Healthy sexuality development in adolescence: proposing a competency-based framework to inform programmes and research

Building Blocks of Parent-Child Sex Communication: Body Talk During Infancy and Early Childhood

The current study investigated how foundational conversations about the body and sexuality begin, how they develop longitudinally, and whether parental body talk varies as a function of characteristics of both the parent and child. Participants included 442 mothers (M age = 32.50, SD = 5.61, 93% heterosexual, 85% White) and 337 available father-figures (M age = 33.99, SD = 5.68, 98% heterosexual, 80% White), who were the parents of infants (age at Time 1 = 28.13 months, SD = 6.85, 52% male). Factor analyses suggested that parents engaged in positive, avoidant, and scolding body talk with their young children, and growth curve analyses suggested that frequency of positive body talk increased from when the child was age two to when they were age four for both mother- and father-figures. Results also suggested that the most consistent predictors of body talk included parents' perceptions of whether their child was too young to discuss sexuality, and the child's own questions and behaviors about their bodies and sexuality. The discussion focuses on the frequency of parental body talk and the active role of the child in the early socialization of healthy sexuality.

Microphallus early management in infancy saves adulthood sensual life: A ‎‎comprehensive review

Microphallus/Micropenis is a rare condition with significant physical and psychological implications for affected individuals. This article comprehensively reviews micropenis, its etiology, epidemiology, and various treatment options. We conducted a thorough literature review to collect relevant information on micropenis and microphallus, as well as related disorders. Our primary databases were PubMed, Medline, and Google Scholar. We searched for articles published in English between 2000 and 2023. Our analysis included 67 review articles, 56 research studies, 11 case reports, one guideline, and one editorial. Our search terms included "microphallus", "micropenis", "congenital hypogonadotropic hypogonadism", "androgen insensitivity syndrome", "pediatric management of micropenis", "testosterone therapy", and "psychosocial implications of micropenis". We focused on diagnosing micropenis and related conditions, including hormonal assessments, medical and surgical treatment options, psychosocial and psychological well-being, sexual development of adolescents, and sociocultural influences on men's perceptions of penile size. Additionally, we explored parenting and family dynamics in cases of micropenis and disorders of sex development, implications of hormonal treatment in neonates, and studies related to penile augmentation procedures and their effectiveness. The article highlights the importance of early diagnosis and intervention in addressing the physical and psychological well-being of individuals with micropenis. Surgical procedures, such as penile lengthening and girth enhancement, and non-surgical approaches like hormonal therapy are explored. The significance of psychological support, education, and lifestyle modifications is emphasized. Early management and comprehensive care are crucial for individuals with micropenis, from infancy to adolescence and beyond. A multidisciplinary approach involving urologists, endocrinologists, and mental health professionals is recommended. Regular assessment of treatment effectiveness and the need for updated guidelines are essential to provide the best possible care. Healthcare professionals should prioritize early diagnosis, and neonatologists should measure stretched penile length in neonates. A collaborative effort is needed among professionals, parents, and affected individuals to create a supportive environment that recognizes worth beyond physical differences. Continuous research and evidence-based updates are crucial for improving care standards.

Re-envisioning Youth Sexual Health Care: Supporting Sex Positivity in a Digital World

INTRODUCTION

Youth in a digital world face challenges to the healthy development of their sexuality from exposure to sexting, pornography, and other sexually explicit media. School-based sexual health education does not cover digital sexual content and its impact on sexuality and sexual relationships. Youth often avoid discussing sexual health with parents or other trusted adults, thus often relying on peers, making them ill-prepared to navigate the complexities (e.g., socially, emotionally, and romantically) of sexually explicit content.

METHOD

A review of emerging evidence for application into clinical practice.

RESULTS

This paper provides nurse practitioners with resources and information to incorporate this re-envisioned approach to sexual health care into practice to provide current, timely, and holistic youth sexual health care.

DISCUSSION

Youth sexual health care must be re-envisioned. Nurse practitioners can improve youth sexual health by incorporating pornography and sexual media literacy, safe sexting, and concepts of consent into care using a sex-positive lens.

Effectiveness of a Comprehensive School-Based Sex Education Program for Young Adolescents in the Netherlands

Most sexual education programs traditionally focused on providing sexual information regarding the risks of sex. However, current studies on sexual behavior in youth show a need for truly comprehensive sex education approaches with a sex-positive focus on sexuality, that effectively improve sexual competence. Therefore, in the current study the effectiveness of "Love is…", a four lesson school-based program based on the Sexual Interactional Competence model and Attitude-Social-Influence-Self-Efficacy-model was studied. A cluster-randomized controlled trial on the effectiveness of "Love is…" was conducted in 2018-2020. The sample consisted of 1160 adolescents in grades 8 and 9 from nine schools in the Netherlands. The sample was 48% female, 34% Dutch/Caucasian, 41% none-religious and 50% higher educated. They were randomized at class level into a program group [n = 32 classes; 567 students (Mage = 13.74 (SD = 0.74))] and a control group [n = 31 classes; 593 students (Mage = 13.86 (SD = 0.73))]. Results showed that "Love is…" increased sexual knowledge, that adolescents in the program group showed less cyber victim blaming attitudes and increased in communications skills after the program. In conclusion, the current study shows that "Love is…" was effective not only on the knowledge level, but also regarding sexual attitudes and competences. However, due to the developmental process of sexuality, there is a necessity to continue lessons in following grades through booster sessions by reinforcing competences as communicating comfortably about sexuality.On 12 November 2019 the study design and hypotheses were registered in the Dutch Trial Registration, number NL8150. ( https://onderzoekmetmensen.nl/nl/trial/26676 ).

Understanding the association between menstrual health and hygiene attitudes and personal agency among very young adolescents in Sao Paulo, Brazil: A cross-sectional study

BACKGROUND

Although menstruation is a monthly biological phenomenon, it is shrouded in stigma and shame which directly impacts health, education, gender equality, decent work, and economic growth. However, there is scarce evidence on how personal agency, an individual's ability to access resources, may act as a protective factor to adequate menstrual health and hygiene practices. Therefore, we assess the association between attitudes toward menstruation and personal agency among very young adolescent girls.

METHODS

We use cross-sectional data from the Global Early Adolescent Study in São Paulo, Brazil, among 10- to 14-year-old girls who have experienced menarche (n = 325) and completed a home-based self-administered questionnaire in 2021. "Attitudes toward menstruation" was created based on five indicators on a Likert scale, with a higher score indicating more positive attitudes. The main covariate was personal agency, comprised of three scales and modeled as three continuous variables: voice, decision-making power, and freedom of movement. Data were analyzed using multivariable linear regression.

RESULTS

Attitudes toward menstruation mean score was 12.5 (range 5-19). Older adolescents (12-14 years-old) had higher mean scores (more positive) than younger adolescents (10-11 years-old) on attitudes toward menstruation, whereas no other sociodemographic or menstrual health indicator (knowledge or access to products) were associated with attitudes toward menstruation. In the multiple regression model, older age and higher freedom of movement remained positively associated with attitudes toward menstruation (βadjust = 0.5; 95%CI 0.1 to 0.8).

CONCLUSION

Positive attitudes toward menstruation are associated with higher freedom of movement among very young Brazilian adolescent girls. The promotion of personal agency should be recognized as key strategies to accelerate young girls' positive approaches to their own menstruation and, consequently, well-being.

Perceived knowledge gained from school-based sexuality education - results from a national population-based survey among young people in Sweden

BACKGROUND

School-based sexuality education is a core component of securing young people's right to attain health equity regarding sexual and reproductive health and rights. This paper aims to explore how perceived knowledge (sufficient or insufficient) of taking care of one's sexual health is associated with knowledge gained from school-based sexuality education and social determinants.

METHODS

The data material is drawn from a population-based survey conducted in Sweden in 2015. The survey had 7755 respondents and a response rate of 26%. To explore the aim descriptive statistics and logistic regression models were used.

RESULTS

Our results show that perceived insufficient knowledge from school-based sexuality education was associated with higher odds of reporting not being able to take care of one's sexual health. The highest significant excess risk for insufficient knowledge was found among young people from sexual minorities.

CONCLUSIONS

Young people in Sweden do not have equal abilities to receive knowledge needed to take care of their sexual health and thus attain sexual health literacy. There is an unequal distribution of perceived knowledge, and LGBTQI+ youth particularly face barriers in using school-based sexuality education as a resource for sexual health literacy.

Psychological and Psychosexual Adjustment in University Students as a Function of Sexual Activity and Relationship Type

The objective of the present study was to examine the differences in some variables of psychological (depression, anxiety, physical self-esteem) and psychosexual (self-esteem as a sexual partner, satisfaction with sexual life, sexual preoccupation) adjustment in a sample of university students, as a function of gender, and divided into three groups: (1) those who had a stable partner; (2) those who did not have a stable partner but did have casual sexual relations; and (3) those who had neither a stable partner nor casual relationships. Participants were 980 students from a mid-size Spanish university, of both sexes (71.3% women, 28.7% men), aged between 18 and 26 years (M = 20.87, SD = 1.88), who completed an online battery of questionnaires. Differences were found in psychological and psychosexual adjustment variables depending on the reference group and both in men and women. Some of these differences were explained by having a partner and others by having sexual relations, regardless of the partner with whom they had sex. These differences and their impact on young people's psychological adjustment and wellness should be taken into account when designing sexual health prevention and promotion programs.

Effect evaluation of a comprehensive sexuality education intervention based on socio-emotional learning among adolescents in Jakarta, Indonesia

Introduction

The field of comprehensive sexuality education (CSE) has switched from a focus on adolescents’ health to a more holistic approach, embracing the concept of sexual development with the aim of improving adolescents’ sexual well-being. The growing interest in the link between CSE and socio-emotional learning (SEL) competencies led to the development of the Journey4Life (J4L), a comprehensive sexuality education curriculum based on socio-emotional learning. In the current research, we evaluate the effectiveness of this program on perceived behavioral control, gender equality attitudes, norms, and intentions related to sexual and reproductive health and rights.

Methods

To this end, we conducted a Cluster Randomized Trial among 14 senior secondary schools in Jakarta, Indonesia. A questionnaire was administered before and after implementation of the J4L program among 16–17 year old pupils; n = 906 completed baseline measurement, n = 771 completed endline measurement. With a final matched sample of N = 466 (65.5% girls) we conducted a mixed model repeated measures ANOVA.

Results

Unfortunately, only limited and inconsistent results were found. We found that at endline, girls had stronger positive gender equality attitudes than boys; that overall attitudes towards reporting sexual violence were stronger for girls than for boys. However, contrary to our expectations, respondents had more positive attitudes toward child marriage at baseline than at endline.

Discussion

Inconsistency and non-statistical significance of results limit our ability to draw firm conclusions about the effectiveness of the Journey4Life. We discuss how complex comprehensive sexuality education interventions could best be evaluated, since our study highlights the need for better conceptualization, operationalization and measurement of the interconnection between comprehensive sexuality education and socio-emotional learning.

Understanding How Gender Transformative Interventions Affect Adolescent Sexuality: A Cross-Cultural Perspective

PURPOSE

Early adolescence is a critical period for developing healthy sexual and reproductive health (SRH) knowledge, attitudes, and behaviors. However, a gap exists in interventions targeting very young adolescents that encompass the multilevel influences impacting healthy sexuality. This examination of two SRH programs in Indonesia and the Democratic Republic of Congo will elucidate facilitators and barriers to improving young adolescent sexuality.

METHODS

The Growing Up Great! (GUG) intervention in the Democratic Republic of Congo and Semangat Dunia Remaja or Teen Aspirations intervention in three districts in Indonesia were evaluated using the Global Early Adolescent Study survey. Adolescents were interviewed in 2017 and one year later in Kinshasa (n = 2,519). In Indonesia, baseline in 2018 was follow-up in 2020 in Bandar Lampung (n = 948), Denpasar (n = 1,156), and Semarang (n = 1,231). Outcomes included SRH knowledge and communication, awareness of SRH services, and attitudes about sexuality. Analysis followed a difference-in-difference approach to compare changes in each outcome over time between interventions and controls.

RESULTS

Both interventions improved pregnancy and HIV knowledge, while Semangat Dunia Remaja or Teen Aspirations also improved SRH communication. Results differed by site in Indonesia, with Semarang, the site that adhered most closely to intervention design, observed the most improvements. Differential effects were also seen by gender, especially in Kinshasa where girls advanced in SRH communication and knowledge but not boys. Girls in Semarang shifted normative SRH attitudes, and boys in Denpasar improved knowledge.

DISCUSSION

Interventions targeting very young adolescents can improve SRH knowledge, communication, and attitudes, though impact depends on context and implementation. Future programs should incorporate the community and environment influencing adolescent experiences with sexuality.

Adolescents' Self Perceptions: Connecting Psychosocial Competencies to the Sexual Self-Concept

Adolescence is a crucial period for the development of the sexual self-concept. While existing research shows that adolescents' sexual self-concept varies, few studies have examined its relation with psychosocial competencies such as the general self-concept, interpersonal skills, and self-control capacities. The objective of this study was to examine the association between dimensions of the sexual self-concept (sexual self- and body esteem, self-efficacy, and anxiety) and psychosocial competencies among Canadian adolescents. Self-reported data from 1584 adolescents aged between 14 and 18 years (49.7% girls) were analyzed using path analysis. Results show that adolescents whose general self-concept was characterized by more internally consistent self-beliefs and greater self-worth, and who perceived their interpersonal skills as more developed, displayed higher sexual self- and body esteem, higher sexual self-efficacy, and lower sexual anxiety. Self-control capacities were positively correlated with sexual body-esteem and negatively correlated with sexual anxiety. These associations were, however, minimal and, when significant, exhibited a counterintuitive relationship with the sexual self-concept in the path model. Age, gender and sexual experience did not moderate these associations. Findings from the study highlight the need to pursue research on the interface between sexuality and psychosocial functioning to increase current understanding of adolescent development.

Dismantling barriers to access: The necessity of cripping sexuality education in Canadian schools

Despite sexuality education in school contexts being a highly politicized and ideologically fueled conversation, discussions of the specific needs of disabled students are often silenced, in particular for those who might be accessing special education programming. In this paper, we provide a call to action to explicate the crucial importance of addressing both ableist attitudes and constructions embedded within conversations of childhood sexuality and sexuality education, as well as policy and curriculum change to create more inclusive sexuality education approaches for disabled students and learners in Canadian provinces and territories. Many Canadian provinces do not mention disability or accommodations for disabled learners in their sexuality education curricula and all provincial curricula do not currently meet requirements set by internationally governing human rights policies. As such, this paper aims to bring to attention the different ways in which current school-based sexuality education is failing the human rights of disabled learners in Canadian schools and how sexuality education can be rethought through a social justice framework to ensure that the needs of all learners and that systems of inequality, such as ableism and heterosexism, are addressed in school contexts. Specific recommendations for policy and professional practice are provided to direct educators, policy-makers, and curriculum developers towards providing more inclusive sexuality education.