3.1 Contents: biology is not enough! A call for sex-positive education

The literature outlines an unbalanced focus of CSE in favour of biology and anatomy to the detriment of a holistic perspective which includes the broader context of romantic relationships. According to young people, learning about biological aspects is not enough, demanding the inclusion of social, psychological, and emotional aspects (Alonso-Martínez et al., 2021; Bradford, DeWitt, Decker, Berg, Spencer, & Ross, 2019; Formby & Donovan, 2020; Grant & Nash, 2019; Laverty, Noble, Pucci, & MacLean, 2021; Lucero et al., 2020; Seiler-Ramadas et al., 2021) such as more knowledge about healthy sexual relationships, respect for rights and duties, and in general information that is richer in inclusivity, relevance and depth (Heslop, Burns, & Lobo, 2019; Narushima et al., 2020). CSE is perceived as teaching facts without tackling the emotions involved, while young people desire more discussions about feelings, and skills to appropriately manage their emotions (Araúz Ledezma, Massar, & Kok, 2020). Furthermore, they perceive that learning about what constitutes healthy relationships and/or sexual encounters beyond the mechanical aspects would allow them to establish their own boundaries and rules about what they will accept or not within a relationship (Formby & Donovan, 2020).

This relates to the call for a more sex-positive approach to SE (Jørgensen, Weckesser, Turner, & Wade, 2019; Roberts et al., 2020). Young people assert that CSE overfocuses on prevention and risk behaviours over sexual wellbeing (Bradford et al., 2019; Lucero et al., 2020), calling for the inclusion of areas such as pleasure, mental health, and wellbeing in general (Hobaica, Schofield, & Kwon, 2019; Laverty et al., 2021; Seiler-Ramadas et al., 2021). They also mention the absence of discussion on masturbation, potentially reproducing taboos and shame around this subject (Patterson et al., 2020).

3.2 Contents: the issue of power dynamics and consent

Students feel ill-equipped to pursue healthy dating relationships and lack realistic role models for healthy romantic relationships (Alonso-Martínez et al., 2021; Marshall et al., 2020; Unis & Sällström, 2020), consequently calling for more discussions on healthy (and unhealthy) relationships. Many identify abusive behaviours between peers in dating relationships (Marshall et al., 2020), underlining the importance of addressing issues of power and control.

Talking about consent is also a crucial concern for students (Lucero et al., 2020; Marshall et al., 2020). Being provided with legal definitions or ideal standards of consent doesn’t help as they claim such abstract definitions lack connection to the complexities of their everyday life (Hirsch, Khan, Wamboldt, & Mellins, 2019, as cited in Setty, 2021). In this vein, young people often see consent as a burden, a complexity simplified through minimum standards of agreement (Setty, 2021). This shows a limited understanding of acceptable behaviours in dating and relationship contexts, and relates to young people’s need to ground consent on topics relevant to them (sexting, for instance), hence engaging with the situated realities of contemporary youth sexual cultures (Jørgensen et al., 2019) and providing them with useful skillsets to safely navigate consent. Addressing consent in a grounded and practical manner, such as teaching students to recognise the relevance of both verbal and non-verbal ways to express it, is paramount for youth wellbeing (Formby & Donovan, 2020), especially considering that young people’s limited education surrounding safe practices in the realm of sexuality can often lead to engagement in non-consensual and unsafe experiences (Hobaica & Kwon, 2017).

Furthermore, students identify the importance of normalising the discourse around SE and its diverse concepts (Lucero et al., 2020), as learning to talk about sex makes it easier for them to identify problematic behaviours and consequently ask for help (Unis & Sällström, 2020). This aligns with the evidence that young people feel discomfort using terminology around sexuality (Rose et al., 2019), highlighting the importance of “learning” how to speak, rehearsing “talk” around sex, love, consent, help, protection and power (Formby & Donovan, 2020).

3.3 Contents: CSE is heteronormative. A call for inclusion and a whole-school approach

The heteronormativity of CSE emerges as a substantial issue highlighted by youth, describing it as non-inclusive and lacking LGBTQ+ content (Bradford et al., 2019; Currin, Hubach, & Croff, 2020; Ezer, Kerr, Fisher, Waling, Bellamy, & Lucke, 2020; Formby & Donovan, 2020; Grant & Nash, 2019; Hobaica et al., 2019; Hobaica & Kwon, 2017; Lucero et al., 2020; Marshall et al., 2020; Mayeza & Vincent, 2019; Paechter, Toft, & Carlile, 2021; Patterson et al., 2020; Roberts et al., 2020). This makes young people feel invisible, creates a sense of exclusion for individuals that do not adhere to a heteronormative approach, and makes their experience undergoing SE lessons deeply uncomfortable (Hobaica & Kwon, 2017).

LGBTQ+ students describe feeling particularly unprepared for sex and relationships due to the narrow content received (Hobaica et al., 2019; Patterson et al., 2020), posing safety concerns for health-related issues as this population would be more vulnerable to harmful sexual health consequences (Paechter et al., 2021), risky sexual behaviours and sexual violence (Hobaica & Kwon, 2017). This also raises mental health concerns, as being “othered” by this exclusion can spark feelings of anxiety, depression and even suicidality (Hobaica & Kwon, 2017).

Homosexuality is perceived as stigmatised content because of its consistent omission within CSE (Heslop et al., 2019; Roberts et al., 2020; Seiler-Ramadas et al., 2021), while young people view it as a natural experience in human sexuality they wish would be discussed in greater depth, along with other LGBTQ+ topics like identity development and transgender identities (Bradford et al., 2019; Hobaica et al., 2019; Jarpe-Ratner, 2020).

Consequently, evidence from the literature indicates a desire among young people for CSE to be more inclusive overall by becoming sensitive to all sexual and gender identities and providing diversity of representation (Hobaica et al., 2019; Laverty et al., 2021). Nevertheless, they warn how schools must be careful when addressing gender identity and sexual orientation in a combined way as it can be perceived as problematic to discuss gender together with sex and sexuality contents. In their study about the experiences of non-binary teenagers in school, Paechter and colleagues (2021) demonstrate how non-binary students wish there was more information on non-binary identities and binary trans identities, but separated from discussions on “having sex” (Paechter et al., 2021). Furthermore, students perceive that conversations about identities should be mainstreamed across the curriculum, rather than confined to the SE realm.

CSE’s heteronormativity also has implications for LGBTQ+ students’ learning about gender-based violence. Evidence from the literature suggests that in the few cases when CSE includes discussions about violence and abuse, it is primarily addressed as a heterosexual problematic, that is, centred on physical violence and reduced to men as perpetrators (Formby & Donovan, 2020). Nevertheless, young people recognise gender-based violence is relevant to everybody’s lives, noting that failing to provide all students with the resources to identify and contend with potentially abusive relationships dismisses significant learning opportunities (Formby & Donovan, 2020).

Moving away from a heteronormative approach in CSE is adamant if we consider that schools continue to be deeply homophobic institutions (Pascoe, 2007, as cited in Santos, Marques da Silva, & Menezes, 2018) and that episodes of discrimination, bullying and violence still exist for LGBTQ+ identities (Santos et al., 2018). Moreover, young people acknowledge schools tend to disengage from their responsibility of dealing with violence and discrimination in the context of students’ sexuality (Santos et al., 2018). This demonstrates how youth perceive schools as homophobic both when they enact a “passive” approach (omission or lack of inclusion) as well as when there are “active” episodes of discrimination (Formby & Donovan, 2020).

3.4 Contents: CSE lacks context-sensitivity. A call for student sensitive CSE

Young people affirm CSE should be context sensitive, in contrast to a “one size fits all” approach (Ritchwood et al., 2020), and should therefore take into account considerations which would ultimately make it “student-sensitive” (Hobaica et al., 2019; Roberts et al., 2020; Sell & Reiss, 2022) and tailored to the needs of each specific student group. This is crucial for the LGBTQ+ population who experience higher levels of depression, anxiety and suicide rates (Hobaica et al., 2019), but becomes relevant for all students of diverse backgrounds in terms of class, race, ethnicity, disability, nationality, gender and sexual orientation (Santos et al., 2018). For example, high quality faith-sensitive CSE appears to be valued by non-religious students because having a greater understanding and respect for difference and diversity would enable young people to gain tools to resist peer pressure (Johnson, Flentje, & Bartholomaeus, 2020; Sell & Reiss, 2022). Nevertheless it is important to note that religious teaching and faith-based schools often carry negative comments and perceptions in their approach to SE, mainly because it tends to promote abstinence-only approaches and is rooted in gender stereotypes (Ezer et al., 2020; Waling, Bellamy, Ezer, Kerr, Lucke, & Fisher, 2020). For example, evidence from a study including students with Muslim, Catholic and Christian backgrounds found that female students expressed having feelings of guilt in relation to sex before marriage, while male students did not, impacting negatively on young girls’ sexual wellbeing socially as well as psychologically (Narushima et al., 2020).

3.5 Pedagogy: Who should teach CSE? Adultcentrism and teacher effectiveness

Moving on to the pedagogical realm, a theme that appears transversally in students’ opinions is the perception of CSE as adultcentric (Setty, 2021), that is, following the logic that young people (passive) absorb information from adults (experts) and consequently change their behaviours. This model lacks resonance with youth because they see adults as disconnected from their needs and realities, and hence perceive lessons as not relevant or adjusted to their reality (Unis & Sällström, 2020). The role of the teacher is therefore crucial for the success or failure of any CSE intervention, impacting students’ level of engagement, comfort, trustworthiness, and overall learning experience. Accordingly, teacher effectiveness emerges as a pivotal finding, evidencing most facilitators have had little or no specific training for the subject (Heslop et al., 2019).

Students perceive a lack of proper teacher preparation which reflects on, for example, reticence, embarrassment, discomfort, lack of motivation, biases, and lack of connection with their concerns (Ezer et al., 2020; Mayeza & Vincent, 2019; Namukonda et al., 2021; Seiler-Ramadas et al., 2021; Thianthai, 2019; Unis & Sällström, 2020). They report concealed meanings and messages being conveyed by their teachers, who often choose to withhold knowledge in order to transmit a normative, abstinence-based agenda (Currin et al., 2020; Narushima et al., 2020; Unis & Sällström, 2020). This use of scare tactics or fear-based messaging makes students feel guilty and ashamed for having engaged, wanting to engage, or even asking questions about sexuality, leaving them feeling unsupported, ill-informed and frustrated (Hobaica & Kwon, 2017; Laverty et al., 2021; Waling et al., 2020).

Young people want well trained professionals who are confident answering questions and teaching CSE (Hobaica et al., 2019; Sell & Reiss, 2022). Hence, they often prefer and feel more comfortable with CSE being delivered by external providers rather than their own teachers (Brown & McQueen, 2020; Heslop et al., 2019; Roberts et al., 2020; Thin Zaw et al., 2021; Waling et al., 2020). In fact, students manifest their learning experiences with external experts are less biased and more inclusive and comfortable than lessons with their usual teachers (Waling et al., 2020). Furthermore, students attribute more credibility to external providers compared to facilitators from within the school system (Heslop et al., 2019). Evidence from youth work on CSE provision has been positively valued by young people, who report, for example, feeling comfortable interacting and discussing LGBTQ+ relationships in informal settings with peer educators (Formby & Donovan, 2020).

Trustworthiness of the subject providing CSE is also relevant for young people: they perceive that without trust in the teacher, not much can be accomplished (Unis & Sällström, 2020), and report feeling concerned and uncertain about judging who to trust. Is it their own teachers or external providers? (Unis & Sällström, 2020). Familiarity with teachers thus appears as a double-edged sword. Young people prefer and appreciate peer educators and external professionals delivering CSE, but agree that teachers with whom they can trust their concerns should also be involved (Seiler-Ramadas et al., 2021; Unis & Sällström, 2020).

This suggests young people would benefit from a mixed approach between schoolteachers and external providers. The World Health Organisation suggested already in 1996 that SE and the promotion of health in the formal school system should comprise collaborations with external providers (WHO, 1996) as well as support from the complete school community, as a whole-school approach suggests. Nevertheless, the literature suggests that young people perceive schools do not actively engage in efforts to expand the offer of educators and experts providing CSE beyond schoolteachers (Heslop et al., 2019).

3.6 Pedagogy: How can a safe space be provided? The importance of school environment

Creating and managing an adequate classroom environment is crucial to youth, acknowledging the strong impact of classroom management skills and other students’ attitudes on meaningful engagement in the CSE class (Laverty et al., 2021; Rose et al., 2019; Unis & Sällström, 2020; Waling et al., 2020). Young people are concerned with how teachers handle students’ behaviour, as peers are often perceived as immature and affect the learning environment of all students (Jørgensen et al., 2019; Rose et al., 2019). In fact, the way peers react to specific content impacts the learning process of all students, especially their meaning-making process for what is considered stigmatised or socially accepted (Laverty et al., 2021).

This leads to young people’s need for a safe space for learning, emphasising the importance of having a shame-and guilt-free channel for asking questions (Jarpe-Ratner, 2020; Laverty et al., 2021; Thin Zaw et al., 2021; Waling et al., 2020). Here, their right to privacy and anonymity is essential (Jørgensen et al., 2019; Seiler-Ramadas et al., 2021), as well as the consistent option to abstain from participating in the lesson should they choose not to (Laverty et al., 2021). Jars, boxes, or similar artifacts have proved to be valuable vessels through which students can anonymously voice concerns, especially considering the sensitive nature of SE topics which can spark feelings of vulnerability and anxiety (Renold, Ashton, & McGeeney, 2021; Rose et al., 2019). Working explicitly on embarrassment and discomfort can be crucial for effective participation (Seiler-Ramadas et al., 2021), especially in contexts with specific obstacles to anonymity, such as small towns where the notion that “everyone knows everyone” appears to transversally hinder CSE provision in general as well as access to information and sexual health services (Heslop et al., 2019).

A final element contributing to a safe learning environment that is appreciated by students is establishing ground rules (Laverty et al., 2021; Rose et al., 2019). Initiating the class by clearly setting rules that promote dialogue, inclusivity, and tolerance gives students a sense of security that disrespect will not be accepted, allowing them to feel protected while exploring the concepts, feelings, and ideas present in CSE (Laverty et al., 2021).

3.7 Pedagogy: Promoting critical thinking and active and fun learning

In line with the evidence that quality learning occurs when experiences settle according to each person’s beliefs and views (Seiler-Ramadas et al., 2021; Unis & Sällström, 2020), young people want more instances that promote critical thinking (Heard et al., 2019; Johnson et al., 2020). In fact, students viewed learning as being facilitated by actively taking part in group discussions, debates, and activities that foster reflection, helping them gain new perspectives and reflect on their own standpoints rather than receiving content in a factual way (Narushima et al., 2020; Thianthai, 2019).

In addition to being provided with content that highlights a diversity of options and choices, they express enjoyment of spaces to reflect and “think hard” about themselves (Araúz Ledezma et al., 2020), fostering autonomous and informed decision-making (Laverty et al., 2021). They assert their enthusiasm about being able to voice their opinions through active learning and value having the space to critically explore issues such as sources of violence, the influence of cultural norms, and the effect of power relations on everyday life and behaviour (Araúz Ledezma et al., 2020). This aligns with evidence that critical thinking and experiential learning can foster more self-efficacy for self-boundaries, values, and norm formation in relationship contexts (Unis & Sällström, 2020).

Students also clearly assert that they want to learn in fun and joyful ways (Johnson et al., 2020; Waling et al., 2020), showing appreciation for interactive and welcoming classes, friendly writing styles that are fun to read, and above all, groundedness on their real-life curiosity and relevance (Thianthai, 2019). Specifically, they request the use of more visual and tangible material (Seiler-Ramadas et al., 2021; Thianthai, 2019) such as films, animated videos, vignettes, pictures, and informative graphics, as well as lessons that involve them meaningfully through student presentations or portfolios on specific themes with independent research (Seiler-Ramadas et al., 2021). Changes in the learning setting are also motivating, such as insightful field visits to clinics (Decker, Dandekar, Gutmann‐Gonzalez, & Brindis, 2021; Seiler-Ramadas et al., 2021). Likewise, evidence from arts-based CSE projects has had positive feedback from young people, where teaching through creativity is considered unique and captivating, and associated with a more informal learning context (Formby & Donovan, 2020).

3.8 Pedagogy: To gender-segregate or not to gender-segregate? Looking into CSE format

Evidence shows that gender affects both teachers’ and students’ level of comfort within the CSE class, both in terms of teacher-student gender dissonance and student composition of the classroom field (Rose et al., 2019). Likewise, young people often prefer gender-separated classes (Brown & McQueen, 2020; Jørgensen et al., 2019; Likupe, Chintsanya, Magadi, Munthali, & Makwemba, 2021; Thin Zaw et al., 2021) acknowledging however the importance that all students receive the same content (Waling et al., 2020). Students also report a preference for same-gender teachers (Brown & McQueen, 2020; Likupe et al., 2021; Thin Zaw et al., 2021), arguing it affects not only student comfort but also teacher comfort toward the student group (Rose et al., 2019). Although this can be interpreted as an opportunity to improve young people’s learning experiences in CSE, a binary categorisation of gender could be problematic for transgender and non-binary students, threatening the ability of CSE’s agenda to become LGBTQ+ inclusive (Haley, Tordoff, Kantor, Crouch, & Ahrens, 2019; Paechter et al., 2021).

Defining a suitable timing for CSE’s contents also emerged as a key finding across the literature. It has been demonstrated that CSE should be age-specific (Lucero et al., 2020; Unis & Sällström, 2020) and start from a young age (Hobaica et al., 2019), however, oftentimes students express that timing is not well aligned with their current needs, experiences, and developmental stage (Laverty et al., 2021; Waling et al., 2020). For instance, some content is perceived as being taught too late (puberty), while other too early (condom use and STI risks) (Waling et al., 2020). When content does not align with timing, young people feel that it is either repetitive or pointless (Laverty et al., 2021).

Insufficient frequency, sufficiency, and duration of CSE interventions were also voiced as a concern for young people, who assert that CSE should be threaded throughout the school curriculum providing ongoing opportunities to learn (Laverty et al., 2021; Rose et al., 2019). They value CSE taught in a spiral curriculum through regular lessons rather than single, off-timetable days (Sell & Reiss, 2022) and perceive they are more likely to forget if information is disassociated from reality or not repeated often enough (Seiler-Ramadas et al., 2021). The more often they receive it, the more they learn, thus their assertion of the need for more CSE (Ezer et al., 2020) and coverage of topics across different subjects to allow them to explore themes in a deeper manner (Waling et al., 2020).