- Adolescent pregnancy
- Sexual and intimate partner/dating violence
- Up to one quarter of sexually and gender diverse youth experience sexual and dating violence, with transgender youth experiencing the highest rate (4-6 times higher than their cishet peers).
- Sexually transmitted and blood-borne infections (STBBIs)
- 2SLGBTQ+ youth are more likely than cishet peers to get tested for STBBIs. This healthy behaviour may partly explain the higher rates of STBBIs.
Introduction
2SLGBTQ+ youth (two-spirit, lesbian, gay, bisexual, transgender, queer/questioning, and others with diverse identities, bodies, and experiences of gender and sexuality) come from all kinds of communities, backgrounds, races and ethnicities, and social and geographical groups. While many sexually and gender diverse youth will experience a healthy and positive transition from childhood to adulthood, others can be impacted negatively by factors rooted in social stigma (e.g., harassment, discrimination, family disapproval, social rejection, violence) and limited access to support. These factors contribute to an increased risk of negative health outcomes for 2SLGBTQ+ youth, including risks associated with sexual health.
This webpage discusses some of the specific sexual health risks that 2SLGBTQ+ youth may face, as well as support strategies that enhance health and well-being, reduce risk, and help ensure all sexually and gender diverse youth can experience a positive and healthy transition into adulthood.

Context
Social determinants of health impact all aspects of individual well-being, including sexual and reproductive health. Like all youth, the health of 2SLGBTQ+ youth is impacted by many individual, interpersonal, community, and societal factors.
2SLGBTQ+ youth face unique stressors stemming from prejudice and discrimination, social stigma, and internalized and external homophobia. All of these stressors can impact sexual health choices and behaviours, and can impact other aspects of health and well-being negatively. Institutionalized homophobia, transphobia, and heteronormativity can also negatively impact youth’s access to information and resources. Understanding how these factors impact decision-making, quality of care, and access to care can aid in the development of solutions that are protective, supportive, and enhance the health and well-being of sexually and gender diverse youth.

Sexual Health Risks and Outcomes for Sexually and Gender Diverse Youth
It is important to recognize that negative outcomes are not inevitable for 2SLGBTQ+ youth, but may be more likely due to the discrimination, marginalization, and isolation that many 2SLGBTQ+ people experience. While many 2SLGBTQ+ youth have healthy and positive sexual health experiences, research * shows that 2SLGBTQ+ youth are more likely than heterosexual and cisgender peers (also known as cishet) to:
- Experience:
- Engage in behaviours that are risk factors for STBBIs and adolescent pregnancy, including:
- Greater number of sex partners
- Less consistent use of barrier methods during sex (e.g., condoms)
- Less likely to use contraception (or consistently use contraception)
- Bisexual females report higher use of emergency contraception than lesbian and heterosexual peers.
- Substance use prior to sex
- Concurrent sexual partners (multiple partners within 90 days)
- Earlier sexual debut
- Have sexual conversations online with people 5 or more years older than them.
Certain subgroups of 2SLGBTQ+ youth are more likely than others to experience specific outcomes. For example, bisexual youth and those who engage in sexual behaviour with both males and females are more likely to engage in risky sexual health behaviours and experience negative sexual and reproductive health outcomes. Female youth who are unsure or questioning their identity or sexuality are less likely to use condoms or contraception consistently, and male youth who are unsure of or questioning their identity were more likely to experience physical and sexual intimate partner violence than any of their peers.
In addition to negative sexual health outcomes, gender and sexually diverse youth also report more negative experiences at school (e.g., bullying, fewer positive peer and teacher relationships, less support). These negative experiences may impact school performance, psychosocial adjustment, and more. For youth with multiple minority and/or oppressed identities (e.g., race, ethnicity, disability, etc.), these effects may be even more pronounced. Fostering protective factors and providing various kinds of support can help reduce risk of negative health outcomes and contribute to overall well-being.
Sexual Health Risks and Outcomes for Sexually and Gender Diverse Youth
It is important to recognize that negative outcomes are not inevitable for 2SLGBTQ+ youth, but may be more likely due to the discrimination, marginalization, and isolation that many 2SLGBTQ+ people experience. While many 2SLGBTQ+ youth have healthy and positive sexual health experiences, research * shows that 2SLGBTQ+ youth are more likely than heterosexual and cisgender peers (also known as cishet) to:
- Experience:
- Adolescent pregnancy
- Sexual and intimate partner/dating violence
- Up to one quarter of sexually and gender diverse youth experience sexual and dating violence, with transgender youth experiencing the highest rate (4-6 times higher than their cishet peers).
- Sexually transmitted and blood-borne infections (STBBIs)
- 2SLGBTQ+ youth are more likely than cishet peers to get tested for STBBIs. This healthy behaviour may partly explain the higher rates of STBBIs.
- Engage in behaviours that are risk factors for STBBIs and adolescent pregnancy, including:
- Greater number of sex partners
- Less consistent use of barrier methods during sex (e.g., condoms)
- Less likely to use contraception (or consistently use contraception)
- Bisexual females report higher use of emergency contraception than lesbian and heterosexual peers.
- Substance use prior to sex
- Concurrent sexual partners (multiple partners within 90 days)
- Earlier sexual debut
- Have sexual conversations online with people 5 or more years older than them.
Certain subgroups of 2SLGBTQ+ youth are more likely than others to experience specific outcomes. For example, bisexual youth and those who engage in sexual behaviour with both males and females are more likely to engage in risky sexual health behaviours and experience negative sexual and reproductive health outcomes. Female youth who are unsure or questioning their identity or sexuality are less likely to use condoms or contraception consistently, and male youth who are unsure of or questioning their identity were more likely to experience physical and sexual intimate partner violence than any of their peers.
In addition to negative sexual health outcomes, gender and sexually diverse youth also report more negative experiences at school (e.g., bullying, fewer positive peer and teacher relationships, less support). These negative experiences may impact school performance, psychosocial adjustment, and more. For youth with multiple minority and/or oppressed identities (e.g., race, ethnicity, disability, etc.), these effects may be even more pronounced. Fostering protective factors and providing various kinds of support can help reduce risk of negative health outcomes and contribute to overall well-being.
Protective Factors
Protective factors are characteristics, conditions, and behaviours that either improve health directly or reduce the negative effects of a risk factor on health. Protective factors can be individual assets such as personality characteristics or individual skills that improve/bolster health, or they can be external resources such as supportive relationships with friends and family or access to medical services that improve/bolster health. Protective factors include parental support, inclusive school environments, emotional connectedness to family and school, positive role models, and social support.
Other protective factors related to schools include school connectedness, supportive educators, anti-bullying policies, and inclusive curriculum. Supportive educators have been found to have the strongest effect on 2SLGBTQ+ student academic success and well-being. For more information about protective factors for 2SLGBTQ+ youth, visit: www.cdc.gov/healthyyouth/disparities/protective-factors-for-lgbtq-youth.htm.
Inclusive Sexual Health Education
Research has shown that comprehensive sexual health education is a highly effective strategy for reducing negative social and biological outcomes experienced by 2SLGBTQ+ youth. Unfortunately, traditional sexual health education has often been critiqued for not being inclusive, not fitting the needs of 2SLGBTQ+ students, and even causing harm through the messaging used. Examples of non-inclusive sexual health education include:
- passive and/or active silencing (e.g., issues related to 2SLGBTQ+ sexual health being excluded, ignored, or dismissed)
- heterocentricity (e.g., abstinence-only education emphasizing heterosexual marriage as essential for healthy sexuality; education focused on pregnancy prevention rather than prevention of STBBIs; only discussing vaginal intercourse)
- pathologizing (e.g., only discussing 2SLGBTQ+ issues in terms of risks and harmful consequences like HIV)

Suggestions from youth for creating more inclusive sexual health education include the following:
- Directly discuss 2SLGBTQ+ issues, including gender diversity, sexual orientation, being queer, stigmatization, and 2SLGBTQ+ role models.
- Emphasize STBBI prevention over pregnancy prevention, which allows for conversations about types of sexual behaviours that can transmit STBBIs even if they do not cause pregnancy.
- Include information about internal and external anatomy (not just the reproductive system), and provide examples of diversity, including intersex bodies, differences in external appearance, and body image.
- Address healthy relationships, particularly communication.
- Provide access to additional resources, including local organizations, print resources, and links to online resources.
Benefits of inclusive sexual health education:
- Ensures inclusiveness by focusing on topics that are relevant to all young people, regardless of gender or sexual orientation.
- Increases relevance of sexual health education to 2SLGBTQ+ youth, which in turn can result in safer sex practices and healthier relationships.
- May create a safer school environment for 2SLGBTQ+ youth, which in turn may result in less stigma-related stress, anxiety, and unhealthy coping mechanisms.
- Requires that all students learn more information about different genders and sexualities.
Helpful Links
- Saskatchewan Prevention Institute – Sexual Health Information for Educators Curriculum Support Documents
- Government of Saskatchewan – Deepening the Discussion: Gender and Sexual Diversity
- Advocates for Youth – Honest Sex Education
- Healthline – LGBTQIA Safer Sex Guide
Gender and Sexuality Alliances (GSAs) and School Support
Gender and Sexuality Alliances, also known as Gay-Straight Alliances (GSAs), strive to reduce bullying and create support systems for 2SLGBTQ+ students. Research has shown that the presence of GSAs is associated with positive outcomes for 2SLGBTQ+ students. On average, 2SLGBTQ+ youth in schools with GSAs experience less absenteeism, smoking, alcohol use, suicide attempts, and sex with casual partners. Youth report that GSAs contribute to a positive school environment by providing safe spaces and decreasing isolation. Involvement in GSAs is associated with developing an increased sense of self-acceptance, and is viewed as a social method of coping with challenges. Students’ self-esteem is also influenced by the presence of teachers willing to intervene when 2SLGBTQ+ are being harassed.
Creating a system of support within schools can extend beyond the presence of a GSA. Evidence suggests that educators who receive professional development on 2SLGBTQ+ issues are more likely to take action to create safe and supportive environments. Long-term solutions include providing more 2SLGBTQ+-related content in education training for teachers, providing diversity training to all school staff, and enforcing anti-bullying and harassment policies.
Helpful Links
- Advocates for Youth – Creating Safer Spaces for LGBTQ Youth
- Canadian Centre for Gender & Sexual Diversity – GSA Resources
- Egale – Guide to Virtual GSAs

Community Support and Resources
Building connections to 2SLGBTQ+ organizations outside of school provides 2SLGBTQ+ youth with access to formal and informal programs, safe spaces to go and meet other youth, support, mentoring, and advice. For youth without access to such organizations, online resources and communities may be beneficial.
Saskatchewan-Based 2SLGBTQ+ Support Organizations
Family and Parental Support
Family support is important for youth who identify as 2SLGBTQ+ in terms of both tangible, practical support and social support. Parental rejection of 2SLGBTQ+ youth has been linked to increased depression, suicidality, and substance use. Research has shown that 2SLGBTQ+ youth who perceive strong support from their families tend to have better mental health and lower risk of substance use and sexual risk behaviours.
Helpful links

Supporting the Sexual Health of Sexually and Gender Diverse Youth
*For a glossary of terms used on this page, please visit www.glaad.org/reference/lgbtq.
Introduction
2SLGBTQ+ youth (two-spirit, lesbian, gay, bisexual, transgender, queer/questioning, and others with diverse identities, bodies, and experiences of gender and sexuality) come from all kinds of communities, backgrounds, races and ethnicities, and social and geographical groups. While many sexually and gender diverse youth will experience a healthy and positive transition from childhood to adulthood, others can be impacted negatively by factors rooted in social stigma (e.g., harassment, discrimination, family disapproval, social rejection, violence) and limited access to support. These factors contribute to an increased risk of negative health outcomes for 2SLGBTQ+ youth, including risks associated with sexual health.
This webpage discusses some of the specific sexual health risks that 2SLGBTQ+ youth may face, as well as support strategies that enhance health and well-being, reduce risk, and help ensure all sexually and gender diverse youth can experience a positive and healthy transition into adulthood.

Context
Social determinants of health impact all aspects of individual well-being, including sexual and reproductive health. Like all youth, the health of 2SLGBTQ+ youth is impacted by many individual, interpersonal, community, and societal factors.
2SLGBTQ+ youth face unique stressors stemming from prejudice and discrimination, social stigma, and internalized and external homophobia. All of these stressors can impact sexual health choices and behaviours, and can impact other aspects of health and well-being negatively. Institutionalized homophobia, transphobia, and heteronormativity can also negatively impact youth’s access to information and resources. Understanding how these factors impact decision-making, quality of care, and access to care can aid in the development of solutions that are protective, supportive, and enhance the health and well-being of sexually and gender diverse youth.

Sexual Health Risks and Outcomes for Sexually and Gender Diverse Youth
It is important to recognize that negative outcomes are not inevitable for 2SLGBTQ+ youth, but may be more likely due to the discrimination, marginalization, and isolation that many 2SLGBTQ+ people experience. While many 2SLGBTQ+ youth have healthy and positive sexual health experiences, research shows that 2SLGBTQ+ youth are more likely than heterosexual and cisgender peers (also known as cishet) to:
- Experience:
- Adolescent pregnancy
- Sexual and intimate partner/dating violence
- Up to one quarter of sexually and gender diverse youth experience sexual and dating violence, with transgender youth experiencing the highest rate (4-6 times higher than their cishet peers).
- Sexually transmitted and blood-borne infections (STBBIs)
- 2SLGBTQ+ youth are more likely than cishet peers to get tested for STBBIs. This healthy behaviour may partly explain the higher rates of STBBIs.
- Engage in behaviours that are risk factors for STBBIs and adolescent pregnancy, including:
- Greater number of sex partners
- Less consistent use of barrier methods during sex (e.g., condoms)
- Less likely to use contraception (or consistently use contraception)
- Bisexual females report higher use of emergency contraception than lesbian and heterosexual peers.
- Substance use prior to sex
- Concurrent sexual partners (multiple partners within 90 days)
- Earlier sexual debut
- Have sexual conversations online with people 5 or more years older than them.
Certain subgroups of 2SLGBTQ+ youth are more likely than others to experience specific outcomes. For example, bisexual youth and those who engage in sexual behaviour with both males and females are more likely to engage in risky sexual health behaviours and experience negative sexual and reproductive health outcomes. Female youth who are unsure or questioning their identity or sexuality are less likely to use condoms or contraception consistently, and male youth who are unsure of or questioning their identity were more likely to experience physical and sexual intimate partner violence than any of their peers.
In addition to negative sexual health outcomes, gender and sexually diverse youth also report more negative experiences at school (e.g., bullying, fewer positive peer and teacher relationships, less support). These negative experiences may impact school performance, psychosocial adjustment, and more. For youth with multiple minority and/or oppressed identities (e.g., race, ethnicity, disability, etc.), these effects may be even more pronounced. Fostering protective factors and providing various kinds of support can help reduce risk of negative health outcomes and contribute to overall well-being.
Protective Factors
Protective factors are characteristics, conditions, and behaviours that either improve health directly or reduce the negative effects of a risk factor on health. Protective factors can be individual assets such as personality characteristics or individual skills that improve/bolster health, or they can be external resources such as supportive relationships with friends and family or access to medical services that improve/bolster health. Protective factors include parental support, inclusive school environments, emotional connectedness to family and school, positive role models, and social support.
Other protective factors related to schools include school connectedness, supportive educators, anti-bullying policies, and inclusive curriculum. Supportive educators have been found to have the strongest effect on 2SLGBTQ+ student academic success and well-being. For more information about protective factors for 2SLGBTQ+ youth, visit: www.cdc.gov/healthyyouth/disparities/protective-factors-for-lgbtq-youth.htm.
Inclusive Sexual Health Education
Research has shown that comprehensive sexual health education is a highly effective strategy for reducing negative social and biological outcomes experienced by 2SLGBTQ+ youth. Unfortunately, traditional sexual health education has often been critiqued for not being inclusive, not fitting the needs of 2SLGBTQ+ students, and even causing harm through the messaging used. Examples of non-inclusive sexual health education include:
- passive and/or active silencing (e.g., issues related to 2SLGBTQ+ sexual health being excluded, ignored, or dismissed)
- heterocentricity (e.g., abstinence-only education emphasizing heterosexual marriage as essential for healthy sexuality; education focused on pregnancy prevention rather than prevention of STBBIs; only discussing vaginal intercourse)
- pathologizing (e.g., only discussing 2SLGBTQ+ issues in terms of risks and harmful consequences like HIV)

Suggestions from youth for creating more inclusive sexual health education include the following:
- Directly discuss 2SLGBTQ+ issues, including gender diversity, sexual orientation, being queer, stigmatization, and 2SLGBTQ+ role models.
- Emphasize STBBI prevention over pregnancy prevention, which allows for conversations about types of sexual behaviours that can transmit STBBIs even if they do not cause pregnancy.
- Include information about internal and external anatomy (not just the reproductive system), and provide examples of diversity, including intersex bodies, differences in external appearance, and body image.
- Address healthy relationships, particularly communication.
- Provide access to additional resources, including local organizations, print resources, and links to online resources.
Benefits of inclusive sexual health education:
- Ensures inclusiveness by focusing on topics that are relevant to all young people, regardless of gender or sexual orientation.
- Increases relevance of sexual health education to 2SLGBTQ+ youth, which in turn can result in safer sex practices and healthier relationships.
- May create a safer school environment for 2SLGBTQ+ youth, which in turn may result in less stigma-related stress, anxiety, and unhealthy coping mechanisms.
- Requires that all students learn more information about different genders and sexualities.
Helpful Links
- Saskatchewan Prevention Institute – Sexual Health Information for Educators Curriculum Support Documents
- Government of Saskatchewan – Deepening the Discussion: Gender and Sexual Diversity
- Advocates for Youth – Honest Sex Education
- Healthline – LGBTQIA Safer Sex Guide
Gender and Sexuality Alliances (GSAs) and School Support
Gender and Sexuality Alliances, also known as Gay-Straight Alliances (GSAs), strive to reduce bullying and create support systems for 2SLGBTQ+ students. Research has shown that the presence of GSAs is associated with positive outcomes for 2SLGBTQ+ students. On average, 2SLGBTQ+ youth in schools with GSAs experience less absenteeism, smoking, alcohol use, suicide attempts, and sex with casual partners. Youth report that GSAs contribute to a positive school environment by providing safe spaces and decreasing isolation. Involvement in GSAs is associated with developing an increased sense of self-acceptance, and is viewed as a social method of coping with challenges. Students’ self-esteem is also influenced by the presence of teachers willing to intervene when 2SLGBTQ+ are being harassed.
Creating a system of support within schools can extend beyond the presence of a GSA. Evidence suggests that educators who receive professional development on 2SLGBTQ+ issues are more likely to take action to create safe and supportive environments. Long-term solutions include providing more 2SLGBTQ+-related content in education training for teachers, providing diversity training to all school staff, and enforcing anti-bullying and harassment policies.
Helpful Links
- Advocates for Youth – Creating Safer Spaces for LGBTQ Youth
- Canadian Centre for Gender & Sexual Diversity – GSA Resources
- Egale – Guide to Virtual GSAs

Community Support and Resources
Building connections to 2SLGBTQ+ organizations outside of school provides 2SLGBTQ+ youth with access to formal and informal programs, safe spaces to go and meet other youth, support, mentoring, and advice. For youth without access to such organizations, online resources and communities may be beneficial.
Saskatchewan-Based 2SLGBTQ+ Support Organizations
Family and Parental Support
Family support is important for youth who identify as 2SLGBTQ+ in terms of both tangible, practical support and social support. Parental rejection of 2SLGBTQ+ youth has been linked to increased depression, suicidality, and substance use. Research has shown that 2SLGBTQ+ youth who perceive strong support from their families tend to have better mental health and lower risk of substance use and sexual risk behaviours.
Helpful links
