Unspoken Sexuality: The Mental Health Impact of Missed Sex Conversations in Youth

Abstract

Across the globe, adolescents often grow up surrounded by cultural silence, taboo, or discomfort regarding conversations about sexuality, relationships, and power. The absence of timely, comprehensive, and honest conversations about sexuality, power dynamics, and sexual pleasure during adolescence can significantly impact young people’s mental health and well-being. This commentary paper examines the detrimental effects of the “unspoken curriculum” surrounding sexuality, characterized by silence, misinformation, and avoidance, on the psychological development of young individuals. It examines how the lack of open dialogue contributes to anxiety, shame, distorted perceptions of sexuality, and vulnerability to exploitation. Furthermore, this article underscores the critical need for parents, educators, and society at large to engage in transparent conversations that encompass not only the biological aspects of sexuality but also the essential elements of power, consent, sexual pleasure, healthy relationships, and emotional literacy. By drawing on global research, this paper reveals both common challenges and unique regional barriers, advocating for culturally responsive yet universally rights-based solutions. By fostering open communication and providing accurate, age-appropriate information, we can empower young people to navigate their sexual development with confidence, respect, and a positive sense of self, thereby safeguarding their mental health and fostering healthier societal attitudes towards sexuality.

1. Introduction

Adolescence is a period of profound physical, emotional, and social transformation, marked by burgeoning curiosity about sexuality. According to the World Health Organization, adolescence is defined as the period between 10 and 19 years of age [1]. Yet, sexual initiation can begin even earlier, particularly in contexts marked by vulnerability or lack of guidance [2]. Ideally, this developmental stage should be accompanied by clear, honest, and age-appropriate conversations that equip young people with the knowledge and skills to navigate their sexual development in a healthy and informed manner. However, for many, this crucial dialogue remains fragmented.

Instead, they are often left to assemble unreliable information from sources such as social media and AI-powered platforms, while confronting a landscape shaped by societal silence and discomfort. This absence of structured education often leads to the internalization of stigmas and misconceptions about sexuality, power dynamics, and sexual pleasure. The “unspoken curriculum” of avoidance and misinformation can have significant and often overlooked consequences for their mental health and overall well-being [3]. Systematic reviews have linked poor access to comprehensive sexuality education (CSE) with increased anxiety, body shame, and high-risk behaviors among adolescents [4].

Conversations that are delayed or omitted, those exploring consent, healthy relationships, power dynamics, pleasure, and emotional literacy, are often neglected due to parental discomfort, societal taboos, inadequate educator training, or the misguided belief that silence offers protection. This void leaves young people vulnerable to anxiety, shame, guilt, and distorted understandings of their own and others’ sexuality [5,6]. Moreover, silence on these issues increases susceptibility to sexual coercion, negative relational patterns, and diminished self-worth.

This commentary article takes a global perspective by examining how diverse sociocultural norms from liberal democracies to conservative, patriarchal, and religious-majority contexts shape adolescents’ access to open and accurate conversations about sexuality. While the extent of the gaps vary, evidence indicates that many adolescents lack access to comprehensive, rights-based, and inclusive sexuality education due to deeply rooted cultural, structural, and ideological barriers [3,7].

This article explores how the absence of unfiltered conversations about sexuality, power dynamics, and sexual pleasure affects youth mental health. It highlights how societal silence perpetuates harmful myths, contributes to psychological distress, and impedes the development of healthy sexual identities and relational well-being. It further advocates for a shift toward open, inclusive dialogue that empowers adolescents with knowledge, emotional intelligence, and skills to engage with sexuality respectfully and confidently. By recognizing the consequences of delayed or missing conversations, we can begin to address the psychosocial impact on youth and move toward a more informed and supportive societal landscape.

2. The Detrimental Impact of Silence and Misinformation

The absence of open conversations about sexuality creates misinformation, peer pressure, and the pervasive influence of media, including pornography, which frequently distorted portrayal of sexuality, power dynamics, and sexual pleasure [8]. In the absence of accurate education and safe inquiry spaces, young people may internalize these misleading representations, leading to anxiety, body image issues, and unrealistic expectations about sexual encounters [9]. This silence is not simply passive; it actively reinforces shame and secrecy. In many societies, discussions about sex are framed as immoral or dangerous particularly for girls, fueling stigma and internalized guilt. In the Gulf Cooperation Council (GCC) countries, for example, entrenched patriarchal norms label sexual discourse as incompatible with cultural values, restricting both parental and school-based dialogue and increasing young people’s vulnerability to coercion [10]. Similarly, a 2025 regional review from Latin America finds that when formal sex education is absent, adolescents are left to navigate a fragmented landscape of digital misinformation, mistrust, and conflicting social messages [11].

2.1. Anxiety and Shame

Cultural and educational silence surrounding sexuality often cultivates shame and secrecy, leading young people to believe that their natural curiosity and developing sexuality are inappropriate or shameful [12]. This can manifest as anxiety, particularly around sexual feelings, experiences, and relationships [13]. Without clear guidance, adolescents may struggle to distinguish between healthy sexual exploration and harmful behaviors, resulting in fear and confusion.

The lack of validation and normalization deepens emotional isolation and a sense of inadequacy [13]. These patterns are evident globally. In Morocco, socio-cultural expectations of female modesty create internal conflict in youth navigating curiosity under restrictive norms [14]. Likewise, in conservative regions of India, silence around sexuality is often perceived by adolescents as rejection of their emerging identities, reinforcing feelings of alienation and anxiety [15].

2.2. Distorted Perceptions of Sexuality

When accurate information is withheld, young people are more likely to rely on unreliable sources, which often sensationalize or misrepresent sexual experiences. Pornography, for example, frequently depicts non-consensual acts, unrealistic bodies, and a narrow focus on male sexual pleasure, which can shape young people’s understanding of sexuality and relationships in harmful ways [16]. This can lead to distorted expectations about intimacy, difficulty in establishing healthy boundaries, and a lack of understanding of mutual respect and pleasure in sexual interactions [17].

2.3. Vulnerability to Exploitation and Unhealthy Relationships

A lack of education about consent, power dynamics, and healthy relationships leaves young people vulnerable to exploitation and coercion. Without a foundational understanding of personal boundaries, assertive communication, and equitable relationships, young individuals may struggle to recognize and respond to unhealthy or abusive situations [6]. When comprehensive sexuality education is absent, young people also tend to develop weaker relational boundaries and become more susceptible to coercive interactions [18]. When discourse around power imbalances is missing, particularly in romantic or sexual relationships, harmful behaviors may be misinterpreted as acceptable [19].

2.4. Negative Self-Image and Body Image Issues

The silence surrounding sexuality often extends to discussions about bodies and sexual development. When young people are not exposed to affirming discussions about natural bodily changes and diversity, they may feel inadequate or abnormal. This is further exacerbated by idealized media portrayals, often filtered or edited to promote unattainable beauty standards. The lack of body-positive education contributes to negative self-image, dissatisfaction, and eating disorders [20]. Studies consistently show that the absence of early, affirming, and body-inclusive sexuality education increases risks of disordered eating and body dysmorphia during adolescence [21,22].

3. The Missing Conversations: Sex, Power, and Pleasure

The “sex talk” that many young people receive, if they receive one at all, often focuses narrowly on the biological aspects of reproduction and the risks of STIs and unintended pregnancy [23]. While this information is important, it neglects crucial dimensions of power dynamics, sexual pleasure, consent, and emotional literacy that are central to comprehensive sexual development. Without these components, youth lack frameworks for understanding relational well-being, emotional intimacy, and gendered power dynamics [3].

3.1. Power Dynamics and Consent

Unfiltered conversations about sexuality must intentionally address power dynamics in relationships. Young people need to understand how power can be used and misused, particularly in the context of sexual interactions. This includes discussions about consent as an active, enthusiastic, ongoing process, emphasizing that silence or passivity does not equal consent and that consent can be withdrawn at any time [19]. Conversations should also explore issues of coercion, manipulation, and the importance of mutual respect and equality in relationships.

3.2. Pleasure and Positive Sexuality

Sexuality education often focuses narrowly on risks, such as STIs and unintended pregnancy, while neglecting the dimension of sexual pleasure [24]. This omission can lead young people to associate sex with fear and shame, rather than recognizing it as a potentially positive, relational, and affirming aspect of human intimacy [25]. Excluding pleasure denies youth a holistic understanding of sexuality and reinforces incomplete, fear-based narratives.

Comprehensive programs should normalize discussions of pleasure by emphasizing mutual satisfaction, bodily autonomy, and personal boundaries [19]. This approach promotes a healthier, more shame-free outlook on sexuality. In Latin America, particularly Chile and Brazil, research shows that integrating pleasure into curricula enhances relational empathy, gender equity, and communication skills among students [19,26].

In contrast, UAE and other Gulf states explicitly exclude pleasure from curricula, framing it as morally inappropriate or culturally dangerous [10]. In East Africa, educators often dilute or omit content on pleasure due to fear of community backlash, despite its importance for adolescent well-being [27,28]. These contrasts reveal stark cultural divides in defining what is considered “appropriate” for youth to learn particularly for young women.

However, integrating pleasure into sexuality education must be ethically grounded. The World Association for Sexual Health affirms pleasure as a sexual right that should be taught within a framework of consent, respect, and autonomy [29]. In many African contexts, pleasure is framed as immoral, especially for girls, reinforcing patriarchal norms and limiting open dialogue [30]. Similarly, in South Asia, cultural scripts around honor and modesty contribute to the near-total exclusion of pleasure from CSE in countries like India and Pakistan [31,32]. Youth in these contexts often internalize guilt and confusion when navigating sexual development.

Across the Middle East, restrictive religious morality often suppresses open discussion about sexuality and pleasure, limiting young people’s access to affirming, rights-based education [33]. In response to such global gaps, the International Technical Guidance on Sexuality Education now formally recommends the inclusion of pleasure as a core element, calling for approaches that are rights-based, age-appropriate, and culturally contextualized [34].

3.3. Healthy Relationships and Emotional Literacy

CSE should extend beyond the biological facts to explore the relational context of sexuality. This involves discussions about communication skills, emotional intimacy, respect, trust, and boundaries all essential to relational well-being [35,36,37]. Emotional literacy supports conflict resolution, assertive communication, and empathy, which are vital for sustaining respectful and safe relationships [38].

Yet, in many Sub-Saharan African contexts, emotional literacy is rarely incorporated into CSE, contributing to relational misunderstandings and increased vulnerability among youth [39]. Similarly, across Middle Eastern settings, rigid gender roles and honor-based norms often suppress discussions of empathy, consent, and affective development elements critical for building safe and equitable relationships [33].

To address these gaps, evidence-based frameworks like CASEL offer structured approaches to developing social-emotional competencies, including self-awareness, responsible decision-making, and relational skills [40]. Trauma-informed models further highlight emotional literacy as a protective factor particularly for adolescents with adverse childhood experiences by promoting psychological safety and inclusion in educational settings [41]. In Peru, school-based health centers that integrate emotional literacy with relationship communication strategies have shown promising results, reducing emotional isolation and strengthening adolescents’ relational capacities [42]. In contrast, Gulf Cooperation Council (GCC) countries often face structural resistance to integrating such content, constrained by gender segregation and strict disciplinary codes [10]. These regional contrasts highlight the importance of culturally anchored models that align with local realities, while also embracing a broader understanding of gender beyond binary categories.

3.4. Diverse Sexualities and Gender Identities

Unfiltered conversations about sexuality should also be inclusive of diverse sexual orientations and gender identities. Recognizing that gender and sexuality exist on spectrums promotes respect, reduces stigma, and supports healthy identity development. For instance, in South Africa, students have reported feeling invisible and invalidated in sexuality education classes that exclude gender-diverse experiences, often reinforcing stigma and shame [43]. In the United States, gender-diverse youth in New Hampshire schools similarly describe emotional distress and isolation when curricula fail to reflect their realities [44]. These concerns are especially relevant among Generation Z, who are more likely to identify outside binary gender norms and expect inclusive content in education [45,46]. Yet, many sexuality educators lack adequate training or understanding of gender diversity, which can further marginalize students whose identities are already underrepresented in mainstream curricula [47]. In several countries, political resistance to LGBTQ+ inclusion has resulted in legal or policy barriers to discussing gender diversity, reinforcing traditional gender norms and silencing important conversations [3].

Inclusive education can reduce stigma, promote empathy, and create a more supportive environment for all young people, regardless of their sexual orientation or gender identity [48].

4. The Impact on Young People’s Mental Health

The absence of these crucial conversations has a significant and often harmful impact on young people’s mental health, contributing to a range of psychological challenges [49].

4.1. Increased Anxiety and Depression

The persistent lack of accurate, age-appropriate information, combined with societal silence exacerbates anxiety and depression among youth [50]. They may feel overwhelmed by conflicting messages, worried about their developing bodies and sexual feelings, and isolated in their experiences [13]. Shame and secrecy surrounding sexuality contribute to low self-worth and hopelessness. Evidence suggests that the absence of culturally relevant, rights-based CSE contributes to adolescent mental health burdens, including shame, social isolation, and internal conflict related to gender roles and sexual identity [51].

In Bangladesh, parental silence is commonly viewed as protective, yet it leaves adolescents emotionally unsupported, especially when grappling with sexual identity and stress [51]. Similarly, in Nigeria and Ethiopia, limited access to CSE correlates with increased shame and psychological distress among youth navigating traditional gender expectations [39]. In South Africa, silence around sexuality, particularly affecting girls has been linked to anxiety, powerlessness, and emotional fatigue [49].

One particularly harmful consequence is internalized stigma, where adolescents absorb and believe negative cultural stereotypes about sexuality. In Malaysia, for example, young people with same-sex attraction report shame, social withdrawal, and suppressed emotional expression due to the lack of affirming education and persistent stigma [52]. These effects are not unique to one region. A recent meta-analysis confirms that adolescents in low-resource settings with poor CSE access experience higher rates of depression, suicidal ideation, and sexual misconceptions [53].

While regional contexts vary, the mental health consequences of inadequate sex education are strikingly consistent. In Cameroon, improved HIV education coincided with falling infection rates, yet emotional distress persisted due to the absence of affective and relational instruction [27]. In contrast, adolescents in Chile exposed to inclusive, emotionally oriented CSE reported lower depression and greater relational self-efficacy [19]. These findings emphasize that it is not merely the presence of CSE, but its quality and scope, that shape mental health outcomes.

In Southeast Asia, stigma around adolescent sexuality fuels shame-related anxiety, particularly among girls [54]. In Curaçao, cultural silence around female sexuality, paired with unfiltered social media exposure, contributes to emotional confusion and distress in adolescent girls [55]. Among gender-diverse youth in Europe, the absence of affirming, inclusive sex education especially when combined with media pressures and institutional silence has been linked to heightened psychological distress [56].

4.2. Body Image Issues and Eating Disorders

While public discourse has evolved to embrace body diversity and inclusivity more visibly than in previous decades, many adolescents still experience significant pressures to conform to narrow, unrealistic beauty ideals. Social media platforms have amplified body comparison, algorithmic appearance-focused content, and filtered or surgically enhanced images [57,58]. Adolescents heavily engaged with image-centric media report increased body dissatisfaction, low self-esteem, and a higher risk of disordered eating [59]. pronounced among girls, gender-diverse youth, and those already at risk for mental health concerns [56]. Crucially, the absence of early, body-affirming education deprives adolescents of tools to critically engage with media and challenge unrealistic aesthetic norms. Consequently, they may internalize harmful ideals and develop problematic behaviors related to eating, exercise, and self-image even in cultures that outwardly promote inclusion [20,21,22].

4.3. Difficulties Forming Healthy Relationships

Without education about consent, communication, and emotional literacy, young people may struggle to form and maintain healthy relationships. They may find it difficult to express their needs, respect boundaries, or recognize harmful behaviors, either in themselves or in others [60]. These challenges can often play out in everyday dynamics—for instance, in parts of Kenya, many adolescents report uncertainty in navigating romantic relationships, shaped by dominant gender norms and a lack of guidance on emotional expression or mutual respect [61]. Meanwhile, in Sweden, where sexuality education places equal emphasis on emotional well-being and communication, young people are generally more confident discussing boundaries and forming respectful relationships [62].

4.4. Increased Risk of Sexual Victimization and Perpetration

A lack of understanding about consent and power dynamics can increase young people’s vulnerability to sexual victimization and, in some cases, contributes to perpetration [6]. Clear, open conversations are crucial for fostering mutual respect and safety. For instance, in Ghana, adolescents who lacked exposure to structured sexuality education were significantly more likely to normalize coercive behaviors or misunderstand consent, leading to increased risks of both victimization and perpetration [63]. Similarly, a study in the United States found that boys who received abstinence-only messages, without discussions on mutual consent, were more likely to engage in non-consensual behaviors in early relationships [64].

4.5. Development of Negative Sexual Attitudes and Beliefs

The absence of positive and accurate information can lead to the development of negative attitudes and beliefs about sexuality, which can impact their sexual well-being throughout their lives. Misconceptions about sexual pleasure, intimacy, and gender roles, if left unchallenged, can sexual dissatisfaction, dysfunction, and unhealthy relationships [65]. For instance, in Sweden, comprehensive sexuality education (CSE) has been shown to foster open attitudes, reduce stigma, and promote healthier sexual behaviors among youth, correlating with lower rates of sexual dysfunction and higher relationship satisfaction [66]. In contrast, a study across several sub-Saharan African countries found that restrictive or inconsistent sexuality education programs led to fragmented knowledge and reinforced gender stereotypes, which negatively influenced sexual well-being and contributed to unsafe practices and relational tensions [67]. Similarly, in Thailand, the integration of digital media in CSE has been effective in increasing not just knowledge, but also positive attitudes toward consent and pleasure, demonstrating that when accurate, culturally adapted information is provided, long-term well-being is enhanced [68].

5. The Path Forward: Fostering Unfiltered Conversations

Addressing the negative impact of the “unspoken curriculum” requires a multi-level, collaborative approach involving parents, educators, policymakers, and communities. These efforts must promote honest, inclusive conversations about sexuality, power dynamics, and sexual pleasure that equip young people with the tools they need to thrive.

5.1. Empowering Parents

Parents are often the primary source of information and guidance for their children. However, many parents feel unprepared or uncomfortable discussing sexuality [69]. This discomfort is amplified in low-resource or conservative settings, where there may be limited access to educational materials, parent-focused training programs, or supportive networks. In religious or traditional contexts, CSE is often actively resisted based on the misconception that it promotes early sexual activity claim not supported by evidence [3,5]. Parental engagement strategies must include culturally relevant communication tools, peer support structures, and campaigns that debunk myths through evidence-based research. By normalizing intergenerational conversations about sexuality, consent, and emotional literacy, parents can become confident partners in supporting adolescents’ development.

5.2. Comprehensive Sex Education in Schools

Schools play a vital role in delivering comprehensive sexuality education (CSE) [70]. Effective curricula must go beyond the biological aspects of reproduction and disease prevention to include consent, power dynamics, sexual pleasure, emotional literacy, healthy relationships, and diverse sexual and gender identities [3,28]. Integrating emotional literacy through peer-led dialogues and role-play exercises has been shown to enhance adolescents’ empathy, boundary-setting, and relational competence [13].

However, implementation is frequently hindered by structural and political barriers, such as inconsistent regional policies, limited teacher training, budget constraints, and ideological resistance from school authorities [11]. For example, in India, the National Adolescent Education Programme (AEP) was banned in multiple states due to cultural objections, removing critical discussions of consent, emotional development, and gender equity from classrooms [31]. In contrast, Chile has reoriented its sex education to include culturally grounded discussions of desire and autonomy, demonstrating that pleasure and emotional awareness can be responsibly incorporated into public education [19]. In Morocco and Pakistan, fear of offending religious sensibilities often results in fragmented, biologically focused instruction [14,31]. In Iran, while adolescents express strong demand for inclusive education, systemic censorship restricts curricula to reproductive health, sidelining emotional and relational components [71]. Even in Sweden, despite progressive policy frameworks, educators often struggle with discomfort when addressing topics such as pleasure, queer identities, and emotional well-being [72].

Conversely, programs in Peru and Uganda that integrate digital storytelling, emotional literacy, and rights-based frameworks have achieved greater student engagement and psychosocial benefits [28]. In Latin America, grassroots educators especially in Chile have reframed CSE through cultural narratives of desire, further strengthening emotional resilience and communication skills among youth [19].

These global contrasts highlight that while CSE holds transformative potential, its impact depends heavily on context-sensitive implementation that balances local norms with adolescents’ psychosocial and developmental needs.

5.3. Media Literacy Education

Given the dominant role of digital media including pornography and AI-generated sexual content in shaping adolescents’ perceptions, media literacy must become central to CSE. Curricula should address issues such as digital manipulation, algorithmic bias, and unrealistic portrayals of sexuality and relationships. Yet, media literacy remains underdeveloped in most educational systems, especially within sexual health frameworks [73]. Educational efforts to explore pornography, gender stereotypes, or digital consent are frequently censored, especially in conservative settings [3]. Policy mandates, teacher training, and public campaigns are needed to legitimize and support media literacy education. Parents also struggle with digital guidance due to their own lack of media literacy [74]. Intergenerational programs can foster shared digital resilience and improve communication between parents and children.

5.4. Creating Supportive Communities

Community norms and collective attitudes toward sexuality play a major role in shaping youth experiences. Supportive communities that normalize open, respectful dialogue can dismantle stigma and reduce harm [3,4,7]. However, many communities remain bound by social taboos, religious orthodoxy, and rigid gender expectations that suppress meaningful conversation [7]. Effective progress requires culturally anchored strategies that engage elders, faith leaders, and youth to co-create inclusive messages. Programs that engage elders and religious leaders, have demonstrated that localized, culturally respectful messaging can be reconciled with sexual rights advocacy to shift norms sustainably [75]. Progress requires culturally anchored interventions that engage religious leaders, elderly, and youth voices to co-develop locally resonant messages.

5.5. Policy and Advocacy

Policy reform is foundational to scaling access to CSE. Yet, in many settings, governments either decentralize mandates to local jurisdictions or allow inconsistent implementation, resulting in patchwork delivery and the systematic exclusion of marginalized groups [76]. Compounding this, CSE often receives inadequate budgetary support particularly in politically polarized or economically constrained regions. Adolescents should be recognized not only as beneficiaries of SRHR services but as active participants in shaping them. Global frameworks recommend formal mechanisms for youth engagement in policy development, including advisory roles, advocacy training, and participatory monitoring [77]. When supported with resources and civic space, youth participation strengthens accountability, inclusiveness, and policy relevance in sexuality education and reproductive health.

Successful advocacy must involve youth leaders, researchers, civil society, and educators. Impactful campaigns require scientific evidence, strategic messaging, media partnerships, and coalition-building to overcome ideological barriers [78]. Policies must recognize sex education as a public health and human rights priority, not an optional or controversial add-on.

6. Conclusions

The absence of unfiltered conversations about sexuality, power dynamics, and pleasure during adolescence has significant implications for young people’s mental health. This silence fosters anxiety, shame, distorted perceptions of sexuality, and increased vulnerability to exploitation. The consequences extend beyond individual well-being, shaping relationship patterns and societal attitudes toward gender, intimacy, and sexual health.

By recognizing the conversations that are routinely omitted or delayed, we can begin to address their psychological and social repercussions. Parents, educators, policymakers, and communities all share responsibility for creating environments where young people have access to accurate, appropriate, and affirming information. When these stakeholders collaborate, young people are better equipped to navigate sexual development with confidence, respect, and a strong sense of self.

Moving forward requires an integral approach to empower parents, implement comprehensive sex education in schools, promote media literacy, create supportive communities, and advocate for policy changes that prioritize youth sexual health and well-being. Collectively, these measures can safeguard adolescent mental health while promoting healthier societal narratives around sexuality.