Sexual and gender development are key components of adolescence. As social media becomes increasingly ingrained in youth culture, it is essential to understand its impact on these developmental pathways. Social media provides a novel avenue for adolescents to explore identity, sexuality, and intimacy—as well as newfound autonomy and risk taking. Adolescents typically use social media for age-appropriate interactions and many find mental health benefits, alongside potential risks to mental and physical health. Clinicians should use a nonjudgmental tone to inquire about adolescent online behaviors and to counsel patients on safe and developmentally appropriate identity and relationship development.
Key points
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Social media offers adolescents alternative access to information, media, and relationships that facilitate key developmental tasks of gender and sexual identity formation and expression.
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For some youth, social media provides connection, support, and mental health benefits.
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Adolescents who form romantic relationships on social media also risk mental and physical harm, including worsened self-esteem, exploitation, abuse, or sexually transmitted infections and unwanted pregnancies.
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Although many adolescents are aware of these risks, clinicians should encourage risk-mitigation strategies, involvement of parental support, and referral to child psychiatry if indicated.
Terminology and background
This review aims to describe the current literature on the interplay between social media and gender and sexual development in adolescents. The authors use a developmental framework to describe the ways in which youth engage with social media as they navigate these developmental tasks. They offer a clinical vignette to highlight important themes and provide clinical tips for clinicians to assess gender and sexual development and their relationships with social media and online interactions.
Sexual orientation, gender identity, and gender expression are distinct concepts. Sexual orientation refers to the types of people toward whom one is sexually or romantically attracted. Gender identity refers to one’s psychological understanding of their gender in relation to masculinity, femininity, a lack of either, or a combination of both. Gender expression refers to the ways in which people present to the world in a gendered fashion through clothing, hairstyles, and pronoun use, among others. The term transgender will be used here as an umbrella term for individuals whose gender identities do not align with societal expectations based on their sex assigned at birth. Transgender is used in opposition to the term cisgender, which refers to those whose gender identities align with societal expectations based on their sex assigned at birth. They also refer broadly to lesbian, gay, bisexual, transgender, queer, and other people that includes both sexual and gender minority (SGM) populations.
Importantly, gender identity development starts in the preschool years, prior to both social media use and the development of sexual identity. Gender identity is a multidimensional construct that includes the relationship to gender roles and expectations, relationship to one’s primary and secondary sex characteristics, and one’s transcendent sense of gender. Research, including twin studies, suggests an innate biologic basis for gender identity. Individuals build upon this innate scaffolding via language and conceptualizations of gender throughout development, impacted by one’s family of origin, culture, and the larger sociopolitical context, toward a cohesive gender identity. Many establish a clear sense of their gender identity by early preschool years, while others continue to explore gender identity into adolescence and beyond. , By high school, an estimated 1.8% of youth now identify as transgender.
The authors define sexual orientation as “a multidimensional construct that has been measured at least using 3 different dimensions: identity, behavior, and attraction.” Common sexual identities include heterosexual or straight (different-gender attraction), with sexual minorities including homosexual or gay/lesbian (same-gender attraction), bisexual (same-and-different gender attraction), and pansexual (attraction to all genders). SGM is an umbrella term commonly used to describe individuals who are not heterosexual and cisgender. Some academic and clinical literature focuses on action-focused categorizations, such as men who have sex with men (MSM) to highlight behavior over identity.
Sexual development is an important task of adolescence involving identity and intimacy. Traditional psychological theory by Erik Erikson highlights “Identity versus Role Confusion” and “Intimacy versus Isolation” as the primary developmental conflicts of adolescence and early adulthood, respectively. Adolescence and young adulthood are characterized by the progression of sexual identity development, formation of intimate relationships, and identification with peers. Erikson’s stages are a theoretic framework; the underlying research of which was not conducted with consideration for SGM youth and therefore will not fully encapsulate the developmental tasks of SGM youth. In this review, the authors use the following developmental tasks to describe sexual and gender identity development of adolescents: identity exploration, formation, expression, community searching, intimacy exploration, autonomy, and risk taking.
The process of sexual development includes formation of sexual identity, sexual behavior, and intimacy. Cultural norms and expectations of sexual identity have significantly changed from the mid-20th century. The increased societal acceptance of sexual minority identities and increased representation of sexual minority characters in mainstream media exemplify this notable cultural shift. The Youth Risk Behavior Surveillance System (YRBSS), which tracks health-related behaviors of high school students with surveys every other year, provides the broadest contemporary dataset. Overall, 88.8% of surveyed youth identified as heterosexual. Overall, 6% identified as bisexual. Overall, 2% identified as gay or lesbian. Overall, 3.2% were not sure of their sexual identity. Subgroup analysis by Philips and colleagues highlighted that 13.9% of female individuals assigned at birth and 7.0% of male individuals assigned at birth identified as Lesbian, Gay, Bisexual (LGB) or “not sure.”
Sexual behavior is also described by the YRBSS. For the years 2005 to 2015, 58.9% of youth had not had sex. The modal age of first sexual intercourse was 15 (11.2%). Among participants who had sex, the most common number of partners was 1 (16.5%) followed by 2 (7.8%) and 6 or more (6.0%). These data help contextualize an adolescent’s sexual behavior. Several studies demonstrate overall decline of sexual behaviors among youth with resulting decreases in high-risk sexual behaviors and outcomes (eg, multiple sexual partners, sexually transmitted infections, and teen pregnancy). ,
Sexual behavior still represents a somewhat taboo subject in American culture. The amount of sex education youth receive, if any, is highly variable, depending in part on differences in their families and educational environments. The Dutch model for sexual and gender education moves beyond preventative intervention or abstinence-only approaches to consider sexual health promotion interventions including considerations of pleasure, intimacy, and discovery. According to this model, healthy sexual behavior occurs in the context of a healthy relationship with one’s body, positive self-esteem, clear consent, an understanding of potential outcomes of sexual behavior, and behavior that generally occurs in the context of a relationship. , One hypothesis offered to explain the decline in adolescent sexual behavior is the relationship with the release of the iPhone in 2007 and the swift uptick in youth having access to their own smartphones. With the ability to connect via their device, in-person gathering, connection, and therefore sexual behaviors may have declined. Easy access to online pornography is also facilitated by smartphone use, and sexual gratification via pornography may have partially displaced interpersonal sexual behaviors.
For the purposes of this review, social media is defined as applications (“apps”) or Web sites that facilitate communication between users (eg, through sharing messages, pictures, and videos). We use a broad definition that includes dating apps designed to connect individuals directly in addition to those who use an open platform. Social media use is very common among adolescents. The landscape of social media changes frequently as platforms rise and fall in popularity. In a 2022 study by the Pew Research Center, YouTube was the most commonly used platform with one large survey identifying that 95% of adolescents use YouTube, followed by TikTok (67%), Instagram (62%), and Snapchat (59%). With the ease of accessibility to social media afforded by modern technology, many adolescents intertwine use with daily activities and some check hundreds of times per day. For example, of those who use TikTok, 16% are on the app “almost constantly.” Many social media platforms allow for either public or private user communication. Apps featuring video and image sharing can also facilitate social connection. In one survey, 41% of adolescents use social media to flirt. Dating apps are also used by adolescents. Although many apps require users to be 18 years and older, age verification is lax. One study demonstrated that 19% of youth use dating apps while underage. Dating apps can provide gender-specific and sexuality-specific spaces for connection, including geosocial networking apps, which allow users to share their locations in real time. SGM adolescents assigned male at birth frequently use dating apps. One study found that 60% of SGM adolescents who used geosocial networking apps had met someone from these apps in person. Our discussion of why SGM youth use these apps, their potential risks, and how clinicians can speak with adolescents and families to address them can be found elsewhere.
Developmental tasks of adolescence
Identity Exploration, Formation, and Expression
What is sexuality? What is gender? What can I be? Who am I?
Gender and sexual education in the United States is extremely variable among states, school districts, and families. As youth explore social media, they frequently encounter sexualized content. Youth often seek information about sex online, potentially building off sexual education received in schools or by families. Increasingly, social media has become a tool for sexual education. SGM youth are often left out of cisgender heteronormative sex education conversations that occur in families or in health classes in school. This group of youth may be more likely to go online to seek health information and information about SGM identities and relationships. Mainstream acceptance of SGM people in media and in certain social media circles has made identity labels and identifiers more accessible to many adolescents.
Pornography (sexually explicit images or videos of people, with or without sexual behavior) is another common means of sexual exploration. The average age of first exposure to pornography in the United States is age 12. Adolescent encounters with pornography are common and varied. Reasons for pornography consumption among young people include in boredom, sexual gratification, to intensify masturbation, as means of exploring one’s sexual self, and to learn about the mechanics of sex. Concerns that adolescent use of pornography may cause some degree of harm—including unrealistic sexual values and beliefs, reinforcement of highly gendered roles and sexual scripts, normalization of violent or coercive behaviors, and earlier experimentation—require further study.
As sexual identity begins to form and solidify, sexual minority youth may choose to share their identity with others, commonly known as “coming out.” Social media and online connections can serve as an important first venue for such identity expression. Online communities offer several advantages, including various degrees of anonymity and dedicated SGM communities. Relationships facilitated by social media can represent lower stakes settings for identity expression, particularly for adolescents who are not ready to share their identity with offline friends or family. Adolescents often feel more comfortable managing personal identity contextually (eg, practicing coming out in online spaces before doing so in real life).
Recent lay media have used the term “rapid-onset gender dysphoria” to refer to supposed maladaptive transgender identity development resulting from social media use. This is not a validated mental health diagnosis, and the American Psychological Association has recommended against its use in diagnostic and clinical contexts. Several lines of research provide evidence inconsistent with this construct. , , Social reactions to gender identity—both peer and parent—are strong predictors of mental health outcomes for transgender and gender diverse youth, and clinicians should routinely assess a young person’s social context as it relates to gender identity and sexual orientation. Clinicians and parents should ensure that adolescents are accessing information about gender identity from reputable resources and also screen for online and offline gender identity-related bullying victimization, which is sadly common among transgender youth. Clinicians should also be aware of the broad range of gender identities and expressions among transgender youth and that not all transgender youth experience physical gender dysphoria or desire gender-affirming medical interventions. Those who do express a desire to better understand their gender identity or gender-affirming medical interventions should be connected with a therapist who specializes in these areas, as current guidelines require a comprehensive biopsychosocial mental health evaluation prior to accessing gender-affirming medical interventions for adolescents.
Intimacy and Sexuality Exploration
Who can be a partner to me? What does intimacy look like? What does the expression of sexuality look like?
Relationships form on the basis of varying amounts of information shared, from anonymous chats to biographic profiles. As different platforms serve different purposes (text chat only, photo and video sharing, dating apps), requirements to self-identify and self-verify vary. Certain social media sites cater to specific goals of the user. For example, dating apps can provide more direct routes to intimacy than those focused on picture or information sharing. Dating platforms connect users one-on-one, in part by prompting users to identify what they are looking for casual sex, relationships, or even specific sexual acts.
Adolescents exploring intimacy and sexuality often use social media to flirt or send sexually explicit messages before attempting such communication in person. Such online exchanges, the first points of intimacy for many, may include messages describing sexual or romantic intentions, explicit sexual language, or shared photos or videos. The varying layers of anonymity offered by these apps encourage many adolescents to express vulnerability in a way they might avoid in person. Conversely, the possibility of those communications being shared by the receiver without the consent of the sender may inhibit others. Sexting has become a relatively normative experience among adolescents and will be explored in further detail in Englander and Weigle’s study of this issue.
As social media can connect individuals across geographic boundaries, adolescents are able to form relationships across long distances. Free from the limitations inherent in relationships made at in-person venues (eg, school and neighborhood), adolescents can do so more selectively based on common interests, extended social networks, and specific romantic desires. This ability empowers adolescents to expand or diversify their social networks, particularly for those lacking social support in their immediate community.
Autonomy and Risk Taking
What does it mean to explore my desires? What are the consequences of sex? What is consent?
It is developmentally normative for adolescents to be curious about sexuality and explore intimacy and romance. Traditionally considered “adult” behavior, sexual exploration can be an exercise of autonomy. Familial and cultural expectations inform varying levels of stigma and perceived risk associated with sexual behaviors. Exploring adolescent autonomy often comes with risk-taking behaviors.
While social media platforms provide adolescents with more potential avenues for sexual and gender identity exploration, they are not without risk. Many of these platforms are designed for adults and fail to accommodate the unique developmental needs of youth. For example, researchers have identified alarmingly high rates of adolescent use of geosocial networking dating applications designed for adults. There are inherent privacy and safety concerns for youth sharing their locations on these apps. Rates of sexual intercourse between people met via these platforms, including unprotected sex, are high. Resulting relations between adults and minors may be inherently inappropriate or abusive.
In adolescence, bodily autonomy and understanding of consent can be impartially formed. Depending on cultural socialization, understanding of personal boundaries may or may not have been established by sexual education or by adult role models.
Clinicians and parents should advise adolescents regarding their bodily autonomy, their ability to consent for sex, and ways to maintain safety online. We have written advice on this elsewhere, specifically to reduce adolescent shame regarding online sexual behavior and encourage disclosure of potentially risky behaviors, to provide adolescents with developmentally appropriate spaces to explore gender and sexuality, and to counsel adolescents on relevant legal and social factors.
Physical health risks
Incomplete sexual education often focuses on only highlighting the physical health risks of sexual activity in adolescents. As previously described, there are several developmental tasks associated with sexual exploration that are normative for adolescents. However, some sexual behaviors carry risks (eg, acquisition of sexually transmitted infection (STIs), unintended pregnancy, and intimate partner violence).
Research sheds light on the link between online behavior and offline sexual risk. One study found that adolescents who send more text messages are more likely to engage in risky sexual behaviors including condomless sex, sex without contraception, concomitant alcohol, and drug use. This study identified correlation between online communication and offline sexual risk, but not causality between the two. Another study found that a minority of surveyed adolescents endorsed risky online sexual behavior (eg, searching for someone on the Internet with whom to talk about sex or have sex, sending photos/videos in which they were partly naked to someone they only knew online). Teens who engaged in risky online behavior were more likely to have had sexual intercourse with someone they had just met with or without protection. Predictive factors for risky behavior in this cohort included low educational level and high levels of sensation-seeking. High-risk, and inherently abusive, situations can occur when adults have online relationships with youth. These interactions can lead to grooming, sex trafficking, and sexual coercion. It is essential to identify these relationships, establish safety plans, consider restricting Internet access, or even involving police or child protective services.
Most adolescents appear to be aware of the risks associated with such behavior. One study found that sexual minority male adolescents perceived risks to meeting partners from online venues including physical harm and deception. Participants used various strategies to mitigate these risks: telling friends about plans to meet up with a partner, choosing a public meeting spot, and staying sober. This literature suggests that counseling adolescents on risk-mitigation tactics may improve safety. It reinforces the need for developmentally appropriate safe spaces for SGM adolescents to meet others like themselves. Initiating non-shaming family conversations around gender and sexuality can be particularly helpful for SGM youth (eg, acceptance therapy).
Mental health risks
Social media has been linked, in pop culture and in research literature, to detrimental mental health effects in certain situations and populations. A frequently cited source of mental distress is the curation of a social media image that imparts unrealistic standards. A young person’s belief about the physical attributes and the lives of their peers are distorted from a myriad of technologic features, including filters and digital retouching of highly selected photo or video posts, posts selected to portray an idealized representation of self, and images that celebrate an “ideal” body image. Youth may perceive enormous pressure to post content that generates positive reactions from peers and may compulsively check social media for response to these posts or in response to a “fear of missing out,” potentially worsening an experience of social isolation.
A sizable body of recent scientific inquiry investigates the effects of online relationships on mental health. One survey-based study found that adolescents endorsing high social support in online and offline settings had higher self-esteem, suggesting social media use may benefit this population. In contrast, those reporting high online social support, but low offline social support, had lower self esteem. A study of adults found swipe-based dating app use to be associated with higher scores for distress, anxiety, and depression. Participants with more extensive dating app use experienced greater distress and depression. Paradoxically, participants believed that these dating apps improved their self-esteem. Youth may struggle to accurately assessing impact of their own social media use. A Pew Research Center report found that most teens deny having good or bad experiences with social media themselves, but 32% believe other teens have mostly negative experiences.
Interpersonal conflict between adolescents and online partners can impact mental health. Such conflict can include verbal abuse and manipulation. One study found digital dating abuse to be common among teens, especially girls. The most frequently experienced abusive behaviors included digital monitoring and control (54%), direct aggression (46%), and sexual coercion (32%). These findings offer ample reason to screen for abusive online relationships among distressed teens.
Adolescents engaging in romantic or sexual interactions online frequently experience deception. The most serious manifestation is “catfishing,” deliberately misrepresenting some or all of one’s identity to further cultivate a relationship. Few studies have validated the impact of this practice on adolescents. One small study found that 65% of rural MSM had encountered deception on dating apps/social media sites, ranging from misrepresented dating interests, to fake or outdated photos, to entirely fabricated profiles. Providers may share tactics to avoid deception with patients likely to seek romance online, including trying to verify identities, encouraging finding mutual connections with other friends, and video chatting before meeting in person.
Clinical vignette and clinical guidance
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