Pornography Use Effects

A synthesis of quantitative and neuroscience studies (2015-2020) by GuardYourEyes.

For more context see here.

Effects relevant to GYE members

Out of control pornography use affects mental health, relationships and happiness. Out of control pornography use makes people more likely to have depressive symptoms, low self-esteem and doubt their ability to succeed in life. Out of control pornography use can also make one feel socially excluded and less psychological happy overall in terms of a sense of freedom, belongingness and competence in one's life. Bőthe et al., 2020a^[1]

Pornography can get you addicted. Men having problems with controlling their pornography use have brain patterns similar to those seen in gambling and substance addicts. The intense craving for pornographic material seems to be responsible for problems associated with pornography use such as extended time spent watching pornography. Gola et al., 2017^[2]

Watching porn? Your sex life might suffer. Watching porn can affect life in a couple: when men watch more porn, their partners have lower sexual desire and they are less likely to have sex with their partner. Relationship satisfaction was not affected by porn use in this study. Vaillancourt-Morel et al., 2020 (in-press)^[3]

Out of control porn use can cause sexual function problems. Out of control porn use (not necessary frequent) has been linked to sexual function problems in both men and women in a study with more than 14,500 participants. Bőthe et al., 2020b^[4]

Porn can cause men to distortedly see women as more likely to engage in porn-like sex. In a new study, men that have watched reality-like porn in the past (e.g. taxi driver and sex with work colleague scenarios) judged women to be more likely to engage in porn-like sex, providing evidence that pornography can distort men’s views and sexual expectations and have a negative impact on the lives of both men and women. Miller et al., 2019^[5]

Younger males more at risk for out of control sexual behavior and associated mental health issues. Almost 9% (8.96) of individuals were found to meet clinical criteria for out of control sexual behavior in a large study in Spain. Young males were more likely to be affected and experience depressive and anxious symptoms, and poorer self-esteem due to out of control sexual behavior. Castro-Calvo et al., 2020^[6]

If porn is a problem, your brain will suffer too. In a fMRI/ neuroscientific study, people with excessive sexual behavior (e.g. high use of pornography) had worse memory performance and brain processing compared to healthy individuals. Sinke et al., 2020^[7]

Out of control pornography use has deep consequences but treatment works. Men seeking help for out of control pornography use at a clinic in Sweden described a myriad of problems associated with their condition including spending extended time watching pornography (some entire days or nights), escalating from using pornography to purchasing sexual services and feelings of anxiety, fear, guilt and shame as well as damaging effects of their relationships. At the same time, treatment and therapy worked and significantly improved their symptoms and problems. Kjellgren et al., 2019^[8]

Porn makes people less moral. A large survey and one experiment prove that viewing pornography causes people to behave less ethical. Pornography seems to dehumanize others and thus make one more likely to behave morally wrong towards them. Unethical behavior has been linked to criminal behavior. Mecham et al., 2019^[9]

Compulsive use of porn has negative effects on human sexuality. People who have trouble controlling their sexual urges are more likely to be anxious, depressed and fearful and less in control of their sexuality. Moreover, intense sexual urges affect people's self-esteem and sexual satisfaction. Kowalewska et al., 2019^[10]

Clinicians describe the dangers of porn. More than 180 clinicians seeing patients with porn and sex related problems responded to a survey showing that porn and sexual addictions can easily get out of control and produce serious consequences such as affecting everyday activities, relationships and even causing financial problems. Short et al., 2016^[11]

Effects: Preoccupation with sexual activity, Recurrent failures to control sexual activity/behaviors, Interference in everyday activities, Sexual activity or behavior that lasts longer than intended, Continuation of sexual activity/behavior despite negative consequences, Need for more sexual activity/behavior to obtain desired result, Physical or psychological distress if unable to act on sexual thoughts (i.e., anxiety, depression), Thoughts about quitting or attempts to quit acting on sexual thoughts/behaviors that are unsuccessful, Interference with relationships, Financial problems related to the cost of sexual activity/material, (less frequent) Legal charges due to sexual activity or behaviors.

Porn forces men to hide in shame. New study provides an in-depth account of men's problems with pornography use. Participants talked about the secrecy around their issue and the need to keep it hidden from close friends, family members, and partners, the difficulties in attempts to reduce or abstain from viewing pornography and using pornography as a way of escaping, and avoiding stressful feelings. Sniewski & Farvid, 2020^[12] Out of control pornography use linked to more violent sexual fantasies and acts. Out of control pornography use has been linked to sexually coercive fantasies and behaviors. Compulsive pornography use also increases the risk of depression and problematic cybersex. Engel et al., 2019^[13]

Effects:
Fantasies of sexual coercion: 59% of men and 18% of women

Acts of sexual coercion: 21% of men and 4% of women

Depressive symptoms

For married members

Masturbating to porn? Your relationship may suffer. Two large surveys from U.S. found that masturbation has a significant negative impact on relationships for both men and women. Masturbation seems to be more harmful for relationships than porn alone. Perry, 2020^[14]

Young guys preferring to masturbate to porn at higher risk for sexual dysfunction. Young men who prefer masturbation with pornography over partnered sex have a significantly higher risk of sexual dysfunction, shows a survey among 518 people working in military services. Porn and sexual dysfunction were more common in young men in this study. Erectile dysfunction issues were lowest (22.3%) in those preferring partnered sex without pornography and increased to 78% when pornography was preferred over partnered sex. Berger et al., 2019^[15]

Additional Effects

Pornography exposure in adolescence has lasting effects. Exposure to pornography as a teen has harmful consequences that can last more than 10 years. Teenagers exposed to pornography were more likely to have their first sexual act before age 17, contract sexually transmitted infections (e.g., gonorrhea) and have an unplanned or teen pregnancy. The negative consequences of pornography exposure persist at least until young adult years, the study found. Lin et al., 2020^[16]

Porn damages the lives of almost 10% of us. In a nationally representative study, 8.6% of individuals (7.0% of women and 10.3% of men) had a clinical-level of distress and/or impairment due to difficulty controlling sexual feelings, urges, and behaviors. Dickenson et al., 2018^[17]

Watching more porn leads to unsafe sex. Watching more porn leads to increased sexual risk, shows an analysis of studies from 18 countries with more than 35,000 participants. The analysis found that pornography drives up participants' excitement too high resulting in more unsafe sex, especially if the pornographic material viewed featured sex without condoms (which is the case with most porn on the internet). Tokunaga et al., 2020^[18]

Overview of Studies

Population	Diagnostics	Study Type	Effects
Teenagers Adults Treatment-seeking Couples	Exposure to pornography / sexually explicit media Problematic pornography use (PPU) Masturbation (solo or excessive) Compulsive sexual behavior disorder (CSBD)	Survey Clinical (treatment) Longitudinal Dyadic (couples), daily diary fMRI / neuroscience Meta-analytic	Personal addiction psychological distress cognitive performance Relational satisfaction Public health risky sexual behaviors sexually transmitted infections (STIs) teen or unplanned pregnancy

Background

Pornography use has been recently defined as “a common but stigmatized behavior, in which one or more people intentionally expose themselves to representations of nudity which may or may not include depictions of sexual behavior, or who seek out, create, modify, exchange, or store such materials” (Kohut et al., 2020, p. 733).

In recent nationally representative studies of Australian, US, and Polish participants, 70% to 85% of participants have ever used pornography in their lifetime with 85% of males reporting lifetime pornography use (cf. Bőthe et al, 2020b).

10.3% of men and 7.0% of women endorsed clinically relevant levels of distress and/or impairment associated with difficulty controlling sexual feelings, urges, and behaviors in a recent US nationally representative sample (Dickenson, 2018).

Objective

To determine the effects of pornography use at the personal, relational and public health/societal level.

Search methods

Google Scholar, PubMed, and ScienceDirect were used to identify studies. The reference lists of relevant articles was also consulted.

Inclusion criteria

Criteria for selecting studies included:

Recency: published between 2015 to date (Aug 2020, including in press articles)
Quantitative design: reported data on quantitative assessments of 1) pornography use or exposure and 2) effects of pornography use or exposure.
High quality methodology: robust sampling and data analysis methods.

Data collection and analysis

Steps:

20 studies that have matched the inclusion criteria have been analysed in-depth and summarised
7 studies deemed highly relevant for the GYE community (e.g. population similarity) were included in the present synthesis.

Studies have been assessed for methodological quality according to criteria specified by Fisher and Kohut (2020), namely:

AA - meta-analytic or systematic review studies

A - longitudinal, experimental or neuroscience studies

B - correlational studies

C - descriptive studies

A “+/-” indicator was also used to denote a large or small number of study participants. Key findings are presented below.

Key findings

Crt.	Study	Population	Study design + sample size	Predictor	Effects	Effect size	Strengths & limitations	Study quality (A-C)
1	Lin et al., 2020	Teenagers / young adults, Taiwan	Longitudinal ( Taiwan Youth Project) with 10-wave measurements, first wave in 7th grade (mean age = 13.3) and the tenth wave in emerging adulthood (mean age = 24.3)	Exposure to sexually explicit media	- earlier onset of first sexual intercourse (first sexual act before age 17) - unsafe sex (e.g., inconsistent condom use) - more sexual partners (i.e., high partner change rate) - sexually transmitted infections (STIs; e.g., gonorrhea) by association with risky sexual behavior - unplanned or teen pregnancy (by association with risky sexual behavior)	Large	No serious limitations	A+
2	Bőthe et al., 2020a	General population, large sample (online)	Correlational, 3 nonclinical samples recruited from general websites and a pornography site (study 1: N = 14,006; study 2: N = 483; study 3: N = 672)	Problematic, high frequency use of pornography	- depressive symptoms - lower self-esteem - relatedness frustration (e.g. feelings of exclusion from the group one wants to belong to) - lower relatedness satisfaction (e.g. feeling that the people one cares about also care about him/her) - competence frustration (e.g. serious doubts about whether one can do things well) - affected well-being (overall frustration in the basic psychological needs of autonomy, relatedness and competence)	Large	High generalizability (large, non clinical sample) Correlational (no causality can be inferred)	B+
3	Gola et al., 2017	Treatment seeking heterosexual males	Functional magnetic resonance imaging (fMRI) study among 28 heterosexual males seeking treatment for problematic pornography use and a control-group with 24 heterosexual males without problematic pornography use	Problematic pornography use	- addiction-like effects - extended time spent watching pornography - more frequent masturbation	Large	Small sample size	A-
4	Perry, 2020	U.S. nationally representative sample(s)	Correlational, two US national surveys: the 2012 New Family Structures Study (NFSS; N = 1,977) and the 2014 Relationships in America survey (RIA; N = 10,106)	Pornography use Solo masturbation (with or without pornography use)	Slight positive association between relational happiness and pornography use (once masturbation and gender differences are accounted for) Negative association between solo masturbation and relational happiness (for both men and women)	Small for pornography-relational happiness association (positive) Large for masturbation-relational happiness (negative)	The surveys did not measure if pornography was watched with the partner or solo	B+
5	Dickenson et al., 2018	U.S. nationally representative sample(s)	2325 adults (1174, 50.5% female; mean age = 34 years)	Compulsive sexual behaviour (difficulty controlling one’s sexual feelings, urges, and behavior)	Distress: feeling ashamed because of the sexual behavior, engaging in sexual behavior as a means of emotion regulation Psychosocial impairment: social, interpersonal, and occupational consequences.	Large	Correlational study, causality cannot be inferred.	B+
6	Castro-Calvo et al., 2020	General population, large sample (Spain)	Two independent community samples: sample 1 included 1,581 university students (females = 56.9%; mean age = 20.58) whereas sample 2 comprised 1,318 community members (females = 43.6%; mean age = 32.37)	Compulsive sexual behavior	More depressive and anxious symptoms Poorer self-esteem	Large for depressive symptoms Small to moderate for anxiety symptoms Small to moderate for self-esteem	Correlational study, causality cannot be inferred.	B+
7	Sinke et al., 2020	Treatment seeking heterosexual males	Functional magnetic resonance imaging (fMRI) study with a working memory performance task with neutral or pornographic pictures in the background was employed in 38 patients and 31 healthy controls	Hypersexual behavior	Poorer mental performance (working memory) in terms of slower reaction times (decrease of performance was related to pornography consumption in the last week)	Large	participant inclusion criteria were defined according to Kafka’s criteria for hypersexual behavior which do not directly translate to ICD-11 criteria	A-

Conclusions and discussion

At the personal level, common effects of pornography use include deprecated mental health and well being (i.e. poorer self-esteem, depression and frustration in psychological needs), although the relationship is not yet clear (e.g. are people more depressed because of using pornography or depression makes people more prone to use pornography?).

At the relational level, pornography use can affect relationship satisfaction, especially if masturbation is involved, although studies with couples (not just one partner) have reported different results.

At public health/societal level, common effects of pornography use include more risky sexual behaviors (e.g. unsafe sex), having sex at a younger age and STIs, with relatively conclusive results.

An increasing number of studies from neuroscience show that pornography can result in a serious addiction similar to gambling or substance use addictions. Moreover, a recent fMRI study suggests that pornography effects extend beyond addiction to affect cognitive performance, such as working memory.

A large number of studies on pornography effects have limitations such as using a correlational design. A correlational design can only reveal associations between variables or presumed effects, not causal effects. Another important limitation in the literature is the lack of multiple validated measures of pornography use and effects, aligned with the ICD-11 criteria for compulsive sexual behavior disorder (CSBD) (Kohut et al., 2020).

Overall, the studies reviewed in this sythesis show that pornography use may contribute to lasting cognitive, affective, and behavioral changes with implications at personal, relational and societal levels.

References

Bőthe, B., Tóth-Király, I., Potenza, M.N., Orosz, G. and Demetrovics, Z., 2020a. High-frequency pornography use may not always be problematic. The Journal of Sexual Medicine.

Bőthe, B., Tóth-Király, I., Griffiths, M.D., Potenza, M.N., Orosz, G. and Demetrovics, Z., 2020b. Are sexual functioning problems associated with frequent pornography use and/or problematic pornography use? Results from a large community survey including males and females. Addictive Behaviors, p.106603.

Castro-Calvo, J., Gil-Llario, M.D., Giménez-García, C., Gil-Juliá, B. and Ballester-Arnal, R., 2020. Occurrence and clinical characteristics of Compulsive Sexual Behavior Disorder (CSBD): A cluster analysis in two independent community samples. Journal of Behavioral Addictions, 9(2), pp.446-468.

Dickenson, J.A., Gleason, N., Coleman, E. and Miner, M.H., 2018. Prevalence of distress associated with difficulty controlling sexual urges, feelings, and behaviors in the United States. JAMA Network Open, 1(7), pp.e184468-e184468.

Fisher, W.A. and Kohut, T., 2020. Reading pornography: methodological considerations in evaluating pornography research. The Journal of Sexual Medicine, 17(2), pp.195-209.

Gola, M., Wordecha, M., Sescousse, G., Lew-Starowicz, M., Kossowski, B., Wypych, M., Makeig, S., Potenza, M.N. and Marchewka, A., 2017. Can pornography be addictive? An fMRI study of men seeking treatment for problematic pornography use. Neuropsychopharmacology, 42(10), pp.2021-2031.

Lin, W.H., Liu, C.H. and Yi, C.C., 2020. Exposure to sexually explicit media in early adolescence is related to risky sexual behavior in emerging adulthood. PloS one, 15(4), p.e0230242.

Perry, S.L., 2020. Is the link between pornography use and relational happiness really more about masturbation? Results from two national surveys. The Journal of Sex Research, 57(1), pp.64-76.

Sinke, C., Engel, J., Veit, M., Hartmann, U., Hillemacher, T., Kneer, J. and Kruger, T.H.C., 2020. Sexual cues alter working memory performance and brain processing in men with compulsive sexual behavior. NeuroImage: Clinical, p.102308.

Appendix

Figure 1. Sexually explicit media exposure and risky sexual behavior (Lin et al., 2020)

	A consistent finding (Fig 1 on the left) was that sexually explicit media exposure in early adolescence was significantly related to risky sexual behaviors in late adolescence. Specifically, the results revealed that relative to their counterparts, adolescents exposed to sexually explicit media in early adolescence were 31.7% and 27.4% more likely to engage in sexual behavior before age 17 and to engage in unsafe sex, respectively (2SLS estimation). Moreover, these youths had on average three or more sexual partners by age 24. Note: OLS, Ordinary Least Squares; 2SLS, Two Stage Least Squares.

Figure 2. Group differences in pornography use (adapted from Bőthe et al., 2020a)