Understanding Sexual Consent Among Adolescents: A 30-Year Scoping Review

Abstract

Sexual consent is one of the most important tools used in the prevention of sexual violence, for which adolescents are especially vulnerable. However, it is unclear how sexual consent processes are defined and used by this population. To bridge this gap in knowledge, this scoping review sought to identify and synthesize the existing empirical research findings on sexual consent conceptualizations and processes among adolescents, as well as determine critical gaps in knowledge. Forty-three articles were reviewed following a systematic search of six academic databases. Articles were included if they were original empirical work published in English between January 1990 and March 2020, included adolescents aged 10 to 17 in their sample, and specifically studied sexual consent conceptualization, communication, and/or behavior. Seventeen articles, diverse in study design and geography, met these criteria and were analyzed. The findings suggest a propensity for adolescents to abstractly define sexual consent as verbal and direct in nature while simultaneously espousing indirect and non-verbal behavioral processes when presented with “real life” scenarios (e.g., vignettes, reflections on personal experience). In addition, the results reveal the significance of concepts like gender norms, normative refusals, and silence as key aspects of adolescent sexual consent. This review demonstrates that research on sexual consent among adolescents is highly limited overall, and the findings that are available indicate some concerning perceptions.

1. Introduction

As a result of differing theoretical, ideological, and methodological frameworks, there is a lack of consensus among researchers and theorists regarding the precise definition of sexual consent. Muehlenhard et al. [1] summarized the various representations of sexual consent found in the literature: “consent as an internal state of willingness, consent as an act of explicitly agreeing to something, and consent as behavior that someone else interprets as willingness” (p. 462). Whether sexual consent is an internal attitude, a verbal indication, or implied by behavioral cues continues to be contested, both in professional institutions and among the general public [1,2,3,4]. In spite of this dissensus, a definition from the Criminal Code of Canada [5] may be of use to the reader: “the voluntary agreement of the complainant to engage in the sexual activity in question”.

While there is no universally accepted definition, fundamental conceptualizations of sexual consent have been developed from the legal definition of sexual violence, namely, if sexual violence is “a sexual act that is committed or attempted by another person without freely given consent of the victim or against someone who is unable to consent or refuse”, then sexual consent is the determining factor between rape and “just sex” [3,6]. While this blunt differentiation has clear relevance for the legal system, it is misleading in that it purports a relatively straightforward, black and white process. Meanwhile, the literature indicates that a large range of sexual violations fall into a complex and ambiguous gray zone that is not adequately accounted for in this binary notion [2,7,8,9]. Contemporary social movements like #MeToo have raised awareness and furthered large-scale societal discourse about sexual consent and related issues, like the pervasive nature of sexual violence [8,10]. On the other hand, this movement has also uncovered widespread confusion, contention, and debate among the general public regarding what constitutes sexual consent.

If adults appear to struggle with the complexity of sexual consent, it is reasonable to assume that adolescents may experience even more difficulty understanding and navigating these processes, as they tend to have less sexual experience and knowledge relative to adults. Adolescence has long been identified as a critical developmental period for the exploration and initiation of dating, including sexual activity [11]. Biological changes associated with puberty, combined with changing peer groups and societal pressures of dating and intimacy, lead many early adolescents to begin exploring partnered sexual activity. The available literature demonstrates that a sizeable proportion of adolescents are sexually active—or have intentions to do so in the near future—and are therefore already engaging in the process of negotiating sexual consent, regardless of whether they have access to appropriate sex education or guidance [12,13,14,15]. These circumstances expose adolescents to the possibility of experiencing coercive, non-consensual, or even violent sexual interactions [13,16], which often result in detrimental health outcomes and trauma for survivors [17,18,19]. These adverse outcomes can persist over time, highlighting the need for early and relevant primary prevention programs. Furthermore, research indicates that when adolescents are sexually harmed, a substantial proportion are unlikely to disclose the experience to a trusted adult, exacerbating negative outcomes and preventing access to timely intervention [20,21,22,23,24].

Despite the importance of sexual consent to sexual violence prevention, it remains an understudied topic, particularly among the adolescent population. What we do know about sexual consent is based predominantly on research with undergraduate students and young adults, the vast majority of whom identify as heterosexual [1]. This research highlights that young adults tend to define sexual consent as a process involving mutual willingness, clear communication, and ongoing agreement; however, conceptualizations often vary based on gender, cultural background, and personal experience [1,25,26]. The evidence also suggests that both explicit (i.e., saying “yes”) and implicit or indirect communication strategies (e.g., body language) are used to conceptualize the consent process, although some express concern for the latter as it poses potential for ambiguity or miscommunication [27]. In practice, young adults often rely on non-verbal cues and contextual assumptions—rather than direct dialogue—to ascertain consent, in part due to the discomfort or disruption to intimacy involved [28,29,30].

There is, however, good reason to believe that adolescents and college-aged adults have distinct conceptualizations and processes of sexual consent as a result of their unique developmental stages, puberty, social norms, educational level, impressionability, knowledge, and experience with dating and sex [31,32]. As such, the adolescent age group would benefit from developmentally appropriate and targeted sexual consent education to build a foundation of healthy communication, ensuring high-quality and safe sexual experiences that persist into adulthood [12,32,33,34,35]. Furthermore, each person’s sense of sexual subjectivity—one’s identity as a sexual being—is formed during adolescence and has been shown to be heavily impacted by gender roles and stereotypes [36,37].

Relatedly, sexual scripts are also developed during this time. Theorized by Gagnon and Simon [38], sexual scripts are socially constructed templates for engaging in sexual behavior that allow people to draw from shared cultural understandings to accurately interpret meaning and respond in appropriate ways. Unfortunately, these scripts are often harmful and disempowering, especially for women [39]. Early adolescence is an ideal time to foster resilience and challenge damaging stereotypes before they become taken for granted norms.

Contemporary sex education curricula are heavily informed by miscommunication theory [3,27,40], which theorizes that coercive or non-consensual sex results from misunderstandings between men and women, “in which consent or non-consent is poorly communicated or inaccurately understood” [41]. This heteronormative framework was born out of Tannen’s [42] and Gray’s [43] popular positivist works about the “inherent” differences in language and communication between men and women. It has inspired popular prevention campaign slogans like “no means no” and “what part of the word ‘no’ do you not understand?” [44]. Furthermore, scholars have argued that increasingly popular affirmative consent standards—defined as an informed, unambiguous, enthusiastic, ongoing, and voluntary agreement to participate in a sexual act [45]—found in law and education are predicated on miscommunication theory [46,47].

A commonly cited miscommunication example is that men misinterpret or overestimate women’s desire to participate in a given sexual activity [40,48,49]. Affirmative consent policies attempt to resolve this issue by promoting the expression of sexual consent (or lack thereof) in clear, unambiguous, and verbally communicative ways [50]. Although admirable on its surface, this messaging is often implicitly directed toward girls and women [3,50,51,52]. As noted by Frith and Kitzinger [44], proponents advocate for “improved communication between the sexes”, but advice is commonly directed at “improving women’s communication skills, rather than men’s comprehension skills” (p. 520). Principles of miscommunication theory and affirmative consent fail to account for situations in which women do not feel able to verbalize “no” due to fear of escalated violence [44], social coercion (i.e., “the pressure to adhere to sex role obligations by individuals in an intimate relationship given the social and cultural expectations of their sexual roles,” [53], or emotional manipulation from their partners [40]. Recent conversation analysis of consent in contemporary media by Magnusson and Stevanovic [54] indicates that consent is portrayed as an interactional and embodied practice that need not be strictly unambiguous in order to be meaningful, contrary to the messages in affirmative consent models. Moreover, in most other social contexts, refusals are expressed less directly (e.g., pausing, making excuses, using prefaces, and making palliative statements) to save face or protect the other person’s feelings [50,55,56,57]. Furthermore, some studies have demonstrated that adolescents deem the strict use of verbal consent as unnatural and awkward, suggesting an incongruence between sex education programs and the real, everyday experiences of negotiating sexual consent [55,58,59].

Sex education and prevention efforts can be an important vehicle for changing sexual norms and outcomes. An enhanced understanding of how adolescents truly conceptualize and navigate sexual consent processes will improve the impact and reach of these programs. Rather than assuming that adolescents lack a basic understanding of sexual consent and communication due to their inexperience, it is important that curriculum developers identify their points of competency, as the relevancy of prevention programs relies on this information [27]. Cowling [60] also stresses the importance of sex education, building on participants’ existing knowledge and experiences. A clearer understanding of this issue from an adolescent perspective may facilitate knowledge translation and dissemination efforts so that sex education may better represent their lived reality.

As such, it is critical that we understand how adolescents define and navigate sexual consent processes. Furthermore, the first author’s extensive familiarity with the literature suggests that the evidence base is limited. Therefore, this scoping review study aimed to (1) identify the range, extent, and nature of existing empirical research; (2) synthesize the findings to issue an overview of sexual consent conceptualizations and processes among adolescents; and (3) determine the existing gaps to guide future research in this area [61]. An overarching research question guided this review: what is known from the existing literature about how sexual consent is defined and communicated by adolescents under the age of 18? In other words, this review sought to understand the “what” and “how” of sexual consent among members of this population.

2. Materials and Methods

This study adhered to the five-stage scoping review methodology developed by Arksey and O’Malley [62]. The review’s design was developed in advance of conducting the research and published in a detailed protocol (see [63]). The authors also followed the reporting guidelines delineated in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) Checklist to strengthen the methodological rigour of the review and adhere to reporting standards [64].

2.1. Search Strategy

In consultation with a university social sciences librarian, the authors developed a comprehensive search strategy involving several sources, including electronic databases and the hand searching of reference lists and key journals. Due to the multi-disciplinary nature of sexual consent, six databases spanning a range of disciplines were selected: Education Source, ERIC, Gender Studies Database, PsycINFO, Social Services Abstracts, and Sociological Abstracts. All searches were conducted by the first author on 22 March 2020. Search terms for the following three concepts were developed: adolescents (e.g., adolescent, youth, student, and teenager), sex (e.g., sexual activity, intercourse, and intimacy), and sexual consent (e.g., sexual consent, sexual communication, agreement, and sexual decision making) to create complex search strings that would satisfy the proposed research question. Search strategies were customized for each database and its particular field codes (see

Table 1. Search strategy used for PsycINFO database.

Concept	Search Terms
Adolescent	(MAINSUBJECT.EXACT.EXPLODE(“adolescent development” OR “adolescent attitudes”) OR MAINSUBJECT(“high school students” OR “junior high school students” OR “middle school students”) OR TIAB(adolescen * OR youth * OR student * OR teen * OR “middle school *” OR “high school *” OR child * OR “young person *” OR “young people *” OR “school-age” OR “school-aged *” OR preadolescen *) OR IF(adolescen * OR youth * OR student * OR teen * OR “middle school *” OR “high school *” OR child * OR “young person *” OR “young people *” OR “school-age” OR “school-aged *” OR preadolescen *))
Sex	(MAINSUBJECT.EXACT.EXPLODE(sexology OR intimacy) OR MAINSUBJECT(“psychosexual behavior” OR “physical contact” OR “sexual partners” OR “sexual intercourse (human)”) OR TIAB(sex OR sexual * OR “sexual activit *” OR intercourse * OR “sexual behav *” OR coit * OR copulat * OR intima * OR sexolog * OR “physical * contact *” OR dating * OR “interpersonal * attracti *”) OR IF (sex OR sexual * OR “sexual activit *” OR intercourse * OR “sexual behav *” OR coit * OR copulat * OR intima * OR sexolog * OR “physical * contact *” OR dating * OR “interpersonal * attracti *”))
Sexual consent	(MAINSUBJECT(“interpersonal communication” OR “body language” OR negotiation OR resistance OR “persuasive communication” OR compliance OR coercion OR “peer pressure” OR agency OR “interpersonal control” OR “decision making”) OR TIAB(consen * OR “sex communicat *” OR “sexual * communicat *” OR “sex decision-making *” OR “sexual * decision-making *” OR “sex decision * making *” OR “verbal * communicat *” OR “nonverbal communicat *” OR “nonverbal cue *” OR agreement * OR “body * language *” OR “interpersonal* communicat*” OR “interpersonal * control *” OR convers * OR “peer * pressure *” OR “social * exchang *” OR complian * OR comply * OR resist * OR persua * OR influential * OR influenc * OR negotiat * OR coerci * OR pressure * OR agency * OR agent * OR comprehen * OR dominance * OR choice * OR dilemma * OR judgment *) OR IF(consen * OR “sex communicat *” OR “sexual * communicat *” OR “sex decision-making *” OR “sexual * decision-making *” OR “sex decision * making *” OR “verbal * communicat *” OR “nonverbal communicat *” OR “nonverbal cue *” OR agreement * OR “body * language *” OR “interpersonal * communicat *” OR “interpersonal * control *” OR convers * OR “peer * pressure *” OR “social * exchang *” OR complian * OR comply * OR resist * OR persua * OR influential * OR influenc * OR negotiat * OR coerci * OR pressure * OR agency * OR agent * OR comprehen * OR dominance * OR choice * OR dilemma * OR judgment *))

for an example of the full electronic search strategy used for the PsycINFO database).

2.2. Eligibility Criteria

Per recommendations set out by Arksey and O’Malley [62] and Levac et al. [65], this scoping review implemented a broad and comprehensive approach to produce a breadth of coverage while also using clearly defined parameters for the study concepts and population. Articles were included if they met all of the following criteria: (1) original empirical work published between January 1990 and March 2020; (2) written in English; (3) study sample included school-age preadolescents and adolescents ages 10 to 17; (4) sexual consent conceptualization, communication, or behavior were the main focus of the study’s aims or findings. This time period was chosen due to increased public and research interest in sexual consent issues in the early 1990s following the publication of two best-selling books by Tannen [42] and Gray [43], which were central to legitimizing the miscommunication theory discussed above. In addition, mainstream and academic dialogue were generated following the US Senate Judiciary Committee’s [66] report that declared a “rape epidemic” in 1990 (p. 1). Regarding the sample age criteria, it is noted that if a range of adolescents and young adults were included in the study (e.g., 15 to 21 years), then the reported mean age must be below 18 years. All types of study designs and geographical locations were included. Peer-reviewed journal articles were prioritized, but related gray literature (e.g., government and community organization-authored reports) was also accepted. The following publication types were excluded: master’s or doctoral dissertations, commentaries, editorials, theoretical papers, books, or book reviews, as well as any articles not available online in full-text form.

2.3. Study Selection Process

Covidence, a web-based collaboration software program, was used for the organization and facilitation of study selection. For screening, the titles and abstracts of each article were first reviewed, followed by a full-text review. Both authors independently screened articles to determine whether they met the above-stated eligibility criteria and represented a “best fit” with the research question [62]. When discrepancies in decisions occurred, they met to discuss and resolve conflicts until full consensus was reached. This process resulted in a final list of articles to be included in the review.

2.4. Charting and Analysis

A data charting form was created in Microsoft Excel to extract and organize pertinent information from each article. Based on our research question and objectives, the following data were abstracted: authors, publication year, country (where the research was conducted), study aims, study design and methodology, sample size and characteristics (demographic information and recruitment details), and key findings specific to sexual consent. The abstracted data were then transferred into a summary table. Charting was conducted by both authors independently and then compared to confirm accuracy; any major discrepancies were discussed and resolved collaboratively until agreement was reached. These data constituted the basis of the analysis.

A descriptive numerical summary was also developed as an overview of the article characteristics and for comparison across studies. A qualitative thematic analysis was performed to identify recurrent themes across articles and produce a narrative account of the findings specific to sexual consent [65]. Qualitative analysis software NVivo v12 was used for the analysis [67]. Per the standard scoping review guidelines, no attempts will be made to assess the quality of individual studies [62].

2.5. Trustworthiness and Reflexivity

To ensure methodological rigour, this scoping review was guided by Lincoln and Guba’s [68] four criteria for trustworthiness: credibility, transferability, dependability, and confirmability. Credibility was strengthened via several strategies, including the use of multiple researchers for independent screening, charting, and coding; prolonged engagement with the data; negative case analysis; and triangulation. In addition, the scoping review process was guided by a pre-established protocol [63] to reduce the potential for bias or inconsistent practices. Transferability was addressed by providing detailed and contextualized information for each article, enabling the reader to assess the applicability of the review’s findings to other populations or settings. Clear and transparent reporting of the review process, as well as maintaining detailed documentation in an audit trail, supported the review’s dependability. Finally, confirmability was enhanced through peer debriefing; reflexive memoing; bracketing; and ongoing, critical self-reflection to increase awareness of the authors’ assumptions and subjectivities.

Given the socio-cultural complexity of this topic and the active role of the researcher in thematic analysis and interpretation, an author’s positionality statement is warranted. Both authors are social work researchers who identify as white, cisgender women and acknowledge the privileges and resources they are afforded, given their social location and access to resources. The first author has lived experience as a survivor of sexual violence, and both authors operate under feminist and social constructivist paradigms. These identities and values are relevant to this review, meaningfully informing various decisions and stages of the process. Continuous and critical reflexivity safeguarded the findings against unexamined assumptions, preconceptions, and biases.

3. Results

The six database searches returned 12,052 results, which were imported into Covidence. Of those, 4678 duplicates were identified and removed, resulting in a total of 7374 for title and abstract screening. A total of 7331 articles did not meet the eligibility criteria and were excluded, leaving 43 articles to be subjected to full-text review. A hand search of the reference lists from these 43 publications resulted in 1 additional article included in the full-text review. Initially, the authors independently reviewed the articles and followed the eligibility criteria strictly. However, one of the criteria—sexual consent conceptualization, communication, or behavior as the main focus of the study’s aims or findings—severely limited the final sample to only four articles [32,55,58,69]. After a discussion, it was determined that the authors would return to the full-text review stage and lower the threshold for criteria to include articles that incorporate some data relevant to sexual consent and the research question, despite it not being the main focus of these studies. Following this process, 17 articles were included for abstraction and analysis. It should be noted that two of these articles came from the same cross-sectional study [70,71]; however, since the analyses differed and produced varying results related to sexual consent, they were both included. See Figure 1 for the PRISMA-ScR flow diagram depicting the screening process.

As reported in

Table 2. Overview of study characteristics.

Characteristics	Number (n)	%
Year of publication
1990–2000	5	29.4%
2001–2010	4	23.5%
2011–2020	8	47.1%
Location
USA	7	41.2%
UK	5	29.4%
Australia	2	11.8%
Finland	1	5.9%
Denmark	1	5.9%
South Africa	1	5.9%
Study design
Quantitative	3	17.7%
Qualitative	10	58.8%
Mixed methods	4	23.5%

, the majority of studies were qualitative (n = 10), conducted in the USA (n = 7) or the UK (n = 5), and published between 2011 and 2020 (n = 8).

Table 3. Summary of reviewed studies.

Authors (Year)	Country	Aims	Design	Sample Size and Characteristics	Key Findings
Anderson et al. (2004) [72]	USA	Examine middle school, high school, and university students’ endorsement of rules and rape myths; determine age and gender differences	Quantitative: cross-sectional survey	n = 361 Middle school, high school, and university students from Indiana Communities Against Rape Project collected in 1998. A total of 62% women. Ages 11–35 years (mean age = 16.4)	Younger student age and identifying as a boy were related to significantly higher endorsement of rape-supportive rules compared to older students and identifying a girl. The majority of middle school and high school boys believed that consent had been given if a woman kisses, touches, grabs, or pets a man (93.0% and 57.6%, respectively) or if she does not say no (70.5% and 51.2%, respectively). A total of 52.5% of middle school girls believed consent was given if a woman kisses, touches, grabs, or pets a man (46.5% of high school girls) or if a woman teases a man about his sexual prowess.
Bindesbøl Holm Johansen et al. (2020) [55]	Denmark	Explore how young people interpret sexual consent in relation to non-consent; explore how these notions are informed by discourses and experiences of unwanted sex	Qualitative: participant observation, focus groups, individual interviews	n = 74 Participants recruited from youth centres and schools in 2015–2016. A total of 57% women. Ages 15–27 years (majority 16–19 years)	Notions of consent reflect a situated “sensing” denoted by non-verbal bodily reciprocity, while non-consent is communicated either verbally or through bodily non-reciprocity. Most participants deemed verbal confirmation of consent “awkward”. An “ethic of care” for the other sexual partner was demonstrated, dependent upon the relational context. Perceptions are influenced by gendered norms.
Brady & Lowe (2020) [69]	UK	Explore young women’s accounts of sex and relationship education, being in relationships, negotiating sexual consent, and perceptions of sexual exploitation	Qualitative: semi-structured focus groups	n = 27 under 18 (54 total) Youth recruited from local colleges, youth clubs, and specialist support services. A total of 69% women. Ages 14–25 years	A “range of embodied communication strategies” (combination of verbal and physical signs) used to demonstrate and interpret consent. Gendered norms and pressures made consent “unclear”, especially within partnerships, as many acquiesced to sex to please their partner or avoid potential conflict. Participants described feeling pressured and sometimes manipulated by their partners to engage in sexual activity they did not necessarily want.
Clüver et al. (2013) [73]	South Africa	Explore lived experiences of sexual coercion, manipulation, and pressure among Black school-going adolescent women	Qualitative: semi-structured individual interviews	n = 4 Young Black women living in Eastern Cape and attending school, recruited from a volunteer focus group. Ages 16–17	Communication of non-consent (refusals) was attempted via direct (verbal) and indirect (e.g., asking for time to think) methods; the male sexual partners, in response, tried to overrule or ignore these refusals. Within romantic partnerships, the participants were better able to communicate their discomfort and unwillingness in direct and verbal ways. These refusals, however, were met with chronic/unrelenting pressure and persuasive and/or manipulative tactics (e.g., expressing love, accusations).
Coy et al. (2013) [58]	UK	Explore young people’s perceptions of consent; explore what informs, influences, and constrains their understandings and decision-making processes	Mixed methods: online cross-sectional survey, focus groups, and individual interviews	n = 607 Youth recruited via social networks, schools, and youth services. A total of 63% women. Ages 13–20	Participants understood how to give consent to sex but had a limited understanding of getting or obtaining consent. Discrepancies were found between “in theory” definitions of non-consent vs. those presented in real life scenarios (vignettes). Many rely on visual (non-verbal) signals for consent communication. Understandings of consent was strongly impacted by gender and constructions of masculinity and femininity, leading to sexual double standards. Rape was largely perceived as forced sex between strangers.
Donovan (1996) [74]	UK	Examine young people’s perceptions of the effect of alcohol on women’s sexual behavior and the gendered conclusions drawn from these perceptions	Qualitative: focus groups	n not stated (10 “heterosexual” focus groups conducted) Young people recruited by a market research recruiter in 1994. Ages 16–19	All participants believed that women are more likely to have sex if they have drunk alcohol. Different perceptions of consent were found based on participant gender—the young women thought that being drunk indicated a lack of capacity to say what she wants, while the young men thought that alcohol gives women less will to resist or say no. Young women also believed that regardless of their intoxication state, they know when or whether they want sex but also recognized the strong influence of men’s pressure.
Gilmore et al. (1996) [75]	USA	Elucidate the cognitive and emotional basis of sexual decision making among young inner city Black adolescents	Qualitative: focus groups	n = 27 Young Black men recruited via social service agencies in Milwaukee. Ages 15–19 (mean age = 16.6)	The participants communicated their desire for sex with women in a variety of ways, including through indirect questioning (e.g., asking the last time she had sex, if they could lay in bed with her), non-verbal cues (e.g., holding up a condom), or insincere flattery (e.g., “sweet talking”). Some indicated that they don’t ask, believing that sex will “just happen” if two people are in love. Many participants thought it was inappropriate/wrong to be too direct or use force; they also agreed that initiating under the assumption that she wants sex is risky.
Hird (2000) [76]	UK	Evaluate the significance of gender on psychological, physical, and sexual aggression in heterosexual dating relationships; explore the meaning and context of adolescent dating violence	Mixed methods: cross-sectional survey, semi-structured focus groups, and individual interviews	n = 487 Students recruited from two secondary schools in South Midlands. A total of 50.3% women. Ages 13–19	All focus group and interview participants agreed that non-consent to sexual intercourse constitutes rape; however, communication of refusal differed by participant gender. The girls indicated that verbal expressions of non-consent were sufficient, while most boys deemed both physical (e.g., body movements like pushing hand away) and verbal expressions necessary. The boys thought that girls’ use of verbal non-consent means that they can be persuaded (“get her into it”), while the girls were clear that “no does not mean yes”, but noted that they sometimes “give in” to “shut them up”.
Hirschman et al. (2006) [77]	USA	Explore the relationship between self-objectification and sexuality among late-adolescent girls	Mixed methods: cross-sectional survey, semi-structured interviews	n = 116 Late adolescent girls from a northeastern US urban school district recruited as part of a larger longitudinal study of adolescent sexual health. Ages 16–19 (mean age = 17.3)	The second theme (“communication of sexual desires and boundaries”) found that the more self-objectified girls had difficulty communicating with their partners in general; they were also much better at communicating sexual boundaries versus desires. These girls communicated their non-consent verbally and directly (i.e., saying “no”), although one participant communicated her boundaries indirectly through mutual friends. The less self-objectified girls were comfortable discussing sexual boundaries and desires openly with their partners.
Michels et al. (2005) [34]	USA	Understand how young adolescents make decisions to engage in early sexual activities to develop a model of decision making	Qualitative: individual interviews	n = 42 Grade nine adolescents at a large suburban public high school recruited from a larger longitudinal study on sexual behavior and risk perceptions. A total of 52.4% women. Mean age = 14.1	Boundary communication was fourth in the authors’ decision-making model. Some participants communicated boundaries to prospective sexual partners before any sexual activity. A minority of girls and many boys negotiated and communicated their limits in the moment. Some girls mistakenly assumed that partners shared their same feelings on sex and did not discuss their personal boundaries in advance, leading to discomfort and a need for refusal in the moment. The boy participants expressed their boundaries both directly (verbally) and indirectly (e.g., making up excuses, small gestures).
Norris et al. (2015) [78]	USA	Explore strategies young adolescent girls use to resist peer pressure to engage in sexual behavior	Mixed methods: open-ended survey	n = 44 Early adolescent Latino girls recruited from after school program in Orlando, Florida in 2010. Ages 11–14 (median age = 12.0)	The majority of participant responses (74%) reflected the REAL (refuse, explain, avoid, leave) typology: 16% fit the refuse definition (e.g., “say no”); 25% resisted through explanation by deferring to situational factors, previous commitments, moral grounds/age-appropriate norms (e.g., “I am too young for that”), or safety issues (e.g., “you can get diseases”); 17% of the responses reflected either proactive (e.g., staying home) or reactive (e.g., ignoring the person) avoidance; and 15% of the responses involved leaving the immediate situation or in general (e.g., walking home). In addition, 11% of responses were coded as yielding to pressure, and 8% of responses reflected examples of verbal (e.g., “back off”) or physical aggression (e.g., “slap them”).
Ott et al. (2012) [79]	USA	Examine contextual narratives regarding first sexual experiences among young boys	Qualitative: semi-structured individual interviews	n = 14 Adolescent boys recruited from a primary care clinic for low-income neighborhoods in Indianapolis. Ages 14–16	The dominant narrative had 3 steps: preparation, the event, and afterwards. In preparation, participants had early conversations to assess their partner’s interest and potential consent (i.e., checking if she would feel comfortable saying “no”). During the event, female initiation almost always involved non-verbal “obvious” cues (e.g., leading them to bed, giving a condom). Two exceptions of verbal consent were noted (e.g., “I want to have sex with you”).
Righi et al. (2021) [32]	USA	Examine perceptions of sexual consent among adolescents	Qualitative: semi-structured individual interviews	n = 29 Adolescents recruited from two high schools: a public charter school and a private school. A total of 61.0% women. Ages 14–18 (mean age = 17.0)	Consistent with the affirmative consent standard, sexual consent was defined straightforwardly as verbally saying “yes”. However, when describing consent in practice, participants shared non-verbal indications of agreement (e.g., kissing, removing clothing) and both verbal and non-verbal indications of refusal (e.g., pushing away). Participants perceived girls as primarily responsible for communicating consent. The absence of sexual refusal (silence) was deemed an indicator of consent and even enjoyment. Boy participants believed it was “easy” for girls to “say no”, where girl participants were more comfortable with non-verbal indicators. Participants believed that re-establishing consent after the first sexual encounter is unnecessary. In long-term relationships, participants believed that partners “know” each other well enough to forego verbal confirmation of consent.
Rosenthal & Peart (1996) [71]	Australia	Examine the rules used by adolescents to guide behavior in a sexual encounter. Explore subtle forms of coercion and understand influence of heteronormative and gendered expectations on beliefs/behavior	Quantitative: cross-sectional survey	n = 191 Adolescents recruited through youth workers in Melbourne and surrounding country. A total of 48.7% women. Ages 15–17 (mean age = 16.3)	The majority of participants indicated that “giving the message” (sexual interest) was most clear via strategies like “parking with them in a car” or “being in a house alone with them;” few gender differences were found. Strategies to avoid unwanted sex were more likely to be acceptable by girls when direct (e.g., stating rules at the start, telling their partner when they have gone too far). Avoidance strategies most used by both girls and boys were offering an excuse, delaying, and distracting their partner.
Rosenthal (1997) [70]	Australia	Study young people’s understanding of sexual coercion. Examine perceptions of communication clarity, level of pressure, and acceptability in response to scenarios	Quantitative: cross-sectional survey	n = 191 Adolescents recruited through youth workers in Melbourne and surrounding country. A total of 48.7% women. Ages 15–17 (mean age = 16.3)	Consent or agreement to sex was more readily recognized by participants as clear communication than non-consent or dissent. Furthermore, the absence of discussion depicted in some of the scenarios was also interpreted as clear communication. Participants’ reporting of pressure was influenced by the outcome (i.e., whether sex occurred or not), with the lowest pressure rating endorsed in those scenarios where sex occurred.
Suvivuo et al. (2010) [80]	Finland	Examine the sexual scripts found in adolescent girls’ narratives of sexually motivating situations. Explore how different scripts are associated with sexually risky behavior	Qualitative: written, open-ended narrative	n = 173 Ninth-grade girls recruited from six European Network for Health Promotion Schools. Ages 14–15	Five scripts were found among the narratives: romantic script, script of rational sex, experience-seeking script, script of desire, and script of postponing intercourse. In romantic, participants described a “naturalness” that did not require direct communication; rather, body language provides knowledge of desire/motive (e.g., “I saw it from his eyes”). Those that endorsed the romantic script also felt pressure to please their partner/consent despite not wanting to (e.g., “it made it difficult for me to say no because I knew my boyfriend wanted it and I loved him”). Other script types (rational sex, postponing) included some form of verbal consent communication (e.g., “I said I don’t want to and we stopped”).
Whittington (2019) [81]	UK	Explore and co-produce an account of sexual consent with young people	Qualitative: participatory action research, participant observation, group discussions	n = 103 Young people recruited from seven sites (e.g., secondary schools, youth clubs, supportive living). A total of 69.0% women. Ages 13–25	Participants began with very limited knowledge of sexual consent from school. Over time, they began to think critically and recognize the complexity of consent by describing it as “mutual” and “withdrawable”. Participants believed that consent must be sought “every time”. Non-verbal cues like body language were seen as risky, as they can be misinterpreted. Some participants thought that consent disrupts the flow and “ruins the moment”.

provides additional detail regarding each study based on data abstraction and charting.

3.1. Definitions and Conceptualizations

The first part of this study’s research question sought to understand how sexual consent was defined and conceptualized by adolescents. A total of 5 of the 17 included studies elicited participants’ sexual consent definitions abstractly (i.e., not in response to “real life” or applied scenarios like vignettes, reflecting on personal experiences, etc.). When participants explained sexual consent in these theoretical terms, they tended to employ terms like agreement, permission, approval, mutual, and voluntary [32,58,76,81]. They also endorsed the idea that sexual consent (or non-consent) should be communicated verbally, directly, and clearly. In Righi and colleagues’ [32] work, participants saw verbal consent as a relatively straightforward process and “the result of a spoken conversation, with most including ‘yes’, ‘no’, or ‘permission’ in the definition” (p. 9). For the participants in Hird’s [76] study, verbally expressing non-consent was necessary to prevent misunderstandings between men and women. These findings align with those reported in one of the quantitative studies, which showed that the majority of their sample believed a man can assume a woman wants to have sex when she “does not say no” [72]. However, an exception is noted in one study by Bindesbøl Holm Johansen and colleagues [55], who reported that their sample of young people (aged 16 to 19) described sexual consent as involving a range of non-verbal cues. These participants used the term “sensing” to represent situated bodily reciprocity, in which the other person expresses interest in sex by responding in kind (e.g., returning a kiss, touching the other person’s body, or removing clothes). In the absence of these signs, these adolescents indicated that they would then turn to verbal confirmation to verify that the other person would like to continue.

Another emergent theme regarding perceptions of sexual consent was that it was often understood in relation to the legal concept of rape, which was mentioned in eight articles. This was evidenced by the notion that rape is the absence of consent [58,75,76], or, similarly, that rape is someone proceeding beyond a verbal “no” [32,58,74,76,79]. For instance, two quotes from interviews with 17-year-olds illustrated these sentiments: “sex without consent I suppose that is rape” and “it’s all about permission because you can’t force someone to have sex with you, that’s rape” [58]. Furthermore, in order to prevent inadvertent rape or coercion, a teenage boy from Ott et al.’s [79] study had initiated consent conversations with his partner in advance of sexual activity to ensure that she would feel comfortable saying “no” to him. In a related vein, some participants reflected on past experiences of pressured and unwanted sex, likening their emotional responses to those of someone who had been raped despite not using the legal definition to label their experience [69,73].

3.2. Communication Strategies and Processes

Although the findings above show that sexual consent was indicated as being communicated via verbal and direct means, several studies also revealed that when discussing behavioral processes, adolescents relayed indirect and non-verbal strategies. This theme was present to some extent in all 17 of the articles and often emerged when researchers provided participants with a consent-related scenario (i.e., vignette) or asked participants to reflect on their past experiences. Some specific examples of these communication processes included conveying desires through mutual friends [77], mentioning or presenting contraception [71,75,79], making sexual jokes or “talking dirty” [71,79], and having conversations days in advance [34,77,79].

More generally, what emerged in the qualitative data was a more implicit and somatic-oriented approach to participants (1) ascertaining that their partner was consenting (or not) to sexual activity and (2) demonstrating to their partner that they were consenting (or not) to sexual activity. This approach can be summed up by the interpretation of body language, such as facial expressions, reciprocated intimacy, tensing up or freezing, removing clothing, touching, moving away, and other non-verbal cues. Since this process was less concrete or tangible than their definition of sexual consent, some of the authors reflected the adolescents’ difficulties in articulating it. A range of terms were employed by the participants: embodied communication strategies [69], “sensing” [55], a “presence” [34], being involved or “part of it” [58], and a “vibe” or “hunch” [32]. Adolescent boys from two of the articles were quoted as saying “people don’t really talk anymore, it’s more of a hands-on thing like if you move a certain direction like if you’re showing attention to the matter then that’s just enough” [32] and “you don’t need to ask, you can just feel it” [58].

Bindesbøl Holm Johansen and colleagues [55] identified “situated bodily reciprocity” (p. 8) as the reciprocation of certain actions (e.g., kissing back and taking the other’s clothing off) to indicate consent to sexual activity. In their sample, situated bodily reciprocity or “sensing” was the preferable option compared to verbal confirmation, which was considered awkward and even “a bit taboo” (p. 9). This sentiment was echoed by some of the young people in Whittington’s [81] study, who felt that explicit discussions about consent can “disrupt the flow” and “ruin the moment” (p. 211). A study using quantitative data supports these ideas, in which the majority of middle and high school students agreed that a man can expect sex from a woman if she “kissed, grabbed, or petted” him [72].

Another theme that emerged regarding consent communication and negotiation was the use of normative refusals, particularly among girls participating in the research. Normative refusals are discursive tools used in a range of everyday conversations to politely indicate one’s dissent so as to save face, protect the other person’s feelings, or otherwise prevent any negative consequences that might result from a direct “no” [57]. Examples of normative refusals might include delaying, making excuses or justifications, changing the subject, prefacing, and making palliative statements [57,82]. Normative refusals, in some form, appeared in nine of the articles. Most often, excuses were offered to show disinterest. As put by one girl in a focus group, “Then you kind of beat about the bush and say no. All the excuses you give are brushed aside and by the end you need more excuses” [55]. Despite some adolescents’ (mostly boys) assertion that verbal refusal is easy for girls [32,55,58], several of the findings reflected the immense difficulty and discomfort that girls experienced when refusing unwanted sex [58,69,73,80], evidenced by excerpts like “I didn’t want to hurt his feelings” [80] and “I didn’t want to make him feel bad” [73]. It should be noted that four of the articles described results that run counter to this theme, in which girls reported using a direct and verbal “no” to decline sexual activity [76,77,78,80].

A related theme, noted in seven of the papers, was the notion that silence was deemed a valid form of consent. In other words, the absence of refusal or dissent was seen as consent. This concept is concerning and again tended to be voiced by the boys in the study samples. The quantitative analyses revealed participants’ beliefs that desire for sex can be assumed if a woman “does not say no” [72], “just letting it happen” is an acceptable strategy to show your partner you want sex [71], and the absence of discussion represents clear communication between prospective partners [70]. The qualitative studies can help elucidate these results. For instance, the idea that “going along with it” was an implicit agreement to sex was found in Coy et al.’s [58] study; as stated by a 17-year-old boy, “if a girl didn’t want to, she would clearly state that…if they didn’t, most people would assume it was alright to carry on” (p. 60). Similar beliefs were noted in other research, even when excessive alcohol use was taken into consideration [74]. A related process was identified by the participants in Righi and colleagues’ [32] research, who stated that people—usually boys and men—initiate sexual activity to test their partner’s boundaries and see whether or not they outwardly object. If they did not, it was inferred that the other person was agreeing to continue. Furthermore, in the same study, the majority of participants (girls and boys) saw silence as evidence of sexual desire and enjoyment, with one girl asserting that “not saying anything, that probably means you like it” [32].

4. Discussion

As demonstrated in this review, the research regarding sexual consent among adolescents between 1990 and 2020 is highly limited, confirming the authors’ suspicions regarding the gap in empirical knowledge. Despite the application of an extensive search strategy and the authors’ choice to widen the inclusion criteria, only 17 articles (from 16 studies) were found. The studies were geographically diverse and relatively balanced in terms of research design (i.e., qualitative, quantitative, and mixed methods). However, the findings indicate that, thus far, adolescent sexual consent research has been conducted through a heteronormative and cisgender lens, revealing a significant lack of understanding of queer, transgender, and non-binary voices and experiences.

The findings indicate that adolescents’ sexual consent definitions and conceptualizations were primarily expressed as a type of voluntary agreement made between two people, which is typically negotiated verbally and directly. However, a notable inconsistency was observed between these abstract constructs and the applied, behavioral practices that adolescents described, which were often framed as being indirect and non-verbal. Indeed, three articles [32,55,58] explicitly identified the co-existence of dual sexual consent notions that emerged from their data.

This contradiction between theory and practice may reflect the ubiquitous infusion of miscommunication theory and affirmative consent ideals in sex education, public health campaigns, news coverage, and feminist activism [83,84]. Rather than simply a reflection of reality, Frith and Kitzinger [44] hypothesized that the popularity of these principles is due to the social functions that they serve—namely, to provide women with (1) an illusory sense of control and empowerment in preventing sexual violence and (2) a way to rationalize their continued participation in heterosexual relationships. By believing that a coercive partner is unaware (but innocent and well-intentioned) and that future instances of sexual violence can be prevented by improving one’s communication, these objectives are accomplished. These hypothesized social functions have been corroborated in contemporary research, detailing the complex ways in which they provide girls and women with an illusory sense of safety and protection [40,85,86,87].

Both miscommunication theory and the affirmative consent standard risk perpetuating our heteropatriarchal culture by emphasizing individual behavior over the impact of broader systemic and structural factors, particularly the unequal distribution of power between men and women [2,44,88,89]. Therefore, adolescents’ description of sexual consent as verbal and direct may demonstrate their exposure to miscommunication discourse and the unconscious perpetuation of these social norms. Social desirability bias may have also played a role in participants’ responses, given that this messaging is what they have been taught and therefore what they “should” emulate.

On the other hand, the more nuanced behavioral perspective (that incorporates non-verbal and/or indirect approaches) expressed by participants may actually be closer to the lived realities of adolescents. It may also, to some degree, represent the behavioral processes modeled in mainstream media. Media sources, including movies, television, music, social media, and pornography, have been shown to be powerful socializing agents for adolescents [90,91,92]. Several content analyses have been conducted to examine the portrayal of sexual consent communication in a range of popular entertainment media, all of which reported that implicit and non-verbal cues were most frequently depicted compared to all other types [90,93,94,95,96]. Media conversation analysis by Magnusson and Stevanovic [54] revealed the depiction of complex and multi-modal interactional processes that combine verbal and embodied resources, suggesting that more nuanced and context-specific examples can be found in mainstream entertainment. Over time, exposure to these portrayals can be internalized by children and adolescents and become an important part of their developing sexual scripts.

Another interpretation of these results is that prevailing adolescent social norms emphasize several principles, including tact, tone perception, and non-verbal comprehension, as important in all kinds of conversations and negotiations [97]. As such, adolescents may instinctively apply these non-verbal communication standards to sexual consent. This theory is supported by some participants’ opinions that direct and/or verbal consent is awkward and unnatural. A byproduct of this phenomenon appears in another finding from this review, in which girls endorsed the use of normative refusals to convey non-consent. In everyday conversation, it is considered rude and unusual to issue a straightforward and direct “no” to any sort of offer or invitation [57]. As previously discussed, refusals are conveyed in much more nuanced ways, and it is reasonable to surmise that sexual refusals have higher stakes than those in other circumstances, especially for adolescents. Concerns of offending the other person, jeopardizing the relationship, or having their “no” not be respected are among the many reasons why many girls and women do not refuse verbally and directly [57,59]. Indeed, women’s preference for and use of normative refusals to decline sex has also been demonstrated in research with young adults [59,98,99,100]. Although there is some debate as to whether boys and men are capable of accurately interpreting normative refusals, the evidence generally suggests that they do possess the level of sophisticated comprehension required [48,52]. Some have argued that consent “misunderstandings” by men serve as justifications for sexual violence and coercion, allowing them to evade personal or legal accountability [52,57].

This review uncovered another unsettling belief among some adolescents that sexual consent may be assumed if the other person is silent or does not resist. The practice in which boys “test girls’ boundaries” by initiating sexual activity and waiting for an overt (often verbal) opposition was demonstrated in some of the findings. Consequently, the onus of sexual consent (and ultimately, whether sexual activity ensues) is placed on girls. As noted by Coy et al. [58], “young people understand what is meant by giving consent to sex, but have a very limited sense of what getting consent might involve”. This process is not reflective of an active and enthusiastic consent standard and epitomizes the traditional sexual script containing “gatekeeper” and “initiator” roles for women and men, respectively [2,101]. Boys are conditioned to actively, persistently, and even aggressively pursue sex with women, while girls are socialized to assume a passive role and either allow or resist men’s sexual advances [39]. There are several adverse implications of this script for both parties; namely, that women’s sexual agency is effectively eradicated, men’s consent becomes assumed and ever-present, and men’s responsibility to solicit and obtain consent is made obsolete [2,102]. These effects have clear consequences for heterosexual consent and are again echoed in studies with young adults [26,27,103].

Through an exhaustive review of the extant literature, our findings reveal not only a dearth of literature pertaining to adolescents’ conceptualizations of sexual consent but also that the research has focused almost entirely on heteronormative and gender-binary considerations. This review confirmed that empirical research is missing knowledge and evidence of consent and sexual scripts regarding same-sex relationships, as well as those of transgender and non-binary experiences. As research uncovered through the review tended to focus on Western and/or High-Income Country contexts, less is known about other cultural norms and trends regarding sexual consent and communication. Future research would benefit greatly from expanding the scope of identity-based group experiences to provide a more complex and diversified understanding of this issue.

4.1. Implications

There are several practice, policy, and research implications that emerge from these findings. First, practitioners working in sexual violence prevention and intervention can use these results to inform their work with adolescent survivors and perpetrators. Providing both groups with effective treatment requires an understanding of how adolescents conceptualize and practice sexual consent that is grounded in empirical research. This awareness can facilitate meaningful therapeutic discourse that challenges and shifts harmful social norms about consent, rape, and gender, encouraging resilience and behavioral change in adolescents. On the other hand, without this understanding, clinicians may inadvertently reinforce or uphold aspects of miscommunication theory and/or sexual scripts that further shield perpetrators and emphasize the victim’s role in their own sexual assault [86]. By the same token, these findings can be applied to sex education as a primary vehicle for shifting sexual norms and scripts as well as in the development of nuanced prevention programming based on sexual ethics versus the “yes/no” binary [56]. The conclusions derived from this review can provide educators and policymakers with a better sense of adolescents’ baseline knowledge and perspectives that can be expanded upon [60], ensuring that the content is relevant to their audience.

In-school sex education is long-form and offers the distinct advantage of time to explore these complex issues in detail [27]. However, sexual violence prevention in the form of awareness-raising campaigns can be more challenging. It is difficult to adequately convey the nuance of sexual consent in a short, pithy statement or a 30 s commercial, for instance [27]. That said, the findings from this study provide some insight into what language and messaging would be most effective for adolescents in order to improve the impact and reach of these campaigns and address the uncovered misconceptions—for example, a social media post that states, “This is what ‘no’ can look like” alongside graphics or brief video clips depicting non-consent in the form of non-verbal cues and normative refusals. Another example comes from the Sexual Assault Voices of Edmonton [104], which created posters with the statement, “Just because she isn’t saying no… doesn’t mean she’s saying yes.” Research that probes the impact of these and other sexual consent advisories may be beneficial and merits further exploration.

Overall, there is a clear need for more exploratory empirical research on this topic, since only four publications were found with a direct focus on sexual consent among adolescents. Future research should also examine and compare sexual consent processes among LGBTQ+ adolescents and those in same-sex relationships with heterosexual and cisgender adolescents, as there is an extreme paucity of data for this population; most of the extant sexual consent research assumes a heterosexual framework [105]. Research that has intersectionally explored such topics with regard to race, ethnicity, religion/spirituality, and cultural norms is also notably missing and could shed more nuanced light on these experiences as well as the internalized, culturally-rooted messaging to which young people are exposed. It would be interesting to examine whether and how the findings reviewed here would apply to a more diverse range of populations. There is also a lack of evaluation research regarding education programs that operate using miscommunication theory as their approach [3]. Critical evaluation of these programs could support advocacy efforts for more progressive programs that employ feminist principles and deconstruct gendered stereotypes. Finally, future studies (e.g., scoping reviews, meta-analyses) on this issue are important to extend and compare these findings beyond 2020. Given the widespread awareness of the #MeToo movement that saw global virality beginning in October 2017 [106] and the direct relevance of this movement to adolescents’ sexual consent understanding, this timeframe is critical to capture. Although this review’s end date of March 2020 likely preceded the majority of research examining the movement’s impact, it can serve as a valuable foundation to assess subsequent developments in this area.

4.2. Limitations

This study’s findings should be considered in light of some methodological limitations. First, the search only included articles published in English between January 1990 and March 2020, which may have led to the exclusion of relevant research published in other languages—limiting cross-cultural observations—or outside of this timeframe. Due to publication delays and resource constraints, the search was conducted and completed in March 2020, limiting the relevancy of the conclusions drawn to this time period. As noted above, important studies published in later years were excluded, including influential research sparked by the global #MeToo movement. Future research efforts to assess the impact of the #MeToo movement on adolescent sexual consent can use this study as a critical point of departure or baseline against which to measure change. Despite this shortcoming, this study contributes significantly to the field by offering a “snapshot” of three decades of synthesized data using broad and comprehensive search strategies (several sources, multiple disciplines, international studies, few exclusion criteria).

In addition, our search for gray literature was largely performed by hand-searching the reference lists of relevant articles—it is possible that less-cited or inaccessible reports were inadvertently omitted. Although the included articles were geographically diverse, most studies were conducted in Western societies and are therefore likely to denote culturally bound and limited perspectives. Relatedly, the results cannot be applied or generalized to other countries and cultures. Finally, due to the nature of a scoping review, the methodological quality of the studies was not evaluated. Systematic reviews that formally examine the quality of studies are recommended as future research efforts.

5. Conclusions

This review confirms that research regarding sexual consent, specifically among adolescents, is scant. In the literature that was identified, a range of potentially harmful inconsistencies were noted in adolescents’ definitions and conceptualizations of consent, in addition to how abstract constructs and communication approaches were applied in actual, real-life scenarios. There are opportunities—and arguably an onus—for future research, intervention development and evaluation, and comprehensive sex education to focus more specifically on adolescents, as well as to diversify the consideration of such topics beyond heteronormative, cisgender, gender-binary, and Western notions of sexual norms and practices.