International Journal ofEnvironmental Researchand Public Health
ArticleCharacteristics of Mother–Daughter Relationships
and Sexual Risk-Coping Consciousness among
Japanese Female University Students
Chisato Yamanaka 1 and Kimiko Kawata 2, *1
2*

Fukuoka Birth Clinic, Fukuoka 819-0006, Japan; mc0420m@gmail.com
Department of Health Sciences, Division of Nursing Sciences, Faculty of Medical Sciences,
Kyushu University, Fukuoka 812-8582, Japan
Correspondence: k-kawata@hs.med.kyushu-u.ac.jp; Tel./Fax: +81-92-642-6742

Received: 30 September 2020; Accepted: 13 November 2020; Published: 26 November 2020


Abstract: For heterosexual Japanese women in their early 20s, it is important to maintain
good sexual health, develop intimate relationships with a partner, and go through the processof having a family. This study aimed to determine the characteristics of mother-daughter
relationships among Japanese female university students and their associations with students’ sexual
risk-coping consciousness. We conducted a cross-sectional study using anonymous self-administeredquestionnaires. Participants were 329 female university students in their junior and senior years.
The mother-daughter relationships of the study respondents were divided into the following threeclusters: controlled group, close group, and independent group. The close and independentgroups often consulted their mothers about sexual matters and, also, tended to be highly capable ofactively expressing their opinions and cooperating with their partner in a sexual setting. In contrast,
the controlled group revealed a significantly lower percentages of consulting their mothers on sexual
matters and scored lower sexual risk-coping consciousness subscale scores. The controlled group
may suffer a negative impact of the relationship with their controlling mothers as they try to build a
good, trusting relationship with others. The characteristics of mother-daughter relationships may be
associated with daughters’ sexual risk-coping consciousness.
Keywords: mother-daughter relationship; sexual risk-coping consciousness; female university
students

1. Introduction
The average age when Japanese women, presently in their early 20s, first experience sexualintercourse was reported to be 18.6 years [1]. Approximately 37% of Japanese female university
students have had sexual intercourse experience [2]. According to a survey of men and women
between the ages of 20 and 59 years by one company, the LGBT (Lesbian, Gay, Bisexual, Transgender)
community in Japan is reported to comprise 7.6% of the population [3], but there are no official statistics
for the LGBTQ (Lesbian, Gay, Bisexual, Transgender, Questioning) community yet. Although not manysources provide details of the subject’s sexual orientation, it is presumed that the majority of Japanesewomen are heterosexual. In order to understand the current sexual behaviors of Japanese people,
Sagami Rubber Industries, Co., Ltd. (Japanese condom manufacturer) conducted an internet survey
targeting approximately 14,000 people in their 20s and 60s who were evenly distributed by gender andage [1]. As a result, about 15% of women in their 20s experienced their first sexual intercourse with aman they met via the Internet, such as a SNS (social networking service), social games, and dating sites.
Additionally, about 16% of them experienced their first sexual intercourse with men who they were not

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www.mdpi.com/journal/ijerph

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dating [1]. Compared to the same survey conducted in 2013 [4], the numbers have increased, and theresults suggested that the opportunity for young women to meet men and for being more accepting
towards casual sex is increasing. In fact, according to a survey of the Japanese Ministry of Health,
Labor and Welfare, the number of STIs (sexually transmitted infections) among women in their early
20s is higher than that of women of other ages and is on the rise [5]. In particular, the increasing of thenumber of chlamydia and syphilis patients is a serious issue. In addition, the number of abortions has
been declining for women of other ages but has remained unchanged for women in their early 20s [6].
Therefore, for heterosexual Japanese women in their early 20s, it is important to maintain good sexual
health, develop intimate relationships with a partner, and go through the process of having a family.
Among the numerous and varied relationships that individual experiences, there is little doubtthat the mother-child relationship is the most influential for children’s social skills and behaviors [7].
Regarding an international comparative study, it was pointed out that young Japanese womentend to have a stronger emotional connection with their mothers than young American women [8].
In addition, the mother-daughter relationship that Japanese female university students perceive andexperience has revealed that they have a high level of trust and intimacy [9,10]. Many healthcare
behaviors are transmitted from parents to children and are learned as vital components of a healthy
lifestyle. Kawata’s study [11] implied that the level of agreement between young women and theirmothers on the method of obtaining axillary temperature measurements is significantly associated withpresently secure mother-child relationships. Several studies also have indicated that health behaviors,
including children’s prosocial and problematic behaviors, are influenced by relationships withcaregivers; the associations between antismoking actions [12], treating caries [13,14], eating behaviors
to avoid childhood obesity [15], and family relationships are said to be protective factors against
unwanted teenage pregnancies [16,17]. Moreover, several studies have suggested that maternal
education and practices are possibly effective in enhancing children’s health status [18,19].
It is also inferred that mother-daughter relationships influence daughters’ sexual behaviors.
Previous studies have reported that mothers are a protective factor against early sexual initiation forgirls [20] and that women in early adulthood with a good relationship with their mothers have a low
likelihood of contracting STIs [21]. Studies have also significantly correlated conversations between
mothers and daughters about sexual matters with the use of condoms and contraceptives [22] andhave shown that these daughters are likely to talk to their physicians or other healthcare professionals
about sexual problems [23]. In Japan, a study on the relationship between high school girls’ sexualintercourse experiences and the family environment reported that having a single parent, having a
private room, and/or does not feel cozy when they are with one’s families were associated withincreasing sexual intercourse [2]. In addition, it was reported that the lower the self-esteem as a family
member, the higher the risk of contact with sexual information on the internet [24].
Having sex only when neither person nor the partner has a STI or having sex with only one partneris believed to be safe. Having sexual intercourse with a stranger or an unspecified number of people
increases the risk of getting STIs or unintended pregnancy [25]. Based on these facts, it is necessary tohighlight the importance of preventing STIs and unintended pregnancies among the younger generationand help them go through the process of developing intimate relationships with their partners while
ensuring good sexual health. Kusano [26] defined the sexual risk-coping consciousness as recognition of
the self-management ability to take appropriate actions to avoid risks in sexual relations and confidence
in the sexual interpersonal ability to communicate intimately with others. The sexual risk mentioned
here is a STI or an unintended pregnancy, and it was proved that those who have experienced sexualintercourse are more conscious of coping with sexual risk. This result suggested the need to consider
appropriate sex education from the perspective of the development of interpersonal relationships.
However, studies on the association between mother-daughter relationships and daughters’ sexual
risk-coping consciousness are insufficient.
Therefore, this study aimed to understand the current situation of mother-daughter relationships
among heterosexual Japanese women in their 20s, who many of become sexually active, as mentioned

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above, and to examine the association of these relationships with daughters’ sexual risk-coping
consciousness and sexual behaviors. The definition of risky sexual behavior is as follows; having sexualintercourse with a stranger, an unspecified number of people, and/or without contraception. The study
was designed to address two primary research questions: (1) What is the current situation of theJapanese mother-daughter relationship? and (2) Is a reliable relationship between a mother and adaughter associated with the daughter’s higher awareness of coping with sexual risk?
2. Materials and Methods
2.1. Study Design
This was an observational, cross-sectional study using an anonymous self-administeredquestionnaire. Participants were recruited using the snowball sampling method from four prefecturesin Japan.
2.2. Participants and Procedures
The survey included female university students in their junior or senior years. A questionnaire
was distributed between June and July 2019, and responses were collected until August.
The researchers discussed the date/time for distributing the questionnaire and the method/place
for collecting responses with 4 universities and 12 university-affiliated clubs that agreed to participate
in the study and visited them according to the set schedule. The purpose and method of this survey,
protection of personal information, and freedom to withdraw were explained both in writing andverbally to the female students targeted by the survey. The self-administered questionnaire form and acollection envelope were distributed to those who provided their consent to participate in this study.
The completed questionnaire was placed in the collection envelope and returned via a collection box orby mail.
In total, 636 questionnaire forms were distributed and 415 collected (response rate: 65.3%).
After excluding those with missing data, 329 respondents were included in our analysis (effective
response rate: 79.3%).
2.3. Contents of Questionnaire
The questionnaire comprised items pertaining to basic attributes, the mother-daughter relationshipscale, sexual risk-coping consciousness scale, and actual sexual behaviors.
(1)

Basic attributes

The basic attributes were age, marital status, department enrolled in, family structure, and familyliving together.
(2)

Mother-daughter relationship scale [27]This scale was used to measure the relationship between mother and daughter in late adolescence
to early adulthood. It is composed of 35 items (6 items are reversed items) of 5 factors: “support formother” (5 items, including “I want to take care of her”), “past conflicts” (6 items, including “Weused to argue constantly”), “mother’s domination” (9 items, including “She forces her opinion onme”), “trust in mother” (10 items, including “I want to understand her feelings”), and “dependence onmother” (5 items, including “I tend to rely on her for everything”). Answers were rated on a five-point
Likert scale from “very applicable” to “not applicable at all”.
The 5-factor scale included 35 items responded to on a 5-point Likert scale. The reliability coefficient(Cronbach’s α) for each of the original scales ranged between 0.78 and 0.90, indicating that the internalconsistency of the scale was sufficiently high. The higher the score, the stronger the characteristic of
the mother-daughter relationship associated with the factor. Permission to use the scale was obtained
from the codevelopers.

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Sexual risk-coping consciousness [26]This scale was used to measure respondents’ recognition of their self-management ability to takeappropriate actions to avoid sexual risk. This 1-factor scale comprised 18 items responded to on a
4-point Likert scale. Cronbach’s α coefficient was 0.87, indicating high reliability. The higher the meanscore, the higher the respondent’s sexual risk-coping consciousness. Permission to use the scale wasobtained from the authors.
(4)

Actual sexual behaviors

These questions pertained to respondents’ experience with sexual intercourse, the presence/absenceof a sexual partner, frequency of contraceptive use, contraceptive method used, history of induced
abortion, and history of STIs.
2.4. Statistical Analysis
For the mother-daughter relationship scale and sexual risk-coping consciousness, a factor analysis
was performed to confirm the factor structure. Thereafter, scores on each factor were converted tostandardized scores, and a cluster analysis was performed. The number of clusters was determinedby examining the characteristics of the factor scores within each cluster and differences between theclusters. In addition, a Kruskal-Wallis test and multiple comparison test (Bonferroni correction) were
performed to examine differences in the factor scores for each cluster. Each cluster name was discussed
and determined by multiple researchers.
Fisher’s exact test and multiple comparison test (Bonferroni correction) were performed to examine
differences in sexual behaviors between the mother-daughter relationship clusters, and a Kruskal-Wallis
test and multiple comparison test (Bonferroni correction) were conducted to examine the scores forsexual risk-coping consciousness. A significance level of 5% (two-sided test) was used in all analyses.
Software HAD 16.0 (https://norimune.net/had. Hiroshi Shimizu, Kansai Gakuin University, Japan,2016) [28] was used for the cluster analysis, statistical software R [29] for the multiple comparison tests,
and IBM SPSS ver. 25 for all other analyses.
2.5. Ethical Considerations
There are no official Japanese statistics on the LGBTQ community. The subject of this study isheterosexual women; however, we may have inadvertently asked members of LGBTQ community
to participate in the study. Therefore, we explained that participation in this survey was completely
voluntary, and it was not necessary to answer questions that they did not want to answer and added“I don’t want to answer” options to some questions.
Since the questionnaire included questions on aspects considered private, the completed form
was collected in a sealed collection envelope.
This study was conducted with the permission of the Clinical Research Ethics Review Board of
the university that the researchers are affiliated with.
3. Results
3.1. Characteristics of Participants
Respondents’ ages ranged from 20 to 27 years, with a mean age of 20.9 (±0.93) years. The numberof respondents enrolled in medical departments (medicine, dentistry, pharmaceutical sciences, nursing,etc.) was the highest at 224 (68.1%). The mothers of all the respondents were alive and well, and 43%of the respondents lived alone. As for sexual behaviors, 175 (53.2%) answered “they had experience ofsexual intercourse”, and 131 (39.8%) answered that “they had a sexual partner”. Among the respondents
who “had experience of sexual intercourse”, 80.3% said they used contraception “every time” and“almost every time”, 0.6% had a history of induced abortion, and 6.3% had a history of STIs (of which

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5 of 1180% had chlamydia and 20% genital candidiasis). None answered that they had been infected withcondyloma acuminatum, gonorrhea, or syphilis (Table 1).
Table 1. Basic attributes (n = 329).
Attributes

Options

Minimum

Maximum

Mean ± SD

202720.9 ± 0.9

Age

n (%)

Department

MedicalOther

224 (68.1)
105 (31.9)

Family living together(multiple answers)

Living alone
Living with family
Other

141 (43.0)
176 (53.3)
12 (3.7)

Family structure(multiple answers)

FatherMother286 (86.9)
329 (100)Experience of sexual intercourse

Yes
No
No response

175 (53.5)
118 (36.1)
36 (10.9)

Age of first sexual intercourse
encounter (n = 174 *)12

21

18.6 ± 1.6

Sexual partner currently dating

Yes
No
No response

131 (39.9)
181 (55.2)
17 (5.2)

Sexual partner currently not dating

Yes
No
No response

33 (10.8)251 (82.3)
45 (13.7)

Number of sexual partners
currently not dating (n = 32 † )Frequency of contraceptive use(n = 175 ‡ )History of induced abortion(n = 175 ‡ )History of sexuallytransmitted infections(multiple answers)(n = 175 ‡ )1

4

1.8 ± 1.0

Every time
Almost every time
RarelyNever
Currently not engaged in sexual intercourse
No response
Yes
No
Don’t want to answer
Chlamydia
CandidaOthers §Never
No response

119 (68.0)
39 (22.3)
10 (5.7)
2 (1.1)4 (2.3)1 (0.6)
1 (0.6)172 (98.3)
2 (1.1)2 (1.1)8 (4.6)0 (0)164 (93.7)
7 (4.0)* Those who answered they had experience with sexual intercourse (one was no response); † Those who answered
they had a sexual partner they were currently not dating (one was no response); ‡ Those who answered that they
had experience with sexual intercourse; § Syphilis, gonorrhea, condyloma acuminatum, genital herpes, and HIV.

3.2. The Mother-Daughter Relationship Scale and Classification of Mother-Daughter Relationships
A factor analysis (principal factor method and promax rotation) was performed to confirm thefactor structure of the mother-daughter relationship scale. In this study, 24 items were adopted(five items with a ceiling effect, five with a floor effect, and one with a factor loading less than 0.35 weredeleted) and four factors (“positive feelings toward mother”, “control by mother”, “past conflicts”,
and “dependency on mother”) extracted. Cronbach’s α coefficient for each of the four factors were
0.88, 0.84, 0.91, and 0.77, respectively (Table 2).

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Table 2. Mother-daughter relationship scale: factor analysis results (n = 329).
ItemαFactor 1: Positive feelings toward mother (10 items)
Factor 2: Control by mother (6 items)
Factor 3: Past conflicts (4 items)
Factor 4: Dependency on mother (4 items)

0.88
0.84
0.91
0.77

A cluster analysis (word method) was performed using the subscale scores of the scale to extract
optimal clusters, and a Kruskal-Wallis test and multiple comparison test (Bonferroni correction) wereconducted to examine differences in the factor scores for each cluster. As a result, the following threegroups were identified: “controlled group”, “close group”, and “independent group” (Figure 1).

Figure 1. Mother-daughter relationship scale: cluster analysis results (n = 329).

In Cluster 1, “control by mother” and “past conflicts” scores were high, and “dependency on
mother” and “positive feelings toward mother” scores were low. Compared to others, this cluster
indicated the highest “control by mother” and the lowest “positive feelings toward mother”;
these participants formed the controlled group. In Cluster 2, since “positive feelings toward mother”
and “dependency on mother” scores were high, and “control by mother” and “past conflicts” scores
were low, it was named the close group. In Cluster 3, “past conflicts”, “control by mother”, and “positive
feelings toward mother” scores were high, and the “dependency on mother” score was almost average.
Since the “past conflicts” score of this cluster was the highest, the “control by mother” score wasrelatively high and “positive feelings toward mother” was slightly higher than others, while the“dependency on mother” score was lower than that of the participants of the close group; therefore,
it was named the independent group.
3.3. Sexual Risk-Coping Consciousness
For sexual risk-coping consciousness, a three-factor structure was identified in this study consistingof “cooperative management type”, “active management type”, and “self-management awareness”.
Cronbach’s α coefficient for each of the three factors was 0.82, 0.75, and 0.69, respectively (Table 3).
Table 3. Sexual risk-coping consciousness: factor analysis results (n = 329).
ItemαFactor 1: Cooperative management type (6 items)
Factor 2: Active management type (6 items)
Factor 3: Self-management awareness (6 items)

0.82
0.75
0.69

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7 of 113.4. The Degree of Respondents’ Consultation with Their Mothers about Sexual Matters in Each
Mother-Daughter Relationship Cluster
The proportion of respondents who consulted their mothers about sexual matters was significantly
lower in the “controlled group” than in the “close group” and “independent group” (close group:
controlled group p < 0.001 and independent group: controlled group p < 0.05) (Figure 2).

Figure 2. Mother-daughter relationship clusters and percentage of those who indicated their “mother asa consultant” in each cluster (n = 329). † Options: mother, father, brother, sister, and other. Fisher’s exact
test and multiple comparison test (Bonferroni correction). The number is the number of respondents,
and the value in ( ) is the %. *** p < 0.001, * p< 0.05.

3.5. Scores for Sexual Risk-Coping Consciousness in each Mother-Daughter Relationship Cluster
Among the mother-daughter relationship clusters, significant differences were noted in two
factors of sexual risk-coping consciousness (p < 0.05 and p < 0.01); therefore, a multiple comparison
test (Bonferroni correction) was performed. As a result, the score for the “cooperative managementtype” was significantly higher in the “close group” than in the “controlled group”, while, in the “active
management type”, the score was significantly lower in the “controlled group” than in the “close group”
and “independent group” (close group:controlled group p < 0.01 and independent group:controlledgroup p < 0.05) There were no differences between the clusters in “self-management awareness” insexual situations (Figure 3).

Figure 3. Examination of sexual risk-coping consciousness scores in each mother-daughter relationshipcluster (n = 329). Kruskal-Wallis test and multiple comparison test (Bonferroni correction); The value isthe median, and the values in ( ) are the 25th and 75th percentiles; ** p < 0.01 and * p < 0.05.

3.6. Sexual Behaviors by Mother-Daughter Relationship Cluster
No significant difference was found between the clusters for “contraceptive use”, “history of
induced abortion”, and “history of STIs”.
4. Discussion
4.1. Basic Attributes of the Study Participants
According to statistics on Japan, the number of female university students is highest in sociology
departments, followed by medical departments and, then, by humanities departments. In this study,
the highest proportion of students was from medical departments [30]. Regarding sexual behaviors,

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8 of 11comparing statistics on Japan, the participants of this study were no different from average female
university students in terms of their experiences with sexual intercourse and frequency of contraceptive
use. However, a substantially lower percentage of our participants had a history of induced abortion
or STIs [5,6].
In Japan, family environments such a having a single parent and having a private room wereassociated with increasing sexual intercourse [24]. In this study population, however, no respondents
had a single parent. In addition, 43% of the respondents answered they lived alone, and the percentage
was almost same as that of the previous report: 35.3–68.1% [31].
4.2. Validity of the Mother-Daughter Relationship Classification and Characteristics of Each Cluster
Among the mother-daughter relationship clusters, the “controlled group” had low levels of“positive feelings toward their mothers”, felt “controlled by their mothers”, and had experienced “pastconflicts” with them. In addition, compared with the other groups, a significantly lower percentageof those in the “controlled group” consulted their mothers on sexual matters. A cluster analysis in apreceding study revealed that the group similar to the “controlled group” in the current study had
little to no sense of being protected or accepted by their mothers, which, presumably, caused them toconsider their mothers annoying or give up on them, leading to early separation [32]. In this study,
it was inferred that the “controlled group” felt strongly controlled by their mothers, causing them todetach from them before they could reconstruct the relationship, which was affected by past conflicts.
In the “close group”, high scores were obtained for “positive feelings toward mother” and“dependency on mother”, while “control by mother” and “past conflicts” scored low. Furthermore,this group indicated “mother” as a consultant for sexual matters more than did those in the“controlled group”.
Although the “independent group” had strong experiences with “past conflicts”, they scoredsignificantly higher on “positive feelings toward mother” than did those in the “controlled group”.
Furthermore, as shown in Figure 2, a higher percentage of respondents in this group indicated theirmother as a consultant for sexual matters than those in the “controlled group”. As a characteristic of
the relationship between a mother and young adult daughter, close contact and frequent negotiations
can often cause them to hurt each other but can also nurture the strong sense of trust and intimacy
between them, making it relatively easy to rebuild the relationship [9]. Additionally, the independentgroup in this study experienced conflicts with their mothers in the past, but currently had positive
feelings toward them, indicating that their adversarial relationship was repaired. Furthermore, in the“controlled group”, which, like the “independent group”, scored high on “past conflicts”, their early
separation from their mothers was associated with their low “dependency on mother”. However, in the“independent group”, the low “dependency on mother” was attributed to being mentally independent
as a result of establishing a good relationship with their mother. Therefore, as a characteristic of the
independent group in this study, it was inferred that, despite having experienced conflicts with theirmothers in the past, their mother-daughter relationships were reconstructed in such a way as to nurturethe daughters’ independence.
4.3. Associations of the Characteristics of Mother-Daughter Relationships with Daughters’ Sexual Risk-Coping
Consciousness and Sexual Behaviors
The investigation of sexual risk-coping consciousness for each of the three mother-daughter
relationship clusters revealed that the “close group” scored significantly higher for the “cooperative
management type” of sexual risk-coping consciousness than the “controlled group”. Additionally,
the “close group” and “independent group” scored significantly higher for the “active managementtype” than the “controlled group”.
“Cooperative management type” and “active management type” are subscales regarding
self-confidence in terms of the sexual interpersonal relationship ability to form an intimate relationshipand be able to communicate with a partner [26]. According to a preceding study, a higher-quality

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relationship between adolescents and their parents, especially between mothers and daughters,
may help to protect against early sexual initiation. When female adolescents find their homeenvironment enjoyable, frequent conversations with parents and a good family atmosphere prevent
their early sexual initiation. [2]. Moreover, a higher percentage of women who find it difficult tocommunicate with their mothers regarding sexual intercourse and contraception choose a less effective
contraceptive method than those who do not find this difficult [33]. Furthermore, it was also reported
that, for adolescent girls, maternal–adolescent communication is the source of information on how toacquire condoms and contraceptives and their effectiveness [22].
In Japanese culture, it has been pointed out that young Japanese women tend to have stronger
mother-child emotional ties than American women [8]. In addition, this study revealed that respondents
in the close group who had reliable relationship with their mothers, and those in the independentgroup who rebuilt their relationships with their mothers, tended to consult and communicate with theirmothers about sexual matters. As a result, they were also capable of building an equal relationshipwith their partners, which presumably has helped them avoid sexual risk by expressing their opinions
in sexually high-risk situations. In contrast to these groups, the “controlled group” may suffera negative impact of the relationship with their controlling mothers as they try to build a good,
trusting relationship with others. These findings suggest that a good mother-daughter relationshipis vital for fostering self-management abilities to avoid sexual risk among young women. To raiseawareness about appropriate actions to avoid sexual risk, it is considered important to provide girls
in early adolescence with support for maintaining a good mother-daughter relationship so that they
can develop positive feelings toward their mothers. In addition, measures are needed to promote thereconstruction of the mother-daughter relationship represented by the “controlled group” in this study.
Our findings suggest the important role of mother-daughter relationships in maintaining andimproving the sexual reproductive health/rights of women in young adulthood, which we consider isof significance in this study.
4.4. Limitations
Since this study did not use a random sampling method, it is difficult to generalize the results
thereof. For sexually risky behaviors, no significant differences were found between the threemother-daughter relationship clusters. The reason we did not find a significant difference between
contraception use, experience of abortion, and STIs and mother-daughter relationships is because it ispresumed that there are several types of contraceptive methods and no specific answer was obtainedin this survey and that the number of respondents who experienced abortions and STIs was very low.
In addition, because the study targeted young women who had a mother, the marital status of themother was not questioned. However, the fact that the presence or absence of a father and the impact
of mother-father relationships were not examined is considered a limitation of this study. Furthermore,
previous studies reported that having a single parent, private room, working mother, older malesibling, and friend of the same age and gender are factors influencing the sexual behaviors of young
adults [2,33]. As various factors are considered influential in the sexual behaviors of young people,
further studies are necessary.
5. Conclusions
The following three clusters were identified regarding our respondents’ mother-daughter
relationships: the controlled group, the close group, and the independent group. Regarding sexual
risk-coping consciousness, the close group and the independent group had higher levels of awareness,
which allowed them to avoid sexual risk by expressing their opinions when communicating with
their partners, and this ability might be influenced by young Japanese women’s positive and healthy
relationships with their mothers.
One of the main findings of this study is that sexual literacy and education toward self-management
may develop close communication between the mother and daughter and infuse trust and intimacy

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10 of 11in the relationships. Our findings suggest that, as a specialized profession, we need to impress onsociety the importance of a good mother-daughter relationship so that young women can develop
self-management abilities to avoid sexual risks.
Author Contributions: C.Y. contributed to the design and implementation of the research, to the analysis of theresults, and to the writing of the manuscript. K.K. encouraged C.Y. to investigate and supervised the findings ofthis work. All authors have read and agreed to the published version of the manuscript.
Funding: This work was supported by JSPS KAKENHI grant number JP 19K11059.
Acknowledgments: The authors would like to thank all of the students for participating in this study.
Conflicts of Interest: The authors declare no conflict of interest.

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