Sexes, Volume 6, Issue 4 (December 2025) – 10 articles

Prepubescent children and young adolescents (ages 7–14) are in a critical developmental stage for establishing the foundations of healthy sexual behavior. Increasing rates of precocious puberty, combined with limited access to accurate and age-appropriate sexual health education, heighten the vulnerability of this age group to sexual health risks. These risks include early and often coerced sexual initiation, exposure to sexual abuse, and consequent outcomes such as sexually transmitted infections and early pregnancies. However, comprehensive cross-regional analyses and evidence-based interventions addressing the sexual health needs of this age group remain limited. Addressing this gap promotes mutual learning, context-specific adaptation, and global alignment of sexual health support efforts, crucial for achieving the Sustainable Development Goal target of universal access to sexual and reproductive health care. This scoping review aims to map the available evidence on the scope and characteristics of sexual health interventions for prepubescents and young adolescents in the United States and Sub-Saharan Africa. The proposed scoping review will be conducted in accordance with the Arksey and O’Malley framework and Joanna Briggs Institute (JBI) methodology for scoping review. A systematic search of English-language articles published from 2010–2025 will be conducted across PubMed, CINAHL, PsycINFO, Scopus, Web of Science, ERIC, and African Index Medicus. Five reviewers will screen the articles in Covidence and independently assess full-text articles using a standardized data extraction form. Discrepancies will be resolved through discussion and with a sixth reviewer. The review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Data will be summarized and synthesized to identify patterns in interventions, delivery methods, outcomes, and implications for practice, research, and policy. Comparative and gap analyses will highlight similarities, differences, and priorities for future research and interventions. An adolescent sexual health expert will help validate and contextualize findings. Results can guide strategies to address shared challenges and advance universal access to sexual health support for prepubescents and young adolescents. Full article

In recent years, the sexual and reproductive health of adolescents and young adults (ages 10–24) in Africa has improved through national and international initiatives. However, major challenges remain in enabling young people to exercise their sexual and reproductive health rights (SRHRs), especially in Côte d’Ivoire. This study aimed to explore the perspectives of stakeholders on the freedom of choice of adolescents and young adults with regard to SRHRs in Haut-Sassandra, Côte d’Ivoire. We conducted this qualitative descriptive study between September and October 2023. Participants were selected using a purposive sampling method. Overall, 137 stakeholders participated in the study: 57 teachers and administrators, 17 community leaders, and 63 parents. Data were collected through interviews and focus groups, using an interview guide. Through a deductive thematic approach, we identified three forms of freedom of choice: conditional, absent, and absolute. The average age of the study participants was 46.1 years. The findings reveal that several factors influence the freedom of choice among adolescents and young adults regarding their SRHRs. These include age, gender, parental involvement, prior education, autonomy, and perceived maturity. Limited freedom was commonly associated with younger age (10–18 years), perceived immaturity, and a lack of autonomy. In contrast, greater freedom was linked to older age (18–24 years) and higher levels of perceived maturity. Stakeholders’ perspectives were shaped by cultural and religious norms, a protective attitude toward youth, and a sense of disengagement from adolescent concerns. This study underscores the importance of interventions aimed at increasing stakeholders’ knowledge and awareness of adolescents’ sexual and reproductive rights. Full article

Background/Objectives: The main contraceptive options for men are condoms, vasectomy and coitus interruptus. Clinical and preclinical trials are being conducted to develop a new male contraceptive (NMC), which can be either hormonal or non-hormonal. A patent landscape and literature review of clinical studies from the last 10 years were carried out to discuss clinical perspectives and sociocultural aspects related to the use of NMC. Methods: An integrative review of clinical aspects was conducted using eleven clinical trials, and a discussion of sociocultural aspects was conducted using thirteen articles. Results: Studies of non-hormonal contraceptives, particularly vaso-occlusive methods, are in more advanced clinical phases, demonstrating contraceptive potential and reversibility. In addition to clinical trials, efforts to develop NMC include addressing gender disparities and understanding masculinity. Alternative technologies and methods for contraception were identified as key to the development of NMC. Despite clinical and technological advances, there is a need to expand clinical studies on male contraceptives, involving larger samples, long-term follow-ups, and reversibility tests. There is a global social need that both men and women should have a wide variety of contraceptive options. Conclusions: This review emphasizes the importance of exploring new technologies for male contraceptives to expand options while optimizing the satisfaction and safety of these contraceptive options for the population. Full article

Sexual consent, although more extensively studied in recent decades, remains a complex and nuanced concept that is often difficult to define and investigate. This study aimed to analyze the relationships between beliefs, attitudes, and behaviors related to sexual consent, and the ability to interpret complex sexual scenarios with varying characteristics. A voluntary sample of 738 individuals over 18 years of age was recruited, mainly through social networks. Data analysis was conducted using descriptive statistics and mean comparison tests. Participants with higher scores for continuous consent, communicative sexuality, and positive attitudes toward consent, as well as lower scores for subtle coercion and (lack of) perceived control, showed more accurate interpretations of sexual assault situations. These findings may contribute to the development and implementation of programs aimed at reducing the use of coercive and violent strategies in sexual relationships. Full article

Background: Sexual and reproductive health promotion is a political and social process that involves not only individual actions but also strategies to change social, environmental and economic factors. It is necessary to know the characteristics of effective interventions in order to design new evidence-based programmes. However, programmes need to follow a holistic approach, hence the importance of Comprehensive Sexuality Education. Methods: An extensive bibliographic search was carried out. Twenty systematic reviews between 2015 and 2025 were selected following PRISMA 2020. Results: This review shows that interventions to promote SRH are effective and have significant results in increasing SRH knowledge, attitudes and skills, the competencies of professionals and improving access to SRH services. It has been possible to extract that it is necessary to promote SRH with the inclusion of young people, the adaptation of interventions according to the needs of each person, the coordination between different areas, the application of the intersectional and gender perspective, the application of a rights-based approach, the use of comprehensive and inclusive education models, the training of professionals and the carrying out of evaluations to disseminate the results. Furthermore, there are shortcomings in the evidence, such as the lack of an intersectional perspective, the lack of inclusion of certain groups and the lack of rigorous evaluations following quality standards. Conclusion: Programmes based on Comprehensive Sexuality Education are effective and have certain common characteristics. Full article

Gender dysphoria stems from incongruence between gender identity and assigned sex, often causing significant distress related to breast anatomy in transmasculine individuals. Gender-affirming hormone therapy typically precedes mastectomy, which is a fundamental intervention in transgender healthcare. Surgical challenges arise in patients with large breasts on lean frames, requiring customized techniques to achieve a natural, proportional, androgynous chest. This case report describes a 23-year-old transmasculine patient with macromastia and a tall, lean build who underwent gender-affirming mastectomy with free nipple grafts and muscular sculpture aimed at an androgynous esthetic. Pre- and postoperative evaluations showed marked improvements in body image, physical strength performance, and emotional well-being. Psychological assessments revealed significant reductions in body uneasiness and gender dysphoria, while human figure drawings demonstrated increasing bodily integration and identity congruence. A general improvement in physical performance over time was reported, particularly in upper body strength, with minor fluctuations potentially related to the surgical intervention and recovery phase. The narrative literature review supports these outcomes, highlighting satisfaction rates above 90%, minimal regret, and consistent gains in psychosocial functioning and sexual and mental health, including reduced anxiety and depression. This evidence reinforces that gender-affirming mastectomy is medically necessary, particularly when tailored to individual anatomical and esthetic needs, affirming identity and alleviating distress. Full article

Despite notable progress in HIV prevention and treatment, men who have sex with men (MSM) continue to bear a disproportionate burden of HIV, particularly in sub-Saharan Africa, where systemic barriers restrict access to HIV testing. This study draws on data from the 2017 Ghana Men’s Study II (GMS II), to examine the socio-demographic, behavioural, and structural factors influencing HIV testing among MSM. The Ghana Men’s Study II dataset, involving 4095 MSM, was de-identified and analysed using STATA (software version 17). Before the analysis, missing information for categorical variables were treated using the mode imputation technique. Chi-square test was done to describe relevant characteristics of the study population, such as socio-demographic/socio-economic variables and behavioural practices. Multivariable logistic regression analysis was performed for variables with p < 0.05 to determine significant predictors of HIV testing among MSM. All the statistical analyses were performed at a 95% confidence interval, with significant differences at p < 0.05. In multivariable logistic regression analysis, age 25–34 (AOR: 1.43; 95% CI: 1.18–1.74, p < 0.001), having a senior high school education (AOR: 1.69; 95% CI: 1.02–2.80, p = 0.040), tertiary education (AOR: 2.03; 95% CI: 1.17–3.55, p = 0.012), being a light drinker of alcohol (AOR: 1.28; 95% CI: 1.04–1.58, p = 0.020), and having a comprehensive knowledge of HIV (AOR: 1.50; 95% CI: 1.26–1.78, p < 0.001) had higher odds for HIV testing. Other factors such as being a Muslim (AOR: 0.69; 95% CI: 0.54–0.90, p = 0.005) and sold sex to other males (AOR: 0.67; 95% CI: 0.50–0.90, p = 0.007) were also positively associated with HIV testing among Ghanaian MSM. The findings revealed a number of socio-demographic and behavioural factors associated with HIV testing among the MSM population in Ghana. Full article

The present research assessed university student stakeholders’ perceptions of positive outcomes (i.e., appropriateness and benefits of conferencing) and negative outcomes (i.e., endangerment and revictimization of the complainant) associated with restorative justice-based direct conferencing in sexual misconduct cases. Stakeholders received random assignment to a 2 (allegation severity: more vs. less) × 2 (evidence strength: lower vs. higher) between-participant experimental design. More severe allegations and higher evidence strength were associated with lower ratings of appropriateness; allegation severity and evidence strength interacted to affect ratings of benefits; and more severe allegations, but not stronger evidence, were associated with higher ratings of endangerment and revictimization. Belief in the alleged perpetrator’s guilt explained the relationship between evidence strength and ratings of appropriateness, and desire to punish the alleged perpetrator explained the relationship between allegation severity and ratings of appropriateness. Researchers and Title IX coordinators should evaluate and respond to stakeholder sentiment toward direct conferencing. Full article

Masculinity norms and gender socialization play a critical role in shaping boys’ attitudes, behaviours, and interactions within society. In South Africa, historical legacies of colonialism and apartheid, coupled with deeply ingrained cultural and societal expectations, have contributed to rigid masculinity norms that emphasize dominance, emotional restraint, and aggression. These constructs not only influence boys’ development but also have significant implications for gender-based violence (GBV). This paper explores how norms of masculinity and processes of gender socialization among boys in South Africa shape attitudes and behaviours that contribute to gender-based violence (GBV). The central aim is to offer a critical theoretical synthesis and contextual analysis that informs the development of gender-equitable policies and interventions. Drawing on theoretical frameworks such as hegemonic masculinities, intersectionality, and social learning theory, this study examines how historical, cultural, and socio-economic factors shape gender socialization and influence boys’ developmental trajectories. Through an intersectional lens, this paper underscores the urgent need to challenge harmful masculinity norms and promote alternative models that encourage emotional expression, empathy, and equitable gender relations. Finally, it provides recommendations on how these harmful norms can be disrupted through educational, community, media, and policy-level reforms to foster healthier masculinity norms and reduce GBV in South Africa. Full article

Personal identity is a multidimensional, universal, and ever-developing construct that forms primarily during youth. One domain of identity—gender—manifests quite clearly in terms of developmental course and psychosocial components in the lives of transgender individuals. Members of this population often initiate various social and medical transitions to rework their gendered characteristics to align more authentically with their internal selves. Consequently, healthcare and social service professionals express growing interest in facilitating and fostering the psychological health of transgender youth. Rather than focus on adversity (e.g., depression, suicidality, mental illness), the current study addresses this concern by describing positive components of the gender identity of 120 transmasculine youth participants. To this end, we operationalized gender identity health through three overarching constructs: developmental process, psychological functioning, and the positive outcomes of being a transgender person. Further, we investigate how these components interrelate, plus compare responses by age and gender identity cohorts. For age, we compared adolescent responses to the identity measures to those of transgender emerging adults (n = 166; 20–29 years) and adults (n = 53; 30–39 years). For gender, we partitioned the adolescent participants into binary (n = 91) versus non-binary (n = 29) identities. The descriptive results demonstrated that identity is reasonably developed, functional, and positive in this adolescent sample. Moreover, the three hypothetical components of transgender identity demonstrated modest overlap with each other. The youth did not differ in identity development, functionality, or positivity compared to older cohorts. Binary transmen scored slightly higher on gender authenticity and commitment than their non-binary transmasculine counterparts, but the two gender groups were the same on the other identity components. We discuss some practical implications of these findings as focus areas for healthcare providers and support systems to continue to foster healthy identity development. Full article