage and the ethics of intimate relationships. About the project: Professional preparation for educational and educational work on children in matters of parenting, marriage and the ethics of intimate relationships. Nitra: Slovdidac, 1996, p. 149-150. ISBN 80-967339-8-2. POLIAKOVÁ, E. 2003. Development of sexual education in Slovakia. In: Bianchi, G. (Ed.). Upgrade for sex education. Bratislava: SAV VEDA, 2003, p. 11-20. ISBN 80-224-0783-6. SWEENEY. L. 2007. Human Sexuality Education from Students with Special Needs. [online], [cited 2008-07-14]. Available online: //www.ejhs.org/volume10/Marsh Media%20White%20Paper.pdf. ŠILEROVÁ, L. 2003. Sexual education: How and why to talk to children about sexuality. Prague: Grada Publishing, 2003. ISBN 80-247-0291-6. ŠTĚRBOVÁ, D. 2007. Sexuality of persons with mental disabilities. Olomouc: Palacký University in Olomouc, 2007. ISBN 978-80-244-1389-2. TÓTHOVÁ, M. 2001. Sexual education and preparation for partnership for people with specific needs. In: KLIMEK, Ľ., KLOHNA, B. (Eds.). Love, partnership, erotica and sexual life of physically disabled citizens: collection of lectures, Zemplínska Šírava, 25.-28.10. 2001. Prešov: ZOM, 2001, p. 9-20. UZEL, R. 2009. Planned parenthood for people with mental disabilities. In: Sexuality of the mentally disabled - II. : collection of materials from the second national conference organized by Fr. with ORPHEUS. Prague: Center of daily services o.s. ORPHEUS, 2009, p. 112-118. ISBN 978-80-903519-7-4. WALTER, J. 1994. Sexuality und Geistige Behinderung. [online], 1994. [cited 2011-08-11]. Available online: http://bidok.uibk.ac.at/library/walter-sexualitaet.html WEISS, P., ZVĚŘINA, J. 2001. Sexual behavior in the Czech Republic – situation and trends. Prague: Portal, 2001. ISBN 80-7178-558-X.