Generational Differences in Sexual Health Education Experiences among LGBTQ+ Adolescents and Adults: Findings from a U.S. National Probability Sample

Abstract

Few U.S. states require school-based sex education to be representative or inclusive of LGBTQ+ people. Data suggests that adolescents’ receipt of necessary topics in sex education has declined in the past 25 years, yet literature on LGBTQ+ people’s sex education experiences in the U.S. is largely limited to non-probability samples. Data are from a national probability sample of adolescents and adults in the U.S. Individuals identifying as LGBTQ+ (N = 818) were asked an open-ended item about the type of sex education they would have liked to have received. Participants were classified into four generational cohorts: Boomer+, Generation X, Millennials, and Generation Z. Inductive content analyses and chi-square test of independence were used. Having a sex education that normalized LGBTQ+ identities was the most reported topic, with Boomer+ being more likely to report this and Generation X being least likely. About one-quarter of respondents indicated they would have liked any type of sex education. Millennials were more likely to report wanting more information on sexual orientation and gender identity and safe sexual practices compared to other cohorts. Nearly one-fourth of respondents indicated their sex education did not need improvement/was unnecessary. Older generations wished their sex education normalized their identities while Generation Z and Millennials reported wanting more information on safe sex and/or sexual violence prevention. Findings from this study can inform the development of tailored sexual health education programs for LGBTQ+ individuals, particularly considering that current programming may not be different compared to the sex education received by earlier generations.

Introduction

Lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) adolescents and young adults face greater sexual health risks compared to their cisgender-heterosexual counterparts. For example, gay, bisexual, queer, and other sexual minority men (SMM) are at an increased risk of HIV compared to heterosexual men; while compared to heterosexual women, lesbian, bisexual, and queer women are at amplified risk of pregnancy and are less likely to receive or use contraceptives (Agenor et al., 2021; Charlton et al., 2018; Mustanski et al., 2015). LGBTQ+ youth partake in more episodes of unprotected sex compared to non-LGBTQ+ youth (Sanchez 2012). In two nationwide U.S. studies, it was found that 24% of gay men, 18% of bisexual men, 37% of bisexual women, and 11% of lesbian women experienced sexual violence and harassment during their time in college (Bloom et al., 2022; Ford & Soto-Marquez, 2016; Snyder et al., 2016). Transgender students are more likely to encounter sexual violence than cisgender students (Sondang et al., 2020). Moreover, intimate violence rates are higher among LGBTQ+ couples heterosexual couples (Graham et al., 2019; Whitfield et al., 2019).

School-based sexual health education can be seen as a state-level or national-level intervention that could intervene to increase contraceptive use, delay sexual activity, and reduce rates of sexually transmitted infections, unintended pregnancy, and sexual violence (Chin et al., 2012; Goseling et al., 2014; Kohler et al., 2008; Lindberg & Maddow-Zimet, 2012; Lindberg et al., 2016). Additionally, school-based sexual health education can also serve as an intervention to reduce sexual health disparities experienced by LGBTQ+ adolescents and young adults. This depends on the program being conducted in an inclusive and comprehensive manner. As LGBTQ+ youth, especially those living in rural and conservative areas, may have few community resources in which they can acquire knowledge about sexual health (Prince-Feeney et al., 2019), school instruction may be the only viable choice outside of virtual spaces. With this, curricula that is inclusive to LGBTQ+ people, such as including LGBTQ+ stories and sexualities in sex education programs, can create safer and more fair learning environments for LGBTQ+ students (Burdge et al., 2013; Toomey et al., 2012; Quinn & Meiners, 2011). Because most LGBTQ+ teens are not out to their parents/guardians and are often fearful of doing so (Mustanski et al., 2015), comprehensive and LGBTQ-inclusive school-based sexuality curriculum could meet the needs of LGBTQ+ teens. That is, being in a school environment that is affirming of their identities and aims to represent their lives and stories can enhance academic and psychological outcomes such as a positive sense of self and belonging, feelings of being respected and safe, higher GPAs, and greater educational aspirations (Aragon et al., 2014; Kosciw et al., 2012; Leung et al., 2022).

However, school-based sexual health education for LGBTQ+ populations can be harmful. The LGBTQ+ community may have varying experiences when it comes to school-based sex education around the country (Planned Parenthood, 2020). Although national sex education standards for K-12 have been identified (Future of Sex Education Initiative, 2020), there is no nationwide sex education curriculum which states must follow, as each state can set their own guidelines (Guttmacher Institute, 2023; Bible et al., 2020). Currently, there are 35 states plus Washington D.C. that require abstinence information, while only 21 states require inclusion of condoms and contraception use (Guttmacher Institute, 2023). LGBTQ+ youth are not represented in abstinence-led curriculums, which are the most common curriculum in the U.S. (Fisher, 2009). Additionally, a focus on heterosexual relationships and marriage often leads to sex education focusing on penile-vaginal intercourse to the exclusion of other sexual behaviors (e.g., oral sex, anal intercourse) (Gowen & Winges-Yanez, 2014), for which information about sexual safety would be important for all students, including LGBTQ+ students. By excluding information about the kinds of sex that LGBTQ+ youth may find themselves contemplating or engaging in, it may lead them to seek information from other sources, such as social media, online searches, and/or pornography (Byron et al., 2013; Roberts et al., 2020). While young people often seek sexual and reproductive health information online (Strasburger & Brown, 2014), which can create opportunity for normalization and a sense of community for LGBTQ+ youth, this information could be inaccurate or overwhelming (Baker, 2021; Lim et al., 2014; Patterson et al., 2019). It could also potentially contribute to potentially harmful and unrealistic ideals of partnered sexual experiences, as may also occur from watching pornography or other sexually explicit media (Herbenick, 2023). Thus, heterosexual-focused sex education excludes LGBTQ+ representation and LGBTQ-related content (Hobaica & Kwon, 2017). Approximately 19 states and Washington D.C. require inclusive information on sexual orientation content which means that, nationwide, very few LGBTQ+ students are likely getting the inclusive-sex education information they need (Guttmacher Institute, 2023; SIECUS, 2023). In fact, only 5 states have laws that require comprehensive sex education, while six states currently have anti-LGBTQ+ sex education curriculum (SIECUS, 2023).

School-based sex education policies are constantly changing, and sometimes regress in more socially conservative political climates. By the end of 2023, there were eight states that restricted topics discussed in sex education, which included sexual orientation, gender identity, LGBTQ+ relationships, and abortion (Wong, 2024). Less than one-fourth (19%) of teachers in Montana are trained in human sexuality, despite more than half (61%) wanting professional development on teaching LGBTQ+ students (Montana Office of Public Instruction, 2016). LGBTQ-inclusive sex education curriculum can vary within and between states, as some school-based sex education teachers have pedagogical authority inside their classrooms while others must abide by a given curriculum. For example, while some sex educators might resist abstinence-only curriculum and anti-LGBTQ curriculum, other sex educators might adhere to their comprehensive and LGBTQ-inclusive curriculum.

Currently missing in the literature is an examination of the generational differences LGBTQ+ adults have experienced with school-based sex education, and why such experiences might vary depending on their age cohort. Prior studies have found generational differences in terms of how people view sexual health: for instance, fewer men who have sex with men (MSM) born in the 1990s were open about their sexual behaviors to their primary care physicians than their older MSM counterparts (Grov et al., 2018), even though they were less likely to engage in sex that was considered high-risk (Hunt et al., 2019). Older generations tended to focus more on their sexual behaviors and less on their identity which no longer holds true for younger generations (Bishop et al., 2020). While younger generations saw pre-exposure prophylaxis (PrEP, an HIV prevention medication), as a means of sexual freedom and less angst, it was seen more as a public health benefit to older generations owning to their own life experiences with HIV/AIDS (Hammack et al., 2017; 2019).

Extant research on LGBTQ+ individuals’ perspectives on sexual health education have largely been limited to sexual minority males (Bishop et al., 2021; Currin et al., 2017; 2020; Flores et al., 2021; Nelson et al., 2019) more so than sexual minority females and gender minority people (Baker et al., 2021). More research is needed to explore the sexuality education topic preferences of all LGBTQ+ people, especially those who do not identify as gay, bisexual, and queer men. Additionally, only one study has collected data from a national sample of LGBTQ+ people and asked about these individuals’ preferences for school-based sex education; however, the study was limited to adolescent sexual minority males (Nelson et al., 2019). Similar studies tend to focus on LGBTQ+ people in specific geographic areas such as central North Carolina (Flores et al., 2021), Oklahoma (Currin et al., 2017; 2020), Montana (Sondag et al., 2020), and cities such as Boston, Massachusetts (Baker et al., 2021). While each of these studies has provided insights on LGBTQ+ sex education needs, data from a more broadly representative sample of LGBTQ+ people in the U.S. are needed. Moreover, most of the methods used have been qualitative interviews and while providing important detail, may limit generalizability (Baker et al., 2021; Currin et al., 2017; 2020; Sondag et al., 2020).

Study Aims

Using U.S. nationally representative survey data, the purposes of this study were to (1) identify what kind of school-based sex education LGBTQ+ adolescents and adults felt would have been helpful to them and what they would have liked to learn; and (2) assess for generation differences between these desired aspects of sex education.

Method

Participants and Procedure

Study protocols were approved by the Institutional Review Board at Indiana University (IRB #16792). Data for the present analyses were from the 2022 National Survey of Sexual Health and Behavior (NSSHB-Wave 8), a confidential U.S. nationally representative study of adolescents and adults. Individuals were recruited from the Ipsos KnowledgePanel^®. Ipsos utilizes address-based sampling methodologies via the U.S. Postal Service’s Delivery Sequence File, through which recruitment occurs by invitation only. Ipsos offers web-enabled devices to households that do not have connectivity to facilitate participation. Members are invited to participate in surveys around twice per month and can earn points for their participation which can be redeemed for merchandise or cash. Though Ipsos sampling is intended to be nationally representative, statistical weights are developed using the latest Current Population Survey (CPS) benchmarks to account for non-response or under/over-coverage.

To reach the desired participation rate of 8600 adults and 1000 adolescents (aged 14-17), Ipsos first identified 14,019 adult members of the KnowledgePanel to partake in the study; of these, 8742 (62.4%) began the survey and 8666 completed it (61.8%). To reach adolescents, Ipsos identified 3357 adult members of the KnowledgePanel who, at the time of the study, were parents of at least one 14–17-year-old and invited them to review information about the study and, if they consented, to share information with their adolescent about the study. Of these, 1451 parent members consented (43.2%) and 1017 adolescents completed the survey (70.1% of those whose parents consented). Of the total sample, 828 individuals (764 adults, 64 adolescents) responded to the item as LGBTQ+, yet 10 respondents indicated they did not identify as LGBTQ+, thus were removed for analyses (N = 818).

Measures

Demographics.

Participants reported their age, gender, sexual orientation identity (lesbian or gay, heterosexual or straight, bisexual, pansexual, asexual, queer, I use a different term (with a textbox provided for individuals to write in or describe an orientation not listed)), gender identity (woman, man, transgender man or trans masculine, transgender woman or trans feminine, gender nonbinary, let me describe/also with a textbox for write-in responses), race/ethnicity, and state of residence. State of residence was recategorized as the four U.S. Census Bureau regions.

Sexuality Education Topic Preferences.

Participants who identified as LGBTQ+ were asked, “Looking back, what kind of school-based sexuality education would have been helpful for you as an LGBTQ+ person? What would you have liked to learn?” and provided with a textbox in which they could type their response to this open-ended survey item.

Data Analysis

Participants’ age was used to classify them into four generational categories. Participants born before 1964 were categorized as “Boomer+”; participants born between 1965 and 1980 were categorized as Generation X; participants born between 1981 and 1996 were categorized as Millennials; participants born between 1997 and 2012 were categorized as Generation Z (though, as noted earlier, the minimum age for study participation was 14). This method is consistent with prior research that examined generational differences among general and LGBTQ populations (Dimock, 2019; Puckett et al., 2022).

The research team for the present study was comprised of five individuals who spanned three generations, included both women and men, and was diverse in terms of gender and sexual orientation identity. Data were analyzed in SPSS version 27 (IBM SPSS Statistics for Windows, IBM Corp, Armonk, New York). Demographic data and perceived topics were analyzed via descriptive statistics: number (N), percentage (%), mean (M) and standard deviation (SD). The open-ended data were analyzed using an inductive content analysis (Elo & Kyngas, 2008). Two coders were involved in the qualitative analysis. The primary coder exported the qualitative data to an Excel file and read responses to become familiar with the data. The primary coder inductively coded responses and inductively developed the codebook. After the codebook was developed, the research team agreed on the codebook. There were 11 codes in total that reflected topics participants would have liked to learn in their school-based sex education courses. Inter-rater reliability was tested using a random sample of 25% of responses. The primary coder sent an uncoded Excel file with the random 25% of responses and the codebook for the secondary coder to code. The secondary coder coded their random list, and the kappa was .84, indicating strong agreement (McHugh, 2012). The primary and secondary coders met to discuss and agree on disagreed responses. A chi-square test of independence (χ²) was used to compare code prevalence between generational cohorts. A p-value (p) of < .05 was statistically significant.

Results

Participant Characteristics

Table 1 presents the demographic characteristics of the sample (N = 818). The mean age was 43.82 (SD = 18.30; range = 14-85). The distribution of the generational cohorts was as follows: Boomer+ (29.9%, n = 236), Gen X (20.8%, n = 170), Millennials (32.4%, n = 265), and Gen Z (18.0%, n = 147). Most participants were cisgender (47.7% cisgender men, 42.7% cisgender women), while 1.6% described themselves as a transgender man/masculine, 0.9% as transgender women/feminine, and 7.2% as gender nonbinary or another gender minority. Most participants reported that their sexual orientation identity was either lesbian or gay (47.6%, n = 389) or bisexual (39.5%, n = 323), and 4.8% of the analytic sample identified as pansexual (n = 39), 2.8% as queer (n = 23), and 5.4% as asexual (n = 44). About three-quarters of participants self-reported to be Non-Hispanic White, followed by 12.7% Hispanic, 6.6% Non-Hispanic Black or African American, 2.7% as another racial/ethnic minority who is of Non-Hispanic origin, and 6.4% who are multiracial. For additional demographic characteristics, see Table 1.

Table 1:

Demographic Characteristics (N = 818)

	N (%)	M	SD
Age, years		43.82	18.30
Generational cohort
Boomer+	236 (28.9)
Generation X	170 (20.8)
Millennial	265 (32.4)
Generation Z	147 (18.0)
Gender Identity
Cisgender man	390 (47.7)
Cisgender woman	349 (42.7)
Transgender man/masculine	13 (1.6)
Transgender woman/feminine	7 (0.9)
Gender nonbinary and other gender minority	59 (7.2)
Sexual Orientation
Lesbian or gay	389 (47.6)
Bisexual	323 (39.5)
Pansexual	39 (4.8)
Queer	23 (2.8)
Asexual	44 (5.4)
Race/Ethnicity
Non-Hispanic White	586 (71.6)
Hispanic	104 (12.7)
Non-Hispanic Black or African American	54 (6.6)
Non-Hispanic Other	22 (2.7)
Multiracial	52 (6.4)
Region
Northeast	131 (16.0)
Midwest	171 (20.9)
South	280 (34.2)
West	236 (28.9)

Preferred Topics by Generational Cohort

Normalization and Acceptance of LGBTQ+ Identities

The open-ended text data included various descriptions of what respondents feel would have been helpful to them, or what they would have liked to learn, in their school-based sex education experiences (see Table 2). Most often, respondents indicated that they wished their sex education had normalized and accepted LGBTQ+ identities (27.1%, n = 222). Some individuals spoke to wanting to hear explicitly about LGBTQ+ acceptance, writing that it would have been helpful to hear “that it’s ok to be gay” (White lesbian Boomer+ woman). Similarly, participants described wanting “to have learned that it is okay” (Multiracial bisexual nonbinary Generation Z woman) or that “LGBT people exist, they are not dirty, LGBT sex is not ‘worse’ or more disgusting than hetero sex” (White lesbian Generation Z woman). Others spoke to feeling it would have been helpful for students to have been told “not to discriminate against other people for being different!” (White bisexual Boomer+ man). Also in this category were those who wanted positive representations of LGBTQ+ lives, saying they wanted “to know that there are people like me that are happy and that they can have a normal life” (White lesbian Boomer+ woman) or “how to be comfortable in my skin [with] full inclusion” (Black lesbian Generation X woman). In terms of generational differences, Boomer+ respondents were the generational cohort that reported this the most (35.1%), followed by Millennial (27.5%), Generation X (22.1%), and Generation Z respondents (15.3%). Boomer+ respondents were more likely and Generation Z respondents were the least likely to report feeling that it would have been helpful for their school-based sexual health education classes to have normalized and accepted LGBTQ+ identities (χ² = 7.89, p = .048).

Table 2:

Desired Sexuality Education Topics (N = 818)

Topic	Total N (%)	Boomer+ N (%)	Generation X N (%)	Millennial N (%)	Generation Z N (%)	X2	Example
Any material	191 (23.3)	48 (25.1)	36 (18.8)	67 (35.1)	40 (20.9)	3.422	▪ I would’ve liked to have a more comprehensive education. I also would’ve liked less pressure and judgment in general. (Gay Millennial man) ▪ Any kind of education. It wasn’t talked about at all in the late 70s early 80s. (Lesbian Generation X woman)
Sexual orientation and/or gender identity	172 (21.0)	39 (22.7)	32 (18.6)	72 (41.9)	29 (16.9)	9.548*	▪ That it is normal to be LGBT, that trans people exist and about trans identities, that more than straight and gay are possible sexual orientations (Bisexual Nonbinary Millennial Trans man) ▪ All the many variations of sexuality in humans in factual and non-judgmental terms (Bisexual Boomer+ woman)
Normalization and acceptance of LGBTQ+ identities	222 (27.1)	78 (35.1)	49 (22.1)	61 (27.5)	34 (15.3)	7.885*	▪ That being gay is a legitimate expression of my sexuality. It was never considered as an option. (Gay Boomer+ man) ▪ How to accept my sexuality without the urge to become a sexualized item. (Bisexual Millennial woman)
Safe sexual practices	61 (7.5)	3 (4.9)	10 (16.4)	30 (49.2)	18 (29.5)	24.312***	▪ How [to have] safe, responsible sex without being straight (Bisexual Generation Z woman) ▪ Comprehensive education on STDs/HIV (Bisexual Millennial man)
Sexual violence prevention	7 (0.9)	1 (14.3)	0 (0.0)	2 (28.6)	4 (57.1)	8.047*	▪ I think there should be sections of sex ed that model healthy relationships for hetero and same-sex relationships. Many of us grow up being unable to identify abuse. (Bisexual Generation Z woman) ▪ Identifying relationship abuse in LGBT relationships (Queer Millennial Trans/nonbinary person)
Sexuality	20 (2.4)	7 (35.0)	5 (25.0)	5 (25.0)	3 (15.0)	0.891	▪ How to negotiate satisfying sex with another man. (Gay Generation X man) ▪ …Not just learning about sex for procreation, but also for pleasure, and between multiple people (Pansexual Millennial gender nonbinary person)
Consent	13 (1.6)	1 (7.7)	2 (15.4)	8 (61.5)	2 (15.4)	5.747	▪ Sexual education needs to start younger and self-advocacy for autonomy and safety and consent/assent are so important… (Bisexual Generation X women) ▪ Being taught consent rather than just say no until you’re married (Bisexual Millennial woman)
Features of healthy relationships	32 (3.9)	4 (12.5)	5 (15.6)	16 (50.0)	7 (21.9)	6.980	▪ It would’ve been nice to know that relationships/love looks different. I was only taught what was “normal” (heterosexual) (Bisexual Millennial woman) ▪ That same sex relationships are every bit as worthy and meaningful as heterosexual relationships may be (Lesbian Boomer+ woman)
Anatomy and physiology	41 (5.0)	10 (24.4)	5 (12.2)	19 (46.3)	7 (17.1)	4.440	▪ Slightly better explanation of female anatomy (Bisexual Generation Z woman) ▪ Even just some basics about [having] anal sex would’ve been nice (Gay Millennial man)
LGBTQ+ culture and history	22 (2.7)	6 (27.3)	6 (27.3)	6 (27.3)	4 (18.2)	0.662	▪ LGBTQ+ history and representation. Learning about important LGBTQ+ figures who have made significant contributions to society. (Gay Generation Z man) ▪ Awareness of famous LGBTQ individuals (Gay Generation X man)
No material	196 (24.0)	69 (35.2)	46 (23.5)	44 (22.4)	37 (18.9)	12.492**	▪ I think the info I got was fine. Learned biological functions and what puberty was for both sexes in 5th grade, and how babies are made. High school health class talked about protection. Seems like all you need. (Asexual Millennial man) ▪ None. Schools should teach academics. Parents, friends, and social networks teach about sexuality. (Gay Boomer+ man)

Note: Responses could have more than one code.

^*p < .05;

^**p < .01;

^***p < .001

Any Sexual Health Education

About one-quarter of respondents wanted any sexual health education given they commented their school-based education was abstinence-only or nonexistent. The generational cohort that indicated this the most was Millennial (35.1%), followed by Boomer+ (25.1%), Generation Z (20.9%), and Generation X (18.8%). Some individuals spoke to not having any relevant information in their sexual health education, saying “I was in school in the 80s where we never said condom, abortion, or anything real in sex ed. With regard to LGBTQ, no one ever spoke about it unless they were bullying a person” (White bisexual Generation X woman) or simply that “none was taught in school” (Hispanic bisexual Millennial woman). Other respondents indicated their sex education was “not helpful at all [and they] would have loved for a better education” (White asexual Generation Z non-binary person) or that “anything would have been better/more than I had” (White bisexual Boomer+ woman).

Sexual Orientation and/or Gender Identity

Nearly one-quarter of respondents wished their school-based sexual health education included information on sexual orientation and/or gender identity (21.0%), with Millennials reporting this the most (41.9%), followed by Boomer+ (22.7%), Generation X (18.6%), and Generation Z respondents (16.9%). Millennials were more likely than other generations to want information on sexual orientation and/or gender identity (χ² = 9.55, p = .023). Participants described a sexual health education program in which they were told “that it is an orientation, not a choice” (Black gay Boomer+ man) or that “its a spectrum, and you don’t have to put labels on your sexuality. You like who you like” (White bisexual Generation Z woman). Other respondents spoke of how beneficial sexual orientation and/or gender identity information would’ve been, like “I would have liked to learn more about different identities. I did not learn about asexuality until I was an adult and may have spent less time being uncomfortable trying to force relationships if I could have identified what I was feeling sooner” (White asexual Millennial woman) or that, simply, “it was okay to experiment to find out who you are” (White lesbian Generation X transgender woman).

Safe Sexual Practices

Some respondents (7.5%) stated wanting more information on safer sex practices, with almost half (49.2%) of those who reported this were Millennials, followed by Generation Z’ers (29.5%), Generation X’ers (16.4%), and Boomer+ (4.9%). Millennials were more likely and Boomer+ were the least likely than the other generations to report this topic (χ² = 24.31, p = < .001). Participants described wanting more information on having safe partnered sex, like “how to practice safe sex in a same sex relationship” (Hispanic bisexual Millennial woman) or “how to be safe with all combinations of partners” (White queer Generation X woman). Others individuals spoke about wanting preventative information such as “It would’ve been nice to be educated on STDs and how to protect yourself in all scenarios, not just straight sex” (White bisexual Generation Z woman) or specifically that they wanted “safe sex practices beyond pregnancy prevention” (White lesbian Millennial woman) or being told “that having sex wasn’t gonna kill me” (Multiracial gay Generation X man).

Anatomy and Physiology

Other respondents indicated wanting more information on anatomy and physiology (5.0%). About half of those who indicated wanting anatomy and physiology topics were Millennials (46.3%), followed by Boomer+ (24.4%), Generation Z (17.1%), and Generation X (12.2%). Participants who reported wanting more information on anatomy or physiology often discussed how LGBTQ+ people have sex, or how same sex/gender people engage in sexual activity, like “how to have sex with a same sex partner” (White lesbian Millennial woman) or asking how “sex work[s] for those that identify other than cis[gender]?” (White pansexual Generation Z transgender man). Others indicated wanting more information on reproductive health: “I would have preferred more detailed information on reproduction, since I’ve had to deal with infertility as an adult” (White pansexual gender nonconforming Millennial).

Healthy Relationships

Few respondents (3.9%) wanted their school-based sexual health education to include more information on healthy relationships, with 50% of those who mentioned this topic being of the Millennial generation (followed by Generation Z with 21.9%, Generation X with 15.6%, and Boomer+ with 23.5%). Some individuals indicated their desire for information on LGBTQ+ relationships and dating, like having more “information about being in a homosexual relationship” (Black gay Millennial man) or “about health, respectful relationships” (White bisexual Millennial woman). Some discussed how important and beneficial it would have been to learn about communication and mutuality in relationships, including how “important [it is] to respect a person when they confess their feelings” (White bisexual Generation Z woman) and of “how to talk about sex with your partner” (Black pansexual Generation Z woman).

LGBTQ+ Culture and History

Few respondents (2.7%) wished their school-based sexual health education courses had lessons about LGBTQ+ culture and history. Boomer+, Generation X, and Millennials reported this equally (27.3%), and Generation Z reported this the least (18.2%). Participants spoke of their desire for learning about influential LGBTQ+ people and historical events, including “learning about important LGBTQ+ figures who have made significant contributions to society” (Non-Hispanic gay Generation Z man) and of how bringing “awareness to LGBTQ+ individuals [would] normalize being gay” (White gay Generation X man). Further, individuals discussed the necessity of “being aware of LGBTQ+ persons from history and their accomplishments, but focus on their achievements and not the[ir] sexuality” (Black gay Boomer+ man) or simply that they “would have liked more role models” (White pansexual nonbinary Millennial).

Sexual Pleasure and Consent Communication

Some respondents indicated they wanted more information on sexual pleasure and negotiation topics (2.4%), with Boomer+ reporting this the most (35.0%), Generation X and Millennials reporting this equally (25.0%), and Generation Z the least (15.0%). Consent communication was mentioned by a handful of respondents (1.6%). Most respondents who listed consent were Millennials (61.5%), followed by Gen Z (15.4%), Gen X (15.4%), and Boomer+ (7.7%). Participants spoke about their desire for their sex education to have had an “openness to healthy expressions of sexuality” (White gay Boomer+ man) or one that spoke about how to have “enjoyable sex with people of the same sex” (White lesbian Generation Z woman). Other individuals discussed wanting to have learned about “the types of intimacy and what consent actually looks and sounds like” (White bisexual Millennial woman) or to have been taught “the difference between procreation and pleasure in intercourse” (White gay Generation X man).

Sexual Violence Prevention

The least mentioned topic was sexual violence prevention, with 7 respondents reporting this. More than half (n = 4, 57.1%) of those who indicated this were Generation Z, 2 (28.6%) Millennials, 1 (14.3%) Boomer+, and no Generation X respondents mentioned sexual violence prevention information. One participant noted their desire to have had a sexuality education program that discussed aspects of sexual violence prevention like that “saying no was okay and of knowing how to protect myself from sexual harassment and abuse” (Hispanic lesbian Boomer+ woman). Others responded that they “should have learned about domestic abuse and relationship violence in queer relationships” in their sexual health education, and expressed that “many of us grow up being unable to identify abuse” (White bisexual Generation Z woman).

Feeling that their Sexual Health Education Was Sufficient or that it Was Not Necessary

Approximately one-quarter of respondents (24.0%) noted their school-based sexual health education did not need improvement or that school-based sexual health education was unnecessary. Boomer+ respondents reported this more than other generational cohorts (35.2%), and subsequent generations reported this less frequently: Generation X (23.5%), Millennials (22.4%), and Generation Z (18.9%) (χ² = 12.49, p = .006). Some participants spoke felt as though their sexual health education was sufficient: “I think the info I got was fine. I learned about biological functions and what puberty was for both sexes in 5th grade, and how babies are made. High school health class talked about protect[ion]. Seems like all you need” (White asexual Millennial man) while another respondent wrote that “the sexual education I received in school was just right for me” (Black bisexual Millennial woman). Others described their perspectives on sexual health education, saying “not sure I would feel comfortable with school-based sexuality education” (White bisexual Generation X woman) or that they simply “do not want to discuss it with anyone” (White gay Boomer+ man).

Discussion

This study extends the extant literature by using data from a U.S. national probability sample to conduct a generational cohort analysis to examine LGBTQ+ adolescent and adults’ preferred sexual health education topics. This novel study overcomes prior limitations in the literature associated with using convenience sampling or recruiting participants from a more narrow age range or a more limited geographic area.

These findings showed that older generations (Boomer+, Generation X, Millennials) reported wanting sex education that normalized and accepted LGBTQ+ identities. This finding may not be surprising given the various social and cultural factors that impacted these generation’s external and internal LGBTQ+ stigma. Same-sex attraction and orientation (i.e., homosexuality) was listed as a psychiatric disorder in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) until the late 1980’s (Drescher, 2015). A similar evolution has been made regarding gender minority identities, from “transsexualism” in the 1980’s to “gender identity disorder” in the 1990’s, to “gender dysphoria” in the 2000’s. However, unlike same-sex attraction and orientation, gender minority identities continue to be pathologized in the DSM (Drescher, 2010). Further, school-based sexual health education programs in the U.S. began including fear-based HIV/AIDS information in the 1980s (Lindberg et al., 2000). Due to this stigma-based HIV/AIDS curriculum, other fear-based messaging on sexual behaviors were widely disseminated and anti-LGBTQ+ attitudes increased (Fairchild et al., 2018). LGBTQ+ visibility was low during the Reagan Administration with a withdrawing of federal funds for comprehensive sex education (McGarry, 1998) and the promotion of abstinence-only curriculum (Santelli et al., 2017).

Generation Z participants were less likely to express wanting their sexual health education to discuss sexual orientation and/or gender identity compared to other generational cohorts. This is consistent with previous qualitative research showing that young people may receive a more comprehensive sexual and reproductive health education in school (Estes, 2017; Jarpe-Ratner, 2019). As states and school districts in the U.S. become increasingly more LGBTQ+ inclusive (Smith-Grant et al., 2022), their received sex education likely taught about sexual orientation and gender identity. In 2022, more states required sexual health education to be inclusive to LGBTQ+ people compared to 2016 (9 vs. 4), fewer states provided instruction that is explicitly discriminatory to sexual and gender minorities, and ten states require instruction to be culturally responsive, that which includes resources and materials relating to diversity in sexual orientation and gender identity (SIECUS, 2016; 2023). Additionally, five states require comprehensive sex education, guidelines developed by the National Sex Education Standards, that requires instruction on sexual orientation and gender identity (Goldfarb & Lieberman, 2021).

This study found that Millennials reported wanting more information on safe sexual practices compared to other generations. Biomedical advancements in HIV and STI prevention have dramatically increased since the start of the 21st century, such as antibiotic and antiviral suppressant medications for HIV/STI treatment, pre/post-exposure prophylaxis for HIV/STI prevention, and rapid diagnostic testing for HIV/STI testing (Leenen et al., 2020; Montgomery et al., 2021; Unemo, 2021). After the HIV/AIDS epidemic and promotion of abstinence-only sexual health education, most Millennials may have received only abstinence-based instruction that did not include safe sexual practice information (Gowen & Winges-Yanez, 2014; Pingel et al., 2013) and were likely one of the first generations to receive fear-based messages that resulted from the epidemic (Bishop et al., 2021). Indeed, abstinence-based sex education can increase the risk of unintended pregnancy and STIs, including HIV (Lloyd et al., 2012; Stranger-Hall & Hall, 2011), and those who choose to abstain from sexual activity are less likely to use contraception or seek sexual health services (Bruckner & Bearman, 2005; Rosenbaum, 2009). Younger generations reporting this less than Millennials may be due to increasing comprehensive approaches to sexual health education in the U.S. (Lindberg & Kantor, 2021) and that young people often seek sexual health information online (Wartella et al., 2016).

Generation Z respondents indicated a desire to have more information on sexual violence prevention compared to other generations. Media and online representations of sexual violence, consent, and sexual communication (Aroustamian, 2020; Jaffe, 2018) have increased, particularly since the #MeToo movement (Acquaviva et al., 2021). But, these discussions often do not include LGBTQ+ people or relationships (Ison, 2019). Furthermore, LGBTQ+ people experience sexual communication and consent navigation differently than their heterosexual and cisgender peers (de Heer et al., 2021), reiterating prior recommendations that consent resources represent sexual and gender minorities (SGMs) by acknowledging the influences of coercion, power dynamics, and gendered biases on these (Edenfield, 2019). If sexual and gender minorities do receive formal sex education that includes information on sexual violence, it may not be representative of their LGBTQ+ identities, reiterates gender stereotypes of victimization and perpetuation that may not apply to them, or does not provide information on how LGBTQ+ individuals experience sexual and other forms of violences at equal or higher rates than heterosexual and cisgender people (Bloom et al., 2022; Sondag et al., 2020). These are similar to prior research on sexual health and sexual violence prevention education experiences among SGMs expressing heteronormative ideals in sex education create senses of “otherness” (Hobaica & Kwon, 2017), reinforce gender binaries (Keenan, 2017; Kendall, 2013), and discourages LGBTQ+ people from learning about sexual violence (MacAulay et al., 2022).

These findings reiterate just how imperative it is that sex education in the U.S. be inclusive to LGBTQ+ and other marginalized communities. Despite widespread parental, public, and organizational (e.g., American Psychological Association, American Academy of Pediatrics, National Education Association, American Medical Association) support for inclusive and comprehensive sex education (AMA, 2024; Breuner & Mattson, 2016; Eisenberg et al., 2008; 2018; SIECUS, 2018), anti-LGBTQ+ legislation and associated LGBTQ+ stress is increasing, particularly in the aftermath of politically conservative administrations in the U.S. (Gonzalez et al., 2018; Haas & Lannutti, 2024; Lannutti & Galupo, 2019; Veldhuis et al., 2018). These results reflect that while earlier generations yearned for visibility and even acceptance of their existences, younger generations like Millennials and Generation Z may not have had the same experiences of direct misrepresentation or complete invisibility that older individuals received in their sex education (i.e., Generation X, Boomer+). While interventions such as PrEP and doxycycline for HIV and STI prevention provide safer sexual experiences, rates of other STIs and infections (e.g., mpox, syphilis, chlamydia) are still increasing among LGBTQ+ and non-LGBTQ+ people (Hazra et al., 2024; Htet et al., 2023; Ramchandani et al., 2023). With this, sexual health education materials must be attentive to all subgroups of LGBTQ+ individuals to be truly effective in their effort toward health education and promotion. That is, while some aspects of LGBTQ+ visibility, acceptance, and appreciation have improved, there is still much work to be done in terms of health equity, sex education programming and inclusivity, and true representations of all bodies, gender identities, relationship structures, sexual behaviors, and sexual orientations.

Limitations

Though this study used national probability sampling, which facilitates generalizability to the U.S. population, study findings should be considered within the context of study limitations. Of the total sample included for this present study, less than one hundred were adolescents, thus narrowing the ability of this research to include ample description of young peoples’ sexual health education experiences. The measure of sexual health education topic preference was measured with a single open-ended item. Conducting a quantitative study on this topic may provide more opportunity to examine demographic and other differences in topic preferences. Moreover, the one open-ended survey item did not allow for an in-depth examination of LGBTQ+ people’s perspectives of sex education compared to other qualitative methods such as interviews. Additionally, our interpretation of participant responses and their relation to social, cultural, or historic events could have been further discussed and probed during interviews, yielding richer data. Participants were asked which state they lived in; however, participants were not asked which state, states, or country they lived in during their school-aged years.

That is, future research should examine how LGBTQ+ populations view their experiences of school-based sex education in the context of state-level sex education policies, federal legislation or decisions on sexual and reproductive health rights, LGBTQ+ health, and population-level trends in sexual behavior among adolescents and adults in the U.S. Finally, the study used a cross-sectional design, implying correlation but not causation. Future longitudinal research is critically needed to examine how different generations of LGBTQ people experience their school-based sex education throughout time, regions, and other contexts.

Conclusions

This study compared sexual health education experiences across generational cohorts. Findings from this study show that sex education content for LGBTQ+ adolescents have changed little over the last several decades, with changes possibly being informed by social and cultural phenomena. Findings highlight that sexual health education content should be tailored to age levels given that some generations might not have been exposed to certain sexual health promotion topics during their schooling. Findings underscore the continued programmatic and policy need to create LGBTQ-inclusive sex education curriculum for adolescents in this current and future generations. Especially given that sexual health education is highly variable by state, district, and school in the U.S.