CLINICAL REPORT Guidance for the Clinician in Rendering Pediatric Care

Sexuality Education for

Children and Adolescents
Cora C. Breuner, MD, MPH, Gerri Mattson, MD, MSPH, COMMITTEE ON ADOLESCENCE,
COMMITTEE ON PSYCHOSOCIAL ASPECTS OF CHILD AND FAMILY HEALTH

The purpose of this clinical report is to provide pediatricians updated abstract

research on evidence-based sexual and reproductive health education
conducted since the original clinical report on the subject was published by
the American Academy of Pediatrics in 2001. Sexuality education is defined
as teaching about human sexuality, including intimate relationships, human
sexual anatomy, sexual reproduction, sexually transmitted infections, sexual
This document is copyrighted and is property of the American
activity, sexual orientation, gender identity, abstinence, contraception, and Academy of Pediatrics and its Board of Directors. All authors have
reproductive rights and responsibilities. Developmentally appropriate and filed conflict of interest statements with the American Academy
of Pediatrics. Any conflicts have been resolved through a process
evidence-based education about human sexuality and sexual reproduction approved by the Board of Directors. The American Academy of
over time provided by pediatricians, schools, other professionals, and Pediatrics has neither solicited nor accepted any commercial
involvement in the development of the content of this publication.
parents is important to help children and adolescents make informed,
Clinical reports from the American Academy of Pediatrics benefit from
positive, and safe choices about healthy relationships, responsible sexual expertise and resources of liaisons and internal (AAP) and external
activity, and their reproductive health. Sexuality education has been shown reviewers. However, clinical reports from the American Academy of
Pediatrics may not reflect the views of the liaisons or the organizations
to help to prevent and reduce the risks of adolescent pregnancy, HIV, and or government agencies that they represent.
sexually transmitted infections for children and adolescents with and The guidance in this report does not indicate an exclusive course of
without chronic health conditions and disabilities in the United States. treatment or serve as a standard of medical care. Variations, taking
into account individual circumstances, may be appropriate.

All clinical reports from the American Academy of Pediatrics

automatically expire 5 years after publication unless reaffirmed,
revised, or retired at or before that time.

INTRODUCTION DOI: 10.1542/peds.2016-1348

The purpose of this clinical report is to provide pediatricians with PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275).
an update on the research regarding evidence-based sexual and Copyright © 2016 by the American Academy of Pediatrics
reproductive health education that has been conducted since the original
FINANCIAL DISCLOSURE: The authors have indicated they have
clinical report on the subject was published by the American Academy
no financial relationships relevant to this article to disclose.
of Pediatrics (AAP) in 2001.1 Education about sexuality that is provided
by pediatricians can complement the education children obtain at school FUNDING: No external funding.
or at home,2,3 but many pediatricians do not address it. In a review of POTENTIAL CONFLICT OF INTEREST: The authors have indicated
health maintenance visits, 1 of 3 adolescent patients did not receive they have no potential conflicts of interest to disclose.
any information on sexuality from their pediatrician, and if they did, the
conversation lasted less than 40 seconds.4
To cite: Breuner CC, Mattson G, AAP COMMITTEE ON ADO-
LESCENCE, AAP COMMITTEE ON PSYCHOSOCIAL ASPECTS OF
CHILD AND FAMILY HEALTH. Sexuality Education for Children
and Adolescents. Pediatrics. 2016;138(2):e20161348

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 BACKGROUND affection, love, and intimacy in ways increased use of contraception at first
consistent with one’s own values, intercourse and in the use of dual
Children and adolescents with and
sexual preferences, and abilities. methods of condoms and hormonal
without chronic health conditions
The various dimensions of healthy contraception in already sexually
and disabilities will benefit when
sexuality comprise the anatomy, active teenagers.13 Nevertheless,
they are provided with accurate
physiology, and biochemistry the United States continues to
and developmentally appropriate
of the sexual response system; lead industrialized countries with
information about the biological,
identity, orientation, roles, and the highest rates of adolescent
sociocultural, psychological,
personality; and thoughts, feelings, pregnancy.14  Importantly, 88% of
relational, and spiritual dimensions
and relationships.6 Ideally, children births to adolescents 15 to 17 years
of sexuality. Information about
and adolescents receive accurate of age in the United States continued
sexuality can be taught and shared
information on sexual health from to be unintended (unwanted or
in schools, communities, homes,
multiple professional resources.8,9 mistimed).15
and medical offices using evidence-
based interventions. Children All children and adolescents need Sexual health information
and adolescents should be shown to receive accurate education about messages are received by children
how to develop a safe and positive sexuality to understand ultimately and adolescents multiple times
view of sexuality through age- how to practice healthy sexual throughout the day from the media,
appropriate education about their behavior. Unhealthy, exploitive, or religious organizations, schools, and
sexual health. Sexuality education risky sexual activity may lead to family peers, parents/caregivers, and
can be disseminated through the health and social problems, such as partners, although the quality of the
3 learning domains: cognitive unintended pregnancy and sexually information varies.16,17 In an article
(information), affective (feelings, transmitted infections (STIs), published in 2013 on how sexually
values, and attitudes), and behavioral including gonorrhea, Chlamydia, experienced adolescents in the
(communication, decision-making, syphilis, hepatitis, herpes, human United States receive sexual health
and other skills).5 papilloma virus (HPV); HIV infection; information, parents and teachers
and AIDS.10 From a 2012 informative were the source of information
Sexuality education is more than for 55% of girls and 43% of boys
report by the National Campaign
the instruction of children and about birth control and for 59%
to Prevent Teen and Unplanned
adolescents on anatomy and the of girls and 66% of boys about
Pregnancy that surveyed 1200 high
physiology of biological sex and STIs/HIV.18 Only 10% of sexually
school seniors, many senior girls and
reproduction. It covers healthy experienced adolescents reported
boys reported having mixed feelings
sexual development, gender health care providers as a source of
about the first time they had sex, with
identity, interpersonal relationships, birth control/STI/HIV information.
more than three-quarters responding
affection, sexual development, More than 80% of adolescents 15
that they would change the way their
intimacy, and body image for all to 19 years of age received formal
first sexual experience occurred.
adolescents, including adolescents instruction about STIs, HIV, or how to
Interestingly, seniors in this study
with disabilities, chronic health say "no" to sex between 2011-2013,
wanted their younger peers to know
conditions, and other special needs.6 yet only 55% of males and 60% of
it was “fine to be a virgin” when they
Developing a healthy sexuality is a females received instruction about
graduated from high school.11
key developmental milestone for birth control.19 Strong support of
all children and adolescents that It has been demonstrated that multilevel expanded and integrative
depends on acquiring information sexuality education interventions sex education is warranted now more
and forming attitudes, beliefs, can prevent or reduce the risk of than ever.20
and values about consent, sexual adolescent pregnancy HIV, and
orientation, gender identity, STIs for children and adolescents
relationships, and intimacy.7 Healthy with and without chronic health Delivery of Sexuality Education
sexuality is influenced by ethnic, conditions and disabilities in
racial, cultural, personal, religious, the United States.12 Adolescent Pediatricians/Health Care Providers
and moral concerns. Healthy sexual activity and teen births and Pediatricians are in an excellent
sexuality includes the capacity to pregnancies have been decreasing position to provide and support
promote and preserve significant since 1991, with the exception of longitudinal sexuality education to
interpersonal relationships; value 2005 to 2007, when there was a all children, adolescents, and young
one’s body and personal health; 5% increase in birth rates. The adults with and without chronic
interact with both sexes in respectful decrease in adolescent birth rates health conditions and disabilities as
and appropriate ways; and express in the United States reflects an part of preventive health care. Over

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 the past decade, increasing numbers privately appropriate as children Previsit Questionnaire (available
of adolescents contend with sexuality grow older.23 at https://brightfutures.aap.org/
in the context of their own chronic Bright%20Futures%20Documents/
Often, the pediatrician can take the
physical or mental health condition CoreTools11-14YearOCVisit.
lead from the parent or caregiver
and/or developmental disability.21,22 pdf) is a good way to address
and then ask a few gentle leading
When sexuality is discussed routinely all of these topics, in addition to
questions about how much
and openly during well-child visits physical activity, nutrition, school,
information the family would
for all children and adolescents and relationships. The AAP policy
like to receive with the child and
in the pediatrician’s office, statement on providing care for
parent together in the room. The
conversations are easier to initiate, lesbian, gay, bisexual, transgender,
dynamics of the sexuality education
more comfortable to continue, and and questioning youth, as well as
conversation can then change as the
more effective and informative for other resources, offer suggestions
child becomes a young adolescent
all participants. Pediatricians and on how to incorporate important
by asking the parent or caregiver
other primary care clinicians can conversations about sexual and
to leave the room after the initial
explore the expectations of parents gender identity in the health
introductions and history taking has
for their child’s sexual development supervision visit.24–26
occurred with the parent in the room.
while providing general, factual
Parents and adolescents benefit from
information about sexuality and can In the office setting, children and
being prepared for these changes in
monitor adolescent use of guidance adolescents have been shown to
adolescent interactions when there
and resources offered over time. prefer a pediatrician who is open
will be time alone for the adolescent
and nonjudgmental and comfortable
to engage with the pediatrician to
Pediatricians can introduce issues of with discussions to address
discuss sexuality, as well as personal
physical, cognitive, and psychosexual knowledge, questions, worries,
and mental health, drug and tobacco
development to parents and their or misunderstandings among
use, and other psychosocial issues.
children in early childhood and children, adolescents with and
The importance of confidentiality
continue discussions at ongoing without chronic health conditions
and its role in adolescent health
health maintenance visits throughout and disabilities, and their parents/
care autonomy should be discussed
school age, adolescence, and young caregivers related to a wide range
with both adolescents and their
adulthood. Sharing this information of topics. These topics include,
parents. Unlike school-based
can help overcome barriers to but are not limited to, anatomy,
instruction, a conversation about
discussing the sexual development masturbation, menstruation,
sexuality with pediatricians
of all children and adolescents and erections, nocturnal emissions
can provide an opportunity for
to improve screening rates for STIs, (“wet dreams”), sexual fantasies,
personalized information, for
pregnancy, and partner violence. It is sexual orientation, and orgasms.
confidential screening of risks, and
also important to provide access to Information regarding availability
for addressing risks and enhancing
current accurate sexuality education and access to confidential sexual
existing strengths through health
and to provide access to confidential and reproductive health services
promotion and counseling. Children
relevant information, services, and emergency contraception
and adolescents may ask questions,
and support over the course of a is important to discuss with
discuss potentially embarrassing
lifetime.18,21 These conversations can adolescents and with parents. During
experiences, or reveal highly
begin with questions the family might these discussions, pediatricians also
personal information to their
have about the child and his or her can address homosexual or bisexual
pediatricians. Families and children
body as well as about self-stimulation experiences or orientation, including
may obtain education together or in
and “safe touch.” With insights topics related to gender identity. It
a separate but coordinated manner.
into the typical stages of child and is also important to acknowledge
Prevention and counseling can
adolescent sexual development, the influence of media imagery
be targeted to the needs of youth
parents can better understand their on sexuality as it is portrayed in
who are and those who are not yet
own child’s behaviors. For example, music and music videos, movies,
sexually active and to groups at high
by recognizing that masturbation pornography, and television,
risk of early or unsafe sexual activity,
is typical toddler behavior, parents print, and Internet content and to
which includes children with and
can better understand and discuss address the effects of social media
without chronic health conditions
self-stimulatory behaviors of their and sexting. According to the US
and disabilities.
teenager. The problem is often the Preventive Services Task Force,
inability to distinguish between Use of a psychosocial behavior intensive behavioral counseling
behaviors that are publicly and screening tool or the Bright Futures is important for all sexually active

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 adolescents and for adults who are increase in condom use.12,32 Some than half of states require public
at increased risk of STIs.27 Although studies also have shown less truancy schools to teach sexuality education,
there may not be time to address all and an improvement in academic and even fewer states require
of these topics in a brief office visit, performance in those who have taken that, if offered, sexuality education
the longitudinal relationship and sexuality education courses.33 must be medically, factually, or
annual well visit present several A student’s experience in school technically accurate. State definitions
opportunities for discussion. In with sexuality education can of “medically accurate” vary, from
addition, more information and vary a great deal. The Sexuality requiring that the department
resources can be shared with Information and Education Council of health review curriculum
adolescents, many of which are easily of the United States and the Future for accuracy to mandating that
accessible and listed at the end of this of Sex Education (FoSE) promote curriculum be based on published
report. evidence-informed comprehensive medical information.40

Most adolescents have the school-based sexuality education Two-thirds of states and the District
opportunity to explore intimacy and appropriate to students’ age, of Columbia allow parents to remove
sexuality in a safe context, but some developmental abilities, and cultural their children from participation or
others experience coercion, abuse, background as an important part opt out from sexuality education.
and violence. In fact, unwanted first of the school curriculum at every Fewer than half of states and
sexual encounters were reported grade.34 A comprehensive sexuality the District of Columbia require
in the National Survey of Family program provides medically accurate parents to be notified that sexuality
Growth among 11% of female information, recognizes the diversity education will be provided. Other
and male subjects 18 to 24 years of values and beliefs represented in states have specific content
of age who had first intercourse the community, and complements requirements, including “stressing
before age 20 years.28 Teenagers and augments the sexuality education abstinence” or precluding discussion
who report first sex at 14 years of children receive from their families, of homosexuality or abortion.41
age and younger are more likely religious and community groups, The status of sexuality education in
to report that it was nonvoluntary, and health care professionals. private schools is less well known.
compared with those who were 17 Adolescents and most parents agree There is little to no information
to 19 years of age at sexual debut.29 that school-based programs need available from parochial or private
Unwanted encounters may include to be an important source of formal scholastic institutions on the
dating violence, stranger assaults, education for adolescent sexual provisions of sexuality education.
and intrafamilial sexual abuse/incest. health.35–37
Although policies exist requiring
Screening for sexual violence and The protective influence of sexuality sexuality education, it may not
nonconsensual sexual encounters education is not limited to the be occurring in an unbiased and
is important when evaluating all questions about if or when to have systematic manner. From the 2012
sexually active adolescents, especially sex, but extends to issues of partner School Health Policies and Practices
for adolescents with chronic health selection, contraceptive use, and Survey, only 71% of US high school
conditions and disabilities, because reproductive health outcomes.38 districts have adopted a policy
they may be more likely to be victims Creating access to medically specifying that human sexuality is
of sexual abuse.5,30 accurate comprehensive sexuality taught. In a separate study comparing
education by using an evidence- high schools, middle schools, and
In the Schools based curriculum and reducing elementary schools, sexuality
Formal sexuality education in sociodemographic disparities in education taught in middle schools
schools that includes instruction its receipt remain a primary goal across states was more likely to
about healthy sexual decision- for improving the well-being of be focused on “how to say no to
making and STI/HIV prevention teenagers and young adults. Ideally, sex” rather than other topics, with
can improve the health and well- this education happens conjointly in approximately 1 in 5 teenagers
being of adolescents and young the home and in the school.39 reporting that they first received
adults.31 If comprehensive sexuality Factors that shape the content and instruction on “how to say no to sex”
education programs are offered in delivery of sexuality education while in the first through fifth grade.
the schools, positive outcomes can include state and school district Adolescent boys were slightly more
occur, including delay in the initiation policies, state education standards, likely than girls to be instructed on
and reduction in the frequency of funding from state and federal how to say no to sex or were using
sexual intercourse, a reduction in the sources, and individual teacher birth control while in middle school
number of sexual partners, and an comfort, knowledge, and skills. Fewer (52% of male teenagers, compared

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 with 46% of female teenagers). materials. The FoSE standards advise to understand environmental
Male teenagers were less likely than that teachers are aware of and take barriers and facilitators that
female teenagers to report first into account their own biases about influence talking about sexuality (eg,
receiving instruction on methods of sexuality, understand guidelines community norms that discourage or
birth control while in high school for discussion of sensitive subjects encourage such communication).43
(38% of male teenagers, compared in the classroom and addressing By increasing parents’ skills and
with 47% of female teenagers).42 confidentiality, and know how to facilitating opportunities for
address disclosure by students of communication through take-home
Teacher training in the United
sexual abuse, incest, dating violence, activities, the program also aims
States is quite variable from district
pregnancy, and other associated to affect the parent-adolescent
to district and school to school
sexual health issues. The goal is for relationship, further influencing
especially in sexuality education.
teachers to feel comfortable and adolescent behavior change (eg, the
The FoSE Initiative has released
committed to discussing human likelihood that adolescents will delay
the National Teacher Preparation
sexuality and to know how to intercourse or use condoms).44
Standards for Sexuality Education
conduct themselves appropriately
to provide guidance to institutions In one study, adolescents were
with students as professionals both
of higher education to better asked whether they received formal
inside and outside of the classroom
prepare future teachers.9 The instruction on 4 topics of sexuality
and school. It is important for
FoSE teacher standards include education at home, school, church,
teachers to have an appreciation for
professional disposition, diversity a community center, or some other
how students’ diverse backgrounds
and equity, content knowledge, legal place before they were 18 years old.42
and experience may affect students’
and professional ethics, planning, They were specifically asked whether
personal beliefs, values, and
implementation, and assessment. they spoke to their parents before
knowledge about sexuality. In the
According to these standards, the age of 18 about topics concerning
United States, 35.5% of districts
teachers may benefit from receiving sex, birth control, STIs, and HIV/AIDS
have adopted a policy stating that
specialized training on human prevention. Two-thirds of male and
there is a requirement that those
sexuality, which includes accurate 80% of female adolescents reported
who teach health education must
and current knowledge about having talked with a parent about at
earn continuing education credits
biological, social, and emotional least 1 of 6 sexuality education topics
on strategies or on health-related
stages of child and adolescent sexual (“how to say no to sex,” methods of
topics. It is important for teachers
development (including sexual birth control, STIs, where to get birth
to develop skills in creating a safe,
orientation) and legal aspects of control, how to prevent HIV/AIDS,
respectful, and inclusive classroom.41
sexuality (ie, age of consent). and how to use a condom). Younger
In the Home (15–17 years old) female teenagers
Professionals responsible for
were more likely (80%) than younger
sexuality education may benefit from Fundamentally, parents and
male teenagers (68%) to have talked
receiving training in several learning caregivers can have an important
to their parents about these topics.42
and behavior theories and how to role as their children’s primary
provide age- and developmentally sexuality educators. However, a The medical literature supports that
appropriate instruction as part of number of factors, including lack of family and parental characteristics
sexuality education lesson planning. knowledge, skills, or comfort, may can dictate patterns of sexual
Ideally, teachers would be familiar impede a parent’s or caregiver’s experience among teenagers, as
with relevant and current state successful fulfillment of that role. shown in the National Survey of
and/or district laws, policies, and Health care providers, schools, Family Growth data from 2006 to
standards to help them choose faith-based institutions, the 2010.28 For example, in both male
and adapt an evidence-based and media, and professional sexuality and female teenagers, a significantly
scientifically accurate curriculum educators are resources that guide smaller percentage were sexually
that is appropriate and permissible and advise parents by providing experienced if they lived with both
within a school district. Ongoing training, resources, understanding, parents when they were 14 years
professional development and and encouragement. One program, of age, if their mothers had their
participation in continuing education "Talking Parents, Healthy Teens," first birth at 20 years or older, if
classes or intensive seminars is aims to influence parents’ skills, the teenager’s mother was a college
advised. Teachers can benefit from such as communication, monitoring, graduate, or if the teenager lived
access to updated and current and involvement. These include with both of his or her parents.28
sexuality information, curricula, intentions to talk about sex, to Further, the approaches parents take
policies, laws, standards, and other monitor and stay involved, and when talking with their adolescent

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 about sex may have a tremendous the relationship boys have with their Adolescent Family Life Act program.
influence on the teenager.45 Parents fathers or other male role models The Community-Based Abstinence
who dominate the conversation have plays a crucial role in their sexual Education program received the
teenagers who do not have as much health, including reducing sexual most federal funds and made
knowledge. Conversely, parents who risk taking and delaying initiation direct grants to community-based
are engaged and comfortable talking of sexual intercourse, especially in organizations, including faith-based
about sexual health have teenagers those boys with a connection to their organizations. Federal guidance
who are more knowledgeable and fathers, whether they live in the same required all programs to adhere to an
may even be more proactive in home or not.52,53 8-point definition of abstinence-only
seeking reproductive health medical education and prohibited programs
It is clear that parents would
services.45 from disseminating information
benefit from support to improve
on contraceptive services, sexual
A review of 12 studies on parental communication with their
orientation and gender identity, and
communication about sex revealed adolescents about sex.
other aspects of human sexuality.
that parents who received training on
Programs promoted exclusive
this topic had better communication
ABSTINENCE EDUCATION abstinence outside of heterosexual
with their adolescents about
marriage and required that
sexuality compared with those who We know that abstinence is 100% contraceptive use, contraceptive
did not.46 Parental conversations effective at preventing pregnancy methods, and specifically condoms
with their adolescents about and STIs; however, research has must not be discussed except to
sexuality education is correlated with conclusively demonstrated that demonstrate failure rates.58
a delay in sexual debut and increased programs promoting abstinence-
use of contraception and condoms.47 only until heterosexual marriage The Obama administration’s
Jaccard and Levitz45 identified occurs are ineffective.54–57 A recent proposed budget for fiscal year
multiple effective components in systematic review examined the 2014 created funding for programs
parent-adolescent sexual health evidence supporting both abstinence- that have been proven effective in
communication, including (1) only programs and comprehensive reducing teen pregnancy, delaying
the extent of communication as sexuality education programs sexual activity, or increasing
measured by frequency and depth designed to promote abstinence from contraceptive use.32,59–61 There are
of discussions, (2) informational sexual intercourse. In that review, still Title V–funded programs for
style, (3) the content of data that most comprehensive sexuality abstinence-only programs in the
is discussed, (4) when and how education programs showed schools and in other places in the
the communication occurs, and (5) efficacy in delaying initiation of community. However, most public
the overall environment where the intercourse in addition to promoting funding now supports evidence-
conversation takes place. other protective behaviors, such as informed interventions that have
condom use. There was no evidence been proven to delay onset of sexual
Discussions of sexuality do not occur
that abstinence-only programs activity, reduce numbers of partners,
equally among mothers and fathers.
effectively delayed initiation of increase condom and contraceptive
One review found that overall, the
sexual intercourse.57 In another use, and decrease incidence of teen
number of discussions parents
review of sexuality education, pregnancy and STIs, including
have with teenagers about sex has
Cavazos-Rehg et al35 found that the HIV.32,59–61 Private and parochial
decreased from 1995 to 2002.48
literature examining the efficacy schools also have their own standards/
From a separate review covering
of current school-based sexuality polices and limited funding stream
1980 through July 2010, mothers
education programs had insufficient for sexuality education.57
were the primary discussant in
evidence to support the intervention
all interventions.49 In reviewing In a 2005 study by Brückner and
of abstinence on the basis of
the role of fathers in sexual health Bearman,62 a review of Add Health
inconsistent results across studies.
discussions, Kirkman et al50 found data suggested that many teenagers
that fathers recognized, by self- The federal government has who take a “virginity pledge” and
report, that they need to share historically provided $178 million for intend to be abstinent before
the role of communication about abstinence-only education through marriage fail to do so and that
this topic with their teenagers but Title V, Section 510 of the Social when these teenagers do initiate
that they leave the conversation to Security Act in 1996, Community- intercourse, they fail to protect
the mothers more often than not. Based Abstinence Education projects themselves by using contraception.
Although mothers can also effectively through the Patient Protection In a review of the virginity pledge
teach their sons about sexuality,51 and Affordable Care Act, and the movement, these researchers found

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 that 88% of teenagers who took the children's questions fully and 10. Abstinence is the most effective
pledge had initiated intercourse accurately. strategy for preventing HIV
before marriage, compared with 99% infection and other STIs, as well
of those who did not take the pledge. 4. Parents and adolescents are as for prevention of pregnancy.
They also found that teenagers who encouraged to receive information
took the pledge were less likely to use from multiple sources, including 11. Preparation for college entry
contraception after they did initiate health care providers and is an excellent opportunity for
sexual intercourse and not to seek sexuality educators, about pediatricians to address issues
STI screening. At 6-year follow-up, circumstances that are associated such as the effects of alcohol,
the prevalence of STIs (Chlamydia, with earlier sexual activity. marijuana, and other drug
gonorrhea, trichomoniasis, and HPV Adolescents are encouraged to feel consumption on decisions about
infection) was comparable among empowered through discussing safe, consensual sexual practices.
those who took the abstinence pledge strategies that allow for practicing
social skills, assertiveness, control, 12. Children and adolescents with
and those who did not.62 special issues and disabilities
and rejection of unwanted sexual
The American College of advances and cessation of sexual may benefit from additional
Obstetricians and Gynecologists, the activity when the partner does not counseling, referrals, and sharing
Society for Adolescent Health and consent. of online resources listed at the
Medicine, the AAP, the American end of this report.
Medical Association, the American 5. Discussions regarding healthy
Public Health Association, National relationships and intimate
Education Association, and the partner violence can be effectively ONLINE SEXUALITY EDUCATION
National School Boards Association included in health care visits. RESOURCES
oppose abstinence-only education
6. Pediatricians are encouraged to School and Community
and endorse comprehensive sexuality
acknowledge that sexual activity
education that includes both
may be pleasurable but also • United Nations Population
abstinence promotion and accurate Fund: http://www.unfpa.org/
must be engaged in responsibly.
information about contraception, public/home/adolescents/pid/
human sexuality, and STIs.62–67 7. Specific components of sexuality 6483. Advocates for and supports
education offered in schools, promotion of comprehensive
religious institutions, parent sexuality education, provides
CLINICAL GUIDANCE FOR organizations, and other programming guidance for both
PEDIATRICIANS community agencies vary school and community settings, and
1. The pediatrician should based on many factors. The advocates for wider educational
encourage early parental pediatrician can serve as a opportunities for all young people
discussion with children at home resource to each. and partners with civil society
about sexuality, contraception, organizations.
8. School-based comprehensive
and Internet and social
sexuality education that • The National Alliance to Advance
media use that is consistent
emphasizes prevention of Adolescent Health: http://www.
with the child’s and family’s
unintended pregnancy and STIs thenationalalliance.org/. Uses
attitudes, values, beliefs, and
should be encouraged. resources, advocacy, collaboration,
circumstances.
and research to improve and
9. The discussion of methods increase access to integrated
2. Diverse family circumstances,
of contraception and STI and physical, behavioral, and sexual
such as families with same-
HPV cancer prevention with health care for adolescents.
sex parents or children who
male and female adolescents
identify as lesbian, gay, bisexual,
is encouraged before the onset • The Future of Sexuality
transgender, or questioning,
of sexual intercourse (see the Education (FoSe): http://www.
create unique guidance needs
AAP statement “Contraception futureofsexed.org/documents/
regarding sexuality education.
and Adolescents”). It is also josh-fose-standards-web.pdf.
3. Modeling ways to initiate talks important to discuss consistent Developed the National Sexuality
about sexuality with children at use of safer sex precautions with Education Standards for teachers to
pertinent opportunities, such sexually active teens. Bright standardize and improve the quality
as the birth of a sibling can Futures recommendations can of sexuality education provided in
encourage parents to answer be used. schools.

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 • Sexuality Information and recommendations about promoting ⚬ Forums where teens can
Education Council of the healthy sexual development and participate in moderated
United States: http://www. sexuality to help health care discussions with other teens.
sexedlibrary.org/index.cfm. A providers during health supervision
⚬ “Sex in the States,” which is a
resource for educators, counselors, visits from early childhood through
state-by-state guide to teens’
administrators, and health adolescence.
rights to sex education, birth
professionals about human
sexuality research, lesson plans, • The Community Preventive control, and more.
Services Task Force: http://
and professional development. The ⚬ Videos about sexual health.
SexEd Library is a comprehensive www.thecommunityguide
online collection of lesson plans .org/hiv/RRriskreduction. ⚬ A sex terms glossary of almost
relate to sexuality education. html. Recommendations about 400 terms.
interventions to promote behaviors
• Sexual Education: Get Real: http:// that prevent or reduce the risk of • Love is Respect: http://www.
www.getrealeducation.org. Get pregnancy, HIV, and other STIs in loveisrespect.org/. Loveisrespect is
Real: Comprehensive Sex Education adolescents. a project of the National Domestic
is a unique curriculum designed Violence Hotline and Break the
for implementation in both middle • American Congress of Obstetricians Cycle. By combining our resources
and high schools. Information and Gynecologists: http://www. and capacity, we are reaching
provided is medically accurate and acog.org/About-ACOG/ACOG- more people, building more healthy
age-appropriate and can reinforce Departments/Adolescent-Health- relationships, and saving more lives.
family communication and improve Care. Information and resources
communication skills for healthy about adolescent sexuality and sex Youth With Disabilities
relationships. education.
• Parent Advocacy Coalition
• Centers for Disease Control and for Educational Rights: www.
Prevention Health Education Youth pacer.org. Parent training and
Curriculum Analysis Tool: http:// • Scarleteen: http://www.scarleteen. information center for families
www.cdc.gov/healthyyouth/ com/. Scarleteen is an independent, of children and youth with all
hecat/pdf/HECAT_Module_ grassroots sexuality education and disabilities from birth through
SH.pdf. The Health Education support organization and Web 21 years old. Parents can find
Curriculum Analysis Tool can site. Founded in 1998, Scarleteen. publications, workshops, and other
help school districts, schools, and com is visited by approximately resources about a number of topics,
others conduct a clear, complete, three-quarters of a million diverse including sexuality and disabilities.
and consistent analysis of health people each month worldwide,
education curricula based on • Your Child Development and
most between the ages of 15 and Behavioral Resources: www.
the National Health Education 25. It is the highest-ranked Web
Standards and the Centers for med.umich.edu/1libr/yourchild/
site for sex education and sexuality disabsex.htm. A program at the
Disease Control and Prevention’s advice online and has held that rank
Characteristics of an Effective University of Michigan that houses
through most of its tenure. a resource list of materials and
Health Education Curriculum.
Web sites about sexuality education
The Health Education Curriculum • Sex, etc: http://sexetc.org/.
Analysis Tool can help schools select for youth with disabilities for
Sexetc.org has comprehensive sex
or develop appropriate and effective families as well as for teachers, and
education information, including
health education curricula and providers.
the following:
can be customized to meet local • Center for Parent Information
community needs and conform to ⚬ Stories written by teen and Resources: http://www.
the curriculum requirements of the staff writers and national
parentcenterhub.org/repository/
state or school district. contributors.
sexed/. Contains information about
⚬ Opportunities to get involved sexuality education for students
Health Care Providers with disabilities for use with
and make a difference on sexual
• Bright Futures: http:// health issues. parents and teachers. The site also
brightfutures.aap.org/pdfs/ contains information about specific
Guidelines_PDF/9-Promoting- ⚬ The Sex, etc. blog, which disabilities and sexuality, such as
Healthy-Sexual-Development.pdf. addresses timely and relevant autism spectrum disorders, cerebral
Preventive health information and news. palsy, and spina bifida.

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 Advocacy LEAD AUTHORS
ABBREVIATIONS
• United Nations Population Cora C. Breuner, MD, MPH
Gerri Mattson, MD, MSPH AAP: American Academy of
Fund: http://www.unfpa.org/
Pediatrics
public/home/adolescents/pid/
COMMITTEE ON ADOLESCENCE, 2015–2016 FoSE: Future of Sex Education
6483. Advocates for and supports
Cora C. Breuner, MD, MPH, FAAP, Chairperson Initiative
promotion of comprehensive
William P. Adelman, MD, FAAP HPV: human papillomavirus
sexuality education, provides
Elizabeth M. Alderman, MD, FSAHM, FAAP STI: sexually transmitted
programming guidance for both
Robert Garofalo, MD, FAAP infection
school and community settings, and
Arik V. Marcell, MD, MPH, FAAP
advocates for wider educational
Makia E. Powers, MD MPH, FAAP
opportunities for all young people Krishna Kumari Upadhya, MD, FAAP REFERENCES
and partners with civil society
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