There is little debate that the words sex and sexuality produce immediate attention. Researchers and teachers in this area have also come to employ the terms family life education, human growth and development, and human sexuality to describe instruction in human reproduction and sexuality (Roth 1993). The Sex Information and Education Council of the United States (SIECUS) recommends the term sexuality education (1992). This term refers to a comprehensive curriculum of instruction addressing not only sexual anatomy and physiology but also reproduction, contraception, sexually disseminated infections (SDIs), and related topics. Sexuality education is viewed by SIECUS as "a lifelong process of acquiring information and forming attitudes, beliefs, and values about identity, relationships, and intimacy." These programs commonly address issues of personality, value formation, decision-making, peer and social pressures, affection, intimacy, body image, gender roles, communication strategies, and various sexual behaviors (Haffner and de Mauro 1991).
There continues to be wide variation in results from various sexuality education interventions in the United States as well as in other countries (Dryfoos 1985; Ekstrand, Siegel, and Krasnovsky 1994). Some have had positive results on actual sexual behavior while others have failed to attain favorable outcomes (Kirby, Short, and Collins 1994). Because a clear means for designing or implementing preventive sexuality education programs has not emerged, researchers and teachers need to remain current on which approaches work best for which students under which circumstances.
Sexuality Education and Development Stages
For clarity, the developmental stages are classified into four very broad categories: younger children (five to seven), intermediate children (eight to ten), older children (eleven to twelve), and teenagers. Education regarding sexuality in children one to four years of age is not examined, since little data exists on sexuality during these ages (Borneman 1983). It is important to note, however, that these children do receive "education" in the form of modeling from their caregivers.
Younger children (five to seven). Children five to seven years of age do not see the distinction between causes and their effects. The process of thinking is centered around themselves, and they have difficulty seeing the perspectives of others (Piaget 1930; Werner 1948). From a sexual standpoint, young children at this stage generally have a clear sense of the basic anatomical distinctions between the sexes. There is typically modesty regarding public exposure of their bodies. Not surprisingly, parents and other adults exert a strong influence regarding issues such as nudity in the home (Masters, Johnson, and Kolodny 1992). At the same time, children have a natural curiosity about their bodies. Since the child considers the parent to be the main guide for appropriate behavior, it is critical that parents not overreact to catching the child in various sexual exploration games such as playing "doctor" or "house" with peers.
By the time the child enters first grade, the frequency of exploration games decreases, and exchange of sex information emerges in the form of sexual jokes, riddles, and rhymes (Borneman 1983). Children become fascinated with the new array of words that have sexual or forbidden connotations. Researchers have studied this phenomenon in children and have suggested that when information on sexuality is not clearly provided by adults (e.g. parents and teachers), sexual jokes become the primary source of such knowledge (Money 1980). Sexuality education at this level requires an emphasis on the importance of knowing and being comfortable with one's sexual self while simultaneously avoiding negative modeling. A sound educational foundation at this level can foster greater social and sexual maturity at later stages.
Intermediate children (eight to ten). During this period, thinking is characterized by the ability to differentiate between self and others, between internal and external bodily events, and by an ability to comprehend cause-and-effect relationships. Sexuality education at this age can illustrate causality and thus more complex information. At this stage, children become intrigued with reproductive mechanisms. The idea of hormones as crystal-like structures flowing through one's blood is not abstract or unbelievable at this stage. Sexuality programs during this period have a twofold purpose: (1) provision of relevant, as well as scientifically correct, knowledge and language usage; and (2) instruction that facilitates the child's ability to understand causation and thus help them act to prevent future problems.
The goal of preventive sexuality education at this stage is important in view of AIDS/HIV in the United States and in other countries, such as those in southern and central Africa. Various medical and scientific authorities agree that the most promising method for controlling this crisis is early preventive and developmentally appropriate sexuality education (Greenberg, Bruess, and Hafner 2000).
Older children (eleven to twelve). During this time children integrate internal and external phenomena into one system. Their level of cognitive sophistication is also more intricate. They can easily see how one factor (lack of knowledge) may interact or combine with another factor (lack of self-esteem) to produce risky sexual acts and teenage pregnancies. Such interactive relationships are crucial in sexuality education designed to foster self-protective thinking among students. In contrast to prior stages, however, the biological side of development now begins to play a major role. There is a strong sense of one's external appearance and how it may be perceived as significant by others. Most children experience puberty at this age. Sex hormones begin to increase in activity and stimulate bone growth. This "growth spurt" typically occurs two years earlier for females than males (on average, age twelve versus fourteen).
Sexuality education is of crucial importance during this time. For girls, there is a need to know about breast development (phelarche), appearance of pubic and axillary hair (pubarche, thelarche), and the onset of menstrual cycles (menarche). There is also a need to know about vaginal secretion changes that may occur (transudation) and, most importantly, that these body changes are part of normal sexual development. In boys, there is a need for information on genital growth and ejaculation. Although males do not have a direct counterpart to menarche in females, the first nocturnal ejaculation of a young boy can cause the same psychological concern. Boys, like girls, also need to know about the onset of pubic and facial hair and how it is a biologically normal process. A condition known as gynecomastia or breast enlargement occurs in many young males whose hormonal systems are still trying to find their balance. Boys need clear and compassionate information that assures them this condition is not life threatening or cancerous and that it typically disappears within a year or two without any harmful effects.
Physical changes are also part of sexual differentiation at this period of development. Young girls tend to be overly concerned with the shape, texture, and general aesthetic of their bodies as estrogen causes fat to accumulate under the skin to produce the classic female figure. Boys, conversely, are more fixated on height and muscle mass comparisons as testosterone production begins to influence muscles that eventually produce the male physique.