Including “sexual” in sexual and reproductive health labor: Gendered experiences of sexually transmitted infection (STI) prevention, testing, and treatment among young people in Texas

Abstract

Sexually transmitted infections (STIs) in the U.S. have been persistently high for over a decade, and they disproportionately burden young people. Yet limited qualitative research has explored how young people understand, navigate, and experience STIs amid this ongoing epidemic. Drawing on in-depth interviews with 33 young people (ages 15–25) across Texas, this study examines the gendered dynamics of STI prevention, testing, and treatment through a reproductive labor framework. Findings reveal adolescent girls and young women assume the majority of sexual health labor: managing prevention, initiating testing, and coping with the emotional and relational consequences of infection. This unequal distribution of labor appears linked to the greater salience of STIs for adolescent girls and young women, as the sexual double standard renders testing positive more consequential for them than for adolescent boys and young men. At the same time, young men’s limited engagement in STI prevention reflects broader structural neglect: sex education and reproductive health policy in the U.S. have long centered on pregnancy prevention and excluded young men. As a result, young people of all genders are poorly equipped to engage in proactive, communicative approaches to STI prevention. By extending the concept of reproductive labor beyond fertility and contraception to encompass STI-related care, this study highlights how gendered and heteronormative systems of education and policy produce unequal sexual health responsibilities. Comprehensive, inclusive sex education that reframes STI prevention as shared sexual health work can help redistribute this labor and reduce STI burden among young people.

Introduction

Sexually transmitted infections (STIs) remain a persistent public health concern in the United States (U.S.). Although national surveillance suggests recent declines in chlamydia, gonorrhea, and syphilis, these trends are difficult to interpret amid ongoing disruptions in reporting (CDC 2025). Regardless, STI rates remain substantially higher than a decade ago, signaling a sustained epidemic.

While STIs can affect all young people, their burden is unevenly distributed by gender. Between 2013 and 2019, 53% of sexually active girls and young women aged 15-24 reported testing for STIs, compared to just 22% of boys and young men (Pleasure et al. 2022). Women are also diagnosed at higher rates, with girls and young women ages 13–24 experiencing the highest STI rates of any demographic group; nearly double those of male peers (CDC 2025).

Although quantitative research documents disparities in STI testing and diagnosis, less is known about how young people navigate STI prevention, testing, and treatment, and how these experiences may differ by gender. Research on other areas of sexual and reproductive health (SRH), particularly fertility and contraception, finds that cognitive, emotional, and logistical labor of care is highly gendered, with women disproportionately responsible for prevention, risk management, and care coordination (Bowleg, Lucas, and Tschann 2004; Dalessandro, James-Hawkins, and Sennott 2019; Fennell 2011; Kimport 2018; Littlejohn 2021). But it is unclear whether these patterns extend to STIs, a domain affecting all young people but carrying distinct risks and stigma (CDC 2025; Orr et al. 1989; Shrier, Harris, and Beardslee 2002).

Existing qualitative research suggests young people face barriers to STI prevention and often rely on ineffective prevention strategies (Akers et al. 2012; Dalessandro et al. 2019; Griner et al. 2022). Gender norms further shape these experiences, as young women frequently accommodate male partners’ preferences and assume responsibility for safe sexual health (Dalessandro et al. 2019; Oliffe et al. 2013). While informative, these studies focus on specific populations (e.g., Black adolescents and college students), limiting understanding of young people’s experiences with gendered STI labor more broadly. Understanding these dynamics is critical, as gendered patterns of prevention, testing, and disclosure influence who bears responsibility for sexual health and may contribute to persistent inequalities in STI burden.

Through in-depth interviews with young people in Texas – a state with limited access to SRH care for young people – this study examines how young people interpret STI risk, navigate care, and experience diagnoses, and how these experiences vary by gender. Findings highlight how gender norms shape the distribution of STI-related labor among young people and extend the concept of reproductive labor to include STI labor, highlighting an underrecognized domain of SRH care work that has received less attention in the literature.

Background

Although sexual health is part of the SRH agenda, it continues to receive less attention than reproductive health. Historically, U.S. programs have prioritized preventing teen pregnancy, an emphasis reinforced by decades of federally funded abstinence programs that framed pregnancy as the primary risk of sex (Solomon-Fears 2016). This narrow focus has come at the expense of comprehensive education addressing consent, communication, gender inequality, and STIs. Further, teen pregnancy prevention efforts have disproportionately targeted girls and young women, particularly young women of color, reinforcing gendered and racialized stereotypes about responsibility and risk (Barker et al. 2019; Geronimus 2003; Ray 2018). As a result, SRH has been constructed largely as a woman’s domain, excluding young men and placing a disproportionate share of reproductive labor on young women (Bowleg et al. 2004; Brown 2015; Dalessandro et al. 2019; James-Hawkins, Dalessandro, and Sennott 2019; Raine et al. 2010).

Women bearing a disproportionate share of SRH labor is not new. The typical American woman spends approximately three decades of her life trying to avoid pregnancy (Boonstra et al. 2006), representing an often invisible workload that scholars term “fertility work” (Bertotti 2013). Because most contraceptive methods are female-controlled, society tends to view pregnancy prevention as a woman’s responsibility (Brown 2015; Dalessandro et al. 2019; Fennell 2011; James-Hawkins et al. 2019; Kimport 2018; Lowe 2005; Raine et al. 2010; Stevens 2015). Thus, women are expected to bear the logistical (e.g., scheduling visits), financial (e.g., paying for care), physical (e.g., managing side effects), and emotional (e.g., advocating for condom use) burdens of contraception (Bertotti 2013; Bowleg et al. 2004; Dusetzina et al. 2013; Kimport 2018; Littlejohn 2013). These burdens are reinforced by the “sexual double standard” (Endendijk, van Baar, and Deković 2020; Reiss 1964), as women face greater stigma and responsibility for sexual activity and unplanned pregnancy, while men are often socially rewarded for similar behaviors (Conley, Ziegler, and Moors 2013; England and Bearak 2014; Sagebin Bordini and Sperb 2013).

While research has documented gendered inequalities in pregnancy prevention, less attention has focused on gendered SRH labor beyond pregnancy. STIs are a common but less visible outcome of condomless sex, and one that affects all partners regardless of gender. In theory, STI prevention should be a more equitable responsibility; however, some research suggests that it is also gendered. Studies have found that young women often have to initiate conversations about safe sex, navigate partners’ reluctance to use condoms or get tested, and rely on ineffective prevention strategies (Akers et al. 2012; Oliffe et al. 2013). Young women also face stigma and moral judgment surrounding sexual activity, making STI testing both socially risky and socially expected, reinforcing the idea that sexual health is a woman’s responsibility (Dalessandro et al. 2019; Griner et al. 2022). Quantitative data also show that young women are more likely than young men to be tested for chlamydia and gonorrhea, yet less likely to receive comprehensive testing or preventive counseling when diagnosed with an STI (Thompson et al. 2021; Yumori et al. 2021). Despite growing recognition that sexual health work is gendered, we still know little about how young people navigate STI labor. Existing literature is limited and relies on quantitative data or specific populations (e.g., Black adolescents and college students), limiting insight into the lived experiences of diverse adolescents and young adults.

This study addresses these gaps by centering young people’s voices to qualitatively examine how they understand and manage STIs. Drawing on 33 in-depth interviews with young people in Texas, this study extends the concept of gendered reproductive labor to include STI prevention, testing, and treatment. Findings reveal that gendered labor does not end with pregnancy prevention. Instead, it shows how the mental, emotional, and time burdens of STI labor fall disproportionately on girls and young women despite more “equitable” prevention and contraction mechanisms. Findings further highlight that STI stigma is more severe for girls and young women than for boys and young men, indicating the sexual double standard is also salient for STIs. This is an interesting finding given that, unlike pregnancy, STIs also impact men’s physical health. Finally, results uncover that STIs are often not a primary concern for young people, especially boys and young men. Therefore, it may be unreasonable to expect young people to perform labor for an activity not salient to their health. This underscores the need for increased education and awareness on this topic, inclusive of all genders and sexualities.

Methods

Sample construction

Using theoretical sampling, 33 respondents (23 girls/young women, 8 boys/young men, and 2 nonbinary) ages 15-25 were recruited across Texas. As derived from prior research, gender, age, and sexual orientation were expected to influence sexual health behaviors and thus served as primary sampling stratifiers (Strauss 2006). Girls and young women composed the majority of the sample (n=23) due to their higher likelihood of prior STI testing (Pleasure et al. 2022). The sample included both teens (n=14) and young adults (n=19), as well as straight (n=20) and bisexual or queer (n=13) participants. In keeping with theoretical sampling, participants were recruited to represent a range of variables theorized to influence STI experiences, including race and ethnicity, geographic location, and previous STI testing.

Recruitment

Participants were recruited through Jane’s Due Process (JDP), a Texas-based non-profit organization that provides young people with SRH information. Clients who called or texted JDP received study details at the end of their conversation and were asked whether they were willing to be contacted. If they agreed, the JDP staff member or volunteer screened them for eligibility. To be eligible, participants had to be English-speaking, aged 15-25, residents of Texas, and have ever engaged in oral, vaginal, and/or anal sex. The JDP staff member or volunteer entered this information, along with preferred contact information, into a Qualtrics form. Participants recruited from JDP’s social media platforms or snowball sampling were directed to the Qualtrics form, which screened them for eligibility and, if eligible, asked them to provide their preferred contact information. The author contacted eligible young people up to three times using each available contact method, starting with the preferred method. The Institutional Review Board at the University of Texas at Austin approved the study protocol and waived parental consent for participating minors, as STI services can be accessed in Texas without parental consent.

Data collection

In-depth semi-structured interviews were conducted between March 2023 and July 2023. The author was a third-year doctoral student with prior experience conducting interviews with young people in Texas. Interviews were conducted via phone or Zoom. After confirming privacy and reviewing informed consent/assent, the author obtained verbal permission to participate and record. Interviews lasted 45–85 minutes.

The author developed the interview guide based on prior research with young people on SRH topics and conversations with Jane’s Due Process. The interview guide asked about participants’ knowledge and perceptions of STIs, where they search for STI information, conversations they had about STIs, decision-making around STI testing, any experiences with STI testing, diagnosis, and disclosure. The interview guide was designed to progress from less to more sensitive topics to enhance rapport and data validity. The author made a conscious effort not to imply or suggest “correct” behaviors when speaking with participants and instead aimed to elicit participants’ STI-related behaviors and contraceptive motivations in their own words and frameworks. Participants received a $25 electronic gift card for participating.

The author’s positionality likely shaped data collection. As a non-Hispanic white, cisgender woman-presenting researcher, the author’s identity may have facilitated rapport with some participants—particularly young women—while potentially creating social distance in interviews with boys and young men of color. This positionality may have influenced how participants framed their experiences; for example, some male participants may have downplayed risk behaviors or emphasized responsibility, while female participants may have felt more comfortable discussing stigma, shame, and emotional aspects of STI experiences. In some interviews, the author selectively disclosed aspects of her background (e.g., rural/religious upbringing, sexual orientation, or prior STI experiences) to help normalize discussion of sensitive topics and reduce potential discomfort. Although the author did not disclose her age, participants often perceived her as a peer based on her communication style and shared cultural references, which may have facilitated more openness.

Analysis

All interviews were audio-recorded, professionally transcribed verbatim, and checked for accuracy. Identifying information was removed, and pseudonyms are used throughout the manuscript to de-identify participants. Saturation for the study’s broader focus on STI perceptions, care-seeking behaviors, and testing experiences was anticipated around 30 interviews (Guest, Namey, and Chen 2020). The author monitored sample diversity, data quality, and thematic variability throughout recruitment. Data collection concluded at 33 interviews once saturation was reached.

A preliminary codebook was developed using inductive and deductive approaches that were informed by an initial review of the transcripts and the interview protocol. Analytic memos were written after each interview, and data were coded using an open coding approach (Corbin and Strauss 1990). While the initial study examined young Texans’ experiences with STIs more broadly, the analysis presented here focuses on participants’ perceptions of and experiences with gender inequities in STI prevention, testing, and treatment.

Although participants were not explicitly sampled for gendered experiences of STI labor, the study demonstrates strong information power – a concept referring to the adequacy of a qualitative sample based on the relevance, specificity, and richness of the data rather than sample size alone (Malterud, Siersma, and Guassora 2016). Participants were purposively recruited based on their engagement with STI prevention, testing, or care, ensuring high relevance to the aims of this analysis. Across interviews, gendered responsibility emerged organically, with rich, detailed accounts that revealed consistent patterns among participants. This convergence, combined with the alignment of findings with prior theory and research on gendered reproductive labor, supports the validity of the study’s information power and findings (Malterud et al. 2016).

A “flexible coding” approach (Deterding and Waters 2021) was used, in which full transcripts were coded topically, followed by secondary analytic coding of key topical excerpts. The primary code used for this analysis was “gendered labor,” referring to data on participants’ perceptions of STI-related gender inequities, whether from their own experiences, second-hand accounts, or broader observations. While coding these excerpts, subcodes were applied to capture various explanations of gender inequities, adding an analytic subcode for each new theme encountered. Throughout data analysis, the author examined disconfirming data to continually refine the argument. NVivo 14 was used for coding and data management.

Results

Sample descriptives

Of the 67 young people who completed the Qualtrics survey and were eligible, 39 scheduled an interview: 33 completed an interview, 5 scheduled an interview but did not show or respond to follow-up messages, and 1 declined to participate. Table 1 provides a demographic overview of participants.

Table 1.

Participant demographic characteristics among a sample of adolescents and young adults in Texas, 2023 (N=33)

	N	%
Gender
Female	23	70%
Male (including one trans man)	8	24%
Nonbinary (assigned female at birth)	2	6%
Age
15-17	6	18%
18-19	8	24%
20-22	11	33%
23-25	8	24%
Sexual orientation
Heterosexual	20	61%
Bisexual	9	27%
Queer	2	6%
Lesbian	1	3%
Pansexual	1	3%
Race/ethnicity
White	13	39%
Hispanic	10	30%
Black	5	15%
Bi-racial: Black and Hispanic	2	6%
Bi-racial: Black and white	1	3%
Bi-racial: Asian and white	1	3%
Asian	1	3%
Geographic location
Urban	19	58%
Suburban	11	33%
Rural	3	9%
Has had an STI test	20	61%
Has tested positive for an STI	13	39%

Most participants identified as female (70%; n=23), 24% as male (n=8), and 6% as nonbinary (n=2). Both nonbinary participants were assigned female at birth. Their experiences aligned more closely with girls’ and young women’s accounts of gendered STI-related labor and are presented alongside them. Participants ranged from 15 to 25 years, with a mean age of 20. Most participants identified as heterosexual (61%; n=20) or bisexual (27%; n=9). The sample was racially and ethnically diverse, with 39% of participants identifying as white (n=41), 30% Hispanic (n=10), 15% Black (n=5), 12% (n=4) bi-racial, and 3% (n=1) Asian. Over half of participants were from urban areas (58%; n=19), followed by suburban (33%; n=11) and rural (9%; n=3). Most had previously been tested for an STI (61%; n=20), and 39% reported testing positive (n=13).

Gendered divisions of STI prevention, testing, and stigma

Gendered division of STI prevention

Participants discussed at length how both societal and relationship scripts had normalized female-identifying partners as the ones responsible for ensuring the health of both partners, including STI prevention. Rebecca, a 23-year-old straight woman who grew up in a very Evangelical community, was taught from an early age that women are responsible for men’s sexual health, saying:

Conversation [in high school] was always very focused on girls and girls got the STDs or girls gave the STDs… But never that boys were possibly people that were infected or carriers. It was just always girls. And I think it goes back to some of ’em were religious messaging… I think that a lot of people got the messaging that women have some responsibility to keep men pure because men can’t help themselves… And part of that was also STDs. It was like, well if girls don’t sleep around, the boys won’t be able to spread STDs between them. So, it’s your responsibility too.

This “responsibility to keep men pure” manifested as female-identifying partners having to initiate conversations with male partners about condom use and previous sexual histories. Participants indicated that young men were often reluctant to wear condoms without specifically being asked, were often not actively thinking of STIs as a problem, and almost never initiated conversations on this topic before having sex. Therefore, if girls or young women wanted to protect their health, they often had to initiate safe sex practices.

Stephanie, a 23-year-old bisexual woman who contracted vaginal herpes – an incurable, life-long STI – after her ex-husband cheated on her, reflected on her dating history since the divorce, saying “People don’t really use protection unless I bring it up. So, it’s like, they obviously don’t wear protection commonly, but [STIs] happen, and it can happen to anybody.” When asked why she thinks her male partners are hesitant to bring up condom use, she explained that men say condoms “don’t feel good” or “don’t feel the same” – a sentiment echoed by other female-identifying participants. Stephanie explained how these sentiments, coupled with a lack of communication about condom use initiated by male partners, sometimes result in young women “not wanting to say anything” because “no one wants the confrontation or the backlash… or we just don’t want them to feel disappointed. I feel like sex in general is kind of surrounded by men’s wants and desires more than ours.”

When asked how it made Stephanie feel that she typically had to initiate conversations about condom use and sometimes faced pushback from male partners, she encapsulated several young women’s attitudes, saying:

I think I’m more confrontational now [after experiencing an STI diagnosis] than I used to be… So that’s a non-issue for me now because we definitely use protection, but prior I feel like I was not very confrontational about things. I just didn’t want to disappoint anybody. So, I feel like it just takes practice being more getting used to being the villain, I guess.

Here we see two interesting points. First, Stephanie mentioned how her previous desires not to upset her partner(s) – because society had taught her that men’s sexual needs come first – resulted in her not being confrontational about condom use. However, experiencing an STI diagnosis gave her a new perspective about the seriousness of STIs and empowered her to be “more confrontational now” and see condom use as a “non-issue.” This sentiment was echoed by other girls and young women in the study. Several weighed the risk of upsetting a partner as greater than the risk of STI contraction and thus did not always demand condom use. However, experiencing an STI changed many young women’s perspectives, and they often felt more urgency and necessity around requiring condom use after their STI experience.

Second, Stephanie’s use of the word “villain” when referencing requesting condom use, especially given her positive herpes diagnosis, is striking since the behavior was protecting the health of both her and her partners. Yet she still felt that the labor she was doing to protect her partners was viewed negatively. This perceived sentiment of “killing the mood” or offending partners by asking about condom use and/or STI status was common among female-identifying participants. Although many girls and young women in the sample engaged in this labor – to the benefit of their partners – they felt awkwardness, discomfort, and even pushback.

The pattern of female-initiated conversations about using condoms for STI prevention also emerged in conversations with male-identifying participants. Esteban, a 19-year-old straight young man, reported that the only conversation he had about STIs was with his girlfriend in high school. He reflected on how it was both his and his girlfriend’s first time having vaginal sex, and “we wanted to talk about it beforehand… The expectation between us, the protection, contraceptive, stuff like that.” Esteban mentioned that his girlfriend was on birth control but that they also wanted to use condoms to “keep it a hundred percent” because their biggest fear was “her getting a kid or me being a father at such a young age.” In addition to condom use for pregnancy prevention, Esteban also discussed how his girlfriend brought up that she could “get really sick” from STIs so she wanted to use condoms. He went on to say, “It was just the first time someone really brought [STIs] up to me because before that she was my first. So, it was kind of a new experience for me.” This last statement is important because it indicates that even though it was both Esteban and his girlfriend’s first time having vaginal sex, his female partner was the one to bring up STIs as something to be aware of when having sex.

Although young women in the sample who had sex with women described somewhat more equitable dynamics around STI prevention, they were not necessarily more proactive than those who primarily had sex with men. Many perceived STI risk as low or irrelevant, often framing STIs as a concern “for gay men“ or linking sexual health exclusively to pregnancy prevention. This sentiment was reflected in a conversation with Jas, a 24-year-old nonbinary, queer young person:

I can’t speak for all, but from my experience, they [lesbians] can’t get pregnant from the type of sex that they have. So I think because of that just initial fear kind of not being a fear anymore, the people are just like, “Okay, it’s cool. We can kind of do whatever here.” And a lot of people not having experience with STIs or hearing about STIs within that particular community and they’re like, “Oh, that’s not something we really deal with in our experience, right?” When people I know think of STIs they are usually talking about gay men specifically, not necessarily lesbians or people who identify as lesbians. It’s just not a conversation that typically comes up within those communities. So I don’t think that is something that people have on their radar because of that.”

However, when STIs did become a reality, such as when Jas tested positive for herpes, prevention proved to be challenging due to limited accessibility and usability of protection methods like dental dams: “For some partners oral’s just out of the question, just because of the fact that the dental dam situation just isn’t ideal. […] It’s just very uncomfortable. […] And then the actual feeling itself and use during sex, it’s just not the same.” This sentiment was also echoed by Ellie, a 23-year-old queer woman, when she stated:

I think one thing that really frustrates me is that as a queer person, I have a female partner, and safe sex to us, it’s just not feasible. I know dental dams exist. They are made by one company. I’ve tried to research other companies. They’re made by one company, and sex stores just don’t have them. And we’re in a long-term relationship at this point. We don’t really need them. But based on portions of our relationship at the beginning, it would have been extremely useful. And it just makes me sad because I know there’s other people out there risking more than what I was risking not able to access that stuff.

These accounts highlight how structural barriers like inadequate investment in queer-inclusive STI-prevention tools restrict options for safer sex among women who have sex with women. This reflects a broader gendered and heteronormative approach to contraception, in which protective methods and educational messaging remain centered on penile–vaginal sex and pregnancy prevention, leaving queer individuals with fewer means of protection and obscuring STI risk for all young people.

Gendered division of STI testing

Participants reported that young women are generally more concerned about their health than young men and have more anxiety around negative SRH outcomes. Girls and young women in the sample attributed this heightened anxiety to their fear of being shamed or stigmatized for their sexual behaviors, resulting in STI contraction being more salient for women than for men. Subsequently, the onus to get tested, disclose status, and minimize transmission generally fell on girls and young women.

Rachel, a 22-year-old straight woman in graduate school who had experienced herpes, mycoplasma, and bacterial vaginosis diagnoses, discussed how anytime she was planning to have condomless sex with a partner, she would get an STI test done first. She gave an example of this, saying, “I remember I wanted to have no condom sex with [a partner] and I went and got tested and I don’t know if he did, but I did. I was like, I never wanted to be the person that gave it [an STI] to them.” Rachel discussed how she always got STI tested before engaging in condomless sex with a partner because she did not want to transmit anything to someone. However, it is evident in her quote that she was not sure if her male partners were also getting tested, highlighting the potentially gendered care and labor that goes into STI testing.

Like Rachel, Jade, a 19-year-old bisexual young woman attending community college, also wanted to get tested for STIs before engaging in condomless sex. Jade described how she and her boyfriend had started having sex more frequently and that “the interest of unprotected sex had come up.” Jade was interested in having condomless sex with her boyfriend but had criteria for taking that step: “I was like, look, if we want to have unprotected sex, I just need to know 1) that I’m on better contraception because I’m on the pill, but your girl’s forgetful… and 2) that we’re both not going to transmit anything to each other to our knowledge.” Jade’s desire not to unknowingly transmit STIs with her partner ultimately led them both to get tested for STIs. However, it was Jade who had to initiate this conversation.

Jade’s boyfriend, Ian, a 20-year-old straight man, concurred that it was Jade who initiated the conversation about condomless sex, other forms of contraception, and getting tested for STIs. When asked how he felt about his girlfriend bringing up having unprotected sex, Ian explained why he did not initiate the conversation:

I was at a point where I was ready to try [condomless sex] and I was probably at that point beforehand, but I wasn’t going to bring it up because I feel like since she’s the one who can get pregnant and whatnot, I think that’s kind of her decision to bring it up whenever she was ready. So yeah, when she brought it up, I was supportive and when she brought up getting STD tested, I totally didn’t take it as any sort of slight or anything suggesting that I’m promiscuous or anything like that, just because I think we share similar values and we both just saw it as a practice what we preached sort of thing.

Although Ian also wanted to engage in condomless sex and was not opposed to getting STI tested, he felt it was more appropriate for Jade to initiate the conversation, given the gendered consequences of condomless sex, notably pregnancy. Ian’s quote highlights how STIs are often not salient for young people, and therefore condom use is primarily viewed as a means of pregnancy prevention, and how even well-intentioned male partners often assign SRH labor to their female partners.

These dynamics were further reinforced by broader norms surrounding masculinity and health-seeking behavior. Several male participants described how seeking medical care was generally discouraged among men, reflecting cultural expectations of toughness and self-reliance. As 19-year-old Ray, a straight male, explained, “Like I think I’m invincible… I’ll be physically sick and hurting, and I just won’t go to the doctor just ’cause… You think, ‘Oh, I’ll just eat it. It’ll be fine.’” Another participant, Trevor, whose story is shared below, echoed this sentiment, noting that “going to the doctor is looked down upon in some ways… anything extra from your annual checkup means you’re lesser than or you’re weaker or something like that.” These accounts suggest that STI testing among men may be shaped not only by the normative gendered division of reproductive labor but also by broader masculine norms discouraging healthcare-seeking behaviors.

A more blatant example of gender inequality in STI testing was described by Emma, a 21-year-old straight young woman who was in college at the time of the interview. Emma shared her first experience with an STI, which had happened a few months prior. While Emma was home from college with her family, her partner at the time texted her that his “penis hole was itching a little bit.” Emma recounted how she responded to him, saying “’Oh man, like I’m sorry.’ I was like, ‘I don’t think I do [have an STI], but honestly I don’t know for sure, so I’ll go get tested as soon as possible and let you know.’” Emma then described having to schedule an appointment at Planned Parenthood and telling her mom she needed to go regarding a birth control issue, because she did not feel comfortable disclosing that she needed an STI test. When asked about whether her partner got tested before her, Emma said:

Emma: No, he just like waited and it wasn’t until I got tested that he was like, okay, I’m gonna go to my doctor.

Interviewer: And how did that, how did that make you feel that he was having symptoms and didn’t go get tested, but you decided to go get tested?

Emma: Honestly, it, it checks out because um, I just feel like that’s just a man thing to do. Like they will be the ones to be like the most promiscuous and then just like, it’s like our job to tell them or something. Um, because yeah, like I had to, I texted like six guys when I got diagnosed because I was like, I don’t know when I got this, and I just want everyone to make sure they’re clean so that no one else has to go through this.

As with Rachel, we again see with Emma how the emotional toll and labor of getting tested often falls on girls and young women. At this point, Emma was not experiencing any physical symptoms, yet she still went and got tested. Conversely, her partner, who was experiencing physical symptoms, waited for Emma’s test results to come back before getting tested. Although Emma likely contracted the STI from the partner who was experiencing symptoms, she still did the emotional labor of informing her previous sexual partners of her diagnosis so “no one else has to go through this.” Even though Emma admitted to being “very anxious at the time” about disclosing to her past partners and feared they might think she was a “whore,” she said she ultimately had to “just do it [disclose] for the girls in the future that they’re gonna sleep with.” Emma’s experience highlights ways in which young women must often perform sexual labor despite it benefiting both partners and even future partners.

However, not all young men in the sample relied on their partners to initiate testing. Trevor, a 22-year-old bisexual man who tested positive for chlamydia, recalled feeling a deep sense of responsibility: “I felt shameful towards myself because I should have been more careful in that situation. I felt like I should have been tested before having another partner.” Following this experience, Trevor described STI testing as a “non-negotiable” and now routinely asks partners about their testing history before engaging in sexual activity. Similarly, many queer-identifying participants described more equitable distributions of testing labor, noting that broader access to information and lower stigma around testing within their communities facilitated proactive care. Still, across the sample and regardless of gender or sexual orientation, testing and conversations about STIs often became routine only after participants experienced a scare or diagnosis, suggesting STI prevention remains largely reactive.

Gendered division of STI stigma

Gender inequality was also present in the perceived stigma associated with STI testing and contraction. Despite almost unanimously saying they themselves did not subscribe to this belief, participants across gender identities felt strongly that people who contracted STIs were generally perceived to have had a lot of sexual partners and to have “slept around.” However, they felt that having a lot of sexual partners was normal or even celebrated for young men, but that women who had a lot of sexual partners could be considered “whores.” Therefore, stigma associated with having an STI was more severe for women than for men. Luis, a 16-year-old straight young man, described it this way:

I think people would assume that they’re having sex with a lot of people. I mean, cause in my head what I’ve heard the most about people having STDs are people who have sex with a lot of people. And I feel as though it’s easier to be a man and say, ‘Oh, I’m getting at all these chicks’ than it is being a woman and being like, ‘Oh, I’m getting at all these guys and I’m letting all these guys have sex with me.’ It’s just harder to say because one is praised and the other is frowned upon.

Here, Luis highlights how the sexual double standard is at play when it comes to STIs. Luis discusses how men and women engaging in the same sexual behavior can be perceived differently, with men being praised for having many sexual partners while women are shamed. As a result, women are more likely to be stigmatized for getting an STI because it implies that they have had a lot of sexual partners, which is deemed not socially acceptable for women. Conversely, men may be less stigmatized for getting an STI because implying that a man has had multiple partners is socially acceptable.

This double standard is further reflected in the experiences of Roxy, a 20-year-old straight college student who had been diagnosed with chlamydia unexpectedly while undergoing surgery. Roxy was unsure when or from whom she had contracted chlamydia and was concerned about disclosing her diagnosis to her current partner because she feared he would not believe she had been monogamous due to previous trust issues in their relationship. Despite Roxy’s mom advising her not to directly disclose her positive chlamydia test to her partner, so that Roxy would not be “the villain,” Roxy chose to be forthcoming. She described her experience disclosing to her partner in the following way:

I was like, ‘Um, so you should probably go get tested. Like, I think you need to go get tested.’ And he was like, ‘You’re lying.’… He was just like, ‘Fuck. Are you serious?’ Like he just seemed like I was just putting this burden on him… I was like, ‘Yeah, I’m sorry. Like I don’t know what to tell you’… I felt horrible. I felt like I was putting this burden on him on top of like everything else that he has to deal with… I just felt bad that I was the one doing that. And it made me feel like, it just made me feel small. It made me feel really small… I also felt like he was just judging me being like, ‘Oh no, she for sure gave it to me. Who knows like who she’s been with, what she’s been doing’… I was really worried about just being put in the light of like, I’m a slut because I had it.

We see in Roxy’s experience that even though she was looking out for the health of her partner by disclosing her chlamydia diagnosis to him, like Stephanie, she was made out to be the “villain.” After disclosing, Roxy’s partner made it obvious to her that he felt burdened by this news, making Roxy feel “really small.” Despite it being possible that Roxy could have contracted chlamydia from that partner, Roxy feared she would be the one stigmatized and labeled a “slut” because it would be assumed that her positive diagnosis meant she had been sleeping around.

Like Roxy, Rachel also expressed sentiments of shame and embarrassment when discussing her positive herpes diagnosis and subsequent disclosure to her partner, with whom she was monogamous. Interestingly, Rachel felt ashamed of disclosing her diagnosis despite being certain it was her partner who gave her herpes. When asked how she felt about disclosing, she responded, “I guess just embarrassed and shameful. I don’t know, it was a sense of like, ‘Oh this is my fault.’ Even though like, I didn’t give my genitals herpes from my mouth. Like obviously it was him. I don’t know, it’s interesting to think about it that way.” Here we see that although Rachel believed her partner gave her herpes, she still felt the diagnosis was her fault and was “embarrassed” to tell her partner, indicating the deeply ingrained gendered responsibility girls and young women feel to prevent STIs.

These sentiments were also true among female-identifying participants who had sex with women. Cris, a 23-year-old queer femme participant, described feeling “disappointed” and “ashamed” for testing positive for chlamydia even though their “sexual partner didn’t express any resentment or negativity.” Cris reflected, “I still felt bad giving it to a person who I actually really care about.” Compared to the anxiety and shame expressed by many girls and young women, boys and young men in the sample reported less emotional distress surrounding STI testing and diagnosis. Ian, who had previously gone to get tested with a female friend, described his experience during the waiting period between testing and receiving results:

My friend, when she was waiting on her results, she kind of stressed more about it, but for me, I didn’t stress much about it because I thought I was likely that I didn’t have anything. And I don’t know, I just tend to feel that kind of, not hypochondria, but health related anxieties, I don’t tend to feel that as much luckily. So, it wasn’t super bothersome to me.

Similarly, Trevor, mentioned earlier, who tested positive for chlamydia after his partner cheated on him, discussed how, although he felt embarrassed and like a “dumb kid” for getting an STI, he was quickly “over it” and felt like it was a learning experience. These experiences from male-identifying participants highlight how the same outcome, a positive STI diagnosis, can be experienced differently for young men than young women. Young women faced more stigma and anxiety from a positive diagnosis because of societal scripts placing the onus on them to prevent STIs in the first place and allowing men to have multiple sexual partners while shaming women for the same behavior.

Discussion

This study extends the concept of gendered reproductive labor to include STI prevention, testing, and treatment. While prior research has focused on gendered inequities in fertility and contraceptive labor (Bowleg et al. 2004; Fennell 2011; Kimport 2018; Littlejohn 2021), this study finds similar inequities in STI-related labor, a comparatively understudied domain. Girls and young women in this study bore disproportionate responsibility for initiating condom use, arranging testing, disclosing diagnoses, and managing the emotional aftermath of infection. Like other forms of reproductive labor, much of this work is invisible (Daniels 1987). STI labor is distinct, however, in that it remains more taboo than pregnancy or contraceptive care, is rarely normalized in sexual health education, and can result in outcomes that physically affect both partners. Despite shared risk and outcomes, gendered patterns persisted—underscoring how pervasive gendered norms are in reproductive labor.

However, these gendered inequities are not the result of individual failings or young men’s intentional neglect, but rather the product of deeply rooted gendered power structures that shape how young people are socialized to think about sex, risk, and care (Shand and Marcell 2021; Strong, Coast, and Chiweshe 2025). Even well-intentioned young men can perpetuate gendered labor. Mirroring findings from James-Hawkins et al. (2019), many male participants believed that sexual health decision-making should be shared, but also that women should have control over their own bodies. As a result, they often deferred to young women to initiate conversations or make decisions about prevention. In principle, they supported equality, but in practice, they did not always participate equally. Instead, they deferred responsibility to respect women’s autonomy but inadvertently placed more burden on them.

Participant accounts also highlighted how stigma around STIs is itself gendered. As several participants described, contracting an STI can signal sexual experience and even confer status for boys and young men, while the same outcome marks girls and young women as promiscuous. Conversely, health-seeking behaviors are more normalized for girls and young women, while boys and young men may feel “weak” for seeking the same care. These dynamics reflect persistent sexual double standards in which men’s sexual activity is normalized or celebrated, but their care-seeking is demeaned, while women’s care-seeking is encouraged, but their sexual activity is policed and stigmatized (Endendijk et al. 2020; Himmelstein and Sanchez 2016). These norms do more than shape perceptions; they actively undermine public health efforts by reducing incentives for boys and young men to get tested, while simultaneously intensifying social penalties for girls and young women if infection occurs (Dalessandro et al. 2019).

Participants’ narratives reflected this imbalance. Many girls and young women internalized responsibility for maintaining both their own and their partners’ well-being, often experiencing guilt, anxiety, or shame in the process. Even among queer and gender-diverse participants, structural barriers such as scarcity of protective tools (e.g., dental dams) and heteronormative sex education limited opportunities for equitable participation in STI prevention. Across groups, the absence of early education around consent, communication, and shared responsibility meant that few participants, regardless of gender, felt equipped to have proactive conversations about testing or risk. Instead, STIs were something most participants reacted to rather than being proactive about.

These findings have clear implications for SRH education and practice. First, young people need sex education. Historically, sex education in the U.S. has focused on teen pregnancy prevention. However, sex education should be comprehensive and inclusive, not focusing solely on pregnancy prevention, but also including STI education, guidance on condom use, regular testing, and sexual health communication for all genders. Further, STI prevention should be presented as a shared responsibility, not the duty of the pregnancy-capable partner. Moreover, STI education should encompass more than just HIV/AIDS. While important, this focus may unintentionally overshadow more common infections like chlamydia and gonorrhea, contributing to low awareness and urgency around STI prevention and testing.

Second, healthcare providers should engage all young people in STI awareness—not just those seeking testing—by offering proactive information, accessible resources, and stigma-free spaces for STI-related questions during routine care. Third, boys and young men should be included in SRH efforts. Historically, SRH education has focused on girls and young women, siloing knowledge and reinforcing the gendered responsibility of care. This narrow framing has left young men undereducated and underengaged in SRH efforts, despite many young men wanting to be involved (Shand and Marcell 2021; Valdez et al. 2023). Initiatives designed for or inclusive of boys and young men can improve their STI knowledge and support them in becoming proactive, engaged partners in SRH care.

While this study provides rich qualitative insights, several limitations should be noted. First, participants were recruited through an SRH nonprofit, which may have attracted individuals who are more informed or engaged in sexual health. However, this recruitment approach also enabled inclusion of participants with limited access to other sources of SRH information and resulted in a more geographically diverse sample beyond high school and college settings. Although this study included a racially and geographically diverse sample, it did not explicitly examine how gendered STI labor may vary by race, class, religion, or place. Participants’ discussions rarely raised these factors in relation to gendered responsibilities, apart from cultural and family influences among some Latine participants. Based on existing literature, we know that SRH labor and experiences intersect with broader social identities and structural factors, which is likely true for STI experiences as well. Future research should explicitly sample and investigate how race, class, and other contextual factors shape distributions of STI-related labor.

Additionally, findings are based on self-reported accounts and may be influenced by social desirability bias, particularly among boys and young men who may underreport risk behaviors or emotional vulnerability. The relatively small number of queer youths also limits the transferability of findings related to sexual orientation. Similarly, small numbers of participants not identifying as cisgender women or cisgender men limit transferability to gender diverse communities. Moreover, this study was not designed to conduct a gender-comparative analysis. Instead, sample composition reflects population-level trends in STI testing and care-seeking, in which young women are disproportionately represented. As a result, girls’ and women’s perspectives comprise most of the sample and provide the primary insight into how STI-related labor is experienced in practice. The inclusion of male participants serves to complement and contextualize these accounts rather than to support direct gender comparisons. Future research should recruit larger samples of boys and young men to more fully examine their experiences with STI prevention, testing, and care, as well as how they perceive their role in STI-related labor. Finally, the Texas policy environment, characterized by limited sexual health education and restricted reproductive health infrastructure, likely shapes these dynamics in distinctive ways. Future research should examine how gendered STI labor manifests across different policy contexts.

Conclusion

This study contributes to growing scholarship on gendered reproductive labor by extending the framework beyond fertility and contraception to include the everyday work of STI prevention, testing, and treatment. Across participants’ narratives, STI-related labor emerged as deeply gendered: girls and young women carried disproportionate responsibility for initiating testing, managing risk, and navigating the emotional and social consequences of diagnosis. Yet these inequities are not the result of individual behaviors but of socialization and policy structures that position sexual health as a woman’s responsibility while leaving men undereducated and underengaged. By excluding boys and young men from SRH education, we have created a system that overburdens young women and underprepares young men, ultimately undermining the health and autonomy of all young people.

Recognizing STI prevention as a shared form of reproductive labor reframes sexual health from a model of individual moral responsibility to one of collective care and communication. Public health interventions and education should normalize STI conversations and testing across genders, emphasize mutual responsibility, and provide equitable access to prevention tools for all sexual orientations and identities. Only by redistributing this labor can we begin to dismantle the gendered hierarchies that continue to shape young people’s SRH experiences.

Highlights.

• STI labor extends gender inequality beyond pregnancy prevention

• Young women perform disproportionate STI prevention and testing labor

• STI stigma is higher for young women than young men

• Young women experience greater emotional burdens from STI labor

Data statement:

The dataset is qualitative and contains several quotes that could potentially identify participants. Therefore, the raw dataset will not be available. However, additional quotes supporting each theme can be provided upon request from the corresponding author.