Adolescence is a time of rapid physical, cognitive, and psychological development. Social relationships are a major focus for teens and they also often begin to explore their sexual development.
Parents and primary care clinicians play a major role in education about healthy sexuality (1). Schools, and sometimes community organizations, also provide sex education programs.
Adolescents benefit from having an appropriate adult with whom they feel comfortable to address questions, worries, or misunderstandings regarding sexuality. Topics may include body image, anatomy, menstruation, masturbation, erections, nocturnal emissions, orgasms, and sexual practices. Such discussions can provide reassurance if adolescents feel embarrassed or are wondering whether they are normal. Discussion can focus on both the positive aspects of sexuality and the potential risks.
Adolescents should be guided to trustworthy sources of information about sexual health. They should also be counseled about forming healthy relationships and avoiding risky situations. Issues regarding sources of sexual health information, relationships, or experiences include the following:
Promoting healthy sexual attitudes and relationships
Recognizing and avoiding misleading or potentially harmful sources of information (eg, some social media or internet sources, pornography)
Communicating and meeting with potential sexual predators
Feeling coerced into or inadvertently sharing sexual images of themselves (eg, sexting)
Feeling coerced into sexual activity
Psychological, physical, or sexual intimate partner violence
Sexual abuse by someone they know or a stranger
In addition, adolescents should be educated about medical aspects of sexual health, including the following:
Safe sex practices
Few elements of the human experience combine physical, cognitive, and emotional aspects as thoroughly as sexuality and all the feelings and experiences that go along with it. Helping adolescents put sexuality, sexual orientation, and gender identity into a healthy context through sex health education and providing a context for discussion and honest answers is extremely important. Adolescents and their parents should be encouraged to speak openly regarding their attitudes toward sexuality.
Adolescents should be provided with resources about how to seek help if needed.
General reference
1. American Academy of Pediatrics. Adolescent Sexual Health AAP Policy Statements. Accessed October 2, 2024.
Sexual Orientation and Gender Identity in Adolescents
Sexual orientation and gender identity are a focus for many adolescents. Some adolescents feel comfortable exploring these aspects of themselves, whereas others struggle and may be afraid to reveal their sexual orientation or gender identity to friends or family members and may fear that they will not be accepted. Such concerns (especially during a time when social acceptance is critically important) can cause severe distress. Fear of abandonment by parents, sometimes real, may lead to dishonest or at least incomplete communication between adolescents and their parents. In some cases, these adolescents are bullied by peers. Threats of physical violence should be taken seriously and reported to school officials or other authorities. The emotional development of adolescents is best helped by supportive clinicians, friends, and family members.
Clinicians and sex education professionals should not make assumptions about an adolescent's sexual orientation or gender identity and should ask open-ended questions and provide sex education and medical care.
Gender identity starts to develop early on, often before adolescence. For some children and adolescents, the sex they were assigned at birth does not match their gender identity.
Definitions regarding gender identity include the following:
Sex: Defined by the traits usually used to distinguish between males and females; sex refers especially to the physical and biologic traits that are physically evident at birth and is often captured in the phrases "assigned male at birth" (AMAB) and "assigned female at birth" (AFAB).
Gender identity: An internal sense of being male, female, or something else, which may or may not correspond to an individual's sex assigned at birth or sex characteristics
Gender expression: Clothing, physical appearance, and other external presentations and behaviors that express aspects of gender identity or role
Gender incongruence: A person’s marked and persistent experience of an incompatibility between that person’s gender identity and the gender expected of them based on their sex assigned at birth
Gender dysphoria: Discomfort or distress related to an incongruence between an individual's gender identity and the sex assigned at birth.
Patients with possible gender dysphoria should receive appropriate evaluation and care, which may include gender-affirming care.
Sexually Transmitted Infections (STIs) in Adolescents
In the United States, prevalence rates of certain STIs are highest among adolescents and young adults (1). Rates of chlamydia and gonorrhea are highest among females during their adolescent and young adult years, and many individuals acquire human papillomavirus (HPV) infection during that time.
Adolescents who initiate sex early in adolescence are at higher risk of STIs. Other adolescents at higher risk of STIs include the following:
Those living in a detention facilities
Those receiving services at STI clinics
Those involved in commercial sex exploitation or survival sex and exchanging sex for drugs, money, food, or housing
Young males who have sex with males (YMSM)
Youths who are transgender
Youths with disabilities, substance misuse, or mental health disorders
Those having unprotected sex
Additional contributing factors include multiple sex partners, lack of education about safe sex practices, unprotected sex (failing to use barrier protection consistently and correctly), having sequential sex partnerships of limited duration or concurrent partnerships, lower socioeconomic status, and facing multiple obstacles to accessing health care.
Clinicians should counsel adolescents about STI prevention, screening, symptoms, and treatment. Routine screening for STIs should be provided, when appropriate.
STIs reference
1. Workowski KA, Bachmann LH, Chan PA, et al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep. 2021;70(4):1-187. Published 2021 Jul 23. doi:10.15585/mmwr.rr7004a1
