Take-home points
- More people are watching pornography, and researchers are debating its impact on sexual dysfunction.
- Evidence has not yet established whether or not pornography affects sexual dysfunction, though the potential impact likely depends on the type of relationship with pornography.
- Problematic pornography use is associated with various indicators of sexual dysfunction, including greater distress, unrealistic sexual expectations, and longer refractory periods.
- If you are concerned about your use of pornography, it’s important to visit your healthcare professional to receive specialised help.
Pornography use is rising
The consumption of pornography is on the rise and remains a controversial topic. According to estimates, around 91.5% of men and 60.2% of women consume pornographic material at some stage.1 The potential adverse effects of regular pornography consumption are hotly debated, with some medical professionals and organisations cautioning against its use.
Pornography use and sexual dysfunction: A review of the evidence
The impact of pornography consumption on sexual health is a growing concern, particularly its potential link to sexual dysfunction. Although a lack of high-quality research exists, small studies and anecdotal reports in men suggest a potential link between excessive pornography consumption and sexual dysfunction.2,3
Can pornogrpahy cause erectile dysfunction?
A consistent observation you may have seen is the paralleled increase in pornography use and sexual health problems like erectile dysfunction, low sexual satisfaction and desire, and delayed ejaculation.4 These observations have led many people to suggest that pornography may be the culprit. Yet, it’s important to highlight the coinciding rise in other established risk factors for sexual dysfunction during this time, such as mental health issues, obesity, and cardiovascular disease.5
The relationship to pornography could be key
Research on the effects of pornography consumption on sexual dysfunction has attempted to control for established risk factors. However, there is still no scientific consensus, with some studies reporting a negative impact on erectile dysfunction, sexual satisfaction, and arousal, while others reporting the opposite.2,6,7
While it is true that men using pornography typically report lower satisfaction with their sex life, the current pool of low-quality research cannot answer why this is the case.8 This association could be explained by pornography itself causing lower sexual satisfaction, but it could also be explained by people with reduced sexual satisfaction being more likely to use pornography. Or a combination of the two.
Conflicting findings from long-term research
The first long-term observational study in over 1,000 Dutch adolescents found that pornography use consistently reduced sexual satisfaction, yet low sexual satisfaction also led to increased pornography use.9 The inconsistency in results highlighted the need to investigate the independent effects of pornography consumption on sexual health.
Researchers then hypothesised that older studies overlooked an important factor: the nature of an individual's relationship with pornography. For example, whether or not people feel that pornography dominates their thoughts and behaviours. This concept is analogous to other activities like alcohol consumption or video gaming. The impact of alcohol on mental health is vastly different in those who are addicted than in those who consume it in moderation. It is therefore important to correctly separate the overall pornography data into those who are addicted to porn or have a problematic relationship, with those who feel in control of their pornography consumption.
Problematic pornography use vs. frequent pornography use
Problematic Pornography Use (PPU) refers to individuals with an unhealthy relationship with pornography. Pornography dominates their thoughts, feelings, and behaviours, and can significantly impact their lives. These individuals may turn to pornography to manage stress or negative emotions and are more likely to consume more extreme pornographic material.2 A similar but distinct condition is frequent pornography use (FPU), where individuals frequently engage with pornography but do not use pornography to manage or respond to emotion, and they do not feel it does not intrude on their lives.2
In one study comprising three distinct samples of men who completed questionnaires on their pornography habits and sexual function, those with PPU were more susceptible to erectile dysfunction. However, one of the samples was a collection of men that were followed for one year. No strong correlation was found when researchers applied a statistical method to control for lifestyle and time-dependent variables (diet, exercise, health conditions).10 In contrast to these results, several surveys examining the nature of the relationship with pornography have reported positive associations between problematic pornography consumption and sexual dysfunction, such as low arousal and erectile dysfunction.2,11
The crux of the issue lies in the lack of high-quality interventional studies or long-term observational studies. This research would help improve our understanding by assessing:
- Changes to sexual function following the treatment or resolution of PPU.
- The long-term associations between PPU and sexual function, considering the severity of PPU, new onset of PPU, and the role of lifestyle-dependent variables.
How could problematic porn consumption cause sexual dysfunction?
Multiple theories have been discussed to explain why excessive or problematic pornography consumption may cause sexual dysfunction. One potential explanation is those who engage in PPU may partake in more masturbation and pornography binges, increasing the likelihood of a refractory period where the user requires more time to become sexually aroused again after an orgasm. This may, overtime, lead to more sexual problems such as low sexual arousal and problems maintaining erections.10
Another possible explanation is that pornography does not accurately reflect real-life sexual activities and experiences. As a result, some men may find sexual intercourse with their partner less stimulating than the pornography they view online. Supporting this theory is research showing that pornography can alter the brain's arousal templates, further impacting sexual responses.2
Could pornography and sexual dysfunction be confounded by association?
It is possible that the association between pornography and sexual dysfunction is confounded, meaning that a behaviour or characteristic linked to PPU might be the true cause of sexual dysfunction, rather than pornography itself. One study found that among men seeking treatment for compulsive sexual behaviours, PPU was positively associated with sexual anxiety and negatively associated with sexual satisfaction. Interestingly though, compulsive pornography consumption was linked to fewer sexual functioning issues than individuals with significantly distressed non-compulsive profiles.12 Stress and emotional regulation are consistently reported as factors in PPU and could be what primarily causes sexual dysfunction, rather than PPU itself. If true, then a person with high levels of stress may be more prone to engaging in PPU, increasing the risk of sexual functioning problems and further stress.
Suspected PPU with your patient?
When addressing PPU, it's crucial to consider the potential causes and the user's individual characteristics. Some people may display varying levels of constructs such as hypersexuality, susceptibility to boredom, self-esteem, discomfort with pornography, and fulfilment of basic psychological needs. If you encounter a potential PPU patient, it's essential to inquire about their relationship with pornography rather than just the frequency of use. The latter is not a reliable indicator of PPU since research suggests the number of people with nonproblematic high-frequency use is three to six times higher than those with problematic high-frequency use.12
I have an unhealthy relationship with pornography, what can I do?
Treating an unhealthy relationship with pornography requires a personalised approach that depends on your healthcare professional's assessment of your condition. Some common treatments include:
- Psychotherapy.
- Cognitive behavioural therapy (CBT) and counselling.
- Support groups.
- Medications such as paroxetine.
- Holistic approaches (lifestyle, exercise, nutrition).
If you're experiencing concerns related to pornography consumption, seeking help from a healthcare professional is crucial to receive the best possible treatment. Don't hesitate to speak with a trusted healthcare provider who offer guidance and support to help you address problematic pornography use and improve your overall well-being.
References
1. Solano I, et al. J Sex Res 2020;57(1):92–103.
2. Bőthe B, et al. Add Behav 2021;112:106603.
3. The guardian. Is porn making young men impotent? Last accessed: April 2023.
4. Johannes CB, et al. J Urol 2000;163(2):460–3.
5. Milbank Q, et al. Milbank Quarterly 2008;86(2):273–326.
6. Carvalheira, et al. J Sex Marital Ther 2015;41(6):626–35.
7. Landripet I, Stulhofer A. J Sex Med 2015;12(5):1136–1139.
8. Dwulit AD, Ryzmski P. J Clin Med 2019;8(7):914.
9. Doornwaard SM, et al. Pediatrics 2014;134(6):1103–10.
10. Grubbs JB, Gola M. J Sex Med 2019;16(1):111–125.
11. Wery A, Billieux J. Comp in Hum Behav 2016;56:257–266.
12. Vallancourt-Morel MP, et al. J Sex Med 2017;14(1):78–85.
13. Bőthe B, et al. J Sex Med 2020;17(4):793–811.
