The Impact of Social Media on the Sexual and Social Wellness
Lisa M. Cookingham MD, Ginny L. Ryan MD, MA *
Department of Obstetrics & Gynecology, University of Iowa Carver College of Medicine, Iowa City, IA
For most adolescents in the United States, the use of social media is an integral part of daily life. While the advent of the Internet has
enhanced information dispersal and communication worldwide, it has also had a negative impact on the sexual and social wellness of
many of its adolescent users. The objective of this review is to describe the role of social media in the evolution of social norms, to illustrate
how online activity can negatively impact adolescent self-esteem and contribute to high-risk adolescent behaviors, to elucidate how this
activity can result in real-world consequences with life-long results, and to provide guidance regarding social media use for those who care
for adolescents. Although research is now aimed at use of social media for positive health and wellness interventions, much work needs to
be done to determine the utility of these programs. Adolescent healthcare providers are important contributors to this new ﬁeld of study
and must resolve to stay informed and to engage this up-and-coming generation on the beneﬁts and risks of social media use.
Key Words: Adolescent health, Sexuality, Social media, Internet
Adolescence is a time of self-discovery, increased social
independence, and transformation into a unique individual.
While peers, parents, and educators have a direct impact on
adolescents during daily face-to-face interactions, Internet-
based entities are playing an increasingly large role during
this critical life stage.
Internet use for social purposes has
increased dramatically over recent years, with 95% of US
adolescents between the ages of 12 and 17 regularly ‘going’
online, and 80% participating in some type of social media
Social networking sites (SNS) are a relatively new phe-
nomenon andincreasingly popular among adolescents. These
are websites that permit social interaction among users
allow users to create online proﬁles that may (or may not)
represent the user's real-life identity. Users personalize pro-
ﬁle pages with images, audio, and text, and can designate
‘friends’and other relationships. These websites are attractive
to adolescents because they allow for individualized self-
promotion as well as inclusion into a group that may not be
attainable in physical reality. During a time when it is as
important to be unique as it is to ﬁt in, SNSs allow adolescents
to manufacture an image they want the world to see.
One model proposed to explain how adolescents inte-
grate media into their development of self is the Media
This model assumes 3 key features in un-
derstanding the effect of media on adolescents: (1) that
most media use is active or interactive; (2) that media use
and its effects are in an active reciprocal relationship with
the user; and (3) that the adolescent's current and evolving
sense of identity is the basis for how media is chosen and
applied in daily life.
The ‘media diet’chosen by the
adolescent, therefore, is a reﬂection of who they believe
they are and who they want to be.
While an SNS may seem
to provide the ideal venue for adolescent identity explora-
tion without committing to real-world consequences, this
model supports the notion that SNS behavior truly reﬂects
real-life behaviors or intent.
As this model suggests, social media use may have a sig-
niﬁcant impact on the social and sexual well-being of ado-
lescents. Many adolescents display limited self-regulation
and judgment skills that are not yet fully mature, which lead
to risky behaviors, especially on SNSs.
Adolescents can fall
easy prey to the ‘online disinhibition effect,’meaning that
personal details and private information are more readily
released into the public domain than they would be face-to-
face interactions due to the dissociative anonymity SNSs
SNSs provide an all too attractive outlet for
adolescents during a time in development where self-
expression and validation are important, and this expres-
sion may translate into risky social and sexual behavior.
Well before the advent of SNS popularity, adolescents
have been vulnerable to negative outcomes from poor
sexual choices. Adolescents are the highest risk group for
contracting a sexually transmitted infection (STI)
nearly 3 million adolescents are infected annually.
common practices contribute to this high risk of contracting
an STI, including: concurrent sexual partners, multiple
sexual partners, and lack of consistent condom use.
now beginning to see that social media may be increasing
these risky sexual behaviors and decreasing the overall
social and sexual wellness in adolescents.
The authors indicate no conﬂicts of interest.
*Address correspondence to: Ginny L. Ryan, MD, MA, Department of Obstetrics &
Gynecology, University of Iowa Carver College of Medicine, 200 Hawkins Dr, 31332
PFP, Iowa City, IA 52242; Phone: (319) 384-9170; fax: (319) 384-9367
E-mail address: email@example.com (G.L. Ryan).
1083-3188/$ - see front matter Ó2015 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc.
Impact on Self-Esteem
In this digital age, popularity is measured by how many
‘friends’or ‘likes’are collected on a SNS. Social media
encourage adolescents to compete for attention in order to
increase their ‘likes’and enhance their self-worth. If a ‘post’
or a ‘pic’doesn't garner enough comments, the adolescent is
encouraged to ‘share’it to make it more newsworthy. Bolder
and more daring behavior is rewarded when the audience
applauds the actions of the performer, and the cycle per-
petuates. These seemingly innocuous online behaviors can
be quite damaging themselves, and they are easily trans-
lated into a risky ofﬂine reality.
While individual conduct can damage self-esteem, so too
can the actions of an online adversary or ‘cyberbully.’This
era's equivalent of a schoolyard bully, a cyberbully is some-
one who deliberately uses social media to perpetuate false,
humiliating, or malevolent information about another in-
Similar to traditional ofﬂine bullying, studies have
shown cyberbullying can lead to depression, anxiety, severe
isolation, and poor self-esteem for the bullied individual.
Cyberbullying can be even more pervasive, however,
because SNSs provide a forum any time of the day or night
for anyone and everyone to see.
Perhaps not surprisingly, it
has also been shown that individuals who participate in
cyberbullying are more likely to participate in ofﬂine
Changing Social Norms and Promotion of High-Risk Behavior
Social norms that evolve over time and are peculiar to a
culture and behavior deemed unacceptable 50 years ago may
now be conventional. Psychological theorists suggest
behavior is strongly inﬂuenced by the perception of peers'
actions, whether or not this is the reality. As such, subjective
norms contribute signiﬁcantly to behavioral intentions and
Research supports the normative in-
ﬂuence that social media, speciﬁcally SNSs, have on today's
adolescents. It has been suggested, for example, that SNSs
may actually serve as a “media super-peer”by endorsing and
establishing social and behavioral norms of an adolescent's
If an adolescent believes that her peers are
participating in a particular behaviordeven high-risk
behaviordshe is more likely to participate in it as well
because it is perceived as ‘normal.’
Much research is being done to highlight the inﬂuence of
SNSs on evolving social norms and promotion of high-risk
behavior. In a recent study assessing the relationship be-
tween the perception and the reality of high-risk sexual
behavior among peers using SNSs, the authors found that
adolescents consistently over-report high-risk sexual
behavior and under-report protective behaviors of their
This suggests that adolescents overestimate their
peers' high risk behaviors.
Another study demonstrated
that adolescents who viewed SNS photos with minimal or no
sexually suggestive content perceived that their peers were
participating in safer sex practices, such as condom use, and
reported that it would inﬂuence their future behavior to do
In the same study, adolescents who viewed
sexually-suggestive SNS photos perceived that their peers
were having sex without protection or with strangers, and
they were more likely to report personal engagement in
these same high-risk behaviors.
These ﬁndings suggest
that high-risk behavior displayed on SNSs may encourage
similar high-risk behavior in others and simultaneously
endorse such behavior as ‘normal.’
While high-risk behavior by adolescents is not new,
SNSs allow for a new manifestation of this behavior that
has been labeled “self-exploitation”by some.
This refers to
the “creation and distribution of explicit or inappropriate”
materialdphotos, comments, suggestionsdon SNSs, social
media websites, other Internet sites, or through personal
There are several speciﬁc types of self-
exploitation common to adolescent SNS proﬁles. In a cross-
sectional study evaluating risk behavior promotion on SNSs,
for example, 54% of proﬁles were found to contain 1 or more
references to a high-risk behavior such as sexual activity,
substance abuse, or violence.
These practices may open
the door for similar behavior in both online and ofﬂine
Studies show it is common for adolescents to self-report
high-risk sexual behavior on personal SNS proﬁles, with
references to sex displayed on 24% of proﬁles reviewed in 1
Other adolescents may not directly reference sexual
behavior but will partake in a practice known as ‘sexting.’
This refers to the sending, receiving, or forwarding of
sexually explicit messages, photographs, images, or videos
via the Internet, a cell phone, or another digital device.
survey found that 20% of adolescents between 13-19 years
old have sent or posted a nude or semi-nude photo or video
of themselves to another adolescent.
In a more recent
longitudinal study, the authors reported that 28% of their
subjects had received a ‘sext’and 57% had been asked to
send a ‘sext.’
More disconcerting was the ﬁnding that
male and female adolescents who engaged in sexting were
more likely to have had sex, and that sexting was associated
with high-risk sexual behaviors in females (this association
was not seen in males).
Adolescents also engage in risk-taking related to sub-
stance abuse and SNS proﬁles have become a popular site for
the promotion of this behavior. In a study examining the
prevalence of risky behaviors displayed on an SNS, substance
abuse was the most frequently cited high-risk behavior, with
41% of proﬁles having some reference to alcohol, tobacco, or
A more recent study measuring online and ofﬂine
inﬂuences on adolescent smoking and alcohol use demon-
strated that exposure to SNS images of partying or drinking
increased both smoking and alcohol use in study subjects.
These data again highlight the concern that online behavior
can readily translate into real world behavior and potential
Ofﬂine Consequences of Online Behavior
While the cost of risky online behavior is clearly high
when it comes to social and sexual health, there are also
potential legal ramiﬁcations. Laws originally created to
protect children are being used to criminalize them as por-
nographers in many states.
One disturbing illustration in-
volves a 14-year-old girl who posted nude photos of herself
L.M. Cookingham, G.L. Ryan / J Pediatr Adolesc Gynecol 28 (2015) 2e53
on a SNS and was subsequently charged with possession and
distribution of child pornography.
Another example in-
volves a teen who received unsolicited explicit photos of his
girlfriend via text message and then mass-e-mailed the nude
photos after their breakup to “get back at her.”
was subsequently convicted of transmitting child pornog-
raphy and labeled a sex offender.
While it seems right that
some punishment should be incurred for such unwise and
often hurtful decisions, few adolescents are aware that the
act of simply hitting ‘send’can cause serious ramiﬁcations.
Inappropriate online behavior can lead to lifelong
repercussions, whether or not the actions are prosecuted.
Images and commentary posted on SNSs are freely accessible
and leave a digital footprint, allowing college admission
committees and employers to pre-screen their applicants.
More distressing than the potential negative impact of SNS
personal disclosure on professional success is the fact that
sexual predators troll SNSs for vulnerable adolescents who
don't understand the effects of haphazard Internet use.
While recent studies suggest that sexual solicitation is more
likely to occur between 2 adolescents (versus an adult
soliciting an adolescent), the threat very much exists.
Utilization of Social Media for Education
Notwithstanding these potential negative outcomes of
SNS use, new research has discovered some positive health
outcomes attributable to SNS use. From studies utilizing
SNSs to prevent the decline of condom use among adoles-
to investigators utilizing SNSs to provide accurate
and age-appropriate STI information,
educators are work-
ing to take advantage of SNS popularity in adolescents. SNSs
should be considered valuable tools for adolescent care
providers, especially when it comes to dissemination of
sensitive information that adolescents may not feel
comfortable discussing in face-to-face interactions, such as
those issues mentioned above. However, because online
resources may be unreliable or biased, utilization of these
outlets for dispersal of health information should not
replace comprehensive sexual education programs or
individualized education by health care providers. Media
literacy should also be taught to adolescents in schools and
at home to help them identify balanced and medically ac-
curate educational resources to ﬁll in the gaps and continue
their life-long learning.
How Adults Can Stay Engaged and Prevent Harm
Inquiring about adolescents' online participation in
activities such as sexting will provide valuable insight into
intention and/or engagement in high-risk behaviors and
afford an opportunity to intervene before irreparable dam-
age occurs. The American Academy of Pediatrics (AAP) rec-
ommends that health care providers ask parents/guardians
two speciﬁc media history questions at every well-child
1. How much recreational screen time does your child or
teenager consume daily?
2. Is there a television set or Internet-connected device in
the child's bedroom?
The AAP also encourages providers to recommend the
following to parents/guardians of adolescents (as summa-
rized by the authors)
Total entertainment screen time should be limited to
less than 2 hours per day
Television sets and Internet-connected devices should
be kept out of the bedroom
Use of Web sites and social media sites should be
A plan for media use should be established and rules for
inappropriate use enforced (ie, at mealtime, bedtime)
It is important for adolescent care providers to not only
teach parents/guardians about the beneﬁts and risks of social
media use, but to remain engaged and educated themselves.
In a rapidly changing world of technology, they must stay up
to date on Internet-based exposures and trends in order to
support adolescents and their parents/guardians as they
navigate this challenging time of development.
Social media have become an integral part of today's
culture and have helped deﬁne the latest generation of
youth. Despite the promise of enhanced socialization,
communication, and education, however, many adoles-
cents' lived experience of social media use has been nega-
tive on balance. From lowering self-esteem to creating new
social norms that encourage increasingly risky behavior,
SNS use jeopardizes the sexual and social wellness of ado-
lescents. New research is aimed at utilizing social media for
positive and effective health and wellness interventions,
but much more work needs to be done to enhance the
positive and mitigate the negative potential of this resource.
One thing is certain: as healthcare providers for this newest
technologically savvy population, it is imperative that we
keep up with the rapid evolution of social media and are
pro-active in managing health outcomes for adolescents.
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