The Secret Life of Sex Education: A TikTok Content Analysis

 

Juliana Schiano

Communication Design, Elon University

Submitted in partial fulfillment of the requirements in an undergraduate senior capstone course in communications

Abstract

Current legislation and political climates have restricted the traditional flow of sex education to young adults. TikTok is a popular platform used by this population and thus offers an opportunity to explore alternative effective information pathways in regard to sexual health. This study aimed to expand upon previous literature by analyzing who is using TikTok to create content related to sexual health and what content themes are being emphasized. Qualitative content analysis was used to examine the top 25 videos labeled under the hashtag “#sexualhealth.” Results found professionals, such as therapists and those with health-related occupations, to be the primary creator type, with the content theme of opinions, recommendations, advice, or reassurance to be the most prevalent. Findings from this study can be helpful in improving upon the use of TikTok as a sexual health education platform.

Keywords: sex education, TikTok, content analysis, social media, sexual health
Email: jschiano@elon.edu

1. Introduction

Forget what your high school gym teacher told you about sex. Gone are the days of health classes and condoms on bananas; young people are now flocking to TikTok as a platform for consuming sexual health education. As mandatory sex education becomes increasingly less inclusive, accurate, and comprehensive in the American public school system, adolescents are forced to look elsewhere for answers to their “down-there” questions (Bordogna et al., 2023). Following large political advances against sexual health care, coverage, and education, conversations surrounding sexual health have been brought to the forefront of American politics. The repeal of Roe v. Wade and congressional bills preventing the mention of LGBTQIA+ topics in public schools (i.e., “Don’t Say Gay”) are just some of many examples of highly publicized sexual health-related content in recent media (Bordogna et al., 2023; Clifford, 2022). As traditional media is replaced by social media, user-based content-driven platforms have become the standard for how adolescents receive information (Schofield Clark & Marchi, 2017). It is possible TikTok has become a modern-day version of sleepover conversations in which adolescents are educating each other. It is also not unlikely that doctors, older individuals, and companies trying to sell products may be tied to the production of sexual health content on TikTok. Who is creating such content must be explored in order to fully understand the impact of this content.

This study examines user-generated content about sexual health and education in the United States on the popular social media platform TikTok. The app is highly prevalent among Generation Z, defined by the Pew Research Center as those born between 1996 and 2010 (Dimock, 2019). Of the active 800 million TikTok users, 41 percent are 16 to 24 years of age (Cervi, 2021). As stricter legislation for school-based sexual health education decreases government-sanctioned information provided to adolescents on sexual health education, this study aims to understand what positive and negative messages exist, if any, in the shift to media-based education. An ever-increasing use of media as an educational platform for sexual wellness makes it pertinent to understand the nature of current media within a platform heavily trafficked by adolescents (Flowers-Coulson et al., 2000).

Analysis of TikTok content in regard to creator demographics, factual information, the prevalence of product placement, and possible political advocacy connections with groups such as Planned Parenthood is imperative in assessing the state of sexual health education within the United States. Without proper information on sexual health and wellness, adolescents will lack the factual information needed to make informed decisions about their own health.

II. Literature Review

This article will review previous literature on a variety of topics, including sexual health education within public schools, the usage and effectiveness of media as a tool for sex education, and medically accepted, evidence-based sexual health education practices.

Medical Recommendations vs. Current Implementations

Sex has always been a topic that garners attention, but in recent years the subject of how young people learn about the “birds and the bees” has become a major area of contention within American political debate (Bordogna et al., 2023; Clifford, 2022; Lindberg & Kantor, 2022). The United States’s policy, especially in traditionally conservative states, has begun to skew largely toward the right of the political spectrum (State Policies on Sex Education in Schools, 2020). As of 2020, only 29 states mandate sex education, with 15 of those states failing to require sex education to be “age-appropriate, medically accurate, culturally responsive, or evidence-based/evidence-informed” (Siecus, 2020).

While numerous studies and publications on the importance of comprehensive and inclusive sex education have been published during the last decade, official policies often limit education on sex, gender, or sexuality in American public schools (Lindberg & Kantor, 2022; The American College of Obstetricians and Gynecologists, 2016). A variety of enacted and proposed state policies outline what is colloquially referred to as “Don’t Say Gay” bills, which prohibit the discussion of LGBTQIA+ identities within schools (Bordogna et al., 2023; Clifford, 2022). Current sex education curriculum recommendations from widely accredited public health organizations, such as The American College of Obstetricians and Gynecologists, vastly differ from such policy, emphasizing the inclusion of comprehensive, inclusive, evidence-based sexual health education (Goldfarb & Lieberman, 2021; The American College of Obstetricians and Gynecologists, 2016).

Organizations cite the importance of Queer-inclusive curricula, research-backed practices, and emphasis on cultural humility, as youth of color and lower socioeconomic statuses are disproportionately affected by issues such as teen pregnancy and sexually transmitted diseases (Boutrin & Williams, 2021; Siecus, 2020; The American College of Obstetricians and Gynecologists, 2016). The lack of consideration for medical recommendations in the implementation of American sexual education policy holds young people, primarily those who identify as LGBTQIA+, a person of color, or of low socioeconomic status, responsible for bearing the weight of negligent policy (Boutrin & Williams, 2021). As adolescents seek information on their own sexual and identity-based wellness, they are forced to look outside of school, often turning toward the internet as a substitute for age-appropriate, inclusive, factually accurate information (Daneback et al., 2012; Schofield Clark & Marchi, 2017).

Influence of Social Media on Adolescents

The influence of media, particularly social media, on adolescents is a widely studied phenomenon. Research on the impacts of social media in regard to eating disorders, brain development, social connections, and more have all come to similar conclusions citing media as having a large influence on adolescents (Jarman et al., 2021; Keles et al., 2020; Rosa et al., 2019; Uchôa et al., 2019). While TikTok remains a relatively unstudied platform due to its recent emergence, it is reasonable to assume that the studied impact of other platforms on young people can be applied to this app. It is important to note that social media offers the unique impact of peer-to-peer influence, which has been noted to be more influential than information provided by those whom adolescents might perceive as dissimilar to them, such as corporations or experts (Wang et al., 2008; Yeo & Chu, 2017). This can be especially true on a platform like TikTok, where the majority of users are young people (Cervi, 2021; Dimock, 2019; Marino et al., 2020).

Sex Education in Media

The use of media as a form of sex education is not a new phenomenon. Countless studies of sexual health-related content in mass media and social media have been published, citing both the positive and negative effects of media as a sexual health education platform (Wang et al., 2008; Yeo & Chu, 2017). Studies of adolescent communications on Facebook have shown that the significance of peer communication and the exchange of advice is incredibly prevalent in online communities. Forums that offered anonymity also provided space to share what might be self-described as “embarrassing” information in the pursuit of peer opinions and validation. Additionally, comments on posts codified as seeking advice were classified as overwhelmingly supportive and appeared largely in the form of direct and indirect advice (Yeo & Chu, 2017). A more dated study found that half of all respondents used the internet for sexual health-based questions and information, citing curiosity and the search for questions regarding sex and the body as motivating factors (Daneback et al., 2012). Research has also explored the role of community-based organizations in using social media to promote public health information. One study found that 42% of organizations used at least one social media platform, with Facebook and Twitter being the most popular at the time. However, most information was uni-directional, and increased audience engagement with content might produce a more significant positive impact (Ramanadhan et al., 2013).

While few studies exist about sex education on TikTok, previous literature has conducted content analyses of TikTok and sexual themes. One study found that themes included anatomy, consent, contraception, sexual health, sexual pleasure and facts, criticism, and satire regarding sex education; in addition, a majority of videos were user-generated content, with only a small amount being produced by public organizations or companies (Fowler, Schoen, & Morain, 2021).

Research Questions

RQ1: Who is producing sex education-related content on TikTok?

RQ2: How do creators use TikTok as a sex education platform?

III. Methods

This study conducted a content analysis of the top 25 videos labeled under the search “#sexualhealth” in April 2023. Videos, regardless of whether they individually included the hashtag “#sexualhealth” or not, were included if they appeared under the search for this hashtag. The hashtag “#sexualhealth” was selected after an initial analysis of “#sexeducation” was found to contain videos mostly irrelevant to the topic of study.

Videos were then coded for engagement statistics, such as the number of views, likes, comments, followers, and shares. The researcher then classified each creator within categories, such as individual, influencer, professional, social organization, or company. Individuals were defined as accounts with less than 5,000 followers, while influencers were classified as individuals with more than 5,000 followers. Professionals were defined as doctors, social workers, sex therapists, nurses, public health officials, service providers, and sex education teachers. Creators that qualified for more than one category were assigned to a single, best-fitting category based on researcher discretion. Companies included media corporations and companies promoting their products and services, among others. Finally, creators could be classified as social organizations, such as government-sponsored health initiatives, and nonprofits involved in advocacy, such as Planned Parenthood.

Videos and captions were then examined for content themes such as sexual performance, facts, anatomy, advice, and personal stories. Videos that contained more than one theme were coded as such. The analysis did not include videos with content unrelated to research interests or those not in English. Microsoft Excel was then used to compile data for later analysis and production of tables.

IV. Findings

Professionals comprised the largest category for creator type. Thirteen of the 25 videos analyzed were created by professionals such as doctors, social workers, sex therapists, nurses, public health officials, service providers, and sex education teachers. Companies filled the second-largest creator category with seven videos. Influencers accounted for the least popular category, with only five videos. Neither individuals nor social organizations were found within the analyzed data.

Table 1 – Creator Types and Content Categories

Safety/
Personal Care		 Pleasure/
Sex Toys/ Performance		 Gender/
Boundaries /Relationships		 Promotional Content Opinion/Advice /Recommendations Facts/Anatomy
Influencer 2 3 2 1 4 2
Professional 4 7 6 2 10 5
Company 5 4 2 3 5 5
Total 11 14 10 6 19 12

The largest content category was in the form of opinions, advice, recommendations, and reassurance, with 19 occurrences (Table 1). Videos under this label contained content that told viewers of things they believed they should know, mistakes, and tips for practice. Unsurprisingly, professionals, the category with the largest percentage of all videos and the most credibility in this sector, accounted for more than half of videos within this category. Both influencers and companies shared relatively similar proportions of videos within this category. Content within this category produced by companies was more likely to also contain promotional content.

Professionals accounted for half the content that discussed topics such as pleasure. Almost every video containing information regarding pleasure from the company creator category also included promotional content. Additionally, companies accounted for the largest proportion of safety/personal care videos. Yet, most of these videos did not contain promotional content.

The category of gender, boundaries, and relationships discussed topics such as gender disparities, sexual assault, and consent was also addressed by professionals, particularly those who identified as health coaches and therapists rather than doctors or medical professionals. Facts and anatomy, which covered topics such as squirting and penis size, were equally produced by both professionals and companies.

V. Discussion

Videos examined in this study existed within six overarching themes: safety and personal care; pleasure, sex toys and performance; gender, boundaries, and relationships; promotional content; opinions, advice, recommendations, and reassurance; and facts and anatomy. These findings for content themes concur with previous research (Fowler, Schoen, Smith, & Morain, 2021). Some scholars have suggested that content might fall within categories related to political opinion. However, no videos mentioned issues like abstinence-only sex education, current political status, or the role of religion in sex education. Additionally, no videos worked to promote any type of political advocacy or movement.

While this study did not analyze the accuracy of statements made in the videos, much of this content was made by professionals. Because of the nature of their occupations, one can infer that the information provided in these videos may be relatively accurate. These findings strongly contrast previous studies, which found that user-generated content was responsible for the majority of content listed under a similar hashtag (Fowler, Schoen, Smith, & Morain, 2021). This might be due to the specificity of the hashtag “#sexualhealth,” but further research is needed to confirm this proposition. Additionally, this study suggests that the number of sexual health-related videos produced by companies may be higher than previously found. Businesses using TikTok can potentially make sexual health education content more easily accessible, but the platform also could help companies foster misinformation in the pursuit of selling a product or service. Including fact-checking technology into the TikTok platform could help alleviate such concerns.

While it was previously assumed that young adults, the primary users of TikTok, would be the largest audience for the consumption of this content, few of the videos mentioned issues specifically related to youth, with some videos specifically targeting individuals in their 20s. The disconnect between the assumed intended audience of videos and actual audience demographics might introduce age-inappropriate content to younger audiences most susceptible to misinformation. The lack of systemic inclusive sex education also reaffirms the need for accurate content production. Thus, disclaimers indicating things such as paid or promotional content or non-professional advice might help users sort out which material is most credible.

Opinions, advice, recommendations, and reassurance totaled 76% of the total videos analyzed. Videos within this category were posted by every creator type. Both the video with the largest number of likes, by “@yoxlyhealth,” and the video produced by the creator with the largest follower base, “@doctor.siya,” included content within this subject category. The video created by “@yoxlyhealth” features a young female in scrubs, answering the user-provided question, shown in video graphics, “I don’t know if I want to pee or squirt during sex💦.” The post from the account “@doctor.siya” shows a middle-aged man in a white lab coat with a stethoscope under text saying, “Things that are BAD for vagina 🤯.” The researcher is intrigued by if and how the creator’s identity as an older male might have impacted the success of a video regarding vaginal and vulvar health. Further research into the impact of identities, i.e., gender, sexuality, and age, might provide interesting insights into how identity impacts public perceptions of sex education content on social media. Additionally, the consistency and popularity of videos within this content category are reflective of TikTok being used as a platform for sexual health education by users, a concept reflective of previous literature.

Professionals can provide a positive outlook on the use of social media as a platform for sex education, but their credentials are not always clear. One creator, “@mysexualhealthcoachtiffany,” works as a respiratory therapist but self-identifies as a sexual health coach, both of which are listed in her bio. The woman primarily appears in videos wearing scrubs and a pager, showing only her face, with hospital equipment in the background. Her qualifications for self-identifying as a sexual health coach are not shared. Since this creator uses healthcare backgrounds in which the general TikTok user would assume are related to sexual health, it may be irresponsible for “@mysxualhealthcoachtiffany,” and similar creators, to not disclose their healthcare expertise within their bios and each video.

The lack of content from social organizations, such as Planned Parenthood, also identifies an opportunity for increased platform usage that can provide accurate educational content. Community-specific organizations can capitalize on the platform’s popularity to promote mezzo-level interventions and campaigns. Political advocacy groups also represent a population that may be able to use videos to show support for the implementation of more inclusive sex-education legislation.

Surprisingly, no videos explored content related to gender or sexual identity, an area of large concern for young adults. Topics such as consent were also rarely mentioned. Large gaps in important content areas must be addressed as these issues are pertinent for young adults. Creators, particularly professionals, which this study found to be the majority creator type, have a responsibility to create inclusive, comprehensive, accurate, and informative content. Finding pathways to promote professionals with current large scopes of reach to mirror such content can offer opportunities for improved usage of TikTok as a platform for sex education.

It is reassuring to find that individuals with backgrounds in health-related professions have primarily produced the content studied in this research. However, it cannot be assumed entirely that non-disclosed paid product promotion or use of the platform for personal marketing do not affect the content produced by these individuals.

VI. Conclusion

This study aimed to understand how the social media platform TikTok is used for sex education. The top 25 videos under the hashtag “#sexualhealth” in April 2023 were analyzed for creator demographics, video engagement, and content themes using content analysis. Professionals comprised the largest group of creators, followed by companies and influencers. The most prominent content category was in the form of opinions, advice, recommendations, and reassurance. This study confirmed previous findings regarding content themes but contrasted previous research in primary creator types. Gaps within usage by social organizations were also found and identified to be an area of potential growth.

This study has a number of limitations that should be kept in mind. The analysis did not include TikTok’s “For You Page,” where content is primarily available to users through the app’s homepage. Videos appearing on a user’s “For You Page” may not be ones with large levels of engagement or from credible sources. Users connecting with mutual followers might also consume peer-produced content. Without a further investigation into how young adults specifically use TikTok in relation to this subject matter, it is impossible to know how factors such as the “For You Page” and content from accounts followed by the users truly affect this platform for sex education.

TikTok remains a popular platform for sex education and content related to sexual health. More research, including in-depth interviews with content creators, is needed to expand upon existing knowledge, which can help to inform opportunities for improved use and policy reform.

Acknowledgements

To Dr. Jane O’Boyle, endless thanks for your help in the research process. Your mentorship is deeply appreciated. To my lovely family, partner, and friends, thank you for all your continued support both in this research and in life. Special thanks to my sister, Angelina, who granted my request to be mentioned by name in her master’s thesis—we are officially even.

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