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This is a plain English summary of an original research article. The views expressed are those of the author(s) and reviewer(s) at the time of publication.

Sex and relationship education in schools is intended to safeguard children from harmful relationships and promote sexual health. This review of 55 qualitative studies, mainly from the UK, suggests the classes do neither and may be failing to prepare, protect or engage young people.

Most studies covered secondary school sex and relationship education for pupils aged 12 to 18. Many pupils felt that classes were wrongly taught like other subjects and by their usual teachers, making them feel embarrassed and vulnerable. Young men concealed sexual ignorance while women feared peer backlash for displaying too much knowledge.

As the first large scale review of young people’s views it has summarised common themes and critical issues for the future. Classes failed to acknowledge that some young people were sexually active and didn’t address issues relevant to them. Modern sex and relationship issues like “sexting” weren’t covered.

Young people’s views should be central to developing more sensitive, relevant, and beneficial classes. There may also be a need for external teachers or experts to deliver classes to avoid problems of broaching the familiar teacher-pupil relationship.

A lack of research on primary school sex education limited this review’s breadth.

Why was this study needed?

Sex and relationship education in the UK aims to safeguard children against sexual exploitation and abuse, and improve sexual health in young people who are, or may become, sexually active.

By law, primary and secondary schools have to cover age-appropriate sexual anatomy and the biology of puberty and reproduction. Secondary schools also need to cover sexually transmitted diseases. But anything else is discretionary, leading to wide variation in what young people actually learn.

Previous studies seeking the views of young people concluded sex and relationship education starts too late, is too biological, negative, and poorly delivered.

This NIHR-funded qualitative review sought to establish if this was still the case, and build further insights into young people’s views.

What did this study do?

This study systematically identified and synthesised results from 55 studies containing the views of young people on sex and relationship education at primary or secondary school.

Studies were published between 1990 and 2015 and about half were from the UK or Ireland. The majority covered secondary school education delivered by teachers to adolescents aged 12 to 18. Only a single study covered younger children aged 6-12.

Young peoples’ views and the study authors’ conclusions were extracted and grouped into common themes. These were further synthesised into main “lines of argument” that multiple researchers believed explained most of the views collected.

The review methods were transparent and took many measures to ensure reliability and validity, including double coding themes and insights. Studies were generally of good to acceptable quality and mostly involved focus groups or interviews.

What did it find?

The main findings said:

  • Schools mistakenly ignored the special and potent nature of sex and relationships as topics, and tried to teach them like any other subjects.
    • Young people reported strong reactions including embarrassment, discomfort and vulnerability, particularly in mixed-sex classes. Some young men felt a need to avoid seeming sexually inexperienced, while some women avoided participation in class discussion for fear of verbal harassment. Many felt unable to ask what they wanted, eroding the value of the classes.
  • Schools failed to adequately acknowledge that some pupils are sexually active.
    • Classes contained limited information for those who were already sexually active so were viewed as irrelevant or out of touch with their lives. Limiting education to heterosexual intercourse also distanced some pupils.
  • Most young people were uncomfortable with their normal teachers giving the class.
    • Many comments related to the teacher’s lack of training to teach the subject, teacher embarrassment, and being unable to answer questions adequately. There were also concern over crossing parent-teacher boundaries when discussing personal and sensitive topics with a familiar teacher.
  • The researchers found an absence of studies covering issues relevant to many young people today, including “sexting”, online safety and pornography.

What does current guidance say on this issue?

The UK Department for Education and Employment published sex and relationship education guidance for secondary schools in 2000. This explicitly acknowledges the uncertainty around delivering sex and relationship education and aimed to address it.

The current review suggests this guidance is outdated, having not changed for 16 years. In the meantime the sex and relationship landscape of young people has changed profoundly due to the widespread adoption and proliferation of internet and smart phone usage.

What are the implications?

The review indicates the content and format of sex and relationship education classes in schools needs to be better aligned with young people’s views and insights in order to make them more relevant, current and valuable.

There may be a need to bring in external teachers or professional trainers from outside the school, to bypass the negativity and limitations of classes led by familiar teachers.

Potential implementation implications of this include trainer procurement, safe guarding children and quality assurance.

Government guidance on sex and relationship education may also need updating.


Citation and Funding

Pound P, Langford R, Campbell R. What do young people think about their school-based sex and relationship education? A qualitative synthesis of young people's views and experiences. BMJ Open. 2016;6(9):e011329.

This project was funded by the National Institute for Health Research School for Public Health Research.



DfEE. Sex and relationship education guidance. Secondary Sex and relationship education guidance. London; Department for Education and Employment; 2000.

Produced by the University of Southampton and Bazian on behalf of NIHR through the NIHR Dissemination Centre

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“Sexting” - a word combination of sex and texting - is the exchange of sexually explicit text or pictures messages, usually over mobile phones. Many mobile phone apps are used by adults and young people to facilitate this anonymously, including apps that self-destruct a sent picture after 10 seconds so it doesn’t stay on the receiver’s phone.
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