sex education topics for group discussion

• Sexual Health Education
• Understanding Your Role
• Get Prepared

Instructional Methods

• Teacher Webinars and Workshops
• Ground Rules/Group Agreements
• Curriculum Overview
• Using the Lesson Plans
• Inclusive Language
• Notifying Parents and Guardians
• Health Resources & Guest Speakers
• Comprehensive School Health
• Your Values
• Gender Identity & Expression
• Sexual Orientation
• Technology & Media
• Responding to Student Questions
• Student FAQs
• Submit a Student Question
• Managing Sensitive Issues
• Lesson Plan & Resource Finder
• Differing Abilities
• CALM (10-12)
• Print Resources
• Alberta’s Education Act
• Best Practice Guidelines
• Additional Resources

Students engage when instructional methods emphasize active and experiential learning. Just as in other curriculum areas, using  role play ,  small groups ,  class discussion and  videos  in sexual health education can bring the curriculum to life. It also helps students explore the content and understand how it relates to their own ideas, values and experiences . These activities will often encourage some great conversations and lots of questions. Remember to use ground rules during the session.

Keep All Students Together

Students of all genders should learn about sexual health together. When students in the class learn together, they gain a greater understanding and respect for different perspectives and experiences. This can promote empathy and reduce the potential for teasing, stigma and discrimination.  

Learning about human sexuality together can help students develop the skills and knowledge they need to form healthy relationships . By communicating about sexual health in a mixed-gender groups, students are better prepared for conversations they may have in the future with partners, healthcare providers, or even their own children.

Keeping all students together is safer and more inclusive for students who are trans, non-binary, intersex , or gender non-conforming. Separating students into a ‘boy’s group’ and ‘girl’s group’ for sexual health lessons means that intersex, trans or non-binary students might not get all the information they need, or may force them into outing themselves which can be unsafe. Even if you are not aware of any trans, non-binary or intersex students in your class, keeping everyone together minimizes the potential harms, has benefits for everyone, and sets the tone for inclusion.

Students of all genders learn together for every other subject at school. Keeping the same students together for sexual health lessons normalizes learning about sexuality and sexual health. It also reduces the misinformation that can be spread when students in the same class hear different messages because they are not taught the same information.

If students are reluctant to ask questions in a mixed gender group, using an anonymous Question Box allows a safe and private opportunity for students to ask questions. This provides anonymity while ensuring all students hear the answers to questions.

Role play is learning how to best handle a situation by practicing scenarios and trying out different ways to approach them. Acting out scenarios, problems and issues in a safe setting helps develop decision-making skills. Role play improves self-confidence and influences student behaviour in sexual health education. When preparing a scenario, it’s important that the structure emphasizes healthy sexuality and reinforces the basic concepts you want the student to learn. 

• allows students to assume other people’s roles to help them learn and understand another person’s point of view
• allows students to safely explore scenarios and solutions
• tends to motivate students to learn
• promotes and develops critical and creative thinking, attitudes, values and social skills

1. Prepare the role play ahead of time

• use student volunteers in front of the class (the teacher doesn’t have to play a role)
• use partners/small group, with every student playing a role
• use small groups with role players and observers
• model the skill with a scripted role play
• Create a hypothetical problem, situation or event that represents their reality.
• Define the problem, situation and roles clearly.

2. Give clear instructions

• Include a short time limit for partners/groups to plan and rehearse their role play.

3. Act out role plays

• Students follow the procedure outlined by the teacher.
• Unless the teacher is playing a role, it helps if the teacher walks around the room to watch how students are carrying out the role play and coach students who are stuck.
• Students may need to repeat the role play taking different roles or revising their responses.

4. Discussion (small group and whole class)

• Begin by having students talk about the feelings they had during the role play.
• Have students identify the sexual health skills shown during the role play.
• Talk about what makes these skills stronger or weaker (e.g., body language).
• Talk about how this role play is or isn’t similar to real life.
• Talk about ways the student can use these sexual health skills in real life situations.

Alternatives to Traditional Procedure

• Have students write role plays as scripts but don’t act them out.
• Have students write down responses and then role play in front of the class.
• Have students make a list of challenging lines, have a student read the lines to the class then have each student give a response.
• Have students develop and act out plays.

Tips for Using Role Play

• To help build student confidence, try introducing readings before role playing to introduce new knowledge and experiences.
• Begin with fairly easy situations and work up to more challenging ones.
• Remember that some students may feel threatened or self-conscious. Using humour can help make students more comfortable. Using role plays that exaggerate weak responses might break the ice.
• Don’t make the topic so abstract or complex that the student misses the concepts.
• If students find it hard to figure out which skills model positive sexual health behaviours, have them watch successful role models or you could ask them to suggest another way of doing it.
• If trying an exercise that hasn’t been scripted, be sure it’s the right approach for your students’ comfort level.

Role Play Activities E xamples

Grade 9 Lesson 5 Safer Sex : Communicating about Protection Students act out passive, assertive and aggressive responses to different communication scenarios.

CALM Lesson 1 Relationships : Relationship Role Play Students learn and practice skills for building, maintaining and enhancing healthy, positive relationships.

Small Group

Interaction is a powerful learning tool. The cooperation, problem-solving, negotiation and critical thinking skills needed for small group work are also part of the positive sexual health skills that students need to develop.

Advantages of Small Groups

When students work in small groups, they think through an idea, present it to others so that they can understand and often exchange ideas and viewpoints. Students learn faster, remember what they’ve learned better and tend to be more positive about the lesson.

• encourages positive attitudes toward sexual health
• increases self-confidence
• promotes intellectual growth
• adds to students’ personal and social development

There’s no one ‘right’ way to approach small group activities when teaching sexual health. You have to choose models and methods that match your teaching style, your students and the lesson content. Following some basic steps at the beginning will help make the small group activities more effective.

Positive Interdependence

Students need to work cooperatively with everyone in the group and contribute to the goal. You may need to set up an ice breaker before the lesson begins to help make the students more comfortable with the topic.

Social Skills

Small group work means students have to listen to one another, ask questions, clarify issues and re-state their point of view. You’ve been teaching your students these skills through demonstration and instruction all year, when you:

• listen when others speak
• maintain eye contact and positive body language
• encourage and show respect
• speak quietly and without hostility

When teaching sexual health, these skills become extra important. This is because students may cover their embarrassment about the content by acting out poor social skills. Clear and direct ground rules will help students remember to use their social skills when working in their small group.

Group Processing

Just as in many other subject areas, students will have a wide range of reactions to the content. It’s important that students feel safe to share their ideas and know how to disagree respectfully without hurting others. Have students think about the positive ways the group worked together to reach their goal. This helps make the process clearer and improves their cooperative learning skills, and also increases their positive sexual health skills.

Types of Small Group Activities

Think-Pair-Share:  Students work independently to write down thoughts or ideas about a topic and then share these ideas with a partner. Partners ask each other questions to make sure they fully understand.

Jigsaw:  Divide class into groups. Assign each group a separate topic. Everyone in each group must be become an expert on the topic by the end of a given time. Form new groups made up of one member of each original group. ‘Experts’ then share findings from various topics from their original groups with the new group members.

Group Investigations : Students work to produce a group project—they may help select the project.

Circle of Voices:  Students are given a topic and a few minutes to organize their thoughts. Each student has uninterrupted time to speak to their small group. Each student should be assigned the same amount of time and have to stick to it. After everyone has had a turn, the group can talk about the topic. During that time, they’re only allowed to build on what someone else has said, not their original ideas.

Snowballing:  Students are divided into pairs, with each pair being given the same material on a sexual health topic. They then join with another pair to compare and contrast differences in their understanding. The groups combine again and repeat the compare-contrast process.

Tips for Using Small Groups

• Direct work towards a clear goal or set of goals.
• Tasks should be specific and outlined in detail.
• Give each group member a specific task (leader, recorder, reporter, monitor, etc.).
• Groups need to be interdependent—relying on all group members to reach a goal.
• Give groups space where they can work face-to-face without being disrupted.
• Watch the group closely during group activities to make sure students stay on task and on track.
• Reinforce positive contributions and remember the ground rules .
• Give enough time for feedback and reflection at the end of each session.

Question Box

The Question Box is a tool that enhances learning by allowing students to ask questions anonymously. Using a Question Box gives you time to review the questions to make sure that you’re comfortable answering them appropriately for the grade level you’re teaching, and that you know the answers.

To use a Question Box effectively, consider these tips:

• Have every student write a question on identical slips of paper.
• If someone doesn’t have anything to ask, they can write a comment about the lesson or just write “No Question” on their slip of paper.
• Collect the questions at the end of each lesson.
• Read through them after class and prepare to answer them during the next lesson.

When answering questions:

• Group similar questions together.
• Read the question to the class. Paraphrasing to maintain anonymity is fine. 
• If personal questions are asked, there is no need to read the question out loud or answer it. Say something like “There are two questions here about my personal sexual experience. I want to remind everyone of the ground rules we made on the first day about not discussing our personal experiences. I expect you all to follow that rule when submitting questions as well.”
• Define words, including slang and continue on using the correct terminology. For example, if a student’s question is “What is a homo?” you could say, “A homo or homosexual is a hurtful slang word used to put down people who have sexual or romantic attraction to people of the same sex .”
• Answer the question clearly, objectively, factually and appropriately for each grade level.
• Assume all questions, even shock ones, are real questions. After all, they came from somewhere. It’s likely a genuine request for information, no matter how shocking it may be!
• Don’t give more information than what was asked for or assume more than what the question asked.

Student questions can usually be grouped into four broad overlapping categories. Click each link below for more information:

• Requests for information
• “Am I normal?” questions
• Permission seeking questions
• Shock questions

Class Discussion

Talking about sexual health with students can be challenging because it’s a subject that touches on our privacy and our vulnerability. Open conversations let students express opinions and exchange information safely within the classroom. They also let students practice healthy communication skills, such as respect for other people’s feelings, asking questions when they feel vulnerable, or sharing their views.

Class discussions will likely be more effective if they take place after you’ve given the material through a lecture, video or reading. You’ll likely need to remind students of the ground rules at the beginning of each class discussion to make sure all students feel safe and respected during the activity.

Advantages of Classroom Discussion

• Helps build a positive classroom climate.
• Leads to student interest in sexual health.
• Makes students feel more positive about themselves and the learning environment.
• Makes the student feel the changes are ‘normal’.
• Allows more students to be involved and express their ideas.
• Set up an atmosphere that assures sensitivity during the activity
• Make sure  ground rules   are in place.
• Introduce the topic with a short lecture, video or skit.
• Define terms to make sure all students are at a similar level of understanding and have the same information.
• Hold the discussion
• Encourage students to take part by asking questions, making suggestions and expressing their ideas.
• Probe, prompt and re-direct students to add to the discussion.
• Encourage students to remember, analyze, generalize and personalize the information.
• Make sure correct information is being shared among the class (correct misinformation and use proper terminology).
• Finish the discussion
• Find consensus or a solution. Talk about what students have learned in the discussion or give a summary (preferably one given by students).

Tips for Using Class Discussion

• Introduce facts and correct any misinformation.
• Help students use the proper terminology.
• Be consistent with ground rules, such as raising your hand or listening to the speaker. Some teachers find using an object (like a talking stick) helps.
• Be respectful of the student’s questions or responses.
• Use ‘wait time’, the pause between asking a question and asking for a response. This gives students time to think about and give a more reflective answer.
• Use open-ended questions to encourage higher level thinking.
• Be aware of your own values and reactions during the discussion (despite what you think or feel, you must model sensitivity and respect).

Grade 4 Lesson 1 Puberty Changes : Good and Harder Changes Normalize the great and tough things about growing up through a group discussion.

Grade 7 Lesson 5 Decision Making : Pressures Brainstorm Help students identify different sources of pressure to become sexually active.

CALM Lesson 2a Consent: Reviewing Consent Revisit what students learned about consent in grade 9, and introduce the concept of sexual assault.

Videos can be an entertaining way to introduce content and raise issues in the sexual health classroom. While there are many videos, not all are appropriate for the classroom. It’s important to find the right media and to use it effectively to ensure student learning is optimized. It’s always a good idea to have videos approved by your school administration.

Advantages of Video

• Stimulates discussion by ‘breaking the ice’ on sensitive topics.
• Can increase your comfort by giving the information visually (e.g. how to use a condom).
• Illustrates complex or abstract concepts (such as internal anatomy and physiology) through animated or 3-D images.
• Preview the media
• Use only those parts of the media that match the lesson’s objectives.
• Make sure the media is appropriate for the grade and age.
• Give parents or other community members a chance to preview the media.
• Evaluate your resource before using it in the classroom.
• Prepare the classroom
• Check the equipment (projector, computer, DVD, website, remote control).
• Arrange the seating.
• Have the media ready ahead of time.
• Include lead-in activities
• Review vocabulary or key concepts.
• Ask students to make predictions about what they think they’ll see and learn.
• Give focus questions ahead of time.
• Segment your viewing
• Pause the media before and after important points to highlight a certain idea or check for comprehension.
• Ask students to connect what they’re seeing to other topics or real-life events.
• Pause the media to create a still picture when important visuals are used.
• Include follow-up activities
• Many programs come with a teacher’s guide with activity suggestions. Think about using a small group discussion, role play or post-test to reinforce the learning.

Tips for Using Video

• Remember, all media comes with a ‘stop’ button.
• Leave the lights on to reinforce that media is not passive entertainment.
• Try turning off the sound or the picture. No sound allows you to narrate based on your students’ needs. No picture (turn down the brightness) encourages students to concentrate on the message.

Use our demonstration videos to show how to use condoms and dental dams . Each video has speaker notes for additional information.

• Using an External Condom
• Using an Internal (Vaginal) Condom
• Using a Dental Dam

Kahoot! Quizzes

New technologies for use in the classroom are ever-evolving; however it can be a challenge to find and use technology in a way that engages and excites students and contributes to meaningful learning. One such technology that is freely available to all teachers is Kahoot!

Kahoot! is easy to learn and easy to use in the classroom. You will need a computer with internet and a projector to display the questions. Your students will need access to wi-fi connected devices (computers, tablets, or phones) – either one device per student or one device per team, to input their answers. You can choose to have the students download the Kahoot! app directly onto their devices, or play from the website  Kahoot.it

The Kahoot! quizzes by TeachingSexualHealth.ca all have between 7 and 15 multiple choice questions. Students can only choose one answer, but some quizzes have more than one correct answer, so you may need to prepare your students for this. Taking time to discuss the answers as you go, including discussing how or why multiple answers are correct, is part of teaching with this interactive tool. The image in each quiz question may be a hint, may provide the answer outright, or is occasionally a distraction from the correct answer(s). The site displays the correct answer(s) for each question as the quiz progresses. Answer keys are also provided.

Find the Kahoot! quizzes for each grade by using the Resource Finder . You can also search the Kahoot! website using #teachingsexualhealth to see all of the available TeachingSexualHealth.ca quizzes.

For more information about using Kahoot! in the classroom, including how to use “ghost mode” for pre-and post-tests, and how to get your students making their own quizzes, visit kahoot.com

Online Learning 

Throughout the COVID-19 pandemic, teachers, educators and students have had to shift, in some cases many times, from in-classroom to online learning. Because of this, many teachers and educators may be providing sexual health education online for the first time. Teaching comprehensive sexual health education (CSHE) online requires a tailored approach, which includes providing children and youth with a safe, supportive virtual environment.

In providing sexual health education online, many in-classroom best practices should be considered along with a few additions:

• Make a plan : Recognize online education is more physically, emotionally, and mentally taxing on students and teachers. Aim to reduce the amount of content in half when teaching online and try to group similar topics together (using the TSH lesson plans may be helpful). You may need to increase the number of sexual health education classes to meet curriculum goals. Anticipate there may be IT disruptions and have a backup plan.
• Inform parents/guardians in advance : As you would with in-classroom learning, let parents/guardians know that sexual health education will be provided and include basic information about the topics that will be discussed. Let parents know about providing a private, secure space at home for their child to learn.
• Establish ground rules : Have students participate in the development of ground rules, but consider specifics to the online learning environment (e.g., using anonymous names if possible, use of the chat box and messaging, use of camera).
• Provide a rich introduction and start with a fun activity : Introduce the topic, as well as yourself, your pronouns and the expectations for the lesson. Starting with an interactive, fun activity such as “what flavor is your day- sweet, spicy, salty, or sour?” can reduce tension and give you an idea of where the students are at.
• Moderate online discussions among students : Ensure that the online space is free from harassment and bullying . Examples of online harassment include using the online space to spread rumors or make fun of someone, sending threatening or abusive messages. Respond immediately to disrespectful chat. If you are unable to respond or the chat escalates, know how to turn off the chat function.
• Provide opportunities for students to anonymously ask questions : Do an online version of the question box where students are encouraged to ask any question that they have about sexual health. Students may feel more comfortable asking questions in an online and anonymous format. This could include having alternative screen names for the lesson, and completing an anonymous response form via a link sent to students.
• Use a range of methods to create active learning opportunities and interaction : Consider using a variety of interactive technology resources or platforms for each class (e.g. breakout rooms, Kahoot quizzes , mentimeter, annotation, chat).
• Link students to credible, online and/or print sexual health education resources .
• Remember, you can do this! What makes you a good educator, makes you a good sexual health educator – no matter if you’re in the classroom or online. Build relationship with your students online by using eye-contact with your camera; use body language like head nods and facial expressions to show you’re engaged.

Safety Tips for Online Learning:

• Be alert to signs of trauma and discomfort. It can be challenging to assess this, but you can look for things such as students indicating they don’t have a safe space to participate in or students not engaging with the content. Address any concerns you might have directly. Continually offer supports (e.g., embed resources in your email signature)
• Encourage, but don’t require cameras to be on, and use and reinforce ground rules
• Clarify that teachers and their invited guests are to be the only adults present

Check out our additional resources for information related to COVID-19 and Sexual Health, and tips for teaching sexuality online here .

• Online Learning 

Appointments at Mayo Clinic

• Sexual health

Sex education: Talking to your teen about sex

Sex education is offered in many schools, but don't count on classroom instruction alone. Sex education needs to happen at home too. Here's help talking to your teen about sex.

Sex education basics may be covered in health class. But teens might not hear — or understand — everything they need to know to make tough choices about sex. That's where you come in.

It can be awkward, but sex education is a parent's job. By connecting with your teen early and often, you can set the stage for a lifetime of healthy sexuality.

Breaking the ice

Sex might be hard to talk about. But it's even harder to avoid. Sex seems to be everywhere — news, entertainment, social media, advertising. But you can use that to get the talk going and keep it going.

Here are some ideas:

• Seize the moment. When sex comes up in a show or song, use it as a way to start a talk. Everyday moments — such as riding in the car or putting away groceries — are often the best chances to talk.
• Talk early and often. A one-time "birds and the bees" talk isn't enough. Start talking to your teen about safe sex during the preteen years. Continue the talk into early adulthood. Change the talk to suit growth and development.
• Be honest. If you're uncomfortable, say so. But keep talking. If you don't know how to answer your teen's questions, offer to find the answers or look them up together.
• Be direct. Clearly state your feelings about sex. Give facts about risks such as emotional pain, sexually transmitted infections (STIs) and unplanned pregnancy. Explain that oral sex isn't a risk-free choice instead of intercourse.
• Think about your teen's point of view. Strict talks and scare tactics can stop connection and encourage rebellious, risky behavior. Instead, listen to your teen carefully. Understand the pressures, challenges and concerns that teens have.
• Move beyond the facts. Your teen needs to know the facts about sex. But it's just as important to talk about feelings, attitudes and values. Teens are more likely to adopt family values when they understand their parents and feel understood by them.
• Focus on well-being. The teen years are known as a time of risk-taking. But they're also the time when healthy self-care behaviors start. Besides talking about risks, model and express the value of healthy relationships and choices.
• Invite more talks. Let your teen know that it's OK to talk with you about sex when questions or concerns arise. Reward questions by saying, "I'm glad you came to me."

Addressing hard topics

Sex education for teens includes not having sex (abstinence), date rape, gender identity, sexual orientation and other hard topics. Be ready for questions such as:

• How will I know I'm ready for sex? Many issues, such as peer pressure, curiosity, and loneliness, might lead teens into early sexual activity. Reassure your teen that it's OK to wait. Sex is an adult behavior. But there are other ways to connect with someone. Explain that intimate talks, long walks, holding hands, listening to music, dancing, kissing, touching and hugging are safe ways to share affection.

What if my partner wants to have sex, but I don't? Be clear that no always means no. Sex should never be pressured or forced. Any form of forced sex is rape, whether it's done by a stranger or someone your teen has been dating.

Point out to your teen that alcohol and drugs can weaken peoples' decisions. And they can make people think less clearly. Date rape and other dangerous situations become more likely when alcohol and drugs are involved.

What if I'm questioning whether I'm lesbian, gay, bisexual, transgender or queer (LGBTQ)? Many teens wonder about their sexual orientation, gender identity or expression. Help your teen understand that teens are just beginning to explore sexual attraction. These feelings may change as time goes on. And if they don't, that's fine.

A negative answer to your teen's sexual orientation, gender identity or expression can have negative effects. LGBTQ youth have a higher risk of STIs, substance abuse, depression and attempted suicide. Family acceptance can protect against these risks.

Above all, let your teen know that your love is unconditional. Praise your teen for sharing their feelings. Listen more than you speak.

Healthy versus unhealthy relationships

Dating violence occurs more often than many teens or adults may think. About 1 in 12 teens has reported facing physical or sexual dating violence. So it's important to get the facts and share them with your teen.

Watch for warning signs of dating violence, such as:

• Alcohol or drug use
• Staying away from friends and social events
• Excusing a dating partner's behavior
• Acting scared around a dating partner
• Loss of interest in school or activities that were once fun
• Suspicious bruises, scratches or other injuries

Teens in abusive relationships have a higher risk of long-term effects. These include poor grades, binge drinking and suicide attempts. The emotional impact of early unhealthy relationships may also set the stage for future unhappy, violent relationships.

Talk with your teen now about the importance of healthy relationships. Model healthy relationships through the way you connect with your teen and others. The lessons your teen learns today about respect, boundaries, and understanding what is right and wrong will carry over into future relationships.

Responding to behavior

If your teen is sexually active, it may be more important than ever to keep the conversation going. Even if you don't think your teen is ready, be open yet honest in your approach. Remind your teen that you expect sex and its responsibilities to be taken seriously.

• Stress the importance of safe sex.
• Contraception. Make sure your teen understands how to get and use contraception such as condoms and birth control.
• Promote exclusivity. An exclusive sexual relationship supports trust and respect while lowering the risk of STIs.
• Set reasonable boundaries. Enforce curfews and rules about visits with friends. This is especially important if you notice sexual attraction between your teen and certain friends.

Your teen's health care provider can help too. A routine checkup can give your teen the chance to talk about sexual health to only the provider in private. The provider can help your teen learn about contraception and safe sex. The provider can also help you build your skills to teach your teen about safe sex.

The provider may also stress the importance of routine human papillomavirus (HPV) vaccination. This vaccine protects people of all genders against genital warts and cancers of the cervix, anus, mouth and throat, and penis. People can usually get the vaccine between ages 9 and 26. But it is sometimes available for people older than age 26.

Looking ahead

Your guidance is key to helping your teen become a sexually responsible adult. Be honest and speak from the heart. If your teen doesn't seem interested in what you have to say about sex, say it anyway. Your teen is probably listening.

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• McKay EA, et al. Parent-adolescent sex communication with sexual and gender minority youth: An integrated review. Journal of Pediatric Health Care. 2020; doi:10.1016/j.pedhc.2020.04.004.
• Miller, E, et al. Adolescent relationship abuse including physical and sexual teen dating violence. https://www.uptodate.com/contents/search. Accessed July 15, 2022.
• Wiemann, CM. Date rape: Identification and management. https://www.uptodate.com/contents/search. Accessed July 15, 2022.
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Group Discussion: Introducing sex education in primary class is jumping the gun

Sex education beneficial or a problem if given at an early age. it`s a very important topic for group discussions in mba entrance exams also. read and find all the aspects of the topic..

Education is the basic framework that makes a child well structured and social. Education makes for the perfection and better growth of a child so that once he/she understands the basics of life and becomes a responsible citizen of the nation he/she doesn’t faces any problem for his/her life being. Education not only means the inculcation of subject knowledge, it involves an overall development.

In today’s world, education has become very much essential as competition is tough, for fetching good marks, creating excellence in academics and getting jobs. Now a days, due to unavoidable circumstances and multiple incidences, Sex education has become one of those social subjects that has been introduced in many of the course curriculum in our nation. Even sex education has also been introduced in the curriculum of primary education in number of schools and is in the process of extension.

But introducing sex education in primary classroom is nothing more than jumping the gun. We may call it a formidable step due to:

1. Too young to understand: Children at primary education are too young to be taught such a serious and intense matter of sex in our nation. They can hardly understand anything and if do then also it’s very difficult to make them aware of its pros and cons.

2. Risk of adverse situations occurring: Due to the untimely education about sex they can turn out into anti-social kids who come up with the adverse situations and incidences promptly. So there is a big risk.

3. Pre-maturity: The children if taught about sex may grow up before time physically and mentally much earlier than expected.

4. Alternatives for children: Since in sex education everything is taught, so this may also lead to generation of a number of alternatives for committing sex related crimes. And this in turn will result in increased number of crime related to sex and that too by juveniles.

On the contrary, if we take this sex education at the primary level on an optimistic note, we may follow this as:

1) Early education leads to better understanding: It will be more apt and feasible if the children are educated about the sex and its various diversions so that they get a better understanding and grow up with pre-installed thoughts of the same.

2) Better for Females: Providing sex education in primary classrooms is much better and convenient for the girls / females as they may get alert and awakened about the same. This may lead to a better self-protectionism and effortless livelihood of females.

3) Need of the society: It has become the need of the society in the current era that sex education has to be delivered to children at a young age so that they become much concerned, alert and aware of the pros and cons of the same. Moreover, it is also true that it’s good to feed the seeds of education of all kinds into disciples as early as possible, so it’s much better to be done and delivered at the Primary level.

Henceforth, whatever be the role of sex education the matter of concern is not when and how is it delivered to children rather the importance lies in the fact that it must serve the true, genuine and apt purpose of delivery of thoughts behind it’s execution.

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Group Guidelines

Written by Meghan, RSEI Educator | Published February 19th, 2019

Here at RSEI, we strongly encourage sex educators to start every new group or first session of a curriculum by creating group guidelines. Group guidelines are a set or rules or expectations for the group to follow when in session together. Participants are given the opportunity to advocate for their needs by suggesting their own group guidelines. In this article we will break down both the importance of and reasoning for setting group guidelines in every learning space, as well as sharing some of our favorites!

Do I Really Need To Do Group Guidelines?

We really want to emphasize the importance of not only creating group guidelines to help structure the learning environment but also that group guidelines provide a space for participants to feel heard about their unique, or not so unique, needs. Especially in sex education a lot of students are coming to the classroom nervous with varying degrees of knowledge. Some participants have likely heard a lot on the subject, others may have yet to receive “the talk”. Setting group guidelines helps acknowledge that different degrees of knowledge are respected and that we will work to meet everyone’s needs during the session.

Group guidelines are also a tool for the facilitator to use if participants start to become rowdy or disinterested in the lesson. They came up with the guidelines and agreed to their terms. If a facilitator is without guidelines the rules might feel more like a personal attack or might not hold any weight for participants. The buy in comes from the process of allowing the participants to voice their needs and in turn has them both invest in the rules but also know that there are clear boundaries for everyone.

How Do I Know Which Guidelines to Add?

There are a few guidelines that we use every time we teach. These guidelines translate well to different situations and help anticipate and prevent common issues we see from derailing an education session.

“Don’t Yuck My Yum”

This guideline often invokes some giggles because the wording is silly. That’s okay! Most people laugh at what they don’t understand, what makes them nervous, or simply at how things are worded. We believe it is okay to have giggles and reactions during a sex education class. What we want to avoid is people’s feelings being hurt. When we say “Don’t Yuck My Yum” it means that different people like (and dislike!) different things. We are all allowed to hold our own opinions, but in this space we are going to treat each other with respect. That means that we won’t say “ew!” or “gross!” or “I can’t believe you didn’t know that!?” in response to other people’s questions or comments. A great way to introduce this is by simply stating “I’m going to cover a lot of information today. You might be thinking ‘Ugh I am not excited for this class,’ and that’s okay! There might be other people who are thinking ‘Finally I’m getting to learn about this!’ and that is also okay! In this class, we won’t call names or make judgments about people, because every one of us is different.”

“Confidentiality”

This is maybe the most important guideline, especially if you are a mandated reporter for abuse or neglect. “Confidentiality” is a big word that students may not know, so its very important to explain the meaning. A simple way to break down this statement is by saying “The stories or comments that you or your classmates say in this group will stay here. What you learn during this session can leave with you and be shared.” (For some groups it may be important to note that other people their age may not have had the opportunity to learn the same material as them and that it’s important to allow their families, or communities to make decisions about how and when people learn this new information). If a person is a mandated reporter they must inform the class that they are required to tell someone else (supervisors, law enforcement, reporting agency) if they are 1. Hurting themselves 2. Hurting someone else 3. Being hurt by another person, or 4. Doing something that is against the law. Depending on the group and the topic(s), it may also be important to explain that illegal sexual relationships fall into this category.

• This guideline has often been referred to as the Vegas Rule. We urge people to move away from this language both because youth are less and less familiar with the outdated ad campaign it refers to AND because the language surrounding “what happens in Vegas stays in Vegas” is not informed by a culture of consent.

“One Diva One Mic”

“One Diva One Mic” is a fun way of saying listen to the speaker, or one person talking at a time. We like to emphasize that if the presenter is talking people should be listening with their eyes and their ears. This also means if another participant is asking a question, reading aloud, or participating in another way that requires them to talk and others to listen, people should give them the same respect they give the presenter. Other ways to say this could be “Track the speaker”, “One voice at a time”, you could also utilize an actual speaking prop that gets passed around if that feels helpful.

“Take Space Make Space”

You may have heard folks call this “Step Up, Step Back” but, recognizing that not all people can take steps, “Take Space Make Space” is a more inclusive way to describe the concept. This guideline acknowledges that some people really like to share or come to answers quickly while others either share less or need more time to process before sharing. The guideline suggests that people who share a lot acknowledge this and make extra space for others to chime in. Similarly, for people who share less frequently this agreement challenges them to take opportunities to share or add to discussion. The overall goal is to make it so all voices, questions, or concerns have an opportunity to be expressed in the space.

We don’t correct slang terms to be uncool, but many slang words can have a wide range of meanings. Just think of the term “hook up”. For one person “hook up” might mean two people are meeting up to hang out as friends, for another person hooking up could mean kissing, and for another person it could mean having some type of sex. We want to make sure that everyone has the same understanding of the language we use which is why we aim to be thoughtful and intentional about it. Participants may still use slang from time to time because often it’s the only way they know how something is referred to. That’s okay, and it doesn’t mean they should get in trouble. When participants use slang we can take the opportunity to either teach or remind them what the medically accurate language is for the term they’re using.

“R-E-S-P-E-C-T”

When asking participants for group guidelines this one will often come up first. While it can fit under several of the other guidelines we have already identified, we think it is important to make this it’s own guideline. Respect is broad but it’s a great reference to have on the board if someone starts to make a comment that falls in the grey area of unkind. It becomes easy to break up hurtful conversation or unwanted comments by saying “In this group we treat each other with respect.” Additionally, you can use “RESPECT” as a way to prompt youth to come up with many of the guidelines above. What does respect mean or look like? (listening to the speaker, don’t yuck my yum, confidentiality.)

Although, we have now given you a list of guidelines that doesn’t mean you should go in with your list ready to go. Giving students the opportunity to come up with guidelines as a group can help with buy-in and sets the tone for the rest of your time together.

Okay But, How Long Will This Take?

We recognize that many times we are trying to teach in a very short time frame. Group guidelines can be done really quickly. As we said above, a lot of the time the participants already know these guidelines and are ready to offer them up pretty quickly.

If time is a concern, or experience is proving that the students take too long coming up with their own guidelines you can bring images or drawings with you to help elicit specific guidelines from the group.

For example: The presenter could bring a picture of a microphone, a clock, a classroom, an emoji that looks grossed out and a telephone.

The presenter could show each image and see what participants think they symbolize. Possible answers include:

Microphone: one person speaking at a time, be brave and speak up, talk so others can hear you, “what is said here stays here what is learned here leaves here”, use appropriate language, R-E-S-P-E-C-T!

Clock: Be on time, stay on track

Classroom: Stay seated, “what is said here stays here what is learned here leaves here”, “take space, make space”

Grossed out Emoji: “don’t yuck my yum”, take care of yourself even if that means stepping out for a minute.

Telephone: No phones, confidentiality.

Overall creating group guidelines doesn’t have to take more than 5 minutes. The process can be quick and help get participants in the mindset of engaging in the material. If you are going to be with a group for multiple sessions the group guidelines should be recorded and revisited quickly at the start of each session as a reminder that they are still in place and that the space is still as safe as it can be.

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Comprehensive sexuality education

Comprehensive sexuality education (CSE) gives young people accurate, age-appropriate information about sexuality and their sexual and reproductive health, which is critical for their health and survival.

While CSE programmes will be different everywhere, the United Nations’ technical guidance – which was developed together by UNESCO, UNFPA, UNICEF, UN Women, UNAIDS and WHO – recommends that these programmes should be based on an established curriculum; scientifically accurate; tailored for different ages; and comprehensive, meaning they cover a range of topics on sexuality and sexual and reproductive health, throughout childhood and adolescence.

Topics covered by CSE, which can also be called life skills, family life education and a variety of other names, include, but are not limited to, families and relationships; respect, consent and bodily autonomy; anatomy, puberty and menstruation; contraception and pregnancy; and sexually transmitted infections, including HIV.

Sexuality education equips children and young people with the knowledge, skills, attitudes and values that help them to protect their health, develop respectful social and sexual relationships, make responsible choices and understand and protect the rights of others. 

Evidence consistently shows that high-quality sexuality education delivers positive health outcomes, with lifelong impacts. Young people are more likely to delay the onset of sexual activity – and when they do have sex, to practice safer sex – when they are better informed about their sexuality, sexual health and their rights.

Sexuality education also helps them prepare for and manage physical and emotional changes as they grow up, including during puberty and adolescence, while teaching them about respect, consent and where to go if they need help. This in turn reduces risks from violence, exploitation and abuse.

Children and adolescents have the right to be educated about themselves and the world around them in an age- and developmentally appropriate manner – and they need this learning for their health and well-being.

Intended to support school-based curricula, the UN’s global guidance indicates starting CSE at the age of 5 when formal education typically begins. However, sexuality education is a lifelong process, sometimes beginning earlier, at home, with trusted caregivers. Learning is incremental; what is taught at the earliest ages is very different from what is taught during puberty and adolescence.

With younger learners, teaching about sexuality does not necessarily mean teaching about sex. For instance, for younger age groups, CSE may help children learn about their bodies and to recognize their feelings and emotions, while discussing family life and different types of relationships, decision-making, the basic principles of consent and what to do if violence, bullying or abuse occur. This type of learning establishes the foundation for healthy relationships throughout life.

Many people have a role to play in teaching young people about their sexuality and sexual and reproductive health, whether in formal education, at home or in other informal settings. Ideally, sound and consistent education on these topics should be provided from multiple sources. This includes parents and family members but also teachers, who can help ensure young people have access to scientific, accurate information and support them in building critical skills. In addition, sexuality education can be provided outside of school, such as through trained social workers and counsellors who work with young people. 

Well-designed and well-delivered sexuality education programmes support positive decision-making around sexual health. Evidence shows that young people are more likely to initiate sexual activity later – and when they do have sex, to practice safer sex – when they are better informed about sexuality, sexual relations and their rights.

CSE does not promote masturbation. However, in our documents, WHO recognizes that children start to explore their bodies through sight and touch at a relatively early age. This is an observation, not a recommendation. 

The UN’s guidance on sexuality education aims to help countries, practitioners and families provide accurate, up-to-date information related to young people’s sexuality, which is appropriate to their stage of development. This may include correcting misperceptions relating to masturbation such as that it is harmful to health, and – without shaming children – teaching them about their bodies, boundaries and privacy in an age-appropriate way.

There is sound evidence that unequal gender norms begin early in life, with harmful impacts on both males and females. It is estimated that 18%, or almost 1 in 5 girls worldwide, have experienced child sexual abuse.

Research shows, however, that education in small and large groups can contribute to challenging and changing unequal gender norms. Based on this, the UN’s international guidance on sexuality education recommends teaching young people about gender relations, gender equality and inequality, and gender-based violence. 

By providing children and young people with adequate knowledge about their rights, and what is and is not acceptable behaviour, sexuality education makes them less vulnerable to abuse. The UN’s international guidance calls for children between the age of 5 and 8 years to recognize bullying and violence, and understand that these are wrong. It calls for children aged 12–15 years to be made aware that sexual abuse, sexual assault, intimate partner violence and bullying are a violation of human rights and are never the victim’s fault. Finally, it calls for older adolescents – those aged 15–18 – to be taught that consent is critical for a positive sexual relationship with a partner. Children and young people should also be taught what to do and where to go if problems like violence and abuse occur.

Through such an approach, sexuality education improves children’s and young people’s ability to react to abuse, to stop abuse and, finally, to find help when they need it. 

There is clear evidence that abstinence-only programmes – which instruct young people to not have sex outside of marriage – are ineffective in preventing early sexual activity and risk-taking behaviour, and potentially harmful to young people’s sexual and reproductive health.

CSE therefore addresses safer sex, preparing young people – after careful decision-making – for intimate relationships that may include sexual intercourse or other sexual activity. Evidence shows that such an approach is associated with later onset of sexual activity, reduced practice of risky sexual behaviours (which also helps reduce the incidence of sexually transmitted infections), and increased contraception use.

On sexuality education, as with all other issues, WHO provides guidance for policies and programmes based on extensive research evidence and programmatic experience.

The UN global guidance on sexuality education outlines a set of learning objectives beginning at the age of 5. These are intended to be adapted to a country’s local context and curriculum. The document itself details how this process of adaptation should occur, including through consultation with experts, parents and young people, alongside research to ensure programmes meet young people’s needs.

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Comprehensive sexuality education topics: what to cover from early childhood - 18+

This CSE Topics overview accompanies our overall programme standards - Putting the C in CSE. It describes Plan International’s vision of sexuality, learning and the healthy development of children, adolescents and young people. It seeks to clarify the different domains or topics of comprehensive sexuality education (CSE) that need to be included, and for which approximate age group. The information is arranged into three sections: 1) Knowledge: what children, adolescents and young people will understand; 2) Attitudes: what children, adolescents and young people will appreciate and recognise; 3) Skills: what children, adolescents and young people will be able to do.

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Breaking Taboos: How to Foster Open Discussions About Sex Education

Sex education is a critical component of overall health and well-being, yet it remains shrouded in societal taboos and misconceptions. Fostering open conversations about sex education is essential for providing accurate information, dispelling myths, and promoting healthy relationships. In this post, we'll explore the significance of breaking these taboos and provide practical tips on how to create a safe space for individuals to learn and ask questions about sexual health.

Understanding the Importance of Open Discussions

Sex education encompasses a wide range of topics, including anatomy, contraception, consent, healthy relationships, sexual preferences, and more. Open conversations about these subjects empower individuals to make informed decisions about their bodies and relationships.

Identifying Common Taboos

Society often imposes taboos on discussing sex, leading to misinformation and discomfort. Some common taboos include:

• Pre-Existing Beliefs : Different cultures and religions may have varying perspectives on sex, leading to reluctance in addressing the topic openly.
• Stigma Surrounding LGBTQ+ Topics : Conversations about sexual orientations and gender identities are sometimes met with resistance, perpetuating harmful stereotypes.
• Body Image and Self-Esteem : Talking about bodies and body image can be uncomfortable, yet it's crucial for fostering a healthy self-image.
• Mental Health and Intimacy : The intersection between mental health and intimacy is often overlooked, but it's an important aspect of overall well-being.

Creating a Safe Space

Building a safe environment for discussing sex education is the first step in breaking taboos. Here's how you can do it:

• Establish Trust : Ensure that all participants feel comfortable and confident that their questions and concerns will be treated with respect and confidentiality.
• Normalize Questions : Emphasize that asking questions is a natural part of learning and that there are no "silly" or "embarrassing" questions.
• Use Inclusive Language : Avoid assumptions about sexual orientations or gender identities, and use inclusive language to make everyone feel welcome.

Educational Resources and Tools

Providing accurate and reliable resources is crucial for fostering open discussions:

• Curated Reading Materials : Share books, articles, and websites that provide accurate information on sexual health, relationships, and consent.
• Guest Speakers and Experts : Invite professionals to conduct workshops or Q&A sessions to address specific concerns and provide expert advice.

Promote Age-Appropriate Discussions

Recognize that age-appropriate sex education is vital at every stage of life:

• Early Education : Introduce basic concepts of anatomy, boundaries, and consent in an age-appropriate manner.
• Adolescent and Teen Education : Address topics like puberty, contraception, and healthy relationships in a supportive and non-judgmental way.
• Adult Education : Continue the conversation about sexual health throughout adulthood, emphasizing the importance of communication in relationships.

Breaking taboos surrounding sex education is a crucial step towards creating a society that values informed decisions, healthy relationships, and overall well-being. By establishing safe spaces, providing accurate resources, and leading by example, we can foster open discussions that empower individuals to make choices that align with their values and desires. Together, we can build a future where everyone has access to the knowledge and support they need for a fulfilling and healthy sex life.

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Sex Education in the Spotlight: What Is Working? Systematic Review

Associated data.

The data presented in this study are available from the corresponding author on reasonable request.

Adolescence, a period of physical, social, cognitive and emotional development, represents a target population for sexual health promotion and education when it comes to achieving the 2030 Agenda goals for sustainable and equitable societies. The aim of this study is to provide an overview of what is known about the dissemination and effectiveness of sex education programs and thereby to inform better public policy making in this area. Methodology : We carried out a systematic review based on international scientific literature, in which only peer-reviewed papers were included. To identify reviews, we carried out an electronic search of the Cochrane Database Reviews, ERIC, Web of Science, PubMed, Medline, Scopus and PsycINFO. This paper provides a narrative review of reviews of the literature from 2015 to 2020. Results : 20 reviews met the inclusion criteria (10 in school settings, 9 using digital platforms and 1 blended learning program): they focused mainly on reducing risk behaviors (e.g., VIH/STIs and unwanted pregnancies), whilst obviating themes such as desire and pleasure, which were not included in outcome evaluations. The reviews with the lowest risk of bias are those carried out in school settings and are the ones that most question the effectiveness of sex education programs. Whilst the reviews of digital platforms and blended learning show greater effectiveness in terms of promoting sexual and reproductive health in adolescents (ASRH), they nevertheless also include greater risks of bias. Conclusion : A more rigorous assessment of the effectiveness of sexual education programs is necessary, especially regarding the opportunities offered by new technologies, which may lead to more cost-effective interventions than with in-person programs. Moreover, blended learning programs offer a promising way forward, as they combine the best of face-to-face and digital interventions, and may provide an excellent tool in the new context of the COVID-19 pandemic.

1. Introduction

Adolescence is a period of transition, growth, exploration and opportunities that the World Health Organization defines as referring to individuals between 10 years and 19 years of age [ 1 ]. During this life phase, adolescents undergo physical, psychological and sexual maturation and tend to develop an increased interest in sex and relationships, with positive relationships becoming strongly linked to sexual and reproductive health as well as overall wellbeing [ 2 ]. Sexual health is understood as a state of wellness comprising physical, emotional, mental, and social dimensions [ 3 ]: it represents one of the necessary requirements to achieve the general objective of sustainable and equitable societies in terms of the 2030 Agenda [ 4 ], which advocates the need for a sexual education that is anchored in a gender- and human rights-oriented perspective.

In high-income countries, sexual debut usually occurs during adolescence [ 5 ], though research suggests that sexual initiation is increasingly occurring at earlier ages [ 6 ]. Adolescents have to deal with the results of unhealthy sexual behaviors, including unplanned pregnancies and sexually transmitted infections [ 7 ], as well as experiences of sexual violence [ 8 , 9 ]. Adolescents are aware that they need more knowledge in order to enjoy healthy relationships [ 10 ], yet do not receive enough of the kind of information from parents or other formal sources that would allow them to develop a more positive, respectful experience of sexuality and sexual relationships [ 11 ].

Sexual education can be defined as any combination of learning experiences aimed at facilitating voluntary behavior conducive to sexual health. Sex education during adolescence has centered on the delivery of content (abstinence-only vs. comprehensive instruction) by teachers, parents, health professionals or community educators, and on the context (within school and beyond) of such delivery [ 12 ]. As regards content, the proponents of abstinence-only programs aim to help young adults avoid unintended pregnancies and sexually transmitted diseases (STDs), working on the assumption that while contraceptive use merely reduces the risk, abstinence will eliminate it entirely [ 13 ]. Nevertheless, an overwhelming majority of studies in this field have shown that programs advocating abstinence-only-until-marriage (AOUM) are neither effective in delaying sexual debut nor in changing other sexual risk behaviors [ 14 , 15 ], and participants in abstinence-only sex education programs consider that these had only a low impact in their lives [ 16 ]. On the other hand, holistic and comprehensive approaches to sex education go beyond risk behaviors and acknowledge other important aspects, as for example love, relationships, pleasure, sexuality, desire, gender diversity and rights, in accordance with internationally established guidelines [ 17 ], and with the 2030 Agenda [ 4 ]. Comprehensive Sexuality Education (CSE) “plays a central role in the preparation of young people for a safe, productive, fulfilling life” (p. 12) [ 17 ] and adolescents who receive comprehensive sex education are more likely to delay their sexual debut, as well as to use contraception during sexual initiation [ 18 ]. Comprehensive sexual education initiatives thereby promote sexual health in a way that involves not only the biological aspects of sexuality but also its psychological and emotional aspects, allowing young people to have enjoyable and safe sexual experiences.

With regard to context, sexual education may occur in different settings. School settings are key sites for implementing sexual education and for promoting adolescent sexual health [ 19 ], but today internet is becoming an increasingly important source of information and advice on these topics [ 20 ]. Access to the internet by adolescents is almost universal in high-income countries. The ubiquity and accessibility of digital platforms result in adolescents spending a great deal of time on the internet, and the search for information is the primary purpose of health-related internet use [ 21 ]. At the same time, this widespread use of technology by young people offers interesting possibilities for sexual health education programs, given the ease of access, availability, low cost, and the possibility of participating remotely [ 22 ]. The topics that young people search for online include information on everyday health-related issues, physical well-being and sexual health [ 23 ]. The majority of internet users of all ages in the US (80%) search online for health information including sexual health information [ 24 ], and among adolescents social media platforms are the most frequent means of obtaining information about health, especially regarding sexuality [ 25 ].

Thanks to the ubiquity and popularity of technologies, digital media interventions for sexual education offer a promising way forward, both via the internet (eHealth) and via mobile phones (mHealth, a specific way of promoting eHealth), given the privacy and anonymity they afford, especially for young people. Digital interventions in school—both inside and outside the classroom—offer interesting possibilities, because of their greater flexibility with regard to a variety of learning needs and benefits in comparison with traditional, face-to-face interventions, and because they offer ample opportunities for customization, interactivity as well as a safe, controlled, and familiar environment for transmitting sexual health knowledge and skills [ 26 ]. As Garzón-Orjuela et al. [ 27 ] argues, contemporary adolescents’ needs are mediated by their digital and technological environment, making it important to adapt interventions in the light of these realities. Online searches for sexual health information are likely to become increasingly important for young people with diminishing access to information from schools or health care providers in the midst of the lockdowns and widespread school closures during the COVID-19 pandemic [ 28 ], with more than two million deaths and 94 million people infected around the world [ 29 ]. Specifically, blended learning programs, consisting of internet-based educational interventions complemented by face-to-face interventions, may prove a significant addition to regular secondary school sex education programs [ 30 , 31 ]. Blended learning programs can be especially helpful in promoting sexual and reproductive health in the context of the COVID-19 pandemic, which is challenging the way we have so far approached formal education, with its focus on face to face interventions, given the need, now more than ever, to “develop and disseminate online sex education curricula, and ensure the availability of both in-person and online instruction in response to school closures caused by the pandemic” [ 28 ].

The present study sets out to research the dissemination and effectiveness in different settings (school, digital and blended learning) of sex education programs that promote healthy and positive relationships and the reduction of risk behaviors, so as to make current sexual health interventions more effective [ 32 ]. Numerous researchers have carried out trials and systematic reviews so as to evaluate the effectiveness of school-based sexual health and relationship education [ 19 , 27 , 33 , 34 , 35 ], as well as that of digital platform programs [ 36 , 37 , 38 , 39 ]. However, there has not been a review that is representative of the literature as a whole. Furthermore, in the reviews that have been carried out, differing aims and inclusion criteria have led to differences in the sampling of available primary studies [ 19 ]. As Garzón-Orjuela et al. [ 27 ] asserts, the field of adolescent sex education is continuously evolving and in need of evaluation and improvement. Better assessments are necessary in order to clarify whether they offer a viable and effective strategy for influencing adolescents, especially with respect to improved ASRH behaviors. Hence, given the need for an up-to-date revision so as to consider more recent emerging evidence in this field, in this study we carry out a review of reviews that includes reviews of interventions both in school settings and via digital platforms, as well as, for the first time, those that combine both formats (blended learning).

The decision to conduct a review of reviews (RoR), assessing the quality and summarizing the findings of existing systematic reviews, rather than working directly with primary intervention studies, addresses the need to include as wide a range of topics covered within the field of sex education as possible [ 40 ]. As Schackleton et al. [ 35 ] (p. 383) point out, in order to provide overviews of research evidence that are relevant to policy making, it is important “to bring together evidence on different forms of intervention and on different outcomes because it is useful for policy makers to know what is the range of approaches previously evaluated and whether these have consistent effects across different outcomes.” Carrying out and publicly sharing reviews of reviews such as the present study constitutes one way of better providing practitioners with evidence they can then carry over into their interventions [ 32 ].

2. Methodology

(1) To systematically review existing reviews of Sex Education (SE) of school-based (face-to-face), digital platforms and blended learning programs for adolescent populations in high-income countries.

(2) To summarize evidence relating to effectiveness.

2.2. Methods

The review is structured in accordance with the PRISMA checklist (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) (see Figure A1 ), and the systematic review protocol has previously been published on the PROSPERO International Prospective Registry of Technical Reviews (CRD42021224537).

2.3. Search Strategy

This systematic review is based on international scientific literature and only peer- reviewed papers have been included. Only meta-analyses (publications that combine results from different studies) and systematic reviews (literature reviews that synthesize high-quality research evidence) were used for this review. Findings from reviews of reviews were not analyzed. To identify reviews, we electronically searched the Cochrane Database Reviews, ERIC, Web of Science, PubMed, Medline, Scopus and PsycINFO. After the list was completed the duplicated papers were automatically removed. Two reviewers working independently applied inclusion criteria in screening citations by titles, abstracts, and keywords to identify records for full-text review. A third reviewer reconciled any disagreement. The same procedure was carried out in screening the full text of studies selected after the title and abstract screening phase. Two reviewers then examined the full text of each article to determine which satisfied inclusion criteria. Data extraction was carried out independently by the first and second reviewer. The extracted data included specific details about the interventions, populations, study methods and outcomes significant to the review question and objective. Any discrepancies were discussed until consensus was reached. Search terms are included in Table A1 .

This RoR included the reviews published since 2015, when the United Nations decided on new Global Sustainable Development Goals, until December 2020. The 2030 Agenda for Sustainable Development [ 4 ] takes into account the relevance of Sexual Health to achieve peace and prosperity.

2.4. Inclusion Criteria

We extracted data using a “Population, Intervention, Comparison, Outcome” structure, PICO [ 41 ].

Population: Reviews of interventions targeting adolescents (aged 10–19 years), school-setting, digital platforms or blended learning education were eligible for inclusion. Reviews in which studies of interventions targeted youth and adults were eligible if the primary studies included people between the ages of 10–19 years.

Intervention: Reviews of interventions developed in school-setting (school-based), digital (digital platforms) or blended learning programs were included. Interventions based on multiple settings or targeted multiple health-related issues were only considered for inclusion if any primary studies were linked to school-based, digital or blended learning interventions, as well as targeting Sexual and Reproductive Health (SRH).

Comparison groups: Randomized controlled trials (RCTs) and studies using a quasi-experimental design (including non-randomized trials—nRCTs). Single group, pre- and post-test research designs, group exposed to sexual education (SE) program (school-based, digital platforms or blended learning) compared with non-exposed control group or another intervention.

Outcomes: Primary outcomes: (1) Sexual behavior and (2) Health and social outcomes related to sexual health. Secondary outcomes: (1) Knowledge and understanding of sexual health and relationship issues and (2) Attitudes, values and skills.

2.5. Exclusion Criteria

Reviews were excluded if:

• Their primary focus was adult people and adolescents were not included.
• Their primary focus was sexual-health screening, sexual abuse or assault or prevention of sexual abuse or rape.
• The studies targeted specific populations (e.g., pre-pubertal children, children with developmental disorders, migrant and refugee, or sexual minorities).
• The interventions focused on low- and middle-income countries or if high income countries were not included in the study.
• Recipients were professionals, teachers, parents or a combination of the latter.

2.6. Risk of Bias and Assessment of Study Quality

Review quality was assessed by the first author using the AMSTAR II checklist [ 42 ]. This is an updating and adaptation of AMSTAR [ 43 , 44 ] which allows a more detailed assessment of systematic reviews that include randomized or non-randomized studies of healthcare interventions, or both. It consists of a 16-item tool (including 5 critical domains) assessing the quality of a review’s design, its search strategy, inclusion and exclusion criteria, quality assessment of included studies, methods used to combine the findings, likelihood of publication bias and statements of conflict of interest. The maximum quality score is 16.

2.7. Data Synthesis

After manually coding the papers and extracting relevant data, we used a narrative/descriptive approach for data synthesis to summarize characteristics of the studies included. Considering the heterogeneity of outcomes, their measures and research designs, meta-analysis of all the studies included was not carried out. Two researchers were involved in data synthesis. Discrepancies were resolved through discussion, and a third researcher was consulted to resolve any remaining discrepancies. For the classification of the information and presentation of the effects of the interventions reported, data was separated (school setting, digital platforms or blended learning) and structured around population, intervention, comparison, and outcome. To address the main review questions, data was synthesized in two phases. Phase 1 addressed the first question, the description of sex education/sexual health interventions. Phase 2 addressed the second question, the effectiveness and benefit of the interventions; studies with a low risk of bias were highlighted, so as to strengthen the reliability of findings (AMSTAR II) [ 42 ].

3.1. Results of Search

Our searches yielded 1476 unique citations. After excluding 776 records based on title and abstract screening, we reviewed 217 full-text articles for eligibility, of which 20 ultimately met inclusion criteria, and proceeded to data extraction. Of the 197 studies that we excluded after full-text review, 82 were carried out in low- and middle-income countries, 47 targeted exclusively adults, 56 dealt with minority groups, and 12 targeted exclusively pre-teen students.

3.2. Risk of Bias in Included Studies

According to the AMSTAR II quality assessment tool’s developers [ 42 ] scores may range from 1 to 16: in this case only 2 reviews scored 16 out of 16: 1 in a school setting [ 45 ], and 1 on a digital platform [ 46 ]. 6 of the 20 systematic reviews were of high quality: 5 in school settings [ 45 , 47 , 48 , 49 , 50 ], and 1 in digital platforms [ 46 ]; there was one study of medium quality in a school setting [ 51 ]. The remaining studies were of low or very low quality (N = 13). It is possible that low quality reviews may not provide reliable evidence, so those scoring in low and critically low quality should be regarded skeptically.

3.3. Reviews Included

Key information regarding the 20 reviews included is shown in Table A2 and Table A3 .

3.3.1. Setting

Ten studies (50%) dealt with school-based interventions [ 45 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 ], 9 (45%) referred to online interventions [ 46 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 ] and 1 (5%) was a review of blended learning programs [ 64 ]. In total 491 studies were included in the 20 reviews covered by the present RoR. The 10 reviews of school setting interventions include a total of 266 studies (54%), the 9 reviews of online interventions cover a total of 216 (44%) studies, and the only review of blended learning interventions includes a total of 9 studies (2%). All studies were conducted in high-income economies following the World Bank classification [ 65 ], including US samples in 16 of the 20 studies, although there are two studies in which the country of the sample is not identified [ 51 , 52 ]. Most of the studies evaluating interventions in school settings also include developing countries (low- and middle-income economies) [ 45 , 47 , 50 , 52 , 53 , 55 ], as is also the case in three reviews of online interventions [ 46 , 61 , 62 ] (see Table A2 ).

3.3.2. Population

The targeted age for reviews in school settings, as shown in Table A2 , is the period of adolescence, from 10 to 19 years of age, though one of the studies covers ages from 7 to 19 years [ 53 ]. All the online studies also include young adults (20–24 years old), alongside the adolescent sample [ 46 , 56 , 57 , 59 , 60 , 61 , 62 , 63 ], whilst the review by DeSmet et al. [ 58 ] extends the upper limit to 29 years of age. Along with the sample of adolescents and young adults, the blended learning studies review also incorporates adults of over 25 years of age [ 64 ].

3.3.3. Interventions/Types of Study

All the studies included in this review of reviews used randomized controlled trials (RCTs), non-randomized controlled trials (non-RCT), and a quasi-experimental design or a pre-test/post-test design to examine program effects.

3.3.4. Outcomes

The term “sexual outcomes” refers to the attitudes, behaviors, and experiences of adolescents consequent to their sex education [ 14 ] (p. 1), and an extensive range of variables was included (see Table A2 ): knowledge (e.g., knowledge of contraceptive effectiveness or effective method use); attitudes (e.g., about sex and reproductive health); beliefs (e.g., self-efficacy); skills (e.g., condom skills); intentions/motivation (e.g., use of birth control methods; condom use); behaviors (e.g., sexual debut; condom use; contraception use; intercourse; initiation of sexual activity) and; other outcomes related to sexual behavior (e.g., pregnancy prevalence; number of partners; rates of sexually transmissible infections (STIs); cervical screening; appreciation of sexual diversity; dating and intimate partner violence prevention; sexual violence).

3.3.5. Country of Review

Of the 10 reviews of interventions in school settings, the authors are from the USA in 7 reviews [ 47 , 48 , 49 , 50 , 53 , 54 , 55 ], from the United Kingdom in 1 [ 45 ], from Australia in 1 [ 51 ], and from Thailand in 1 [ 52 ]. Of the 9 reviews of interventions in digital settings, the authors are from the United States in 3 reviews [ 59 , 60 , 63 ], from the United Kingdom in 2 [ 46 , 56 ], from Australia in 1 [ 62 ], from Belgium in 1 [ 58 ], from France in 1 [ 61 ] and from Turkey in 1 [ 57 ]. The authors of the blended learning review are from the USA [ 64 ].

3.3.6. Year of Last Paper Included

The studies cited in the reviews that met the inclusion criteria for this review were published over a wide range of years (between 1981–2019), although only one [ 61 ], with articles published up to and including 2019 was published later than 2017. Of these, 3 were carried out in school settings [ 49 , 51 , 53 ], and 1 on digital platforms [ 46 ].

3.3.7. Search Tools

All reviews include more than 2 tools to carry out the search, in a range of 3–12, and in 7 of them the review of gray literature was included.

3.3.8. Multicenter Studies and Number of Studies Included

All reviews from school settings are multicenter, except that of Mirzazadeh et al. [ 49 ], which includes only one North American sample. The same is true for the blended learning review [ 64 ] and for the reviews of digital platforms, except for the reviews by Bailey et al. [ 56 ], L´Engle et al. [ 60 ], and Widman et al. [ 63 ]. Regarding the number of countries included in the reviews, the range in the school-setting reviews is from 1 to 11, in digital platforms reviews from 1 to 16, and in the only review of blended learning, 3. As for the range of studies included, in the reviews in school setting the range is between 8 and 80, in digital platforms, between 5 and 60, and in the only review of reviews of blended learning 9 studies were included.

3.3.9. Number of Reviews Covered That Include Meta-Analysis

As for the number of reviews that carry out a meta-analysis, there are 8 in total: 4 in school settings [ 45 , 48 , 49 , 55 ] and 4 on digital platforms [ 43 , 46 , 56 , 58 ], while in the only review of blended learning there is no meta- analysis.

3.4. Effectiveness

3.4.1. school settings.

Half of the reviews conclude that interventions are not effective in promoting healthy sexual behaviors and/or reducing risks [ 45 , 47 , 48 , 49 , 50 ]. These reviews are of high quality and with a reduced risk of bias (see Table A4 ), so that the results are highly reliable, even though in most of the studies cited the risk of bias was judged to be high and the quality of evidence was low or very low. These reviews include those of the Marseille et al. [ 48 ] and Mirzazadeh et al. [ 49 ] team, who in two studies—each led by one of the two authors—analyze, on the one hand, the effectiveness of school-based teen pregnancy prevention programs [ 48 ], and, on the other hand, the effectiveness of school-based programs prevent HIV and other sexually transmitted infections in North America [ 49 ]. The results of the studies question the usefulness of interventions carried out in schools to prevent both unwanted pregnancies and the incidence of HIV and other sexual transmitted infections in adolescents in North America. In addition to these results, those of Lopez et al. [ 47 ] focus on analyzing the effectiveness of programs implemented in schools to promote the use of contraceptive methods and conclude that many trials reported contraceptive use as an outcome but did not take into consideration whether contraceptive methods and their relative effectiveness were part of the content. For its part, the review by Mason-Jones et al. [ 45 ] also concludes that the educational programs covered had no significant effect as regards the prevalence of HIV or other STIs (herpes simplex virus, moderate evidence and syphilis, low evidence), nor was there any apparent effect in terms of the number of pregnancies at the end of the trial (moderate evidence). Finally, the review by Oringanje et al. [ 50 ] finds only limited evidence for program effects on biological measures, and inconsistent results for behavioral (secondary) outcomes across trials and concludes that it was only the interventions which combined education and contraception promotion (multiple interventions) that led to a significant reduction in unintended pregnancies over the medium- and long-term follow-up period.

In contrast to these negative results in terms of the effectiveness of the programs implemented in the school environment (identified in 5 of the 10 reviews included), 3 of the 10 reviews concluded that the programs evaluated were mostly effective in promoting knowledge, attitudes and/or in reducing risk behaviors [ 51 , 52 , 53 ] whilst programs were effective in terms of some of the primary outcomes in the reviews by Haberland et al., [ 54 ], and Peterson et al. [ 55 ]. However, these data must be taken with caution since the level of bias in these reviews—excepting that of Kedzior et al. [ 51 ] with a medium quality level—is at a low or critically low-quality level. In the review by Chokprajakchad et al. [ 52 ], 22 programs reviewed were effective in changing targeted adolescent psychosocial and/or behavioral outcomes, in 12 of 17 studies evaluating delay in the initiation of sexual intercourse, the programs were effective and many of the reviewed studies demonstrated impacts on short-term outcomes, such as knowledge, attitudes, perception and intention. The review by Goldfarb et al. [ 53 ] identifies changes in appreciation of sexual diversity, dating and intimate partner violence prevention, healthy relationships, child sex abuse prevention and additional outcomes. According to the review by Kedzior et al. [ 51 ], focused on studies promoting social connectedness with regard to sexual and reproductive sexual health, the programs reviewed improved condom use, delayed initiation of sex, and reduced pregnancy rates. Additionally, in this review, program effectiveness was influenced by ethnicity and gender: greater improvements in condom use were often reported among African American students. For its part, in the study by Peterson et al. [ 55 ] the meta-analysis of three randomized trials provided some evidence that school-environment interventions may contribute to a later sexual debut while their narrative synthesis of other outcomes offered only mixed results.

Finally, the review by Haberland et al. [ 54 ], which focused on studies analyzing whether addressing gender and power in sexuality education curricula is associated with better outcomes, concluded that where interventions addressed gender or power (N = 10/22) there was a fivefold greater likelihood of effectiveness than in those that did not.

3.4.2. Online Platforms

The reviews included show a very diverse panorama of digital platforms used to carry out educational interventions (e.g., websites, social media, gaming, apps or text messaging and mailing), which makes it difficult to compare the results. Of the 9 reviews of studies included, only one—in which the effects of TCCMD (Targeted Client Communication delivered via Mobile Devices) are evaluated [ 46 ]—meets the quality criteria according to the AMSTAR II quality assessment tool [ 42 ] (see Table A4 ); the rest include biases that limit the reliability of the results so that these must be taken with caution. In the studies reviewed by Palmer et al. [ 46 ] among adolescents nine programs were delivered only via text messages; four programs used text messages in combination with other media (for example, emails, multimedia messaging, or voice calls); and one program used only voice calls.

When compared with more conventional approaches, interventions that use TCCMD may increase sexual health knowledge (low certainty evidence), and may modestly increase contraception use (low certainty evidence) while the effect on condom use remains unclear given the very low certainty evidence. Additionally, when compared with digital non-targeted communication, the effects TCCMD on sexual health knowledge, condom and contraceptive use are also unclear, again given the very low-certainty evidence. The review finds evidence of a modest beneficial intervention effect on contraceptive use among adolescent (and adult) populations, but that there was insufficient evidence to demonstrate that this translated into a reduction in contraception.

Most of the reviews included refer to changes to a greater or lesser extent [ 56 , 57 , 59 , 60 , 62 , 63 ], while no changes determined by the intervention were identified in the study by DeSmet et al. [ 58 ]. Finally, the review by Martin et al. [ 61 ] does not include details about changes as a result of the programs.

The review by L´Engle et al. [ 60 ] assesses mHealth mobile phone interventions for ASRH (almost all of which were carried out via SMS platforms, with the notable exception of only four of the programs covered which used other media formats instead of or as well as SMS). The interventions reviewed set out to foster positive and preventive SRH behaviors, augment take-up and continued use of contraception, support medication adherence for HIV-positive young people, support teenage parents, and encourage use of health screening and treatment services. Results from the studies covered in the review offer support for diverse uses of mobile phones in order to help further ASRH. The health promotion programs that made use of text messaging demonstrated robust acceptability and relevance for young people globally and contributed to improved SRH awareness, less unprotected sex, and more testing for STIs. However, the review also found that improved reporting on essential mHealth criteria is necessary in order to understand, replicate, and scale up mHealth interventions. Holstrom’s [ 59 ] review, focused on evaluations of internet-based sexual health interventions, finds that these were associated with greater sexual health knowledge and awareness, lower rates of unprotected sex and higher rates of condom use, as well as increased STI testing. Moreover, the review explores young people’s continuing use of and trust in internet as a source of information about sexual health, as well as the particular themes that interest them. Specifically, the study finds that young people want to know not only about STIs, but also about sexual pleasure, about how to talk with partners about their sexual desires, as well as about techniques to better pleasure their partners.

The review by Widman et al. [ 63 ] reveals a significant weighted mean effect of technology-based interventions on condom use and abstinence, the effects of which were not affected by age, gender, country, intervention, dose, interactivity, or program tailoring. The effects were more significant when evaluated with short-term (one to five months) follow-ups than with longer term (over six months) ones. Moreover, digital programs were more effective than control programs in contributing to sexual health knowledge and safer sex norms and attitudes. This meta-analysis, drawing on fifteen years of research into youth-oriented digital interventions, is clear evidence of their ability to contribute to safer sex behavior and awareness. In the review by Wadham et al. [ 62 ] the majority of studies used a web-based platform for their programs (16 out of 25). These web-based programs varied between complex, bespoke multimedia interventions to more simplified educational modules. Five studies employed SMS platforms both via mobile phone messaging and web-based instant message services. Three of the programs used social networking sites, either for live chat purposes or alongside a web-based platform. Several studies showed that variety in terms of media and platforms was associated with stronger positive responses among participants and improved outcomes. Eleven of the twenty-five studies focused specifically on HIV prevention, with seven finding a statistically significant effect of the program with regard to knowledge levels about prevention of HIV and other STIs, as well as about general sexual health knowledge. However, only twenty percent of the programs that assessed intended use of condoms reported significant effects due to the intervention.

The review by Bailey et al. [ 56 ] (p. 5) assesses interactive digital interventions (IDIs), defined as “digital media programs that provide health information and tailored decision support, behavioral-change support and/or emotional support” and focuses on the sexual well-being of young people between the ages of thirteen and twenty four in the United Kingdom. IDIs have significant though small effects on self-efficacy and sexual behavior, although there is not sufficient evidence to ascertain the effects on biological outcomes or other longer-term impacts. When comparing IDIs with in-person sexual health programs, the former demonstrate significant, moderate positive effects on sexual health knowledge, significant small effects on intention but no demonstrable effects on self-efficacy. The review by Celik et al. [ 57 ] looks at digital programs (the majority internet- and computer-based with only six making use of mobile phone-based applications) and sets out to understand their effectiveness in changing adolescents’ health behaviors. Findings from the studies ( n = 9) suggest that the digital interventions carried out with the adolescents generally had a positive effect on health-promoting behaviors. However, in another study focused on fostering HIV prevention [ 66 ], there was a statistically significant increase in health-promoting behavior in only one of the four studies reviewed.

In the review by DeSmet et al. [ 58 ], no significant behavioral changes as a result of the interventions for sexual health promotion using serious digital games are identified, although the interventions did have significant though small positive effects on outcomes. The fact that so few studies both met the inclusion criteria and also analyzed behavioral effects suggests the need to further investigate the effectiveness of this kind of game-based approach.

Finally, in the review by Martin et al. [ 61 ] 60 studies were covered, detailing a total of 37 interventions, though only 23 of the reviews included effectiveness results. A majority of the interventions were delivered via websites ( n = 20) while online social networks were the second most favored medium ( n = 13), mostly via Facebook ( n = 8). The programs under review favored online interaction, principally amongst peers ( n = 23) but also with professionals ( n = 16). The review concludes that ASHR programs promoting these kinds of online participation interventions have demonstrated feasibility, practical interest, and attractiveness, though their effectiveness has yet to be determined, given that they are still in the early stages of design and evaluation.

3.4.3. Blended Learning

In the only blended learning review included in our study [ 64 ], the authors conclude that blended learning approaches are being successfully applied in ASHR interventions, including in school-based programs, and have led to positive behavioral and psychosocial changes. However, these results should be treated with caution as the review does not follow the guidelines recommended in the AMSTAR II quality assessment tool [ 44 ] (see Table A4 ) and only includes nine studies.

4. Discussion

The present review of reviews assesses, for the first time jointly to our knowledge, the effectiveness of sexual education programs for the adolescent population (ASRH) developed in school settings, digital platforms and blended learning. Of the twenty reviews included (comprising a total of 491 programs, mostly from the USA), ten correspond to reviews of programs implemented in school settings, nine to those dealing with interventions via digital platforms and only one deals with studies relating to blended learning. Twelve (60%) of the reviews included (6 out of 10 in school settings, 5 out of 9 on digital platforms, and the only blended learning review) have been published in the last 3 years (between 2018 and 2020). Thus, the present study constitutes the most up-to-date and recent review of reviews incorporating several contemporary studies not covered by earlier reviews [ 19 , 27 , 33 , 35 , 36 , 37 , 38 , 39 ].

4.1. Interventions Reviewed

The interventions included in the reviews covered by our study were largely focused on reducing risk behaviors (e.g., VIH/STIs and unwanted pregnancies), and envisaging sex as a problem behavior. Programs reviewed often focused on the physical and biological aspects of sex, including pregnancy, STIs, frequency of sexual intercourse, use of condom, and reducing adolescents´ number of sexual partners. One exception is Golfard’s et al. [ 53 ] review about comprehensive sex education, which is centered on healthy relationships and sexual diversity, though it also makes reference to prevention of violence (dating and intimate partner violence prevention and sex abuse prevention). However, Golfard’s et al.’s [ 53 ] rejects more than 80% of the studies initially reviewed because they were focused solely on pregnancy and disease prevention. In the reviews of interventions on digital platforms and via blended learning all the outcomes focused on behaviors related to sexual health (focused on the prevention of risk behaviors), and in several cases also addressed perceived satisfaction and usability. These results are in line with other studies that confirm the over-attention given to risk behaviors, to the detriment of other more positive aspects of sexuality [ 67 , 68 ]. Teachers continue to perceive their responsibility as combating sexual risk, whilst viewing young people as immature and oversexualized [ 69 ], even as adolescents themselves express a preference for sex education with less emphasis on strictly negative sexual outcomes [ 16 ], and more emphasis on peer education [ 70 ].

As for more positive views of sexuality, only on rare occasions do interventions address issues such as sexual pleasure, desire and healthy relationships. Desire and pleasure were not included in the outcome evaluations for school settings, nor for digital and blended learning programs included in this review: again this is in line with the position of other authors cited in the present study, who advocate the need to also embrace the more positive aspects of sexuality [ 53 , 56 ]. Specifically, Bailey and colleagues [ 56 ] (p. 73) suggest as “optimal outcomes” social and emotional well-being in sexual health. Young people want to know about more than STIs, they also “want information about sexual pleasure, how to communicate with partners about what they want sexually and specific techniques to better pleasure their partners” [ 59 ] (p. 282). Similarly, Kedzior et al. [ 51 ] also argue for the need to move beyond a risk-aversion approach and towards one that places more emphasis on positive adolescent sexual and reproductive health.

Pleasure and desire are largely absent within sex and relationship education [ 71 ] and, when they are included, they are often proposed as part of a discourse on safe practice, where pleasure continues to be equated with danger [ 72 ]. The persistent absence of a “discourse of desire” in sex education [ 73 , 74 ] is especially problematic for women, for whom desire is still mediated by (positive) male attention, and for whom pleasure is derived from being found desirable and not from sexual self-expression or from their own desires [ 75 ]. Receiving sexualized attention from men makes women “feel good” by increasing their self-esteem and self-confidence [ 76 ]. However, it is still men who decide what is sexy and what is not, based on the attention they pay to women “girl watching”, [ 77 ] (p. 386), which leads the latter to self-objectify [ 78 ] with all the attendant negative consequences for their overall and sexual health [ 79 ]. In fact, women experience “pushes” and “pulls” [ 80 ] (p.393) with regard to sexualized culture. In one sense, the sexualization of culture has placed women in the position of subjects who desire, not just that of subjects who are desired, but at the same time it becomes a form of regulation in which young women are forced to assume the current sexualized ideal [ 81 , 82 ] in order to position themselves as “modern, liberated and feminine,” and avoid being seen as “outdated or prudish” [ 83 ] (p. 16). Koepsel [ 84 ] provides a holistic definition of pleasure as well as clear recommendations for how educators can overcome these deficits by incorporating pleasure into their existing curricula. At present, sexual education is still largely centered on questions of public health, and there is as yet no consensus on criteria for defining sexual well-being and other aspects of positive sexuality [ 85 ]. Patterson et al. [ 86 ] argue for the need to mandate “comprehensive, positive, inclusive and skills-based learning” to enhance people´s ability to develop healthy positive relationships throughout their lives.

The absence of desire and pleasure in the outcomes of the evaluated reviews is connected with the absence of gender-related outcomes. Only one of the reviews addresses the issue of gender and power in sexuality programs [ 54 ], illustrating how their inclusion can bring about a five-fold increase in the effectiveness of risk behavior prevention. Nonetheless, men are far less likely than women to sign up for a sexuality course, and as a result of masculine ideologies many young males experience negative attitudes towards sex education [ 87 ]. To date we still have little idea as to what are the “active ingredients” that can contribute to successfully encouraging men to challenge gender inequalities, male privilege and harmful or restrictive masculinities so as to help improve sexual and reproductive health for all [ 88 ] (p.16). Schmidt et al.’s [ 89 ] review looks at 10 evidence-based sexual education programs in schools: the majority discuss sexually transmitted diseases and unplanned pregnancy, abstinence, and contraceptive use, while very few address components related to healthy dating relationships, discussion of interpersonal violence or an understanding of gender roles.

The International Guidance on Sexuality Education [ 90 ], and the International Technical Guidance on Sexuality Education [ 17 ] promote the delivery of sexual education within a framework of human rights and gender equality to support children and adolescents in questioning social and cultural norms. The year 2020 marked the anniversaries of several path breaking policies, laws and events for women’s rights: the 100th anniversary of women´s suffrage in the United States; the 25th anniversary of the Beijing Platform for Action, a global roadmap for women´s empowerment; and, the 20th anniversary of the United Nations Security Council Resolution for a Women, Peace and Security agenda. Although there have been important advances in recent years in research relating to the inclusion of gender equality and human rights interventions in ASRH policies and programming still “fundamental gaps remain” [ 40 ] (p.14). Gender equality, and to an even greater extent human rights, have had very little presence in sexual and reproductive health programs and policies, and there is a pressing need to do more to address these issues systematically. Specifically, issues such as abortion and female genital mutilation, with clear repercussions in terms of gender equality and human rights, are rarely dealt with [ 40 ].

Furthermore, sexual education that privileges heterosexuality reinforces hegemonic attributes of femininity and masculinity, and ignores identities that distance themselves from these patterns. Our collective heteronormative legacy marginalizes and harms LGB families [ 91 ] and LGBTQ+-related information about healthy relationships is largely absent from sexual and reproductive health programs [ 92 ]. Students want a more LGBTQ+ inclusive curriculum [ 92 ]: in the present RoR one review [ 53 ] addresses the issue of non-heteronormative identity in sexuality programs with significant results; and other authors are exploring promising initiatives which are also challenging this lack of inclusivity [ 93 ] and rectifying heterosexual bias [ 94 ]. However, unfortunately, the underlying neoliberal focus of the majority of contemporary sexuality education militates to assimilate LGBTQ+ people into existing economic and social normative frameworks rather than helping disrupt them [ 95 ].

4.2. Effectiveness

This present review of reviews shows a variety of types of sexual health promotion initiatives across the three settings (school-based, digital and blended learning), with inconsistent results. The reviews with lower risk of bias are those carried out in school settings and those that are most critical regarding the effectiveness of programs promoting ASRH, both in the prevention of pregnancies and of HIV/STIs. Reviews dealing with digital platforms and blended learning show greater effectiveness in terms of promoting adolescent sexual health: however, these are also the studies that incorporate the highest risks of bias. Specifically, in digital platforms programs the great variety of alternatives makes comparability difficult. Moreover, these programs, along with blended learning, are in a more incipient state of evaluation, compared to school-setting evaluations, and present greater risks of lower quality than reviews in school settings.

The results of the present RoR are in line with those of previous RoRs [ 19 , 32 ]. The review of reviews by Denford et al.s´ [ 19 ] RoR covered 37 reviews up to 2016 and summarized 224 primary randomized controlled trials: whilst it concludes that school-based programs addressing risky sexual behavior can be effective, its reviews of exclusively school-based studies offer mixed results as to effectiveness in relation to attitudes, skills and behavioral change. Some of those studies report positive effects while others find there are no effects, if not even negative effects, in terms of the aforementioned outcomes [ 19 ]. As regards pregnancy, programs appear to be effective at increasing awareness regarding STIs and contraception but overall the findings suggest that the impact of these interventions on attitudes, behaviors and skills variables are mixed, with some studies leading to improvements whilst others show no change. Moreover, the fact that community-based programs were also taken into consideration might have led to the effectiveness of school-based programs being exaggerated [ 19 ].

However, although in our RoR the higher quality/lower bias studies—in keeping with the findings of previous reviews [ 19 , 33 ]—fail to show a clear pattern of effectiveness, the interventions could nevertheless be generating changes as Denford et al. [ 19 ] suggest, though not in the measured outcomes, bearing in mind the low incidence of sexual intercourse and pregnancy in school-going adolescents.

With regard to school settings, Peterson et al. [ 55 ] conclude that further, more rigorous evidence is necessary to evaluate the extent to which interventions addressing school-related factors are effective and to help better understand the mechanisms by which they may contribute to improving adolescent sexual health. With regard to digital platform programs, Wadham et al. [ 62 ] (p. 101) argue that “although new media has the capacity to expand efficiencies and coverage, the technology itself does not guarantee success.” An interesting observation in their review was that interventions which were either web-based adaptations of prior prevention programs, or were theory-based or had been developed from models of behavioral change appeared effective independently of the chosen digital media mode. However, digital programs are still in the early stages of design and evaluation, especially in terms of the effects of peer interaction and often diverge from existing theoretical models [ 61 ] (p. 13). The expert opinion-based proposal of the European Society for Sexual Medicine [ 96 ] argues that e-sexual health education can contribute to improving the sexual health of the population it seems the future of CSHE is moving towards smartphone apps [ 97 ].

However, “despite clear and compelling evidence for the benefits of high-quality curriculum-based CSE, few children and young people receive preparation for their lives that empowers them to take control and make informed decisions about their sexuality and relationships freely and responsibly” [ 17 ] (p. 12), and during “the current public health crisis, the sexual and reproductive health of adolescents and young adults must not be overlooked, as it is integral to both their and the larger society’s well-being” [ 28 ] (p. 9). In the light of these challenges, Coyle et al.’s [ 64 ] suggestion that the blended learning model may end up achieving a far more dominant role in the future of sexual education acquires even more relevance.

4.3. Limitations

This study represents the first review of reviews, as far as we are aware, in which the effectiveness of sex education programs in different settings (school-based, digital and blended learning) is evaluated, using a rich methodology and providing interesting conclusions. However, the present review of reviews is not without its limitations.

While systematic reviews and reviews of reviews can offer a way synthesizing large amounts of data, the great heterogeneity and diversity of measured outcomes make it difficult to establish a synthesis of the results, even more so in cases where it is not possible to apply meta-analysis. Furthermore, the quality of reviews of reviews is limited by that of the reviews they include and RoRs do not necessarily represent the leading edge research in the field.

In addition, although we searched for a wide range of keywords on the most commonly used databases in the field of health (namely ERIC, Web of Science, PubMed, and PsycINFO) to identify relevant papers, it is possible that the choice of keywords and database may have resulted in our omitting some relevant studies. Moreover, our review has focused on articles in international journals published in English, allowing us access to the most rigorous peer-reviewed studies and to those with greater international diffusion, given that English is the most frequently used language in the scientific environment: notwithstanding, this has also limited the scope of our review by precluding research published in other languages and contexts. Nor have documents that could have been found in the gray literature been included, given that only peer-reviewed studies have been considered for inclusion.

It is worth remembering moreover that most of the data on the outcomes of the studies included are self-reported, with mention of only occasional biological outcomes, which may limit the reliability of the effectiveness results. This represents another interesting reflection on the way in which the evaluation of the effectiveness of programs on sexual education is being carried out, and alerts us to the need for change.

Finally, it should be noted that this review of reviews is focused on adolescents from high-income countries, and our results show that studies carried out in the United States are largely overrepresented, since it is the country that provides the highest number of samples, especially in school settings: this may give rise to bias when it comes to generalizing from these results. Once again, this raises another necessary reflection on the capitalization that studies focused on American samples are having in the construction of the body of scientific knowledge on sexual and reproductive behavior, when in reality sexuality is conditioned by socio-economic variables that require a far-more multicultural and world-centric approach.

5. Conclusions

This review of reviews is the first to assess jointly the effectiveness of school-based, digital and blended learning interventions in ASRH in high-income countries. The effectiveness of the sex education programs reviewed mostly focused on the reduction of risky behaviors (e.g., STI or unwanted pregnancies) as public health outcomes; however, pleasure, desire and healthy relationships are outcomes that are mostly conspicuous by their absence in the reviews we have covered. Nonetheless, the broad range of studies included in this RoR, with their diversity of settings and methods, populations and objectives, precludes any easily drawn comparisons or conclusions. The inconsistent results and the high risk of bias reduce the conclusiveness of this review, so a more rigorous assessment of the effectivity of sexual education programs is pending and action needs to be taken to guarantee better and more rigorous evaluations, with sufficient human and financial resources. Schools and organizations need technical assistance to build the capacity for rigorous program planning, implementation and evaluation [ 98 ]. To this end, there are already examples of interesting proposals, such as that of the Working to Institutionalize Sex Education (WISE) Initiative, a privately funded effort to help public school districts develop and deliver comprehensive sexuality programs in the USA [ 99 ].

The extent of the risks of bias identified in the reviews and studies covered by this RoR points to an important conclusion, allowing us to highlight the precariousness that characterizes the evaluation of sexual education programs and the consequent undermining of public policy oriented to promoting ASRH. Public policies that promote ASRH are of vital importance when it comes to minimizing risks related to sexual behavior, and maximizing healthy relations and sexual well-being for the youngest members of our society.

Above all it is important to recognize the opportunities afforded by new technologies, so ubiquitous in the lives of young people, since they allow for programs that are far more cost-effective than traditional, in-person interventions. Finally, blended learning programs are perhaps even more promising, given their combination of the best of face-to-face and digital interventions, meaning they provide an excellent educative tool in the new context of the COVID-19 pandemic, and may even become the dominant teaching model in the future.

Flow diagram Preferred reporting items for systematic reviews and meta-analysis, PRISMA).

Search Terms Used.

Description of studies.

Characteristics and main results of the studies included.

Evaluation of the studies included (AMSTAR II).

1 1. Did the research questions and inclusion criteria for the review include the components of PCIO?; 2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the report justify any significant deviations from the protocol?; 3. Did the review authors explain their selection of the study designs for inclusion in the review?; 4. Did the review authors use a comprehensive literature search strategy?; 5. Did the review authors perform study selection in duplicate?; 6. Did the review authors perform data extraction in duplicate?; 7. Did the review authors provide a list of excluded studies and justify the exclusions?; 8. Did the review authors describe the included studies in adequate detail?; 9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review?; 10. Did the review authors report on the sources of funding for the studies included in the review?; 11. If meta-analysis was performed, did the review authors use appropriate methods for statistical combination of results?; 12. If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or other evidence synthesis?; 13. Did the review authors account for RoB in primary studies when interpreting/discussing the results of the review?; 14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review?; 15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss its likely impact on the results of the review?; 16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? 2 H = Hight; M = Media; C = Low; CL = Critically Low. N = No; Y = Yes.

Author Contributions

Conceptualization, M.L.-F. and R.M.-R.; methodology, M.L.-F.; R.M.-R.; Y.R.-C. and M.V.C.-F.; formal analysis, M.L.-F.; R.M.-R.; Y.R.-C. and M.V.C.-F.; investigation, M.L.-F.; R.M.-R.; Y.R.-C. and M.V.C.-F.; writing—original draft preparation, M.L.-F. and R.M.-R.; writing—review and editing, M.L.-F.; R.M.-R., and Y.R.-C. and.; supervision, M.L.-F.; R.M.-R.; Y.R.-C. and M.V.C.-F. All authors have read and agreed to the published version of the manuscript.

This research received no external funding.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Data availability statement, conflicts of interest.

The authors declare that they have no conflicts of interest.

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The Sex Ed. Battleground Heats Up (Again). Here’s What’s Actually in New Standards

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When Judy LoBianco first started teaching health education decades ago, she leaned into what she called the “shock value.”

LoBianco, now the supervisor of health and physical education for the Livingston public schools in New Jersey, remembers showing students videos of childbirth and the movie “Super Size Me,” a 2004 documentary about the negative health effects of fast food.

Over the past couple of decades, though, best practice has shifted, LoBianco said—away from trying to scare kids off behavior that carries any risk and toward an approach that emphasizes decisionmaking, risk management, and self-advocacy.

“It’s about building skills and giving them practice,” LoBianco said. “Because when kids feel confident in their skills, they’ll act in more healthy ways.”

But two states that have updated their standards to reflect this research-based shift are now facing pushback from a vocal group of critics.

In Illinois and New Jersey , where changes to health and sex education standards are rolling out this school year, the revisions have sparked outbreaks of fierce, pointed controversy—a backlash that sex education experts say targets LGBTQ youth and deliberately mischaracterizes the standards and their aims.

At school board meetings in New Jersey districts, opponents of the new standards have claimed that they show young children “sexually explicit” material and are “indocrinating” kids into “woke ideology.” In May, several members of the state board of education called for the standards to be reevaluated , a request that the full board and the acting education commissioner denied.

In Illinois, where districts are not required to provide comprehensive sex education, many school systems have chosen not to adopt the new standards.

Over the past year, the outcry has become a talking point for Republican politicians in these states and a headline issue for national conservative media outlets, which have denounced the standards’ gender inclusivity, contending that they introduce children to age-inappropriate material.

This is a moral panic that comes whenever society moves away from this patriarchal, Christian, white supremacist view of the way the world should be.

In a sense, this is a familiar story. Pitched debate about the scope of health classes isn’t a new phenomenon, said Nora Gelperin, the director of sex education and training at Advocates for Youth, a group that works for adolescent sexual and reproductive health.

Gelperin was one of the writers of the National Sex Education Standards , which Illinois has adopted. The national standards also influenced New Jersey’s guidelines.

But now, the focus of this pushback has shifted more forcefully toward anti-LGBTQ rhetoric, she said.

Sex education advocates linked this resistance to the anti-LGBTQ legislation that at least 15 states have considered or passed this legislative session . The most well-known of these laws, Florida’s, prevents teachers from instructing K-3 students about gender or sexuality. Other proposed legislation would limit how teachers can use students’ pronouns, restrict use of materials featuring LGBTQ characters or themes, or regulate clubs for LGBTQ students.

And the outrage about sex education has once again put a spotlight on schools’ instructional choices, a situation that some advocates fear could make educators hesitant to address certain topics altogether.

“I have no problem with someone deciding for their own child, but when you get out there and start hijacking the narrative for everyone else’s kid, that’s dangerous,” said LoBianco.

A shift from risk prevention to a more proactive approach

The changes in Illinois and New Jersey are part of an evolution in the field of sex education, said Eva Goldfarb, a professor of public health at Montclair State University. Goldfarb contributed to the most recent version of the National Sex Education Standards, published in 2020.

The guidelines were developed by the Future of Sex Education Initiative, a partnership between three groups that support comprehensive sex education: Advocates for Youth, Answer, and SIECUS: Sex Ed for Social Change. This version is an update from the 2011 edition, which 41 percent of school districts said they’d adopted as of 2016 .

In the 1980s and early ‘90s, the big debate in schools was whether teachers should take an abstinence-only approach or whether they should provide information about how to avoid pregnancy and sexually transmitted infections, Goldfarb said.

In response to the HIV/AIDS epidemic, sex education advocates pushed for and won state-level mandates for prevention education, Goldfarb said.

Still, abstinence-only education has a strong foothold in U.S. schools. The federal government has offered funding for abstinence-only sex education since the 1990s , and funding levels increased during the Trump administration.

But research shows that when schools broaden the scope of sex education classes beyond abstinence or risk prevention—to discuss gender roles and identity, normalize sexual diversity, and focus on social and emotional skills—students can see better outcomes. A research review by Goldfarb and her colleague Lisa Lieberman of 30 years of studies found that this kind of approach—now generally known as comprehensive sex education—can lower anti-LGBTQ bullying, improve the skills that support healthy relationships, and reduce intimate partner violence.

“The goal is helping people to have the important, functional knowledge and skills and attitudes to make healthy decisions for themselves, to appreciate and enjoy their own bodies and sexuality, and to appreciate and respect the bodies of others as well,” Goldfarb said.

What does that mean in practice? Take a few examples from the National Sex Education Standards.

The standards still require schools to provide information about how to mitigate risk. By the end of 8th grade, for example, students should be able to identify different forms of contraception and STI prevention as well as develop a plan for eliminating or reducing the risks of sexual activity.

But the standards also aim to teach students how to seek out information and how to develop their own values. Eighth graders are expected to know how to find medically reliable sources on these topics and to identify factors that are important in deciding whether and when to engage in sexual behaviors.

A classroom assignment might ask students to practice research skills that they’ve learned, said LoBianco . For example, she said, she might divide students into groups and assign each to research a different sexually transmitted infection. As they conduct their research, students would have to evaluate the reliability of the sources they find.

The national standards spiral, covering topics like consent and healthy relationships, anatomy and physiology, gender identity and expression, and sexual health throughout successive grade levels. But that doesn’t mean that topics like STIs, sexual identity, and sexual violence are introduced right away.

Instead, the standards aim to build knowledge and skills sequentially. In 2nd grade, for instance, the national standards require that students can list medically accurate names for the body parts, including genitals, and that students can define “bodily autonomy” and personal boundaries.

The standards are learning goals—what students should know and be able to do. Districts and schools select, create, or purchase the curriculum and lessons they use to convey them.

Anti-LGBTQ groups spread ‘hysteria’ about gender identity

Most parents have historically supported sex education that covers these kinds of topics.

In a 2017 survey of Democrats and Republicans , about 90 percent of parents supported classes that cover healthy relationships, STIs, birth control, and abstinence in high school; 78 percent of parents supported these subjects covered in middle school.

Parents in a 2012 study were less sure about elementary sex education but still mostly positive: About 90 percent were in favor of instruction on communication skills, about 65 percent supported anatomy instruction, and about 52 percent supported instruction about gender and sexual identity.

Now, a vocal group of parent activists and commentators has commandeered the national conversation. They claim that schools are “grooming” young children by discussing LGBTQ identity and providing information about sexual health.

The term “grooming” refers to the behavior of sexual predators, who develop inappropriately close relationships with child victims in order to isolate them and reduce the chance that they will report incidents. But as Education Week reported earlier this year , some conservative commentators have weaponized the word to falsely equate discussions about LGBTQ identity with sexual abuse, a development sociologists and others warn is dangerous.

In a recent C-SPAN interview , Tina Descovich, the co-founder of the right-wing group Moms for Liberty, said that the biggest concern reported from local chapters was “the oversexualization of children.”

“The National Sex Education Standards right now, they actually say in K-3 that they want to teach gender ideology, that children … by the time they reach 7 years old, should be able to understand completely that they could be a boy, or a girl, they could be neither or both. And a lot of parents just don’t want that discussed with their youngest children,” Descovich said.

But experts stressed that this is a misreading and that conversations about gender aren’t inherently sexual in nature.

Kids have 24/7, 365 access to information about their sexual health, and if no adult is intervening or providing info, they’re going to seek out information.

The national standards say that 2nd graders should be able to “define gender, gender identity, and gender-role stereotypes,” as well as discuss how people express their gender and how stereotypes might limit behavior. In 5th grade, students are expected to “demonstrate ways to promote dignity and respect for all people.”

What this means in practice, said Goldfarb, is that teachers might explain to the youngest children that there aren’t “girl toys” or “boy toys” and that however kids want to express themselves is OK. The message, she said, is “we all get to feel good about ourselves and our bodies as we are.”

She attributes the “hysteria” she says activists are creating around gender identity to deeper fears about changing social mores and expansions of rights. “This is a moral panic that comes whenever society moves away from this patriarchal, Christian, white supremacist view of the way the world should be,” Goldfarb said.

Parents also regularly cite concerns about language and definitions, said Advocates for Youth’s Gelperin. For example, the national standards require that by 2nd grade, students know the medically correct terms for their genitals. By 8th grade, students should be able to define vaginal, oral, and anal sex.

“I think there’s this worry that if we say the words like ‘penis’ and ‘vulva’ and ‘anus,’ that’s going to be damaging for kids. And that’s just not the case,” Gelperin said. In fact, research suggests that teaching students accurate terms can help prevent child sexual abuse.

And standards for older students, on defining vaginal, oral, and anal sex, aren’t about providing a how-to guide, said LoBianco. Rather, the idea is to give students accurate information from a trusted source so that they’re not relying on Google searches and social media.

“Kids have 24/7, 365 access to information about their sexual health, and if no adult is intervening or providing info, they’re going to seek out information,” LoBianco said.

How some schools are approaching these changes

In LoBianco’s state of New Jersey, only a handful of districts have publicly opposed the standards. Sex education is mandatory, and department of education officials have said that they will penalize districts that don’t teach a curriculum that aligns to the new standards.

But some districts have put in place workarounds.

The East Hanover school district said that it plans to include some new lessons to meet the standards—but they’ll all be taught on the last day of school, according to local news reports .

And while all districts in the state must let parents opt students out of any sex education lessons, the Middletown Township school system is planning to require parents to opt in.

Considering all the controversy “swirling around,” the district wanted to be as transparent as possible with parents, said Kate Farley, the curriculum committee chair on the Middletown board of education.

In April, New Jersey state Sen. Holly Schepisi, a Republican, posted some sample materials on Facebook, saying that “some go so far as unnecessarily sexualizing children further.” The post ignited a media firestorm and brought fresh pushback from GOP state lawmakers.

It illustrated the confusion between standards and curriculum: The lesson plans Schepisi posted aren’t mandatory.

And in Middletown, parents and community members thought that some of the lessons they’d seen would be required. Or, Farley said, they had heard that there was a specific “gender lesson” in 2nd grade or that the district was planning to teach kindergartners about sex. None of that is true, said Farley.

So, the district selected a set of materials for K-5 and posted all of them online for parents to review. “What you see is exactly what you get,” Farley said. “There’s just no room for any sort of question about what their child will be exposed to.”

Given this intense scrutiny and social-media misinformation, Gelperin suggested that schools take a similar approach to transparency, and make information about what curriculum they’ll be using readily available.

Schools can also hold family nights when parents can come in to look at materials and ask questions, she said.

Teachers and school leaders can always come back to the “why,” said LoBianco—that schools are giving students information and skills that they can use to protect themselves and feel confident in their identities.

“When you explain this to the most reasonable of parents, then they start to understand,” LoBianco said. “If there’s one thing that parents want their children to be, it’s healthy and safe.”

A version of this article appeared in the September 07, 2022 edition of Education Week as The Sex Ed. Battleground Heats Up (Again). Here’s What’s Actually in New Standards

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Comprehensive sexuality education: For healthy, informed and empowered learners

Did you know that only 37% of young people in sub-Saharan Africa can demonstrate comprehensive knowledge about HIV prevention and transmission? And two out of three girls in many countries lack the knowledge they need as they enter puberty and begin menstruating? Early marriage and early and unintended pregnancy are global concerns for girls’ health and education: in East and Southern Africa pregnancy rates range 15-25%, some of the highest in the world. These are some of the reasons why quality comprehensive sexuality education (CSE) is essential for learners’ health, knowledge and empowerment. 

What is comprehensive sexuality education or CSE?

Comprehensive sexuality education - or the many other ways this may be referred to - is a curriculum-based process of teaching and learning about the cognitive, emotional, physical and social aspects of sexuality. It aims to equip children and young people with knowledge, skills, attitudes and values that empowers them to realize their health, well-being and dignity; develop respectful social and sexual relationships; consider how their choices affect their own well-being and that of others; and understand and ensure the protection of their rights throughout their lives.

CSE presents sexuality with a positive approach, emphasizing values such as respect, inclusion, non-discrimination, equality, empathy, responsibility and reciprocity. It reinforces healthy and positive values about bodies, puberty, relationships, sex and family life.

How can CSE transform young people’s lives?

Too many young people receive confusing and conflicting information about puberty, relationships, love and sex, as they make the transition from childhood to adulthood. A growing number of studies show that young people are turning to the digital environment as a key source of information about sexuality.

Applying a learner-centered approach, CSE is adapted to the age and developmental stage of the learner. Learners in lower grades are introduced to simple concepts such as family, respect and kindness, while older learners get to tackle more complex concepts such as gender-based violence, sexual consent, HIV testing, and pregnancy.

When delivered well and combined with access to necessary sexual and reproductive health services, CSE empowers young people to make informed decisions about relationships and sexuality and navigate a world where gender-based violence, gender inequality, early and unintended pregnancies, HIV and other sexually transmitted infections still pose serious risks to their health and well-being. It also helps to keep children safe from abuse by teaching them about their bodies and how to change practices that lead girls to become pregnant before they are ready.

Equally, a lack of high-quality, age-appropriate sexuality and relationship education may leave children and young people vulnerable to harmful sexual behaviours and sexual exploitation.

What does the evidence say about CSE?

The evidence on the impact of CSE is clear:

• Sexuality education has positive effects, including increasing young people’s knowledge and improving their attitudes related to sexual and reproductive health and behaviors.
• Sexuality education leads to learners delaying the age of sexual initiation, increasing the use of condoms and other contraceptives when they are sexually active, increasing their knowledge about their bodies and relationships, decreasing their risk-taking, and decreasing the frequency of unprotected sex.
• Programmes that promote abstinence as the only option have been found to be ineffective in delaying sexual initiation, reducing the frequency of sex or reducing the number of sexual partners. To achieve positive change and reduce early or unintended pregnancies, education about sexuality, reproductive health and contraception must be wide-ranging.
• CSE is five times more likely to be successful in preventing unintended pregnancy and sexually transmitted infections when it pays explicit attention to the topics of gender and power
• Parents and family members are a primary source of information, values formation, care and support for children. Sexuality education has the most impact when school-based programmes are complemented with the involvement of parents and teachers, training institutes and youth-friendly services .

How does UNESCO work to advance learners' health and education?

Countries have increasingly acknowledged the importance of equipping young people with the knowledge, skills and attitudes to develop and sustain positive, healthy relationships and protect themselves from unsafe situations.

UNESCO believes that with CSE, young people learn to treat each other with respect and dignity from an early age and gain skills for better decision making, communications, and critical analysis. They learn they can talk to an adult they trust when they are confused about their bodies, relationships and values. They learn to think about what is right and safe for them and how to avoid coercion, sexually transmitted infections including HIV, and early and unintended pregnancy, and where to go for help. They learn to identify what violence against children and women looks like, including sexual violence, and to understand injustice based on gender. They learn to uphold universal values of equality, love and kindness.

In its International Technical Guidance on Sexuality Education , UNESCO and other UN partners have laid out pathways for quality CSE to promote health and well-being, respect for human rights and gender equality, and empower children and young people to lead healthy, safe and productive lives. An online toolkit was developed by UNESCO to facilitate the design and implementation of CSE programmes at national level, as well as at local and school level. A tool for the review and assessment of national sexuality education programmes is also available. Governments, development partners or civil society organizations will find this useful. Guidance for delivering CSE in out-of-school settings is also available.

Through its flagship programme, Our rights, Our lives, Our future (O3) , UNESCO has reached over 30 million learners in 33 countries across sub-Saharan Africa with life skills and sexuality education, in safer learning environments. O3 Plus is now also reaching and supporting learners in higher education institutions.

To strengthen coordination among the UN community, development partners and civil society, UNESCO is co-convening the Global partnership forum on CSE together with UNFPA. With over 65 organizations in its fold, the partnership forum provides a structured platform for intensified collaboration, exchange of information and good practices, research, youth advocacy and leadership, and evidence-based policies and programmes.

Good quality CSE delivery demands up to date research and evidence to inform policy and implementation . UNESCO regularly conducts reviews of national policies and programmes – a report found that while 85% of countries have policies that are supportive of sexuality education, significant gaps remain between policy and curricula reviewed. Research on the quality of sexuality education has also been undertaken, including on CSE and persons with disabilities in Asia and East and Southern Africa .

How are young people and CSE faring in the digital space?

More young people than ever before are turning to digital spaces for information on bodies, relationships and sexuality, interested in the privacy and anonymity the online world can offer. UNESCO found that, in a year, 71% of youth aged 15-24 sought sexuality education and information online.

With the rapid expansion in digital information and education, the sexuality education landscape is changing . Children and young people are increasingly exposed to a broad range of content online some of which may be incomplete, poorly informed or harmful.

UNESCO and its Institute of Information Technologies in Education (IITE) work with young people and content creators to develop digital sexuality education tools that are of good quality, relevant and include appropriate content. More research and investment are needed to understand the effectiveness and impact of digital sexuality education, and how it can complement curriculum-based initiatives. Part of the solution is enabling young people themselves to take the lead on this, as they are no longer passive consumers and are thinking in sophisticated ways about digital technology.

A foundation for life and love

• Safe, seen and included: report on school-based sexuality education
• International Technical Guidance on Sexuality Education
• Safe, seen and included: inclusion and diversity within sexuality education; briefing note
• Comprehensive sexuality education (CSE) country profiles
• Evidence gaps and research needs in comprehensive sexuality education: technical brief
• The journey towards comprehensive sexuality education: global status report
• Definition of Sustainable Development Goal (SDG) thematic indicator 4.7.2: Percentage of schools that provided life skills-based HIV and sexuality education within the previous academic year
• From ideas to action: addressing barriers to comprehensive sexuality education in the classroom
• Facing the facts: the case for comprehensive sexuality education
• UNESCO strategy on education for health and well-being
• UNESCO Health and education resource centre
• Campaign: A foundation for life and love
• UNESCO’s work on health and education

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• News Release

LGBTQ+ students may need to seek sex education outside school due to curricula gaps

Doing so could force them to seek inaccurate, potentially dangerous advice elsewhere

Media Information

• Embargo date: June 17, 2024 12:01 AM CT
• Release Date: June 14, 2024

Media Contacts

Kristin Samuelson

• (847) 491-4888
• Email Kristin

Journal: The Journal of Sex Research

• Addressing negligence could be ‘life-saving,’ argue study authors
• Curricula based on abstinence-only approaches or religious principles, or contained oppressive, suppressive elements marginalized LGBTQ+ youth, survey found
• ‘I wish I was taught about gay sex, sexual orientation, and all the other controversial topics that [are deemed] ‘grooming,’ one survey respondent said

CHICAGO --- Children across the U.S. who identify as LGBTQ+ say the sexual health-education curricula they receive is leaving them without essential information to make informed decisions about their sexual health, which could force them to seek potentially inaccurate or dangerous advice elsewhere.

The results of a new, national, peer-reviewed survey, show these young people — aged 13 to 17 — believe crucial topics surrounding sexual orientation and gender identity are being omitted from sexual health-education programs.

One survey respondent said, “I wish I was taught about gay sex, sexual orientation, and all the other controversial topics that [are deemed] ‘grooming.’ When kids aren’t taught good sex ed, they learn how to do it in an unhealthy way from other sources like the internet or word of mouth. If we teach children about these topics, they’ll be safer when they become teenagers.” (Read more comments below)

Experts who led the study say the addition of key items in the curricula could be “life-saving.”

The study was published June 17 in The Journal of Sex Research .

“LGBTQ+ youth expressed a strong desire to learn more about topics related to their sexual orientation and gender identity, highlighting a critical gap in existing curricula,” said study author Erica Szkody , a postdoctoral research associate at Northwestern University Feinberg School of Medicine who led the data collection for the study.

“Despite the well-known benefits of comprehensive sexual health education, the majority of school sexual health-education curricula in the U.S. is non-comprehensive and excludes LGBTQ+ students. Our analyses underscore the extent of this exclusion.”

Szkody works in the Lab for Scalable Mental Health , which is directed by Jessica Schleider, associate professor of medical social sciences and pediatrics at Feinberg.

Of more than 800 survey respondents, most participants reported a lack of LGBTQ+ content in their sexual health-education experiences. In order to be educated on sexual health, most were using extracurricular sources including online spaces, friends and personal experiences with sexual exploration. The authors found these extracurricular sources are frequently preferred by LGBTQ+ youth; but may lack accuracy and reliability.

Overall, participants described feeling marginalized by curricula that were based on abstinence-only approaches, religious principles or contained oppressive and suppressive elements, such as negative remarks about LGBTQ+ individuals or skipping required LGBTQ+ content altogether.

“The exclusion of LGBTQ+ students from the curricula may contribute to poor health outcomes in LGBTQ+ youth, with some research beginning to document these experiences and provide recommendations for curricula changes,” said lead author Steven Hobaica, clinical psychologist and research scientist at The Trevor Project, whose mission is to end suicide among LGBTQ+ young people. “Addressing this negligence is urgent and could be life-saving.”

“Given the current political climate, with legislation attempting to exclude LGBTQ+ information in schools, we encourage policymakers to continue fighting for LGBTQ+ inclusion in curricula as a means to prevent health problems for a vulnerable group,” he said.

The survey also provided LGBTQ+ young people the opportunity to openly share on their experiences and recommendations for change regarding sexual health education:

These suggestions included:

• More LGBTQ+ content in sexual health education curricula, as well as more detail on healthy and diverse relationships (e.g., non-monogamy, polyamory), consent, safety in relationships and communication skills.
• Creating safe and supportive spaces while considering legitimate fears due to a possible increase in bullying, as they had heard students make fun of the material or use discriminatory language during past implementation.
• Updating sexual health-education materials to reflect LGBTQ+ lived experiences, history and risk factors.
• Creating sexual health interventions focused on LGBTQ+ experiences and concerns. Improving access to reliable sexual health information.
• Creating more accessible sexual-health information via other avenues, such as online and through mobile applications.

Other comments from survey respondents include:

“I wish others understood that while the anatomy-related knowledge is important, we need sexual [health] education that is relevant to today’s world. This involves sexual [health] education [about] dangers and safety on the Internet, [same-sex/gender] relations, and education geared towards attraction and feelings rather than a lesson only [regarding] heterosexual procreation. I wish they took our real-life experiences and insecurities into account.”

“It is NOT HARMFUL to talk about gender identity and sexuality with high schoolers. It SAVES LIVES.”

The authors hope their findings contribute to a “critical” policy shift toward including LGBTQ+ young people in sexual health education, a community that is “often underserved.”