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Understanding Sexual Development

Healthy sexual development [1] involves biological, psychological, and socio-cultural processes. Like all aspects of adolescent development, sexual development occurs both within an individual and through interaction with the environment. For example, the biological triggers of puberty are genetic, and are also affected by the available food. Psychological and social processes occur through interactions with family, cultural institutions, and peers, and are also affected by brain development. Adolescent sexual development is likely to be healthy, and to lead to positive sexual health, when each of these processes is appropriately supported in a young person's environment.

Putting all of these factors together, healthy adolescent sexual development occurs not along a single path, but through many trajectories. It involves much more than a teenager avoiding sexually transmitted infections or an unintended pregnancy between childhood and adulthood. Healthy adolescent sexual development trajectories prepare a person for a meaningful, productive, and happy life.

For additional resources, visit Toolkit: Domains of Development.


Puberty involves the physical changes of a girl becoming a woman, or a boy becoming a man. These changes lead to the ability to reproduce. The changes of puberty occur on the inside and the outside of the body, but what is most noticeable both to the adolescent and the rest of the world are the external changes.

In both girls and boys, puberty starts in the central parts of the brain that control other functions in the body such as temperature, blood pressure, and heart rate. The brain controls puberty by producing hormones, which are chemical messengers that travel in the bloodstream to various organs.

  • The sex organs -- also called gonads -- are stimulated to make sex hormones.
  • A girl's ovaries are stimulated to make the female hormone estrogen. Estrogen causes the normal changes of puberty in girls, such as breast development, increasing height, widening of the hips, and an increase in body fat. Menstrual cycles are caused by the balance in estrogen and another hormone from the ovary, progesterone.
  • A boy's testicles are stimulated to make the male hormone testosterone. Testosterone causes the normal changes of puberty in boys, such as growth of the penis, increasing height, widening of the shoulders, deepening of the voice, and growth of facial hair.
  • Normally, girls' ovaries also make a little testosterone, and boys' testicles also make a little estrogen, but in different amounts.
Up to age 25, changes in brain development also have a significant impact on adolescents' ability to make decisions.

Identity Development

Developing a stable sense of one's self and one's role in society, identity development, is a key feature of healthy adolescent development. From the standpoint of sexual development, a strong sense of self prepares an individual for intimacy in young adulthood. As is true of all aspects of identity development, experimentation and role play are common ways in which teens develop their sexual self-concept. Although identity has many facets that influence sexuality, only two will be discussed here: gender identity and sexual orientation.
  • Gender identity relates to an individual's perception of self as being male or female. Gender identity is formed very early in human development and, in its most fundamental sense, is not related to the way in which a child is raised. An internal sense of gender is a deeply engrained and enduring trait that presents challenges when not aligned with the physical sexual attributes of the body.
  • Sexual orientation refers to the sexual attraction of an individual to others. The term "sexual preference" is misleading because it implies an option; sexual orientation is not a simple preference for one sex over another. Attraction may be toward the opposite sex, the same sex, or both.

Socio-Cultural Influences

Socio-cultural influences on adolescent sexual development may include an adolescent's:
  • Family, peers, and social networks based on common interests and beliefs
  • Traditions related to race, ethnicity, culture, or religion
  • Neighborhood and neighbors; the immediate environment
  • School, which forms a micro-environment for up to 10 hours a day for at least 180 days a year
  • Faith community, which may have codes of conduct about sexual behaviors
  • Involvement in youth-serving agencies or community service
Shaped by so many different factors, healthy sexual development may look very different from one individual to another.

Sexual Behaviors

There are a variety of common behaviors that, in and of themselves, have no negative health effects, and that many consider elements of healthy adolescent sexual development, preparing youth for positive sexual lives.
  • Masturbation. Touching one's own genitals in masturbation is a normal part of sexual development. Overall, more adolescents masturbate than engage in sexual intercourse. Although it tends to be done alone in privacy, males sometimes masturbate in groups.
  • Same-sex touching. Early in adolescent development, sexual exploratory behavior often occurs with members of the same sex. This behavior does not predict being gay or lesbian in the future.
  • Genital touching. As adolescents get older, they are more likely to engage in genital touching.
Sexual intercourse is a common behavior among adolescents, but whether it represents healthy sexual development or not depends on a number of factors. Nonconsensual sex of any kind can never be considered healthy. Use of contraception decreases the risk of pregnancy, and use of condoms or dental dams (in oral, vaginal, and anal sex) decreases the risk of disease, including HIV. Anal intercourse, whether heterosexual or homosexual, carries an especially high risk of disease transmission.

Other factors affecting the health consequences of sexual activity may include an individual's ability to access health care services, cultural and familial contexts, motivations and self-awareness, risk behaviors, mental health, relationships, personal values, maturity, and capacity for coping with the possible consequences of sex.


[1]   The content on this page is condensed from the ACT for Youth presentation Healthy Adolescent Sexual Development by Richard E. Kreipe, MD. Dr. Kreipe is professor of pediatrics and a practicing physician in the Division of Adolescent Medicine at Golisano Children's Hospital at the University of Rochester Medical Center, an ACT for Youth partner.
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