Sexual wellbeing in adolescence

Sexual wellbeing means....

...... feeling respected, safe, at ease and supported, while also having a sense of self-worth and agency, in relation to sex and sexuality. Sexual wellbeing is integral to consensual, healthy and pleasurable sexual experiences and relationships. A person’s sexual wellbeing is shaped by the people around them and their environment, including sexual partners, family, friends, education and health systems, media, laws, faith-based and cultural norms. (Lewis et al., 2026)

The framework of sexual wellbeing below, was designed via a consensus process with Scottish and International experts. The process is described here.

 

 

This framework of sexual wellbeing integrates elements of psychological wellbeing most relevant to sexuality. Sexual wellbeing is relevant to all stages of life, regardless of sexual experience and relationship status. It is not a one-off event or a moment in time but refers to feelings and thoughts over time. These are malleable and may improve or deteriorate depending on experiences or intervention. 

Sexual wellbeing is a useful concept to understand the links between sexual behaviour, sexual health and mental health. 

You can read more about the development of our conceptual framework of sexual wellbeing here, and about our qualitative investigation of sexual wellbeing among adults in UK here.

Based on our conceptualisation of sexual wellbeing, we have developed a 13-item measure for adults aged 16 and over (Natsal-SW). You can read about how our measure was developed and validated here.

If you would like to use the Natsal-SW in your study, please contact kirstin.mitchell@glasgow.ac.uk for permission.

The focus of health-related research on adolescents and sex is most often on deficit and risk-taking. Studies on sexual wellbeing are rare (a good example is Horne & Zimmer-Gembeck, 2005; also see Harden, 2014 for a discussion of a sex positive framework for research).

In adolescence, priorities for sexual wellbeing are different to those in later life. This is because adolescence is a time of rapid sexual development, new experiences, experimentation, and fluidity in perception of self. Adolescent sexual wellbeing is important because early experiences can have lasting – sometimes lifelong – consequences for health.

There are several useful frameworks which capture adolescent sexual health and wellbeing. Hensel and Fortenberry (2013) propose a holistic sexual health framework that includes dimensions of wellbeing (developed with young women but also relevant to young men). Harden (2014) proposes a sex-positive framework of adolescent sexual wellbeing that includes sexual self-efficacy, sexual self-esteem, feelings of sexual pleasure and satisfaction, and freedom from pain and negative affect regarding sexuality. Kågesten and van Reeuwijk (2021) propose a competency-based framework based on (1) sexual literacy, (2) gender-equal attitudes, (3) respect for human rights and understanding consent, (4) critical reflection skills, (5) coping skills, and (6) interpersonal skills. Most recently, Remmerie et al., (2024) worked with young people to co-create a culturally sensitive framework of young people’s sexual wellbeing which recognises the importance of an enabling environment (including access to services), capabilities (including decision making and bodily autonomy) and subjective experiences (such as consent, desire, pleasure). 

The Good Measure project asked young people what matters most to them regarding their sexuality and mental wellbeing. Their answers are here (Turner et al., 2023). We worked with young people to design a brief measure of adolescent sexual wellbeing, the Adol-SW. You can read about how the measure was developed and validated here. The 13 question in this measure are:

I feel confident I could get sexual health support (e.g. condoms, contraception, testing for sexually transmitted infections) if I needed it.

I have someone that I can talk with openly about sex and relationships. 

If I were to have a bad sexual experience, I have someone I can talk to. 

Thinking about sex makes me feel ashamed. 

The idea of having sex makes me feel anxious. 

I feel left out when people talk about sex. I feel comfortable with who I am attracted to (e.g. boys, girls, any gender, no one). 

I’m anxious that someone might try to touch me in sexual ways I don’t want. 

I feel pressure to do things sexually that I don’t want to. 

I worry that if someone asked me out, they would only want sex. 

I worry about being bad at sex. 

Most days I feel attractive. 

I feel anxious about what others will think of my naked body. 

If you would like to use this measure, please contact Kirstin.mitchell@glasgow.ac.uk

 

Sexual health and sexual wellbeing are sometimes conflated, but they are not the same thing.

 Sexual health focuses on behaviours and potential outcomes such as pregnancy, STIs, sexual function and sexual violence (Mitchell et al., 2021). Sexual wellbeing focuses on psychosocial elements of sexual experiences; primarily what people think and feel.

Sexual wellbeing comprises one of four overlapping pillars of a comprehensive approach to positive and healthy sexuality. The other three are sexual justice, sexual pleasure and sexual health. 

You can read more about this here. 

From “What is sexual wellbeing and why does it matter for public health?,” by K. R. Mitchell et al., 2021, The Lancet Public Health, 6(8), e608-e613. Creative Commons CC-BY.