Sexting Behavior

‘Sexting’ Associated with Risky Sexual Behavior in Girls

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Three of every four U.S. teenagers carry a cell phone, typically to keep in touch with friends and family and emergencies that may arise.[1] In addition, teens use their phones to transmit text messages (texts). In fact, one study estimates that the average teen receives 3000 texts per month.[2] And now that the technology has matured to allow the sending of video along with text, ‘sexting’ (‘sex’ plus ‘texting’)—the sending of graphic sexual images or messages electronically—has become more prevalent among teenagers.

To date, there are little data to quantify just how prevalent this activity has become and how it fits within the domain of teenage dating and sexual behaviors. But according to a study published in the Archives of Pediatrics & Adolescent Medicine, ‘sexting’ is far more widespread than previously estimated and is associated with risky sexual activity among girls.[3]

In this new study, nearly 1000 ethnically diverse students in public high schools in the Houston area completed surveys about sexting and their sexual behaviors. Participants ranged in age from 14 to 19 years and were in either the 10th or 11th grade. Of the participants, 55.9% were female; the race/ethnicity makeup of the analyzed sample was 26.6% black, 30.3% white, and 31.7% Hispanic.

Overall, more than half of the students reported having been asked to send a naked picture of themselves. One-quarter of the students reported doing so although many felt ‘bothered’ about it. The researchers did not define ‘bothered,’ so it’s not clear whether the students meant they were annoyed by the requests or embarrassed by the requests.  While there was no difference between girls and boys who sexted, there was a gender gap among those requesting sexts and those who were asked to send a sext. Boys were significantly more likely to request a sext (46% versus 21%) and girls were more likely to be asked to send them (68.4% versus 42.1%); requests for a sext peaked at ages 16-17.  Teens with parents who had a high school education or less were more likely to request a sext. Girls who sexted were more likely to start dating, have sex (both monogamously and with several partners), and use alcohol or drugs before sex. Among girls who had not sent a sext, 42.0% reported having sex. Among girls who had sent a sext, 77.4% reported having sex, with the same association not observed in boys.

Why do teens sext?

While some kids sext for fun, to flirt, or to feel sexy, peer pressure appears to be the key motivator. According to a 14-year-old girl who responded to a 2009 Pew Internet survey on the subject of sexting.[1]

“When I was about 14-15 years old, I received/sent these types of pictures. Boys usually ask for them or start that type of conversation. My boyfriend or someone I really liked asked for them. And I felt like if I didn’t do it, they wouldn’t continue to talk to me.”

Second, ‘sexting’ is a perfect fit for the natural risk taking and sexual exploration that takes place during the teen years. Unfortunately, wide-spread circulation of sexts among teenagers can also lead to humiliation, abuse, and in some cases—suicide. Law enforcement practices are emerging to deal with sexting and vary significantly between jurisdictions. In Florida, a teen who distributed nude photos of his girlfriend was convicted of sending child pornography and was required to register as a sex offender.

How does this affect you, your teenaged patients, and their parents? Well, social media is now clearly a part of the integrated self of the adolescent patient, according to the study’s authors. Given the prevalence of sexting and this new link to sexual behavior, you might consider screening for sexting behaviors. Questions about sexting could provide insight into whether a teen is likely engaging in other sexual behaviors, and might be more comfortable for teens to answer than questions about sexual risk factors. The authors of the study encourage you to use the issue to start a discussion about safer sex, concluding that it is “essential that pediatricians and adolescent medicine specialists and other healthcare providers become familiar with, routinely ask about, and know how to respond to teen sexting.”

Many parents are conscientious about checking the content of the messaging apps built into their kids’ phones. However, there’s a growing trend among young people using the apps to hide sexting from their parents. You might want to remind parents that an increasing number of teenagers are using mobile apps such as Textfree and TextPlus as alternatives to traditional texting, allowing them to send sexts hidden from the eye of even the most vigilant parent.

Jill Shuman, MS, ELS
Published July 31, 2012



  1. Lenhart A. Teens and Sexting:  How and why minor teens are sending sexually suggestive nude or nearly nude images via text messaging.  Pew Internet & American Life Project; Washington DC; 2009.
  2. Lenhart A, Ling R, Campbell S, Purcell K. Teens and Mobile Phones.  Pew Internet & American Life Project; Washington DC; 2010.
  3. Temple JR, Paul JA, van den Berg P, et al.  Teen sexting and its association with sexual behaviors.  Arch Ped Adolesc Med 2012; July 3, 2012 [online before print].