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Original Article 

Volume 13     Number 2     April 2020 
Copyright © 2020 Tehran University of Medical Sciences. 
This work is licensed under a Creative Commons Attribution-NonCommercial 
4.0 International license (https://creativecommons.org/licenses/by-nc/4.0/).  
Non-commercial uses of the work are permitted, provided the original work is 
properly cited. 

Ethical considerations and challenges of sex education for 

adolescents in Iran: a qualitative study 

Kobra Joodaki1, Saharnaz Nedjat2, Marziyeh Vahid Dastjerdi3, Bagher Larijani4*  
 

1. PhD Candidate in Medical Ethics, Department of Medical Ethics, School of Medicine, Tehran University of Medical 
Sciences, Tehran, Iran. 
2.Professor, Department of Epidemiology and Biostatistics, Knowledge Utilization Research Center, School of Public 
Health,  Tehran University of Medical Sciences, Tehran, Iran. 
3.Associated Professor, Department of Obstetrics and Gynecology, School of Medicine, Tehran University of Medical 
Sciences, Tehran, Iran. 
4.Professor, Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences 
Institute, Tehran University of Medical Sciences, Tehran, Iran. 
 

Abstract 
Adolescence is a period in one’s lifetime during which sexual 
maturation occurs. Major changes and increased sexual instinct 
raise many questions in the minds of adolescents. Receiving 
wrong education or inappropriate information can affect 
adolescents’ life and future deeply. Obviously, ethical 
considerations cannot be ignored in nationwide macro policies 
and educational programs on such a sensitive issue. In this 
qualitative study, we attempted to explore the ethical 
considerations and challenges of sex education for adolescents. 
The study was conducted between May 2015 and March 2017. 

Data were collected through semi-structured in-depth interviews 

with 25 participants, and MAXQDA 11 was used for coding. 

Six hundred sixty-two codes (662) were extracted and classified 

into four categories: 1) the potential risks of sex education for 

adolescents; 2) the advantages of sex education for adolescents, 

and the approaches; 3) the challenges in the interval between 

sexual maturation and marriage, and the role of religion; and 4) 

the measures implemented in Iran. 

Shame, embarrassment, and some cultural beliefs surrounding 

the subject of sex education are obstacles to providing 

adolescents with the necessary information. According to the 

principles of medical ethics, the main principle in sex education 

is beneficence, and sometimes infringement of confidentiality 

has its advantages.  

Keywords: Ethical considerations; Sex education; Adolescent; 
Medical ethics; Reproductive ethics 

  

*Corresponding Author 
  
Bagher Larijani 

No. 10, Jalal Al-Ahmad St., Next to 

Shariati Hospital, Chamran Hwy., Tehran, 

Iran. 

Tel: (+98) 21 88631296 

Email: emrc@tums.ac.ir 

 

Received: 25 Dec 2018 

Accepted: 26 Jan 2020 

Published: 11 Apr 2020 

 

Citation to this article:  

Joodaki K, Nedjat S, Vahid Dastjerdi M, 

Larijani B. Ethical considerations and 
challenges of sex education for 

adolescents in Iran: a qualitative study. J 
Med Ethics Hist Med. 2020; 13: 2. 



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Volume 13     Number 2     April 2020 

 

  Introduction 

Adolescence is a transitional period in life 

when rapid physical growth and 

development and sexual maturation lead to 

one’s physical capability to reproduce. 

Based on the definition offered by WHO, 

adolescents are “young people between the 

ages of 10 and 19 years” (1). Since 

adolescents and young adults are going 

through the growth stage, their health can be 

affected either positively or negatively by 

their interactions with their environment, 

their friends and peers, their parents and 

family members, people in the society, 

policies and social rules (2, 3). In the course 

of sexual maturation, adolescents undergo 

fundamental changes and face with 

questions and ambiguities, and if they do not 

receive the right answers, they turn to their 

peers or media such as satellite TV, Internet 

and cyberspace. In this way, they often do 

not find proper answers and may even 

receive wrong ones, which will be 

problematic in the future. Therefore, 

education on the subject of sex and sex 

ethics is a necessity that must not be 

overlooked, and not only has to be provided 

by the parents and the society, but is also a 

fundamental right of adolescents (4). Due to 

its unique characteristics, sex education is 

accompanied by a number of challenges in 

all countries and cultures, and unique ethical 

considerations are associated with it (5). 

Talking about these subjects in public is 

tabooed in some countries (6). In some 

Western countries such as England, having 

sexual activity is accepted as a norm for 

young adults, but even in those countries 

there is a tendency not to talk about sexual 

intercourse and contraception with 

adolescents (7). In many Muslim countries 

such as Iran, sexual intercourse outside of 

marriage is prohibited both culturally and 

religiously (8,9). In such countries, sex 

education is insufficient and restricted, and 

is often avoided by teachers since they do 

not feel right talking about such subjects 

(10) There is currently no ongoing policy on 

sex education in Iran. 

Although sex education has improved and 

different aspects of it have been dealt with, 

there has been little discussion about the 

associated ethical issues or the development 

of moral codes (11). Many studies have 

explored education about puberty and sexual 

matters in Iran and have examined the 

necessity of sex education, the content of the 

educational material, educators, and time of 

the training rather than the existing 

challenges (8, 9, 12, 13, 14, 15). However, 

no studies have been conducted on the 

ethical considerations and challenges related 

to this topic thus far. There have been a few 

studies on the issue in Western countries that 

have dealt with the ethics of sex education in 

general rather than adolescents and the 

issues specific to them (16,17). Those 

studies that have included young adults were 

mainly focused on criticizing the policies 

and regulations of Western countries in 

either advocating abstinence or offering 

comprehensive sex education, and compared 

the outcomes of the two systems of 

education with each other; in other words, 

they have not often dealt with the ethical 

considerations surrounding sex education 

(18, 19). 



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Volume 13     Number 2     April 2020 

It is clear that ethical considerations cannot 

be ignored when nationwide macro-policies 

and educational programs are involved, 

especially regarding such a sensitive issue. 

In this qualitative study, we tried to clarify 

the ethical considerations and challenges of 

sex education for adolescents in Iran. 

 

Methods  

This qualitative study was conducted 

between May 2015 and March 2017. 

We used in-depth interviews and sampling 

of special or unique cases in this qualitative 

study due to its being flexible and in-depth 

(20). Participants were selected 

purposefully, and the attempt was to choose 

diverse subjects who were knowledgeable 

and experienced in the topic of the research. 

To ensure confidentiality, their job and 

social status were not disclosed. The 

interviews lasted 25 - 65 minutes, the 

average duration being 42 minutes. The 

questions were open-ended and exploratory 

to encourage participants to express their 

personal experiences and help to conduct in-

depth interviews. The interviews started with an 

explanation of adolescents’ access to 

cyberspace and an uncontrollable environment, 

and information was obtained directly or 

indirectly about the subject. The main 

questions were extracted from studies 

conducted on education about puberty and 

sexual subject matters in Iran, such as the 

necessity of sex education, the proper 

training age, choosing a suitable person for 

the purpose, teaching methods, educational 

content, the effect of cultural differences, the 

negative impact of knowledge or lack of 

education, and the difference between girls 

and boys. At the end of the interview, if the 

interviewees had adolescent offspring, they 

were asked: “What do you do for your 

adolescent offspring in the way of sex 

education?” The discussions continued until 

data saturation was reached when 

participants proposed no new items in the 

last three interviews. The interviews were 

transcribed verbatim.  

Qualitative Analysis 

After a final review of the transcripts, the 

MAX-QDA 11 software was used for the 

coding process, and the data were analyzed 

through Corbin and Strauss’s content 

analysis method (21). The first stage or 

substantive coding was done, a theme was 

ascribed to basic concepts in sentences and 

paragraphs, and the main theme was 

identified. Subcategories also emerged when 

coding at the next stage, and similar themes 

were placed in one subcategory or group. 

The classified concepts were then compared 

with each other and subcategories were put 

in categories. At the final stage, the main 

categories were formed. 

The Trustworthiness of the Study  

The trustworthiness of the study was 

assessed to confirm data accuracy in terms 

of the following four criteria: dependability, 

credibility, transferability, and conformability 

(22). To increase the dependability of the 

research, the codes were reviewed several 

times in order to classify them and find the 

main themes and main categories. 

Knowledgeable participants were selected 

from a large variety of majors, and 

triangulation technique was used to increase 



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Volume 13     Number 2     April 2020 

the consistency of the study (23). The 

recorded files of some interviews, their 

transcriptions, and the extracted codes were 

sent to some of the participants to confirm 

the transcription and method of coding 

(conformability). To heighten the reliability 

of the research, an external rater was used. 

Five anonymous transcribed files were 

coded by a researcher who was not involved 

in the study. The similarity of coding was 

estimated to be more than 75 percent 

(transferability). 

Ethical Considerations 

The participants were informed about the 

purpose of the study and their verbal 

informed consent was obtained. The 

researcher guaranteed privacy and 

confidentiality of the information, protection 

of recorded voices, and anonymity of the 

transcriptions. Whenever asked by the 

participants, the researcher would turn the 

recorder off. It should be added that this 

article was part of a larger study done for a 

Ph.D. dissertation in medical ethics, 

approved by the Ethics Committee of Tehran 

University of Medical Sciences (Approval 

No. IR.TUMS.REC.1395.2508). 

 

Results  

In the present study, twenty-six participants 

were interviewed. The demographic and 

background characteristics of the 

participants are presented in Table 1. After 

the interviews were transcribed, one of the 

participants asked to be excluded from the 

research. 

Table 1. Demographic and background characteristics of participants (N=25) 

Demographic No. 

Age (yr.) 

25 - 44 

45 - 64 

65 and > 

 

10 

11 

4 

Gender 

Female 

Male 

 

16 

9 

Marital Status 

Single 

Married 

 

5 

20 

Having Teenage Children 

 

Yes 

no 

 

 

19 

6 

Education 

Less than high school diploma 

High school diploma 

Bachelor’s degree  

Master’s degree 

PhD 

Doctor of medicine degree 

 

1 

1 

4 

2 

7 

10 



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Demographic No. 

Background Characteristics of Participants 

 Physicians and medical ethicists                                                          
  
 Doctors of theology (Islamic studies) and religious experts                 
  
 Clients in health centers, one with a primary school certificate and 

one with a high school diploma (12 grades of schooling) 

 

 Clinical psychologists holding master’s degrees who worked in 
health centers as psychologists and counselors for behavioral 

disorders and as mental health experts 

  
 Midwives: three of them offered contraceptive services as health 

care providers in a clinic, and one worked in a maternity hospital 

  
 Medical specialists: One pediatrician; one occupational medicine 

specialist, and medical ethics teacher; one psychiatrist, religious 

expert, and medical ethics teacher; one pathologist, religious 

expert, and medical ethics teacher; three gynecologists and 

obstetricians  

 

Experts (graduates) in basic medical sciences including: A PhD in               

clinical pharmacy who is also a medical ethics teacher; a 

nutritionist, PhD, and religious expert; a PhD in environmental 

health; An MD, PhD in reproductive health; a PhD in community-

oriented medicine and fellow of sexual behavior (sexology); a PhD 

in epidemiology 

 

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Six hundred and sixty-two (662) codes were 

extracted from 25 interviews. These codes 

were classified into 25 themes, 12 

subcategories and four categories (Table 2).  

 

Table 2. Ethical considerations and challenges of sex education for adolescents 

Categories Subcategories Themes 

Potential risks of 
sex education for 

adolescents 
 

Harmful effects of sex 
education on 
adolescents 

Having sexual intercourse without fear of its 
consequences 

Encouraging them to practice sex 

Disapproval of sex 
education by the 
society and 
organizations 

Unpreparedness of the society and the educational 
system 

Interference between cultural and religious affairs 

Advantages of sex 
education for 

adolescents, and 
the approaches 

 

Harms of not offering 
sex education to 
adolescents 

Misconception that adolescents are encouraged to 
practice sexual acts by being informed 

Violation of adolescents’ rights 
Unwanted pregnancies 

Adolescent sexual abuse 

Disadvantages of not knowing about a healthy spousal 
relationship 

Getting wrong information from inappropriate 
resources 



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Categories Subcategories Themes 

Appropriate age for 

sex education 

The necessity for sex education and providing the 

needed information 

Age-appropriate education 

Educators 

The role of the family 

Friends and peers 

The role of cyberspace 

Teachers in schools 

Education by a specialist 

Media 

Pharmacies 

Methods of sex 

education for 

adolescents 

Educational content 

The method for education 

Decreased age of 

starting sexual 

intercourse 

Decreased age of learning about sex topics 

The role of technology advancement and modernity 

Increased sexual relationships in adolescence 

Challenges in the 
interval between 

sexual maturation 
and marriage, 
and the role of 

religion 

The necessity of 

decreasing the age of 

marriage 

 

The necessity of 

establishing a moral 

institution to resolve 

the challenges 

pertaining to the 

interval between 

sexual maturity and 

social maturity 

 

Abstinence Creating normal anxiety to prevent sins 

Measures 
implemented in 

Iran 
 

Teaching about 

puberty in universities 

and schools 

 

Lack of transparency 

in the education 

system of Iran 

Inconsistencies related to sex education in schools 

 

 

The four main categories included: the 

potential risks of sex education for 

adolescents; the advantages of sex education 

for adolescents, and the approaches; the 
challenges in the interval between sexual 

maturation and marriage, and the role of 

religion; and the measures implemented in 

Iran. Subcategories, themes, and some 

participants’ statements are presented in 

Tables 3 - 6.  

 
 
 
 
 



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Table 3. Category of the potential risks of sex education for adolescents 

 

 

 

 
 
 

Subcategories Themes Quotes and Examples 

Harmful 
effects of sex 
education for 
adolescents 
 

Having sexual 
intercourse 
without fear of 
its 
consequences 

One of the medical specialists stated: 
“We teach them. We help a 13-year-old girl; an 11-year-old boy 
satisfies his sexual desire. We help them, we prepare the way and the 
ground for their sexual activities. They experience it whenever they 
can.” (No. 24) 
 

Another medical specialist mentioned: 
“The education is for times when sexual activities are legitimate and 
within the Islamic framework. Outside of this framework, adolescents 
should remain uninformed in order not to be sexually stimulated. 
Once the function of a body organ is known, especially in case of 
reproductive organs, they want to put it into action to see the effects. 
Simultaneously, their sexual desire is triggered. Considering all this, our 
educational measures help to propagate sexual immorality.” (No. 21) 

Encouraging 
them to act 

One of the medical ethicists maintained: 
“Sex is a powerful force. It is neither the desire for something edible 
or drinkable, nor an artistic work or music, so we cannot expect an 
adolescent to control himself/herself if he/she craves it. Can he/she? 
Definitely not! If you offer him/her sex education, you have actually 
prepared the ground for him/her to have sexual activities; he/she does 
it in any possible way, the first opportunity he/she gets.” (No. 16) 
 

On the subject of sex education and provoking curiosity in 
adolescents, one of the medical specialists stated: 
“I cannot say this for sure, not without evidence, but based on my own 
experience, I think if sex education starts sooner than the appropriate 
time, or if it is done very openly, it provokes curiosity.” (No. 7) 
 

One of the clients of a health center explained: 
“Sometimes knowledge leads to wrongdoing; perhaps it depends on 
the kind of family the child is brought up in.” (No. 4) 

Disapproval 
of sex 
education by 
the society 
and 
organizations 
 

Unpreparedness 
of the society 
and the 
educational 
system 

Highlighting the unpreparedness of the social climate, a Ph.D. 
believed that sex education puts young adults at risk: 
“Naturally, the society is not ready yet so that we can offer sex 
education directly to adolescents. Why isn’t it ready? Because the 
educational system does not have sufficient platforms for this; we are 
always worrying about the challenges, and we should always be 
cautious not to jeopardize adolescents and put them at risk by giving 
them sex education.” (No. 19) 

Interference 
between 
cultural and 
religious affairs 

One of the medical specialists mentioned: 
“We have a major challenge: the interference between religious and 
cultural views. Most of the times religion allows us but culture 
doesn’t. We do not have any rules about this. Based on our 
constitution, we borrowed a rule from religion, but even our religious 
leaders gave in to politics. This is the very thing that keeps us silent. 
Why should I victimize myself more in my domain of work where I am 
influential but not supported by the system?” (No. 7) 



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Table 4. Category of the advantages of offering sex education to adolescents, and the approaches 

 

Subcategories Themes 

Harms of not offering sex 

education to adolescents 

 

Misconception that adolescents are encouraged to practice 

sexual acts by being informed 

Violation of the rights of adolescents 
Unwanted pregnancies 

Adolescent sexual abuse 

Disadvantages of not knowing about a healthy spousal 

relationship 

Getting wrong information from inappropriate resources 

Appropriate age for sex education 

 

The necessity for sex education and giving needed information 

Age-appropriate education 

Educators 

 

The role of the family 

Friends and peers 

The role of cyberspace 

Teachers in schools 

Education by a specialist 

Media 

Pharmacies 

Methods of sex education for 

adolescents 

Educational content  

The method for education 

Decreased age of starting sexual 

intercourse 

Decreased age of learning about sex topics 

The role of technology advancement and modernity 

Increased sexual relationships in adolescence 

 

 
Table 4-1. Subcategory of the harms of not teaching sex education to adolescents 

Themes Quotes and Examples 

Misconception that 

adolescents are 

encouraged to 

practice sexual acts 

by being informed 

One of the PhDs disagreed with the view that being informed of sexual subject matters 

encourages adolescents to have sexual relations: 

“Because I am talking about an adolescent, a human being. Those who disagree with sex 

education were themselves once adolescents; they are human beings. Firstly, they have to 

challenge themselves, they should go deep into their mind. You, I, that physician, that 

religious leader should go deep into our minds and ask ourselves, ‘once I became familiar 

with sexual relations in my sexual world, did I practice sex?’ ” (No. 19) 

Violation of  

adolescents’ rights  

One of the PhDs considered the necessity of education as one of the main rights of 

adolescents: 

“Yes, they have a right to know. They have the right to know what the norms of their sexual 

value system are. They are not like weed that grows automatically. We as adults, we as 

knowers, I as the mother or teacher should know how to give value to their sexual world. 

When they understand this value, certainly their responsibility increases.” (No.19)  

Unwanted 

pregnancies 

One of the PhDs explained: 

“I wonder what the authorities plan to do about what is currently happening and what we 

hear now and then. It seems they want to ignore these adolescents so that … this means we 

let young adults give birth to illegitimate children.” (No. 25) 

Adolescent sexual 

abuse 

One of the clinical psychologists stated: 

“We, as psychologists, believe that we should make even pre-school and school children 

aware of the intimate parts of their bodies to prevent potential abuse. We believe that from 

4-5 year-old children and younger to adults who, for instance, are university students, all 

need to be given scientific and academic sex education under the supervision of a 

professional. There is no difference; everyone needs sex education   their age. Children 

need to be educated due to the rapes that are reported more frequently nowadays.” (No.12) 



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Themes Quotes and Examples 

Disadvantages of 

not knowing about 

a healthy spousal 

relationship 

A PhD, who was also a religious expert, stated: 

“An important problem is lack of knowledge that is essential for young couples. This 

shortage manifests itself in disagreements, misunderstandings separations, and other 

problems.” (No. 23) 

A gynecologist and obstetrician explained: 

“We have cases who have been married for a couple of years, but cannot bear the smallest 

sexual touch or physical contact because of the fears they had, caused by myths their 

family told them about sexual relationships.” (No. 20) 

Getting wrong 

information from 

inappropriate 

resources 

Many experts pointed out to the harms of getting wrong information from inappropriate 

resources. 

One religious expert said: 

“It is absolutely wrong to keep silent, to keep our mouths shut, not to talk about sexual 

subject matters, to let them get information from the disturbed market outside and immoral 

sources while we are happy that they know nothing.” (No. 23) 

One of the medical ethicists stated: 

“It may be harmful if the education is inappropriate. For instance, porn movies are the 

worst kind of education. These movies show sexual violations and unrealistic or wrong sexual 

behaviors in a way that the adolescent child thinks they are good and healthy sexual 

relationship. These movies not only are not educational but are absolutely harmful.” (No. 18) 

  
 

Table 4-2. Subcategory of the appropriate age for sex education 

Themes Quotes and Examples 

The necessity for 
sex education and 
giving the needed 
information 

One of the religious experts explained: 
“Some say that we should talk to adolescents about sexual subject matters when 
they enter puberty. I do not have a good experience of this. I feel children should be 
told about sex topics gradually from childhood when they come to understand 
sexuality – for instance at 9 or 10 years old – and we should make them ready little 
by little; then we can continue by telling them if extra information and tips are 
needed.” (No 22).  
 
One of the midwives said: 
“Sex education should be started from a very young age. Since website contents are 
replete with inappropriate and uncontrolled information about sex, the sooner sex 
education starts, the better it is.” (No 11). 

Age-appropriate 
education 

A very large number of codes were pertinent to age-by-age and age-appropriate 
education. 
In this respect, one of the medical ethicists stated: 
“I think education should be age-by-age and start from the onset of puberty.” (No. 
24) 
One of the clinical psychologists explained: 
“Some adolescents may concentrate on their studies and some may not. Perhaps 
some adolescents would like to experience sexual activities earlier than others and 
therefore questions arise for them about sexual topics. These things really matter.” 
(No.12) 

 
 
 
 
 
 
 
 
 



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Table 4-3. Subcategory of educators and the resources for gaining information 
Themes Quotes and Examples 

The role of the 
family 

One of the clinical psychologists explained: “Generally we say that parents should start 
sex education from childhood by teaching their children the correct names of genital 
organs as private parts of their bodies. Nevertheless, if the parents do not know how to 
do this, they have to be taught.” (No.12) 
One of the PhDs stated:  
“Parents should have a complete parenting education program. They should know how 
to teach and convey educational contents to their offspring.” (No.19) 
One of the religious experts said:  
“I would prefer a friendly teacher as a counselor in the school to tell students about such 
topics rather than myself; it is better that mothers do not tell them anything.” (No.22) 
One of the clients of a health center said:  
“People’s manners of speaking about such topics are very different. Someone may speak 
comfortably, openly, and extensively with no censorship. I myself prefer not to give all 
the details.” (No. 6) 
One of the medical ethicists stated:  
“Due to the embarrassment and shame that exist in our families – and many believe 
there is no reason for it – we cannot talk about such topics. Unfortunately, this is the 
case in our family; therefore, parents cannot act as counselors of sex education for their 
offspring, even though they are the safest and most empathetic people for their kids. 
Sadly, this is how things are in our society.” (No.16) 
With regard to the difference between girls and boys, one of the clinical psychologists stated: 
” Based on what I know and studied and learned in the workshops, it is preferable that 
sex education be given by the same-sex parent of the adolescent from puberty on; for 
girls, sex education should start from their first menstrual period. At puberty, a series of 
changes happen to boys. A 15-16-year old boy may have night-time erections. As parents 
we should be able to answer the questions of these curious minds.” (No.12) 

Friends and peers 

Most of the participants believed that the role of friends and peers in sex education is 
negative as they may convey wrong and harmful information. One of the health care 
experts said:  
“But if they get the information from their friends, they may be encouraged to have 
sexual experiences.” (No.12) 

The role of 
cyberspace 

Most participants referred to the role of cyberspace in education about these affairs and 
highlighted its uncontrollability, wide accessibility, and negative effects on the education 
of adolescents. One of the PhDs stated:  
“Previously, children’s access to such information was limited. They could only ask 
their friends. Now all of them have access to cyberspace on their cell phones. Therefore, 
they certainly go there and get wrong information.” (No.1) 

Teachers in schools 

One of the medical specialists stated:  
“Such subjects should be taught by a teacher who is always present in the school, not by 
someone from outside who teaches and leaves. The reason is that a student may have no 
questions when he/she is being taught, but that does not necessarily mean that he/she has 
no problem or will not have any problems in the next week. Students should know that 
they can refer to the teacher who has taught them whenever they have a question. Of 
course, the teacher should be selected very carefully and cautiously.” (No.8) 

Education by a 
specialist 

One of the psychologists said:  
“I emphasize that it should be a reliable form of education under the supervision of 
specialists. In this way, they are not sexually stimulated.” (No.12) 
One of the PhDs explained:  
“Iatrogenic factors that happen in case teachers are non-professional or non-expert in 
sex education are definitely harmful.” (No.19) 

Media 

Participants advocated making use of the media for sex education, though cautiously. 
One of the medical ethicists stated: 
“Education has to be started in the family; media should have a role in education too; 
the significant subject matters should be presented in mass educational media.” (No.13) 

Pharmacies 

Due to adolescents’ referral to pharmacies to get contraceptives, one of the PhDs 
suggested the opportunity for sex education in pharmacies and said: “If a 14-15-year old 
adolescent refers to a drugstore and asks for contraceptives, he/she can receive it. 
However, firstly he/she has to be guided. Here the adolescent is showing that he/she has 
the right to know. The pharmacist has to give the necessary information to him/her and 
guide him/her toward safe behaviors.” (No.3) 

  



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Table 4-4. Subcategory of the methods of sex education for adolescents 

Themes Quotes and Examples 

Educational 
content  

Teaching reliable scientific materials was highlighted by some participants. 
A clinical psychologist said: 
“I agree with sex education 100 percent, but the content to be taught should be 
reliable and offered under the supervision of specialists.” (No.12) 
 

Considering adolescents’ background information was also highlighted by many 
participants. 
One of the gynecologists stated: 
“It’s almost a crime to cause adolescents to have an unhealthy attitude toward 
sexual subject matters; or distract the thoughts of adolescents who are only busy 
with their studies to issues which they were not supposed to know.” (No.20) 
 

One of the medical ethicists explained: 
“Some factors are influential here, for example, how much information they get 
from other resources. Because when education is wrong, they may receive wrong 
information.” (No.18) 
 

Another question was, “Should adolescents’ living place and local culture 
influence the type and method of education?” Some of the participants 
highlighted the cultural differences between cities or even between various areas 
within a city, which lead to different needs of the adolescents for education. 
 

One of the clinical psychologists said: 
“Education should be given based on adolescents’ continuum of development; it 
should be appropriate for their age range and in accordance with their culture 
and the family in which they are growing up.” (No.12) 
 

One of medical ethicists said: 
“There should be a specialized program for education based on adolescents’ age, 
gender, geographical location, culture, and the content of the subject matter to be 
taught. For instance, teaching some topics may have priority over some other 
topics when you are teaching boys; the same is true for education of some topics 
in accordance with age. Or education may be different based on whether you are 
teaching in a city or a village; it has to be. Seemingly we fail if we cannot develop 
a specialized program for education.” (No.16) 

The method for 
education 

Participants insisted on indirect teaching. 
 

One of the religious experts said: 
“We are facing a dilemma: should we be silent and allow adolescents to do as 
they wish, or should we teach them responsibly and within a framework of 
educational and moral structure? But this doesn’t have to be announced explicitly 
on media or in public where 6-year-old children would hear and ask what the 
whole thing means. The information has to be given wherever it has to.” (No.23) 
 

One of the midwives said: 
“Yes, it should not be taught overtly. For instance, we can say to them that there 
are methods people use to prevent unwanted pregnancies; of course, this should 
be done as indirectly as possible; However, naming the methods may be 
inappropriate in some cultures; for instance, telling boys directly to use condoms 
may be very unpleasant. I myself have a son, it will be very embarrassing for me 
if someone comes and says this to my son.” (No.14) 

 
 
 

  



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Table 4-5. Subcategory of the decreased age of starting sexual intercourse 

Themes Quotes and Examples 

Decreased age of 

learning about 

sex topics 

Most participants expressed their worries about the decreased age of learning about 

sexual topics. One health care expert who had been to a middle school to offer 

health education to students stated: 

“They knew many things, I mean they knew much more than a 40-year-old woman in 

the past generation, they knew everything. I was supposed to teach them, but they 

themselves knew everything in detail.” (No.10) 

 

Another health care expert told about students in the first grade of high school: 

“I realized from what they said that they knew many things about sexual subject 

matters, they knew everything, and most of them stated this overtly.” (No.14) 

The role of 

technological 

advancements 

and modernity 

With respect to technological advancements and modernity, one of the medical 

ethicists explained: 

“If you live in a city where you have electricity, a cell phone, and a tablet, you 

cannot restrict their accessibility to the resources.” (No.18) 

 
 

 
Table 5. Category of the challenges in the interval between sexual maturation and marriage, and the 

role of religion 

Subcategories Themes Quotes and Examples 

The necessity to 

decrease the age of 

marriage 

 

One of the medical ethicists said: 

“In a religious society, it can be helpful if the education is based 

mainly on informing adolescents, which leads to abstinence, and 

simultaneously the policies are to decrease the age of marriage. It is 

not reasonable to demand that individuals practice abstinence when a 

very strong force from outside is telling them the reverse. But if you 

focus your attempts on decreasing the age of marriage to 19 or 20 

years, you can expect them to wait because in this way they think that 

they can marry 2 or 3 years later and tell themselves that when they 

finish high school, they will. In such conditions, you can expect 

abstinence from adolescents.” (No.16) 

The necessity of 

establishing a 

moral institution to 

resolve the 

challenge of the 

time between 

sexual maturity 

and social maturity 

 

One of the medical ethicists said: 

“In the current situation, it is impossible. Therefore, the society can 

establish a moral institution in which adolescents can have sexual 

relationships in the interval between puberty and marriage; a 

relationship acknowledged by the society that commands commitment, 

not promiscuousness, and is based on common sense and ethical and 

social principles. Meanwhile, adolescents will receive sex education 

at the right time. Such an institution is absent in our society." (No.18) 

 Abstinence 

Creating 

normal 

anxiety 

to 

prevent 

sins 

The opinions about abstinence and adolescents’ ability to practice it 

were different. 

One of the medical ethicists stated: 

“You cannot expect an individual whose sexual impulsions have been 

activated since 15 to practice abstinence. You don’t have the right to 

pressure him/her to wait until 30 to marry. This means that you want 

them to practice abstinence for half of their lives. Are the teachers 

who sex educate themselves able to do this?” (No.16) 

One of the PhDs believed that intense sexual desire can be controlled 

through education: 

“Why should young adults be taught to be animalistic or be told they 

are not able to control their sexual desires? If I am to teach them, I 



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Subcategories Themes Quotes and Examples 

will tell them that sex drive exists, but it is controllable; I will tell 

them that sexual activities are not the only source of pleasure, we can 

derive pleasure from drinking this tea as much as the pleasure we 

derive from watching a woman or a man. Now they can choose for 

themselves. I will give them measuring devices to choose by. I will not 

speak nonsense. I will tell them to think and see which pleasure has 

priority for them, so they can choose.” (No.19) 

One of the PhDs said:  

"Such moral issues are not resolved by forbidding watching videos or 

satellite TV. These measures are not helpful. The only way is the way 

of the prophets. Prophets tried to prevent moral corruption by their 

power. If they had no power, they tried to train and guide human 

beings. How? By giving human dignity to human beings, through fear 

of divine retribution and promises of divine rewards.” (No.23) 

 

 
Table 6. Category of the measures implemented in Iran, and the related challenges 

Subcategories Themes Quotes and Examples 

Teaching about 

puberty in 

universities and 

schools 

 One of the specialist physicians stated: 

“At that time we did this: we set aside the educational system 

and financially supported any institution that had political 

power. We were friends with representatives in the Iranian 

parliament, and we knew university authorities. We went ahead 

and prepared puberty packages and gave them to the girls.” 

(No.7) 

A Ph.D. said:  

“In cooperation with the Ministry of Health, schools and the 

educational system can set certain objectives and develop a 

course for education in schools. Of course, this education 

should not violate the norms but should still be informing.” 

(No.25) 

Lack of 

regularity in 

education in Iran 

Inconsistency 

of sex 

education in 

schools 

In this regard, one of the Ph.Ds. said:  

“What is happening today is that everyone acts as they wish. 

One school starts sex education very soon, another teaches all 

about it in detail, and another one does not offer any 

education, everyone does whatever they like.” (No.9) 

 

1. The Potential Risks of Sex Education 

for Adolescents  

The participants disapproved of providing 

adolescents with sex education mainly on 

account of possible harmful effects. Some of 

the hazards pointed out by the participants 

were: engaging in sexual activity following 

sex education; having sexual intercourse 

without fear of the consequences; being 

sexually stimulated as a result of curiosity 

about sexual subjects; and feeling 

encouraged to experience sexual activities. 

The participants also emphasized the 

necessity for conducting a study on the role 

of sex education in propagating sexual 

relations. Furthermore, they strongly 

disagreed with open and direct sex 

education, reasoning that the society and the 

predominant climate of the Iranian 

educational system are still not ready for it. 



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Most of the participants highlighted the 

taboo of talking about sex topics in the 

society and some of them mentioned the 

prevalent social atmosphere as the reason for 

their disagreement.  

This category was classified into two 

subcategories and four themes. The category 

and the related subcategories, themes, and 

some participants’ statements are presented 

in Table 3. 

2. The Advantages of Sex Education for 

Adolescents, and the Approaches  

In the current study, most of the participants 

agreed on the necessity of sex education. 

Although they mentioned the harms of lack 

of sex education, they indicated the 

dominant cultural atmosphere of the society 

and the taboo of talking about sexual subject 

matters in the society and families, and 

believed that public presentation of sex 

education can interfere with modesty and 

chastity in the society. Some of the 

participants did not see a formal and clear 

discussion about these subjects as 

appropriate and proposed certain 

considerations; for instance, they believed 

that sex education should not violate the 

norms or encourage an individual to have 

sexual activities. Most participants agreed on 

the importance of providing reliable 

materials for teaching and indirect 

education, and highlighted the necessity of 

educating individuals who have risky 

behaviors.  

In support of sex education, advocates 

mentioned the fundamental right of 

adolescents to be informed about the subject, 

the decreased age of learning about sexual 

matters and engaging in sexual relationships, 

the effect of advancements in technology 

and modernity on this matter, and the 

increase in unsafe sexual relationships 

among adolescents caused by the 

inappropriate behaviors of families, wrong 

education, and internet accessibility. As for 

the disadvantages of not offering sex 

education and using the reductio ad 

absurdum rule, they mentioned adolescent 

sexual abuse, receiving wrong information 

from inappropriate resources, increased rates 

of unwanted pregnancies, illegitimate births 

and abortion, lack of information about 

proper marital relations, increased divorce 

rates due to sex-related problems, and fear of 

building legal and legitimate sexual 

relationships. Some of the participants 

advocated sex education for adolescents, 

arguing that it would prevent unwanted 

pregnancies and thus decrease the rate of 

abortion and birth of illegitimate children. 

This category was classified into five 

subcategories and 20 themes. The category 

is presented in Table 4, and its subcategories 

and related themes and some interviewees’ 

statements are separately shown in Tables 4-

1, 4-2, 4-3, 4-4 and 4-5. 

3. The Challenges in the Interval between 

Sexual Maturation and Marriage, and the 

Role of Religion  

One of the challenges proposed by 

participants pertains to the interval that 

exists between puberty and marriage. The 

main concern was that it is not rational to 

educate adolescents on sexual relations and 

contraception but expect them to wait until 

they are married, which may be as long as 

20 years away.  



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This category was classified into three 

subcategories and one theme. The category 
and its related subcategories, themes, and 

some interviewees’ statements are presented 

in Table 5. 

4. The Measures Implemented in Iran, 

and the Challenges 

Most participants believed that there is no 

consistent policy regarding sex education in 

Iran, and the predominant atmosphere in the 

society and the Ministry of Education 

prevent the issue from being properly dealt 

with. They also considered the measures 

taken in Iran as insufficient. They believed 

that there is no clear policy with regard to 

sex education in schools, and that sex 

education is offered based on what the 

people in charge think should be done. 

Consequently, lots of students do not have 

sufficient awareness of pubertal health or the 

necessary skills to select proper sex 

behaviors. 

This category was classified into two 

subcategories and one theme. The category 

and its related subcategories, themes, and 

some participants’ statements are presented 

in Table 6. 

 

Discussion  

Like many other countries, there is no 

consistent policy on sex education in Iran, 

and the predominant atmosphere in the 

society is the main cause. Some of the 

arguments that have been proposed in 

opposition to sex education include the 

harmful effects of sex education on 

adolescents, non-existence of the required 

infrastructures in the educational system and 

schools, and the clash between culture and 

religion. However, sexual abuse of non-

informed adolescents, and unwanted 

pregnancies and consequent unsafe abortions 

were pointed out as some of the harms and 

unpleasant outcomes of an absence of sex 

education. We will discuss our findings 

according to the different categories 

extracted in this qualitative study. 

The Potential Risks of Sex Education for 

Adolescents  

Only a few participants were against sex 

education for adolescents, and believed the 

appropriate time for sex education to be after 

puberty and at the time of marriage. The 

reason for their disagreement was the harms 

brought about by sex education. These 

results are in accord with those of other 

studies that showed most parents agreed 

with sex education for adolescents, and only 

a few were against it. In a survey, more than 

80 percent of the parents agreed with sex 

education in schools and only a few parents 

disagreed because they were worried that 

sex education would provoke the curiosity of 

adolescents and encourage them to have 

sexual activities (24). In a nationally 

conducted study in the USA, the data 

obtained in surveys from parents of 

adolescents studying in high schools showed 

that 90 percent of parents believed that it is 

either absolutely or almost essential to offer 

sex education in schools. Only seven percent 

of the parents disagreed with sex education 

and providing information on contraception 

in schools. (19) Moreover, only a few 

studies reported that sex education caused an 



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increase in sexual activities (25).  

The Advantages of Sex Education for 

Adolescents, and the Approaches 

The findings of our study are in accordance 

with other studies conducted in Iran and 

elsewhere. Kalantary et al. reported that 

appropriate sex education leads to the 

development of adolescents’ self-esteem and 

their skills in decision-making as well as 

decreased high-risk behaviors (5).  

The Harms of not Educating Adolescents 

in Sexual Matters 

Despite the common belief that sexual health 

education encourages adolescents to have 

sexual relations, a study shows that lack of 

sex education not only does not prevent 

sexual relationships, but also develops and 

solidifies false beliefs and information 

among Iranian adolescents. When 

adolescents do not receive sex education, 

they turn to porn journals and websites as 

well as sexual content on satellite TV 

channels (14). Also, a review of 65 articles 

showed 7.9 percent of the boys and 19.7 of 

the girls had been sexually abused under the 

age of 18 (26). 

The above-mentioned information has been 

confirmed by numerous studies in which 

adolescents have expressed their desire for 

training in sexual matters. They believed 

that receiving detailed information at a 

younger age does not increase the chance of 

practicing sex, but limited knowledge may 

arouse curiosity and encourage adolescents 

to experience sexual relations (8). Lack of 

knowledge and the right attitudes toward 

pubertal and reproductive health may cause 

many adolescents to have negative feelings 

and a sense of guilt toward their pubertal 

processes and sexual desires, which may 

lead to consequent problems and adverse 

effects in their future married life (6). One 

study showed that receiving information 

about AIDS and sexual health correlated 

with more positive attitudes toward sexual 

abstinence. It also revealed that students’ 

needs and expectations in terms of learning 

about AIDS and sexual health are not 

satisfied in schools (18). 

Age-Appropriate Education 

One of the main challenges with regard to 

sex education was determining the proper 

time, and a consensus could not be achieved 

among participants in this respect. Most 

participants highlighted taking adolescents’ 

age and background information into 

account and opted for indirect education. 

Obviously, there is a different time for 

teaching various aspects of health (physical, 

sexual, mental and social) in puberty. 

Further investigations are needed to 

determine the proper time for education in 

each aspect of pubertal health, considering 

the sociocultural factors of the society (15). 

This education has to take place before the 

beginning of puberty, and the gender of the 

adolescent needs to be taken into account; in 

this way, adolescents become familiar with 

the signs and changes associated with 

puberty so that they will not be frightened by 

them, and will thus be able to resolve their 

problems (27). Informing adolescents of sex 

topics has to start a little sooner than the 

time they engage themselves actively in 

these issues (16). Most parents and teachers 

know the time for sex education, for instance 

issues such as fertilization of ovum and 

pregnancy may be discussed with girls near 



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the time of marriage, and the best time for 

teaching about sexually transmitted diseases 

may be in high school. However, teachers 

consider the right time for sex education to 

be sooner than the time pointed out by 

parents (9). In another study on adolescents 

in Iran (2010), some students believed that 

education on topics such as menstruation is 

more helpful in the final years of primary 

school; they also commented that sex 

education at the time of marriage – which is 

common in Iran – is too late and senseless 

(28).  In a review article it was mentioned 

that the proper time for teaching different 

aspects of pubertal health is different; 

according to this study, in order to bring 

about maximum benefits for adolescents, the 

proper time for sex education should be 

determined based on the sociocultural 

conditions of the society. This study pointed 

out that sex education for girls should be 

started before puberty and around the ages 

of 9 to 10 (8). 

Educators and Training Resources  

The first resource for education on puberty 

is families, especially mothers. 

Unfortunately, research findings show 

parents’ lack of sufficient information or 

skills for teaching valuable content to their 

offspring; moreover, feelings of shame and 

embarrassment lead to negligence in 

transferring experiences and knowledge by 

parents, or even in schools (5, 29, 30). Also, 

parents and educators sometimes do not 

have the necessary information about sexual 

behaviors and issues related to puberty. 

They may simply not know how to talk 

about such subject matters to adolescents (8, 

31). In our study, participants named 

teachers as the most reliable resource for 

education after parents. However, they 

emphasized that teachers should have the 

required skills and proficiency on the 

subject. In most studies, adolescents 

reported that they received critical 

information about sexual subject matters 

from their friends, siblings and media rather 

than the material that is formally presented 

in schools. In a study, Malek et al. found out 

that adolescents’ resources for gaining 

information about sexual health are their 

close friends, photos, magazines, books, 

audiovisual tools, school teachings, 

physicians, Islamic religious leaders, 

counseling centers, family and close 

relatives, respectively (32). Studies also 

showed that receiving unreliable information 

from friends could be a risk factor for high-

risk behaviors (33). Female adolescents’ 

primary resource of information about 

puberty is their mothers and near others in 

their family. Their resources about sexual 

subject matters, however, are their friends, 

which they confirmed to be unreliable (34, 

35). Boys become familiar with sexual 

subject matters by their friends or in military 

service (29). Numerous studies have 

highlighted the negative role of satellite TV 

channels and the Internet, which they have 

shown to be not only unreliable resources 

for sex education, but also sexually 

stimulating (36, 37). Iranian adolescents are 

bombarded by multiple sexually stimulating 

messages that lack right and sufficient 

information about sexual reproduction. A 

study showed that learning about sex from 

peers and media correlates with increased 



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probability of having sexual intercourse, 

while learning from adults (parents or 

religious leaders) will more likely lead to 

abstinence (38). 

Another source of information that had not 

been reported by other studies was 

pharmacists. When adolescents refer to these 

professionals to obtain contraceptives, they 

can gain proper knowledge, learn how to 

protect themselves, and be warned of high-

risk behaviors. 

The other challenge reported by a few other 

studies (36, 38, 39) was the families’ 

awareness of sex education offered to their 

adolescent children. In our study, most 

participants emphasized that parents have to 

know the content of materials taught to their 

offspring and some of them highlighted that 

no education should be offered to the 

students without their parents’ permission; 

they also mentioned that informing the 

parents should be compulsory, especially 

when the students were in early adolescence 

years and under legal age. Mothers have 

been shown to have concerns and fears about 

their daughters’ vulnerabilities, and potential 

physical and psychological harm to them.  

There is a sort of conservatism in Iranian 

families pertinent to their offspring’s sex 

education. The discussion about such 

matters seems indecent to typical Iranian 

parents (39). A study showed Iranian 

adolescents and young adults are not 

sufficiently skilled to manage their sexual 

activities. The main reason for this problem 

was pointed out to be inappropriate 

interactions between parents and offspring 

(38).  A study showed that mothers and 

fathers employ different methods when 

dealing with their children’s sexual issues; 

their approach to the subject is influenced by 

the sort of sex education that they 

themselves received, their value and belief 

system about sexual subject matters, and 

their attitudes toward such issues (36).  

A study by Sajjadi et al. showed that fathers’ 

awareness about puberty in boys is not at an 

acceptable level, and 88.9 percent did not 

have accurate information about the 

religious aspects of puberty in boys and the 

time they are obligated to take full 

responsibility under Islamic law (40). The 

results of another study which aimed to 

determine the educational needs of fathers 

for the puberty period of their sons showed 

that the highest frequency in the educational 

needs of boys during puberty is related to 

religious subject matters (41). Lack of 

fathers’ communicative skills is not 

exclusive to the Iranian society. For 

instance, mothers talk more than fathers 

about sexual subject matters to their sons in 

the US. Furthermore, girls are more 

comfortable talking about sex topics with 

their mothers than boys (42). 

Method for Sex Education 

The results of the current study are in line 

with those in other studies. Sex education 

should be offered in a way that it would 

cause the lowest rate of complications 

possible. Considering that all sexual subject 

matters are not at the same level in terms of 

being sexually stimulating, it is suggested 

that subject matters that are more so be 

educated indirectly (43). 

Educational contents and materials have to 

be comprehensive, sufficient, and cover all 

the aspects of puberty. Furthermore, the 



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method for teaching the materials must 

increase the effectiveness of education so 

that it will lead to skills development 

through proper planning and use of different 

methods (8). Training should not discourage 

individual from engaging in sexual practices, 

and the materials should cater to all 

personality types in adolescents. It is a 

widely held belief that that if sex awareness 

is not formed appropriately, it can be a risk 

factor for other problems. Moreover, sex 

education has to be proportionate to 

individuals’ gender, age, level of cognition, 

and sociocultural background (44).  

Decreased Age of Starting Sexual 

Relations  

Most participants expressed their worries 

about the decreased age of learning about 

sexual topics. Considering the increase in 

sexual relationships among adolescents, 

participants highlighted the necessity of sex 

education, especially for individuals with 

high-risk behaviors, in order to improve 

their knowledge and prevent unpleasant 

outcomes. Some referred to the difference in 

the increased rate of adolescents’ sexual 

practices in various areas of the cities, and 

some who had experienced working in this 

field saw no such difference, but confirmed 

that the relationships were safer and more 

protected among families with higher 

educational levels. 

Detailed statistics reported in studies of 

other countries showed that the above-

mentioned factors were the main reasons for 

having approved laws for compulsory sex 

education in schools, but statistics are not 

accurate in Iran. However, according to the 

statistics published by the Iranian Ministry 

of Health and Medical Education and a 

study conducted by the Iranian Ministry of 

Education, the condition in Iran is similar to 

that in Western countries. One study 

confirms the increased rate of sexual 

relationships before marriage among Iranian 

adolescents (6, 45). Evidence shows that the 

pattern of HIV transmission due to sharing 

needles and drugs injection equipment has 

changed to unprotected sexual intercourse 

among Iranian young adults (46). In the 

report titled “Islamic Republic of Iran َ  AIDS 

Progress Report: On Monitoring of the 

United Nations General Assembly Special 

Session on HIV and AIDS”, 6.1% of men 

and women aged between 19 and 24 

answered they had had sexual activities 

under age 15 (47). 

The Challenges in the Time between 

Sexual Maturation and Marriage, and the 

Role of Religion 

One of the issues mentioned by some of the 

participants that had not been reported in 

any other study was about the relatively long 

time between sexual maturation and 

marriage. The sexual instinct is at a peak 

during this time, and there exists an 

abundance of environmental stimulation 

while adolescents have no prospect of 

marriage. The common sense among 

Iranians, the religion of Islam, and some 

Abrahamic religions recommends self-

restraint (abstinence) in this period. 

Participants mentioned that it is not rational 

to expect one to practice abstinence 

sometimes 20 years after sexual maturation, 

considering the conditions in the society and 



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the increased sexual stimulations in the 

community. Temporary marriage (sigheh) 

was also referred to as one solution to this 

problem. Moreover, the necessity to 

decrease the age of marriage was mentioned. 

Studies confirm the effectiveness of 

religious beliefs and faiths on appropriate 

sex education and controlling and preventing 

sexual relationships before marriage or out 

of wedlock. In our research, religious 

experts and some other participants believed 

that Islamic doctrines are comprehensive in 

terms of sex education. They mentioned that 

sexual discipline in Islam starts from early 

childhood by giving gender identity to 

children. As children and adolescents 

develop, training should become more 

specific, deal with physical and 

psychological health, and highlight the 

legitimate use of sexual instinct. Education 

on puberty and sexual health is considered to 

be the duty of parents and is parallel to the 

educational role of prophets, God’s warnings 

and promises. They also believed that in 

addition to providing adolescents with the 

necessary information on sex topics, creating 

a fear of the unpleasant outcomes of sexual 

perversion is very useful. Sexual discipline 

in Islam means training individuals who can 

distinguish between halal (unforbidden) and 

haram (forbidden) when they reach puberty, 

recognize marital and spousal duties and 

responsibilities, refrain from unrestrained 

sexual relationships, and have virtues of 

Islamic modesty and chastity in their 

personality and manner of life (5). Another 

study showed that informing adolescents 

about sexual subject matters and important 

ethical values are the duty of parents from 

the Islamic perspective (34). A study 

indicated that religion has a significant role 

in refraining from high-risk behaviors. The 

possibility of establishing an illegitimate 

sexual relationship is 27 to 54 percent lower 

among religious young adults than 

unreligious ones. These adults also have 

fewer sexual partners compared to their 

peers (48).  In a review article, Bahrami et 

al. confirmed the significant role of religion 

in individuals’ beliefs, especially in 

discouraging adolescents from having sexual 

relationships before marriage. This study 

also showed that the society is moving in the 

direction of sexual liberation, which 

endangers the Iranian culture and values. 

Besides, they stated that education has little 

role in postponing sexual behaviors until 

marriage and mentioned religious faith and 

spirituality as primary factors in preventing 

individuals from prohibited sexual 

relationships in Iran and other countries 

(49). Victor et al. studied 2202 adults in 

terms of the effect of moral perspectives on 

the number of sexual partners they had over 

the years (a sexual risk indicator). They 

concluded that moral worldviews influence 

sexual behaviors over time. However, they 

have a considerably protective effect only 

for individuals who have high levels of 

moral beliefs (50) 

A study on the effect of the current policies 

regarding sex education in high schools of 

the United States on students’ risky sexual 

behaviors showed that all the policies 

advocating abstinence correlated positively 

with risky sexual behavior; comprehensive 

policies on sex education that offer a 

combination of contraception and 

abstinence, however, caused a decrease in 

the rate of risky sexual behaviors. This study 



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concluded that policies or programs based 

on “abstinence-only” as a choice for 

adolescents are incomplete both 

scientifically and ethically (51). 

Measures Taken in Iran and the Related 

Challenges 

Most participants believed that on the one 

hand, there is no consistent policy for sex 

education in Iran, and on the other, the 

predominant atmosphere in the society and 

the Ministry of Education prevents educators 

from dealing with this issue seriously. 

Although international organizations 

recognize sexual health education as a 

human right and a requirement for 

developing and propagating justice (52), 

there is a resistance to sex education in Iran, 

which was both pointed out by our 

participants and inferred from contemporary 

literature review on the subject and media. 

So far, it seems impossible to have an 

integrated and specific policy for sex 

education within the Iranian educational 

system. In 2005, the Ministry of Health and 

Medical Education and the Ministry of 

Education jointly developed and proposed 

for executing a comprehensive curriculum 

for health education in schools from pre-

school to the end of college (53). The second 

chapter of the curriculum – titled “Social 

and Family Health” – offered discussions 

about maintaining sexual self-control, 

preventing teen pregnancy, and identifying 

unhealthy and harmful relationships. 

Information on sexually transmitted diseases 

was sporadically explained among other 

discussions in other chapters. However, 

resistance to this curriculum did not allow it 

to be included in the Iranian system of 

education. Ever since, these discussions 

have been offered at schools sporadically 

and at the discretion of those in charge, and 

recently under the title “Prevention of Social 

Harms” (53).  

Moreover, we can refer to the two courses 

about puberty and marriage in universities 

titled “Population and Family Planning” 

which changed to “Population and Family 

Knowledge” since the first semester of the 

2003-2004 educational year due to changes 

in the national policies concerning 

population. This is a core course that 

university students of all majors must pass to 

get their bachelor’ degree.  

Ethical challenges that parents or teachers 

face in sex education are complicated (29). 

In order to resolve such challenges, we 

should decide ethically based on the four 

basic principles of medical ethics 

(autonomy, beneficence, non-maleficence, 

and justice) (54). To verify whether a state is 

ethical or not, we have to determine which 

principle is superior to the other ones for 

resolving the ethical dilemma, and then 

employ this principle to assess the state and 

make a decision (30). Seemingly, non-

maleficence (one ought not to inflict evil or 

harm) and beneficence (one ought to do or 

promote well) are two significant principles 

that have to be taken into consideration. 

Limitations of the Study 

One limitation of the present study was that 

some people are ashamed to talk about this 

subject, although due to the scientific 

outlook and description of the study 



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objectives, most of the participants answered 

the questions thoroughly and clearly. If the 

participants’ answers happened to be 

ambiguous, the subject would be clarified 

through more specific, in-depth questions. 

Another limitation of this study was the 

absence of adolescents among the 

participants. Participants were asked to 

express whether they desired to have had 

knowledge of these contents in their teenage 

years or not to overcome this limitation.  

 

Conclusion 

Clearly, one of the main issues relating to 

adolescence is teaching the various aspects 

of pubertal health. Not having information 

or having wrong information about sexual 

subject matters not only increase the risk for 

occurrence of a range of sexual disorders, 

high-risk behaviors, sexually transmitted 

diseases, unwanted pregnancies and family 

problems, but have harmful effects on 

adolescents’ lives. Embarrassment and 

shame, the taboo of talking about sexual 

topics, and common sense conventions and 

beliefs in Iran are the barriers to adolescents’ 

access to the necessary information. Stigma 

and shame are among the main reasons for 

avoiding sexual discourse, especially at a 

family level.  

Nevertheless, unwillingness to talk about 

sexual issues is not exclusive to Iran, but is 

also seen in countries with similar cultural 

backgrounds.  In these countries, there is a 

stiff resistance to sex education for 

adolescents due to a wrong understanding of 

the nature, objectives and effects of such 

knowledge; as a consequence, adolescents 

have no access to sex education. On the 

other hand, the spread of mass media and 

high-speed information transmission in 

recent years have set the ground for 

incorrect sex information transfer. It is not 

easy for many people to discuss sexuality 

and acceptable sexual behavior with close 

friends or peers, or in a broader social 

environment. Furthermore, since these topics 

concern the most personal and private parts 

of one’s life, there is a lack of social 

tendency to talk about them. 

Education should not be sexually stimulating 

and distract a student whose mind is distant 

from such environments. Cultural and 

personality differences must be taken into 

account, and in addition to giving general 

information to all adolescents, each one 

should be guided individually, considering 

his/her needs and in specific cases. The 

justice principle requires that all adolescents 

have access to appropriate and necessary 

information. Education should be given 

based on adolescents’ continuum of 

development, and it should be suitable for 

their age, cultural background and family 

conditions. In accordance with religious 

experts and Islamic scriptures, this education 

must be embedded in the core of sexual 

disciplining, which starts with giving gender 

identity to children and continues in every 

phase of their physical and mental 

development, depending on their needs. 

Considering adolescents’ age and 

background information at the time of sex 

education is highlighted indirectly. The 

proper time for education in different aspects 

of pubertal health (physical, sexual, mental, 



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and social) is different. It is important that 

each element of puberty be taught to 

adolescents at its proper time and 

considering their cultural and social 

condition. Decision-making is complicated 

when adolescents’ parents are against such 

education. It appears that not giving the right 

knowledge to adolescents, who can access 

an ample amount of wrong information, is in 

contrast with principles of non-maleficence 

and beneficence.   

In this regard, the degree of adolescents’ 

understanding and capacity should serve as 

the criterion, and it is also very helpful to 

educate and persuade parents in such cases. 

Furthermore, confidentiality is often a key 

concern, and autonomy should be respected. 

 

 

 

      

 

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