Puberty is the period during which a child’s body matures into an adult body capable of reproduction. Although we may think of puberty as beginning during adolescence, some of the first indicators of puberty actually occur during middle childhood.

During middle childhood, the hormonal changes that occur during puberty are the result of the activation of the hypothalamic-pituitary-gonadal (HPG) axis, which controls the release of hormones that regulate sexual development. In females, the HPG axis leads to an increase in the production of estrogen by the ovaries, which stimulates the growth and development of the breasts and other secondary sexual characteristics. It also leads to the development of the ovaries and uterus in preparation for menstruation. In males, the HPG axis leads to an increase in the production of testosterone by the testes, which stimulates the growth and development of the penis, testes, and other secondary sexual characteristics. It also leads to the development of muscle mass and the deepening of the voice.

The stages of puberty during middle childhood are characterized by a gradual development of secondary sexual characteristics. These stages include:

1. Prepubertal: In this stage, there are no visible signs of puberty. Children’s bodies are still in the early stages of development.
2. The onset of puberty: In this stage, children start to develop secondary sexual characteristics, such as breast buds in females and testicular and scrotal enlargement in males. Females may also experience the onset of pubic hair growth.
3. Continued growth and development: During this stage, children continue to grow and develop. Females may experience breast development and the growth of pubic hair, while males may experience the growth of the penis and testicles.
4. Rapid growth and development: In this stage, children experience a rapid growth spurt, which may be accompanied by the development of additional secondary sexual characteristics. Females may experience the growth of pubic hair and the onset of menstruation, while males may experience voice changes and the growth of facial and body hair.
5. Final stages of puberty: In this stage, children reach their adult height and continue to develop additional secondary sexual characteristics. Females may experience the full development of breasts and pubic hair, while males may experience the full growth of facial and body hair.

The timing and pace of puberty can vary greatly between individuals, and some children may not experience the onset of puberty until their teenage years.

Sexual Identity Development During Puberty

The hormonal changes that begin to occur during middle childhood may affect sexual identity development. The two main hormones that are involved in sexual development are estrogen and testosterone. Estrogen is the primary hormone responsible for the development of female sexual characteristics, such as breast development and the onset of menstruation. In males, testosterone is responsible for the development of male sexual characteristics, such as the deepening of the voice and the growth of facial and body hair. While hormonal changes can contribute to physical changes that are associated with sexual identity, it’s important to note that gender identity is a complex and multifaceted process that is influenced by many factors, including genetics, culture, and socialization.

During middle childhood, children may become more aware of their own gender identity and may begin to identify as boys, girls, or nonbinary. This process is influenced by a variety of factors, including the child’s upbringing, their exposure to different gender roles and expectations, and their interactions with peers and adults. It’s important for parents, teachers, and caregivers to provide a supportive and inclusive environment for children as they explore and develop their sexual identity. This can involve respecting their gender identity and expression, providing opportunities for them to learn about different gender identities and sexual orientations, and promoting acceptance and understanding of diversity.

Children as young as elementary school age are navigating and exploring gender identity. Because this developmental stage is a critical period of self-discovery and identity formation, it is important for the health and wellness curriculum to approach this topic in a supportive manner. By allowing children to explore and express their gender identity freely, we create an environment that fosters self-awareness, acceptance, and understanding of diversity. Restricting children’s exploration of gender can lead to feelings of confusion, shame, or repression, hindering their emotional well-being and self-esteem. However, offering support and validation for children’s gender exploration helps them develop a healthy sense of self-confidence and resilience, paving the way for positive mental health outcomes later in life.

Sex Education During Middle Childhood

Sex education is all about teaching individuals about sexuality, sexual health, and relationships. It’s important because it provides people with accurate information and skills they need to make informed decisions about their own sexual health and well-being.

Sex education covers a wide range of topics, including anatomy and physiology, puberty, contraception and birth control, sexually transmitted infections (STIs), healthy relationships, consent, and sexual orientation. It’s taught in a variety of settings, including schools, healthcare settings, and community organizations. There can be a lot of controversy around sex education, with some people disagreeing on what should be taught and how it should be taught. However, most experts agree that comprehensive, evidence-based sex education is essential for promoting sexual health and well-being. When done well, sex education can help individuals develop healthy attitudes toward sexuality, promote positive relationships and communication, and reduce the risk of unintended pregnancies, STIs, and other negative outcomes.

Sex education can be a sensitive topic. There are several approaches to educating people about changes to their body as it relates to maturing sexually.

Abstinence-Only Sex Education

Abstinence-only sex education is an approach to sex education that promotes abstinence as the only method for avoiding unwanted pregnancy, sexually transmitted infections (STIs), and other negative consequences of sexual activity. This approach typically focuses on teaching young people to delay sexual activity until marriage and to avoid sexual behavior outside of heterosexual marriage. Abstinence-only sex education programs typically do not provide comprehensive information about contraception, STIs, or other aspects of sexual health. Instead, they may emphasize fear-based messages about the risks of sexual activity, such as unwanted pregnancy and STIs.

Critics of abstinence-only sex education argue that it is ineffective and unrealistic, as many young people will engage in sexual activity regardless of the messages they receive. They also argue that it ignores the fact that young people have a right to accurate and comprehensive information about sexual health. Many experts recommend a comprehensive approach to sex education that includes information about abstinence as well as contraception, STIs, and other aspects of sexual health (Goldfarb & Lieberman, 2020). This approach acknowledges the reality that some young people will engage in sexual activity and aims to provide them with the knowledge and skills they need to make informed and responsible decisions.

Peer-Led Sex Education

Peer-led sex education is an approach to sex education in which young people, typically of a similar age or life stage as the target audience, lead and facilitate discussions and activities related to sex education. The goal of peer-led sex education is to create a safe and comfortable space for young people to discuss sex and relationships and to learn from their peers. Peer-led sex education programs may be structured in various ways, but they typically involve training for the peer educators, followed by group discussions or activities. Peer educators may also provide information about resources, such as healthcare services or community organizations.

Peer educators may be more relatable and approachable for young people, leading to increased engagement and participation. They may have a better understanding of the challenges and concerns faced by their peers and can provide advice and support based on their own experiences. They may also help break down stigma and create a more open and supportive environment for discussions about sex and relationships. Peer-led sex education should be supported by trained professionals who can provide guidance and ensure that accurate and appropriate information is being shared. Additionally, peer-led sex education should be inclusive of all identities and orientations and should not perpetuate harmful stereotypes or biases.

Sex-Positive Sex Education

Sex-positive sex education is an approach to sex education that promotes a positive and healthy attitude toward sexuality. It focuses on providing accurate information about sexual health and relationships, as well as promoting sexual autonomy, respect, and pleasure. In the context of middle childhood, sex-positive sex education may involve teaching children about the basics of anatomy, reproduction, and sexuality in a way that is age-appropriate and respectful. It may also involve teaching children about consent, boundaries, and healthy relationships, as well as promoting body positivity and diversity.

Sex-positive sex education aims to help children develop a healthy and positive attitude toward their own bodies and sexuality and to reduce the stigma and shame often associated with sexuality. It also aims to empower children to make informed and responsible decisions about their own sexual health and relationships.

Critics of sex-positive sex education argue that it may be too permissive toward sexual activity. However, proponents argue that it is essential for promoting sexual health and reducing the risks of negative consequences, such as unwanted pregnancies, STIs, and sexual violence. Overall, sex-positive sex education can be a valuable approach to helping children navigate their developing sexuality in a healthy and positive way, while also promoting respect, autonomy, and pleasure.

Equity Issues in Accessing Sex Education

Sex education in schools can sometimes be unfair because not all students have the same access to information and resources. As a result, some students might not get the information they need to make good decisions about their sexual health and relationships, which can affect their well-being. The lack of equal access to sex education can be due to a variety of factors, including the following:

• Access to comprehensive sex education: Not all students have access to comprehensive sex education that covers topics such as contraception, consent, and sexual health. Students from low-income families, students of color, and LGBTQIA+ students may be particularly affected by this inequity.
• Representation: Sex education materials, resources, and curricula may not represent the diversity of identities and experiences among students. This can lead to feelings of exclusion and marginalization among certain groups of students.
• Cultural norms: Cultural norms and values can impact how sex education is taught in schools. For example, abstinence-only education may be more prevalent in communities with conservative values, which can lead to a lack of information about contraception and safe sex practices.
• Stigma and discrimination: Stigma and discrimination around certain identities and behaviors, such as LGBTQIA+ identities or teen pregnancy, can impact how sex education is taught in schools. This can lead to inadequate or biased information being provided to students.
• Language barriers: Students who do not speak the dominant language in the school or community may face barriers in accessing sex education materials and resources that they can easily understand.

To make sex education more fair and inclusive, schools can take different actions. To address equity issues in sex education, schools can take steps such as:

• providing comprehensive sex education to all students, regardless of their background or identity
• ensuring that sex education materials and resources are inclusive and representative of diverse identities and experiences
• engaging with families and communities to better understand cultural norms and values around sex education
• addressing stigma and discrimination through education and awareness building
• providing language support and translations for sex education materials and resources

By taking these steps, schools can help ensure that all students have access to accurate and inclusive sex education that promotes healthy relationships and behaviors. Let’s take a closer look at specific gaps in sex education and their impact.

Race and Sex Education

Within sex education, racism can manifest in various ways, exacerbating inequalities and perpetuating harmful stereotypes that disproportionately impact communities of color and those from lower-socioeconomic communities.

Sex education programs may not adequately address the cultural differences and norms related to sexuality among different racial and ethnic groups. Ignoring or dismissing these differences can alienate students and contribute to a sense of cultural erasure.

Furthermore, the curriculum itself may contain biases that reflect racial stereotypes. For example, discussions about teenage pregnancy may disproportionately focus on minority communities, perpetuating the stereotype of irresponsibility among certain racial or ethnic groups. Discussions about STIs and HIV/AIDS may also reinforce negative stereotypes about certain racial or ethnic groups, leading to stigmatization and discrimination. For instance, the association of HIV/AIDS primarily with Black communities can perpetuate harmful myths and discrimination.

Minority communities often face disparities in access to comprehensive sex education resources. This can include limited access to educational materials, healthcare services, and contraception options, which can exacerbate existing inequalities in sexual health outcomes. In addition, sex education materials often lack diversity in their representation of different races and ethnicities. This can lead to a lack of relatability for students from minority backgrounds and reinforces the idea that sex education is primarily for White individuals.

Language barriers and cultural differences can also make it difficult for students from minority backgrounds to fully engage with sex education materials. This can result in misunderstandings or misinformation about sexual health and reproductive rights.

Addressing these issues requires a comprehensive approach that involves incorporating diverse perspectives into sex education curricula, training educators to be culturally competent, and ensuring equitable access to resources and health-care services for all communities. It’s essential to recognize and challenge the ways in which racism intersects with sex education to create more inclusive and effective programs.

Racism in sex education contributes to increased sexual violence in BIPOC communities. One of the most important ways that racism in sex education harms communities of color is how it impacts cultural representations of people of color, particularly individuals who identify as women. For example, hypersexualization of Black, Indigenous, and people of color (BIPOC) communities is a significant issue within sex education that stems from historical and cultural stereotypes. Inaccurate representation in the media can lead to biased assumptions about the sexual practices of BIPOC communities and ultimately result in dangerous disparities in protections against violence compared to White communities. Stereotypes influence curriculum and contribute to implicit bias among educators.

Addressing the hypersexualization of BIPOC communities within sex education requires a concerted effort to challenge stereotypes, provide culturally responsive education, and promote inclusivity and equity in all aspects of sexual health programming. This includes diversifying curriculum materials, training educators to recognize and address biases, and creating safe and inclusive spaces for discussing sexuality free from judgment and discrimination.

The Importance of LGBTQIA+ Inclusion in Sex Education

LGBTQIA+ sex education is important for middle childhood because it can help create a more inclusive and supportive environment for all students. Middle childhood is a time when children are starting to develop their own identities and are becoming more aware of social norms and expectations. This is also a time when children may start to experience feelings of attraction and develop romantic relationships with others.

For LGBTQIA+ students, this can be a particularly challenging time. They may feel isolated or marginalized if they don’t see themselves represented in the sex education materials and resources provided in their schools. They may also face discrimination or stigma from their peers or teachers.

LGBTQIA+ sex education can help to address these issues by providing accurate and inclusive information about sexual health, relationships, and identity. It can also help to create a more welcoming and supportive environment for LGBTQIA+ students by fostering a sense of belonging and validation.

Moreover, LGBTQIA+ sex education can help to decrease stigma and bullying, which can have serious negative effects on mental health and academic performance. By teaching students about the diversity of sexual orientations and gender identities, schools can help to promote acceptance and understanding, which can ultimately lead to a more positive and healthy school climate for all students.

Overall, LGBTQIA+ sex education is an important step toward creating a more equitable and inclusive school environment where all students feel valued and supported.

Teaching Consent as Part of Healthy Sexual Development

Teaching children about consent before they become sexually active can help them develop healthy attitudes toward relationships and boundaries. One way to teach your child about consent is to start with basic concepts like respect for personal space and asking for permission before touching or hugging someone else. For example, you can encourage your child to always ask before giving someone a hug and to respect other people’s boundaries if they say no. You can also use teachable moments to talk about consent in everyday situations. For example, if your child wants to borrow a toy from a friend, you can talk about the importance of asking for permission and respecting the friend’s decision if they say no. As your child grows older, you can start to have more in-depth conversations about consent and how it relates to sexual activity. You can explain that it’s important for both partners to agree to any sexual activity and that it’s never okay to pressure someone into doing something they’re not comfortable with.

Teaching consent during middle school builds on the foundation laid during elementary school and helps students develop a deeper understanding of consent, healthy relationships, and communication. During early childhood, teaching consent begins with discussions about personal boundaries, the importance of asking permission before touching, and age-appropriate vocabulary for body parts. As kids grow and mature, understanding consent becomes a little more complex. Here are some ways to teach consent during middle school:

• Teach students about power dynamics and how they can impact consent. For example, students can learn about how age, gender, social status, and other factors can affect someone’s ability to give or withhold consent.
• As students become more aware of their own sexuality, it’s important to teach them about consent in the context of sexual activity. This includes discussing sexual consent, boundaries, and communication.
• Emphasize the importance of enthusiastic consent, which means that both partners actively and enthusiastically agree to engage in sexual activity. This helps students understand that consent is not just the absence of a “no” but also the presence of an enthusiastic “yes.” Hesitation before a “yes” should be treated as a “no.”
• Teach students about the role of alcohol and drugs in affecting someone’s ability to give or withhold consent. This includes discussing the risks of impaired judgment and the importance of not engaging in sexual activity under the influence of drugs or alcohol.
• Discuss sexual harassment and assault with students, including how to recognize it, how to report it, and how to support survivors.
• Teach students about healthy relationships, including the importance of communication, mutual respect, and setting boundaries.

Overall, teaching children about consent is about promoting healthy boundaries and respect for others. It can start with basic concepts, such as personal space and permission, and progress to more complex ideas, such as body awareness changes. By having ongoing conversations about consent as your child grows older, you can help them develop healthy attitudes toward relationships and sexuality.

Licenses and Attributions for Sexual Development

“Sex Development” by Terese Jones is licensed under CC BY 4.0.