Background Population-level rates of sexual health indicators such as STI rates have stimulated interest in a public health approach to improving sexual health in the United States. We used several existing definitions (World Health Organization, U.S Surgeon-General’s office, CDC/HRSA Advisory Committee) to derive sexual health principles: recognition of sexuality as intrinsic to individual health and relationships should have positive outcomes for all partners involved.

Methods Studies for a systematic review of intervention literature were drawn from Medline and PsycInfo databases (English language, adult populations, published between 1996–2011, country with developed public health infrastructure). They addressed outcomes in one or more domains: knowledge, attitudes, communication, healthcare use, sexual behaviours or adverse events. Data were summarised in a narrative review organised by population (adults, parents, sexual minorities, vulnerable populations) across domains. Selected data from knowledge, attitudes and behaviours were summarised in meta-analyses.

Results From 9064 studies, 58 were retained in the narrative review. Studies employed qualitative, experimental, pre-post and matched comparison group designs; the number of studies published was correlated with publication year (r = 0.77, p < 0.001). Interventions were predominantly individual and small-group in-person designs that addressed sexual behaviours (42 studies, 72%) and attitudes/norms (32, 55%). Studies with parents covered communication. All but one study reported at least one positive finding, but many (29 studies, 50%) also reported null findings. The most consistent positive effects on behaviours and adverse events were found for sexual minorities and vulnerable populations; interventions with parents uniformly increased attitudes and communication skills.

Conclusions Sexual health-framed interventions generate positive effects across adult populations, as well as mental and behavioural domains and adverse outcomes. Interventions may be especially effective among vulnerable populations and in improving parent communication. Where scalable, incorporating aspects of existing sexual health definitions into public health may contribute to improving sexual health.