(1) "Am I normal? Am I dying? Am I okay?”: A qualitative study examining the attitudes and practices of adolescents and young adults regarding vulvovaginal health

Background: Vaginal self-care and vulvovaginal health trends are topics frequently viewed by adolescent and young adults (AYA) on social media. Understanding AYA perspectives on vulvovaginal health and the degree to which social media may influence their beliefs and behaviors is critical to minimize misinformation and adverse outcomes. This study explored AYA understanding, attitudes, knowledge, and practices regarding vulvovaginal health, hygiene, and care, with particular attention to the positive and negative influences of social media.

Methods: Patients aged 15-25 years and assigned female at birth were recruited from an urban AYA primary care and subspecialty practice. Semi-structured interviews were conducted to assess current attitudes and practices regarding vulvovaginal health and social media use. Interviews were recorded, transcribed verbatim, and thematic analysis was used to identify emergent themes with Dedoose software. Enrollment continued until thematic saturation was reached.

Results: We recruited n=24 participants (mean age 18y). We identified four major themes. (1) Most participants believed that vulvovaginal health is important to their overall health and is often overlooked. (2) The most common self-care practice reported was daily washing with water or gentle soap and shaving. A small number used products specifically marketed towards vaginal health such as vaginal washes and wipes, or tried treatments such as “vajaycials”. (3) All participants had experienced viewing advertisements or watching short form video content on social media centered on a vulvovaginal product or practice. AYA had a distrust of health and wellness information presented to them on social media (especially regarding vulvovaginal health). Rather than relying on this information, most participants reported that they based their practices and beliefs on recommendations from older female relatives (mother or sibling) and/or their healthcare provider. (4) There was a range of attitudes, both positive (i.e. safe community to explore concerns) and negative (ie feeling ashamed about their bodies), among participants regarding vulvovaginal products and practices on social media. Recommendations emerged, such as more comprehensive sex and health ed in schools.

Conclusions: While social media is a common source of vulvovaginal health information, AYA report skepticism on the products and practices viewed, while appreciating raised awareness of vaginal health on these platforms. Health care providers should be aware of this and provide evidence based education and anticipatory guidance to AYA.