MN ALIGNING WITH NATIONAL SEX EDUCATION STANDARDS IS PROBLEMATIC: NATIONAL SEX ED STANDARDS BASED ON 5 DANGEROUS FALSEHOODS
Michelle Cretella, MD, Chair, Adolescent Sexuality Council of the American College of Pediatricians
School-based comprehensive sexuality education (CSE) curricula in the U.S. are based on the National Sex Education Standards published by the Sexuality Information and Education Council of the United States (SIECUS). This is dangerous because the National Sex Education Standards are founded on at least five underlying falsehoods:
- Adolescent sexual activity is unavoidable and healthful.
- Sex exists on a spectrum
- LGBTQ behavior is innate and healthful.
- Health disparities between heterosexually and LGBTQ identified youth are due solely to discrimination/minority stress.
- And finally, that CSE is effective.
Adolescent sexual activity is neither unavoidable nor healthful. The CDC reports a significant decrease in adolescent sexual activity between 2003 and 2023. Nearly 70% of high school students are virgins, proving youth are capable of abstinence.[1] Sexually abstinent youth not only make healthier decisions compared to sexually active peers, but also avoid teen pregnancy, teen birth and parenting, teen abortions, sexually transmitted diseases (STDs), sexual violence, and depression and suicide caused by sexual activity.[2]
The National Sex Education Standards promote the myth that sex is a spectrum rather than a binary biological trait of medical significance. According to the DSM-5, sex is the “Biological indication of male and female (understood in the context of reproductive capacity), such as sex chromosomes, gonads, sex hormones, and nonambiguous internal and external genitalia.”[3] Two sexes exist because only two gametes exist: sperm and ova. The colloquialism “intersex” refers to a group of rare disorders of sex development (DSD) associated with impaired fertility. DSDs are deficiencies and malformations of the binary human reproductive system. Sex is determined at fertilization and registered in every nucleated cell of the body.[4]
A 2019 study revealed same-sex sexual behavior is no different from other behaviors. This means that no child is genetically or innately pre-determined for LGBTQ sexual behavior. [5] This is important since LGBTQ-identified youth are at greater risk of experiencing the aforementioned health risks of sexual activity. This sexual health disparity exists in LGBTQ-affirming countries where minority stress is minimal; even higher rates of attempted suicide are not explained by discrimination. [6],[7] Adverse childhood events, psychological conditions, and high-risk behaviors may better explain disparities, particularly among men who have sex with men.
National Sex Education Standards ignore the fact that anal intercourse carries greater risk than other sexual behaviors even with consistent condom use. Anal intercourse is a high-risk activity because the large intestine is not a receptive organ; it is structured to excrete feces. The vagina, a receptive reproductive organ, produces natural lubrication and endures friction without trauma. Consequently, the risk of contracting HIV from a single act of receptive anal intercourse is 20 times greater than for receptive vaginal intercourse (0.1%).[8]
Additionally, semen has immune-suppressant activity which promotes fertilization during vaginal intercourse, but increases cancer risk during anal intercourse. Anal and rectal carcinomas result from sexually transmitted HPV infection. [9],[10] Women who have sex with women are also at higher risk for STDs and other health problems than are heterosexual women.[11] As lesbian-identified scholar Camille Paglia states, “Nature exists whether academics like it or not. And in nature, procreation is the single relentless rule. That is the norm… Our sexual bodies were designed for reproduction.”[12]
CSE programs based on the National Sex Education Standards created by SIECUS and Planned Parenthood have proliferated in schools for over three decades. Based on the secondary public health principle of risk reduction, they are touted in the scientific literature as “effective” at reducing teen risk behavior, pregnancy and STDs.[13] Yet, U.S. teen pregnancy and STD rates are still among the highest of industrialized countries. Why?[14],[15]
In 2024, the Institute for Research and Evaluation (IRE) analyzed seven systematic literature reviews of school-based CSE applying public health standards of effectiveness. IRE found no long-term evidence of improvements in abstinence, consistent condom use, reduced teen pregnancies, or reduced STDs in the same program.[16] One of the systematic reviews identified 6 CSE programs with significant negative effects: increases in sexual initiation, higher rates of oral sex without condoms, lower levels of contraceptive use, and increases in teen pregnancy.[17] Given Planned Parenthood’s financial conflict of interest, these findings are not surprising.
A promising alternative exists: sexual risk avoidance education (SRAE). When the IRE analyzed SRAE in schools the evidence—though limited—was more positive:
[E]vidence of effectiveness … appeared somewhat greater than for CSE in U.S. schools (seven AE studies vs. three CSE studies) and the overall success rate … at 47%, [was] higher than that of school-based CSE in the U.S., at 15%. Moreover, the prevalence of negative effects appeared somewhat lower for AE (6%) than for CSE in U.S. schools (12%).[18]
SRAE is based on the primary public health principle of risk avoidance which the CDC has long acknowledged:
Abstinence from vaginal, anal, and oral intercourse is the only 100% effective way to prevent HIV, other STDs, and pregnancy. The correct and consistent use of male latex condoms can reduce the risk of STD transmission, including HIV infection. However, no protective method is 100% effective. And condom use cannot guarantee absolute protection against any STD or pregnancy.[19]
SRAE teaches six universally transferrable principles:
- Sexual delay is a protective factor for sexual health.
- The fewer lifetime partners a person has, the healthier the sexual outcomes.
- Teen sex is high-risk but certain behaviors are especially risky, even with a condom.
- Healthy relationships have a greater opportunity to develop when they are not complicated with sexual activity.
- Setting boundaries, learning refusal skills, and acquiring date-rape prevention strategies help to prevent victimization.
- Reserving sex for a lifetime, sexually faithful, monogamous relationship with an uninfected partner is the best protection against contracting STDs or sexually transmitted HIV.[20]
Contrary to critics’ claims, effective SRAE based on the Medical Institute’s K-12 Sex Education Standards, (now owned by Ascend) is medically accurate, discusses condoms and contraceptives without demonstrations, and has helped students commit to abstinence without decreasing condom or contraceptive use.[21]
CSE rooted in the National Sex Education Standards already fails to provide positive outcomes for LGBTQ-identified students, let alone all students. More of the same is not the answer. Adolescent sexual activity is harmful. There is promising early evidence for SRAE alongside CDC data which indicate adolescents are capable of sexual abstinence. This is good news upon which to collaborate.
[1] Lifetime sexual intercourse | YRBS-Graph | CDC (2023)
[2] Ihongbe TO, Cha S, Masho SW. Age of Sexual Debut and Physical Dating Violence Victimization: Sex Differences Among US High School Students. Journal of School Health. 2017 Vol. 87(3):200-208; Hallfors DD, Waller MW, Ford CA, Halpern CT, and Brodish PH, Iritani B. “Adolescent Depression and Suicide Risk: Association with Sex and Drug Behavior. American Journal of Preventative Medicine. 27 (2004): 224-230; McIlhaney, J and McKissic Bush, F. Hooked: New Science on How Casual Sex is Affecting Our Children. Northfield Publishing, Chicago. 2008, pp.77-78.
[3] American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed;p. 829; 2013.
[4]American College of Pediatricians. General FAQs – Biological Integrity (2025). Accessed September 17, 2025.
[5] Gana A et al. “Large-scale GWAS reveals insights into the genetic architecture of same-sex sexual behavior.” Sciene. Available here Large-scale GWAS reveals insights into the genetic architecture of same-sex sexual behavior | Science; Also see “Born That Way” No More: The New Science of Sexual Orientation – Public Discourse Accessed September 17, 2025.
[6] Bailey JM. It is Time to Stress Test the Minority Stress Model. Arch Sex Behav. 2021 Apr;50(3):739-740. doi: 10.1007/s10508-021-01912-1. Epub 2021 Feb 3. PMID: 33534042; Bailey JM. The Minority Stress Model Deserves Reconsideration, Not Just Extension. Arch Sex Behav. 2020 Oct;49(7):2265-2268. doi: 10.1007/s10508-019-01606-9. Epub 2019 Dec 18. PMID: 31853696.
[7] Wang, J., Ploderl, M., Hausermann, M., & Weiss, M. G. (2015). Understanding suicide attempts among gay men from their self-perceived causes. Journal of Nervous and Mental Disease, 7, 499-506. http://dx.doi.org/10.1097/NMD.000000000000319
[8] Pinkerton SD, Martin JN, Roland ME, Katz MH, Coates TJ, Kahn JO. Cost-effectiveness of postexposure prophylaxis after sexual or injection-drug exposure to human immunodeficiency virus. Arch Intern Med. 2004 Jan 12;164(1):Table 4, p.50. doi: 10.1001/archinte.164.1.46. PMID: 14718321.
[9] Potterat JJ, Brewer DD, Brody S. Receptive anal intercourse as a potential risk factor for rectal cancer. Cancer. 2011 Jul 15;117(14):3284; author reply 3284-5. doi: 10.1002/cncr.25909. Epub 2011 Jan 18. Erratum in: Cancer. 2012 Mar 1;118(5):1470. PMID: 21246539. Available here Receptive anal intercourse as a potential risk factor for rectal cancer – Potterat – 2011 – Cancer – Wiley Online Library Accessed September 17, 2025.
[10] The Federal Health Group website Understanding the Link Between HPV and Anal Cancer: Answers to Your Most Pressing Questions December 19, 2024. Accesssed September 17, 2025.
[11] CDC website Women Who Have Sex with Women (WSW) and Women Who Have Sex with Women and Men (WSWM) accessed September 17, 2025.
[12] Paglia C. Vamps & Tramps: New Essays. Vintage Books, NY; 1994.
[13] Goldfarb ES, Lieberman LD. Three Decades of Research: The Case for Comprehensive Sex Education. J Adolesc Health. 2021 Jan;68(1):13-27. doi: 10.1016/j.jadohealth.2020.07.036. Epub 2020 Oct 12. PMID: 33059958.
[14] OPA/HHS website Data and Statistics on Adolescent Sexual and Reproductive Health | HHS Office of Population Affairs accessed September 17, 2025.
[15] World Population Review website STD Rates by Country 2025 accessed September 17, 2025.
[16] Institute for Research and Evaluation website. Seven-research-reviews-show-lack-of-CSE-effectiveness-in-schools-July-24-2024.pdf accessed September 17, 2025.
[17] Institute for Research and Evaluation website. Re-Examining the Evidence for Comprehensive Sex Education in Schools in the United States. December 17, 2019. Accessed September 17, 2025.
[18] Institute for Research and Evaluation website Global_CSE_Report_12-17-19.pdf accessed September 17, 2025.
[19] CDC website Sexual Risk Behaviors | Reducing Health Risks Among Youth | CDC
[20] Ascend Website SRA & Gay Teens (2022) accessed September 17, 2025.
[21] Institute for Research and Evaluation website. An Evidence-Based Rebuttal to a Critique of Abstinence Education. May 2020. Accessed September 17, 2025.
