New validated scale offers brief measure of adolescent sexual wellbeing

The Missing Question in Teen Health: Scientists Build the First Validated Scale of Adolescent Sexual Wellbeing

Scientists have built the first brief, rigorously validated measure of sexual wellbeing designed specifically for adolescents — and it could close one of the most conspicuous blind spots in youth health research. The 13-item Adolescent Sexual Wellbeing Scale, or Adol-SW, developed by a University of Glasgow-led team through the UK Research and Innovation-funded Good Measure project and reported in the journal SSM – Mental Health, is short enough to slot into national health surveys alongside established instruments for sleep, anxiety and body image, yet broad enough to capture what teenagers themselves say matters most: confidence, safety, comfort, self-esteem and support. Tested on more than 1,700 UK adolescents aged 14 to 19, the scale deliberately includes young people with no sexual experience at all, a group most existing measures ignore. Its developers argue that measuring how teenagers feel about sex and sexuality — not merely what risks they take — is essential to understanding and protecting adolescent mental health.

The gap the scale addresses is structural and long-standing. Large national and international adolescent surveys, such as the Health Behaviour in School-Aged Children study, routinely assess sleep, exercise, family and peer relationships, substance use, social media use and academic pressure — but rarely ask anything about sexuality development. When sexuality does appear, questions are typically reduced to age at first intercourse, sexual orientation or risk behaviours such as non-use of condoms or contraception. Research has mirrored that narrow framing, concentrating overwhelmingly on adversity: sexual violence, sexually transmitted infections and unintended pregnancy, with adolescent sexuality treated mainly as a hazard for poor health outcomes. Yet adolescents themselves have signalled that this is not what they want studied. In a recent global priority-setting exercise published in The Lancet Child & Adolescent Health, young people identified the interplay between mental health challenges and sexual health as a major concern. The Glasgow team argues that the mismatch between what researchers measure and what adolescents want answered has helped produce services and interventions designed for young people but discordant with their actual needs.

Conceptually, the instrument rests on a modern definition of wellbeing as “feeling good and functioning well”, spanning hedonic components — feelings and affect — and eudaimonic components such as meaning, agency and relationships. The task was to specify what feeling good and functioning well looks like for sex and sexuality during adolescence. The team drew on an earlier framework developed with adults through qualitative research and a Delphi study, which defined six domains of sexual wellbeing: sexual respect, sexual agency, sexual safety, sexual self-esteem, comfort with sexuality and support. They then integrated the leading models of positive adolescent sexual development: Hensel and Fortenberry’s holistic sexual health framework for adolescent women; K. Paige Harden’s sex-positive framework emphasising self-efficacy, self-esteem, pleasure and satisfaction; Kågesten and van Reeuwijk’s competency-based model built on sexual literacy, gender equality, consent and interpersonal skills; and Remmerie and colleagues’ culturally sensitive framework highlighting supportive environments and capabilities such as consent and pleasure. Crucially, no existing instrument treated adolescent sexual wellbeing as an explicitly defined multidimensional construct, and most overlapping measures ran beyond 15 items while assuming partnered sexual experience.

Development began with agenda-setting. Four online workshops gathered 28 young people aged 14 to 23, recruited through youth organisations and an LGBTQ+ group to ensure diversity in gender and sexuality, alongside separate workshops with four parents, eight researchers and three policy professionals from education, a mental health charity and government. On a shared digital whiteboard, participants posted examples of how sexual experiences had affected mental health — positively and negatively — then discussed and voted on the issues that mattered most, each casting three votes. The team mapped the results onto the six-domain framework. Ten priority topics emerged: self-confidence and self-esteem; body confidence; sexual pressure and expectations; the ability to trust partners; confidence in one’s sexuality and identity; access to community and support around sex; sexual shame; sexual knowledge and experience; the impact of early sexual experiences; and sexual communication.

Those ten topics became the scaffolding for five further online focus groups with 38 adolescents aged 14 to 19, split by age and gender — girls and boys aged 14 to 15 and 16 to 19 — plus a 13-member LGBTQ+ group, recruited through a specialist youth research agency with quota sampling. Participants reacted to everyday scenarios: feeling unsure who you are attracted to, starting a new relationship, kissing for the first time, being shown a sexual image for the first time. From the discussions, researchers generated an initial pool of 33 candidate items, reviewed by a Youth Advisory Group and experts in adolescent mental health and measure development. Cognitive interviews with 18 more young people, run in three iterative waves using think-aloud and verbal probing techniques, stress-tested every item for comprehension, clarity and acceptability. Jargon such as “sexuality”, “partner” and “sexual preferences” was dropped after young people flagged it as unfamiliar, and items presupposing sexual experience — such as “I am able to say what I want in my sex life” — were rewritten or removed so the scale stays meaningful for adolescents who have never been sexually active. Iterative refinement condensed the pool to 22 items for field testing.

The proving ground was a web-based survey of UK adolescents aged 14 to 19, recruited through a hybrid of youth work services and targeted social media advertising to widen reach. Quota targets were set for age, gender, sexual attraction, ethnicity and region, and the target of 1,500 responses followed Comrey and Lee’s benchmark for an “excellent” sample size in factor analysis, minimising the risk of chance correlations. Data quality was policed aggressively: embedded age and region checks, hidden questions, IP filtering, bot and fraud detection, duplicate screening and completion thresholds excluded 1,830 questionnaires, leaving 1,710 usable responses. The final sample was unusually broad: 61.4 per cent girls or young women, 28.7 per cent boys or young men and 6.3 per cent non-binary; 10.8 per cent identified as trans; roughly a third reported attraction to both boys and girls; and 27.9 per cent reported no partnered sexual experience, with 54.3 per cent not yet having had sex — precisely the adolescents most existing measures overlook.

What followed was a textbook psychometric workup. After pre-specified reduction criteria — non-response above five per cent, ceiling effects in which more than 80 per cent of respondents chose the same answer, thin adjacent response categories and inter-item redundancy — removed five weak items, exploratory factor analysis suggested three-, four- or five-factor solutions, with eigenvalues of 5.07, 1.80, 1.25, 1.21 and 1.04. The four-factor structure made the most conceptual sense, and confirmatory factor analysis then pitted competing architectures against one another: a second-order model, in which a higher-order factor subsumes four correlated first-order factors, versus a general-specific model with a single global factor explaining all item variance. Analyses ran in Mplus 8 using the weighted least squares mean and variance adjusted estimator, suited to ordinal rating data, with full information maximum likelihood handling missing data. The second-order model prevailed on interpretability and fit with the underlying theory, delivering an RMSEA of 0.064, CFI of 0.954 and TLI of 0.941 — comfortably within accepted thresholds, where CFI and TLI above 0.95 signal good fit and RMSEA below 0.08 adequate fit.

The final scale condenses four subdomains into a single overall sexual wellbeing score. Support covers confidence in obtaining sexual health help — condoms, contraception, testing for sexually transmitted infections — having someone to talk to openly about sex and relationships, and having someone to turn to after a bad sexual experience. Comfort and Respect probes shame, anxiety and social exclusion, with items such as “Thinking about sex makes me feel ashamed” and “I feel left out when people talk about sex”, alongside comfort with who one is attracted to. Safety and Agency captures fear of unwanted sexual touch, pressure to do things sexually one does not want, and the worry that romantic interest is purely about sex. Self-Esteem includes worry about being bad at sex, anxiety about others’ judgement of one’s naked body, and feeling attractive. Items are answered on a five-point agreement scale, with negatively worded items reverse-scored. Comfort with sexuality and sexual self-esteem carried the strongest loadings on the overall factor — echoing what young people had emphasised from the first workshop onward: feeling confident and in control of their choices.

External validation gave the scale psychological teeth. In structural models adjusted for age, gender identity and expected occupation at age 20, higher Adol-SW scores were significantly associated with lower depression, at a standardised coefficient of −0.378 on the two-item Patient Health Questionnaire, and lower anxiety, at −0.337 on the GAD-7. They were also positively associated with body image (0.763), overall mental wellbeing on the Warwick–Edinburgh Mental Well-being Scale (0.462), control over sexual experiences and acceptance of one’s own sexuality on the Positive Sexuality in Adolescence Scale (0.571 and 0.528), sexual and reproductive empowerment (0.586) and friend support around sexuality (0.521). Every association was significant at p < 0.001. The pattern dovetails with earlier evidence linking body satisfaction to sexual satisfaction and good sexual health to lower depression in adolescent women, strengthening the case that sexual wellbeing is not a peripheral construct but one woven through adolescent mental health — with the relationship plausibly running in both directions.

The team is candid about the caveats. Measurement invariance — the statistical guarantee that a scale measures the same construct the same way across groups — held across age bands and, for the four subdomains, across gender identity and cisgender status, but invariance of the overall score was only partial across gender, driven mainly by weaker fit among cisgender boys, so total-score comparisons between genders should be treated as exploratory for now. Negatively worded items also outperformed positive ones, leaving seven negative items in the final set — a face-validity quirk the authors defend, since reverse scoring preserves interpretation, as in mixed-item instruments such as the GHQ-12. Small ethnic minority subsamples prevented invariance testing across ethnicity; the validation population was UK-only; and test–retest reliability and cross-cultural validation, especially in low- and middle-income countries, remain future work. None of this dims the ambition. Because it is brief, developmentally tailored and workable for adolescents with or without sexual experience, the Adol-SW can be embedded in national surveys to track sexual wellbeing as a core indicator, used as an outcome measure in intervention evaluations, and deployed in sex education framed around wellbeing rather than hazard alone. Built on the same conceptual foundation as the adult Natsal-SW measure from part of the same team, it opens the door to analyses spanning the life course. As the authors conclude, the 13-item scale is a significant step toward treating sexuality as an integral part of adolescents’ overall wellbeing — and toward health systems that finally ask the questions young people have been trying to answer all along.