Building Better Sex Education for Blind Students: A Review of APH’s Guidebook

Resource Reviews

By Laura Millar, MPH, MA, BSAN co-founder

Blind young people deserve sexuality education that helps them understand their bodies, communicate their boundaries, build relationships, and make informed choices. The quality of an accessible lesson depends on the understanding and agency it gives the learner.

The American Printing House for the Blind (APH) publishes Health Education for Students With Visual Impairments: A Guidebook for Teachers. Its third chapter, “Sex Education,” by Stacy M. Kelly and Gaylen Kapperman, offers teaching guidance for educators, including teachers of students with visual impairments, often called TVIs. APH describes the guidebook as a supplement for teachers, rather than a complete curriculum.

The chapter considers how to make sexuality education accessible when lessons often rely on pictures and visual demonstrations. It discusses tactile teaching materials, preparation for classroom learning, condoms and other barriers, sexually transmitted infections (STIs), consent, and sexual-assault prevention. These are practical decisions about what students learn and how they experience a lesson.

You do not need to have read the chapter to take part in this discussion. The central questions apply across sexuality education: Does a teaching method respect the learner’s consent? Does it support independence and accurate understanding? Does it make room for relationships, pleasure, and choice? We explain the relevant examples below and include section names for readers at APH and others who have access to the chapter.

Developing accessible teaching materials takes substantial research, practical work, and collaboration. This chapter offers useful approaches and deserves thoughtful engagement. It also contains recommendations that need correction or reconsideration.

This is a public health review informed by disability justice. It asks whether the information is accurate, whether the teaching supports informed decisions and access to care, and whether the learner’s dignity and choices are respected. It also asks whose experience shaped the material and whether blind people have a meaningful role in improving it.

These questions matter beyond one guidebook. Information about bodies, prevention, and relationships becomes useful when people can understand it, apply it, and obtain support. A lesson that produces shame, implies dependence, or leaves a practical skill unexplained can fall short even when its materials are available through touch.

What the chapter contributes

The chapter recognizes that a lesson built around pictures and visual demonstrations needs more than a change of format to become accessible. Its practical attention to tactile models, descriptions, and preparation gives educators ways to make body knowledge more concrete.

There are other strengths worth building on: supporting participation in classroom instruction, making anonymous questions accessible, recognizing diverse sexual and gender identities, and teaching that sexual assault is not the victim’s fault. The chapter also addresses consent and acknowledges that sexually transmitted infections can occur without noticeable symptoms.

These are meaningful foundations. They make room for information and questions that blind students should have access to throughout their education.

My review and our BSAN conversations

I am Laura Millar, a co-founder of the Blind Sexuality Access Network (BSAN). I submitted professional reviewer feedback on an earlier draft of this chapter. That feedback drew on my research, work in public health and sexuality education, and lived experience as a blind person. The guidebook acknowledges my contribution.

Several of the original concerns I raised in that professional review remain unresolved in the version examined here. These include how consent is put into practice during teaching, assumptions about blind people’s independence, the framing of sexual health, and whether students have meaningful choices about their learning.

Some changes in the 2019 version are consistent with my recommendations, including added lubricant education and a revision concerning parental permission for adult students. I cannot confirm which changes resulted from my feedback or how much of it was incorporated. Those changes do not resolve the concerns that remain, and acknowledgment of my contribution does not mean endorsement of every recommendation.

Within BSAN, we also had conversations about this chapter and approaches we did not find blind positive or sex positive. We discussed the importance of creating educational materials that would benefit blind students and could also improve learning for all students.

For us, blind positive education recognizes blind people as capable learners and decision-makers, with knowledge and experience that should shape teaching. Sex positive education provides accurate, age-appropriate information without shame and makes room for consent, pleasure, diverse identities, relationships, and the choice not to be sexual. A material can be available by touch and still fall short if the lesson undermines a learner’s agency or frames sexuality mainly through fear.

What we learned from testing models

As part of our research for the Blind Positive Sex Ed project, we built and tested some of the models recommended in the chapter. The feedback we received from community members ranged across the board: some models were experienced as unhelpful or comical, while others were incredibly useful, especially when paired with other teaching approaches, including our 3-D printed models and tactile graphics.

That range of responses matters. It does not support a blanket judgment that every recommended model works or that none of them do. It points to the importance of asking learners what a model helps them understand, explaining its limitations, and combining materials in ways that fit the learner and the lesson.

This experience also informs our wider goal: education developed with blind students can offer more ways for all students to understand bodies, ask questions, and take part. The value of a material depends on what it helps someone learn and how it is used, not simply on whether it can be touched.

Teaching examples: what to keep and what to change

The purpose of this review is to help blind people and their educators get more useful, accurate, and respectful sexuality education. The following examples explain the activity or recommendation, the learning goal it is meant to serve, the feedback, and how the approach could improve. You can use the reflection questions when planning a lesson or discussing revisions with colleagues.

The health corrections address specific inaccuracies. The teaching critiques examine what an activity may communicate and whether it supports the learner’s understanding, consent, and agency. The alternatives are BSAN’s recommendations. Section names and references to my original feedback give APH and educators a way to locate the issues without requiring other readers to consult the chapter.

1. Consent and physical guidance

The example and its purpose. In the instructions for making an oral-sex barrier from a condom, the chapter recommends hand-over-hand instruction while cutting the condom. This means an educator physically guides a learner’s hands through the task. Such assistance can convey a movement that a visual demonstration would otherwise show. The passage does not include an explicit step to obtain the learner’s permission before doing so.

The feedback and why it matters. My original review asked educators to introduce consent early, return to it throughout the chapter, and ask before touching students or moving their hands. The issue is more than whether a student completes the task. If an adult takes control of the learner’s hands without agreement during a lesson about bodily autonomy, the method can undermine the message. Permission to attend sex education is not permission for every form of touch used in teaching it.

A stronger teaching approach. Explain the task and available forms of assistance before beginning. Ask which approach the learner wants: verbal directions, independent exploration of a prepared example, or an agreed form of physical guidance. If guidance is chosen, agree on how the student can pause or stop it. A student who declines touch should still receive access to the lesson. Teach safe tool use and barrier placement as distinct skills, with support matched to the learner.

For educator reflection. What would happen in this lesson if the student said no to being touched? Would the educator change the method and continue teaching? That response is itself a lesson about consent.

Chapter location: Condom Use for Other Sexual Activities. Original reviewer feedback: page 2.

2. Independence, companions, and guide dogs

The examples and their purpose. In discussing drink spiking, the chapter recommends that a blind person be accompanied by a trusted sighted friend who can guard against someone altering a drink. Elsewhere it suggests considering a guide dog as a possible deterrent to sexual assault, while acknowledging a lack of supporting research. Both recommendations are presented as ways to reduce danger.

The feedback and why it matters. My original review questioned these recommendations because they place protection in sighted supervision or a mobility aid. A companion may be helpful when wanted, but being sighted does not establish that someone is trustworthy or able to prevent harm. A guide dog’s presence should not be presented as an evidence-based assault-prevention measure. These recommendations can also imply that blind people must secure special supervision before participating in ordinary social life.

A stronger teaching approach. Build on the chapter’s useful ideas about planning, communication, and student-generated strategies. Work through a hypothetical outing: choosing transportation, agreeing on optional check-ins, identifying people or venue staff to approach, and planning how to leave. Let the learner select support. Discuss what friends, educators, and venues can do to make help accessible, rather than placing the entire burden on the person at risk.

For educator reflection. Are we expanding the student’s options, or making another person’s supervision a condition of participation? Would we make the same demand of a sighted student? Retain and reinforce the chapter’s statement that assault is not the victim’s fault. None of these choices transfers responsibility away from the person who commits harm.

Chapter locations: Protection Against Sexual Assault for Young Adults; Alcohol, Narcotics, and Date Rape Drugs; Date in Smart and Safe Ways. Original reviewer feedback: pages 8–10.

3. Drink-spiking education

What happens in the activity. The drink-spiking demonstration gives each student two glasses of water to taste. The educator then adds powdered sugar to one glass without the student knowing and asks the student to taste again. The directions also prevent students from protecting their drinks. The changed taste reveals that someone altered the water.

The stated teaching purpose. The chapter uses this demonstration to show that someone can add a substance to a drink without the drinker noticing. The 2019 version explicitly tells educators to distinguish sweetened water from drugs that may have no detectable taste or smell. It also includes cautions about food allergies, sensitivities, and medical conditions. Those qualifications matter. My original feedback raised the difference between detectable sugar and potentially undetectable drugs, and the later explanation addresses that part of the concern.

What remains problematic. The activity still asks the educator to alter something a student will consume without their knowledge, while withholding the option to protect it. The result is built into the exercise. It does not demonstrate the student’s actual ability to make decisions or use strategies. It may leave the student with a lesson about powerlessness or mistrust of the educator, rather than practice in what to do. Food-related cautions do not resolve that consent problem.

Detection is also the wrong skill to assess. A student’s ability to taste sugar does not establish whether a real drink is safe. NHS information on spiking explains that a contaminated drink may offer no reliable warning through taste, smell, or appearance. Students should not be asked to taste a suspicious drink to test it.

A stronger teaching approach. Replace the surprise with an announced, optional scenario that requires no drinking or covert alteration. For example, describe an unattended drink or a friend who suddenly feels unusually unwell. Invite students to work through stopping consumption, reaching trusted help, communicating their location and access needs, and seeking urgent medical help when appropriate. Practice the words they could use and how they could assist a friend. Explain the scenario before participation and offer an equivalent discussion option.

For educator reflection. What should the student be able to do afterward? Evaluate whether they can describe options and seek help, rather than whether they detect a hidden ingredient. Keep responsibility for spiking with the person who does it, regardless of whether someone followed every suggested precaution.

Chapter location: Activity: Drink Spiking. Original reviewer feedback: pages 9–10. The consent and trust analysis above develops the critique beyond the original comment about taste.

4. STI symptom models and stigma

What happens in the examples. Under its teacher-made models of STI symptoms, the chapter describes a mixture of confectioner’s sugar and water with fish oil or fish sauce added to produce a noticeable odor. It is used to represent abnormal discharge. A separate model uses pieces of cauliflower to represent the rough, irregular appearance of more pronounced genital warts. These are simulated bodily signs made from familiar materials.

The stated teaching purpose and existing cautions. The chapter says these models are intended to help students recognize that something may be wrong, rather than diagnose an infection. It acknowledges that infections may produce no noticeable signs and that the models may be difficult for learners with smell or touch sensitivities. It also includes food-related cautions. A fair review must recognize those statements.

The feedback and why it matters. My original review questioned whether recreating a strong odor or a pronounced symptom adds useful understanding beyond a clear description. It warned that emphasizing striking examples could repeat the fear-based approach of graphic STI photographs. Making that approach available through smell or touch does not, by itself, make it good sexuality education.

The concern is the relationship between the memorable experience and the intended lesson. A student may remember a strong fish smell more readily than a qualification about infections without symptoms. The model may reinforce disgust or shame about genitals and bodily fluids, or suggest that infection can reliably be identified by smell or texture. These are risks in the teaching approach, not claims that every learner will react in the same way.

The health distinction needs to be taught explicitly. Many STIs have no symptoms or only mild symptoms, as the Centers for Disease Control and Prevention (CDC) explains. A fish-like odor can also occur with bacterial vaginosis, a common, treatable vaginal condition. An odor alone does not identify a specific STI or establish someone’s sexual history. Similarly, genital warts vary in size and form; cauliflower represents only one possible presentation.

A stronger teaching approach. Begin with the learning goal: understanding possible changes, the limits of symptoms, and how to obtain care. Use neutral descriptions and accessible information about testing and treatment. Teach that a person can need testing without noticing a change, and that a noticeable change warrants appropriate clinical advice rather than a classroom diagnosis. Practice asking a clinician a question, arranging an accessible appointment, or requesting an explanation of a test.

If a learner wants a tactile representation because it would clarify a specific feature, explain what it represents, what it exaggerates, and what it cannot establish. Provide a description as an equal option. Our recommendation is to replace the fish-oil odor demonstration with clear, neutral explanation; strong sensory exposure should not be a requirement for learning about sexual health. The aim is informed care and bodily confidence.

For educator reflection. If a student remembers only one thing from this activity, will it help them seek care without shame? Ask what they understand about a person who has no symptoms, and how they would respond respectfully to someone who does.

Chapter locations: Teacher-Made Models of Signs and Symptoms of Sexually Transmitted Infections, especially Abnormal Discharge and Genital Warts; STIs Without Visible Signs or Symptoms. Original reviewer feedback: pages 8 and 11–12.

5. Accuracy of health information

Distinguish infection from a possible consequence. The chapter lists cervical cancer among STIs. Human papillomavirus (HPV) is an infection; persistent infection with certain types can cause cervical cancer. Cancer itself is not an STI. This distinction matters because prevention, testing, screening, and treatment are different actions. A corrected lesson should help learners understand those differences without suggesting that an HPV infection inevitably leads to cancer. See CDC’s explanation of HPV and cervical cancer.

Teach lubricant compatibility accurately. The chapter limits its recommendation to water-based lubricant. For latex condoms, water-based or silicone-based lubricants can be used, while oils can weaken latex. The teaching goal should be that students can identify the condom material, access the product instructions, and choose a compatible lubricant. A rule remembered without that practical access leaves a gap. See CDC guidance on condoms and lubricants.

Make barrier placement clear. The chapter describes holding an oral-sex barrier over the mouth and lips. A dental dam is placed flat over the vulva or anus, between the mouth and the area being contacted. An educator should explain both the barrier’s purpose and its orientation, then let the learner practice placement on an appropriate model with their chosen support. Successfully cutting a condom into a sheet does not establish that the learner understands where that sheet goes. See CDC’s dental-dam instructions.

For educator reflection. Can the learner explain or demonstrate the relevant decision using an accessible format? Check understanding of the health concept as well as completion of the physical steps. These are specific corrections for APH and practical checks for anyone adapting the chapter.

Chapter locations: STIs Without Visible Signs or Symptoms; Teacher-Made Models of Signs and Symptoms of Sexually Transmitted Infections; Condom Use for Other Sexual Activities. Current health guidance is linked alongside each correction.

6. Gender inclusion and supervision

The example and its purpose. The chapter recognizes lesbian, gay, bisexual, transgender, queer, asexual, and intersex people. Yet its preteaching guidance specifies two female educators for a female student, and at least one male educator for a male student, with a female educator remaining in the background. It presents these arrangements as ways to support comfort and appropriate instruction.

The feedback and why it matters. My original review asked for inclusion throughout the teaching directions, not only in an opening statement. These binary arrangements leave unclear how a transgender or nonbinary learner or educator fits. They also assume that shared gender establishes comfort. A student’s anatomy, identity, learning needs, and preferences cannot be reliably inferred from a gender category.

A stronger teaching approach. Use accurate anatomical language and ask learners privately about support preferences without requiring them to disclose an identity or sexual history. Select qualified educators and transparent safeguarding arrangements consistent with applicable requirements. Teach relevant barrier skills across genders. Make the reason for any additional adult’s presence clear, and preserve meaningful opportunities for private questions.

For educator reflection. Could a student use this lesson without correcting an assumption about their body, gender, or partners? Would they have a way to express discomfort with an educator or support arrangement?

Chapter locations: Statement of Inclusivity; Preteaching Considerations and Guidance; Condom Use. Original reviewer feedback: pages 2–5.

7. Classroom participation and tactile access

The example and its purpose. The chapter supports blind students remaining in sex education with their classmates. In its anatomy examples, however, students explore models beforehand in a separate setting, then participate in the classroom task through another format. It discourages handling those models alongside sighted peers because this could draw attention to blindness. The intended benefit is preparation and avoiding unwanted attention.

The feedback and why it matters. My original review welcomed the commitment to classroom inclusion and asked for better descriptions and explanations of models. The further question is who decides that tactile exploration would be embarrassing. Being physically present in a class is not the same as having access to the materials and discussion at the moment they are used. A blanket separation rule may unintentionally teach that blind ways of learning should be concealed.

A stronger teaching approach. Offer advance preparation and private instruction when useful, while also making models, tactile graphics, and description available during shared lessons. Ask the learner what works, without expecting them to design every accommodation themselves. A model available to the whole class can give everyone another way to learn. Students should also be able to choose privacy without losing access.

Explain how each representation relates to a body: its orientation, scale, materials, simplified features, and the variation it cannot show. Ask learners to describe what a part represents, rather than merely name a craft material. Our experience combining recommended models with 3-D printed models and tactile graphics supports offering complementary ways to understand a concept and checking what each person finds useful.

For educator reflection. Is this arrangement based on the learner’s expressed preference and learning needs, or an adult’s assumption about embarrassment? Can the learner engage with the same concept and discussion as classmates?

Chapter locations: Examples That Require Preteaching; Teacher-Made Models. Original reviewer feedback: pages 1, 3–4, and 10–11.

8. Lubricant education and demonstrations

The example and its purpose. The lubricant activity has a learner inflate and tie a latex condom, rub water-based lubricant on one side, and then rub an oil-based product on the other until it bursts. The purpose is to demonstrate that oils damage latex. The chapter advises educators to try the activity first and includes a latex-allergy caution.

The feedback and why it matters. I proposed a similar demonstration in my original review, when asking for lubricant education. That history deserves acknowledgment and the same critical scrutiny as other recommendations. The underlying compatibility lesson is important, but a bursting object may create unwanted sensory exposure. It also should not be mistaken for a realistic demonstration of the timing or manner of condom failure during use.

A stronger teaching approach. Use accessible product labels and instructions to practice selecting a compatible lubricant, explaining the choice, and asking questions about unfamiliar products. Offer description and suitable models for handling and application skills. A surprise burst is not necessary to assess understanding. If an educator considers a sensory demonstration, participation and expectations should be agreed beforehand, with an equivalent alternative.

For educator reflection. Does the learner understand which product to choose and why, or mainly remember a startling event? Revising my own recommendation is part of the same commitment to useful, respectful teaching.

Chapter location: Activity: Lubricants and Condoms. Original reviewer feedback: page 5. Lubricant compatibility is addressed in the health-information section above.

9. Pleasure, relationships, and choice

The broader teaching issue. The chapter contains anatomy, prevention, safety, and relationship information. My original review also asked where pleasure belongs and recommended teaching the choice not to have sex. The concern is about the overall educational emphasis and explicit learning goals, not a claim that the chapter contains nothing positive.

Why the feedback matters. A student can learn to name anatomy or identify a risk without gaining language for what they want, enjoy, dislike, or feel unsure about. Blind people deserve education that supports relationships, curiosity, and bodily confidence alongside prevention. Sex positive teaching respects diverse interests and asexual identities; it does not assume or require sexual activity.

A stronger teaching approach. Pair age-appropriate body knowledge with hypothetical conversations about affection, comfort, boundaries, mutual interest, and changing one’s mind. Let students practice asking a question, expressing a preference, checking another person’s wishes, or declining an activity. No one should have to disclose personal experience to demonstrate learning. The World Health Organization’s understanding of sexual health includes well-being, respectful relationships, and the possibility of pleasurable experiences free from coercion.

For educator reflection. What language and choices will the learner take from this lesson into their own life? Include the ability to seek enjoyment, express uncertainty, and choose not to participate when evaluating what a lesson offers.

Review connection: This is a recommendation about the chapter’s overall teaching goals. Original reviewer feedback: pages 5 and 8.

A revision plan for APH

The following changes correspond to the nine areas reviewed above. Each is a proposed editorial or instructional action, rather than a claim that the chapter has no value.

1. Consent and physical guidance: Add explicit permission, alternatives to touch, and a way to pause or stop to every activity involving physical assistance. Distinguish permission to attend the lesson from consent to a teaching method.
2. Independence and safety: Remove the expectation of sighted accompaniment and the unsupported guide-dog deterrence recommendation. Replace them with learner-chosen support, practical planning, and accessible routes to help.
3. Drink-spiking education: Replace covertly altered drinks and required tasting with an announced scenario. Retain the explanation that sensory detection is unreliable and assess help-seeking and decision-making.
4. STI symptom models: Replace the fish-oil odor demonstration with neutral explanation and care-seeking skills. Review other symptom models for learning value, exaggeration, sensory choice, and the risk of stigma.
5. Health accuracy: Correct the cervical-cancer classification, lubricant compatibility, and dental-dam placement. Have qualified sexual-health reviewers check medical content and identify a date for the next review.
6. Gender inclusion: Revise binary educator and student arrangements. Provide guidance based on relevant anatomy, learner preferences, qualified instruction, and applicable safeguarding requirements.
7. Classroom access: Replace blanket restrictions on shared tactile learning with options for preparation, classroom participation, and privacy. Explain model scale, orientation, limitations, and bodily variation.
8. Lubricant demonstrations: Make compatible-product selection and accessible instructions the learning goal. Reassess the bursting-condom activity, including the similar demonstration in my own earlier feedback.
9. Pleasure and choice: State age-appropriate learning goals for comfort, enjoyment, communication, mutual respect, and choosing whether to be sexual. Include learners with varied identities and interests.

APH should involve blind learners and educators, alongside qualified sexual-health professionals, in reviewing the revised activities. Ask what learners understood, what they could apply, and whether they had meaningful choices. Make corrections available to existing purchasers and identify the version and revision date so educators can tell which guidance they are using.

Using the chapter thoughtfully now

An educator can use the chapter as a source of ideas while checking the learning purpose, accuracy, and method of each activity. Before teaching, work through these questions with the relevant examples above:

• What should the learner understand or be able to do? Name an outcome such as explaining a body part, choosing a compatible product, communicating a boundary, or asking for care.
• What does this material clarify? Explain its limits and combine it with description, tactile graphics, 3-D models, or discussion when that improves understanding.
• What choices will the learner have? Explain touch and sensory experiences in advance. Offer an equivalent way to learn, and allow questions without requiring personal disclosure.
• What access is needed to use the knowledge? Include practical ways to read instructions, locate information, communicate with a provider, or obtain chosen support.
• How will understanding be checked? Invite the learner to explain a decision or work through a hypothetical situation in their preferred communication format. Assess understanding rather than compliance with a demonstration.

Afterward, ask what was useful, confusing, uncomfortable, or missing. A learner’s request for a different method is information that can improve the lesson. These practices can strengthen learning for blind students and their classmates.

The standard we should expect

The chapter represents a meaningful investment in accessible education. Its useful ideas deserve recognition, and its limitations deserve a direct response.

Several concerns from my original professional review remain substantive. The needed revisions span consent, independence, health accuracy, inclusion, classroom access, teaching methods, and sexual well-being. Each deserves a response, as set out in the revision plan above. Useful tactile materials can be retained or adapted with clear explanations and attention to what learners actually understand.

For APH, that means revising both the factual statements and the instructions educators follow, then involving blind learners and educators in evaluating the revised activities. For educators using the chapter now, it means selecting and adapting an activity according to its learning purpose, rather than assuming that accessibility of the material establishes the quality of the lesson.

The ultimate beneficiaries should be blind people and the educators working with them. A stronger resource would help learners understand their bodies, make choices, communicate, seek care, and participate with confidence. That is the standard this review asks the chapter, and our own teaching, to meet.

Add your perspective

Have you taught from this chapter or experienced similar teaching approaches as a student? You are welcome to respond even if you have never read it. What makes a sexuality education lesson accessible, respectful, and useful to you? Which models or combinations of teaching materials have helped, and what would you change?

We welcome blind young people and adults, families, educators, and sexual-health professionals. You do not need professional credentials to contribute. APH and the chapter’s authors are also welcome to share corrections, context, or information about revisions.

Sources and review scope

This review draws on my original 2017 professional reviewer feedback, the earlier chapter draft, and the 2019 version examined, together with our BSAN conversations and experience building and testing teaching models through the Blind Positive Sex Ed project. The guidebook acknowledges my contribution as a reviewer. Community feedback about the models is described separately from this signed editorial assessment.

Chapter 3 is part of a paid guidebook. The private review copy is not provided here. For information about obtaining the guidebook, see the American Printing House for the Blind’s official guidebook listing. Section references in this review are provided as text for readers who have authorized access to the chapter. This review applies to the 2019 version examined; it does not establish whether APH’s currently distributed files have changed.

This review focuses on selected teaching approaches and health information in Chapter 3. It is not an assessment of every chapter, accompanying video, or accessible format. Page references to my original feedback identify where concerns were raised; that historical document is not treated as current medical guidance. Public health sources are linked beside the relevant explanations.

Illustration: AI-assisted artwork created for BSAN. The scene represents community collaboration and does not depict an actual review meeting.