Sexual Health

Towards an inclusive and culturally sensitive conceptualisation of sexual well-being of young people: preliminary framework development using a modified Delphi methodology.

TL;DR

A modified Delphi study co-created with 15 young SRHR professionals from across Europe, Asia, Africa, and South America produced a culturally sensitive framework recognising sexual well-being as a subjective concept requiring both individual capabilities and an enabling environment.

Key Findings

A sexual well-being framework was co-created by 15 young SRHR professionals aged 18–30 from countries across Europe, Asia, Africa, and South America using a modified Delphi methodology.

  • Participants were young professionals (aged 18–30) in sexual and reproductive health and rights (SRHR) with different backgrounds.
  • The Delphi process consisted of three rounds of online discussions: a shared online board, an online meeting, and a feedback session.
  • The multi-round design gave participants time to think and rethink their ideas before reaching consensus.
  • Countries represented spanned four global regions: Europe, Asia, Africa, and South America.

The framework recognised sexual well-being as a subjective concept with different meanings, applying an open understanding of sexual activity and intimacy.

  • Sexual well-being was defined as a subjective concept that should not be judged by different understandings.
  • The framework applied 'an open understanding of sexual activity, and intimacy.'
  • The framework acknowledged that sexual well-being can mean different things for different individuals and cultures.
  • The framework explicitly states that people should 'continue learning what sexual well-being means to different people.'

The framework identified ten key individual capabilities inherent to sexual well-being.

  • The capabilities identified were: informed decision-making, bodily autonomy, consent, exploration, self-awareness, pleasure, communication, comfort, safety, and self-esteem.
  • These capabilities were framed as elements that young people should be able to realise.
  • The framework positioned these capabilities as universal components of sexual well-being across cultural contexts.
  • These capabilities were described as only realisable within an enabling environment.

The framework included access to sexual health information and services, acceptance, respect, safety, and freedom from coercion and violence as key components of the enabling environment required for sexual well-being.

  • Enabling environmental factors were considered essential because the individual capabilities 'can only be realised within an enabling environment.'
  • Environmental components included: access to sexual health information and services, acceptance, respect, safety, and freedom from coercion and violence.
  • The framework acknowledged that 'societal injustices' create challenges for individuals in 'fully understanding and achieving their sexual well-being.'
  • The supportive environment was framed as empowering individuals 'to define and pursue sexual well-being in a way that honours their experiences and needs.'

The study identified that current discussions about sexual well-being and its measurement are mainly happening among academics, leaving out young people, local communities, and the LGBTQIA+ community.

  • The authors noted that important groups such as young people, local communities, and the LGBTQIA+ community 'deserve to be part of the conversation.'
  • The study was framed as 'a first step towards giving voice to youth perspectives in defining sexual well-being.'
  • The exclusion of these groups from academic discourse was cited as a key motivation for the co-creation approach.
  • The authors expressed hope that this research 'motivates researchers to include more voices, making sexual and reproductive health research more inclusive and culturally sensitive.'

The framework acknowledged societal injustices as barriers that make it difficult for young people to define and achieve sexual well-being.

  • The framework explicitly noted 'the challenges individuals face in fully understanding and achieving their sexual well-being, due to societal injustices.'
  • The authors acknowledged that 'society can make it hard for young people to define and achieve sexual well-being.'
  • This recognition of structural barriers was incorporated as a foundational element of the framework rather than treated as peripheral.
  • The framework's focus on enabling environments was directly linked to addressing these structural challenges.

What This Means

This research brought together 15 young professionals (aged 18–30) working in sexual and reproductive health from countries across Europe, Asia, Africa, and South America to collaboratively build a framework for understanding sexual well-being in young people. Using a structured discussion method called a modified Delphi study, participants engaged in three rounds of online conversations to share, debate, and refine their ideas. The result was a jointly designed framework that treats sexual well-being as something personal and culturally variable—meaning it can look different for different people—rather than as a fixed, universal standard. The framework identified two interconnected layers of sexual well-being. The first is a set of individual capabilities: the ability to make informed decisions, control one's own body, give and receive consent, explore one's sexuality, experience pleasure, communicate openly, feel comfortable and safe, develop self-awareness, and build self-esteem. The second layer is the environment needed for these capabilities to be possible, including access to sexual health information and services, as well as broader conditions like acceptance, respect, freedom from violence, and freedom from coercion. The framework also recognized that social injustices—such as discrimination and inequality—can make it harder for young people to understand or achieve their own sexual well-being. This research suggests that the way sexual well-being is defined and studied has largely excluded the voices of young people, local communities, and LGBTQIA+ individuals, even though these groups are directly affected by the topic. By co-creating a framework with young professionals from diverse global backgrounds, the study offers a more inclusive starting point for future research and policy. The authors suggest this work should prompt researchers and policymakers to actively involve a broader range of voices—particularly those most marginalized—when defining what sexual well-being means and how it should be measured and supported.

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Citation

Remmerie L, Annageldiyeva G, Grossman K, Kaba Kogoziga C, Leonetti N, Mosiashvili A, et al.. (2025). Towards an inclusive and culturally sensitive conceptualisation of sexual well-being of young people: preliminary framework development using a modified Delphi methodology.. Sexual and reproductive health matters. https://doi.org/10.1080/26410397.2025.2474337