What Is Healthy Sexual Development?

Depending on your view, the answer to that question might seem really obvious or very tricky and hazy.

This is a subject that's talked about all the time, however, when it is, there's often little to no clear definition about what healthy sexual⁠ development is. Many easy assumptions get made, and ideas about what's healthy for all people are often based in or around personal agendas, ideas and personal experiences of sexuality, rather than being based in broader viewpoints, truly informed and comprehensive ideas about all that human sexuality and development involves and real awareness of possible personal or cultural bias.

We think this question is very, very tricky and that the answers aren't at all obvious or easy: sexuality is incredibly complex, especially given its incredible diversity, not just among a global population, but even within any one person's lifetime. Our cultures also are often sexually unhealthy in many ways, and so ideas about healthy sexual development, deeply influenced by culture, are often flawed, incomplete or limited, and can sometimes present things as healthy which truly are not, but are so pervasive or so much a part of cultural frameworks that people assume they are or must be. So, what healthy sexual development is is hardly a simple question, nor a question we can answer casually or without a whole lot of deep thought and consideration, both ideally coming from multiple perspectives and kinds of expertise.

At a recent conference I was part of in London, Alan McKee presented a talk which included a piece published in the International Journal of Sexual Health (2010, 22(1), Healthy sexual development: a multidisciplinary framework for research, Alan McKee, Kath Albury, Michael Dunne, Sue Grieshaber, John Hartley, Catharine Lumby and Ben Mathews). As someone who's worked for many years in sexuality and sex⁠ education, and who worked in early child development for several years before that, I've heard "healthy sexual development" tossed around a lot, but have often felt dissatisfied with the way it was undefined or some of the things it has implied when people have used it. Often, critical pieces seem to be missing, personal agendas seem to be central and unrecognized, or the way it's defined hasn't been broadly inclusive, holistic or thoughtful.

What McKee and his colleagues determined to be the core parts of healthy sexual development had me jumping up and down in my seat with joy (literally: I may have disturbed my fellow attendees with my bouncing). It summed up the things we try to support, encourage and inform our users with and keep core at Scarleteen so well, and so much of what I think -- after many years of thinking hard about and working with these issues, and being fully and broadly immersed in them with a very diverse population -- truly is central to healthy sexual development.

Their work also makes it wonderfully clear that sex education and supporting healthy sexual development isn't just something that can or does happen in what we call sex education, but can -- and should! -- be present in and come from many different kinds of education, information and support. Not only do I think this list includes the key issues for the development of healthy sexuality for individuals, I think it's also an excellent framework for working towards cultures which are sexually healthier than most are and have been.

I'm delighted to have permission to excerpt and reprint this framework here. I believe the domains listed are benchmarks everyone can use whether we're providing sex education, parenting or mentoring, evaluating the health of our sexual interactions or relationships with others, or working on our own personal growth and well-being when it comes to our sexuality. I've included alternate ways of understanding the key points and also some links to get started with on our site in exploring ways of supporting these aspects of healthy sexuality at the end.

From the paper: "A consultative group was gathered consisting of seven Australian experts across a number of disciplines relating to children, development and sexuality. The group included a psychologist specialising in preventing child sexual abuse⁠ ; an early childhood expert; a legal expert in children’s rights; a specialist in sexuality education; experts on sexual socialisation; and on the media’s impact on children’s development. The group commissioned literature reviews of the research on children’s sexuality across their disciplines; and worked together to develop a consensual definition of healthy sexual development that drew on the insights of their various disciplines."

"One key point emerged early in the discussions: this would be a holistic approach to healthy sexual development. In much of the literature in this area the sole concern is the prevention, diagnosis and treatment of child sexual abuse (see for example Haugaard & Emery, 1989; Lamb & Coakley, 1993; Ryan, 2000). The group agreed that preventing unwanted sexual encounters is a key element of healthy sexual element – but it is far from being sufficient for an understanding of the important elements in that development. There is more to healthy sexual development than simply preventing abuse. Important positive skills and understandings must be developed. We identified fifteen key domains which provide a multidisciplinary framework for understanding healthy sexual development:

i. Freedom from unwanted activity.

Healthy sexual development takes place in a context in which children are protected from unwanted sexual activity (Haugaard & Emery, 1989; Sanderson, 2004). This is a fundamental point. Its complexity must also be acknowledged. Hence the second point is:

ii. An understanding of consent, and ethical conduct more generally.

Healthy sexuality is not coercive (Wardle, 1998; Ryan, 2000; Chrisman & Couchenour, 2002; FPQ, 2006). And so children need to understand the nature and complexity of consent⁠ – not just their own, but also other people’s – in sexuality. They need to learn about the ethics of human relationships, and how to treat other people ethically.

In other words: Healthy sexual activity is only activity that is truly wanted by anyone and everyone directly involved in it. Consenting and acquiring consent, and the freedom to withhold or withdraw consent, always; knowing what consent really means and involves for everyone are key to healthy sexual development and to a healthy sexuality and sex life.

iii. Education about biological aspects of sexual practice

In healthy sexual development, children are provided with accurate information about how their bodies work. Research has shown that ‘[i]n the absence of adequate and systematic sex education, children invent their own explanations for biological and sexual processes often in the form of mythologies’ (Goldman & Goldman, 1982, p. 392).

In other words: This means things like accurate words for body parts, science and fact-based explanations of how bodies can or do function not just around sexual reproduction, but also around sex itself and the debunking of mythologies about bodies, sexuality and reproduction.

iv. An understanding of safety.

In healthy sexual development, children learn what is safe sexual practice. This is meant in the widest possible sense, including physical safety, safety from sexually transmitted diseases (Allen, 2005, p. 2), and safety to experiment.

In other words: It's vital to know about safer sex⁠ , preventing or reducing the risk of injury, illness and other harm, and how to explore sex and sexuality in ways which are known and shown as most likely to be physically and emotionally safe.

v. Relationship skills.

In healthy sexual development, children learn relationship⁠ skills more generally. This includes, but is not limited to, communication⁠ and assertiveness skills. Children learn to ask for what they want assertively in relationships generally. At an appropriate point this also includes sexual relationships (Impett et al, 2006).

In other words: Part of everyone's sexuality involves interpersonal relationships, whether that's about sexual relationships expressly, or any relationship in which someone's sexuality may be addressed. Learning what is and is not healthy in all relationships -- including family relationships, friendships, interactions with healthcare providers or people outside those spheres -- is a big part of learning what is healthy in sexual relationships.

vi. Agency.

Emerging from the previous point, in healthy sexual development children learn that they are in control of their own sexuality, and in control of who can take sexual pleasure from their bodies. They are confident in resisting peer pressure. They understand their rights. They learn to take responsibility for making their own decisions (SIECUS, 1995).

In other words: Sexual agency is about having and being afforded ownership of one's body and sexuality, not being externally controlled by others. This includes freedom from unwanted sexual activity and sexual coercion. Agency also means that we're the owners of our own actions and choices. With real agency, we are both held accountable and responsible for them and are allowed the liberty of having ownership for the choices we make.

vii. Lifelong learning.

Every researcher who has studied the healthy sexual development of children insists that children are naturally ‘curious’ about their bodies and about sex (Sanderson, 2004: 62). Studies over many decades have shown that they explore their bodies – including touching and sometimes masturbating their genitals⁠ – from birth (Levy, 1928; Ryan, 2000; Larsson & Svedin, 2002b); they ask questions about sex at the same time as they begin to ask questions about other aspects of society (Hattendorf, 1932; Larsson & Svedin, 2002); and they play ‘sex games’ like doctors and nurses with other children from an early age (Isaacs, 1933; Lamb & Coakley, 1993; Chrisman & Couchenour, 2002; Larsson & Svedin, 2002b; Sandnabba et al, 2003). Research has shown that this behaviour is not only normal, it is healthy and has no harmful effect on later sexual development (Kilpatrick, 1992; Greenwald & Leitenberg, 1989; Leitenberg et al, 1989; Okami et al, 1998; Larsson & Svedin, 2002b). Similarly, learning about sexuality does not stop at the point where (or if) sexual intercourse⁠ begins. Adults continue to learn about their sexuality throughout their lives, improving their knowledge of and attitudes towards their sex lives.

In other words: Being curious about sexuality and wanting to explore it needs to be understood and presented as healthy and acceptable. Exploring sexuality in healthy ways is also learning about sexuality, and that learning, and feeling open to always learn more, is part of our sexual well-being throughout all of life.

viii. Resilience.

There is a necessary element of risk in all learning. This is also true of sexual learning (Chrisman & Couchenour, 2002, p. 3). In healthy development, children develop agency in order to facilitate resilience, so that bad sexual experiences are opportunities for learning rather than being destructive.

In other words: Sometimes sex can suck, doesn't meet our expectations or things happen to us or by us sexually which are painful or traumatic. In order to be as healthy as we can, we need resilience so that we can deal with and/or heal from disappointment, embarrassment, harm or trauma⁠ , rather than being unable to recover or move forward in our lives and sexualities.

ix. Open communication.

Healthy sexual development requires open communication between adults⁠ and children, in both directions. As noted above, this means that children are provided with age-appropriate information about sex (SIECUS, 1995), and particularly that they are given honest answers to any questions they may ask (Chrisman & Couchenor, 2002). There is absolute agreement in the literature that this is important for preventing sexual abuse (Krafchick & Biringen, 2002, p. 59; Sanderson, 2004, p. 55), development of a healthy attitude towards their own bodies and sexuality (Chrisman & Couchenour, 2002, p. 14; Impett et al, 2005), and preventing unwanted pregnancies and STDs when they do become sexually active⁠ (Lindberg et al, 2008). On the other hand, in healthy situations, children feel comfortable in coming to adults with problems, concerns or issues they may have about their bodies or what is happening to them.

In other words: Healthy sexuality doesn't and can't often happen in a culture or environment of silence. Talking about sex and sexuality openly and honestly is part of developing healthy sexuality and healthy sexual development, both with peers and and with parents, guardians and other adults, and also part of reducing the risk of sexual harms or negative outcomes.

x. Sexual development should not be ‘aggressive, coercive or joyless’

This is a key distinction between healthy and unhealthy sexual development. Healthy sexual development is ‘fun’, playful and lighthearted (Okami et al, 1998, p. 364). Unhealthy sexual development is aggressive⁠ , coercive or joyless (Sanderson, 2004: 79).

In other words: It's not healthy for anyone to be pushed into or away from sexual development: both should happen at a pace that's right for each individual. As well, ideally sexual development is something that others support as being okay, something people experiencing it can feel relaxed about and even have fun with and enjoy.

xi. Self-acceptance.

In healthy sexual development children are supported in developing a positive attitude towards their own sexual identity⁠ (Impett et al, 2006); and a ‘positive body self concept’ (Okami et al, 1998, p. 363).

In other words: Part of sexual well-being is accepting who we are, uniquely, and feeling accepted in who we are, even if and when our sexuality, sexual identity, embodiment or the ways we are sexual does not conform to someone else's ideas of what our sexualities should be or what our bodies should feel, look or function like.

xii. Awareness and acceptance that sex can be pleasurable.

Children learn to understand that it is acceptable for sexuality to be pleasurable in healthy development (SIECUS, 1995; WHO, 2002, p. 5). It is not shameful to enjoy it. It is a desirable outcome that when they become adults they will have to option of enjoying satisfying and high quality sexual relationships should they choose to do so (Okami et al, 1998, pp. 361, 365).

In other words: Sex isn't just about making babies, something people only do because someone else wants or expects them to or something to exchange in order to get something else. It's also about pleasure. In fact, when sex (of any kind, including masturbation⁠ ) is truly wanted and consensual and when it occurs in healthy social contexts where everyone involved has agency, it's most often mostly about pleasure. Seeking or experiencing sexual pleasure isn't something to be ashamed of or embarrassed about: it can be a healthy, happy part of life.

xiii. Understanding of parental and societal values.

In healthy development, children learn social and parental values around sexuality to enable them to make informed decisions about their own sexuality in relation to them. These vary greatly (WHO, 2006: 6). Research shows that parental values around sexuality range from extremely conservative to extremely liberal (Okami et al, 1998), and that judgments about what is appropriate sexual behaviour in children differ dramatically in different societies (Aries, 1962; Higonnet, 1998; Jenkins, 1998).

In other words: Whether we wind up agreeing with them or not, it's important we understand the values and ethics of our world and our closest communities, including those within our families. When we are aware of and understand those well, we can inform our choices with them and also work out⁠ what our own values are, whether they're the same or different from the values of our parents or our culture.

xiv. Awareness of public/private boundaries.

As a particular subset of values, children learn how the public/private distinction works in their culture as part of healthy sexual development. This allows them to manage their own privacy, understand public behaviour, and how to negotiate the boundaries between the two (Larsson & Svedin, 2002; Sanderson, 2004, p. 60).

In other words: A healthy sexuality involves boundaries, including boundaries between public and private expressions of sexuality, even though all people don't have the same boundaries. As well, how we present our sexuality and put it into action often is different when it's public and when it's private, both in our individual experiences and when it comes to how we are treated by others. To make sound choices about sexual behavior and expression, choices which include keeping ourselves and others safe, we need to be aware of the differences between what's public and what's private.

xv. Competence in mediated sexuality.

In healthy sexual development, children will develop skills in accessing, understanding, critiquing and creating mediated representations of sexuality in verbal, visual and performance media (Higonnet, 1998; Hartley & Lumby 2003; Buckingham & Bragg, 2004; Ward et al, 2006; Mazzarella & Pecora, 2007; Lafo, 2008).

In other words: Everyone knows that there is (as there always has been) sex and sexuality in all kinds of media. The media is a big presence in our world, especially over the last couple decades, so it's important that we learn how to make sense of and ask questions about what we see, hear or read in it so that we can have a sense of its impact on us and others and know the difference between what the media shows us and how it presents it and how different sexuality can be and often is in real life.

Want to find out about some of those key domains right here at Scarleteen? The following articles are some good places to get started:

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