Mind the gaps:

Sexual health services have lost £1 billion in funding since 2015¹, and against that backdrop, women face difficulties accessing reliable information and support around menstrual and reproductive health. 

Flo Health research can reveal that:

• Almost one in four women (23%) feel they have learnt more about women’s health from social media than they did in school.
• 72% of women never double-check the health information they get on social media.
• 54% of women were not aware of premenstrual syndrome (PMS) before their first period.
• Almost one in 10 women (8%) think it’s ‘normal’ to soak through a pad or tampon every hour.
  A third of women (35%) are unaware that vaginal discharge changes through your cycle.
• 21% of women feel that masturbation is shameful or wrong.
• More than one in four UK women (26%) don’t understand how sexually transmitted infections (STIs) can be acquired during oral, vaginal, or anal sex.²

This report reveals the situation for women in the United Kingdom right now, makes predictions for the coming year, and provides advice for identifying medically credible content.

Menstrual health

Flo research can reveal that:

• Nearly one in 10 women only learnt about periods when theirs started.
• 54% of women were not aware of PMS (common symptoms women can experience before their period) prior to their first period.³
• A third of women (34%) think period pain or PMS is ‘just something to put up with’.
• Almost one in four women (23%) feel they have learnt more about women’s health from social media than they did in school.
• Only 28% of women double-check the information they get about women’s health on social media.
• More than one in 20 women aged 18 to 24 (7%) go to porn to gain new knowledge about sex and reproduction.
• Almost one in 10 women (8%) believe that it’s ‘normal’ to soak through a pad or tampon every hour.
• 34% of women would like to grow their knowledge of women’s health.⁴

According to the NHS, most girls start their period when they’re about 12. However, they can start as early as 8,⁵ and yet it’s only been compulsory to teach primary school-aged children about periods in England since 2020. 

That may explain why among the women Flo surveyed aged 18 to 55, only 33% first learnt about the existence of the menstrual cycle and periods at school. A quarter (24%) learnt from their parents, but nearly one in 10 (9%) only learnt about periods when they bled for the first time, and the same proportion say they figured it out on their own.⁶

Given starting your period involves bleeding — sometimes heavily — for the almost one in five⁷ girls who weren’t prepared, that may have been a scary experience. Indeed, research by Plan International UK from 2018 found that when girls in Northern Ireland were asked if they had felt prepared for their first period, all of them said no. When describing starting menstruation, they used words and phrases like ‘scared’, ‘horrible’, and ‘I thought I was going to die’.⁸

Mind the knowledge gaps

While today all primary school-aged children are taught about periods, that doesn’t mean we can feel confident that there will be no knowledge gaps going forward. A 2022 study⁹ which surveyed teachers from 789 UK primary and secondary schools revealed that one in four teachers (23%) felt uncomfortable teaching about the menstrual cycle, with less than half feeling confident in their knowledge. 

However, women want to be informed; according to Flo’s research, while women aged 18 to 34 are most likely to admit that they do not have a great understanding of women’s health, 34% say they would like to grow their knowledge of women’s health.

Yet when we look at where they’re going to fill their knowledge gaps, the picture becomes even more alarming, as they are also — perhaps unsurprisingly — the group most likely to access poor-quality information online.¹⁰

TikTok as teacher

Flo research found that nearly one in five women aged 18 to 24 (18%) turn to social media for information around menstrual health, with the same proportion accessing online forums like Reddit and 16% going to YouTube.¹¹

At the same time, fewer than a third of women (28%) double-check the information they get about women’s health on social media, despite research showing it is often inaccurate.¹²

It’s understandable that women would turn to social media or AI for answers. TikTok is the world’s most downloaded app, with over 1 billion monthly active users and 3.5 billion downloads,¹³ while AI chatbot ChatGPT is the ‘fastest-growing consumer application in history’,¹⁴ but these platforms cannot be trusted to provide accurate or credible health advice.

Fertility experts are constantly fighting a tidal wave of disinformation online: TikTok videos that claim that the colour of your period blood reveals deficiencies or that if you ‘optimise’ your periods, they won’t last more than three days. To compound the issue, research has shown that our internet literacy is lacking, so we may not spot falsehoods.¹⁵ According to the Department for Digital, Culture, Media & Sport, there are still key gaps and issues in the United Kingdom’s media literacy landscape that need to be addressed. For instance, 40% of users do not have the skills to critically assess online content.

A 2022 Ofcom report showed that 30% of adults did not know or did not consider the potential truthfulness of online information at all, and 6% believed that all the information they find online is truthful. Nearly two-thirds (61%) of adult social media users who felt confident in judging whether online content is true or false lacked the skills to do so,¹⁶ and 34% of 16- to 24-year-olds think that if websites have been listed by a search engine, they will contain accurate and unbiased information.¹⁷

But when women don’t have the information they need to safely manage their periods, they increasingly head online to fill in the blanks. Flo’s research reveals that 56% of all British women aged 18 to 55 rely on search engines for their information about menstrual health, making search engines women’s next most trusted health resource after doctors.

Confusion in the capital

While a third of women across the United Kingdom first learnt about the existence of the menstrual cycle and periods at school, with nearly one in 10 (9%) looking to social media when they want to gather more information about periods, in some regions the knowledge gap could be worse.

In the capital, only 20% of women first learnt about periods at school, with more saying they picked up that information from a friend (23%). Today, Londoners are most likely to use social media to gather information about menstrual health, with almost twice the national average, nearly one in five (17%), relying on these platforms.

Londoners are also most likely to say they learnt more about women’s health from social media than they did in school. Nearly a third (32%) agree with this statement,¹⁸​ and only a third (34%) go to other sources to check if the information they gained is true. It’s a problem that’s at risk of continuing, given Ofcom found that a majority of children under 13 have their own profile on at least one social media app or site; 33% of parents of children aged 5 to 7 said their child had a profile, and 60% of those of children aged 8 to 11 said they had one.¹⁹

Regional talking points

• 33% of women first learnt about the existence of the menstrual cycle and periods at school, but this is only true for 20% of Londoners.
• More than half of British women (54%) were not aware of PMS before their first period, rising to 72% among women in Oxford. 
• 32% of Londoners feel they learnt more about women’s health from social media than they did in school.
• Within the United Kingdom, Londoners are the ones who are most likely to use social media to gather information about menstrual health, with nearly one in five (17%) relying on these platforms.

Menstrual products shrouded in mystery

When it comes to where we first learnt how to use menstrual products, 10% of women told Flo they had to figure it out on their own.²⁰ As recently as 2020, there were knowledge gaps. Department for Education research found that schoolgirls didn’t just find tampons difficult to use but ‘were not sure how to use them properly’.²¹  While period product schemes mean UK girls should now be provided with the relevant usage information, that has only been the case since 2022.²²

Being unprepared can have negative consequences. ‘Menstrual products that aren’t used correctly can be uncomfortable or painful. For example, menstrual cups and tampons are a great option for some people, but if put in or removed incorrectly, they may feel uncomfortable,’ says Dr Claudia Pastides, general practitioner (GP) and medical advisor at Flo Health. Missing out on information around how to use menstrual products when you’re young can mean you avoid using them in adulthood, wrongly but understandably assuming they are uncomfortable.

Far-reaching impacts of female cycles

Flo research also reveals that more than half of British women (54%) were not aware of PMS before their first period.²³ That’s a significant knowledge gap, says Dr Pastides. ‘If you know what PMS is and can recognise the symptoms in yourself, you’ll be able to speak to a health care professional about it with much more ease and get help and advice,’ she explains.

Just 31% of women feel that most of their knowledge about their menstrual cycle has been accurate, and overall, British women have revealed themselves to have a poor level of knowledge of the phases of the menstrual cycle. Only 21% and 17% could name the luteal and follicular phases, respectively. With increasing evidence that our cycle phases impact everything from mental health²⁴ and exercise²⁵ to diet²⁶ and sleep,^27,28, there’s a strong and growing argument that a solid understanding of these cycle phases matters.

Dr Pastides comments, ‘Each of the cycle phases have a different hormone pattern from one another, where one hormone may be higher or lower, rising, or falling. Knowing what your hormones are up to and how they may be impacting your mood, energy, sex drive, appetite, and so on is fascinating and can also help you understand why you may be feeling a certain way one day and another the next.’

Understanding our cycle phases gives us important insights into our overall health, but a third of British women (35%) don’t know that vaginal discharge changes throughout the menstrual cycle. Again, Dr Pastides argues this is valuable knowledge to have: ‘Discharge changes throughout the cycle in response to hormones. For example, it gets slippery, stretchy, and resembles egg whites around the time of ovulation,’ says Dr Pastides. If you’re trying for a family, this is useful knowledge to have.

Discharge is also an important indicator of other health issues. ‘It is important to be able to recognise what changes in discharge are normal for you and your cycle, as changes out of the norm may be a sign of infection, both sexually transmitted (e.g., chlamydia) and non-sexually transmitted (e.g., thrush). Being able to spot what discharge is healthy and what might not be will mean you can get medical advice and treatment early,’ says Dr Pastides.

Mind the myths

Sexual health

There are some worrying trends when it comes to sexual health in the United Kingdom. Cases of gonorrhoea³⁵ have jumped 21% since 2019, and thanks to £1 billion of cuts from local council budgets, there has been a 17% reduction in spending on STI testing, contraception, and treatment over seven years.³⁶ This makes knowledge around STIs and unplanned pregnancy prevention even more crucial.

Flo research can reveal that:

• When asked about their knowledge of common STIs like chlamydia and human immunodeficiency virus (HIV), 27% of women said they’d heard of them but felt they weren’t familiar, while one in 50 (2%) had never heard of them.
• Women aged 18 to 24 are nearly 10 times more likely than women aged 44 to 55 to turn to social media for reproductive health information.
• One in four British women (26%) don’t understand how STIs can be acquired during oral, vaginal, or anal sex.
• Two in every 100 women turn to porn to gather new information on sex and reproductive health, rising to seven in every 100 women aged 18 to 24.
• Just 19% of British women know how many days a month they’re fertile for.
• When deciding on a form of contraception, close to one in 10 women (18%) don’t do any research at all.
• Almost one in six women (18%) think that it’s harder to get pregnant after coming off birth control.³⁷

Teachers, families…porn

Flo research shows that many participants found school to be the top source of information when it comes to first learning about what causes pregnancy and how to prevent it (43% and 46% respectively), followed by a parent, relative, or friend. But when seeking information on sex and reproductive health more generally, nearly one in four British women (39%) turn to search engines, 14% figure it out for themselves, and 2% learn from porn, rising to 7% of 18- to 24-year-olds.³⁸

Pornography, though, has been found to normalise sexual aggression, to breed a lack of empathy towards women, to shape unrealistic expectations of what women want and enjoy doing sexually, and is associated with an increased likelihood of committing both verbal and physical acts of sexual aggression.³⁹

Social media teaches sex ed?

Women aged 18 to 24 are more than 20 times more likely to turn to social media to gain new knowledge about sex and reproduction than women aged 44 to 55 (22% versus 1%). In the capital, 13% of women seek out this information on social media.

These platforms are poorly regulated and therefore rife with misinformation, but influencers’ opinions hold serious sway.⁴⁰ Recent research⁴¹ that analysed advice given by social media influencers found that they regularly provide inaccurate sexual health information.

It’s a worryingly similar picture to menstrual health. When women aged 18 to 34 want sexual and reproductive health information, search engines attract 41%, nearly 10% go to YouTube, more than one in 10 (11%) go to social media, and the same proportion turn to online forums.⁴² 

So what actions do women take to check for accuracy? Worryingly, nearly one in 10 women (9%) do nothing. The most common source for fact-checking is the internet (for 46% of UK women), but given what we know about the pitfalls of search engine use, that doesn’t necessarily mean they’ll be getting any clarity. Four in 10 women would ask their doctor; and 36% would turn to a friend, peer, parent, or relative; but 8% would search on social media to fact-check.

When deciding on a form of contraception, British women are most likely to speak to a doctor or nurse (57%), and 27% access the NHS website, but 8% revealed that they don’t do any research at all.

Unfamiliarity bites: sexually transmitted infections

With HIV testing rates far lower than they were in 2019, increases in sexually transmitted infections including gonorrhoea and syphilis,⁴³ and sexual health services dealing with a backlog in the aftermath of mpox (previously known as monkeypox),⁴⁴ women need to be clued up. It’s worrying, then, that many British women are unfamiliar with common STIs like chlamydia and HIV. Two in every 100 women (2%) have never heard of them.⁴⁵

A lack of knowledge can have far-reaching implications, as Dr Pastides points out. ‘Some STIs can cause long-term problems if left untreated, such as infertility, pain, and even some types of cancer. Being aware of safe sex and how to reduce the spread of STIs, plus how and when to get tested and how to spot the signs of an STI, can help keep you and any sexual partners healthy.’

More than a quarter of British women (26%) don’t understand how STIs can be acquired during oral, vaginal, or anal sex, and nearly six in 10 British women (59%) don’t know that you can catch an STI without having sex. ‘Feeling embarrassed can be a barrier to preventing STIs,’ warns Dr Pastides. ‘People may fear judgement or feel ashamed when it comes to talking about sex, and this unfortunately can lead to infections going untreated and being spread to others.’

Contraception concerns

Government figures show that 45% of pregnancies and one-third of births in England are unplanned or associated with feelings of ambivalence,⁴⁶ so knowledge around contraception is key.

However, among the 41% of UK women using contraception, nearly one in 10 women (8%) wrongly believe that the pullout method is 90% or more effective at preventing pregnancy — a worrying statistic for medical professionals.

‘Pulling out can be very difficult to do perfectly, and research has found that with “typical use”, meaning in real life, it’s 80% effective,’ says Dr Pastides. ‘This means that, typically, one in five women using this method of contraception will fall pregnant within one year. The other important thing to know about using the pullout method is that it doesn’t protect against STIs.’

Missing fertility facts

There are also knowledge gaps around fertility; only 19% of British women know how many days a month they’re fertile for, and nearly half (46%) don’t know when in their cycle is the best time to have sex if they want to get pregnant. ‘Knowing how many days of the month you’re fertile for increases your chances of getting pregnant,’⁴⁷ says Dr Pastides. ‘Knowing when you’re likely to ovulate and the fact that sperm can live in the female reproductive tract for up to five days, you’ll be aware of when your six-day fertile window is.’

Mind the myths

Regional talking points

• When seeking information on sex and reproductive health, nearly one in 10 women in Bristol (9%) learn from porn.
• 13% of women in London go to social media to gain new knowledge about sex and reproduction.
• 13% of Liverpudlians have never heard of STIs.
• 67% of women in Gloucester and two-thirds of women in Edinburgh (66%) don’t use any form of contraception.
• One in five women in Brighton and Hove (20%) use the pullout method as contraception.
• 18% of women in Cambridge and one in 10 Londoners mistakenly believe you can’t get pregnant while breastfeeding.
• 17% of women in Cambridge and Bristol think you need to have an orgasm in order to conceive.

Stubborn taboos we still haven’t shaken

Despite mandatory sex education, we have a way to go when it comes to shaking off taboos. Indeed, in 2022, UK researchers who looked into sexual health in modern Britain concluded that ‘there is still significant stigma around sex and sexual health’.⁵¹ Our research reflects this.

• Flo research can reveal that:
• More than a fifth of British women believe that masturbation is shameful or wrong.
• 29% of British women feel embarrassed to talk to their partner about what they like during sex.
• Nearly one in 10 think the more sex you have, the looser your vagina will be.
• 44% of British women avoid having sex on their period.
• More than one in 10 women (11%) wrongly think you should wash inside your vagina.⁵²

One area where Flo has identified a stubborn sense of shame is masturbation. More than a fifth of British women (21%) either strongly or somewhat agree with the statement ‘masturbation is shameful or wrong’. One reason for this may be a lack of information around it, which gives the impression it’s somehow ‘wrong’.

Recently, there has been alarm around sex education including information about masturbation.⁵³ The fact it’s such a contentious issue may in part explain why this sense of shame is stronger among younger women; a quarter of those aged 18 to 34 (25%) agree or somewhat agree that masturbation is shameful or wrong versus 15% of women aged 45 to 55.

Female masturbation as a sexual right

British women are also more likely than American women to associate shame with masturbation (21% versus 18%). Perhaps it’s something to do with a reluctance to talk about it. While British women are on average 11.5 years old when they first learn about sex, they are 13.4 years old when they first learn about masturbation.

While the UK government has ordered a review of sex education in light of concerns its content is age inappropriate,⁵⁴ one piece of research⁵⁵ including European and North American women found that female masturbation was not covered in sexual education, but 59% of participants felt it should be. It also revealed that 59% of women always orgasmed while masturbating solo, but only 15% orgasmed during sexual intercourse with a partner. The researchers concluded that in avoiding mentioning female masturbation, sexual education programs fail to prepare students for safe, consensual sex.

When pleasure is off-limits

Masturbation is one way women can work out what is pleasurable for them, so the stigma around it has a knock-on impact on female pleasure. That’s made worse as three in 10 British women (29%) feel embarrassed to talk to their partner about what they like during sex.⁵⁶ If we’re too uncomfortable to discuss our sexual needs, put simply, they may well not be met. 

Another area women can struggle to navigate is whether to have sex during their period. Nearly half of British women (44%) avoid having sex on their period. It’s understandable that some women may not want to have sex, but avoidance shouldn’t be thanks to any sense of shame or fear.

Mind the myths

Flo research has revealed some old wives’ tales, and new social media nonsense has firmly lodged itself as fact in women’s minds.

Regional talking points

• 22% of women in Wolverhampton attach shame to masturbation.
• 14% of women in Belfast didn’t learn about masturbation until they were aged 21+.
• Almost half of women in Wolverhampton (44%) ‘strongly agree’ that they are sometimes embarrassed to talk to their partner about what they like during sex. 29% of women in Gloucester and 22% in Cambridge also feel this way.
• 76% of women in Coventry don’t avoid period sex; 80% of women in Aberystwyth do.
• 25% of women in Wolverhampton wrongly think you should wash inside your vagina.
• 23% of women in Brighton and Hove think that nipple hair isn’t normal.

What next? Predictions for the future

Flo predicts three key trends will take precedence over the next year.

Artificial intelligence (AI) is a major talking point. In positive news, AI has been shown to cut cancer waiting times,⁵⁸ accurately read mammograms,⁵⁹ and speed up skin cancer diagnoses,⁶⁰ but there are many ethical concerns⁶¹ around its use in medicine, regarding everything from privacy to the loss of human kindness and empathy.

The highly publicised launch of ChatGPT has attracted plenty of interest, but while AI has the potential to reduce diagnostic and therapeutic errors as well as help detect diseases faster, experts at Flo Health suggest that it still needs to be trained to produce unbiased information, as opposed to inheriting and propagating gender bias in health. 

It’s well documented that within medicine and medical research, women — particularly women of colour — are underrepresented. That ‘gender gap’ means there is less information available on women’s health for AI to learn from, making it likely that it will perpetuate male bias. 

While the technology has advanced rapidly, it cannot accurately and ethically answer personalised questions about health, especially women’s health topics. As such, the medical experts at Flo predict that AI will play a significant and increasing role in the future of health, particularly as it is fine-tuned and becomes more accurate. 

While AI is likely to perform many tasks within health care, potentially speeding up diagnoses and helping to suggest the most appropriate treatments, medicine is an art as well as a science, and the subtle nuances within it are always likely to require a human touch.

Misinformation and deliberate disinformation will continue to exist across the internet and social media platforms, but Flo Health predicts that an increasing number of medical influencers will try to redress the balance, sharing medically credible information and tackling shame. 

With the pandemic having exposed how vulnerable we are to health misinformation and how dangerous that can be, efforts will be made to increase digital literacy. As such, Flo predicts that we will become increasingly aware of how to identify misinformation and disinformation and more knowledgeable about how to access trustworthy sources online.

Friend or foe: Assessing expertise online

Whether via a podcast, a social media account, or a blog, many people now follow medical influencers, but it’s important to be discerning.

A series of letters after someone’s name, a white lab coat, a stethoscope slung around their neck, personal experience of a particular condition … These things don’t always mean that the person speaking is credible or what they’re saying applies to you. Here, Dr Pastides explains how to spot credible influencers:

1. Check their qualifications: Is the doctor you’re following for advice about women’s health an obstetrician, gynaecologist, or a GP? Check the qualifications they list on their social profile / website / Linkedin profile (e.g., university degree, medical or surgical training qualifications, society membership, etc.).
2. Question their claims: A good and sensible clinician is aware of the limitations of sharing health information online, so they should explain that not all the information they give is suitable for everyone to follow. 
3. Look for references: Check if the medical influencer shares references for any cited statistics or facts. Then check out that research to see if it is credible. For instance, is it from the World Health Organization, Centers for Disease Control and Prevention, NHS, etc.? Don’t hesitate to question where someone got a statistic if it isn’t clear.
4. Don’t buy into ‘miracle cures’: In medicine, there are rarely quick-fix solutions and even fewer that would apply to everyone. If an online doctor is promoting something that seems hard to believe (e.g., juice cleanses, dietary restrictions, etc.), it often isn’t credible.

In the age of technology and with traditional sources of information under increasing threat, women will supplement their menstrual and sexual health knowledge with personalised health insights. 

As explored, search engines, social media, and AI tools don’t always provide the most relevant or even medically accurate results. If you want to know why your period hasn’t arrived or how to determine if you are ovulating, you may find a long list of confusing and potentially inaccurate information that doesn’t even answer your questions. You need information that is tailored to you, your body, and your cycle.

The most relevant information for you

Through its machine-learning model, Flo Health uses the information you log in the app about your body and your cycle, such as days of menstruation and different symptoms of your experience, to provide the most relevant insights tailored to you. This means that the more you log, the more you learn.

Women deserve better, what Flo is doing

Women want to increase their knowledge about their own bodies, with good reason. Limited health literacy is linked with unhealthy lifestyle behaviours and an increased risk of premature death. Menstrual health affects women for most of their lives, while knowledge around sexual and reproductive health helps them to start families at the time of their choosing, avoid STIs, and enjoy a healthy and pleasurable sex life.

Being well informed about your health is empowering, so it’s no wonder women want to take charge of it. Nearly nine in 10 Flo users (89%) say Flo has helped them feel more informed and educated about their cycle health.⁶³ Beyond helping individual women to better understand their bodies, Flo is also actively helping to close the medical research gender gap and producing medically credible content to help inform millions of women.

Disclaimer: If you are ever concerned about your health, please get in contact with your primary care physician or a medical provider.

Disclaimer: As a note, Flo Health uses the terms ‘women / woman’ interchangeably with ‘female’ in this report, as our research only sampled those who identify as ‘women.’ However, Flo Health recognises that both sex and gender can exist on a spectrum. We aim to be inclusive of all people born with female reproductive organs, regardless of gender, anyone who identifies as a woman, and all individuals who menstruate.

About Flo

At Flo we recognise that every woman’s body is different, and every woman’s experience with menstrual and reproductive health is unique. Flo Health works with experts in female health and produces hundreds of evidence-based, medically accurate articles to help women access useful information, because when we understand our bodies, we can get the most out of them physically and emotionally. Breaking down supposedly taboo topics and discussing subject matter that can feel off-limits within families ultimately improves health literacy. That matters, because low health literacy is a direct contributor to the spread of misinformation⁶⁴ and leads to poor health outcomes and unhealthy behaviours,⁶⁵ especially in the areas of menstruation and sexual and pregnancy health. 

Flo is aligned with the World Health Organization⁶⁶ in the assertion that every woman has the right to accurate information and education as well as access to necessary health care.