Education, Implications, Sex, Technology

Sexting: New Technology but an Old Problem (Medscape Today)

Mary E. Muscari, PhD, CPNP, APRN-BC, CFNS

Published: 05/01/2009

Sexting: New Technology but an Old Problem

Eighteen-year-old Jessie Logan sent a nude photo of herself to a boy she was dating. She later learned that the photo circulated among students at area high schools, and she was taunted as a “whore.” She hanged herself on July 3, 2008.[1]

An 18-year-old youth in Florida was arrested and convicted on felony child pornography charges when, following an argument, he sent naked photos of his ex-girlfriend to dozens of her family and friends. He was sentenced to 5 years’ probation and required to register as a sex offender.[2]

In Greensburg, Pennsylvania, 3 teenage girls were charged with disseminating child pornography for sending nude/seminude photos to their boyfriends, and the boys were charged with possession. Similar charges have been reported in Alabama, Connecticut, Florida, New Jersey, New York, Texas, Utah, and Wisconsin.[3]

Cell phones continue to pose dangers to adolescents’ health. First, it was “DWT — driving while texting,” but now it is “sexting.” Sexting is the sending of sexually charged messages or images via cell phone, and it has become headline news because of incidents similar to those mentioned above. Young lives lost to suicide or damaged by the collateral consequences of felony convictions make sexting a public health issue.

Epidemic, Phase, or a Sign of the Times?

Sexting may be new, but the teenage sex drive is not, especially in an era when the sexualization of juveniles is prominent in everything from children’s clothing to kids’ meal commercials. Sharna Olfman summarizes this barrage beautifully in the first paragraph of her book, The Sexualization of Children:

…the lines that separate the lifestyles of even very young children from adults are blurring. In today’s world, children dress like miniature adults, and creative outdoor play is being replaced by media entertainment that is saturated with sex, violence, and gender stereotyping. Internet pornography is easy and routinely accessed by preteen boys, and pornographic depictions of women and girls have been glamorized, mainstreamed, and marketed to children through dolls, clothing lines, video games, comic books, music, magazines, television and movies.[4]

If what was once soft porn is now the norm, it is no wonder teens are not hesitating to expose their bodies for the camera.

Today’s teens can also trace their sex-drive roots back to their grandparents’ days of Woodstock, free love, and streaking. Teens have a history of using whatever technology is at hand to express themselves and share their behavior with the world. Instant cameras, video cameras, and even copy machines paved the way for Webcams, social networking sites, and now cell phones. However, the wonder of hormonally charged technocommunications is not without cost. Laws have changed. Streaking may have been just a nuisance in its heyday, but it could be deemed a sexual offense today, just as a photo of an underwear-clad teen may now be considered child pornography. While behaviors and attitudes have shifted with time, most underlying moral beliefs have not. The nude image that took just seconds to send can last forever in cyberspace, causing chaos if recognized by family, friends, school administrators, college admission committees, scholarship foundations, or law enforcement.

Given the relative newness of sexting, few data about this phenomenon exist. However, The National Campaign to Prevent Teen and Unplanned Pregnancy and[5] conducted a survey of 653 teens (ages 13-19) and 637 young adults (ages 20-26) to better understand the connection between sex and cyberspace. They found that 20% of teens (22% of girls and 18% of boys) electronically sent or posted online nude or seminude photos or videos of themselves. Eleven percent of young teens (ages 13-16) electronically sent nude/seminude photos. Even more teens (39% overall, 37% of girls, and 40% of boys) sent sexually suggestive text messages, emails, or instant messages: Forty-eight percent of teens stated that they received sexually explicit messages. The numbers were higher in all areas for young adults.

Of the teens with positive results in this survey, 71% of girls and 67% of boys sent or posted suggestive content to a boyfriend/girlfriend, whereas 21% of girls and 39% of boys sent suggestive messages to someone with whom they wanted to date or hook up (typically meaning “have sex” to today’s teen, but can have other meanings). When asked why they send suggestive content, 51% of the teen girls said that it was because of pressure from a guy, whereas only 18% of teen boys blamed pressure from a girl. Sixty-six percent of girls and 60% of boys said that they did it for fun or to be flirtatious; 52% of girls did it as a sexy present for their boyfriends; 44% of teens sent sexy messages in response to receiving similar messages. Thirty-four percent sent or posted suggestive messages to feel sexy. The most disturbing finding was that 15% of teens sent nude/seminude images of themselves to someone they only knew online.

This survey also demonstrates a common issue encountered in adolescent health — teens participating in high-risk behaviors, even though they know that they should not. Seventy-five percent of teens agreed that sending sexually suggestive content can have serious negative consequences, and 36% of girls and 39% of boys said that it is common for nude/seminude photos to be shared with people other than the intended recipient.

High Risk and High Cost

Adolescence is synonymous with risk-taking. Given that 75% of surveyed teens know that sending suggestive content can have serious negative consequences (yet they still do it), risk-taking is not always the result of a generalized knowledge deficit. However, these teens may not understand the specific and long-lasting consequences of their actions. Combined with what Elkind[6] calls the personal fable — the belief that one is unique, special, and invulnerable to the consequences of risky behavior — this is a recipe for disaster.

Anecdotal cases demonstrate some of the extreme consequences of sexting, and although empirical data are lacking, it is not difficult to imagine the problems that may arise from sexting:

  • Guilt: A 1-second click can result in years of guilt, even if the photo reaches only the intended recipient. As soon as the “Send” button is released, senders may regret their actions and wonder what the recipients are thinking about them, and what will happen when they next meet. Sexting guilt can also creep up in the future as that nagging feeling when disciplining one’s own children about their technosexual misadventures.

  • Anxiety: Sexting can fuel the fire of adolescent angst. The teen years are tough enough without having to worry about how many eyes caught a glimpse of one’s naked photos — not to mention whose eyes are viewing them. The “what ifs” can be extremely stressful: “What if we break up and she/he wants to get even?” “What if my mother sees the photos?” “What if the college admissions department finds them and turns me down for admission?” “What if I get arrested?”

  • Shame: If one third of teens know that it is common for sexually explicit photos to be shared with people other than the intended recipient, then two thirds of teens do not think about this possibility. Kids can be very cruel, and the viewing, or even just hearing about, a classmate’s sexting escapades can result in endless tormenting of the teen whose photo has circulated. This may be especially damaging to vulnerable, shy teens who use sexting as a desperate means of gaining attention from boys or girls they like or to fit into the “in” crowd. As illustrated by the case of the 18-year-old suicide victim, the results can be deadly.

  • Victimization: Fifteen percent of the surveyed teens sent the nude/seminude images to someone they only knew online. These teens have no idea whether the recipient is a sexual predator. Predators seek vulnerable prey; most want victims who give the least resistance and who are least likely to report the relationship. The predator has already committed a noncontact offense (or a more serious one) by soliciting the nude images from a minor, and at the very least, the teen’s photo can become an object of the predator’s masturbatory fantasy. Sex offenders may then use the photos for blackmail, threatening to send the photos to parents or friends to convince teens to meet with them for physical sexual contact.

  • Legal problems: Possessing and distributing nude/seminude photos of minors are child pornography crimes in most jurisdictions, and often constitute felonies. A felony is a serious crime that may be punishable by incarceration in a state correctional facility if the teen is convicted as an adult. Incarceration is bad enough, but a felony conviction can haunt a teen for life. State laws vary, but convicted felons may have difficulty finding a job; be denied government clearance for security jobs; be unable to enter some foreign countries; be disqualified from serving as jurors; forfeit their right to vote, be a candidate for or hold public office; be unable to qualify for federal assistance, including loans, grants, and work study; be disallowed to possess firearms; and may be denied licensure in certain professions. The felony conviction could prevent the teen from becoming a foster or adoptive parent in the future, especially after being branded a sex offender. Individuals convicted of child pornography charges typically must register as sex offenders for a term of 10 years, 20 years, or even life. Depending on the state, the offenders’ photos may be posted on the state’s Sex Offender Registry Website for the whole world to see, and they may be assessed to determine whether they meet their state’s criteria to be deemed a sexually violent predator.[7,8]

Speaking of the Law…

District attorneys want to do what is best for their constituents, and they are duty-bound to uphold the law. However, the law does have difficulty catching up with the lightning speed of technology and its often unexpected uses. The sexting problem requires careful scrutiny from a multidisciplinary perspective to ensure that child pornography laws do what they were originally intended to do — keep children safe.

Perhaps the first issue should be differentiating among sexting, cyberbullying, harassment, and sexual offending. Potential examples for differentiating these actions, different from how they are defined at present, might be:

  • A 16-year-old sending a nude photo of herself to her boyfriend is sexting;

  • Mean girls secretly taking and sending photos of a peer undressing in a locker room is cyberbullying;

  • A vindictive 15-year-old sending nude photos of his 15-year-old ex-boyfriend to the class listserv without the boyfriend’s knowledge is harassment; and

  • A 17-year-old downloading and collecting photos of nude 13-year-olds is a sex offender.

The first teen needs a long talk with her parents, forfeiture of her cell phone, and other appropriate consequences. The other teens need to become well acquainted with counselors and law enforcement, but only the last scenario should be considered a sex crime. Key issues that must be addressed are the sex offender label and its ramifications, and participating teens getting the appropriate intervention when their sexting activities become known.

The focus must remain on the safety of our children. Adolescents should not suffer harsh legal consequences for developmental mishaps. However, extreme caution must be used to close legal loopholes that could be used later by sex offenders to mitigate the charges that have been imposed — keeping in mind that juveniles can be sex offenders. Therapeutic strategies usually permit more flexibility than legal strategies. By working together, health and legal professionals can develop solutions that protect children, while providing them with needed therapeutic interventions. After all, mental health and drug courts have continuously demonstrated that success can come from collaboration.

Calling All Public — and Other — Health Professionals

The first step for all healthcare professionals is recognizing sexting as a public health problem that requires multiple approaches: collaboration, research, education, and practice. As noted, healthcare professionals should collaborate with legislators to pass more appropriate laws for teens involved in sexting.

The topic of sexting is nearly nonexistent in the health research literature. A search for “sexting” on ProQuest Central (multiple databases) yielded 268 results, but when the search was refined to include only scholarly journals, the list crashed down to zero. There are many unanswered questions about sexting. Among them are: What is the true prevalence of sexting? What is the prevalence by age group (preteen through older adolescents)? Are there differences in sexting behavior between heterosexual teens and LGBT (lesbian, gay, bisexual, and transgender) teens? Are there racial, ethnic, or religious disparities? What are the characteristics of teens who participate in sexting? How does sexting correlate with sexual behavior? How does sexting compare with other forms of sexual communication?

Education begins at home, and it is not just for the teens. Healthcare professionals must become more comfortable and adept at sexual assessment and intervention not only with teens, but with their parents as well. Although most clinicians have little difficulty discussing the “basics” of pregnancy and sexually transmitted infection prevention, many are not discussing issues, such as nonheterosexual sex and noncoital sexual behavior (including sexting). A study of 416 physicians showed that although most felt comfortable and adequately trained in taking sexual histories, 58% asked about sexual activity at a routine visit, and only 12% to 34% asked about components of the history, such as sexual orientation, types of sexual activities, and number of partners.[9] In a separate study of 508 pediatricians, 87% believed that it was equally or more important to provide sexual risk reduction guidance to parents of adolescents; however, only about 1 in 4 respondents reported routinely offering anticipatory guidance.[10]

As with other health problems, sexting must be managed on all 3 levels of prevention.

Primary Prevention

Encourage schools to address with students the potential consequences of sexting and other electronic forms of sexual communication. Peer education and dramatization may be helpful. Healthcare providers should include questions about sexting on their growing list of assessment questions, and clinicians should provide teens and parents with information designed to discourage this practice. Here is a list of helpful tips for parents and teenagers to prevent/avoid sexting.[11,12]

Tips for teens:

  1. Once you send or post your photos, you can’t change your mind. Things never truly disappear in cyberspace.

  2. The intended recipient may not react the way in which you expect.

  3. If your boyfriend or girlfriend asks you to send a suggestive photo, say, “No.” A person who really cares about you would not ask you to do something that makes you feel uncomfortable. Don’t do it on a dare, either. No one is worth compromising your reputation.

  4. Privacy can quickly vanish when you post or send naked photos. Your photos may be shared with other classmates and posted on various social Internet sites where everyone can see them, including your parents, friends, and teachers as well as police, potential employers, college admissions personnel, and sex offenders.

  5. Think about how classmates will perceive and respond to you or what they will say behind your back. A single photo can severely damage your reputation.

  6. Nothing is really anonymous; your photos can be traced back to you.

  7. You can be arrested, charged, and convicted for possessing and distributing child pornography, even when sending a photo of yourself.

  8. If someone sends you a suggestive photo of himself or herself, don’t forward it — it’s still a crime.

  9. If you are sharing your photos with someone you only know online, you may be sharing them with a sex offender, and that sex offender may use your photos to blackmail you into doing things that you don’t want to do.

Tips for parents:

  1. If you’re not tech savvy, start learning. Get some instructional CDs; take a noncredit college course; or, better yet, have your kid teach you.

  2. Know what your children are doing, including what they do in cyberspace.

  3. Talk with them about relationships and the importance of their reputations, and discuss their online and cell phone activity. Make sure that they understand that their cell and online activities are not truly private or anonymous.

  4. Set rules for the use of electronic devices, including cell phones, and make sure to include consequences for breaking the rules. Set expectations for using language and photos appropriately in technocommunications.

  5. Know who your kids are spending time with online and on the phone.

  6. Monitor and limit their device use. The easiest way to do this is to keep tech toys out of their bedrooms. The computer should be in an area where it can be monitored, and cell phones should be turned in before bedtime to prevent nightly text fests and potential sexting.

  7. Know what your children are posting online. If something is posted for everyone to see, you’re included in the “everyone.” Make sure that they are not posting anything unsafe, including their contact information.

Secondary Prevention

When you encounter a teen who is already sexting, goals should be to halt sexting activity, prevent or minimize psychological trauma, and assist with legal consequences. To prevent future sexting, reinforce the primary prevention strategies. Assess the teen’s psychological state, especially those who are already compromised by psychiatric disorders. Ask whether they are being teased because of the photos, and determine suicidality status. Refer them for counseling when indicated. To assist with legal consequences, encourage the parents to meet with an attorney.

Tertiary Prevention

Sexting teens who have been convicted of child pornography charges and who have been required to register as sex offenders will need considerable support to overcome this stigma and get on with their lives. Many will have to participate in sex offender treatment programs, surrounded by other sex offenders, and some will have to endure having their photos posted on state sex offender registry sites. They will need to be reintegrated into society, find suitable employment, and deal with being treated as an outcast.


Adolescence is difficult enough without being burdened with the legal, social, and psychological consequences of sexting. Public health and primary care professionals must act now to keep kids from making a 1-second mistake that can cause a lifetime of grief.

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