Background : Transgender and non-binary (TNB) youth face barriers in accessing health information, including gender affirming information on sexual anatomy and health. At present, most sex education curricula are not designed to fit the needs of TNB youth, who are likely to face unique challenges and sexual risks as they navigate social transition and puberty compared with their cisgender peers.
Methods : We conducted 21 qualitative, semi-structured interviews with 5 caregivers of TNB children, 11 TNB youth age 18 and older, and 5 healthcare affiliates associated with Seattle Children’s Gender Clinic to identify the sexual health education needs of TNB youth. We used theoretical thematic analysis technique to analyze transcribed interviews, and consensus coding was conducted by three independent team members.
Results : Participants identified content areas for inclusion in a curriculum: puberty-related dysphoria, medical and non-medical gender affirming interventions, consent and relationships, sex and desire, STI prevention, fertility and contraception, and accessing healthcare. Participants emphasized that ungendered language, as well as representation and normalization of TNB experiences, are critical components of a transgender inclusive curriculum.
Conclusions : This study demonstrates that TNB youth have sexual education needs that are not covered in most sexual health curriculums, and that transgender inclusive sexual health curricula have the potential to promote self-esteem in TNB youth and directly improve their self-efficacy in setting boundaries and negotiating safer sex. In addition to increasing access to accurate health information, sex education provides a contextually appropriate space to disrupt cisnormative and binary assumptions about gender, anatomy, and sexuality. Curriculum recommendations from this study are broadly applicable to clinical, school and community-based settings.