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Vwewrswio.cnhi-ngyDneauetksochlo:gie.ch Ausgabe 2.2024
Influences of social media on
sexual behavior in adolescents
Associations between excessive use and risky sexual behavior
Contemporary research underscores the pivotal nexus between adolescent development, media influence, and self-esteem, underlining its profound implications for global health paradigms. Here we focus on recent studies which highlight associations to risky sexual behavior. On the other hand we point out education from professional web-sides.
VICTORIA CROFTS, DEHLIA MOUSSAOUI, MICHAL YARON
Victoria Crofts Dehlia Moussaoui Michal Yaron
According to the World Health Organization, adolescents represent one-sixth of the global population (1). Adolescent development encompasses various aspects, including self-esteem and sexual behavior, which are crucial for overall well-being and health outcomes (2). One significant influence on these aspects is media exposure, which has been extensively studied due to its potential impact on adolescent perceptions and behaviors (3). With the widespread adoption of smartphones and easy access to the internet making digital communication an integral part of their daily routines. Qualitative research conducted with young people in Australia, the UK, and North America, suggests that adolescents utilize social media platforms to negotiate aspects of sexuality and gender identity, demonstrating diverse behaviors ranging from humor and flirtation to intimacy or aggression (4). Excessive technology use, including frequent texting and prolonged periods on social media platforms, has been linked to unhealthy behaviors and poorer perceived health among adolescents (5).
At a glance
n Adolescents, constituting one-sixth of the global population, undergo multifaceted developmental stages crucial for their well-being, encompassing self-esteem and sexual behavior influenced significantly by media exposure.
n Negative media representations perpetuate harmful stereotypes, affecting adolescents’ sexual decision-making processes and contributing to increased rates of unplanned pregnancies and sexually transmitted infections.
n Social media and web-based interventions may also have a positive impact on sexual health, by promoting healthy habits, teaching about sexual health, and providing anonymous support for marginalized or victimized individuals.
n Efforts integrating web-based interventions with traditional sexual education methods are vital to empower adolescents with accurate information, especially for marginalized groups, while promoting positive self-esteem and comprehensive sexual education to mitigate the adverse effects of media on adolescent well-being.
Increase of risky sexual behaviors
Exposure to sexual content has been associated with heightened sexual activity, earlier sexual initiation, unprotected intercourse, or involvement in activities with multiple partners leading to increased rates of unplanned pregnancies and rise in incidence of sexually transmitted infections (STIs) among adolescents (6–8). The proliferation of dating apps has further revolutionized adolescent relationships, facilitating connections based on location and preferences. Studies have identified dating app usage as a significant risk factor for engaging in risky sexual behaviors, with the likelihood of condomless sex increasing among individuals seeking partners online (9) while also increasing the risks of online unwanted sexual solicitations, including exploitation by predators (10). Concurrently, sexting has emerged as a prevalent means of sexual exploration among adolescents, coinciding with increased internet usage. However, adolescents who engage in sexting for social validation are susceptible to experiencing negative psychological effects, alongside potential victimization from sexual coercion, cyberbullying, and harassment (11). In addition, negative media representations, perpetuated by many films, often reinforce harmful gender stereotypes, normalize non-consensual behavior, and depict violence during sexual encounters. Prolonged exposure to such content can influence adolescents’ perceptions of reality and contribute to the internalization of these stereotypes effecting adolescents’ sexual decision-making process (12).
Association between self-esteem and sexual behavior
Media portrayals often present idealized images of beauty, success, and social acceptance, which can create unrealistic standards for adolescents (13). This phenomenon contributes to diminished self-esteem,
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particularly regarding body image dissatisfaction and feelings of inadequacy and idealized selves contribute to heightened vulnerability to psychosocial issues such as depression, anxiety, and disordered eating behaviors (14). Social media platforms exacerbate these effects by facilitating constant comparison with peers’ curated online personas, intensifying adolescents’ dissatisfaction with their own self-perceptions (15). Recent studies have highlighted the association between low self-esteem and increased engagement in risky sexual behaviors among adolescents (2). Low self-esteem may be associated with a lack of assertiveness in sexual decision-making, making individuals more prone to engaging in unprotected sex or other risky behaviors (16). Early sexual debut has been positively associated with low self-esteem, while condom use has been linked to higher self-esteem among adolescents (17). Adolescent girls with low self-esteem may be particularly vulnerable to peer pressure and may seek validation through risky sexual behaviors. However, the relationship between self-esteem and risky sexual behaviors is multifaceted and influenced by various individual and contextual factors (18). Marginalized adolescents, including those from lower socioeconomic status or diverse backgrounds, are disproportionately affected by media representations, exacerbating existing disparities in self-esteem and sexuality (19). Limited representation and stereotypical portrayals in mainstream media further compound feelings of exclusion and marginalization among these groups (20).
Positive aspects of social media on sexual health
In contrast with the above, the use of social media may also be associated with many positive aspects in terms of sexual health in adolescents. There is growing evidence that social media can be an effective tool to teach adolescents about sexual health and promote healthy habits. Data support an increase in knowledge about sexual health associated with web-based interventions, although evidence regarding a subsequent change in behaviors (eg. condom and contraception use, STIs screening) is weaker (21–26).
Web-based interventions for complementing sexual education «Sciences, Sexes, Identités» (SSI, www.unige.ch/ssi) is a scientific and educational program developed at the University of Geneva (Faculty of medicine UNIGE, HUG; Santé sexuelle Suisse, Geneva State education dpt), whose mission is sexual health promotion and gender equity by generating courses and pedagogical tools for a positive sex education among children
and adolescents. The program includes in-person and online courses for teachers, sex-educators and/ or parents to generate a favorable environment for sexual health promotion. It provide education and health professionals with tools to use with their student/patients: videos available on free internet platforms on genital anatomy, sexual physiology, gender identity and sexual orientation (subtitled in 8 languages) as well as illustrated booklets, and 3D kits of the female and male genital organs (27). «The Bioscope», Geneva University biology’s outreach lab, offers middle and secondary school classes, in the context of SSI, a 2h interactive scientific workshop on biological sex development, intersex conditions and related psychosocial issues. We argue that web-based interventions should complement sexual education provided by the parents, school, and healthcare providers. It must be kept in mind that possibility to discuss sexual health for adolescents in their family is highly variable, depending on social factors, parental education, cultural background, and individual specificities. Despite encouragement to gradually introduce sexual education from childhood, in a manner that is suitable to the child’s development (28), many parents hesitate to engage in discussions about sexual health with their children. This reluctance might stem from fears of inadvertently encouraging sexual activity (contrary to evidence [29]) or because of discomfort and lack of knowledge (28).
The role of health care providers and reliable online platforms For those adolescents who do not have access to sexual health information at home, internet and social media may be the easiest way to apprehend sexual health. Adolescents need help navigating these sources of information, to identify reliable resources and remain critical about information provided that may be inaccurate. Healthcare providers should be able to guide their patients to reliable online resources which have been listed by authors (28) and local institutions (30, 31). The anonymous use of websites or platforms may also facilitate healthcare access to marginalized individuals (such as the LGBTQ+ community). This may provide them with support from an online community who shares similar characteristics, including gender identity, sexual orientation, or chronic health conditions (32). In addition, new technologies do offer a unique opportunity to change norms which are usually depicted in traditional media. For example, the «labia library» initiative aims at showing the diversity of female genital organs which can empower individuals and make them reconsider the concept of «normality» (33). This could also serve as a useful resource during
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medical consultation, especially with the growing number of requests for genital surgery, in particular labiaplasty, based on the standard labia depicted in porn films. Interestingly, social media has also been a «safe space» enabling victims to disclose sexual violence, often after years of silence. Embodied by the «MeToo» movement, this phenomenon highlights barriers to sexual assaults disclosure among families, social groups, and questions the ability of healthcare providers to explore violence in their patients (34).
Conclusion
Understanding the complex interplay between me-
dia influence, self-esteem, and adolescent sexuality
is crucial for promoting positive youth development
and addressing health disparities. Comprehensive
approaches that encompass media literacy educa-
tion and regulatory policies are necessary to mitigate
the adverse effects of media on adolescent well-
being. Efforts to promote positive self-esteem and
provide comprehensive sexual education are essen-
tial for addressing risky sexual behaviors in adole-
scents and fostering healthy development in this
population.
n
Dre. méd. Victoria Crofts Dre. méd. Dehlia Moussaoui Dre. méd. Michal Yaron E-Mail: Michal.Yaron@hcuge.ch Department of Pediatrics, Obstetrics and Gynecology Geneva University Hospitals 1205 Genève The authors have no conflict of interests to declare with this article.
Funding: The authors are supported by a grant from the «Fondation privée des HUG», Geneva University Hospitals, Geneva, Switzerland.
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