essay about how sexuality affect family health

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Importance of Sexual Health

Last Updated May 2023 | This article was created by familydoctor.org editorial staff and reviewed by Kyle Bradford Jones, MD, FAAFP

Sexual health is a big part of life. It can affect and is affected by other aspects of health. This includes physical, mental, emotional, and social health. Being in good sexual health means you are well informed, careful, and respectful to yourself and others. It also means enjoying yourself sexually in a way you are comfortable with.

Path to improved health

Most people learn about sexuality and sex early on. You may have discussions with parents, siblings, teachers, or mentors. Or you may discover it on your own. You learn about gender and genitalia. You learn about what sex is and the risks it carries. Risks include pregnancy, sexually transmitted infections (STIs), and sexual abuse. It is important to learn as much as you can about sex. The more informed you are, the more prepared you are to make good choices.

Safety is a key aspect of sexual health. There are many ways to protect your sexual health and care for yourself. Abstinence is the only way to 100% prevent pregnancy and STIs. This means not having vaginal, anal, or oral sex.

If you decide to be sexually active, you may want to consider a form of birth control. Different types include a condom, pill, patch, shot, implant, diaphragm, or intrauterine device (IUD). These can help prevent unwanted pregnancy. Condoms are the only method to help prevent STIs.

Talk to your doctor before you start having sex. They will talk to you more about safety, risks, and prevention. They can answer any questions you have about sexual health. They also can prescribe a form of birth control.

Some people have sexual problems or restrictions. Certain medicines and conditions can limit desire or function. Talk to your doctor before you take over-the-counter (OTC) drugs, or if you have side effects, such as pain, from sex.

Another part of sexual health is communication. Talk about sex to a doctor, parent, or adult you trust. It is best to be honest with questions and concerns.

You also need to be direct and clear with the partner you are sexually interested in. Talk about your expectations and set boundaries. Do not let them, or other peers, pressure you into anything. And do not pressure them to do anything they do not want to do. You each should only do things that you agree, or consent, to do. Do not do something that you don’t want to do or that makes you uncomfortable. If you find yourself in a situation like this, tell the person no. Then leave the situation and tell someone you trust about it. They can protect you and get you help, if needed.

If you have been diagnosed with an STI, you should tell your sexual partner(s). They may be affected as well. The more partners you have, the higher your risk of getting an STI. Treatment can help cure or relieve symptoms of some STIs. There can be long-term negative effects of untreated STIs.

Things to consider

It is normal for your sexual health to evolve as you age. To stay healthy, it is best to regularly reflect on your thoughts, feelings, and emotions. Doing this in advance will prepare you for sexual encounters.

Sexual health is not something you should manage on your own. It is something you should talk about with people you trust or love. You can talk about what is considered safe and what the risks are of certain actions. You should understand what consent is and that it’s okay to say no.

If you think you are pregnant, have an STI, or have been abused, seek help right away. For pregnancy and STIs, a doctor can do a test to confirm. They can provide you with more information and discuss your options. For abuse, a doctor can perform tests and provide treatment. A police officer or lawyer can provide legal assistance. You also may want to see a counselor, who can offer emotional support.

Questions to ask your doctor

• How will I know if I’m ready to have sex?
• What are the risks of having sex?
• If I decide to have sex, do I need to be on birth control?
• How can I practice safe sex?
• Are there any vaccines I should get before I have sex?
• I had sex, but now I wish I hadn’t. What can I do?
• How do I know if I am in poor sexual health?
• What should I do if I’m concerned about my sexual health?

American Academy of Family Physicians: Birth Control Options

Centers for Disease Control and Prevention: Sexual Health

Planned Parenthood: Get the Facts on Sexual Health

Last Updated: May 3, 2023

This article was contributed by familydoctor.org editorial staff.

Copyright © American Academy of Family Physicians

This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.

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The impact of sexuality in the family

This article was written by a former member of Counselling Directory.

This is an article that explores the impact of diverse sexuality on the family and the self. How coming to terms with different sexual orientation can contribute to mental distress if it is not understood and given appropriate support. SEARCHING FOR ‘SOMEWHERE OVER THE RAINBOW’. LIVING AND SURVIVING IN THE FAMILY. The emotive searching and longing in that Judy Garland song has such a universal appeal to it that it seems to tug at somewhere very deep in most hearts and souls. It suggests a yearning and need to belong to a place, a community somewhere where we will be understood, loved and accepted. These are basic needs that most people require in order to survive and be mentally healthy. People need to belong, have value and not to hide who they are, but to be able to acknowledge and celebrate their individuality. However, for some lesbian, gay and bisexual adults and adolescents, growing up in a family which may have felt hostile, prejudiced and alienating, can cause a person to feel excluded and isolated. This may inevitably sow the seeds that encourage the individual to hide their real feelings, identity and sexuality. A history of family exclusion may promote future self-exclusion, a type of internalized homophobia. A pressure to hide and carry secrets may continue throughout a person’s life and may lead to an individual conforming and compromising their own feelings by marrying in order to ‘please their family’ or the wider family that we live in- society. The consequences of this can all too often be distressing for the entire family system. Like Dorothy in the “Wizard of OZ’, the adolescent may leave or contemplate leaving the nest prematurely in order to ‘follow the yellow brick road”- searching for that place, family or community that will accept them for who they are and who they wish to become. Yet, like for Dorothy, the road may point to a new promised land-the “gay scene” . Unfortunately what may be discovered in reality is a new land that is at times fraught with disappointment and artificial images. This may merely heighten the person’s sense of alienation. Of course we all know that Dorothy wakes up from her journey to discover that it was all a dream. But for many people this is no fantasy, but a real journey-an emotional roller coaster that can shape a future life in many ways. Families affect and influence how we experience the world and our relationships in it. They can promote and nurture positive feelings but can also create seeds of doubt, self-hatred and at times, due to our sense of ‘homelessness’, can foster depression and suicidal feelings. Many of the distressed characters who Dorothy meets on her journey seem to remind us of potential damage and loss. They too are searching to find parts of themselves in order to feel complete. The cowardly lion has lost his courage and confidence to express himself. The tin man has rusted up as he has lost a sense of his feelings, and the scarecrow needs a brain to help him think. These are all basic human functions which can be affected and interrupted if we are not provided with a sense of belonging, love and self acceptance. Having worked in various mental health and therapeutic settings for fourteen years, I have witnessed numerous young and older adults continuing this inherited family/societal pressure to hide or deny sexual and emotional feelings, which in time may contribute to their mental distress. Our individual journeys from family to larger community, work settings and intimate relationships will of course vary from person to person, but what I believe shapes a great deal of that journey is our relationship to, and our place in, our family. As Dorothy’s story demonstrates, we all carry our ‘family’ within us wherever we go and return at different stages throughout our lives. Some lesbians, gay men and bisexuals have been fortunate to have access to supportive and nurturing gay, lesbian and bisexual counselling services, that have provided vital support and information. Others have not and have had to make the journey alone. This is why I feel passionately that counselling can play a vital role in working with and supporting the members of the family where an individual has experienced distress, confusion or conflict over sexual issues. There may not be a yellow brick road over the rainbow, but I believe that there is a place for people which will listen, support and recognize the importance of family and the role that sexuality has within it.

The views expressed in this article are those of the author. All articles published on Counselling Directory are reviewed by our editorial team .

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Family, Sexuality, and Communication: What Have We Learned from Parents and Teens?

Year Published: 2020

Authors: Jennifer Grossman , Ph.D., Amanda Richer , M.A.

Talking about sex can be an uncomfortable topic for both teenagers and their parents. To better understand family communication around this topic, researchers interviewed 23 pairs of teens and parents from an urban Northeast city about conversations they have regarding dating, sex, and relationships. They talked with the pairs once in seventh grade and again in tenth grade. This fact sheet presents preliminary findings from the study and offers research-informed tips for parents and extended family members on how to talk to teens and young adults about sex.

Parents in the study said they were more comfortable talking with teens about sex when the teens were in high school rather than middle school. On the other hand, teens said they were less comfortable talking with parents about this topic in high school, highlighting one of the many challenges families face in having these conversations. To guide these conversations, the researchers suggest discussing the topic before teens have sex, offering medically accurate information, and talking with both sons and daughters about sexual health.

This work was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development [R03HD073381-01].

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Family trouble: Heteronormativity, emotion work and queer youth mental health

Elizabeth mcdermott.

Lancaster University, UK

Jacqui Gabb

Open University, UK

Rachael Eastham

Ali hanbury.

The Proud Trust, UK

Conflict with the family about sexual orientation and gender diversity is a key risk factor associated with poor mental health in youth populations. Findings presented here derive from a UK study that employed an interdisciplinary critical mental health approach that de-pathologised emotional distress and conceptualised families as social and affective units that are created through everyday practices. Our aim was to explore how family relationships foster, maintain or harm the mental health and well-being of LGBTQ+ youth. Data were generated through exploratory visual, creative and digital qualitative methods in two phases. Phase 1 involved digital/paper emotion maps and interviews with LGBTQ+ youth aged 16 to 25 (n = 12) and family member/mentor interviews (n = 7). Phase 2 employed diary methods and follow-up interviews (n = 9). The data analytic strategy involved three stages: individual case analysis, cross-sectional thematic analysis and meta-interpretation. We found that family relationships impacted queer youth mental health in complex ways that were related to the establishment of their autonomous queer selves, the desire to remain belonging to their family and the need to maintain a secure environment. The emotion work involved in navigating identity, belonging and security was made difficult because of family heteronormativity, youth autonomy and family expectations, and had a stark impact on queer youth mental health and well-being. Improving the mental health of LGBTQ+ youth requires a much deeper understanding of the emotionality of family relationships and the difficulties negotiating these as a young person.

We know from psychological research that the family is significant to the mental health of LGBTQ+ 1 youth. Research indicates a clear link between negative family experiences and poor mental health in young LGBTQ+ people ( Grossman et al., 2011 ; Ryan et al., 2009 ; Simons et al., 2012 ). D’Augelli et al. (2005) found a strong association between suicidality among LGB youth and parental mistreatment and abuse. Studies have shown that family rejection is a significant predictor in reported levels of depression and suicidal thinking in LGB youth ( Ryan et al., 2009 ). Lack of family support is also a risk factor for suicide in LGB young people ( Needham and Austin, 2010 ).

In contrast, family acceptance and parental support have been found to protect the risk of poor mental health in LGBTQ+ young people ( Espelage et al., 2008 ; Ryan et al., 2010 ). In a systematic review of parent influences on LGB youth health and well-being, Bouris et al. (2010) found that the emotional dimension of the parent–child relationship, such as support, caring, connectedness and conflict, influenced LGB youths’ mental health. Across studies, a supportive and caring parent–child relationship has emerged as an important correlate to good mental health ( Needham and Austin, 2010 ; Ueno, 2005 ; Van Beusekom et al., 2015 ). These patterns and associations are similar for trans and gender diverse youth ( Katz-Wise et al., 2018 ; Simons et al., 2013 ). Furthermore, positive family environment has also been found as a protective mechanism against LGB discrimination ( Freitas et al., 2016 ). Although this is not a consistent finding with some studies showing that family support was not a protective factor against victimisation in LGB youth ( Stettler and Katz, 2017 ).

However, this evidence is limited and generally tells us that youth whose parents respond well to LGBTQ+ disclosure have better mental health than those whose parents reject or are hostile to a disclosure ( Stettler and Katz, 2017 ). The research has mainly focussed on parental–child relationships and other significant relationships (e.g. friends, aunts, extended family), and factors such as ethnicity, disability and socioeconomic status have had less attention paid to them. There is still much we do not understand about why family relationships impact LGBTQ+ youth mental health. In our view, existing research limits our understanding in three ways: (1) by employing a biomedical framework that conceives of emotional distress as an indication of individual pathology, (2) the under-theorisation of ‘family’ and ‘youth’ and (3) the dominant use of quantitative survey methods which reduces very complex relationships, meanings and emotions to discrete variables ( McDermott and Roen, 2016 ). These methods are important for establishing relationships between factors and capturing the scale of the problem, but they are less able to explain why and how family relationships influence LGBTQ+ youth mental health.

The approach taken in this study was to de-pathologise emotional distress and conceptualise families as social and affective units that are created through everyday practices. Contemporary social science research has effectively debunked any unitary basis of ‘the family’ ( Gabb, 2008 ). The family as a monolithic, biologically constituted institution fails to accurately represent the diversity of family forms. We conceptualised families as affective spaces of intimacy within which meanings and experiences are constituted by family members in a historical sociocultural context rather than in accordance with naturalistic understandings of reproductive and/or socialisation function ( Smart, 2007 ). In other words, families are envisaged as relationships materialised through sets of practices rather than as a consequence of fixed social categories (mother, father, sibling, etc.) ( Morgan, 1996 ).

Our theoretical framework also considered family relationships as emotive and ‘troublesome’ ( Ribbens McCarthy et al., 2013 ) but important to all young people, regardless of sexuality or gender, because family can provide bonds of belonging, love, support, intimacy, care, safety, food and protection. Wyn et al. (2011) argue that the family has become more relevant as a site of connection and security because young people live in an increasingly uncertain and fragmented world. Bessant et al.’s (2017) analysis of five different countries (United Kingdom, United States, Australia, France, Spain) demonstrates that this insecurity or precarity has been largely precipitated by the evaporation of resources in society to support the transition from childhood to adulthood (such as employment, training, education, homes and finances). Young people in these countries face an increasing burden of deprivation, inequality and disadvantage compared to those over 35, and this impacts their welfare and well-being ( Bessant et al., 2017 ; Standing, 2014 ). Family support, resources and contact are perhaps more important than ever because of the precarious nature of young people’s lives ( Edwards et al., 2014 ; Smart, 2007 ). However, the family as a site of security, identity and belonging has always been potentially problematic for young queer people because they may face hostility towards their sexual or gender diversity from family members.

Our research sought to understand the impact of family relationships on LGBTQ+ youth mental health and well-being from a relationship-oriented perspective . We focussed on young people’s emotional experiences of connection to, ambivalences with, and isolation from, family relationships. We were interested in the way emotions and relationships were intertwined in the process of managing non-heterosexual sexualities and gender diversity within families and the impact on mental health and well-being. In the next section, we outline our interdisciplinary critical mental health approach that de-pathologises emotional distress. The subsequent section describes the two-phased methodology and then we present findings that suggest family relationships can be troublesome to queer youth mental health because of identity, belonging and security.

De-pathologising emotional distress in youth mental health research

The medicalisation of human misery and suffering puts the difficult subject of disruptive emotions, feelings and thoughts into the hands of psychology and psychiatry. In this biomedical framework, emotional distress is conceived as an indication of psychological abnormality requiring diagnosis and treatment. The problem for psychiatry is that it has never been able to reliably identify causality, pathology or aetiology of mental dysfunction ( Boyle, 2011 ; Busfield, 2011 ; Rapley et al., 2011 ). A key weakness of the discipline is that there are very few visible markers of the ‘disorders’ it attempts to treat ( Pilgrim, 2014 ). Mental health symptoms are subjective descriptions of feelings and emotions (e.g. I have lost interest, I am anxious, I am worried), rather than visible, physical symptoms (e.g. damaged blood vessels, clots, lumps, swellings, heightened immune indicators). Many of the phenomena identified as mental illness within psychiatric diagnostic criteria are regular emotional reactions to life’s difficulties. The subjective experiences of pain, sorrow, elation and misery occur without any necessary implication of pathology ( Fernando, 2010 ).

Mainstream psychiatric and psychological conceptualisations of adolescent mental disorder similarly focus on individual psychological abnormalities as the primary source of distress ( Boyle, 2011 ). The research examining the role of the family in relation to LGBTQ+ youth mental health has largely been conducted within a psychological paradigm utilising the Minority-Stress explanatory framework ( Meyer, 2003 ). In this model, stigma and discrimination specifically related to being a sexual minority make LGB populations vulnerable to poor mental health. The model distinguishes between two types of minority distress: distal processes that are external, objective stressful events and conditions ( Meyer, 2003 : 676), and proximal processes that are subjective, related to the internalisation of negative sexual attitudes and concealment of identity. This model has also been adapted to use with trans populations ( Hendricks and Testa, 2012 ). As the field of research has developed, psychologists have taken an interest in developing this model and asking what are the mechanisms linking stigma-related stress and mental health problems in sexual-minority youth. Emotional regulation (ER) has been highlighted as one possible mechanism ( Hatzenbuehler, 2009 ; Stettler and Katz, 2017 ). ER is conceptualised as processes that change an individual’s emotional experience that may be considered adaptive or maladaptive such as rumination, concealment and catastrophising.

Undoubtedly, emotions are crucial to understanding how experiences of being young and queer translate into distress and poor mental health. However, the concept of ER keeps young people’s emotions reduced to diagnostic ‘problem’ categories such as ‘concealment’ and ‘rumination’, and are thus ‘contained’ within a psychomedical rationalist paradigm ( McDermott and Roen, 2016 ). For example, Stettler and Katz (2017) state, ‘identifying whether deficits in ER are major risk factors for psychopathology in GLB youth may help guide clinical interventions with these adolescents’ (p. 385). Investigations of ER are framed by individual psychopathology – a deficit model – that is happening solely in an individual’s mind. There is no discussion that working on emotions we experience may have a social component, that our relationships, expectations, employment, material circumstances might impinge on how we manage our emotions.

Significantly, sociologists and cultural theorists have demonstrated that the emotions we experience are shaped partly by social norms ( Ahmed, 2004 , 2010 ; Bendelow and Williams, 1998 ; Hochschild, 1979 ; Lupton, 1998 ). Hochschild (1979) asserts that feeling rules are social norms that tell us what, when, where to feel and how long and strongly we can feel. As Hochschild (1979) suggests, not only are emotions and feelings influenced by the social mores of the day, but what we ‘do’ with our emotions or our response to our feelings has also been shown to be governed by these social and cultural norms. If we feel failure or disappointment, this is in relation to perhaps an idealised event such as a wedding. Both Hochschild ([1983] 2003) and Ahmed (2010) use the heterosexual wedding to illustrate the way we ‘manage our hearts’ and how happiness is socially proscribed. Ahmed (2010) states, ‘Disappointment can be experienced as a gap between an ideal and an experience that demands action’. In experiencing an inappropriate emotion – a disappointed bride on their wedding day – this prompts some sort of emotion work, that is, the conscious act of trying to influence the degree/quality of a feeling. The rational individual is expected to discipline their emotions in order to experience the appropriate emotion at different times and places ( Elias, 1994 ; Rose, 1999 ).

The control of emotions is central to normative developmental discourses that define adults as mature and able to control their emotions, and youth as emotionally immature and unable to control their emotions ( McDermott and Roen, 2016 ; Lesko, 2001 ). The underlying message is that young people’s ‘disorderly’ emotions are not to be taken seriously; they are a product of hormonal changes and a common phase of the adolescent years that will diminish over time ( McDermott and Roen, 2016 ). The tendency for young people’s emotions to be temporalised (‘it’s a phase’, ‘they will grow out of it’) serves to reproduce a hierarchical division between the rational adult and the emotional adolescent ( Burman, 2008 ; Lesko, 2001 ). In this study, we de-pathologise emotional distress and argue that to understand how family relationships contribute to LGBTQ+ youth mental health and well-being requires a focus on the ways in which young people embody, negotiate and manage emotion, and the social, economic and cultural familial context in which this takes place. In the next section, we describe the emotion-centred methodology we employed to answer the research question: ‘In what ways do family relationships impact on LGBTQ+ youth mental health and well-being?’

Methodology

Researching young people who are marginalised by their age, LGBTQ+ status and mental health, and asking about experiences of family relationships and mental health, constitutes a ‘hard-to-reach’ population and a ‘hard-to-talk-about’ topic. Our methodological approach recognised that ‘youth’ occupy a distinct and precarious social position that is controlled through specific policy and legislation (e.g. age of consent laws, compulsory schooling) and often positions them as powerless in relation to adults ( Heath et al., 2009 ; Sime, 2008 ). Consequently, what youth research participants disclose can put them at risk of censure, objectification and surveillance ( Cahill, 2007 ).

Traditional qualitative methods such as interviewing can represent an adult centred, top-down approach to data collection ( Drew et al., 2010 ) that privileges the verbal articulation of experience and provides limited access to the emotional dimensions of young people’s lives ( Bragg and Buckingham, 2008 ). Consequently, we employed visual, creative and digital qualitative methods to facilitate youth inclusivity and value their agency and ‘ways of knowing’ ( McDermott, 2015 ; McDermott and Roen, 2012 ; McDermott et al., 2013 ). This was particularly important because we were generating ‘sensitive’ data on experiences that could be stigmatised or distressing (e.g. family rejection, homo/bi/transphobia, self-harm) ( Meezan and James, 2009 ; Panfil et al., 2017 ). Our critical mental health framework put emotions at the centre of the research process, but emotions are often difficult to express through words ( Mays et al., 2011 ; Sime, 2008 ). We designed a study using visual, creative and digital qualitative methods to facilitate the capture of different and non-verbal dimensions of emotional experience ( Bagnoli, 2009 ; Copeland and Agosto, 2012 ; McDermott et al., 2017 ).

Asking youth about their sexual orientation may place them at risk from discrimination (e.g. homophobic bullying) or harm (e.g. emotional distress) and/or be sensitive because they are undecided, confused and/or apprehensive about their LGBTQ+ status and/or their mental health ( Elze, 2009 ; McDermott and Roen, 2016 ). Anonymity was ensured through recording interviews using an encrypted digital recorder, and transcription was undertaken by a transcriber who had signed a confidentiality agreement. All identifying features were removed from the data. All anonymised data were stored electronically on a password protected secure drive on a university server. All original data were deleted once the anonymised versions of the data had been created. Paper consent forms and visual data were kept in a locked filing cabinet in the locked office of the principal investigator. We collaborated carefully with participants to ensure their safety and anonymity were guaranteed. In one case, for example, we agreed to use abstract/opinion-based quotes only in publication, as the participant was extremely concerned about being recognised. Recruitment and all face-to-face meetings took place exclusively through LGBTQ+ organisations so participants had consistent access to support services via telephone, Internet or face to face, and could easily and immediately access help if required.

Informed consent was gained through written or electronic signatures from all participants (participants were 16–25 years old and parental consent is not required) before the research commenced and verbal consent was sought at intervals throughout the study ( McDermott et al., 2016 ). Face-to-face interviews were recorded using an encrypted digital recorder. All identifying features were removed from all data which were stored electronically on a password protected secure drive on a university server or in a locked filing cabinet. All data were anonymised and participants were ascribed pseudonyms. The research received full ethical approval from the Faculty of Health and Medicine, Lancaster University ethics committee.

This study utilised visual, creative and digital qualitative methods in two phases. Phase 1 involved (1) face-to-face and online semi-structured interviews and family mapping with LGBTQ+ youth (n = 12), and (2) face-to-face and online semi-structured interviews with ‘family members’ (n = 7). Phase 2 involved LGBTQ+ youth keeping a week-long diary and follow-up interview (n = 9). All participants had to be over 16 years of age, living in England and have the capacity to give consent. Youth participants’ eligibility included self-definition as LGBTQ+ and aged between 16 and 25 years; family members were eligible if they self-identified as family, or family-like to an LGBTQ+ young person aged 16 to 30 years old. Both phases used a purposive recruitment strategy ( Patton, 1990 ) with specific attention paid to ethnicity and socio-demographic status. Participants were recruited via LGBTQ+ youth organisations in England using paper/digital flyers and face-to-face contact. Tables 1 and ​ and2 2 show the sample demographics for both phases of the research.

Young people participants.

Family member participants.

Data collection phase 1

The aim of phase 1 was to collect LGBTQ+ youth and family/family-like perspectives, experiences and emotions about family relationships and their impact on LGBTQ+ youth mental health and well-being. The semi-structured face-to-face and online interviews with LGBTQ+ youth (n = 12) were facilitated by a ‘toolkit’ of visual activities and an interview schedule. The map-making structured and prompted the discussion and minimised the pressure on participants in the face-to-face research encounter. To capture emotion, we adapted emotion mapping techniques ( Gabb and Singh, 2015 ; Gabb, 2008 ) and used emoticon stickers to reflect their feelings about different family relationships. We also used ‘scenario stickers’ to stimulate discussion about the characteristics of different relationships within their families, asking, for example, which family member would they be most likely to ask to borrow money for a bus to youth group. The interview schedule had four sections focussed on family relationships, social support, sexuality and gender, and mental health and well-being. At the end of the interview, participants completed a short demographic questionnaire. The semi-structured face-to-face/online interviews with family members (n = 7) used an interview schedule to structure discussion about their relationships with their respective LGBTQ+ young person. The schedule had four sections focussed on family relationships, young person’s coming out, managing LGBTQ+ identity within the family, and mental health and well-being. These participants also completed a short demographic questionnaire.

Data collection phase 2

The aim of phase 2 was to capture immediate, everyday practices and emotions of LGBTQ+ youth. Youth participants (n = 9) kept a diary of family interactions over 1 week in a format of their choosing – paper or online. Diary methods offer a privacy, which can be effective for sensitive topics ( Gabb, 2008 ). Participants were asked to answer five questions each day such as ‘Who from your family have you seen/had contact with today? How did these interactions make you feel?’ As with phase 1, participants used emoticon stickers to capture their feelings about events they wrote about. Participants also completed a daily single subjective mental health and well-being question (Office for National Statistics Personal Wellbeing Domain for Children and Young People). After the diary was complete, participants had a follow-up face-to-face or online unstructured interview that explored the meanings of the interactions captured in the diary.

Data analysis

All face-to-face interviews were transcribed, and the online interviews electronically archived. Family maps and diary data were anonymised and scanned into a digital format, and all materials were inputted into the data analysis software NVivo. There were three stages to our data analytic strategy. First, we conducted a case analysis for the data we had for each individual youth participant (demographic, interview 1, map, diary, mental health questions, interview 2, field notes) ( Miles and Huberman, 1994 ; Yin, 2014 ). The case analysis utilised an ‘I-feel’ mapping exercise, drawing on ‘I-Poems’ ( Edwards and Weller, 2012 ), to trace how a participant spoke about their feelings/emotions in relation to their family. We then designed a case analysis question template ( Miles and Huberman, 1994 ) to interrogate how the participant orientated to their family, LGBTQ+ identity and emotions/mental health.

The second stage of the data analysis strategy was a cross-sectional approach to the entire dataset. Guided by the research questions and the case-study analysis, a coding framework was developed by three members of the research team to improve inter-coder validity and reliability ( Braun and Clark, 2006 ). The descriptive (e.g. age), interpretative (e.g. frivolity) and theoretical (e.g. heteronormativity) codes that resulted were applied across the whole dataset, including the family member data. Subsequently, the project team conducted a thematic analysis of data in each of the cross-sectional codes ( Mason, 2002 ). The third stage of the data analysis strategy involved a meta-interpretation to develop relationships between the cross-sectional code data analysis (e.g. emotion work, family practices of communication) within our theoretical frame to answer the research question, ‘How do family relationships impact queer youth mental health and well-being?’ We present, in the following three sections, these findings that suggest family relationships can be troublesome to queer youth mental health.

Happy families: belonging, security and becoming

In response to the direct question about how family relationships impact their mental health, all participants were quite clear that family was very important to theirs and other young people’s mental health. Participants stated there was something specific about family support that was qualitatively different from other sources of support such as friends. Hannah (Lesbian, unsure-female, White British) stated,

I think it does, I think it has more of a, because it’s your support network at the end of the day. You have your friends support network but it’s the support network that you are born with, hopefully, and that’s the most important, not the most. I think it impacts it in ways even if you don’t realise it.

Similarly, Melissa (bisexual, Cis-female, Black, Asian & Minority Ethnic (BAME)) explained,

I think at first I was really upset because I was like this is my mum, she’s kind of meant to love you no matter what you do.

Hannah and Melissa had different relationships to their families and this is reflected in their answers to the interview question. Melissa left home because of her family’s attitude to her sexuality. Hannah has a better relationship with her family; she has disclosed her sexuality (and mental health) but this was quite fraught emotionally. Family members gave examples of ‘unconditional’ relationships with their LGBTQ+ young people, and Katie (heterosexual, Cis-female, White British) described this explicitly in relation to her sister’s LGBTQ+ identity:

We have always been told that it honestly doesn’t make a difference to us whether you are gay, whether you’re straight, whether you are bisexual, it doesn’t matter. Happiness is what matters […] I know I could tell my parents anything and they would still love me.

As this suggests, our participants described that the ‘ideal’ family should feel supportive, caring and close and provide an unconditional love where you are looked after, feel safe and can be happy. These views were drawing on cultural expectations that biological family should be a site of love, happiness and positive family relationships ( Gabb, 2008 ; Ahmed, 2010 ). Being able to explore their sexual and gender identity in a safe environment and simultaneously remain bonded to their families was very important to their mental health and well-being ( Gabb et al., 2020 ). Josh (gay, Cis-male, White British) emphasised the importance of some of his family accepting his sexuality and staying connected to them despite his mother’s homophobia (she threw him out of home):

Everything’s changed with these because they accept who I am, and they are not fazed by it. Like my sister, my brother and my dad – I’m still me. I am still the happy go lucky chavvy lad that they brought up, the one that fights and gets in trouble and I’m still me.

Jamie (bisexual, trans male, White British) described how he would have liked his family to respond to his trans identity:

yesterday I went to see [FILM] at the cinema the new LGBT film and there was this part where, spoilers by the way, where the mother was being like really supportive of him and he like started crying; it was all really sweet and then I started crying like why did I never get that; why did I never have a big speech about the fact that I won’t change to them and I’m still accepted in the family.

Unfortunately, the experience of recognising themselves as sexually and/or gender diverse often meant our participants felt there was a tension in their family life. Our data suggest the ongoing process of becoming an autonomous queer individual that did not fit with heteronormative family expectations created difficulties/tensions in belonging to their families, and for some it threatened a secure and safe home and was damaging to mental health.

Family trouble: heteronormativity, autonomy and expectations

The majority of the participants when speaking about their mental health made a direct link between their LGBTQ+ identity and their family’s attitudes to sexual and gender diversity. Chris described the negative impact of a hostile family environment:

It’s like with my family I knew I didn’t like the constant insults […] and with casual homophobia I think that ended up impacting my mental health quite a lot and not being to be as open meant that I was very inwards which I think ended up just exasperating the whole mental health problems. (Pansexual, Other male, White British)

In contrast, Hannah explained how openness within the family improved her depression:

I don’t know whether it’s linked or whether its not linked but when I came out to my dad, maybe a month after I just started feeling [PAUSE] better and have not really had any problems since, any major episodes since. (Lesbian, unsure female, White British)

The data from the participants demonstrated a consistent presence of homo/bi/transphobia from across a range of family members – sister, brother, granddad, mum, dad, uncle, aunt, extended family. Our dataset had plenty of incidents of homo/bi/transphobia, and the participants were well aware of who in the family were hostile to LGBTQ+ people. For some participants, this hostility resulted in being thrown out of home and for others they left of their own accord because they were no longer able to manage the situation. The emotional difficulties of navigating heteronormativity within the family – trying to judge what to say, who to tell, who to hide from – had a direct impact on the participants’ mental health and well-being. These problems were often compounded by young people’s unequal power relationships with the adults in their family. Young people lacked autonomy and felt they had to comply with a raft of family expectations in relation to education, employment, religion, culture and ethnicity. Melissa (bisexual, Cis-female, BAME) described how trying to be a ‘good’ daughter made her unhappy:

I think it was because when I was younger I tried to do everything I could to like not impress her, but just like make her happy in a way. Everything that she wanted me to do to be a good daughter, I suppose. But then I got to the point where I was like either I’m going to be really unhappy, we’re both actually going to be really unhappy or I can try to make myself happy.

Melissa ‘failed’ to comply with her mother’s expectations because she was bisexual, stated she was not getting married or having children, refused to observe religious customs and had not pursued her mother’s expected education and employment pathway. Her ‘disobedience’ created a very stressful family home, which contributed to Melissa’s mental health problems. Similarly, Jamie (bisexual, trans male, White British) described the strain of being trans, the weight of expectation on young people and having limited autonomy with the family:

Its stressful being LGBT because society can just screw you over sometimes. It is especially stressful being trans because you can’t escape a situation where you don’t have, where you don’t announce your transgender. It’s stressful being a young person in today’s society because there is a lot of pressure on young people. You have to get a job, you have to work towards getting a job, you need all these qualifications otherwise you can’t get into college and can’t get a job. Then it is finally very, very stressful to function in a family unit because there is a lot of responsibility on you to please your parents.

Within a complex negotiation of regulatory heteronormative discourses and relationships, economic dependency, cultural expectations and material constraints, the participants in our study were not ‘rebelling’ but, instead, struggling for autonomy to become their sexual/gendered young adult selves. Autonomy is commonly understood to be important to developing into a rational and mature subject, and it is defined as a growing independence from parents and carers with free will to act ( Walkerdine et al., 2001 ). The problem for some queer youth is that their struggle for autonomy takes place in circumstances which can be hostile, where life is dependent on adults. This creates a tremendous pressure and conflict between wanting to be a mature, autonomous queer young person but wanting to belong to the family and remain in a secure setting ( McDermott and Roen, 2016 ). For queer youth, their transgression of heteronormativity, not fulfilling family expectations, and lack of autonomy can threaten their security and family connection. Our data analysis suggests that the emotions required to decipher sets of ‘paradoxical family practices’ ( Gabb et al., 2020 ) required young people to navigate family relationships that did not fit a standard norm. Making sense of family-specific relationships and surviving stressful family settings were significant to mental health and well-being.

Emotion work and queer youth mental health

As indicated in the previous sections, family relationships were important to the youth participants and they worked hard to maintain their familial bonds. Our analysis suggests it is the emotion work involved in this relationship maintenance, endurance, repair and re-negotiation that is key to explaining why family relationships are so influential to queer youth mental health and well-being ( Gabb et al., 2020 ). In this study, we had a specific critical mental health framework that put emotions at the centre of conceptualising young people’s mental health. The research team was still surprised by the intensity of the emotions in the data, from young people and family members, when explaining their LGBTQ+ status, family relationships and mental health. In addition to intensity, it was the extent that young people were managing, coping, reacting, changing and adapting their emotions and their responses to their emotions. Participants specifically described this as ‘Stiff upper lip’ (Chris); Coping with ‘a weight’ (Emma); ‘Carrying a weight’, ‘Side stepping’ (in conversation), ‘On guard’, ‘Bite my lip’ (Hannah); ‘Grew a thicker skin’, ‘Just deal with it’, ‘Grit your teeth and bare it’(Jamie); ‘Take it on the chin’, ‘Brave face’ (Josh); ‘Stop trying’, ‘Shut down’, ‘Get used to it’ (Melissa); ‘Detachment’, ‘Stop feelings’; ‘Act fairly normal’ (Skye).

In Table 3 , we characterise the forms of emotion work expressed by the participants. We do not mean these to be a typology of ‘emotion work’, but they serve more to demonstrate the emotionality of the strategising, thinking, managing, feeling, required to survive family life when you are young and queer. We also think this shows the burden on mental health. We do not want to repeat the psychopathologising of queer youth emotional distress, or suggest particular emotion work strategies lead to particular mental health problems. In contrast to Hochschild (1979) , our view is that the participants’ emotion work cannot be ‘chopped up’ in meaningful ways as the modes typically overlap and can be temporal, and would prove reductive and limit our understanding of the extent of emotion work being undertaken by the participants.

Characterisation of queer youth emotion work.

Our analysis does suggest, however, that participants’ emotion work is crucial to understanding the relationship between families and queer youth mental health. Most importantly, this emotion work is agentic, and not a sign of psychopathology or maladaptive ER. If we take ‘withdrawal’ as an example, this was emotion work we recognised in our analysis where young people described keeping silent about their emotions and making no emotional demands on family relationships. In our data, this was a common strategy where young people described withdrawing, both temporarily and permanently, because it seemed like the only way to deal with confusing, hurtful, unnamed feelings and relationships – often related to their queerness. So withdrawal or isolation is agentic not imposed by outside world nor is it a sign of psychopathology or maladaptive ER. It is a reasonable survival strategy to employ when living in a hostile environment with few resources, little autonomy and no economical independence. For example, Melissa (bisexual, Cis-female, BAME) states regarding her mum:

if I don’t live in the same house as her she’s not always like [PAUSE] policing what I’m doing, and when she does that I get more irritated and I just shut down even more and I just stop talking to her about anything and it just gets worse and worse.

This contrasts with young people in families where they did not need to withdraw because family members were invested in supporting them and understanding their emotional distress. In the interviews with family members, Lisa (Lesbian, Cis-female, White British) spoke of efforts to understand the potential root of her daughter’s anxiety and support her using mental health services. Similarly, Mark (gay, Cis-male, White British) mentioned his own mental health issues too while considerately reflecting on how this interplays with and impacts those of his daughter.

However, for many of our participants, ‘doing’ emotion work and maintaining the ‘happy family pretence’ was a survival strategy that enabled some to remain housed, fed and safe. The precarious nature of young lives was evident in our participants’ concerns about security, housing and finances, and some reflected how they could not afford not to do emotion work of some sort. For example, Kelly (bisexual, Cis-female, BAME) had been in care and was estranged from her family home, with very limited resources and stated she was ‘used to feeling terrible’. Homeless Josh (gay, Cis-male, White British) deployed a ‘brave face’ to get on with in his current circumstances. In both cases, the imperatives to engage in emotion work were for the purposes of basic survival, and these were often detrimental to their mental health.

The findings from this study suggest that queer young people’s mental health is deeply affected by their relationships with their families but in complex ways. Our findings indicate that while the disclosure of sexual and/or gender diversity to family members is crucial to good mental health, it is the emotionality of family relationships, and queer youth negotiation of these, that is important to recognise when trying to understand why and how family is so influential of queer youth mental health. It is the meaning – socially, culturally and economically – of ‘paradoxical family practices’ ( Gabb et al., 2020 ) that matters.

Through the use of an interdisciplinary critical mental health approach that conceived emotional distress as a regular capacity of humans to feel, and utilised sociological theorisations of family, youth, sexuality and gender, we employed a creative, emotion-centred methodology to capture intricate relationships, meanings and emotions. As a result, our analysis centred queer youth within the powerful and emotional dynamics of family life to investigate their mental health.

Youth is a central concept in this project, and it has been young people’s position within the family which has perhaps been most forcefully ‘present’ throughout our analysis. The power dynamics between young people and the adults in their family are usually absent from investigations of LGBTQ+ youth mental health, youth is conceived as an age on a development spectrum and family relationships are categories of biological kin (mother, father, etc.). What has ‘pressed’ upon our analysis, through our engagement with all the participants (youth and family), has been the difficulties youth have negotiating family life because of their age, sexual and/or gender diversity, ethnicity/religion and economic dependency. The emotion work involved in becoming their autonomous queer young adult selves, in becoming who they felt they were, but remaining connected to family as a site of identity, love and sometimes just for safety, was intense and often overwhelming, and this compromised their mental health and well-being.

Despite these difficulties, the young people in our study showed an agentic intent, competency, self-awareness and extensive compassion to family members, which, we think, intensified the emotion work involved in maintaining their family relationships. In other words, because they loved, respected, were grateful and cared for their family members, they tried hard to remain connected and belong. Similarly, where there were positive family relationships, this was nearly always where family members gave time, respect and space for the young person to develop their autonomy and self-determination in a supportive and communicative environment. Unsurprisingly, it was these types of relationships that promoted queer youth well-being.

Alongside the power differential between youth/adults, heteronormativity imbued family relationships that made them often oppressive, hostile and controlling. Levels of heteronormative surveillance, scrutiny and policing by family members increased levels of emotional distress in the young people and in some circumstances meant they left or were forced to leave their family home. Our analysis showed quite clearly that within a complex negotiation of regulatory heteronormative discourses and relationships, economic dependency, cultural expectations and material constraints, the participants in our study were not ‘rebelling’ but, instead, struggling for autonomy to become their sexual/gendered young adult selves. The emotion work involved in this struggle had a direct negative impact on youth mental health.

Within our analysis, we could not avoid the precarious position of young people and this was especially acute for those who were poor and/or BAME. The site of the family as the only major resource in the lives of most of our participants underscores the ways that the navigation of family heteronormativity can intensify queer youth’s precarious position. The transgression of heteronormative family expectations has potentially dire consequences for queer youth if their family is the only resource that is available to provide shelter, food, love and care. Taking an intersectional viewpoint, it was evident that multiple layers of inequalities can compound challenges; in other words, queerness can amplify the precariousness of young poor or Black lives.

The study is limited by its size and while non-probability samples of LGBTQ+ youth allow the study of important health issues, it is difficult to determine whether findings are characteristic of the population in general or solely the sample recruited. Longitudinal prospective studies of cohorts of LGBTQ+ and non-LGBTQ+ young people that compare family and mental health would help explain the relationships identified in this study as well as other (as yet unrecognised) factors. Our findings are embryonic, but the study contributes theoretically, methodologically and empirically to developing a future frame of investigation that de-pathologises emotional distress and disrupts tenacious stereotypes of young people as over-emotional and ‘out of control’. Our findings suggest that tackling queer youth mental health and promoting well-being might require a different angle of intervention, one that is non-clinical, away from psychopathology and stigma. Social and psychological interventions must help queer youth and their families better navigate their relationships while understanding their complex emotionality and providing a safety net for queer youth if family relationships break down.

Author biographies

Elizabeth McDermott , PhD, MSc, BA is professor of Health Inequality in the Faculty of Health & Medicine at Lancaster University, UK. She is a public health specialist in LGBTQ young people’s mental health. Her research expertise is focussed on explaining why there are inequalities in young people’s mental health, and unravelling the mechanisms by which poor mental health is distributed unfairly across the adolescent and young adult population.

Jacqui Gabb , PhD, MA, BA is a professor of Sociology and Intimacy in the Faculty of Arts and Social Sciences at The Open University. She has completed investigations on long-term couple relationships, intimacy and sexuality in families, LGBTQ young people and mental health. Publications include Couple Relationships in the 21st Century (Palgrave, 2015) and Researching Intimacy in Families (Palgrave, 2008).

Rachael Eastham , PhD, MRes, MSc, BSc is a senior research associate in the Faculty of Health & Medicine at Lancaster University, UK. She is primarily a qualitative researcher with a particular interest in using creative, visual methods to research sexualities, gender, young people, sexual health and mental health inequalities.

Ali Hanbury , PhD, MRes, PGDip., BSc (hons) is the LGBT+ Centre Manager at The Proud Trust, UK. She is a professionally qualified youth and community worker who has been working in local authority and charity settings since 2006. She also delivers the nationally recognised LGBT+ inclusive training programme, Sexuality aGender.

1. We use LGBTQ+ to refer to sexual and gender identity because this was the preferred term used by participants. References to other research use the author’s original terminology for sexuality/gender. We use ‘queer’ to indicate a theoretical orientation to Queer Theory and Heteronormativity.

Funding: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Wellcome Trust [206792/Z/17/Z].

Contributor Information

Elizabeth McDermott, Lancaster University, UK.

Jacqui Gabb, Open University, UK.

Rachael Eastham, Lancaster University, UK.

Ali Hanbury, The Proud Trust, UK.

• Research article
• Open access
• Published: 18 November 2016

Sexual dysfunction among youth: an overlooked sexual health concern

• Caroline Moreau 1 , 2 ,
• Anna E Kågesten   ORCID: orcid.org/0000-0002-5458-8319 1 &
• Robert Wm Blum 1  

BMC Public Health volume  16 , Article number:  1170 ( 2016 ) Cite this article

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There is growing recognition that youth sexual health entails a broad range of physical, emotional and psychosocial responses to sexual interactions, yet little is known about sexual dysfunctions and well being in youth populations. This study explored sexual dysfunctions among youth and its associations with other domains of sexual health. Sexual dysfunctions were defined as: problems related to orgasm, pain during intercourse, lack of sexual desire or sexual pleasure.

Data were drawn from the 2010 French national sexual and reproductive health survey comprising a random sample of 2309 respondents aged 15-24 years. The current analysis included 842 females and 642 males who had sexual intercourse in the last 12 months. Chi square tests were used to test for differences in sexual dysfunctions by sex and explore associations with other domains of sexual health.

Half of females (48%) reported at least one sexual dysfunction versus 23% of males. However, over half (57%) of youth reporting at least one dysfunction did not consider this to hinder their sexuality. Altogether, 31% of females cited at least one sexual dysfunction hindering their sexuality—more than three times the 9% of males. Sexual dysfunction was strongly and inversely related to sexual satisfaction for both males and females and additionally to a recent diagnosis of STI or unintended pregnancy for females. Sexual dysfunctions hindering sexuality were also correlated with a history of unintended pregnancy among males.

While most youth in France enjoy a satisfying sexual life, sexual dysfunction is common, especially among females. Public health programs and clinicians should screen for and address sexual dysfunction, which substantially reduce youth sexual wellbeing.

Peer Review reports

The World Health Organization (WHO) defines sexual health as a continuum of physical, psychological, and socio-cultural wellbeing associated with sexuality [ 1 ]. Although a growing body of work addresses the complex interrelation of the different domains of sexual health including aspects of sexual wellbeing among adult populations, research on these topics among youth remains scarce. Rather, sexual health research among youth has traditionally taken a risk reduction perspective, mostly concentrating on sexually transmitted infections (STIs) including HIV, unintended pregnancy, and sexual coercion due to their significant contributions to disability adjusted life years for youth [ 2 ].

There is growing recognition however, that youth sexual health entails a broader range of physical, emotional and psychosocial responses to sexual interactions than just physical morbidities [ 3 , 4 ]. Studies in adult populations have revealed high prevalence of sexual dysfunction [ 5 , 6 ], which, according to the International Classification of Disease (ICD-10) [ 7 ], encompasses a spectrum of symptoms including lack of sexual desire, lack of sexual pleasure, failure of genital response, orgasmic dysfunction, premature ejaculation and dyspareunia [ 2 , 6 ]. This symptomatology follows the Masters and Johnson [ 8 ] and Kaplan [ 9 ] frameworks of the three-phase model of sexual response (desire, arousal, and orgasm), with the addition of sexual pain. Adding to the symptomatology itself, the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) specifies the duration and severity of symptoms to distinguish sexual dysfunction from variation of normal sexual response and the clinical significance of these symptoms [ 10 , 11 ]. The addition of clinical distress reflects an ongoing debate contrasting a bio-medical model of sexual functioning focusing on physiological response with a psychosocial model that also considers the psychosocial aspects of sexuality including the social expectations of sexual relations [ 4 , 11 ].

Measuring sexual dysfunction in population-based surveys is challenging given the sensitive nature of the topic, time constraints and potential recall errors [ 12 ]. The most widely used instruments are the Female Sexual Function Index (FSFI) (19 items) for females [ 13 ] and the International Index of Erectile Function (IIEI) for males [ 14 ]. The FSFI instrument only covers a 4-week period, failing to distinguish transient from prolonged symptomatology among females while the IIEI instrument only focuses on erectile dysfunction omitting other functional dimensions of sexual activity among males [ 6 ]. None of these instruments assess aspects of sexual distress. While definitions, measures and sampling strategies vary, population based surveys consistently report that the nature and frequency of sexual dysfunctions vary by sex, with females mostly citing hypoactive sexual desire and orgasm while males mostly report premature ejaculation and erectile dysfunction [ 5 , 15 ].

Furthermore, evidence indicates that many individuals experiencing sexual dysfunctions are not distressed by these symptoms [ 11 ]. While sexual dysfunctions emerge early in the sexual trajectories of adults who present with such problems [ 16 ], little is known about sexual dysfunctions and their consequences on youth sexual health [ 15 , 17 ]. The few studies conducted among youth reveal high levels of sexual dysfunction, including pain, lack of desire and failure of genital response [ 15 ]. A recent study by Sullivan [ 18 ] among 411 Canadian youth aged 16 to 21 years indicated that half of the participants reported at least one sexual functioning complaint. While sexual dysfunctions were frequent, distress related to such dysfunctions was less prevalent: half of those with sexual complaints suffered clinically significant sexual related distress [ 18 ].

Sullivan’s study provides a thorough investigation of sexual functioning using validated instruments of male and female sexual functioning [ 18 ]. Yet, the small convenience sample of adolescents limits the generalizability of the findings; and the focus on sexual dysfunction and sexual distress alone does not allow an exploration of the interrelation of sexual functioning with other domains of sexual health.

Recent studies conducted in the Great Britain [ 19 ] and Flanders, Belgium [ 20 ] seek to address some of these gaps, assessing sexual functioning in larger samples of the general population. While the Flanders study reports age-specific prevalence of sexual difficulties and associated distress, the study draws inferences from a convenience sample of the population (online survey advertised through media channels), which raises concern regarding the generalizability of their findings [ 20 ]. In contrast, The National Survey of Sexual Attitudes and Lifestyles (Natsal) study in Great Britain assesses sexual functioning among male and female youth, using a nationally representative probability sample [ 19 ]. The Natsal survey however uses a different measure of sexual function problems [ 12 ] based on a conceptual framework that includes both psycho-physiological and relational aspects of sexual functioning [ 21 ]. The Natsal sexual functioning instrument excludes measures of severity and distress, based on the psychometric proprieties of the scale [ 12 ]. In addition, questions cover a short period of time (three months) [ 12 ].

Building on a more conventional psycho-social and physiological conceptualization of sexual functioning, the present study aims to provide new information on the prevalence of youth sexual dysfunction and its consequences on sexuality in France, and the intersection between sexual dysfunctions with other domains of sexual health, including sexual satisfaction, STIs and unintended pregnancies.

The current study addresses three main questions. What are the patterns of youth sexual dysfunctions and to what extent do young people consider such dysfunctions to affect their sexuality? How do these patterns differ by sex? How are youth sexual dysfunctions related to other domains of sexual health? In this article we refer to sex differences in behaviours and outcomes as we compare males and females without accounting for their gender identity, because gender identity was not assessed in the FECOND study. However, we acknowledge that much of the sex differences that are reported are not only biologically, but also socially driven.

Study design and sample

Data were drawn from the 2010 French national sexual and reproductive health survey, FECOND, comprising 8475 individuals aged 15 to 49 years residing in France. Participants were selected following a two-stage probability sampling method. Phone numbers (including both landline and cell-phones) were generated using random digit dialling. One individual per phone number was selected for participation. The refusal rate was estimated at 20% [ 22 ].

After verbal consent, participants responded to a 40-min telephone questionnaire. The FECOND study was approved by the French Commission Nationale de l’Informatique et des Libertés and the current secondary analysis was approved by the Bloomberg School of Public Health Institutional Review Board at Johns Hopkins University.

The present analysis was restricted to respondents aged 15 to 24 years ( n  = 2309) who reported ever having had sexual intercourse ( n  = 944 females and n  = 731 males). Sexual intercourse was assessed as a positive response to any of two questions “Have you ever had sexual intercourse with a woman?” and “Have you ever had sexual intercourse with a man?” The definition of sexual intercourse did not distinguish between different types of sexual practices. Questions on sexual difficulties and satisfaction were only asked of respondents who reported having had sexual intercourse in the last 12 months ( n  = 886 females and n  = 679 males). We further excluded participants who stopped responding to the survey before the sexual health module ( n  = 41 females and n  = 32 males). Our final sample comprised 1484 participants ( n  = 842 females and n  = 642 males).

Topics explored in the multi-thematic FECOND study included socio-demographic status, reproductive histories, past and current sexual health indicators. The key outcome of interest in the present study was sexual dysfunction and sexual dysfunction hindering sexuality in the past 12 months, assessed through a set of five questions for females and six questions for males. These questions were derived from the last national sexual health survey “The Context of Sexuality in France (CSF)” conducted in France in 2006 for comparative purposes [ 23 ]. The CSF sexual dysfunction module was based upon the the ICD-10 classification of sexual dysfunction [ 7 ]. The questions examined the following symptoms: lack of sexual desire, lack of pleasure during intercourse, difficulty reaching orgasm and pain during intercourse. In addition, females were asked about vaginal dryness while males were asked about problems of erections and premature ejaculation. Response options assessing the frequency of each sexual difficulty in the last 12 months ranged from “often”, “sometimes”, “rarely”, or “never”. We examined each sexual difficulty separately and constructed a prevalence indicator summarizing the number of problems reported (none, 1, >1). This indicator was based on the four most common sexual problems that were reported among males and females in order to compare results by sex. Following the CSF survey module [ 23 ], which not only assessed the frequency of sexual difficulties but how such difficulties related to an individual’s assessment of their own sexuality, respondents were also asked if each of these four components “constituted a problem for their own sexuality”. Based on this information, we constructed a revised set of measures of sexual dysfunctions hindering sexuality in the rest of the article.

We further investigated the association between sexual dysfunctions with four other domains of sexual health. First, history of STI in the last five years was assessed by a question asking about having had an STI during this time period. If respondents indicated having had an STI in the last five years, they were further asked if the infection were “herpes”, “mycosis” (thrush) or another infectious agent, and in the later case they were asked to provide the name of the infectious agent. Thrush was excluded from the definition of STIs in this analysis. Secondly, lifetime experience of an unintended pregnancy was a constructed measure summarizing participant’s pregnancy intentions at the time of each pregnancy. Third, forced sexual intercourse in the last 12 months was assessed with a single question asking if the respondent had had forced sexual intercourse against his/her will in the last 12 months (often, sometimes, rarely or never). A dichotomous measure was constructed opposing never to all other responses. Lastly, youth were also asked about sexual satisfaction at the time of the survey, operationalized as “very satisfied”, “rather satisfied”, “rather not satisfied” or “not satisfied at all” with current sexual life. We also explored the association between sexual dysfunctions and frequency of intercourse in the last four weeks. All measures were self-reported.

Statistical analysis

Descriptive statistics were used to explore sex differences in sexual dysfunctions and assess the extent to which each of these dysfunctions hindered sexuality among youth. Using a prevalence indicator of number of reported sexual dysfunctions, we then examined the associations across sexual dysfunctions and other domains of sexual health, including sexual satisfaction, sexual violence, STI, unintended pregnancy and frequency of sexual intercourse. We performed the same analysis assessing associations between sexual dysfunction hindering sexuality and other indicators of sexual health. Chi square tests were used to explore differences in sexual dysfunctions and sexual dysfunctions hindering sexuality by sex and to unveil associations between sexual dysfunctions indicators with other domains of sexual health.

The mean age of respondents was 20.2 years with no difference by sex (p = 0.23). Most respondents had a partner at the time of the survey, with a greater proportion of females in a cohabitating partnership than males (31% versus 18%) (Table  1 ). The mean reported age at sexual debut was 16.5 years for females and 15.8 years for males. Males reported a greater number of lifetime sexual partners than females (6.4 versus 3.6, p < 0.001). Frequency of intercourse was equally distributed by sex, with 23% of males and 17% of females reporting no sexual relations in the last 4 weeks. Four percent of respondents reported ever having a same sex partner, with no difference by sex. There were no significant sex differences in the proportion of respondents reporting a history of unintended pregnancy or an STI in the last 5 years. Three percent of respondents reported an experience of forced sex in the last 12 months, with no difference by sex.

Patterns of youth sexual dysfunctions and sexual dysfunctions hindering sexuality

Female youth were more likely to report sexual dysfunction than their male counterparts (Table  2 ). Lack of sexual desire and difficulty reaching orgasm were the most commonly cited problems for females: 26% and 31% indicated that these problems occurred on a regular basis (often or sometimes) versus 11% and 8% of males ( p  < 0.001). Pain during sexual intercourse was also more frequent among females: 21% cited that this difficulty occurred often or sometimes versus 4% of males ( p  < 0.001). In addition, 21% of males indicated that they regularly experienced premature ejaculation while a minority (4%) reported problems of erection. One in 11 females (9%) indicated they experienced vaginal dryness on a regular basis.

Using the prevalence indicator of combined sexual dysfunctions common to both sexes, results show that half of females (53%) reported no sexual dysfunctions, while one in five (21%) indicated more than one dysfunction occurring “often” or “sometimes” in the last 12 months. For males, 80% cited no dysfunction while 4% cited more than one dysfunction ( p  < 0.001). The number of dysfunctions reported did not significantly vary by age with 21% of adolescent females 15-19 years and 4% of adolescent males citing more than one dysfunction.

Female youth were more likely to report that a sexual dysfunction affected their own sexuality than male youth. Almost one in three females (31%) cited at least one sexual dysfunction causing a problem for their own sexuality as compared to 9% of males ( p  < 0.001), with no significant differences by age. This sex difference was due primarily to the higher prevalence of sexual dysfunctions (twice as high among females than males) and to a lesser extent to differences in whether these symptoms were perceived to hinder sexuality. Specifically, 59% of all females reporting at least one symptom considered it posed a problem for their own sexuality versus 39% of males ( p  = 0.02). The extent to which dysfunctions caused a problem for one’s sexuality varied by symptom: 44% to 77% of sexual dysfunction symptoms among females and 34% to 52% among males were considered a to cause a problem for one’s sexuality (data not shown). Pain during sexual intercourse was most likely to hinder sexuality for both sexes, followed by problems of erection for males and vaginal dryness for females (Table  2 ).

Relationship between sexual dysfunctions and other domains of sexual health

Table  3 presents the associations between sexual dysfunctions or sexual dysfunctions hindering sexuality that were common to both sexes (lack of sexual desire, lack of pleasure during intercourse, difficulty reaching orgasm and pain during intercourse) and other domains of sexual health. Results indicate a strong association between sexual dysfunctions and sexual satisfaction: 74% of females were very satisfied with their current sexual life when they reported no sexual dysfunction versus 36% of those with more than one dysfunction ( p  < 0.001). In the absence of dysfunction, half of males (54%) were very satisfied with their sexual life but that dropped to about one third (29%) when they reported more than one sexual dysfunction ( p  < 0.001). Associations were stronger when respondents reported a sexual dysfunction hindering their own sexuality. Sexual dysfunction alone was not associated with frequency of intercourse, however sexual dysfunction hindering one’s sexuality was related to frequency of intercourse among males, but not among females. Specifically, over half of males (53%) reported having had no sexual intercourse in the last four weeks if they suffered more than one sexual dysfunction hindering their sexuality, more than double that of males who either reported no or one sexual dysfunction hindering their sexuality ( p  = 0.002). While the overall association between sexual dysfunction and a recent STI diagnosis among females was not significant, further analysis indicated that females reporting more than one sexual dysfunction were more likely to report a recent diagnosis of STI as compared to females without such problems (4% versus %, p  = 0.03). This association was borderline significant in the presence of more than one dysfunction hindering one’s sexuality (4% versus 2%, P  = 0.07). In addition, sexual dysfunction was related to a history of unintended pregnancy among female youth ( p  = 0.05), and the presence of more than one dysfunction hindering sexuality was borderline related to unintended pregnancy among females ( p  = 0.06). Males who reported more than one sexual dysfunction as opposed to none were more likely to report an unintended pregnancy (19% versus 7% p  = 0.01); this association was highly significant when considering sexual dysfunction hindering sexuality (37% versus 7%, p <0.001). None of the associations were significant for either males or females when examining the relation between sexual dysfunctions and forced sexual intercourse in the last 12 months. Taken together, there were no sex differences in the associations observed.

Table  4 shows the correlations between sex-specific sexual dysfunctions and other sexual health indicators. None of the sex-specific sexual dysfunctions were related to frequency of sexual intercourse, STI, forced sex or unintended pregnancy. Problems of erection and premature ejaculation were both related to sexual satisfaction especially if they were considered to hinder one’s sexuality while there was no significant association between vaginal dryness and sexual satisfaction among females.

While a majority of sexually experienced youth aged 15-24 years in France enjoy a satisfying sexual life (93% of females and 92% of males reported that they were satisfied or very satisfied with their sexual life), this study indicates that sexual dysfunctions are common although for many young people such symptoms are not reported to be a problem for their own sexuality. Specifically, we found that half of females and a third of males reported at least one sexual dysfunction; however, only a third of females and 9% of males reported that the dysfunctions hindered their sexuality.

Our estimates are difficult to compare to existing literature, since such reports are scarce in this age group [ 17 ], use different populations or different survey instruments and different time frames to assess the prevalence of sexual dysfunctions and sexual distress [ 15 ]. Compared to a recent Flemish study conducted among a convenience samples of 15000 women aged 16 to 74 years recruited online and responding to Sexual Functioning Scale questionnaire, our study showed similar levels of vaginal dryness and absence/delayed orgasm alone among the youth population but lower prevalence rates of lack of desire and dyspareunia [ 20 ]. The proportion of sexual problems causing distress was generally above 50% in the Flanders study [ 20 ], which is higher than our estimates of sexual dysfunction hindering sexuality. However, sexual distress and the relation of sexual dysfunction to sexuality are two different constructs, the later extending far beyond sexual practice to encompass notions of identity, attitudes and feelings towards sex. In addition, the sexual distress measure of the Flemish study criteria included both personal and partner distress as recommended in the DSM-IV classification, which may have inflated their estimates, as interpersonal distress is no longer a criterion for sexual dysfunction in the DSM-V [ 10 ]. Differences in sampling method (convenience sample in the Flemish study versus probability sampling in the FECOND study) may also account for some of the differences observed. The Natsal study in Britain used an extended definition of sexual functioning (incorporating both psycho-physiological and relational aspects of sexual functioning) and a short time frame to assess sexual dysfunction (3 months) [ 12 ]. In addition, the Natsal measure did not specifically assess the overall consequences of sexual dysfunctions on the respondent’s own sexuality. While these differences preclude meaningful comparisons with our current study, the Natsal study also reported that a significant proportion of youth had low sexual function (14% of young women and 13% of young men aged 16 to 24 years) [ 19 ], calling our attention to address sexual functioning problems across the lifespan.

In our study a substantial proportion of males and females did not consider sexual dysfunctions to be problematic for their own sexuality (41% of females and 61% of males). The gap between symptomatology and related distress is the focus of much debate regarding the diagnostic criteria for sexual dysfunctions [ 11 ]. The proponents of a medical model (reflected in the ICD-10 classification) argue that the diagnostic criteria for sexual dysfunction should not include its clinical or psychosocial consequences, while others referring to a socially inspired model of sexual functioning consider distress as an indicator of sexual dysfunction (DSM-V), drawing attention to the functional utility of the definition [ 11 ]. This later perspective has gained momentum in the advent of marketing of drugs for erectile dysfunction, bearing on the medicalization of sexual health [ 4 ]. While the added value of distress to the specificity of the measure remains controversial, the subjective experiences of sexual functioning should be considered as critical elements underlying healthcare seeking behaviours. The relation of sexual functioning to one’s sexuality extends beyond the notion of sexual distress by considering that sexual functioning can also affect one’s sexual identity and one’s attitudes and feelings related to sexual interactions.

Beyond its prevalence assessments, this study contributes new knowledge in several important ways. First, our results indicate marked sex-differences in the prevalence of sexual dysfunction starting in adolescence, which were not observed in the Natsal survey in Britain [ 19 ]. However, similar findings were reported in the previous French sexual health survey (CSF survey) conducted in 2006 in a slightly older population, as women between 18 and 35 years were more likely to report sexual distress than men while the reverse was true after the age of 35 [ 23 ].

Expanding on prior work, our results further show that sexual dysfunctions are inter-correlated; 30% of females and 19% of males who reported any dysfunction indicated more than one symptom. These sex differences in the interconnection of sexual functioning problems have been described in other studies among older populations [ 15 ] and call attention to the relational context in which sexual interactions occur. The Natsal study stresses the importance of the relational nature of sexual interactions [ 21 ], but includes the relational aspect of sexual activity within the sexual functioning scale precluding a direct investigation of the intersection of psycho-physiological and relational attributes of sexual function. Further longitudinal exploration of sexual symptoms and clusters of sexual symptoms, as well as how they affect an individual’s sexuality identity, their attitudes, feeling and relational experiences of sexual activity is warranted to understand how dysfunctions evolve over time and across relationships.

Our third contribution highlights the intersection of sexual dysfunctions with other domains of sexual health. In particular, we found a highly negative correlation between sexual dysfunctions and sexual satisfaction, highlighting the important contribution of sexual function to youth sexual well-being. Importantly, we found that the clustering of dysfunctions was related to a history of STI among females, and increased likelihood of reporting an unintended pregnancy in both sexes. A similar correlation between low sexual function and a past history of STIs was also reported in the Natsal study, although this association was not specific to youth [ 19 ].

The current study has a number of limitations. Because of the multi-thematic nature of the FECOND study, we did not use a validated measure of sexual functioning, although our questions were drawn from the national sexual health survey conducted in France in 2006, which captured all dimensions of sexual dysfunctions assessed in the most widely used scales (Female Sexual Functioning Index [ 13 ] or the Brief Sexual Function Inventory) [ 24 ]. However, unlike validated scales that assess symptoms over a four week period and do not measure the subjective repercussions of sexual dysfunction on sexuality, our construct of sexual dysfunction (difficulties that occur often or sometimes and affect individual’s sexuality over the last 12 months) is more in line with the most recent DSM-V definition of sexual dysfunction, involving symptomatology causing significant distress for a prolonged period the time. Our measurement however, does not include precise estimates of frequency and duration, specified in the DSM-V definition, which requires symptoms to be present between 75 and 100% of the time for a minimum of 6 months [ 9 ]. As mentioned above, we also recognize an important difference between sexual distress and dysfunctions causing a problem for an individual’s sexuality.

While we assessed the association between sexual dysfunctions and a number of sexual health indicators, we were not able to examine the association with contraceptive usage, the most proximate determinant of unintended pregnancy, due to the small number of youth with an unmet need for contraception ( n  = 9 females and n  = 8 males). Likewise, the small percentage of youth engaged in casual sex at last intercourse did not allow for a meaningful exploration of condom use at last sexual intercourse. Small sample sizes also limited the interpretation of results related to forced sexual intercourse.

Because this study was based on cross sectional data, we cannot establish causality. Further research using longitudinal design is needed to ascertain the persistence of sexual dysfunction and sexual dysfunction hindering sexuality over time and their predictive effect on other domains of sexual health. Further investigation is also needed to describe the socio-demographic and contextual factors related to sexual dysfunction and dysfunction hindering sexuality with specific emphasis on partner-related factors given the diversity of relationship experiences in adolescence and early adulthood.

While most youth in France enjoy a healthy sexual life, sexual dysfunctions are common, especially among females. Public health and clinical programs should screen for and address sexual dysfunction, which substantially reduces youth sexual wellbeing and are related to other common sexual health concerns among youth including STIs and unintended pregnancies.

Abbreviations

Diagnostic and statistical manual of mental disorders

French National Fertility Survey

International statistical classification of diseases and related health problems (10th revision)

National survey of sexual attitudes and lifestyles

Sexually Transmitted Infection

World Health Organization

World Health Organization. Sexual Health. (2012). Retrieved on 30 November 2012 from http://www.who.int/reproductivehealth/topics/sexual_health/sh_definitions/en/

Gore FM, Bloem PJ, Patton GC, Ferguson J, Joseph V, Coffey C, Sawyer SM, Mathers CD. Global burden of disease in young people aged 10-24 years: a systematic analysis. Lancet. 2011;377:2093–102.

Article   PubMed   Google Scholar  

Tolman D, McClelland S. Normative sexuality development in adolescence: a decade in review, 2000–2009. J Res Adolesc. 2011;21:242–55.

Article   Google Scholar  

Wellings K, Mitchell K, Collumbien M. Sexual health: a public health perspective. London: Open University Press; 2012.

Laumann EO, Nicolosi A, Glasser DB, Paik A, Gingell C, Moreira E, Wang T, GSSAB Investigators' Group. Sexual problems among women and men aged 40–80 y: prevalence and correlates identified in the Global Study of Sexual Attitudes and Behaviors. Int J Impot Res. 2005;17:39–57.

McCabe MP, Sharlip ID, Atalla E, Balon R, Fisher AD, Laumann E, Lee SW, Lewis R, Segraves RT. Definitions of sexual dysfunctions in women and men: a consensus statement from the fourth international consultation on sexual medicine. J Sex Med. 2016;13:135e–143.

World Health Organization. International statistical classification of diseases and related health problems. 10th ed. Geneva: World Health Organization; 1992.

Google Scholar  

Masters WH, Johnson VE. Human sexual response. Boston: Little, Brown; 1966.

Kaplan HS. The new sex therapy. New York: Brunner/Mazel; 1974.

IsHak WW, Tobia G. DSM 5 changes in diagnostic criteria of sexual dysfunctions. Reprod Sys Sexual Disorders. 2013;2:122. doi: 10.4172/2161-038X.1000122 .

Hendrickx L, Luk Gijs L, Enzlin P. Distress, sexual dysfunctions, and DSM: dialogue at cross purposes? J Sex Med. 2013;10:630–41.

Mitchell K, Ploubidis G, Datta J, Wellings K. The Natsal-SF: a validated measure of sexual function for use in community surveys. Eur J Epidemiol. 2012;27:409–18.

Article   PubMed   PubMed Central   Google Scholar  

Rosen R, Brown C, Heiman J, Leiblum S, Meston C, Shabsigh R, Ferguson D, D'Agostino Jr R. The Female Sexual Function Index (FSFI): A multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther. 2000;26:191–208.

Article   CAS   PubMed   Google Scholar  

Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A. The International Index of Erectile Function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology. 1997;49:822–30.

McCabe MP, Sharlip ID, Lewis R, Atalla E, Balon R, Fisher AD, Laumann E, Lee SW, Segraves RT. Incidence and prevalence of sexual dysfunction in women and men: a consensus statement from the fourth international consultation on sexual medicine. J Sex Med. 2016;13:144e–152.

Shifren JL, Monz BU, Russo PA, Segreti A, Johannes CB. Sexual problems and distress in United States women: Prevalence and correlates. Obstet Gynecol. 2008;112:970–8.

Ahern NR, Kiehl EM. Adolescent sexual health and practice: a review of the literature - implications for healthcare providers, educators, and policy makers. Fam Community Health. 2006;29:299–315.

O'Sullivan LF, Brotto LA, Byers ES, Majerovich JA, Wuest JA. Prevalence and characteristics of sexual functioning among sexually experienced middle to late adolescents. J Sex Med. 2014;11:630–41.

Mitchell KR, Mercer CH, Ploubidis GB, et al. Sexual function in Britain: findings from the third National survey of sexual attitudes and lifestyles (Natsal-3). Lancet. 2013;382:1817–29.

Hendrickx M, Gijs L, Enzlin P. Age-related prevalence rates of sexual difficulties, sexual dysfunctions, and sexual distress in heterosexual women: results from an online survey in Flanders. J Sex Med. 2015;12:424–35.

Mitchell KM, Wellings K. Measuring sexual function in community surveys : development of a conceptual framework. J Sex Res. 2013;50(1):17–28.

Legleye S, Charrance G, Razafindratsima N, Bohet A, Bajos N, Moreau C. Improving survey participation cost effectiveness of callbacks to refusals and increased call attempts in a national telephone survey in France. Public Opin Q. 2013;77:666–95.

Levinson S. Difficulties with sexual function: contexts, determinants and meanings. In: Bajos N, Bozon M, editors. Sexuality in France (p449-468). Oxford: Bardwell Press; 2012. Originally published 2008.

Mykletun A, Dahl AA, O'Leary MP, Fosså SD. Assessment of male sexual function by the Brief Sexual Function Inventory. BJU Int. 2006;97:316–23.

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Acknowledgements

We thank all women and men who participated in the FECOND survey.

This work was supported by a grant from the French Ministry of Health, a grant from the French National Agency of Research (#ANR-08-BLAN-0286-01), and funding from National Institute of Health and Medical Research (INSERM) and the National Institute for Demographic Research (INED). Caroline Moreau is also supported by the William Robertson endowment funds and Robert Blum through the William H. Gates Sr. endowment.

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Authors’ contributions

CM conceptualised the study, conducted the analysis and drafted the manuscript. AEK helped conceptualise the study including the analysis, wrote parts of the manuscript, and provided extensive revisions to the text. RWB contributed to the analytical strategy, provided critical review of drafts for intellectual content, and edited the text. All authors read and approve of the final manuscript.

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The FECOND study was approved by the French Commission Nationale de l’Informatique et des Libertés and the current secondary analysis was approved by the Bloomberg School of Public Health Institutional Review Board at Johns Hopkins University.

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Moreau, C., Kågesten, A.E. & Blum, R.W. Sexual dysfunction among youth: an overlooked sexual health concern. BMC Public Health 16 , 1170 (2016). https://doi.org/10.1186/s12889-016-3835-x

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DOI : https://doi.org/10.1186/s12889-016-3835-x

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Parents’ perspectives on family sexuality communication from middle school to high school.

1. Introduction

2. materials and methods, 2.1. recruitment and participants, 2.2. interview protocol, 2.3. data analysis, 3.1. reasons for sexuality communication, 3.2. comfort talking about sex, 3.3. perceptions of teens’ experiences of sexuality communication, 3.4. talk about dating and relationships, 3.5. talk about readiness for sex, 3.6. talk about sexual risk and protection, 4. discussion, 5. conclusions, acknowledgments, author contributions, conflicts of interest.

• Kann, L.; McManus, T.; Harris, W.A.; Shanklin, S.L.; Flint, K.H.; Hawkins, J.; Queen, B.; Lowry, R.; Olsen, E.O.; Chyen, D.; et al. Youth risk behavior surveillance—United States, 2015. MMWR Surveill. Summ. 2016 , 65 , 26–28. [ Google Scholar ]
• Martin, J.A.; Hamilton, B.E.; Osterman, M.J.; Driscoll, A.K.; Mathews, T.J. Births: Final data for 2015. Nat. Vital Stat. Rep. 2017 , 66 , 1–70. [ Google Scholar ]
• Sedgh, G.; Finer, L.B.; Bankole, A.; Eilers, M.A.; Singh, S. Adolescent pregnancy, birth, and abortion rates across countries: Levels and recent trends. J. Adolesc. Health 2015 , 56 , 223–230. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Finer, L.B.; Zolna, M.R. Declines in unintended pregnancy in the United States, 2008–2011. N. Engl. J. Med. 2016 , 374 , 843–852. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Grossman, J.M.; Tracy, A.J.; Charmaraman, L.; Ceder, I.; Erkut, S. Protective effects of middle school comprehensive sex education with family involvement. J. Sch. Health 2014 , 84 , 739–747. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Murry, V.M.; McNair, L.D.; Myers, S.S.; Chen, Y.-F.; Brody, G.H. Intervention induced changes in perceptions of parenting and risk opportunities among rural African American youth. J. Child Fam. Stud. 2014 , 23 , 422–436. [ Google Scholar ] [ CrossRef ]
• Clawson, C.L.; Reese-Weber, M. The amount and timing of parent-adolescent sexual communication as predictors of late adolescent sexual risk-taking behaviors. J. Sex Res. 2003 , 40 , 256–265. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Miller, K.S.; Levin, M.L.; Whitaker, D.J.; Xu, X. Patterns of condom use among adolescents: The impact of mother-adolescent communication. Am. J. Public Health 1998 , 88 , 1542–1544. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Greydanus, D.E.; Pratt, H.D.; Merrick, J. Sexuality in childhood and adolescence. In Sexuality: Some International Aspects ; Merrick, J., Greydanus, D.E., Eds.; Nova Science: Hauppauge, NY, USA, 2016; pp. 1–31. [ Google Scholar ]
• Mollborn, S.; Everett, B. Correlates and consequences of parent-teen incongruence in reports of teens’ sexual experience. J. Sex Res. 2010 , 47 , 314–329. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Malacane, M.; Beckmeyer, J.J. A review of parent-based barriers to parent–adolescent communication about sex and sexuality: Implications for sex and family educators. Am. J. Sex. Educ. 2016 , 11 , 27–40. [ Google Scholar ] [ CrossRef ]
• Beckett, M.K.; Elliott, M.N.; Martino, S.; Kanouse, D.E.; Corona, R.; Klein, D.J.; Schuster, M.A. Timing of parent and child communication about sexuality relative to children’s sexual behaviors. Pediatrics 2010 , 125 , 34–42. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Centers for Disease Control and Prevention (CDC), 1995–2015 Middle School Youth Risk Behavior Survey Data. Available online: http://nccd.cdc.gov/youthonline/ (accessed on 8 December 2017).
• Carver, K.; Joyner, K.; Udry, J.R. National estimates of adolescent romantic relationships. In Adolescent Romantic Relations and Sexual Behavior: Theory, Research, and Practical Implications ; Florsheim, P., Florsheim, P., Eds.; Lawrence Erlbaum: Mahwah, NJ, USA, 2003; pp. 23–56. ISBN 978-0805838305. [ Google Scholar ]
• Grotevant, H.D.; Cooper, C.R. Patterns of interaction in family relationships and the development of identity exploration in adolescence. Child Dev. 1985 , 56 , 415–428. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Wray-Lake, L.; Crouter, A.C.; McHale, S.M. Developmental patterns in decision-making autonomy across middle childhood and adolescence: European American parents’ perspectives. Child Dev. 2010 , 81 , 636–651. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Zimmerman, B.; Cleary, T. Adolescents’ development of personal agency: The role of self-efficacy beliefs and self-regulatory skill. In Self-Efficacy Beliefs of Adolescents ; Pajares, F., Urdan, T., Eds.; Information Age: Charlotte, NC, USA, 2006; pp. 45–70. [ Google Scholar ]
• Dishion, T.J.; Piehler, T.F.; Myers, M.W. Dynamics and ecology of adolescent peer contagion. In Understanding Peer Influence in Children and Adolescents ; Prinstein, M.J., Dodge, K.A., Eds.; Guilford: New York, NY, USA, 2008; pp. 72–93. [ Google Scholar ]
• Pariera, K.L. Barriers and prompts to parent-child sexual communication. J. Fam. Commun. 2016 , 16 , 277–283. [ Google Scholar ] [ CrossRef ]
• Kuhle, B.X.; Melzer, D.K.; Cooper, C.A.; Merkle, A.J.; Pepe, N.A.; Ribanovic, A.; Verdesco, A.L.; Wettstein, T.L. The ‘birds and the bees’ differ for boys and girls: Sex differences in the nature of sex talks. Evol. Behav. Sci. 2015 , 9 , 107–115. [ Google Scholar ] [ CrossRef ]
• Kapungu, C.T.; Baptiste, D.; Holmbeck, G.; McBride, C.; Robinson-Brown, M.; Sturdivant, A.; Crown, L.; Paikoff, R. Beyond the ‘birds and the bees’: Gender differences in sex-related communication among urban African-American adolescents. Fam. Proc. 2010 , 49 , 251–264. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Hutchinson, M.K.; Montgomery, A.J. Parent communication and sexual risk among African Americans. West. J. Nurs. Res. 2007 , 29 , 691–707. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Moncloa, F.; Wilkinson-Lee, A.M.; Russell, S.T. Cuídate sin pena: Mexican mother-adolescent sexuality communication. J. Ethn. Cult. Divers. Soc. Work 2010 , 19 , 217–234. [ Google Scholar ] [ CrossRef ]
• Guilamo-Ramos, V.; Goldberg, V.; Lee, J.J.; McCarthy, K.; Leavitt, S. Latino adolescent reproductive and sexual health behaviors and outcomes: Research informed guidance for agency-based practitioners. Clin. Soc. Work J. 2012 , 40 , 144–156. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Fletcher, K.D.; Ward, L.M.; Thomas, K.; Foust, M.; Levin, D.; Trinh, S. Will it help? Identifying socialization discourses that promote sexual risk and sexual health among African American youth. J. Sex Res. 2015 , 52 , 199–212. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Golish, T.; Caughlin, J. “I’d rather not talk about it”: Adolescents’ and young adults’ use of topic avoidance in stepfamilies. J. Appl. Commun. Res. 2002 , 30 , 78–106. [ Google Scholar ] [ CrossRef ]
• Crohn, H.M. Communication about sexuality with mothers and stepmothers from the perspective of young adult daughters. J. Divorce Remarriage 2010 , 51 , 348–365. [ Google Scholar ] [ CrossRef ]
• O’Sullivan, L.F.; Meyer-Bahlburg, H.F.L.; Watkins, B.X. Mother-daughter communication about sex among urban African American and Latino families. J. Adolesc. Res. 2001 , 16 , 269–292. [ Google Scholar ] [ CrossRef ]
• Morgan, E.M.; Thorne, A.; Zurbriggen, E.L. A longitudinal study of conversations with parents about sex and dating during college. Dev. Psychol. 2010 , 46 , 139–150. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Koepke, S.; Denissen, J.J.A. Dynamics of identity development and separation-individuation in parent-child relationships during adolescence and emerging adulthood—A conceptual integration. Dev. Rev. 2012 , 32 , 67–88. [ Google Scholar ] [ CrossRef ]
• Grossman, J.M.; Charmaraman, L.; Erkut, S. Do as I say, not as I did: How parents talk with early adolescents about sex. J. Fam. Issues 2016 , 37 , 177–197. [ Google Scholar ] [ CrossRef ]
• Braun, V.; Clarke, V. Using thematic analysis in psychology. Qual. Res. Psychol. 2006 , 3 , 77–101. [ Google Scholar ] [ CrossRef ]
• Sandelowski, M. Theoretical saturation. In The Sage Encyclopedia of Qualitative Research Methods ; Given, L., Ed.; SAGE: Thousand Oaks, CA, USA, 2008; pp. 875–876. [ Google Scholar ]
• Miles, M.B.; Huberman, A.M. Qualitative Data Analysis: An Expanded Sourcebook , 2nd ed.; SAGE: Thousand Oaks, CA, USA, 1994. [ Google Scholar ]
• QSR International. NVivo Qualitative Data Analysis Software ; Version 10; QSR International: Melbourne, Australia, 2012. [ Google Scholar ]
• Elliott, S. Talking to teens about sex: Mothers negotiate resistance, discomfort, and ambivalence. Sex. Res. Soc. Policy 2010 , 7 , 310–322. [ Google Scholar ] [ CrossRef ]
• Caughlin, J.P.; Golish, T.D.; Olson, L.N.; Sargent, J.E.; Cook, J.S.; Petronio, S. Intrafamily secrets in various family configurations: A communication boundary management perspective. Commun. Stud. 2000 , 51 , 116–134. [ Google Scholar ] [ CrossRef ]
• Grossman, J.M.; Tracy, A.J.; Richer, A.M.; Erkut, S. The role of extended family in teen sexual health. J. Adolesc. Res. 2015 , 30 , 31–56. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Harper, G.W.; Timmons, A.; Motley, D.N.; Tyler, D.H.; Catania, J.A.; Boyer, C.B.; Dolcini, M.M. ‘It takes a village’: Familial messages regarding dating among African American adolescents. Res. Hum. Dev. 2012 , 9 , 29–53. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Jones, D.J.; Zalot, A.A.; Foster, S.E.; Sterrett, E.; Chester, C. A review of childrearing in African American single mother families: The relevance of a coparenting framework. J. Child Fam. Stud. 2007 , 16 , 671–683. [ Google Scholar ] [ CrossRef ]
• Stanton-Salazar, R.D. Manufacturing Hope and Despair: The School and Kin Support Networks of U.S.-Mexican Youth ; Teachers College Press: New York, NY, USA, 2001. [ Google Scholar ]
• Epstein, M.; Ward, L.M. ‘Always use protection’: Communication boys receive about sex from parents, peers, and the media. J. Youth Adolesc. 2008 , 37 , 113–126. [ Google Scholar ] [ CrossRef ]
• Trinh, S.L.; Ward, L.M.; Day, K.; Thomas, K.; Levin, D. Contributions of divergent peer and parent sexual messages to Asian American college students’ sexual behaviors. J. Sex Res. 2014 , 51 , 208–220. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Kirby, D.; Miller, B.C. Interventions designed to promote parent teen communication about sexuality. In Talking Sexuality: Parent-Adolescent Communication ; Feldman, S., Rosenthal, D., Eds.; Jossey-Bass: San Francisco, CA, USA, 2002; pp. 93–110. [ Google Scholar ]
• Santa Maria, D.; Markham, C.; Bluethmann, S.; Mullen, P.D. Parent-based adolescent sexual health interventions and effect on communication outcomes: A systematic review and meta-analyses. Perspect. Sex. Reprod. Health 2015 , 47 , 37–50. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Albert, B. With One Voice 2010: America’s Adults and Teens Sound Off About Teen Pregnancy ; The National Campaign to Prevent Teen and Unplanned Pregnancy: Washington, DC, USA, 2010. [ Google Scholar ]

Share and Cite

Grossman, J.M.; Jenkins, L.J.; Richer, A.M. Parents’ Perspectives on Family Sexuality Communication from Middle School to High School. Int. J. Environ. Res. Public Health 2018 , 15 , 107. https://doi.org/10.3390/ijerph15010107

Grossman JM, Jenkins LJ, Richer AM. Parents’ Perspectives on Family Sexuality Communication from Middle School to High School. International Journal of Environmental Research and Public Health . 2018; 15(1):107. https://doi.org/10.3390/ijerph15010107

Grossman, Jennifer M., Lisa J. Jenkins, and Amanda M. Richer. 2018. "Parents’ Perspectives on Family Sexuality Communication from Middle School to High School" International Journal of Environmental Research and Public Health 15, no. 1: 107. https://doi.org/10.3390/ijerph15010107

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