Associations Between Sexting and Sexual Behaviours in Adolescents: A Systematic Review and Meta-Analysis

Adolescent sexting has been associated with a range of sexual behaviours, yet prior reviews have primarily focused on its relationship with sexual intercourse or sexual risks. This review examined associations of adolescent sexting and specific sexual behaviours.

PubMed, PsycInfo, Web of Science, CMMC, and MEDLINE were searched in December 2023, February 2024, and September 2025 yielding 5310 references. Eligible studies examined associations between sexting and sexual behaviours among adolescents (10-19 years), published in English. Two reviewers independently screened and extracted data per PRISMA guidelines. Quality was assessed using the JBI Critical Appraisal Checklist. Meta-analyses used a random-effects model, with heterogeneity assessed via I² statistics.

Seventeen studies from the EU, Australia and USA, comprising 54,373 adolescents were included in this review; nine contributed to the meta-analysis. Most studies framed sexting as a risk behaviour, fewer adopted normative or dual perspectives. Sexting was associated with multiple sexual behaviours, particularly among older adolescents, LGBTQ+ teenagers, and those in romantic relationships. Meta-analysis found sexting was significantly associated with sexual intercourse (OR = 5.69), oral sex (OR = 12.50), vaginal intercourse (OR = 9.50), anal intercourse (OR = 12.30), and multiple sexual partners (OR = 2.10). Subgroup analysis found specific measures of vaginal intercourse yielded more consistent estimates than unspecified sexual intercourse.

These associations highlight the need for multisystem interventions that address both the risks of adolescent sexting and its role in adolescent sexual development in the digital era. Effective responses to sexting should integrate both its risks and its role in adolescent development into policy, education, and health strategies.