Abstract
Background
Cyberchondria may influence women’s health-related behaviors by shaping how they search for and interpret online health information. This study aimed to examine the effect of cyberchondria levels on genital hygiene behaviors in women of reproductive age.
Methods
This cross-sectional study was conducted with 366 women aged 15–49 years registered at a family health center. Data were collected using a Demographic Information Form, the Genital Hygiene Behaviors Scale (GHBS), and the Cyberchondria Severity Scale Short Form (CSS-12). Descriptive statistics, Student’s t-test, ANOVA, Pearson correlation, and multiple linear regression analysis were used in the analysis of the data.
Results
The mean total GHBS score of the participants was 87.28 ± 10.20; the CSS-12 score was 32.19 ± 9.35. Regression analysis showed that the excessiveness and reassurance-seeking subdimensions of cyberchondria were significant positive predictors of genital hygiene behaviors, while the anxiety subdimension was a significant negative predictor (p < 0.001). Although the overall cyberchondria score showed a weak positive correlation with genital hygiene behaviors, it was determined that age may play a more significant role in explaining genital hygiene behaviors.
Conclusions
Our findings indicate a limited association between cyberchondria and genital hygiene behaviors. However, they suggest that age and related life experiences may be more significant determinants of these behaviors. Genital hygiene behaviors are more influenced by sociodemographic factors such as education, income level, and access to hygiene education. Cyberchondria is not a strong predictor on its own and should be evaluated in conjunction with other individual factors.
Keywords: Cyberchondria, Genital hygiene, Women's health
Introduction
Cyberchondria is a contemporary health phenomenon derived from the combination of the concepts “cyber” and “hypochondriasis,” referring to an individual’s excessive and repetitive search for health information online driven by health-related anxieties [1]. While the exact origin of the concept is unknown, it is reported to have been brought to the forefront in 1999, highlighting the potential for uncontrolled health information on the internet to increase anxiety in individuals [2]. Today, cyberchondria is defined as an individual’s excessive search for health information online, their attempt to self-diagnose by misinterpreting this information, and the resulting increased health anxiety [3, 4].
The rapid development of technology and the ease of access to the internet have led individuals to turn to digital platforms as their primary source of information for health problems. While the internet provides quick, low-cost access to health information, exposure to unverified or exaggerated content can lead to increased health concerns among some individuals [3, 5, 6]. Research indicates that cyberchondria is not merely an intense information-seeking behavior; it is also a multidimensional construct associated with compulsive searching tendencies, a need for reassurance, distrust of health professionals, and increased health anxiety [4, 6, 7].
From a women’s health perspective, genital system infections are among the most common health problems in women of reproductive age. Developing as a result of disruptions in the natural defense mechanisms of the reproductive system, genital infections are a significant reason for visits to gynecology clinics [7]. Due to women’s fertility and the frequent occurrence of genital infections, genital hygiene practices play a fundamental role in protecting women’s reproductive health. Genital hygiene is a multifaceted self-care area encompassing external genital cleaning, menstrual hygiene, appropriate use of underwear, post-toilet cleaning habits, and recognition of abnormal genital findings [8]. Inappropriate genital hygiene practices, influenced by many factors such as age, education level, socioeconomic status, and cultural habits, increase the risk of bacterial vaginosis, vulvovaginal candidiasis, and other genital infections [9].
Furthermore, in the age of technology, the reliability of health information obtained from the internet and its interpretation by individuals can directly affect women’s health. It is thought that individuals experiencing cyberchondria may perceive incorrect or incomplete information encountered online as a threat, interpreting normal genital symptoms as signs of illness, which can lead to improper hygiene behaviors such as excessive genital cleaning, frequent vaginal douching, or the use of inappropriate products [3, 4]. A literature review shows that there are studies examining the relationship between cyberchondria and health anxiety [10], chronic disease management [5], sexually transmitted diseases [11], and Human Papilloma Virus [12]. However, no studies evaluating the relationship between cyberchondria and genital hygiene behaviors have been found in the current literature. Although cyberchondria is closely related to the search for health-related online information and health anxiety, its potential effects on preventive self-care behaviors such as genital hygiene practices have not yet been sufficiently investigated. The direction of this effect is also unclear. On the one hand, the increase in the search for health-related information may lead women to adopt recommended hygiene practices and pay more attention to their genital health. On the other hand, misinterpretation of online information and increased health anxiety may lead to inappropriate behaviors such as excessive cleaning, frequent vaginal douching, or the use of unnecessary hygiene products [3, 4, 10]. Therefore, it is important to reveal the relationship between cyberchondria and genital hygiene behaviors. This research aims to contribute to filling this gap in the literature by examining the effect of women’s cyberchondria levels on their genital hygiene behaviors.
Research questions
What are the levels of cyberchondria in women of reproductive age?
What are the levels of genital hygiene behaviors in women of reproductive age?
Does cyberchondria affect genital hygiene behaviors in women of reproductive age?
Materials and methods
Type and location of the study
This cross-sectional study was conducted between April and July 2025 among women of reproductive age (15–49 years) registered at Family Health Center No. 6 in Ağrı Province. The study population consisted of 7,088 women aged 15–49 years registered at the center. The minimum required sample size was calculated as 365 women using a known population sampling method with a 95% confidence level and a 5% margin of error. A total of 366 eligible women were ultimately included in the study. Simple random sampling was used to select the participants. During data collection, women who visited the family health center and met the inclusion criteria were invited to participate in the study, and data were collected until the sample size was reached.
Inclusion criteria
Voluntary participation in the study,
Being between 15 and 49 years of age,
Being literate,
Using a smartphone or having internet access,
Not having communication problems.
Exclusion criteria
Having any psychological problem,
Having a sexually transmitted disease or an active genital infection (as the current symptoms will affect both genital hygiene practices and health information-seeking behaviors).
Data collection tools
Data were obtained using the “Demographic Information Form”, “Genital Hygiene Behaviors Scale (GHBS)”, and “Cyberchondria Severity Scale Short Form (CSS-12)”.
Demographic information form
The form was prepared by researchers based on a review of the relevant literature [7, 9, 13]. The form consists of 10 questions that assess demographic and health-related characteristics. These are: age, marital status, education level, employment status, income level, having children, time spent searching for health-related information online, trust in online health information, health concerns, and previous genital hygiene education.
Genital hygiene behaviors scale (GHBS)
Developed by Karahan in 2017. The scale, consisting of 23 items in total, is evaluated using a five-point Likert scale and comprises three sub-dimensions: General Hygiene Habits (first 12 items), Menstrual Hygiene (items 13–20), and Awareness of Abnormal Findings (items 21–23). Items are rated from “strongly agree = 5” to “strongly disagree = 1”. Items 7, 14, 19, 20, and 23 are reverse-scored. A minimum score of 23 and a maximum score of 115 can be obtained from the scale. As the score obtained from the scale increases, the rate at which women exhibit correct genital hygiene behavior also increases. The Cronbach alpha coefficient for the total scale was determined as 0.80, for the genital hygiene habits sub-dimension as 0.70, for the menstrual hygiene sub-dimension as 0.74, and for the awareness of abnormal findings sub-dimension as 0.81 [14]. In this study, the Cronbach’s alpha coefficient for the total scale was 0.75.
Cyberchondria severity scale short form (CSS-12)
The Turkish adaptation of the scale developed by McElroy and Shevlin was made by Söyler et al. in 2021. The scale, comprising 12 items, is composed of four sub-dimensions: excessiveness, anxiety, reassurance-seeking, and distress. The excessiveness sub-dimension consists of questions 1, 3, and 6; the anxiety sub-dimension consists of questions 4, 8, and 9; the reassurance-seeking sub-dimension consists of questions 5, 11, and 12; and the distress sub-dimension consists of questions 2, 7, and 10. The five-point Likert-type scale can be administered to individuals aged 15 or older. The score obtained from the scale ranges from 12 to 60. The scale is evaluated based on the total score; 12–24 is considered very low, 24–36 is considered low, 36–48 is considered moderate, and 48–60 is considered a high level of cyberchondria. There are no items in the scale that require reverse scoring. The scale’s total Cronbach’s alpha was 0.86 [15]. In this study, the Cronbach’s Alpha value was 0.87.
Data collection
During the research planning phase, the researchers obtained written permission from the scale providers via email. After obtaining ethical committee and institutional permissions, the research data were collected between April and July 2025 from women of reproductive age registered at Family Health Center No. 6 in Ağrı province, after obtaining their consent, through face-to-face interviews and questionnaires. Because the study involved questions about genital hygiene behaviors, data collection was conducted in a private room at the family health center to ensure participants’ privacy and comfort. Participants completed the questionnaires individually in an environment where family members or other people were not present. Participants were informed that the study was voluntary, that their responses would remain confidential, and that they could withdraw from the study at any time. No personal identifying information was collected, and all data was used solely for research purposes.
Data analysis
The research data were analyzed using IBM SPSS Statistics 27. Descriptive statistics were presented as frequencies and percentages for categorical variables and as means ± standard deviations for continuous variables. The normality of continuous variables was assessed using the Kolmogorov–Smirnov and Shapiro–Wilk tests, together with skewness and kurtosis values. Although the normality tests yielded statistically significant results for several variables, skewness and kurtosis values were within the acceptable range (± 2), indicating no substantial deviation from normality. Considering the large sample size (n = 366) and the robustness of parametric tests in large samples, parametric analyses were considered appropriate. Student’s t-test was used for comparisons between two groups, and one-way analysis of variance (ANOVA) with Bonferroni post hoc tests was used for comparisons involving three or more groups. Relationships among variables were assessed using Pearson’s correlation analysis. Multiple linear regression analysis was performed to identify factors predicting the total score of the Genital Hygiene Behaviors Scale (GHBS). The assumptions of linear regression were evaluated by examining linearity, independence of errors, multicollinearity, and model fit using residual analyses, the Durbin–Watson statistic, tolerance values, variance inflation factor (VIF) values, and R² statistics. A p-value < 0.05 was considered statistically significant.
Ethical aspects of the research
Ethical committee permission was obtained from the Scientific Research Ethics Committee of Ağrı İbrahim Çeçen University, dated 29.11.2024 and numbered 451. Institutional permission was obtained from the Ağrı Provincial Health Directorate, dated 03.01.2025 and numbered 150, to conduct the study. Participation was voluntary, and informed consent was obtained before the study. The research was conducted in accordance with the principles of the Helsinki Declaration.
Results
The average age of the participants was 27.31 ± 9.20, with 56.8% (n = 208) being single, 38.0% (n = 139) being university graduates, and 78.4% (n = 287) not working. It was determined that 66.1% (n = 242) of the participants had income equal to their expenses, and 62.0% (n = 227) did not have children. When the time spent researching health-related information online was examined, 33.6% (n = 123) of participants reported spending 1 h a day. In addition, it was determined that 61.5% (n = 225) of the participants did not trust the health information obtained from the internet, 57.9% (n = 212) had no health-related concerns, and 85.2% (n = 312) had not received prior training on genital hygiene (Table 1). No statistically significant relationship/difference was found between participants’ age and marital status and their total GHBS scores (r = -0.099; p = 0.59; F = 1.146; p = 0.319). A statistically significant difference in GHBS scores was found by educational level (F = 8.538; p < 0.001), and in the post-hoc analysis, university graduates had higher average scores than other groups. Significant differences were also found in GHBS scores based on employment status and income level (t = 3.891; p < 0.001; F = 3.059; p = 0.048). In contrast, no statistically significant difference was found in GHBS scores based on having children and the amount of time spent researching health-related information online daily (t=-1.844; p = 0.066; F = 0.726; p = 0.624). No significant differences were found between the groups in terms of trust in health information obtained from the internet or in the presence of health-related concerns (t = 1.426; p = 0.155; t = 0.017; p = 0.986). However, it was determined that the mean GHBS scores were significantly different according to whether or not they received genital hygiene education (t = 4.736; p < 0.001) (Table 1).
Table 1.
Comparison of participants’ demographic characteristics with their mean GHBS scores
| Variable | Mean ± SD | GHBS Mean ± SD | Statistic (t/F/r) / p |
|---|---|---|---|
| Age | 27.31 ± 9.20 | - |
r=-0.099 p = 0.059 |
| Marital status | n (%) | ||
| Single | 208 (56.8) |
87.95 ± 8.93 86.48 ± 11.83 84.20 ± 1.79 |
F = 1.146 p = 0.319 |
| Married | 153 (41.8) | ||
| Other | 5 (1.4) | ||
| Education level | |||
| Literate1 | 34 (9.3) |
82.38 ± 11.07 83.45 ± 11.59 86.89 ± 8.60 90.56 ± 9.42 87.75 ± 11.1 |
F = 8.538 p < 0.001 4 > 1.2.3 |
| Primary School2 | 65 (17.8) | ||
| High School3 | 116 (31.7) | ||
| University4 | 139 (38.0) | ||
| Postgraduate5 | 12 (3.3) | ||
| Employment status | |||
| Yes | 79 (21.6) |
91.16 ± 8.96 86.21 ± 10.29 |
t = 3.891 p < 0.001 |
| No | 287 (78.4) | ||
| Income level | |||
| Income less than expenses | 92 (25.1) |
88.45 ± 10.93 86.42 ± 9.59 90.47 ± 11.89 |
F = 3.059 p = 0.048 |
| Income equal to expenses | 242 (66.1) | ||
| Income more than expenses | 32 (8.7) | ||
| Having children | |||
| Yes | 139 (38.0) |
85.94 ± 12.03 88.11 ± 8.85 |
t=-1.844 p = 0.066 |
| No | 227 (62.0) | ||
| Daily internet research time on health-related activities | |||
| No research | 19 (5.2) |
90.26 ± 9.90 86.94 ± 11.75 86.15 ± 9.67 86.93 ± 6.67 82.55 ± 14.64 87.28 ± 10.21 |
F = 0.726 p = 0.624 |
| Less than 30 min | 117 (32.0) | ||
| 30–60 min | 31 (8.5) | ||
| 1 h | 123 (33.6) | ||
| 2 h | 56 (15.3) | ||
| 3 h and over | 20 (5.5) | ||
| Trust in health information (internet) | |||
| Yes | 141 (38.5) |
88.24 ± 9.61 86.68 ± 10.54 |
t = 1.426 p = 0.155 |
| No | 225 (61.5) | ||
| Health-related concerns | |||
| Yes | 154 (42.1) |
87.29 ± 10.60 87.27 ± 9.94 |
t = 0.017 p = 0.986 |
| No | 212 (57.9) | ||
| Receiving genital hygiene training | |||
| Yes | 54 (14.8) |
93.19 ± 11.33 86.26 ± 9.66 |
t = 4.736 p < 0.001 |
| No | 312 (85.2) | ||
*Mean SD, Standard Deviation; F, One-way ANOVA; t, Student’s t-test; r, Pearson correlation coefficient. Bonferroni post hoc comparison for education level: 4 > 1. 2. 3. 1=Literate, 2= Primary School, 3= High School, 4= University, 5= Postgraduate
*GHBS mean scores are presented only for categorical variables. Age was analyzed as a continuous variable using Pearson correlation
Bold values indicate statistically significant results
The mean total GHBS score of the participants was 87.28 ± 10.20. The mean scores of the GHBS subdimensions were 46.01 ± 5.86 for genital hygiene habits, 30.48 ± 4.87 for menstrual hygiene, and 10.78 ± 2.70 for awareness of abnormal findings. The mean total CSS-12 score was 32.19 ± 9.35. The mean scores of the CSS-12 subdimensions were 9.51 ± 3.06 for excessiveness, 9.12 ± 3.00 for anxiety, 7.21 ± 3.26 for reassurance-seeking, and 6.33 ± 2.94 for distress (Table 2).
Table 2.
Average scores of participants on the scales
| Scales | Observed Minimum Score | Observed Maximum Score | Mean ± SD |
|---|---|---|---|
| GHBS | 48.00 | 115.00 | 87.28 ± 10.20 |
| Genital Hygiene Habits Subscale | 21.00 | 60.00 | 46.01 ± 5.86 |
| Menstrual Hygiene Subscale | 13.00 | 40.00 | 30.48 ± 4.87 |
| Awareness of Abnormal Findings Subscale | 3.00 | 15.00 | 10.78 ± 2.70 |
| CSS-12 | 12.00 | 60.00 | 32.19 ± 9.35 |
| Excessiveness Subscale | 3.00 | 15.00 | 9.51 ± 3.06 |
| Anxiety Subscale | 3.00 | 15.00 | 9.12 ± 3.00 |
| Reassurance Seeking Subscale | 3.00 | 15.00 | 7.21 ± 3.26 |
| Distress Subscale | 3.00 | 15.00 | 6.33 ± 2.94 |
SD, Standard Deviation; CSS-12, Cyberchondria Severity Scale Short Form
A multiple linear regression analysis was conducted to determine the variables predicting the total GHBS score, and the model was found to be statistically significant (F = 15.578; p < 0.001). The model explains 14.7% of the variance in GHBS scores (R² = 0.147; Adjusted R² = 0.138), indicating a modest explanatory power. The analysis revealed that the sub-dimensions of excessiveness and reassurance-seeking significantly predicted genital hygiene behaviors positively, while anxiety significantly predicted them negatively (p < 0.001). The distress sub-dimension did not have a significant effect (p > 0.05) (Table 3).
Table 3.
Factors predicting the total score of the GHBS
| Independent Variable | B | SE | β | t | p | %95 CI |
|---|---|---|---|---|---|---|
| Constant | 83.885 | 1.845 | 45.475 | < 0.001 | 80.257 to 87.513 | |
| Excess | 1.035 | 0.207 | 0.311* | 5.000 | < 0.001 | 0.628 to 1.442 |
| Anxiety | -1.135 | 0.211 | -0.334* | -5.378 | < 0.001 | -1.550 to -0.720 |
| Reassurance-seeking | 0.721 | 0.189 | 0.230* | 3.811 | < 0.001 | 0.349 to 1.093 |
| Distress | -0.206 | 0.211 | -0.059 | -0.975 | 0.330 | -0.621 to 0.209 |
For the model, Durbin–Watson = 1.616; F = 15.578; p < 0.001; R = 0.384; R²=0.147; Adjusted R²=0.138. Dependent variable: Genital Hygiene Behaviors Scale (GHBS)
CI, Confidence Interval; SE, Standard Error; β, Standardized regression coefficient
*p < 0.05
In the multiple linear regression analysis examining variables predicting the total GHBS score, the total CSS-12 score was a significant positive predictor in Model 1 (β = 0.118; p = 0.024). Although the model was found to be significant when the age variable was added in Model 2, the effects of the total CSS-12 score and age variables on GHBS were not significant (p > 0.05) (Table 4).
Table 4.
Factors predicting the total GHBS score (multiple linear regression analysis for CSS-12 total score and age)
| Independent Variable | B | SE | β | t | p | %95 CI |
|---|---|---|---|---|---|---|
| Model 1 | ||||||
| Constant | 83.129 | 1.912 | 43.471 | < 0.001 | 79.368 to 86.889 | |
| CSS-12 total | 0.129 | 0.057 | 0.118* | 2.260 | 0.024 | 0.017 to 0.241 |
| Model 2 | ||||||
| Constant | 86.078 | 2.729 | 31.547 | < 0.001 | 80.712 to 91.443 | |
| CSS-12 total | 0.113 | 0.058 | 0.103 | 1.946 | 0.052 | -0.001 to 0.226 |
| Age | -0.089 | 0.059 | -0.080 | -1.513 | 0.131 | -0.204 to 0.027 |
For Model 1, F = 5.107; p = 0.024; R = 0.118; R²=0.014; Adjusted R²=0.011. For Model 2, F = 3.706; p = 0.026; R = 0.142; R²=0.020; Adjusted R²=0.015. Durbin–Watson = 1.567. Dependent variable: Genital Hygiene Behaviors Scale (GHBS)
Abbreviations CI, Confidence Interva;, SE, Standard Error; β, Standardized regression coefficient; CSS-12, Cyberchondria Severity Scale Short Form
*p < 0.05
Pearson correlation analysis showed statistically significant but weak relationships between some GHBS and CSS-12 subdimensions. A weak positive correlation was found between the GHBS menstrual hygiene subscale and the CSS-12 excessiveness subdimension (r = 0.258, p < 0.001). A weak positive correlation was also found between the GHBS general hygiene habits subscale and the CSS-12 reassurance-seeking subdimension (r = 0.245, p < 0.001), whereas a weak negative correlation was observed between the GHBS general hygiene habits subscale and the CSS-12 anxiety subdimension (r=-0.176, p = 0.001). In addition, very weak positive correlations were found between the GHBS awareness of abnormal findings subscale and the CSS-12 excessiveness (r = 0.110, p = 0.035), reassurance-seeking (r = 0.132, p = 0.011), and total CSS-12 score (r = 0.113, p = 0.031). No statistically significant correlations were found between the remaining GHBS and CSS-12 subdimensions (p > 0.05). Overall, these findings indicate a limited association between cyberchondria and genital hygiene behavior subdimensions (Table 5).
Table 5.
Pearson correlations between GHBS subscales and CSS-12 subscales
| Variables | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 |
|---|---|---|---|---|---|---|---|---|
| 1. GHBS-General Hygiene Habits | 1 | |||||||
| 2. GHBS-Menstrual Hygiene | 0.412** | 1 | ||||||
| 3. GHBS-Awareness of Abnormal Findings | 0.271** | 0.255** | 1 | |||||
| 4. CSS-12 Excessiveness | 0.079 | 0.258** | 0.110* | 1 | ||||
| 5. CSS-12 Anxiety | − 0.176** | − 0.038 | 0.042 | 0.571** | 1 | |||
| 6. CSS-12 Seeking Reassurance | 0.245** | 0.099 | 0.132* | 0.423** | 0.320** | 1 | ||
| 7. CSS-12 Distress | 0.046 | − 0.022 | 0.053 | 0.350** | 0.431** | 0.538** | 1 | |
| 8. CSS-12 Total | 0.069 | 0.100 | 0.113* | 0.770** | 0.756** | 0.761** | 0.757** | 1 |
*p < 0.05; **p < 0.01. Pearson correlation analysis was used
* GHBS, Genital Hygiene Behaviors Scale; CSS-12, Cyberchondria Severity Scale Short Form
*Pearson correlation coefficients (r) and corresponding significance values (p) are presented. GHBS: Genital Hygiene Behaviors Scale; CSS-12: Cyberchondria Severity Scale Short Form. *p < 0.05; **p < 0.01
Discussion
In our study examining the effect of cyberchondria on genital hygiene behaviors, we found that education level, employment status, income level, and receipt of genital hygiene education significantly affected genital hygiene behaviors. A study found that women with higher levels of education and income, and those who had received genital hygiene education, exhibited more positive hygiene behaviors [9]. Similarly, other studies have reported that education level, income level, and knowledge of genital hygiene significantly affect genital hygiene behaviors [7, 13]. A systematic review study found that women who received genital hygiene education scored higher, supporting the finding that education strengthens correct hygiene habits [8]. A randomized controlled experimental study determined that video-assisted genital hygiene education was an effective method for improving women’s genital hygiene behaviors and self-care skills [16]. Recent studies have also emphasized that health literacy and access to reliable health information are important determinants of preventive health behaviors among women [17]. In contrast, the lack of statistically significant results for variables such as age, marital status, having children, and health-related internet use suggests that genital hygiene behaviors are shaped by knowledge, education, and awareness levels rather than demographic characteristics.
In this study, participants obtained a mean GHBS score of 87.28 ± 10.20 and a mean CSS-12 score of 32.19 ± 9.35. These findings suggest that genital hygiene behaviors and cyberchondria severity should be interpreted based on their observed scale scores rather than categorical classifications. Çalık et al. reported that women’s genital hygiene behaviors were generally at a positive level; education level and knowledge about genital hygiene positively influenced these behaviors [7]. A study conducted in China with individuals with chronic diseases reported that the level of cyberchondria could vary according to the quality of health-related social media use. That reliable, patient-centered online health communication had a protective effect against cyberchondria by reducing perceptions of uncertainty [5]. A systematic review on cyberchondria indicated that cyberchondria is a multidimensional construct associated with excessive online health information searching, increased health anxiety, uncertainty intolerance, and compulsive reassurance-seeking behaviors. It is emphasized that repeated online searches for health information can increase anxiety rather than reduce it [4]. A study conducted with at-risk groups reported higher levels of cyberchondria in individuals at risk of STIs/HIV [11]. The low level of cyberchondria observed in our study is thought to be related to the general population-based nature of our sample and to the fact that participants did not directly perceive a high health threat. However, these findings should be interpreted with caution, as studies involving HPV- or STI-related populations focus on specific health conditions, whereas genital hygiene behaviors represent routine preventive self-care practices. Furthermore, the absence of a direct study in the literature examining genital hygiene behaviors underscores the originality of our research in this respect. It can also be said that genital hygiene behaviors are influenced not only by digital health information searches but also by individuals’ education level, knowledge base, and access to reliable health sources.
In our study, the fact that the dimensions of cyberchondria—excessiveness and reassurance-seeking—positively predict genital hygiene behaviors, while the anxiety dimension negatively predicts them, suggests that health information-seeking behavior can provide protective effects up to a certain level. Still, increased anxiety can reverse this positive effect. In their study, Zheng et al. define cyberchondria as excessive or repetitive online health information-seeking behavior associated with increased health anxiety. The researchers emphasize that excessive information-seeking behavior, in particular, can increase unnecessary health anxiety [4]. In another study, it was determined that individuals at risk of STIs/HIV had significantly higher levels of cyberchondria compared to the control group; specifically, the risk group scored higher in the sub-dimensions of “excessiveness,” “anxiety,” “reassurance-seeking,” and “compulsion,” and no significant difference was found only in the sub-dimension of “distrust of medical professionals” [11]. A study conducted among young individuals found that preferences for online health information sources influenced intolerance to uncertainty and cyberchondria, and that a tendency towards unreliable sources could increase health anxiety [18]. Mestre-Bach and Potenza stated that cyberchondria share compulsive and addictive characteristics, helping to explain why reassurance-seeking may persist despite increasing anxiety [19]. Our findings are similar to the literature, showing that moderate health information seeking supports genital hygiene behaviors; however, when this process is combined with intense anxiety, the positive effect can be reversed. It is possible that higher levels of anxiety make it more difficult for women to respond to health concerns in a balanced way, which may negatively affect their hygiene practices. Further studies are needed to better understand this relationship. At the same time, these findings suggest that seeking health information online may not always have negative consequences. For some women, access to health information through digital sources may increase awareness and encourage healthier genital hygiene practices.
The fact that the total CSS-12 score alone weakly predicts genital hygiene behaviors, but this effect disappears when the age variable is added to the model, suggests that the effect of cyberchondria on hygiene behaviors is limited and not independent of other individual factors. The model explained a relatively small proportion of genital hygiene behaviors, suggesting that these behaviors are influenced by many factors beyond cyberchondria. This finding may indicate that age-related experiences and behaviors contribute to the observed relationship between cyberchondria and genital hygiene behaviors. A review of the literature emphasizes that cyberchondria is not a fixed behavioral pattern but a complex structure that emerges in interaction with an individual’s psychological characteristics, health anxiety level, and personal traits [3, 4, 19]. Another study found that the probability of cyberchondria decreases with age; however, using newspaper- or magazine-based online health resources and an increased intolerance for uncertainty significantly increase cyberchondria [18]. The low level of correlation between cyberchondria and genital hygiene behaviors in our study suggests that the effect of internet-based health anxiety on these behaviors is limited. Recent evidence also indicates that e-health literacy may buffer the negative psychological effects of online health searching, suggesting that the impact of cyberchondria on health behaviors may depend on individuals’ digital competencies [17]. A review of the literature reveals that cyberchondria is a multidimensional construct related to health anxiety and online health information seeking, and that genital hygiene behaviors can be influenced by numerous factors [3, 4, 9]. A study conducted in Pakistan reported a strong correlation between cyberchondria and health anxiety, with health literacy playing a moderating role in this relationship [17]. This suggests that the effect of cyberchondria on health behaviors is indirect and dependent on individual factors. These findings suggest that cyberchondria may influence genital hygiene behaviors through multiple pathways rather than through a direct linear relationship. The positive effects of information-seeking behaviors and the negative effects of anxiety may coexist, resulting in a complex and multidimensional association between cyberchondria and genital hygiene behaviors. Since there is no study addressing cyberchondria and genital hygiene behaviors, it is thought that there is a need for studies to evaluate the relationship between them.
Results and recommendations
Our study determined that cyberchondria has a limited and multidimensional effect on genital hygiene behaviors, and that genital hygiene behaviors are more influenced by sociodemographic factors such as education, income level, and access to hygiene education. The strong association between prior genital hygiene education and hygiene behaviors highlights the continuing importance of structured health education in promoting healthy practices. Accordingly, it is recommended that initiatives aimed at improving women’s genital hygiene behaviors should include not only hygiene education but also access to reliable digital health information and programs to increase health literacy. Health professionals should also support women in critically evaluating online health information and distinguishing reliable sources from anxiety-provoking or misleading content. It is important for health professionals to guide women, especially those of reproductive age, on the correct evaluation of health information obtained from the internet, and for the findings to be supported by multicenter studies with different samples. Future studies may benefit from using Structural Equation Modeling (SEM) or Partial Least Squares Structural Equation Modeling (PLS-SEM) to further examine the complex relationships between cyberchondria and genital hygiene behaviors and to explore potential mediating or moderating factors.
Limitations
The fact that the research was conducted in a single center with a limited sample size restricts generalizability. The collection of data through self-report may create bias. The scarcity of similar studies limited the comparison.
Acknowledgements
The authors would like to thank all the participants. Without their voluntary participation, this study would not have been possible. We would also like to thank Tübitak for supporting our research.
Authors’ contributions
F.B. and H.Y. designed the study. F.B. and H.Y. contributed to the literature search. H.Y. data collection. F.B. data analysis. F.B. and H.Y. wrote the paper. F.B. provided critical reviews. All authors contributed to the article and approved the final manuscript.
Funding
This research was supported by TÜBİTAK 2209.
Data availability
Research data are not shared. Data will be made available to the editors of the journal for review or query upon request.
Declarations
Ethics approval and consent to participate
Ethical approval was obtained from the Scientific Research Ethics Committee of Ağrı İbrahim Çeçen University (Approval No: 451; Date: 29.11.2024). Institutional permission was obtained from the Ağrı Provincial Health Directorate (Permission No: 150; Date: 03.01.2025). Written informed consent was obtained from all participants prior to data collection. Participation was voluntary, and participants were informed that they could withdraw from the study at any time without any consequences. The study was conducted in accordance with the principles of the Declaration of Helsinki.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
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Data Availability Statement
Research data are not shared. Data will be made available to the editors of the journal for review or query upon request.