Sex education instruction methodComprehensive sex education (CSE) is an instructional approach aimed at providing individuals, particularly young people, with accurate, holistic information about sexuality, relationships, and reproductive health. Unlike abstinence-only education, CSE includes a broad curriculum that covers topics such as safe sex practices, contraception, sexually transmitted infections (STIs), sexual orientation, gender identity, and relationship skills. This approach seeks to empower individuals to make informed, responsible decisions regarding their sexual health and to promote respect and equality in sexual relationships.
CSE is widely supported by health organizations for its effectiveness in improving public health outcomes. Research shows that comprehensive sex education contributes to reduced rates of unintended pregnancies and STIs, delayed initiation of sexual activity, and increased use of contraceptives among sexually active youth. Furthermore, CSE addresses the diverse needs of young people, including LGBTQ+ youth and individuals from various cultural backgrounds, fostering inclusivity and helping reduce health disparities across communities.
In the United States, the implementation of CSE varies significantly across states due to decentralized education policies. Some states mandate CSE or HIV education, while others continue to prioritize abstinence-based programs. The debate around CSE often involves ideological and political conflicts, with advocates emphasizing its health benefits and critics raising concerns about age-appropriateness and cultural values. Internationally, CSE is recognized by agencies like UNESCO and the World Health Organization as a critical component of human rights and adolescent development, with recommended integration into school curricula for its role in enhancing both individual well-being and public health.
History.
As of 2019, sex education in the United States is mandated at the state level, with individual states, districts, and school boards responsible for determining the implementation of federal policy and funds for sex education. Currently, 24 out of the 50 U.S. states and the District of Columbia mandate general sex education, while 34 states mandate HIV education. Notably, in states where sex education is mandated, there is no federal policy requiring the instruction of comprehensive sex education.
During the George W. Bush administration, conservative Republicans in Congress strongly supported abstinence-only-until-marriage sex education. Conversely, under the Barack Obama administration, there was opposition to abstinence-only education, with suggestions to eliminate it. With advent of President Trump's administration, the federal agenda reverted back to supporting an abstinence-based approach. 
According to the 2014 School Health Places and Practices Study conducted by he Centers for Disease Control and Prevention, high school courses, on average, dedicate 6.2 hours of class time to human sexuality, with a notable emphasis on abstinence. However, the same study found that 4 hours or less are typically allocated to topics such as HIV, other sexually transmitted infections and pregnancy prevention.
Benefits.
Studies have found that comprehensive sexuality education is more effective than receiving no instruction and/or those who receive abstinence-only instruction. Acknowledging that people may engage in premarital sex rather than ignoring it (which abstinence-only is often criticized for) allows educators to give the students the necessary information to safely navigate their future sexual lives. Additionally, young people that do not identify as heterosexual or their gender identity assigned at birth, have increased sexual risk behaviors and adverse health outcomes compared to their heterosexual and cisgender peers. Sex educators argue comprehensive sex education, which includes specific attention to minority groups, is essential for improving this health disparity and ensuring the livelihoods of all people, including LGBTQ+ youth, racial minorities, or students with disabilities. 
CSE advocates argue that promoting abstinence without accompanying information regarding safe sex practices disregards reality, and is ultimately putting the student at risk. For example, programs funded under AEGP are reviewed for compliance with the 8 standards (listed below in "Abstinence Education Grant Program (AEGP) Requirements), but are not screened for medical accuracy. Therefore, critics believe that students under these educational programs are put at a disadvantage because it prevents them from making informed choices about their sexual health. Additionally, under these AEGP programs, health educators have referred to those that engage in sex, especially females, as "dirty" and "used". They have also used phrases such as "stay like a new toothbrush, wrapped up and unused" and "chewed-up gum" to teach abstinence. Under a CSE model, language would be more sensitive.
There is clear evidence that CSE has a positive impact on sexual and reproductive health (SRH), notably in contributing to reducing STIs, HIV and unintended pregnancy. Sexuality education does not hasten sexual activity but has a positive impact on safer sexual behaviours and can delay sexual debut. A 2014 review of school-based sexuality education programmes has demonstrated increased HIV knowledge, increased self-efficacy related to condom use and refusing sex, increased contraception and condom use, a reduced number of sexual partners and later initiation of first sexual intercourse. A Cochrane review of 41 randomized controlled trials in Europe, the United States, Nigeria and Mexico also confirmed that CSE prevents unintended adolescent pregnancies. CSE is very beneficial in regards to teen pregnancy because studies show that, teen pregnancy and childbearing have a significant negative impact on high school success and completion, as well as future job prospects. A study in Kenya, involving more than 6,000 students who had received sexuality education led to delayed sexual initiation, and increased condom use among those who were sexually active once these students reached secondary school compared to more than 6,000 students who did not receive sexuality education. CSE also reduces the frequency of sex and the number of partners which in turn also reduces the rates of sexually transmitted infections.
UNAIDS and the African Union have recognized CSE's impact on increasing condom use, voluntary HIV testing and reducing pregnancy among adolescent girls and have included comprehensive, age-appropriate sexuality education as one of the key recommendations to fast track the HIV response and end the AIDS epidemic among young women and girls in Africa.
As the field of sexuality education develops, there is increasing focus on addressing gender, power relations and human rights in order to improve the impact on SRH outcomes. Integrating content on gender and rights makes sexuality education even more effective. A review of 22 curriculum-based sexuality education programmes found that 80 per cent of programmes that addressed gender or power relations were associated with a significant decrease in pregnancy, childbearing or STIs. These programmes were five times as effective as those programmes that did not address gender or power. CSE empowers young people to reflect critically on their environment and behaviours, and promotes gender equality and equitable social norms, which are important contributing factors for improving health outcomes, including HIV infection rates. The impact of CSE also increases when delivered together with efforts to expand access to a full range of high- quality, youth-friendly services and commodities, particularly in relation to contraceptive choice.
A global review of evidence in the education sector also found that teaching sexuality education builds confidence, a necessary skill for delaying the age that young people first engage in sexual intercourse, and for using contraception, including condoms. CSE has a demonstrated impact on improving knowledge, self-esteem, changing attitudes, gender and social norms, and building self-efficacy.
Benefits of Pleasure-Inclusive Material.
Though a focus on behavior change (i.e., increased condom use and delayed onset of sexual debut) is an important benefit and measure of outcomes associated with sex education, a pivot to exploring the mental health and well-being implications associated with shifting the narrative from a purely biological and procreative approach to a pleasure-inclusive and sex positive approach showcases a host of beneficial outcomes. Two avenues hold particular interest when implementing a pleasure-based curricula: Benefits of CSE and Benefits of Sexual Expression.
Such avenues have been recognised by official organising bodies such as the World Association of Sexual Health (WAS). Indeed, their Sexual Pleasure Declaration outlines that the pursuit of pleasurable and safe sexual experiences, free from discrimination and coercion, is integral to sexual health and overall well-being. Recognising sexual pleasure as a fundamental aspect of human rights - which also holds its own declaration on Sexual Rights - its diverse expressions should be incorporated into global education, health promotion, research, and advocacy efforts, fostering comprehensive, immediate, and sustainable actions for individual well-being and contributing to global health and sustainable development.
Another notable organisation paving the way of pleasure-inclusive sex education curricula is The Pleasure Project. Which recently published a systematic review uncovering the distinct value added by embedding a pleasure-based lens within sexual health interventions. The Pleasure Project also underscores seven guiding principles: Be Positive, Rights First, Think Universal, Be Flexible, Talk Sexy, Embrace Learning, and Love Yourself.
Criticism.
Comprehensiveness.
While CSE implementation is on the rise in the United States, it remains difficult for state officials to regulate what is and is not taught in the classroom. This is due in large part to the undefinability of CSE; CSE has the potential to comprise such a wide range of sexual information, and over-all focus varies widely between curricula. Educators have also accused CSE of fundamentally operating as a form of "abstinence-plus", due to the reality that CSE often involves minimal body-related information and excessive promotions of abstinence. "So-called Comprehensive Sex Ed" says Sharon Lamb, a professor at the University of Massachusetts Boston, "has been made less comprehensive as curricula are revised to meet current federal, state, and local requirements."
Inclusion of LGBT community.
The LGBT population experiences multiple health disparities which may be impacted by stigma, discrimination, and lack of provider cultural sensitivity. This population is subject to systemic barriers to adequate healthcare services ultimately impacting their wellbeing and welfare negatively. They often receive care from clinicians without specialty training in addressing the concerns of this population; which may hinder communication and trust, and ultimately influence the quality and adequate delivery of healthcare. Discrimination and lack of cultural sensitivity may also contribute to the limited health-seeking behaviors experienced by this population. This lack of health-seeking behavior both limits preventative services, and increases and prolongs illness and ailments. Research shows a higher risk of contracting HIV and other STDs; particularly in gay men of color. Lesbian and bisexual females are less likely to obtain routine care like breast and cervical cancer screenings. Gay men are at an increased risk of prostate, testicular, anal, and colon cancers, while lesbian and bisexual women have an increased risk of ovarian, breast, and endometrial cancers. As a result of stigma, discrimination, victimization, and sexual abuse, LGBT youth are more likely to be involved in high-risk sexual behaviors at an earlier age.
While comprehensive sex education exists in schooling, many programs do not address the needs of the LGBT community. This population faces different health disparities ultimately driven by discrimination, shortfalls of peers, the lack of parental support, community services, and school-based sex education. The implementation of LGBT comprehensive sex education utilized as an intervention seeks to combat these health disparities, by informing the population of the importance of developing sexual health. Sexual health involves not only preventing disease, but also a respectful approach to sexual relationships, sexuality, and accepting an individual's gender identity and sexual orientation.
The term "comprehensive" is also often misleading because some comprehensive programs do not show the holistic picture of human sexuality. LGBT advocates have long been critical of the ways in which comprehensive sex education generally promotes marriage as the end goal for students. LGBT advocates want to express other forms of relationships other than marriage. They advocate that students should have sex education that encompasses the different forms and should be allowed to exercise those forms in which they are most comfortable with. Even when curriculums claim to be inclusive of LGBT experiences, they often promote heteronormative lifestyles as "normal." Inclusion of LGBT identities and health topics is necessary for LGBT students to feel safe and seen in their sex ed classrooms. When sex education fails to include LGBT identities and experiences, LGBT youth can be vulnerable to risky sexual behaviors and experience negative sexual health outcomes. Due to the lack of LGBT sex education provided in schools, LGBT youth will look to peers and the internet, which can lead to misinformation. When these students do not have access to or an interest in marriage they are practically erased from the CSE narrative.
In Canada, a federal report showed that the LGBT community has less access to health services and faces more comprehensive health challenges compared to the general population. As a result of the lack of support for the LGBT population, the Comprehensive Health Education Workers (CHEW) Project emerged in October 2014. Their goal is