Background Sexual wellbeing is integral to consensual, healthy and pleasurable sexual experiences and relationships among young people. Priorities for, and experiences of, sexual wellbeing differ across the life-course and young people face unique sexual developmental tasks in this regard. Sexual wellbeing has been variously defined and our focus is on psychological wellness: feeling safe, secure, respected, comfortable, and confident in relation to sexuality, and able to work through changes, challenges, and negative past experiences. We understand young people's sexual wellbeing to be shaped by. their environment, including family, peers, education and health systems, laws, and cultural values.

Methods We carried out a qualitative evidence synthesis to explicate young people’s (age 16-24) sexual wellbeing across cultural contexts. We drew on a 7-domain sexual wellbeing model developed for adults to inform the study design. We systematically searched 4 databases. Included papers were thematically synthesised (PROSPERO: CRD42022315593).

Results 71 papers across 20 countries met eligibility criteria. We focused on sexual wellbeing outcomes in the context of youth sexual development. Those reporting positive initial sexual experiences discussed feeling certain about their sexual values, not feeling rushed, being guided by curiosity, and being comfortable to communicate about sex. In contrast, those reporting negative experiences were unsure of what they wanted, of how to talk about sex, and of how to enact their boundaries. Positive experiences were more often reported in contexts and countries where the integration between young people’s sexual and wider self was welcomed. Secondly, in the context of initial experiences of desire and exploration, young people contended with the sexual messages and silences they had absorbed. These messages could help develop young people’s sexual compass and decision-making. However, they also resulted in many learning judgements about sexuality before they had developed their own sense of a sexual self. This was particularly the case for those living in sexually conservative contexts and countries. Thirdly, because of heightened sensitivity towards other’s evaluations, the desire to be wanted, to have one’s sexual identity validated, or to comply with gendered ideals shaped negotiation of sexual wellbeing.

Conclusion Understanding how sexual wellbeing uniquely manifests for young people is key to supporting young people in in their early sexual lives. This synthesis led to refinements to our sexual wellbeing conceptual framework. We reflect on the important of self-understanding (the task of developing knowledge about one’s sexual self, preferences, and desires) to sexual wellbeing.