Can AI Teach Sex Ed? A Systematic Review of the Use of Artificial Intelligence in Sexual and Reproductive Health Education

Background: Artificial intelligence (AI) is evolving and expanding at an unprecedented rate across healthcare and education. AI for sexual health education has the potential to reduce sexual health stigma, provide convenience for many populations of all genders, sexualities, and ages who were previously receiving insufficient or outdated information, and reduce the resources needed to provide this essential education. The aim of this systematic review is to assess the acceptability, feasibility, and impact of generative AI in sexual and reproductive health education. Methods : We searched PubMed, Web of Science, and Scopus in August 2024 combining artificial intelligence and sexual education search terms. We included experimental and observational studies of any analysis technique published between 01/01/2014-8/16/2024. Data was managed in Covidence. Screening and extraction utilized two non-expert reviewers. Quality assessment utilized the Mixed Methods Appraisal Tool and reporting adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist. Results: Initial database search yielded 4,044 records, 21 full-text articles meeting inclusion criteria. All were observational studies. Data included 146,990 individual participants (mean=7000, median=100) from eight countries. Five (23.8%) compared an AI chatbot to another format of sex education. Eighteen studies assessed acceptability, 12 studies assessed feasibility, and 13 studies assessed impact. Users of AI primarily seek factual information, find the chatbot's responses easy to understand, and appreciate the immediate responses compared to human responses. AI helps users exercise sexual rights, discuss sexual feelings/needs, and learn information about HIV and family planning. However, chatbot responses differ in tone and empathy than human responses and require long reading times. While chatbots are generally viewed as clinically safe and hold potential for providing accessible sexual health information, users show skepticism about their credibility for sensitive topics compared to human interactions. Conclusions: Usage of AI is surpassing high-quality evidence about its acceptability, feasibility, and impact. While initial studies show promise of AI chatbots for presenting sexual health information, high-quality, randomized studies with human participants and comparator groups are needed before AI can be trusted to successfully deliver such education.