University of Edinburgh

Workshop 2: Sex Education, who is limited? Knowledge, skills and feelings of both parties

From the Conference: Sex Education for Children and Young People with Visual Impairment, Scottish Sensory Centre, March 1998

Dr Sytske Brandenburg,
Theofan Institute, The Netherlands


I will start by introducing myself: My name is Sytske Brandenburg. I work within an institute and school for children with visual impairment. It is very similar to the Royal Blind School. Within this institution, I work as an educational psychologist with adolescents.

You made me come over from the other side of the North Sea specially to tell you something about sexual education, because a book was written about the subject. A large part of my lecture is based on the yet unpublished literature study of a fellow-institution, called Visio. For a time, I was a member of the group which advised the writer. And now I can already tell you that the content of the book will not solve your problems.

The aim of this book was to develop special education for children and young people with visual impairment. A main question was how visually handicapped children and young people are dealing with the visual information which sighted children receive intentionally for a small part and unintentionally for the greater part. The sexual development of visually impaired children was compared to the sexual development of sighted children of the same age-group. At the end of each chapter recommendations are given.

For my lecture, I made use of the content of the book, but I included other references as well, and my personal experiences in the school and residential setting as a counsellor of teachers and care staff.

Within our institution, the extra interest in the subject of sexual education comes up regularly.

On the one hand, we have to make sure from time to time that the responsibilities between parents and care staff is properly defined: we have to prevent the situation in which parents are assuming that the institution takes care of sexual education, while we are assuming that this is the responsibility of the parents.

On the other hand, this extra attention is connected with the fact that pupils are more open nowadays about, for instance, incest experiences, so that, within our institution, we have to discuss how to deal with this phenomenon and how to recognize its signs.

2. AIM

With the sexual education of children and young people with a visual impairment we do not want to achieve anything other than with the education of sighted children. The road towards this aim is sometimes different, because of the impairments.

First of all, I would like you to join me in looking at the aim we set ourselves for every child in principle. What do we want to achieve with our sexual education? What do we aim for our own children?

a. First, we want to achieve that, now and in the future, children will enjoy sexuality.

b. Second, one of the aims of sexual education is to teach sexual standards and values as well
For example: They should know about which sexual behaviour of adults is outside the commonly accepted standards and values, such as voyeurism, 'child molesters', unwanted liberties at home, at school and during their spare time or at school, and they should know how to react.

c. Third, we want to achieve that children and adolescents have sufficient technical knowledge concerning sexuality.

I hope you agree with me on these three aims: enjoying sex, standards & values and knowledge.

When we know what we want to achieve, the next step is: what do children need at what time, in order to achieve this aim. And who is responsible! We need knowledge about the sexual development of children and about the available educational means. If a child has limitations, it is good to know whether these limitations influence sexual development and education. And parents are responsible for sex education: I am responsible for the sex education of my own children and nobody else: what the school contributes is OK, but it remains the responsibility of the parents.


Sexual development can be described from various theoretical perspectives. We will briefly mention three models:

  • the biological model,
  • Freud's theory and
  • the theory in which sexual development is regarded as a social learning process.

The biological model emphasizes physiological development, cerebral activity and hormonal influences.

Freud's theory, which distinguishes 5 stages in childhood (oral, anal, phallic, latency and genital), assumes that during the latency stage sexual behaviour disappears from children's interest.

The theory describing sexual development as a social learning process, provides the largest number of leads for sexual education.

Sexual development is then regarded as a learning process during which the child builds up a particular script or scenario, which will be adjusted in the course of a person's development, by new experiences and new cognitive and emotional developments.

So our behaviour in this respect towards the child will form a part of the scenario of the child's sexuality and therefore is important for how the child deals with sexuality.

Now I would like to concentrate on describing how the sexual development of sighted and visually impaired children takes place.


You all know that in the development in question we can distinguish the following periods
A. Infancy, up to 2 years old
B. Toddlers and preschooI years, 3 to 6 years old
C. School-age years, 7 to 12 years old
D. Adolescence, 13 to 17 years old
E. Early adulthood 18 to 23 years old

I will start with:

A. Infancy, up to 2 years old

The development of a child into a woman or a man starts at conception when the composition of chromosomes determines whether a girl or a boy will be born. The parents go along with this biological fact by giving the baby a 'girl's name' or a 'boy's name'. The child's sexual development has started then. Parents, and important others, confirm a child's sex by naming it, "yes, it is a boy", by the type of toys, by the colour of its clothes, the way of reacting, etc.

The baby is not yet aware of being either a girl or a boy. A baby experiences lust: it explores its own body and accidental behaviour causes pleasurable sensations. Visual perceptions do not influence a baby's experience of lust. Visual limitations do influence the early-parental interaction and the formation of a sense of self. This sense of self is prerequisite to the formation of self-awareness. And, subsequently, this is important for the sexual development of a toddler.

As you know, children with a visual impairment develop this sense of self later than sighted children, and this development therefore requires extra parental support.

Now we turn to the

B. Toddlers and preschool years, 3 to 6 years old

First, a toddler becomes aware of himself, begins to experience himself as 'I' and knows to what sex he belongs. Sexual interest originates from sexual curiosity about his own body, but in particular about other people's bodies. A young child compares itself with others and notices that not everybody looks the same: some people are tall, others are small, some people have a beard and others have long hair; what also attracts their attention, when they see other people's naked bodies, is the fact that not all children and adults look the same. They begin to name what they see, they ask how this or that is called, they ask: "why don't you have a willy, why do you have breasts and why doesn't daddy?"; they compare with themselves and discover similarities and differences.

Usually, these questions come up as one goes along; the child's attention is soon attracted by something else and it does not need detailed explanation. All these small conversations in and around the bath room, swimming pool and bedroom within a familiar environment give a child the feeling that it is about very normal matters about which you can ask whatever you like, just as about the cat that died and the toy car that is broken.

I already mentioned, self-awareness of blind children starts a little bit later than that of sighted children; they also call themselves 'I' a little bit later, but the course of development runs as good as parallel.

Asking spontaneous questions about what they see will not occur in the case of blind and severely visually impaired children. They have to rely on other senses and in this situation, the sense of touch provides most of the information. At this age only is it socially acceptable that children are using their hands to feel other children and adults, also at more intimate places. Bathing and showering together, not deliberately covering nakedness, helping to bathe a baby and being allowed to feel it, feeling the breast of a breast-feeding mother, are all moments in which blind children can make comparisons naturally by touch and ask questions. It is important that the answers fit in with what the child is equal to. The answers should not become theoretical lessons: short and clear answers will do for visually impaired children as well. If they sense that the opportunity for asking questions is there, they will ask again some other time.

A second characteristic in this period is that a child's behaviour is exploratory and not much restrained by feelings of shame and guilt. They touch erogenous zones, ask questions, watch naked people uninhibitedly, make remarks which are purely informative from the point of view of the child.

We, as 'care staff' are nearly always confronted with our own boundaries when children are touching our erogenous zones. When, in the case of blind and seriously visually impaired children, touch is the only way for a child to acquire anatomical information, 'care staff' are confronted with their own boundaries even more. They will feel the responsibility to provide the information by touch, but, at the same time, touching can evoke feelings of insecurity:

What will happen when the child in question talks about it to other people?
Is the child learning now that it can touch everybody's penis or vulva?
Being touched by the child could also evoke feelings of an erotic nature.
You all know that erotic feelings of the adult are making the interaction between child and adult more complicated. The adult is not just the provider of care in such a situation, but a sexual participant as well.

The only way, I think, to deal with this is to communicate about your feelings with your partner and, in a residential school setting, with somebody you trust. When you have made it clear for yourself where your limits are to being touched by someone else, you will be able to respond appropriately to the child and the situation will sort itself out.

As a third point, I will mention the importance of play

During play, sex roles become clearly recognizable. It is the period of sex-tinted games: playing doctors and nurses, playing house. Children become fascinated by nudity. Through play, they discover much about themselves and other people, they discover feelings of lust in themselves by touching, by themselves or by others.

Dolls with a willy and with a vulva provide visually impaired children the opportunity to ask questions that belong to their age and to explore by touch in peace and quiet without the direct presence of adults.

Sighted children are learning role behaviour by imitation. They see how father makes the meal or washes the dishes, they see how mother uses her make-up.

Blind and severely partially sighted children hardly ever come to fantasy play spontaneously. First they should act out together with adults what sighted children are imitating, and the toys should be handed to them. Supervision of play is very important in this period in order to give the visually impaired children the opportunity to experiment with the role of man and woman and to discover their own and someone else's body through play.

And now:

C. School-age years: 7 to 12 years

I already mentioned that Freud assumed that during this period sexual behaviour disappears from children's interest, which is refuted by recent research, however.

First I want to mention that in this period, children are curious about facts about sex. They are interested in the technical story about sperm-cells and egg-cells, but that does not have much to do with their own sexuality. In this period, children ask less and talk less about sex. But that does not mean that they are less interested in sex.

In the case of blind and severely visually impaired children, the feelings of shame and knowing the generally accepted norms may start some-what later and adults could find themselves in awkward situations because of these children.

For example: Our new deputy director of the school was introduced to a class with 7-8 years old visually impaired children. In a loud voice, one of the blind girls asked him whether he has a willy. He felt really embarrassed.

For the child's self-image it is important to react properly in this case: on the one hand one should be clear about what is not proper anymore at this age in order to protect them against rejection (teaching the values & standards); on the other hand one should take a somewhat slower development of the visually handicapped child into account and give the child the chance to complete its development properly.

Every time it is important to realize in what direction you will adjust the internal scenario of the child about sex!!!

At the end of the school-age years all children, but the visually impaired children in particular, should know the most important facts about sex. This includes the differences between men and women, how children are 'made', how children are born, which contraceptives are available, etc.

Visually impaired children should feel what the contraceptives look like, they should feel what a condom, a sanitary towel looks like. This is important for both girls and boys.

They should know what is 'going on' with the other sex: boys should be informed about menstruation, girls about erection and ejaculation.

To be well-informed is immensely important for visually impaired children, because they never know exactly what they have missed. It is important to prevent insecurity when their 'more mature' peers are telling jokes and are eager to take advantage of the greenness of the 'younger and more naive children.

Sighted children pick up a lot of information casually through television and commercials, by just looking around. They are looking at pictures in books. Information books are often richly illustrated. They can look at one thing and another at their leisure.

This information should be offered differently to partially sighted and blind children. When reading to the children, adults could pick between a book containing sexual information or a book which invites discussion about this subject. Children can also listen to books on tapes about sexuality. In this case too, it is important that the adults take up what the child wants to know: it should not become a lesson.

The adult should pay attention to matters which are day-to-day occurrences for sighted children: for instance, how do people in love cuddle, hug and kiss? In the Netherlands, we have a soap which is broadcasted daily, containing many leads for explaining one thing and another in the field of sex information and relationships. This applies to sighted children, but to visually impaired children in particular, and for their educators it is a unique opportunity to talk about sex in a natural situation.

Sighted boys and girls know the anatomical differences between the two sexes by looking at naked people and by watching television and reading books. They do not need to touch anymore.

Because of some delay in development and because of lack of visual information, blind children still need touch as a source of information. The information by touch must be given before the child becomes emotionally and perhaps erotically involved in the exploration. There is not one and the same solution for all children: talk about how to deal with it with the parents for each child individually. Look for alternatives when parents find it difficult if their child touches the parent's erogenous zones. Create an open sphere in which everyone, parents and care staff in the residential school, can talk about the difficulties and possibilities.

In our residential unit, parents come twice a year to set up and evaluate the individual education plan together with the care staff. Sexual development is one of the topics that are discussed on these occasions. So twice a year, parents and care staff can adjust to each other on this subject.

In addition to curiosity about sex, children feel a strong need for identification with their own sex during this period. Sometimes they react against the other sex. They have a clear idea of which behaviour belongs to boys and which behaviour to girls.

This applies to visually impaired children as well. A point of special attention in this respect is that some children sometimes need support which enables them to join the games of other children. For example, it is easier to join in a game with sighted girls in the playground when the teacher picks it up and teaches the rules of this game during P.E. Play and social behaviour offer possibilities of developing a positive sexual identity. This concerns the creation of favourable conditions, rather than specific support of sexual development.

During this period, sexual feelings for each other do not play a role yet, but children can become aware of sexual feelings in themselves as the result of masturbation or 'playing games' with each other.

Now we turn to the fourth stage:

D. Adolescence, 13 to 17 years old

For young people with visual impairment, the following is of special importance:

a. Information about sexuality:
* The information they already have takes on another dimension.
On the one hand, they can follow the mainstream school programme in which the elements of sexual education are included. When they need more detailed information and exploration, they mostly need more privacy, and, in particular the blind pupils, more time to ask the questions they really want to ask.

In a rather small residential area, everybody knows one another very well. For the boys and girls who need protection of their privacy before they really ask the questions they want, it is better to provide the sexual information and to relate it to others, individually or in a small group of pupils, who are suited to each other. Then, separate groups for boys and girls are necessary. When you work in this way, with small groups, providing this information is rather the task of the care-staff member who lives with the children than of the teachers.

Secondly, an important element is the development of identity and social skills. Visually impaired adolescents with sufficiently developed social skills develop their identity largely within their peer group.

Since many contacts are made and built up by means of eye contact, it requires extra social skills of visually impaired adolescents to gain the same experience within their peer group: they rely on the help of their friends, for example to find out whether a boy, who they find attractive, is looking at them. Asking for this type of help, is one of these social skills.

Another thing is that because of their eye disorder, the eyes often look deviant and this can frustrate a first contact because this deviation does not fit in with the general image of a good-looking girl or boy. The first impression of a visually impaired person is often one of innocence and adolescents have to compensate for this with good social skills to have an equal chance to get to know each other.

Social skills can be learned spontaneously within a peer group. Some-times, it requires extra support. This is possible by participating on purpose in structured activities in which making contact is inherent in the activity, such as taking dancing classes. The organization of a birth-day disco can also be a possibility to ensure contacts with peers. Or by participating in a social skills training course, together with other visually impaired adolescents.

Another point is that a positive development of identity with boys can be hindered when they need physical guiding by other boys. Because this can be interpreted as homosexuality. To be called a homosexual is very often experienced as threatening and wounding by boys. The way in which adults can react to this by rejection of homosexuaIity can also be threatening to boys who are recognizing homosexual feelings in themselves.

Now the last period:

E. Early adulthood, 18 to 23 years old

During this period, people will develop what they have started during previous periods. This period is characterized by starting relationships, the further development of sexual behaviour, the formation of the self-image and identity.

During this period, good information should have been given already, or should be given now, about the possible heredity aspect. It is important that a young adult knows about the risk of having a visually impaired child. It might influence the relationship with somebody of the opposite sex.

There must be room for sharing the pain when a young adult establishes that he does not want to give his child the same handicap.

I would now like to finish the first part, in which I spoke with you about the sexual development and education of the sighted and the visually impaired in general.

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I would like to finish my lecture by paying attention to some special groups:

A. MuIti-handicapped children and young people
B. Children and young people with a non-western cultural background
C. Young people with a contact disorder, related to autism


In the case of this group, parents and educators will have to reconsider the aims again: what does our education aim at:

  • the preparation for a sexual relationship, or
  • a way of expressing sexual feelings without a relation with another, for example by masturbation,
  • learning the standards and values?

With some of them we have to answer questions like: how do you deal with the desire to have children and how do we react to the pain and disappointment this can bring?

In the Netherlands, we have an information package for sighted mentally handicapped people with teaching material about friendship, courtship, etc. It is supported by video films about people who are making love, about masturbating people. We use part of this material for our young people. It requires an expert balance between the develop-mental level of the person in question and the available material.

At the institute Ganspoel in Belgium, teaching material has been developed for sexual development, in which care staff and teachers carry out these lessons together. As a working instrument the "Diagram of the Scaraborough Method" is used, in which knowledge, skills (social and sexual) and attitude are all dealt with.

It is set up as follows:

  • Explanation of the concept (with pictures and words)
  • Emotional influence of seeing and hearing
  • Personal hygiene and health aspects
  • Socially adjusted behaviour
  • Biological explanation
  • Psycho-emotional effects
  • Social-biological effects

I shall explain this with an example:

Subject: masturbation

Brief definition of the subject and explanation of the concept

Attention to how the person behaves when hearing the explanation

How do you take care of your own body? What do you do afterwards? What if you fail? What if you need help? Whom will you ask?

When and where can you masturbate?

Biological explanation

How do you feel in this act? Do you have enough privacy? Is this sufficiently respected? Do you feel guilty?

Directing your attention to the other person, in search of a lover, building up a relationship, procreation.

These themes are all dealt with in this way in the case of visually impaired and mentally handicapped young people. The higher the intellectual and social level, the further the diagram can be explained. It is important to always keep the same structure, otherwise they will get confused.

The second special group:


I will not enter into this in detail because the cultural background of the ethnic minority here differs from our country.

The main problem within our institute occurs if sex before marriage is not allowed within the culture in question. For this reason, sex education is not necessary and even forbidden. But if we notice that within the residence sexual contacts do occur and if we think that that is quite normal and good, we are placed in the dilemma of whose responsibility this is and how we will cope with the risk of unwanted pregnancy. We find out, together with the boy or girl concerned, in what way they are acquiring their information. They all follow the normal program in our school and will certainly obtain their information that way. Sometimes, it is acceptable for the young people and the parents if a medical doctor gives information about contraceptives.


These young people form a growing part of our institute and school population, now that the greater part of the young people attend integrated education. As early as in their elementary school period, this group shows typical behaviour. Characteristic is that on the one hand they behave quite normal, but on the other hand one can see that, in spite of their need for contact, they express this need in such a way that it is decidedly odd. Some of them are strongly oriented towards a particular activity or particular objects or have good contacts with adults only.

During the individual talks with boys, several spoke to me about curious ways of becoming sexually exited. One of them became sexually excited by handling the hair of other boys. Another one by hearing a vacuum cleaner, while touching a bathing slipper, belonging to peers or adults, with his bare foot

They were looking for these kinds of contacts with others, but this behaviour is only socially isolating them even more

Expert supervision which recognizes these feelings is very important in this case. But at the same time, it must be indicated that this is not socially accepted behaviour. Trying to find socially accepted alternatives together with the young person concerned is a long and often difficult process.


I hope you have understood that we have to provide the children with knowledge, with skills and with a positive attitude to sex.

We need to have:

  • knowledge about sex development, educational means and about standards and values;
  • skills to communicate with the children
  • an attitude that gives the children the opportunity to see our real feelings about sexuality and, hopefully, to see that sex is something to enjoy.

The task to do deal with all these aspects well is just as impossible as having a simultaneous orgasm with your partner every time.

So, please forget everything I have said, use your own common sense and take a number of steps:

The following steps could be worthwhile:

A. Set up a work group with a parent, a care staff member and a teacher for each stage and go through the next steps:
- Make clear, in concrete aims, what you want the child to know about facts, what about sexual behaviour and what about sex in a relationship.

- Look at society and ask yourself:

  • what is normally the responsibility of the parents and what happens in mainstream schools;
  • where and when do you, in your private situation, talk about sex with your own children?
  • sitting round the table during dinner or after dinner
  • during washing the dishes
  • when you go out with one of them
  • when you say goodnight
  • when you are watching a TV programme or reading a book to the child.

B. First do the regular things:

Establish that, in the first place, parents are responsible for sex education;

Choose for the school a published Sex Education Scheme to provide a framework;

Make living situations in the residential area as natural as possible:

  • let the pupils live in normal houses, with the same kind of privacy as regards bathrooms, etc.
  • let pupils eat together in their own living group
  • let pupils travel by train and by bus, etc.

C. Create sufficient possibilities in the residential area and in the home environment for the visually impaired to make contacts with peers: this is the most important condition for sexual development.

D. Adjust the school Sex Education Scheme to blind and visually impaired children, have this done by the same work group and take into account:

  • these children will develop a little bit slower than sighted children of the same age: allow them more time
  • they obtain information somewhat slower
  • they acquire information in a different way: they have to touch more

E. But perhaps most important: create an atmosphere of openness and respect among those who provide care: the parents, the care staff and the teachers, with respect for each other's feelings and boundaries.
Perhaps this is the most important message the children will need and will take with them.


American Foundation for the Blind, Inc. (1975) "Sex Education for the visually handicapped in schools and agencies... .selected papers". New York.

Dickman, I.R. (editor) (1975) "Sex education and family life for visually handicapped children and youth: a resource guide". New York.

Gort, A. (editor) (1995) "KIeine mensen, grote gevoelens". SymposiumversIag Rutgers Stichting.

Kef, S., Hox, J.J. & Haekothe, H.T. (1997) "(On)zichtbare steun". Onderzoek naar visueeI gehandicapte jongeren en hun netwerk. Amsterdam.

Kent, D. (1983) "Finding a way through the rough years; How blind girls survive adolescence". In: Journal of visual impairment & blindness 1983 77 (6) 247-252

Neff, J. (1983) "Sexual well-being: a goal for young blind woman". In: Journal of visual impairment & blindness 1983 77 296-299.

Schuster, C.S. "Sex-education of the visually impaired child; The role of parents." In: Journal of visual impairment & blindness 1986 80 (4) 675-680.

Schuster, C.S. "Sex-education of blind children Re-examined". In: Journal of visual impairment & blindness 1987 81 (3) 95-99.

Scheepers, M. e.a. (1997) "Seksualiteit en relatievorming bij personen met een visuele handicap". Vormingsprogramma, samengesteld door Ganspoelinstituut, GanspoeI 2, 3040 HuIdenberg, Belge.

Stuart Green, L., Stone, J. (1996) "The sexual abuse of children with visual impairments" In: The British Journal of visual impairment, 1996 14:2.

Terlouw, A. (editor) (1994) "Geen kind meer"; SeksueIe voorIichting aan jonge-ren met een verstandelijke handicap vanaf 1 2 jaar"; uitgave van de Rutgers Stichting.

Visio-uitgave (yet unpublished) "SeksuaIiteit onder de loep"; De seksuele ontwikkeIing van slechtziende en bIinde kinderen en jongeren. Address: Visio Centraal Bureau, Amersfoortsestraatweg 180, 1272 RR Huizen, The Netherlands. Tel. + +31 35-698571 l/fax. + +31 35-6938456