Sex education in the United States is limited in both its content and the measures used to collect data on what is taught. The risk-reduction framework that guides the teaching of sex education in the United States focuses almost exclusively on avoiding unintended pregnancy and sexually transmitted diseases, overlooking other critical topics such as the information and skills needed to form healthy relationships and content related to sexual pleasure.

Young people express frustration about the lack of information on sexuality and sexual behavior that is included in sex education programs; sexual and gender minority youths, in particular, feel overlooked by current approaches.

International guidance provides a more robust framework for developing and measuring sex education and suggests a number of areas in which US sex education can improve to better meet the needs of youths.

Sex education is the one school subject that is supposed to provide adolescents with the information and skills they need to navigate relationships, understand sex and sexuality, and find the resources they need for obtaining additional information and relevant health services. Despite often being framed in the United States as a tool for risk reduction, quality sex education should be guided by the broader goals of supporting young people’s sexual health and well-being and helping them grow into sexually healthy adults.1,2

In the United States, available guidelines for sex education include the Guidelines for Comprehensive Sexuality Education, K-12, which were first published by the Sexuality Information and Education Council of the United States (SIECUS) in 1991 and have been updated twice (most recently in 2004),3 and the National Sexuality Education Standards, published by the Future of Sex Education Initiative in 2011.4 These guidelines, as well as international guidelines for sex education, especially the recent UNESCO International Technical Guidance on Sexuality Education, identify learning objectives in key areas that embrace a broad view of sexuality, including relationships, gender, skills for health and well-being, and sexuality and sexual behavior.5 The available research on sex education in the United States reveals that most young people receive instruction on only a small subset of these topics, with greatest attention given to more narrowly focused risk-reduction topics; even the measures used to ascertain what young people are learning are largely confined to these risk-reduction topics.6,7 Focusing on these topics and measures overlooks many key aspects of young people’s current and future sexual lives, including the ability to form and maintain healthy relationships; the right to decide whether, when, and with whom to engage in sexual behavior; and the fact that sex should be pleasurable, to name just a few.

Thus, the narrow content of sex education in the United States needs to expand to focus more on sexual health than sexual risk8; surveillance metrics also need parallel expansion beyond risk prevention. Traditional public health goals for sex education in the United States have largely focused on helping young people to avoid unintended pregnancy and sexually transmitted infections (STIs), and the proximate sexual and contraceptive behaviors related to these outcomes. The federal government’s Healthy People 2020 objectives related to sex education only include target levels for adolescents’ receipt of formal instruction about abstinence, birth control methods, HIV/AIDS, and STIs.9 These narrow objectives both reflect and inform the collection of national surveillance data.