Research Article

Understanding Adolescent Journal of Psychosexual Health

4(4) 237–242, 2022
© The Author(s) 2022
Sexuality: A Developmental Reprints and permissions:
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Perspective DOI: 10.1177/26318318221107598
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Anupama Hegde1, Suhas Chandran2 and Jigyansa Ipsita Pattnaik3

Abstract

Adolescence is a period of transition from childhood to adulthood, during which the individual undergoes significant
biological, psychological, and social changes. The development of sexuality, though begins at conception, gets shaped during
this period. The changes occurring differ in males and females not just in terms of biopsychosocial organization but sexual
behavior and functioning as well. Adolescent sexuality is although highly acknowledged but is quite complex and needs
in-depth understanding. Challenges faced by adolescents include being vulnerable to risky sexual behaviors, unprotected
sex, nonconsensual sexual interactions, sexually transmitted infections, stigmatization from society, and so on. In developing
countries such as India, adolescents deal with additional challenges with higher risk associated with early marriages, unplanned
pregnancies, sexual abuse, patriarchy, and insufficient information regarding sexual behavior and risks.This article is an attempt
to review the nuances of adolescent sexuality, particularly in developing countries, to ensure appropriate culturally sensitive
yet scientifically sound intervention programs.

Keywords
Adolescent psychology, adolescent sexuality, sex education, sexuality

Introduction Development of Sexuality in Adolescents

Adolescence is a critical stage in the human developmental The development of sexuality starts as early as in the womb
process. It is a period of transition during which an individual and continues throughout the lifespan. Adolescence plays a
undergoes physical, hormonal, and psychological changes. vital role in determining one’s sexuality as it brings profound
Humans develop formal operational thought processes, abstract alteration to hormonal, anatomic, and neuropsychological
thinking, learn to envision consequences of one’s actions, a substrates of sexuality and the interpersonal, familial, and
sense of identity, social involvement, peer interaction, and an social significance of these changes.2 The biopsychosocial
awareness of one’s sexuality in this stage.1 Sexuality cannot be theory of adolescent sexual development explains the
defined purely based on the biological changes an individual
undergoes. It is a lifelong process that includes various domains
of experience such as emotions, urges, motivation, feelings, 1
Akash Medical College, Devanahalli, Bengaluru, Karnataka, India
forms of attention, aspects of self, biological processes, moral 2
Department of Psychiatry, St Johns Medical College and Hospital, Bengaluru,
precepts, interpersonal relationships, and social interactions. In Karnataka, India
3
Department of Psychiatry, Kalinga Institute of Medical Sciences (KIMS), KIIT
this article, we aim to highlight the various aspects of adolescent University, Bhubaneswar, Odisha, India
sexuality including development, gender differences, common
Corresponding author:
sexual behaviors in adolescents, the role that culture, parents, Jigyansa Ipsita Pattnaik, Department of Psychiatry, Kalinga Institute of Medical
and educators could play, as well as challenges youth face Sciences (KIMS), KIIT University, Bhubaneswar, Odisha 751024, India.
concerning sexuality. E-mail: [email protected]

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238 Journal of Psychosexual Health 4(4)

multifaceted growth of the individual during adolescence. However, development beyond childhood is completely
Biological changes that determine biological sex also affect different. There are no generally achieved biological or
psychological sex. Hormonal changes play a significant role psychological milestones during the teen years, and no
in causing the onset of puberty; the secondary sexual scientific or psychological evidence that differentiates a state
characteristics are expressed during this critical period. of maturity as teenagers progress through development into
Psychological factors such as personality or temperament their 20s. Adolescent sexuality development can be seen of as
determine the attitude of the individual toward one’s sexuality. a long-term shift that is self-regulated, qualitative, and
Literature suggests that introverts are found to have more progressive rather than simply induced by the environment.
difficulty than others in sexual expression.1 Parenting styles, The importance of the interplay between sexual,
parental attitude toward sexuality, family environment, peer cognitive, and emotional development is stressed here. The
relationships, and the influence of culture and community are era of curiosity and experimenting is commonly referred
the social substrates that influence the development of an to as adolescence. Youth of this age lack the cognitive
individual’s sexuality. and emotional development required to make intelligent and
Freud’s psychosexual development theory explains healthy sexual decisions, as well as the ability to cope with
the genital stage, in which the individual indulges in the consequences of sexual engagement. This is especially
experimentation to discover one’s sexuality. It is characterized terrible because today’s teenagers are sexually active earlier
as a transition from self-directed pleasure as in the phallic than prior generations. Such experiences, on the other
stage, directed toward heterosexual pleasure. He states that hand, set the groundwork for further romantic and sexual
the sexual instinct, which remains quiescent during the encounters.
latency stage, becomes active in the genital stage. According
to him, this need for heterosexual pleasure increases and
continues into adulthood.3 Gender Differences
In today’s era of digitalization and globalization,
the online platforms provide an important source of Larsson stated that “what we term healthy and natural
sexual behavior modelling. Adolescents may suffer from sexuality is formed from the society that we live in and
internalizing ideal standards from inappropriate body image depends on our gender.” As this quote indicates, children
depiction and overambitious sexual activity demonstration, learn about sexuality through a gendered lens.4,5 Gender is a
thus resulting in poor self-esteem and socially unacceptable significant feature of our social environment and is the most
channels of sexual expression and needs. This can thus visible subdivision within our species. Children use this
contribute to appropriate social and sexual withdrawal in rather dramatic, categorical way of social grouping to ascribe
anticipation of perceived preformed and unattainable ideal meaning to their social behavior. Similarly, they learn that
standards, resulting in a vicious cycle. sexual behavior is gendered.

Understanding Sexuality Through Developmental Lens

At the basic level of anatomy and physiology, the transition to The sociological and cultural environment heavily
adolescence occurs when children sexually mature and influences sexuality in all of its forms. Despite historical
become capable of reproduction. After a series of early stages shifts in perceptions of gender roles and expectations, recent
of sexual development in childhood, this maturity emerges. research suggests that men and women have different sexual
Hegde et al. 239

ideals. This hypocritical standard dictates strict expression behaviors include abstinence, masturbation, and partnered
and experiential norms for women, whereas men are given sex.
more freedom in exploring their sexuality in adolescence.
Also, the discouragement from peers to have sex is seen 1. Abstinence in adolescence is described as refraining
highly in females, whereas males face peer pressure to carry from oral, vaginal, or anal partnered sexual behaviors.
out sexual behaviors earlier than females.5 The view of abstinence among adolescents is
Gender differences have been seen in the emotions linked distinctive from that among younger children, which
with sexual engagement. Boys reported feeling more proud is influenced by their developmental experiences in
after sex, while female said they felt “dirty” and ashamed. the sociocultural context. The emergence of sexual
The sexual double standard in the perception of virginity is cognitions, conscious sexual identities, motivations,
also highlighted, with women viewing their virginity as a gift and desires are hormonally mediated in association
to give to a cherished spouse, while more males saw it as a with adrenarche and pubarche.9 Studies have shown
stigma and a lack of sexual opportunities.5 that young adolescents consider abstinence as part of
Objectification occurs in social and cultural frameworks a continuum, in which it is considered as a standard to
as well as by potential romantic and sexual partners. Sexualized be developmentally ready to make a transition from
images of women and girls are prevalent in mainstream media sexual abstinence to active sexual interactions.
and are linked to sexual behavior outcomes.6 Studies have 2. Masturbation is the second-most prevalent adolescent
shown that objectification is associated with increased body sexual behavior. Though it is widely subjected to
dissatisfaction and higher rates of depression among girls stigma and societal condemnation, the medical field
with more advanced puberty, and those who are involved in holds it to be developmentally normal behavior.2
romantic relationships.6 The age of onset of masturbation is not well defined
Considering the sexual behavior among adolescents, in the literature. Retrospective studies stipulate it
boys are generally expected to be more expressive and take to be 13 years for men and 15 years for women.10
proactive roles whereas girls adopt a reactive role in setting Masturbation is associated with other adolescent
the boundaries of sexual interactions. Partnered sexual sexual behaviors. It may provide a means of
behaviors gradually become prominent during mid- and gaining familiarity and comfort with one’s sexual
late adolescence. Changes in the testosterone levels during responses and genitals. Young women who engage
early adolescence determine the timing of sexual initiation in masturbation and noncoital orgasm exhibit high
in males, and increased sexual interest and sexual activity levels of sexual self-awareness, higher effectiveness
in females. Boys and girls who matured later were slower to in attaining sexual satisfaction, and resistance to the
report dating and to have sexual intercourse.2,5 sexual double standard.
Masturbation is one of the most prevalent sexual 3. Partnered sexual behavior includes kissing, touching
behaviors in adolescence. Masturbation is more common erotogenic body parts, partner-assisted masturbation,
among male adolescents as compared to females and it cunnilingus, fellatio, penile-vaginal intercourse, and
persists across the lifespan.7 Imaging studies show that the penile-anal intercourse. Another contemporary behavior
cortical subsystems associated with visuospatial perception that is included in this repertoire is sexual exchange
are more advanced in male adolescents, and are associated via electronic media, generally known as phone sex or
with functional polymorphisms in the androgen-receptor sexting.7 The essential element of partnered sex is its
gene. This explains the substantial gender difference during dyadic nature. This defines the adolescent’s perspectives
adolescence and throughout the sexual life span.8 on social attitudes, motivations, and outcomes of their

Sexual Behaviors and Functioning sexual relations. Partnered, noncoital sexual behaviors
comprise the majority of the adolescents’ sexual
The development of adolescent sexuality consists of experience. It does serve as an experiential framework
4 domains of the sexual response cycle-sexual desire, sexual for their first-ever coitus and determine risky sexual
arousal, sexual behaviors, and sexual functioning. Sexual interaction with their partners.
240 Journal of Psychosexual Health 4(4)

The sexual functioning of the individuals can be determined of contracting sexually transmitted infections, substance use,
by their subjective experiences during sexual interactions. and various mental health issues. Bisexual and homosexual
Pleasure is considered an important motivation for sexual women were more vulnerable to unplanned pregnancies,
encounters. Studies have suggested that men place more screening for human papillomavirus, and other infections like
emphasis on pleasure during sex as compared to women.11 genital herpes and bacterial vaginosis.
Also, the usage of barrier contraceptives like male and female
condoms are perceived to have detrimental effects on sexual
activity by many adolescents. Orgasm is the physical and Culture and Sexuality in Adolescence
emotional sensation experienced at the height of sexual
arousal, typically as a result of sexual organ stimulation. Humans being social beings, from the dawn of civilization,
There is a paucity of research on the physiological and have formed and revised a set of norms appropriate to the
psychological correlates of orgasm in teenagers younger than time and region to abide by for smoother functioning of
18 years old. Women experience their first orgasm on average the society. Culture plays a vital role in an individual’s holistic
at 15 years of age, while men experience theirs at 13 years. development. Today, the world is a hub of diverse cultures
The ability of adolescents to experience orgasms is and they continue to influence us in different areas of our
influenced by traits such as autonomy, general self-esteem, lives, including adolescent sexuality. However, certain
and empathy.11 Pain, which is connected with the initial attitudes toward sexuality were universal in youth like
penile-vaginal encounter among women, is another crucial hygiene and general behavior of the sexual partner were
feature of subjective experience in partnered sex. Nonetheless, significant factors, use of condoms was considered to be
this pain may endure throughout the entirety of a person’s stigmatizing and a sign of lack of trust, penalties and rewards
sexual life. Despite the agony, young women continue to for sex, gender stereotypes determined social expectations
engage in sexual activity for a variety of reasons, including which had a detrimental effect on behavior, and communication
being attentive to their partners’ needs and sex as an expression about sex were some of the common themes found across
of their femininity. almost all the cultures.14
Studies comparing the sexual development of adolescents
in collectivist and individualistic societies have revealed
Sexuality and Sexual-Minority Youth disparities in adolescent sexual development. Youth who
were raised in collectivist societies as compared to those from
Sex and gender are two different concepts of one’s sexuality. individualistic cultures were more conforming and sensitive
Sex is determined at the time of birth, whereas gender is how toward social as well as sexual norms, thus being more
an individual perceives oneself as a sexual being. Some conservative about sexual decision-making. Regardless,
people may not find congruency between these two. the ethnic minority in most parts of the world faces similar
Adolescence is a developmental stage during which individual challenges as the target of social discrimination and at
experiments and discovers about self. There is no definitive risk of negative sexual health outcomes like early sexual
way suggested in researches that whether same-sex interests initiation, unprotected intercourse, unplanned pregnancies,
and activities in adolescence will or will not persist into and infections.13
adulthood. Hence, the same-sex sexuality is often discounted
as insignificant, transitional, and rather just experimental. An
Role of Family and Parents
undeniable fact is that these youth face various challenges in
society for their interests and orientation, as it puts them The parents and family play a significant role in the develop­
outside the framework of conventional cultural and social ment of sexuality in the individual. Social sexualization
norms on sexuality. They become targets of multiple personal begins as early as late childhood and continues through adole­
and social scrutiny such as self-victimization, criticism by scence, which involves parents, siblings, peers, and significant
others, harassment, victimization, stigmatization, lack of other adults. Parents are the primary source of information for
public support, and acknowledgement.12 Sexual minority any child to gain knowledge about sexuality. Some of the
individuals experience fear of disclosure, shame, guilt, and components of family sexual culture are gender attitudes,
acceptance of self, while heterosexual individuals experience words for genitals, exposure to adult nudity, parents’ dating
feelings that indicated acceptance of society. and sexual behaviors, conversation about sex and reproduction
Sexual health among sexual minority youth is a matter in the family, and norms for a dyadic relationship, which
of concern as they lack proper sexuality education, are poorly influence adolescent’s knowledge of sexuality.13 In most
supported by society, are known to have sexual risk behaviors, conservative societies, the concept of sexuality is not well
and are subject to various negative psychosocial outcomes discussed within the family. Parents hesitate to provide proper
such as bullying, dating violence, sexual harassment, and sex education to their children for various reasons. It might be
mental health concerns like suicide and unprotected sex.13 It due to lack of education in the parents, parent-child
was found that men who have sex with men have a high risk relationship, parental negative attitude toward sexuality,
Hegde et al. 241

anxiety about the safety of their children, or the feelings of India is a collectivistic, conservative society with
awkwardness to discuss sex with their kids. The child-parent limitations in freedom to express and experience sexuality
relationship is an important aspect that affects the adolescent’s in open, or before marriage. With emerging globalization
attitude toward sexuality. Studies suggest that youth who and Western trends, Indian youth are exploring the new
have a weak interpersonal relationship and poor hierarchy in options and opportunities in front of them. As adolescence is
the family tend to exhibit a bad attitude toward sexuality.15 vulnerable to several health-related concerns, it is important
And those who reported having at least 1 parent as warm and to plan and address their needs. Due to lack of awareness
supportive were found to delay the onset of sexual intercourse and unpreparedness among health-care professionals and the
and indulge in sexual activities less frequently. public, the sexual and reproductive health needs of adolescents
are either overlooked or not completely understood in India.16,17

Role of Peers and Friends

Challenges Faced
If parents discourage adolescents from engaging in impulsive
sexual behavior, it is believed that classmates and friends will Sexuality is seen as a domain that requires maturity to experi-
have a paradoxical effect. Parents feel that the majority of ence and to express, which is assumed to be the characteristic
sexuality related knowledge acquired by adolescents comes of adulthood. Hence, adolescent sexuality is considered
from their peers.15 Peers influence adolescents’ sexuality and innately dangerous, experimental, and inept.1,2 Aspects such as
sexual behavior by providing either conventional or deviant time of sexual onset, related substance use, contraceptive
lifestyle models, by providing models for sexual attitudes and measures, sexually transmitted infections, unwanted preg-
behaviors, by serving as sources of information and sources nancy in adolescence are in the focus, subsequent to their
of social approval and disapproval for certain attitudes and impact on the global economy, social constructs, cultural
behaviors, and by providing sexual and potential partners.15 norms, and health policies.
However, for better or worse, gathering sources from the Teenagers who are in their early and middle adolescence
environment is very important. And peers serve as the best are generally impulsive and sensitive to social pressure. They
source in that way to help adolescents discover themselves as tend to have minimal knowledge about sexual interactions and
sexual beings. lack confidence and assertiveness in their sexual encounters.12
Hence, researchers suggest that they are vulnerable to
potential risks such as condomless sex, nonconsensual
Role of Educators
sexual experience, sexually transmitted infections, teenage
Parents are undeniably the primary and significant source of pregnancy, and multiple sexual partners.
acquiring knowledge about sexuality. But for adolescents, Key Recommendations:
they may not serve as providers of certain factual information
and social skills concerning sex education. The role of both 1. To include psychologists/counsellors/mental health
parents and educators in sex education influences adolescent professionals for sexuality education, in addiction to
behavior, and parents and adolescents’ preferences. Because, teachers.
during adolescence, the individuals begin to create a new 2. Create avenues like anonymous platforms for open
self-identity, build role models, and social values by turning discussion about sexuality involving parents, teachers,
more toward the society rather than the parents. Parents who and adolescents.
do not share a cordial relationship or those who have 3. Addressing current gaps in interventions by generating
reservations about the concept of sexuality fail to provide appropriate trained volunteers to support peer-led
sufficient information to the adolescents. Hence, educators culturally sensitive interventions.
need to provide factual and sufficient information, create a
supportive environment for the adolescents to express and
sort their concerns about sexuality, keeping in mind the social, Conclusion and Future Directions
familial, and religious sensitivities.15
The development of sexuality begins at conception and is
shaped throughout adolescence, not just in terms of
Adolescent Sexuality in Indian Scenario biopsychosocial organization, but sexual behavior and
functioning as well. Parents act as primary providers of
Adolescents comprise around 18% of the world population, information, but often adolescents rely on peers, media, and
out of which approximately 88% live in developing countries. educators for factual and necessary information on sexuality.
India has the largest adolescent population in the world with Irrespective of the culture, girls are more restricted about
more than 50% of them living in urban areas. These statistics sexuality than boys and sexual minority youth face additional
highlight the significance and relevance of catering to various problems around disclosure, associated with guilt and
health needs of this population.16 reluctance to accept their sexuality.
242 Journal of Psychosexual Health 4(4)

In developing countries such as India, challenges 6. American Psychological Association. Report of the APA Task
for adolescents increase with higher risk associated with Force on the Sexualisation of Girls. 2010. https://www.apa.
early marriages, unplanned pregnancies, sexual abuse, and org/pi/women/programs/girls/report. Accessed on June 10,
insufficient information regarding sexual behavior and risks. 2022.
Parents, teachers, health-care providers, and the general 7. Herbenick D, Reece M, Schick V, Sanders SA, Dodge B,
public has a greater responsibility to cater to the needs of Fortenberry JD. Sexual behaviour in the United States: results
adolescent sexual health, as they occupy 18% of the world from a national probability sample of men and women ages
population. Flexible, religious, and culturally sensitive yet 14-94. J Sex Med. 2010;7(5):255–265.
scientifically sound developmentally informed programs are
8. Peterson JL, Hyde JS. A Meta-analytic review of research
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Declaration of Conflicting Interests
9. Graber JA, Nichols TR, Brooks-Gunn J. Putting pubertal
The authors declared no potential conflicts of interest with respect to timing in developmental context: implications for prevention.
the research, authorship, and/or publication of this article. Dev Psychobiology. 2010;52:254–262.
10. Pinkerton SD, Bogart LM, Cecil H, Abramson PR. Factors
Funding
associated with masturbation in collegiate sample. J Psychol
The authors received no financial support for the research, author- Hum Sex. 2002;14:103–121.
ship, and/or publication of this article.
11. Latka MH, Kapadia F, Fortin P. The female condom:
effectiveness and convenience, not “female control,” valued by
ORCID iD U.S. Urban adolescents. AIDS Educ Prev. 2008;20:160–170.
Jigyansa Ipsita Pattnaik https://orcid.org/0000-0001-8563-7200 12. Diamond LM. Sexual-Minority, Gender-Nonconforming,
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