Skip to Main Navigation Skip to Section Navigation Skip to Main Content Skip to Footer

Sexual Health and Development

Understanding Puberty and Sexual Development

Sexuality is a birthright, fundamental to being human, but — as anyone who has dabbled in romance knows — building healthy, fulfilling sexual relationships requires the development of a set of skills. In adolescence, our romantic and sexual attractions grow stronger. We begin to learn how to manage and express our feelings and desires, and how to negotiate new romantic relationships. Exploring sexuality is an important part of adolescent development.

Healthy sexual development involves biological, psychological, and socio-cultural processes. Like all aspects of adolescent development, sexual development occurs both within an individual and through interaction with the environment.

For example, the biological triggers of puberty are genetic, and are also affected by the available food. Psychological and social processes occur through interactions with family, cultural institutions, and peers, and are also affected by brain development. Adolescent sexual development is likely to be healthy, and to lead to positive sexual health, when each of these processes is appropriately supported in a young person's environment.

Putting all of these factors together, healthy adolescent sexual development occurs not along a single path, but through many trajectories. It involves much more than a teenager avoiding sexually transmitted infections or an unintended pregnancy between childhood and adulthood. Healthy adolescent sexual development trajectories prepare a person for a meaningful, productive, and happy life.


Puberty is the period of life during which our bodies become capable of reproduction. The onset of puberty intensifies sexual development, including early sexual behaviors such as masturbation.

Puberty starts in the brain — and at first, it's all about cascading hormones. A hormone in the hypothalamus (gonadotropin-releasing hormone or GnRH) signals the pituitary gland to start producing chemical messengers associated with puberty (luteinizing hormone and follicle-stimulating hormone). These hormones travel through the bloodstream to the ovaries or testicles. In turn, these organs start making the sex hormones (estrogen and testosterone) that produce the major physical changes of puberty.

  • The brain signals the pituitary gland to produce hormones associated with puberty.
  • The ovaries begin to make estrogen; the testicles begin to make testosterone.
    • Estrogen drives breast development, increasing height, widening of the hips, growth of pubic and underarm hair, and an increase in body fat. Menstrual cycles usually begin about two years after breast development starts.
    • Testosterone causes the testicles and penis to grow, sperm to appear in ejaculate, muscle mass and height to increase, and more.
    • The vocal cords thicken and the voice deepens.
    • Body and facial hair begin to grow.

Pubertal Timing

Many young people ask themselves "Am I normal?" Clearly, children do not follow a single pattern of physical development. There is great diversity in growth that is considered healthy and "normal."

Typically, breast development may begin as early as 8 and as late as 13. The range at which menstrual cycles begin is roughly from 9 to 16. Testicular growth may start as early as 9 and as late as 13.

Early Development

The age at which puberty begins has been dropping. While the reasons are not fully understood, improved nutrition, increased stress, and endocrine disruptors in the environment (such as certain chemicals found in plastics and pesticides) may be behind the change. There are challenges associated with early puberty:

  • Children may look older than they really are. Adults may expect them to behave as if they were more developed emotionally and cognitively. When racial bias is also involved, Black children can suffer terrible consequences, as they are commonly misperceived as potentially threatening adults rather than young children in need of protection [1]. This issue goes beyond early puberty, extending through the teen years.
  • Early developers may also attract sexual attention before they are ready to handle it. They may need support and strategies for handling situations that their less-developed peers don't have to confront.
  • Girls who develop earlier than their peers are also more likely to suffer depression and other psychological challenges.

Late Development

Late development can bring emotional and social challenges.

  • Young people who develop later than their peers may wonder if they are normal — which, of course, they are.
  • They may also be concerned about their romantic and sexual future. Many boys wonder if they are loveable and attractive to potential partners, and suffer anxiety over penis size.
  • Boys who develop late are also more prone to depression and may be subject to harassment and bullying.

Puberty and Transgender Youth

Puberty poses unique challenges for children who are transgender and their families and caregivers. A child who is transgender may feel that their anatomy conflicts with their identity, and that going through puberty would be unbearable. For some transgender youth it is important to find a gender-affirming health care provider who can help delay puberty with hormone treatments, giving some breathing space so that the child can make further decisions when they are ready. However, it's also important for youth work professionals to keep in mind that not all youth who are transgender or nonbinary hate or feel trapped by their bodies.

Identity Development

Identity development — forming a stable sense of oneself and one's role in society — is a key feature of healthy adolescent development. From the standpoint of sexual development, a sense of self prepares us for intimacy in young adulthood. Gender identity and sexual orientation are two aspects of our identity that may be either securely established at a young age or may develop over time. As is true of all aspects of identity development, experimentation and role play are common ways through which adolescents develop their sexual self-concept.

Socio-Cultural Influences

Socio-cultural influences on adolescent sexual development may include an adolescent's:

  • Family, peers, and social networks based on common interests and beliefs
  • Traditions related to race, ethnicity, culture, or religion
  • Neighborhood and neighbors; the immediate environment
  • School
  • Faith community, which may have codes of conduct about sexual behaviors
  • Involvement in youth-serving agencies or community service

Shaped by so many different factors, healthy sexual development may look very different from one individual to another.

Sexual Behaviors

There are a variety of common behaviors that, in and of themselves, have no negative health effects, and that many consider elements of healthy adolescent sexual development, preparing youth for positive sexual lives.

  • Masturbation. Touching one's own genitals in masturbation is a normal part of sexual development. Overall, more adolescents masturbate than engage in sexual intercourse. Although it tends to be done alone in privacy, males sometimes masturbate in groups.
  • Same-sex touching. Early in adolescent development, sexual exploratory behavior often occurs with members of the same sex. This behavior does not predict our sexual orientation.
  • Genital touching. As adolescents get older, they are more likely to engage in genital touching.

Sexual intercourse is a common behavior among adolescents, but whether it represents healthy sexual development or not depends on a number of factors. Nonconsensual sex of any kind can never be considered healthy. Use of contraception decreases the risk of pregnancy, and use of condoms or dental dams (in oral, vaginal, and anal sex), decreases the risk of infections, including HIV. HIV transmission can also be prevented through regular use of the medications PrEP and PEP.

Other factors affecting the health consequences of sexual activity may include an individual's ability to access health care services, cultural and familial contexts, motivations and self-awareness, risk behaviors, mental health, relationships, personal values, maturity, and capacity for coping with the possible consequences of sex.


  1. NPR. (2014, March 19). Consequences When African-American Boys Are Seen As Older.

Resources: Transgender Youth and Puberty

Gender-affirming Care: What It Is and Why It's Necessary

This article provides background on the basic needs of transgender and nonbinary children and clarifies what gender-affirming care is and is not. Learning for Justice.

Supporting & Caring for Transgender Children

This guide explains the difference between "gender-expansive" and "transgender," describes what it means to affirm a child's gender identity through transition, and more. Human Rights Campaign, American College of Osteopathic Pediatricians, and American Academy of Pediatrics.

Puberty and Transgender Youth

This video for youth defines the concept of being transgender and encourages talking to a parent, doctor, or therapist about feelings of anxiety or confusion about gender. It also introduces puberty blockers. Further information and resources are provided for youth, parents, and educators. Amaze.