Young people would rather rely on TikTok than talk to you about sex, but your information is better.
We’ve all seen the social media memes of what gives people the ick.
It’s personal, hilarious and more than a bit confronting if you know you’re guilty of a sin on the current ick list. Whether it’s the dreaded ugly feet, mouth breathing or mummy’s boys, the lists of people’s icks is unending.
For health workers, it seems we have a starring role in one big ick – having to talk to a doctor about sex.
There is compelling evidence to show there is still a lot to learn and a long way to go to break down the stigma and shame that prevents open and frank discussion of reproductive and sexual healthcare between patients and their regular physicians.
In Australia, sexual and reproductive stigma begins early. Schools update their sexual health curricula infrequently, and most restrict themselves to a sex-avoidant, personal responsibility lens, focusing on unplanned pregnancies, STIs and, recently, consent. Sometimes this works, and sometimes the knowledge gaps are bewildering.
In research published last year, I surveyed more than 2600 adolescents about their sexual health needs and 80% said the education they were getting at school fell short of answering all their questions.
And while our education curricula still focus on sex and relationships from a gender-normative, heterosexual lens, youth from all backgrounds continue to have high rates of unanswered questions and misinformation.
Which means that for patients, there are lots of unspoken questions.
This is a tricky space for GPs, who are the trusted port of call and likely have the answers to their patient’s sexual health needs but may never get the chance to help. Young people are clear that engaging with positive, health-focused content through personal interactions is enormously uncomfortable.
If you’re treating youth, you’ll be aware of the extensive time they spend on screens. Social media has become a delivery point for young people to receive sexual content, whether they are searching for it or not. For many young people it’s convenient – they are less likely to talk out loud about their concerns or needs and are much more comfortable receiving information through reels, threads and viral memes.
A Family Planning Australia study in which we interviewed young refugee and migrant women about their experiences with long-acting reversible contraceptives (LARCs) showed that social media stories were a huge influence on decision-making – in this case, a bad influence, leading many of the respondents to fear LARCs due to anecdotal stories. This is a big problem, as LARCs are the most effective and long-lasting forms of contraception and when inserted by trained nurses or doctors should be well tolerated.
In the US, a study of TikTok videos that were labelled as sex ed found those most watched, amassing more than two million views, were about contraception and sexual pleasure. A 2022 study of men’s health information on TikTok and Instagram – which searched terms like testosterone and erectile dysfunction – found that health professionals made up less than one-third of content examined and that an overwhelming amount of content contained misinformation and inaccuracies.
Research with Australian young adults aged 18 to 21 showed that young people separate medical information on risks such as pregnancy or STIs from their lived experience of sexuality and gender. Less reliable sources of information, like Reddit, were used when sexual health issues related to a lived experience need, like diversity in gender – as official websites were perceived as unlikely to cater for people with these backgrounds.
Social media and the internet are full of stories and personal accounts, rather than practical information that is likely to improve health outcomes. An Australian study from 2023 examined what people might find when they google LARCs. They found that most webpages had accurate information about benefits and risks, but it was harder to find information about how LARCs work, where to get one, how much it costs and the side-effects. The most practical and encouraging information is the hardest to find.
Sexual health stigma is also present across the lifespan, carried by young people into their adulthood. A national study of sex and relationships of Australians aged 60+ found a strong influence of stigma on trust in sex, communication about STIs, and lack of knowledge.
Sometimes patients arrive at practices already set on what the outcome or diagnosis should be. Often this is the result of “doom scrolling” or “Dr Google”, although few patients will acknowledge these sources.
If you think a patient has been searching for information online and this has led to their current visit or request, a great way to open conversations with a patient might be to first acknowledge their issue with empathy (“that sounds challenging”) and then screen for how they came to this conclusion with an open-ended approach (“tell me more about why you think this”) and finally share your expert advice (“there are a lot of options, a few I would recommend and some others you might like to consider, let me outline them for you …”).
This starts a discussion about sexual health knowledge, attitudes, experiences and needs. Being open to learning from their experiences and acknowledging the way they have acquired knowledge and concerns, regardless of inaccuracies, will foster a mutual understanding and respect.
Acknowledging the role of social and digital media in sexual health information and education can be challenging for health professionals, given prevalence of misinformation and scarcity of scientific evidence. However, dismissing social media and other online platforms may erode trust between patients and the people they need to turn to for help.
Creating a welcoming space for sexual health can even be as simple as listing these services on your practice website with brief descriptions of care that is available. We know that people with less understanding of sexual health are unsure what aspects require a specialist and what can be done by their GP. It also relieves any concerns about whether approaching their regular doctor with these concerns is appropriate or “normal”.
A doctor who is doing really great things in women’s health on social media is Dr Jen Gunter. Author of The Vagina Bible and blog the Vagenda, she has a presence across most social and mainstream media platforms and is winning at getting quality information to people through these very modern platforms. Intrigued? Well, she is speaking in Sydney later this year for the Festival of Dangerous Ideas.
Sexual health services like Family Planning Australia work in partnership with our GP peers – the intention is not to replace that close patient relationship but to educate and equip GPs with important resources and clinical education. For patients we offer a more anonymous and specialised space and services like abortion and LARCs, which not everyone can access near home.
But we too have patients who are more comfortable scrolling for a diagnosis than visiting a clinic. Despite all the faults of social media and web resources, all of us in healthcare need to acknowledge they are an important part of community information seeking, have open minds when patients reference these sources, harness some digital power, and drive out the “ick” from sexual healthcare.
Dr Emmalee Ford is a senior research and evaluation officer at The Family Planning Australia Research Centre, and a 2024 winner in the ABC Top 5 program for science.
