Purpose: This paper provides a systematic review of the published literature examining the association between sexting and self-esteem in adolescents. It further attempts to identify gaps in the current literature and provide recommendations for future research as well as patient care and education. Methods: Electronic databases (CINAHL Plus with Full Text, Iceberg, and PsycINFO) were searched with publication dates between January 1, 2014 and September 30, 2019. The keywords used to conduct the search were: sexting, adolescents, self-esteem, youth, and teenagers. All records were screened to meet established criteria. The inclusion criteria included the following: a) articles written in the English language, b) study includes a comparison between sexting and self-esteem, c) study includes human subjects, and d) age of subjects is between 13 and 19. Studies where cyberbullying was the main component of the study methodology and consisted of instruments with lack of validity evidence were not included in the review. The review was conducted in concurrence with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: In total, 7 studies were included in the systematic review. Results suggest that sexting and self-esteem are associated, with an increased likelihood of sexting in adolescents with low self-esteem. Adolescents engaged in sexting behavior reported lower emotional self-efficacy (p < 2 0.01, 95% CI [0.22-0.61]) and self-esteem (p < 0.05, 95% CI [1.02-1.12]). Female adolescents were more likely to engage in sexting than male adolescents. Conclusions: Although research in sexting is no longer in its infancy, more research examining the association between sexting and self-esteem is needed. With an increasing prevalence of sexting behavior, it is also important for schools, parents, and clinicians to incorporate the discussion of sexting and its negative effects with adolescents. Thus, a greater emphasis on developing and implementing programs and interventions is necessary.