Literature number	Authors/Date of Publication	Study Design/Subjects	Purpose	Results
[12]	Kondo Abbott, Fusae, et al. 2001	Quantitative 81 school nurses	To investigate sexual issues among high school students and the state of conducted sex education.	Sex education was mainly provided by physical education teachers, while the school nurses taught about HIV/AIDS, pregnancy, reproductive organs, abortion, STDs, and intersexual relationships. The school nurse teachers were involved through individual counseling, and their counseling topics were, in order of frequency: intersexual relationships, pregnancy, abortion, contraception, and other sexual problems, with 70% to 80% of the counseling related to sexual activity and abortion.
[13]	KASHIRO Kimiko 2004	Quantitative 20 school nurses 53 health and physical education teachers. 24 home economics teachers	To investigate the state of sex education conducted by health & physical education teachers, home economics teachers, and school nurses working a high school and their needs.	The content taught by more than 90% of the health & physical education teachers consisted of AIDS, menstruation, contraceptive methods, and the psychological and behavioral differences between men and women, while for the home economics teachers it was pregnancy and menstruation. The school nurses taught more specialized content dealing with the pyschological and incidental aspects of sexual behavior, such as AIDS, STDs, and contraception. More than half of the teachers wanted an outside instructor specialized in sex education, and felt that sex education using only on-campus resources would be difficult.
[14]	HOSAKA Aiko, et al. 2006	Qualitative 2 school nurses	To describe the efforts of two school nurses working in different environments; one urban and one rural.	While there were some differences in problems regarding sexually transmitted diseases between schools, there were no regional differences between urban and rural areas. School nurses had a sense of difficulty in dealing with the problem of sexually transmitted diseases because they were not only consulted by current students, but also by graduates, and because they were unable to take the desired preventive actions.
[15]	TSUBOI Ryūta 2006	Quantitative 180 high school students 97 male 83 female	To investigate the results of a collaborative class with a midwife and a school nurse using HIV as a topic for incorporating perspectives of sex education into a first-year civics/contemporary society class at a high school.	In a post-class survey, 78 respondents described “making wise decisions and behavioral choices about sexual behavior as a human being,” and 33 of them described “thinking deeply about sexuality.” Regarding HIV infection, only 5 respondents were concerned about “discrimination and unfair prejudice against infected people. 122 students responded that they understood how to prevent sexually transmitted infections, while 7 responded that “abstinence is the key to prevention.”
[16]	SHIMOMURA Junko, et al. 2010	Quantitative 169 high school students	To investigate the matters that need to be considered when providing sex education to high school students, through the practice of sex education for high school students by a school nurse.	98% of the students responded that the sexual health lecture was good. The reason was they “felt comfortable learning about it.” The high evaluation was due to the fact that the school nurse gave consideration to the use of language, etc., based on their assessment of the high school students’ feelings of embarrassment and differences in the level of interest, and that they prepared in advance by understanding the needs of both the students and the teachers.
[17]	ISHINO Akiko, et al. 2012	Quantitative 106 school nurses	To specify items to be considered in school health for the smooth implementation of safe HPV vaccination and cervical cancer prevention.	Regarding HPV vaccination, school nurses believed that the basic knowledge that HPV is a cause of cervical cancer and can be prevented with a vaccine was important for upper elementary school students, junior high school students, and their parents. In addition, they believed that only knowledge that can be used immediately in accordance with each stage of development was necessary. Although a notice from the Ministry of Education, Culture, Sports, Science and Technology would allow them to provide education on cervical cancer, they felt it was difficult to teach the topic at their own invividual discretion.
[18]	SUGIHARA Toyoko 2012	Quantitative 176 high school students (79 male, 93 female)	To discuss the survey results of the health class conducted under the theme of “Becoming an Adult: Love/Life” and the perceptions of sex, and consider what sex education should look like in the future.	20% - 30% of boys and girls had some knowledge before the health lecture, but with the addition of the lecture, nearly 80% of the students had correct knowledge. 70% said they would go to a clinic if they contracted a sexually transmitted disease. Among the free responses, there were some comments such as “it does not concern me, I am not interested,” etc. Sex education should take into account the ambivalent attitudes of high school students.
[19]	KAWAGUCHI Mariko 2013	Practical report	To report the barriers felt in practicing adolescent sex education.	Sex education is an important and indispensable part of life, but even as times change in Japan, individual perceptions of sex as taboo have not changed. With the spread of unprotected sexual networks, telling adolescent students who lack concrete knowledge of contraception and preventing sexually transmitted diseases that “life is important” is ineffective. School nurses have difficulty providing guidance based on scientific evidence because sex education is mistaken for teaching sexual anatomy, and they get caught up in terms related to the genitalia and sexual intercourse.
[20]	TAKAHASHI Yūko 2014	Quantitative 27 school teachers	To clarify the influence of the organizational structure for school health on the promotion of school health activities and the role played by school nurses in this process.	48.2% of the teachers were “willingly involved in the implementation of school health activities,” 80.8% “exchanged information with school nurse teachers,” 26.9% “exchanged opinions with the school organization on issues of student health solutions,” and 32% “coordinated among different subjects.” The roles of the school nurse were “dissemination of information” and “interpersonal communication,” and through these roles, to encourage teachers and staff to “be aware of their active involvement in school health activities and to recognize their own role in school health.
[21]	SHIKAMA Kumiko 2014	Quantitative 89 school nurses	To clarify the state of awareness and efforts of high school school nurses in sex education, to make comparisons between nurse teachers and teachers who are in-school collaborators, and to consider measures for promoting sex education.	School nurses were likely to attend workshops and purchase books, which they selected with key words related to sexuality. They stated that sex education “allows students to expect positive changes” and recognized the need for sex education not only for current issues but also for students’ futures. However, they had difficulty in finding time for sex education, difficulty in gaining understanding from others, uncertainty about their own teaching methods, and difficulties in group instruction.
[22]	MATSUURA Kenchō 2015	Feature article	To consider the future of sex education	School sex education emphasized health learning and group health lectures. Knowledge and understanding were the main focus. While there is a weak link between knowledge and sexual behavior, academic ability and sexual behavior are closely related, and rational behavior is inhibited in adolescence when emotions are high. As the gap in sexual maturity among children continues to widen, emotional, individualized support, and personalized support are important to overcome this situation.
[23]	AOYAGI Chiharu 2016	Qualitative 2 school nurses	To identify the difficulties and challenges that school nurse teachers working in high schools experience in providing sex education.	The difficulties felt by the school nurses were “no placement in the curriculum, lack of an in-school guidance system, inadequate teaching skills, difficulty in situation assessment, and inability to raise funds for expenses. The reasons for this were that the school nurses were too busy to collaborate with the teachers or to improve their own teaching skills. Tasks for the future are to provide sex education as a form of human education that can be applied to future life, to examine teaching methods, to collaborate with specialized institutions, proper placement in the curriculum, and assessing students situations in order to provide sex education that meets the needs of students.
[24]	OCHIAI Katsuko 2016	practical report school nurse	To consider issues related to education on sexuality through the practice of preventative education and support in high schools.	To address children’s sexual health issues, sexuality-related knowledge and behavioral skills are not enough. It is necessary to provide education that fosters unbiased values, a sense of human rights, and the ability to make rational decisions, as well as to enhance self-esteem.
[25]	GUNJI Natsumi 2016	Quantitative 262 second-year high school students	To implement a lesson design to teach about prevention of sexually transmitted diseases and examine how the effectiveness of the lesson design differs by gender.	Familiar concerns for boys were using a condom, and for girls, being considerate of their partner. In terms of STD prevention, only girls mentioned refusing to have sexual intercourse as a preventive measure. After the class, both boys and girls recognized the risk of contracting sexually transmitted diseases. Girls’ knowlege of sexually transmitted diseases and sense of risk was higher than that of boys.
[26]	HOSAKO Kyōko, et al. 2017	Quantitative 454 first-year high school students	To survey high school students attending puberty classes on 10 topics: secondary sexual characteristics, fertilization, the process of pregnancy, fetal development, childbirth, sexually transmitted diseases, human rights, sexual violence, sexual concerns, and contraception to obtain foundational data for sex education based on differences awareness by gender.	The most understood item for both boys and girls was fertilization, at 62.4% for boys and 47.2% for girls. This was followed by infection at 49.0% for boys and 40.1% for girls, while understanding of secondary sexual characteristics was low for both sexes. Boys’ understanding was significantly higher than girls’ in secondary sexual characteristics, fertilization, sexual violence, sexual problems, and contraception, while there were no differences between boys and girls in the topics of pregnancy, fetal development, childbirth, and human rights.
[27]	SEKINE Shinako, et al. 2018	Quantitative 320 high school students	To clarify the state of sex education in high schools and examine its relationship with the school system	In terms of the school structure in sex education, 37.2% - 42.5% of the respondents indicated that they had support from the administration and cooperation from other teachers. Concerning the psychological and physiological aspects of sex education content and aspects related to sexual activity, more than 80% of the schools had implemented 18 out of 37 items. Schools that had the cooperation of the administration and other teachers, a school nurse in charge of sex education, the presence of a specialist with medical knowledge who could be consulted and training, and meetings with parents implemented more sex education content.
[28]	KIKUCHI Minako 2018	Qualitative 11 school nurses	To investigate the approaches employed by school nurses to build trust with students at the initial stage of health consultation and counseling.	The seven core categories to building trust with students were “Approaches to motivating students to visit school nurse’s office”, “Consideration of physical factors in students, Building a trusting relationship with students utilizing the student’s positive reactions as an indication of progress”, “Continuation of relationships while maintaining distance”, “Approaches that failed to build a trusting relationship”, “Trial and error in building a trusting relationship”, and “Approaches to understanding physical factors in student health”.
[29]	AKIZUKI Yuri, et al. 2021	Qualitative 3 school nurses	To examine the experiences of school nurses working in high schools in teaching about sexuality and their recognition of high school students’ sexual issues, as well as their experiences with and perceptions of fertility education.	High school nurses listed the following categories of sexual issues: “menstruation, pregnancy and childbirth, sexual assault, gender dysphoria, and counseling boys on sexuality.” Their experiences in teaching about fertility were “counseling girls who are losing weight, counseling students with menstrual irregularities, counseling students with eating disorders, and counseling students in sexual relationships with multiple partners.” They recognized the possibility of incorporating fertility into the lecture on menstruation which is held before school trips, and of teaching about fertility in the context of having students consider a life design for forming a happy family in the future.