Links between adolescent sexuality and mental health
There is often limited survey space for questions on sexuality, and it can be difficult to know which aspects to focus on. This section highlights recent key studies on areas of adolescent sexuality linked with mental health, to help guide researchers in making these decisions. It is not intended to be exhaustive or to replace a formal literature review.
In considering the links between sexuality and mental health, researchers should be aware that other factors may mediate or confound the relationship. These factors include gender, disability, ethnicity, religion, socio-economic status, and family background.
The studies included here are primarily from UK, Europe and North America. For a global perspective on sexual behaviour (although now somewhat dated) see Wellings et al. (2006) and Doyle et al. (2012).
Asexuality
- Asexuality (experiencing no sexual attraction) is an emerging area of research. Less than 1% of adults in the 2021 Census (England and Wales) reported being asexual (ONS, 2021) Prevalence among adolescents is unclear.
- A recent US-based study suggested that, - compared with other sexual minority youth - asexual youth had higher internalised LGBTQ-phobia and poorer mental health (e.g., depression). However they reported less interpersonal discrimination/prejudice and less risk behaviours (e.g., substance use) (McInroy et al., 2022).
- A recent meta-analysis (of all age-groups, not just adolescents) found elevated risk of depressive symptoms but no additional risk of self-harm or suicide attempts compared with heterosexual individuals. It found similar risk of depression and lower risk of self-harm and suicide attempts compared with LGB groups (Yin Zu 2023)
Sexual repertoires
- Young people’s sexual repertoires are increasingly diverse, including oral and anal sex (e.g. UK - Lewis et al., 2017) and Sub-Saharan Africa - Morhason-Bello et al. 2019).
- A global meta-analysis found that 22% of sexually active young people report ever having had anal sex and 3-24% of reported sex acts involve anal intercourse. Patterns vary substantially by geographical region (Owen et al., 2015).
- There is stigma associated with anal sex, including from health professionals. This can adversely affect mental health as well as help-seeking. This editorial and response in the British Medical Journal reflects the debate.
Body image and genitals
- A longitudinal study of Norwegian adolescents found that baseline body satisfaction in both men and women predicted levels of sexual satisfaction as a young adult, regardless of relationship status and frequency of sexual activity (Kvalem et al., 2019).
- A US based study found correlations between sexual body-esteem, self-esteem and happiness among young women (Horne & Zimmer-Gembeck, 2005).
Contraception
- Uptake of contraception amongst 16-24 year olds is in decline (NHS Digital, 2024) and this may be partly due to inaccurate or negative information on social media (Pfender & Devlin, 2023), especially in relation to hormonal contraception such as IUD (Allen, 2025).
- A recent review found a link between oral contraceptive use and depressive symptoms in adolescents (but not other age groups) (Kraft et al., 2024). Another review noted that the risk of depression, antidepressants, or psychotropic drug use from hormonal drug use decreases with age (from adolescence to adulthood) (Jahanfar et al., 2024).
- Another recent review suggested that the inconsistent evidence on hormonal contraceptive use and depression in adolescents may be due to sampling bias (specifically the practice of combing never and former users). The authors argue that once this bias is removed, the evidence of a link is more consistent (Chen, 2025).
Early and first sex
- Globally, most people have first sex between 15 and 19 (Wellings et al., 2006).
- There is some evidence to suggest that early sexual intercourse is associated with depressive symptoms among women but not men (Vasilenko et al., 2016). This may be due to greater social censure on young women’s sexual expression.
- A social network study in USA found that female adolescents who reported having sex experienced a decrease in peer acceptance over time, whereas male adolescents reporting the same behavior experienced an increase (Kreager et al., 2016).
- Feelings about the timing of first sex, and the context (including willingness) may be more important than age in influencing health outcomes (Palmer, 2016; Rouche, 2019)
Masturbation
- Masturbation is common in adolescence but remains stigmatised and is not commonly researched.
- A US national study of adolescents aged 14-17 found that 74% of males and 48% of females report having masturbated at least once, with rates increasing with age (Robbins et al., 2011).
- Masturbation can be positive for sexual health and wellbeing (Coleman, 2008). There is no reliable evidence that masturbation itself has a detrimental effect on mental health, but adolescents may struggle with contradictory feelings related to pleasure and taboo ( Kaestle, 2011) internalised stigma and shame about the behaviour may impact mental health.
Pornography use
- Access to pornography has changed at such a rapid rate that research in this area becomes quickly outdated. It is a controversial topic and many studies have methodological and theoretical shortcomings which it make it difficult to be confident about findings.
- A review of 20 years of research on adolescence and pornography (Peter & Valkenburg, 2016) found that prevalence of porn use varied greatly. More frequent porn use was associated with being male and at more advanced pubertal stage.
- A recent Swedish study compared pornography use in adolescents between 2004 and 2021, finding a decline in ‘ever use’, from 98% to 90% for boys, and from 76.5% to 59.3% for girls) but a surge in daily or weekly pornography use, from 40% in 2004 to 76% in 2020–21 among boys, and from 2% to 19% in girls. They also found evidence of desensitisation to porn over time ( Donevan, 2024 ).
- A longitudinal study of Croatian adolescents found no significant correspondence between porn use and wellbeing over time, but did suggest possible adverse effects for younger female adolescents (Štulhofer et al., 2019).
- A Swedish study of senior school students found no consistent relationships between ever watching porn or frequency of porn use and mental health, and suggests other factors may be more important predictors of mental health (Svedin et al., 2022).
- A qualitative evidence synthesis (30 studies) found that pornography use is considered normal and a tool for pleasure, information and instruction, but young people find misogynistic, racist, homo/trans phobic, and violent content distressing (Peterson 2022)
- A recent general review (not focused on adolescents) found that an inconsistent relationship between problematic porn use and mental health, and suggested that the relationship may be mediated by factors such as loneliness, anxiety, and self-esteem (Vieira, 2024).
- When appraising research in this area, check that studies differentiate between types of porn, distinguish porn use from problematic use, and control for confounders. The mental health effects of porn use will depend on the type of porn, extent of use and internalised stigma related to using porn.
Risky sexual behaviour
- Adolescent risk behaviours have declined in high income countries, including risky sexual behaviour (Ball et al., 2023).
- There is evidence of association between risky sexual behaviour and depression in low/middle income countries (Pozuelo, 2021) and high income countries (Bahnsen, 2023).
- The relationship between sexual risk behaviour and poor mental health is likely bi-directional.
- It is unclear whether risky sexual behaviour in adolescence has long term consequences for mental health.
Rough sex and choking
- Rough sex, including strangulation, appears to be an emerging trend in young people’s sexual behaviour, and may be initiated in adolescence. Research is still limited and still primarily based on college students in USA (Herbenick et al., 2021; Herbenick et al., 2022).
- There is little research in UK, apart from a report (Smailes & McGowan, 2024) by the Institute for Addressing Strangulation, and a study commissioned by the BBC (BBC article 2019).
- Strangulation is primarily done by men to women, and is associated with poor mental health (Herbenick et al., 2021) and a history of intimate partner violence (Herbenick, 2025).
- Emerging research suggests notable variation in consent and safety practices and underestimation of the risks involved (Conte, 2025).
- While some young people say they enjoy choking, others feel pressured or do it to please a partner (Herbenick, 2022).
Sexual function problems, satisfaction and anxiety about sex
- Sexual function refers to an individual’s ability to respond sexually or experience pleasure. Sexual dysfunction problems (sexual difficulties) include anxiety about sex, painful sex, and lack of interest in sex, as well as difficulties with arousal and orgasm.
- Distressing sexual problems affect 1 in 10 young people (aged 16-21) in UK and affect slightly more young women than young men. Among women but not men, some problems decline with increasing experience (possibly a ‘practice effect’) (Mitchell et al., 2019).
- A study in Australia found that sexual difficulties were common in young people attending a youth mental health service (McMillan, 2017); clinical sexual dysfunction was present in just under 40% of the sample.
- Sexual problems in adolescents are associated with depression (Deumic, 2016), but the evidence on anxiety is less consistent. The relationship between depression and sexual problems is bidirectional.
- Poor mental health and depression are predictive of premature ejaculation and erectile difficulties in young men (Akre, 2014).
- SSRI’s to treat depression are known to have sexual side effects in adolescence (Levine & McGlinchey, 2015). This is a concern given the increase in prescribing of anti-depression medication to this age group. To date, there is limited research on this topic.
- Higher levels of sexual satisfaction are associated with lower levels of anxiety for adolescents and lower levels of depression for young adults in Spain (Carcedo et al., 2020).
Sexual and gender minorities
- There is strong evidence that adolescents expressing minoritised sexual and gender identities are at higher risk of poor mental health, including elevated rates of depression (Amos et al., 2020), suicide attempts (Di Giacomo et al., 2018) and non-suicidal self-injury (Liu et al., 2019).
- These health disparities are explained by the effects of ‘minority stress’, which includes discrimination and victimisation, occurring alongside proximate stressors such as concealment (of identity), expectations of rejection by others and internalised homophobia or transphobia (Meyer, 2003; Goldbach & Gibbs, 2017). Sexual and gender minoritised youth may also experience lower levels of social safety (reliable social connection, inclusion and protection) (Diamond & Alley, 2022).
- Heterosexism and cisgenderism are embedded in existing power structures and LGBTQ+ adolescents may not be consciously aware of their disadvantaged position within this system (Diamond & Alley, 2022). Also, heterosexual and cisgendered adolescents may not be consciously aware of their privileged position.
Sexual experiences and mental health
- Research suggests that positive experiences of sex and relationships correlate with better overall self-reported physical and psychological health for emerging adults (Anderson 2013).
- There is much less research on adolescents and findings are mixed, but there is evidence of an association between good sexual health and self-esteem and lower self-reported depression (Hensel et al., 2016).
- Evidence from longitudinal and behavioural genetic studies does not indicate any negative psychological impact of sexual intercourse in adolescence. The context of sex is key; sex that occurs within a healthy relationship is associated with fewer depressive symptoms (Harden & Mendle, 2010; Harden, 2014).
Sexual violence and gendered harassment
- Sexual harassment is common in adolescence (Girl Guiding Association, 2017), and often takes place at school (Sweeting et al., 2022).
- Childhood sexual abuse is also common and impacts adolescence. A large study in USA estimated a prevalence of 1 in 10 (three-quarters women) and showed were associated with significantly higher risk of poor mental health (Pérez-Fuentes, 2013).
- There is strong evidence that sexual violence in adolescence leads to adverse mental health outcomes (Bentivegna & Patalay, 2022).
- A longitudinal study of middle school students in the USA found that increases in perpetration and victimisation of sexual harassment and homophobic name-calling predicted increases in symptoms of depression (Rinehart et al., 2020).
- Adolescent victims of sexual violence remain at high risk of mental ill health at 15 months post assault (Clarke et al., 2021).
Social media, image sharing, online
- Sharing of sexual images and messages on social media is an emergent trend in adolescent sexual behaviour.
- ‘Sexting’ has wide-ranging outcomes for young people. A recent review (Doyle et al., 2021) identified four types of outcome: psychological (victimisation, sexual abuse/victimisation, mental health and quality of life, and emotional outcomes), behavioural (risk behaviour, sexual activity, and perpetration of sexual abuse/harassment), relational (personal connections with others and reputational outcomes), and systems-level outcomes (public exposure of private content beyond intended recipients). They found a continuum of outcomes for adolescents ranging from beneficial to harmful, but harmful outcomes were more prevalent than beneficial.
- A recent systematic review found an association between non-consensual image-sharing, mental health (depression, anxiety, and suicidal ideation) and adverse social consequences (harassment and victim-blaming) which compounded distress (Schmidt et al., 2023).
STIs and mental health
- Rates of sexually transmitted infections (STIs) are rising across all age groups, with young people aged 15 to 24 most likely to be diagnosed with an STI (AHPH, 2023).
- The relationship between STI diagnosis and depression/anxiety is bidirectional: depressive symptoms increase the risk of an STI diagnosis, and an STI diagnosis increases the risk of developing depression and anxiety (Khan, 2009; Shrier, 2002).
- The stigma and shame surrounding STI diagnosis is associated with increased risk of depression and anxiety (Singh & Singh, 2021; Harmanci et al., 2023).
- Recurrent urogenital infections (e.g., UTIs and thrush) are associated with lower mental health and increased risk of anxiety and depression (Thomas-White et al., 2023; Grigoryan et al., 2022).
Unplanned pregnancy
- Pregnant and parenting adolescents are at greater risk for experiencing depressive symptoms than adult women (Siegel & Brandon, 2014).
- A recent meta-analysis of international studies on the post-partum period found an association between being an adolescent mother and depression, but no relationship with anxiety or suicidal ideation (Rahim, 2023).
- The pervasive stigma attached to adolescent pregnancy worsens mental health outcomes for adolescent mothers (Yardley, 2008).
