Effects of pornography

Short description: Influence of pornography on an individual and their intimate relationships

The .xxx domain is intended for pornographic material

Pornography has been defined as any material in varying forms, including texts, video, photos or audio that is consumed for sexual satisfaction and arousal of an individual or partnership. Pornography would have varying effects in regard to things such as exposure and consumption. The effects of pornography on individuals or their intimate relationships depend on the type of pornography used and differs from person to person. The consumption of Pornographic material could have both positive and negative outcomes.

The effects and impacts of consuming pornographic material could vary in terms of psychological effects, cognitive effects, sexual effects, and even lasting impacts on the relationships itself. Pornography could also have impacts on performer health and safety in the industry.[1]

Pornography has been studied particularly for associations with addiction.[2] The problem is often overlooked and it may be enhanced with the impacts mentioned above. [3]

Some literature reviews suggest that pornographic images and films can be addictive.[4][5] this is emphasized particularly when combined with masturbation,[6] while others maintain that data remains inconclusive.[7][8][9][10][11] Other research has looked at pornographic material's relation to acts of sexual violence, with varying results.[12][13] The use of pornographic material also lends itself well to further research and its impact on individuals. Some theories have been proven in association with pornographic consumption behaviors that help figure out why the effects happen in the first place.[14]

## Contents

* 1 A few key theories
* 1.1 Sexuality theories
* 1.1.1 Sexual Strategies Theory
* 1.1.2 Reward and Conditioning Theory
* 1.1.3 Social Exchange Theory
* 1.2 Sexual scripting
* 1.2.1 Scripting framework
* 1.3 Affection exchange theory
* 2 Psychological effects
* 2.1 Pornography addiction
* 2.1.1 Men and addiction
* 2.2 Studies and evidence of effects
* 3 Cognitive effects
* 3.1 Contradicting views
* 3.2 Withdrawal symptoms
* 3.2.1 Pornographic control proposals
* 4 Mental Blocks in Individual "Physicality" and its Studies
* 4.1 Men and masculine "attractiveness"
* 4.2 Women and self-consciousness
* 4.3 Delay discounting and dehumanization
* 4.4 Public health
* 5 Sexual effects and its studies
* 5.1 Sexual desire
* 5.2 Sexual function
* 5.3 Sexual satisfaction
* 5.4 Sexual preferences
* 5.5 Aggression and extreme content
* 5.6 Sexual violence
* 5.6.1 Controlled studies
* 5.6.2 Epidemiological studies
* 6 Effects on relationships
* 6.1 Relationship satisfaction
* 6.2 Communication
* 6.3 Pornography mirroring and consent
* 7 Pornographic effects on adult film performers
* 7.1 Famous cases
* 8 See also
* 9 References
* 10 Further reading
* 11 External links

## A few key theories

### Sexuality theories

#### Sexual Strategies Theory

Sexual Strategies Theory can be strongly linked to pornography consumption and its effects. This theory is originally proposed by psychologists David Michael Buss and David P. Schmitt in 1993.[14] The theory details how men and women are biologically wired differently when it comes to seeking avenues of sexual and romantic endeavors. it argues that these biological evolutions and differences still exist today when choosing sexual material or even a romantic partner. Some other researchers also backed up Buss and Schmitt's theory, emphasizing how men are more attracted to the physicality of a person, while women are attracted to more of the status of a person.[3]

In the context of pornography consumption, the sexual strategies theory comes in to play especially for men. Males would consume more pornography to have a visual physicality of certain pornographic actors, which would play into even more frequent consumption of the material.[14]

#### Reward and Conditioning Theory

Reward and Conditioning Theory is linked with addiction and consumption as well. This theory explains how sexual desire and behavior are flexible. They are designed to adapt to whatever their environment is. If the individual is within an environment that is inherently more sexual or, in this case, consumes more pornographic material, then they would partake in that activity more frequently. They would also change the patterns of their sexual behavior and get affected by pornographic effects in a more acute manner.[3]

#### Social Exchange Theory

Example of General Social Exchange Theory Model

Social Exchange Theory is another that is related to pornographic and sexual effects. The theory examines how relationships between individuals are created through the concept of costs and benefits. It explains the expectation to reciprocate actions and behaviors within relationships. In the case of pornography and intimacy in said relationships, social exchange theory is observed in partnerships to mutually reach sexual satisfaction by determining the rewards of sexuality in that relationship. Should sexual satisfaction not be achieved, one could turn to pornographic materials to satisfy their needs[3][15]

### Sexual scripting

Pornography research is greatly influenced by Script Theory. Originally proposed by researcher Silvan Tomkins, Script Theory proposes that behavior is a series of "scripts", or programs in order to achieve a goal.[16][17] These scripts provide meaning for specific patterns, actions or behaviors that an individual does in certain contexts of achieving that goal. In 1986, Simon and Gagnon applied script theory to sexuality research, asserting that sexual scripts fall under a category of cultural scripts to regulate sexual behaviors.[17] Modern research has applied this concept to work with pornography, and specifically how pornography may influence sexual scripts and behaviors. Some studies argue that pornography functions as a sexual script, cluing people in to the certain patterns, behaviors and actions mentioned above which would influence their own sexual behaviors in later encounters.[16][18]

Pornography may alter individuals' expectations regarding sexual activity, which then impacts their ability to form and maintain romantic, or sexual, relationships.[16][18] Pornography functions as a cultural script, a media through which individuals may pick up on or learn sexual cues. One concern is that, by relying on pornography for education on sexual cues or sexual scripts, individuals may have an altered sense of what sexuality and sexual intercourse truly entail.They might not perform appropriately in their real life sexual relationships, potentially causing misunderstandings or, in a more extreme cases, abusive behavior.[19][20][18]

Typical gender roles can also confuse and alter expectations for the traditional heterosexual sexual script.[21] The way sexuality is taught, learned and expressed is different due to societal gender expectations.[21]

Pornography can often display women acting with traditional male sexual scripts or exaggerated female scripts. Pornography thus creates a double-standard for the male partners of expecting a female partner to act in an unrealistic, exaggerated way that is many scenes that are considered fantasy.[22]

Furthermore, many young adult men can get confused or perplexed when having a sexual experience with a woman using a traditional female sexual script, as opposed to a more embraced (even sometimes aggressive) sexuality, often outside the confines of an exclusive relationship, that is shown frequently in pornography that is constructed to cater to men.[22]

#### Scripting framework

The most applicable theoretical framework of sexual scripting comes from Paul J. Wright's Sexual Script 3 AM (Script acquisition, activation, application).[23] This framework enhances the understanding of Sexual Scripting from a relationship perspective. due to the availability of pornographic categories that are more violent and aggressive, people that are exposed to that sort of material would have a different understanding of their sexual scripts and would more likely enact violent and abusive tendencies against women in their relationships.[24]

### Affection exchange theory

Further information: Philosophy:Affection Exchange Theory

Affection Exchange Theory classifies human affection and interaction as innate acts which assist individuals in mating, reproduction, and survival, as well as in developing and maintaining healthy relationships.[25] This theory can be extended to sexuality to consider sexual acts as significant contributions to affection behavior. Humans express affection through a myriad of actions, including verbal affirmations and physical touch. This theory takes a more modern approach to traditional evolutionary theories, and extrapolates that affection communication plays a role in sexual selection and reproduction.[25] Furthermore, Affection Exchange Theory posits that, although often found together, affectionate expression is separate from affectionate emotion. An individual may express unauthentic affection (expression without emotion), or may feel affection that they suppress (emotion without expression). Beyond relationship findings, more affectionate people also report better overall health, including more self-esteem, less anxiety, less fear of intimacy, and greater satisfaction with their lives and their relationships.[25] Research on Affection Exchange Theory has been connected to pornography and couples research as a potential mitigator to relationship and sexual satisfaction, as well as sexual desire.[16]

## Psychological effects

### Pornography addiction

Pornography addiction is a purported behavioral addiction characterized by compulsive, repeated use of pornographic material which causes serious consequences to one's physical, mental, social, and/or financial well-being.[26][27][28] There is no diagnosis of pornography addiction in the current Diagnostic and Statistical Manual of Mental Disorders (DSM-5),[26] though the DSM-5 considered the diagnosis of hypersexuality-related behavioral disorders (to which porn addiction was a subset), but rejected it because "there is insufficient peer-reviewed evidence to establish the diagnostic criteria and course descriptions needed to identify these behaviors as mental disorders."[26] Instead, some psychologists suggest that any maladaptive sexual symptoms represent a manifestation of an underlying disorder, such as depression or anxiety which is simply manifesting itself sexually, or, alternatively, there is no underlying disorder and the behavior simply is not maladaptive. It is argued that psychologists do not recognize the concept of addiction, only chemical dependence, and some believe the concept and diagnosis to be stigmatizing and unhelpful.[29][30]

#### Men and addiction

Even though pornographic consumption is not limited to gender, men who consume pornography regularly have reported less stable mental health, specifically higher levels of depression.[19][31]

### Studies and evidence of effects

Two 2016 neurology reviews found evidence of addiction related brain changes in internet pornography users. Psychological effects of these brain changes are described as desensitization to reward ( which can be related to cognition), a dysfunctional anxiety response, and impulsiveness.[8][10] Another 2016 review suggests that internet behaviors, including the use of pornography, be considered potentially addictive, and that problematic use of online pornography be considered an "internet-use disorder".[11]

Introductory psychology textbook authors Coon, Mitterer and Martini, passingly mentioning NoFap (former pornography users who have since chosen to abstain from the material) speak of pornography as a "supernormal stimulus" but use the model of compulsion rather than addiction.[32]

Psychological effects

A number of studies have found neurological markers of addiction in Internet pornography users,[33][11][10] which is consistent with a large body of research finding similar markers in other kinds of problematic users.[11] Yet other studies have found that critical biomarkers of addiction are missing.[34]

According to the American Society of Addiction Medicine, some psychological and behavioral changes in response to developing addiction include addictive cravings, impulsiveness, weakened executive function, desensitization, and dysphoria.[35] BOLD fMRI results have shown that individuals diagnosed with compulsive sexual behavior (CSB) show enhanced cue reactivity in brain regions associated traditionally with drug-cue reactivity.[8][36]

These regions include the amygdala and the ventral striatum.[8][36] Men without CSB who had a long history of viewing pornography exhibited a less intense response to pornographic images in the left ventral putamen, possibly suggestive of desensitization.[8] ASAMs position is inconsistent, however, with the American Association of Sex Educators, Counselors, and Therapists, who cite lack of strong evidence for such classification, describing ASAM as not informed by "accurate human sexuality knowledge".[37]

## Cognitive effects

Pornographic content also has substantial impact to a person's executive function and would cause a greater case of desensitization as mentioned above. A Neuroscience perspective paper mentioned a German study done back in 2007 resulted in the finding that the persistence of sexual urges can cause physical changes to a person's brain.[38][39] A more extreme case of Pornography use could even result in impaired decision making. In some other cases, extreme levels of consumption could result in sexual bias, in which an individual would respond more greatly if there is an active presence of sexual stimuli [40]

### Contradicting views

Neuropsychopharmacological and psychological researches on pornography addiction conducted between 2015 and 2021 have concluded that most studies have been focused entirely or almost exclusively on men in anonymous settings, and the findings are contradicting.[36] Some researches support the idea that pornography addiction qualifies as a form of behavioral addiction into the umbrella construct of hypersexual behavior and/or a subset of compulsive sexual behavior (CSB),[citation needed] and should be treated as such, whereas others have detected the increased activation of ventral striatal reactivity in men for cues predicting erotic but not monetary rewards and cues signaling erotic pictures, therefore suggesting similarities between pornography addiction and conventional addiction disorders.[36]

The International Classification of Diseases,11th edition (ICD-11) added pornography to Compulsive Sexual Behavior Disorder (CSBD).[41] CSBD is not an addiction and should not be conflated with sex addiction.[42][43][44][45][46][47][48]

DSM-5-TR, published in March 2022, does not recognize a diagnosis of porn addiction.[42][49][50][51]

### Withdrawal symptoms

Individuals who have developed some form of dependence on pornography use, and do consider themselves as addicted to pornography, have experienced withdrawal symptoms. A study on effects and consumption of pornography across large sample of students from various universities has shown more than a half tried to give up consumption for pornography (or at least minimize the use of such material). Within those who at least made one attempt, almost 75% experienced at least one symptom of withdrawal. Withdrawal symptoms included erotic dreams, irritability, attention disturbance, and sense of loneliness.[52] Other recorded potential symptoms included depression, anxiety, obsessive thoughts, and an intense longing for pornography.[53] On topic on anxiety, a survey performed on a sample of internet users with porn dependency, concluded 24% of the participants had experienced anxiety symptoms if access to porn on the Internet was inhibited.[54] Individuals who showcased an abstinence from online pornography has shown "most common positive effects" to include improvements in day-to-day functioning, increased energy, mental clarity and productivity. Some surveyed individuals even experienced enhanced sensation and greater pleasure from ordinary activities.[55]

#### Pornographic control proposals

Some clinicians and support organizations recommend voluntary use of Internet content-control software, internet monitoring, or both, to manage problematic online pornography use.[56][57][58] Sex researcher Alvin Cooper and colleagues suggested several reasons for using filters as a therapeutic measure, including curbing accessibility that facilitates problematic behavior and encouraging clients to develop coping and relapse prevention strategies.[56] Cognitive therapist Mary Anne Layden suggested that filters may be useful in maintaining environmental control.[58] Internet behavior researcher David Delmonico stated that, despite their limitations, filters may serve as a "frontline of protection."[57]

## Mental Blocks in Individual "Physicality" and its Studies

Although there are no significant outward effects on the physicality of an individual, Pornographic consumption can still have an affect on how individuals view their bodies and how they would change certain aspects of their physicality to better mirror those in the pornographic material. This in turn will lead to issues of self-esteem, body dysmorphia and overall body image issues [59]

### Men and masculine "attractiveness"

Statue of David, the "ideal" masculine frame

A study of 359 college men found that high viewership of pornography relates to increased masculinity and body dissatisfaction.[60] Sexual performance changes a man's view of his masculinity, and often his self-esteem. Pornography is not the only factor affecting men's self-esteem and body image. Popular media often depicts strong but lean men as the ideal attractive body type and goal. Pornography is significant to men's self-image. It connects a lean body type to sexual validation.[60] Men would also make comparisons with the pornographic models due to a level of dissatisfaction. These can include face shape, hair and muscle mass. All of these elements could significantly contribute to men's self esteem levels.[61] As of 2021, few studies have evaluated how exposure to pornography relates to men's body image. Researchers recommend that others conduct more studies on pornography's effect on men's psychology.

Heterosexual pornography reinforces a concept called the centerfold syndrome. In 1995, psychologist Gary R. Brooks wrote about men and the centerfold syndrome. This concept asserted that gender roles in media contribute to high sexual dysfunction in men.[62] Sexual dysfunction has many parts. One part is the viewing of women as body parts, trophies, or sexual conquests. These concepts are often known as voyeurism, objectification, and trophyism. Another part is tying female approval of manliness to a man's self-image. The third part of sexual dysfunction includes avoiding intimacy, attachment, and emotions. Heterosexual pornography reinforces this syndrome through observational learning. In other words, the story within pornography becomes the expected reality. Deviations from that story create low self-esteem.

### Women and self-consciousness

Studies rarely observe women's viewership of pornography. One modern study with female subjects provided mixed results. Pornography does not affect women's perception of body image and relationship satisfaction if it is free of behavior.[63] Violence is one example. All other viewership appears to minimally affect body image and relationship satisfaction.

A 2021 study has shown a mediating role of pornography use among women and how it affects the consciousness of body image and attachment insecurities.[64] Girls who have not experienced a sensitive response to their needs and/or were emotionally deprived under the parent/caretaker childhood environment had a greater chance of developing insecurities about their body image. The use of pornography would more likely amplify attachment fears and anxiety. Such anxiety is strongly connected to females seeking validation and approval of their physicality in intimate settings from their partners and relationships.

The findings did correlate with past research articles which found that "anxious but not avoidant attachment affects body image, the drive for thinness, body dissatisfaction[65] and body appreciation."[66] Furthermore, pornography use could also amplify women's body image self-consciousness in an intimate setting. The acts performed in pornographic movies created a feeling of pressure among women, not only creating a higher negative body image but also the feeling of being criticized by their partners if their body was not resembling the body shape of models in pornographic content.[64]

However, mediating role between pornography, and anxiety attachment, and body image self-consciousness was found only in women in a relationship at the time of the study, which correlated with attachment theory.

### Delay discounting and dehumanization

A 2019 survey of 1083 U.S. adults by Mecham, Lewis-Western and Wood evaluated the relationship between pornography and unethical behavior in the workplace.[67] Unethical behavior, according to the researchers, consists of delay discounting and dehumanization. Delay discounting involves the idea of waiting with steps that usually involve more process and work versus acting now, taking a faster route and getting instant reward. It is to expect lower rewards in the future versus acting in the moment. The expectation of a high, instant reward for acting now can lead to reduced self-control and increased impulsivity [68]

Dehumanization is a form of moral disengagement in which people view others as less than human. According to the study, increased pornography use causes increased dehumanization and unethical behavior.[67] Regressing women to be looked at as sexual objects is a prime example of Dehumanization due to Pornography. Dehumanization also relates to Sexual Objectification. In relation to pornography, Men who are consuming porn that depict sexual objectification and regression towards women, would more likely engage in a few forms of dehumanization of women in real life. These can range from their change of attitude towards women, being more aggressive or the underestimation of women, where one thinks that women are of a lesser status.[69]

### Public health

Pathologizing any form of sexual behavior, including pornography use, has the potential to restrict sexual freedom and to stigmatize. Researcher Emily F. Rothman, author of Pornography and Public Health stated that the professional communities are not advocating for the "push" in labelling pornography as a "public health crisis".[70]

She and another researcher have called these moves a "political stunt".[71] The ideas supporting the "crisis" have been described as pseudoscientific.[72]

## Sexual effects and its studies

The sexual effects of pornography on intimacy and relationships observe some of the most gendered differences. Men and women differ vastly in how they are impacted by pornography both within and beyond a romantic or sexual relationship.

The consumption of pornography has been shown to have an impact on sexual risk-taking, including less frequent usage of condoms and birth control, as well as more casual sexual encounters.[19][73] It can negatively impact sexual functioning, especially in men.[74] However, pornography can function as an educational resource for individuals to improve their sexual knowledge,[19][75] and women who consume pornography more regularly experience increased desire for sexual activity, indicating that pornography might be useful as a form of foreplay.[19][76]

### Sexual desire

Sexual desire is one of the factors that have an impact on the gender differences the most. In general, men experience the most acute effects from pornography in terms of sexual desire. Straight men report less sexual desire, both for their partner and in general, directly after consuming pornography.[76] Men also typically utilize pornography for masturbation and solo-sexual activities, rather than partnered or joint purposes.[77][78][79] Strong associations exist between increased pornography consumption, frequency of pornography consumption, and problematic decreases in sexual desire for men. Men who use pornography more frequently report less desire for their partner, and for sex in general.[78]

While most modern research on pornography focuses on men, the findings in women hold interesting information on pornography's gendered impact on sexual desire. Women have found a positive correlation between pornography consumption and sexual desire, indicating that women who view pornography feel more positively about expressing their sexual impulses.[79][80] In addition to increased sexual desire, women may express more sexual attraction specifically for their partner on days when they watch pornography.[76]

Even though men and women have significant differences in terms of their sexual mood, behavior and overall porn consumption, Their brain activity would prove to be similar to each other. Both gender's brain activity is nearly identical to each other when consuming pornography, suggesting that men and women experience similar arousal effects due to pornographic exposure.[81] Further, both genders report significant support for female-centric pornography, though men express similar levels of arousal to both "focuses" of pornography. Women meanwhile, report more general negativity towards traditional, male-centric pornography and express stronger support for female-centric pornography. Women also report higher levels of self-reported arousal when exposed to female-centric content.[18]

In general, pornography consumption in couples has been associated with greater sexual desire.[75] Although research in the way of same-sex relationships is limited, available findings indicate that pornography use is connected to an increased level of sexual desire. Men partnered with women report less sexual desire in general with increased pornography consumption, whereas women in both mixed-sex or same-sex relationships report greater sexual desire overall. Also, individuals were less likely to consume pornography the day after engaging in sexual intercourse.[76]

### Sexual function

Sexual function is a rising concern with pornography consumption. Primarily thought to affect men, there is a notable relationship between pornography consumption and sexual function problems. Commonly reported problems include erectile dysfunction, delayed ejaculation, anorgasmia, and a lack of sexual desire.[80] Recently, the rates of sexual dysfunction have been increasing in younger age demographics.[80] Medical professionals suspect pornography may be one factor contributing to this increase, however there is little causal evidence of such an effect.[80][82] Another issue is delayed ejaculation, an issue where men may experience a large disconnected sensation between their orgasm and ejaculation. Some may difficulty achieving ejaculation altogether. Overarching research shows little evidence of pornography having any effect on delayed ejaculation.[80] Despite the lack of evidence for more physical issues with sexual function, pornography is related to problematic decreases of sexual desire and sexual satisfaction, This correlation requires further research in the field in order for its effects to have greater impact, however.[78][80][83]

In women, there is little evidence for pornography-induced sexual dysfunction. The most commonly observed effect is increased anxiety or distress, which may then lead to issues of overall sexual function. The most commonly reported issue for women is arousal dysfunction, indicating a difficulty in achieving or maintaining arousal during sexual activity.[80] This could potentially lead to physical issues, such as painful penetration or vaginismus, making sexual intercourse painful and unpleasant.[80] Women also tend to report more negative effects towards pornography, including strong feelings of shame or guilt.[80]

Pornography may influence both genders to make riskier decisions with their sexual health. A study analyzing the use of barrier contraceptives by German adults found that when pornography is used as an educational tool on sexuality and sexual culture, there is an opposite effect that happens. People who consume more pornographic content would use condoms less frequently.[84] Overall, the most frequently reported issues with sexual function that relate to pornography are decreases in sexual desire for men, and decreases in sexual satisfaction overall.[78][80]

### Sexual satisfaction

Research on pornography's effect on sexual satisfaction is highly varied. Numerous studies looking at both individuals and couples have found different, at times contradictory, results. One study found a negative relationship between pornography consumption and sexual satisfaction across two samples of men.[78] In addition, the frequency of pornography consumption, rather than the type of pornography consumed, is negatively correlated with sexual satisfaction; the type of pornography consumed had no effect on sexual satisfaction.[78] When considering couples and their pornography consumption, couples with a greater lack of agreement over content choice reported being more sexually dissatisfied than couples who watched pornography together, as well as couples who jointly abstained from pornography altogether.[75]

In women, there is a more positive correlation between pornography consumption and sexual satisfaction. Some suggest that males have a different relationship with pornography consumption, with men resorting to pornography due to further sexual satisfaction or even reaching a cyclical effect.[18] An indirect, yet positive, effect on sexual satisfaction has been found when looking at sexual preference.[78]

Individuals who use pornography alongside masturbation as the primary tool of sexual arousal and satisfaction (or needs) may become conditioned to prefer pornography more than other methods of sexual arousal. Furthermore, a 2017 study by Wright et al. has shown that the "frequency of pornography consumption was also directly related to a relative preference for pornographic rather than partnered sexual excitement."[85] The individuals in the given study primarily used pornography for masturbation purposes.The preference of consuming pornography over achieving a level of sexual satisfaction with a partner, especially in the case of extracting sexual information from pornography, would lead to lower overall sexual satisfaction. Individuals who seek pornography as the main source of information about sexuality were associated with lower sexual excitement, and as a result would have a significantly lower level of sexual satisfaction with their partners. Gender did not affect the results of such findings.[85]

However, pornography among some individuals is not only used for sexual satisfaction. A study on affection substitution has shown that "pornography consumption is positively related to affection deprivation, depression, and loneliness and inversely related to experienced affection, relational satisfaction, and closeness."[86] All presented above variants, except affection deprivation, had a significant correlation based on statistical data. Due to such positive relations, individuals who consume pornography not only use it to satisfy their sexual arousal but also to reduce loneliness and create a coping mechanism against social disconnection. Some of the examples of coping mechanisms may include "creating parasocial relationships with the characters depicted in pornography."[86]

### Sexual preferences

The use of pornography is extremely varied, especially in the United States. Measured rates such as: general consumption, frequency of consumption, length of time, and type of pornography— would vary by individual. This would further be classified by gender, age, and relationship status, as well as frequency of consumption, which all factor into the overall consumption rates. In general, men consume more pornographic content, and in a more frequent manner, than women.[77][19][87] A vast majority of men report having consumed pornography, with rates ranging from 50% to 90%, usually plateauing in the upper 80% range. Women, however, report significantly less frequency and more varied consumption of pornography, with 30% and 80% of women saying they have viewed pornography in their lifetime.[87] This variation reflects differences in nationality and culture in terms of sex positivity and pornography acceptance, as well as the unreliability of self-reporting. Despite the variation and lower reports of pornography consumption for women, female viewership of pornography is steadily increasing. Women tend to prefer less hardcore porn compared to men, and men report consuming pornography in conjunction with masturbation more frequently than women.[77]

More recent findings dictate that pornography has an impact on sexual preference. The increase of consumption for pornographic content may affect a person's sexual preference significantly. This can lead to actions, wants and needs during sexual encounters that would mirror those in pornography. These may include the acts depicted, behaviors displayed by actors, doing things that have never been done in the relationship, the triggering of other fantasies and many more.[88] Among men, there is a positive relationship between the type of pornography they consume and a desire for more porn-like sexual experience.[78] Frequency of consumption and type of pornography consumed are related to increased desire for more porn-like sex, which is measured by items indicating an expressed preference for "kinkier sex," "hotter sex," and a more porn-like "sexual appearance."[83] The latter includes grooming habits, as well as hair color and body type. The findings do present evidence that pornography consumption has a role in sexual preferences, though causal relationships cannot be confirmed. The findings affect both genders. This effect is mitigated by both the type of pornography consumed, as well as the frequency of pornography consumption.[78][83]

A study done in 2013 by Seigfried-Spellar and Rogers found results which suggested deviant pornography use followed a specific progression, concluding that individuals with a younger "age of onset", meaning younger age of exposure for pornography were more likely to engage in deviant pornography such as bestiality or child pornography compared to those with a later "age of onset".[89] Prolonged exposure to pornographic content can lead to increased sexual stimuli tolerance. Study showed earlier exposure may lead to potential desensitization to the stimuli, meaning individuals seek longer stimulation (12.0%) and more intensive sexual stimuli (17.6%) to reach climax.[52] Such increase in tolerance was connected to a change in online pornography use pattern, major one's being "switching to a novel genre of explicit material (46.0%), use of materials that do not match sexual orientation (60.9%) and need to use more extreme (violent) material (32.0%)."[52]

### Aggression and extreme content

A cross-sectional study on prevalence and patterns in pornography use has detected individuals who mentioned an increased need for more extreme content.[52] This has been theorized to be caused by the desensitization factor mentioned above. [90] However, the actual cause comes from aggression as "more extreme pornography material was more frequently reported by males describing themselves as aggressive."[52][91] On the other hand, females who increased their search for extreme pornographic content came from the curiosity aspect itself rather than a need due to desensitization.[52]

The research focused on associations of dark personality traits with online activities. They found that some dark traits are closely related to online sexual use.[92] Specific online activities of the study covered social media, online gaming, online gambling, online shopping and online sex. The results showed that the specific traits of Machiavellianism, spitefulness, sadism, and narcissism were related to different types of internet activities such as online sex, social media use, online gambling, online gaming, and online shopping."[93]

Individuals' correlation to sexual use to such study variables is Machiavellianism (.32), spitefulness (.31), sadism (.34), narcissism (.24), and psychopathy (.26).[93]

### Sexual violence

#### Controlled studies

A controlled study describes the relationship between given behaviors or environmental conditions and health effects in a laboratory setting in which conditions other than those under study are effectively held constant across groups of participants receiving various levels of the experimental condition(s).[94] The findings of the experiments were unable to be generalized outside of the field of the experiments. However, explanations of said studies are still required to prove their importance for understanding the subject matter. This is especially true when it comes to health consequences.

The link between pornography and sexual aggression has been the subject of multiple meta-analyses.[95] Meta-analyses conducted in the 1990s by Allen et al. suggested to researchers that there might not be an association of any kind between pornography and rape supportive attitudes in non-experimental studies.[96] However, a meta-analysis by Hald, Malamuth and Yuen (2000) suggests that there is a link between consumption of violent pornography and rape-supportive attitudes in certain populations of men, particularly when moderating variables are taken into consideration.[95]

A meta-analysis conducted in 2015 found that pornography was associated with sexual aggression in a global scale towards both genders. Verbal aggression were done more frequently than physical aggression, albeit with the same impact. The patterns suggest that violent pornography could be the driving force behind these aggressive actions[97]

A literature review by Ferguson and Hartley in 2009 argued that it would be wise to let go of the notion that pornography contributes to increased sexual assault behavior.[98] The authors stated that the experts of some studies tended to highlight positive findings while de-emphasizing null findings. They would then conclude that controlled studies, on balance, were not able to support links between pornography and sexual violence.

Ferguson and Hartley updated their review with a 2020 meta-analysis. This meta-analysis concluded that mainstream pornography could not be linked to sexual violence and was associated with reductions in sexual violence at the societal level. Small correlations were found between violent porn viewing and sexual aggression, but evidence was unable to differentiate whether this was a causal or selection effect (i.e. sexual offenders seeking out violent porn).[99]

Researcher Emily F. Rothman stated in 2021 that five separate studies have found that the people who commit sexual violence had consumed less porn than other criminals and that these people could potentially ruin the enjoyment of those who consume violence-based porn scenarios.[100] There is no reason to assume that pornography is a cause of rape.[101] There is not enough backing evidence to link violent pornography as the cause of rape.

#### Epidemiological studies

An epidemiological study describes the association between given behaviors or environmental conditions, and physical or psychological health by means of observation of real-world phenomena through statistical data. Epidemiological studies would generally be useful in describing real life events outside of the experimental field but would have a weak correlation with cause and effect relationships between specific behaviors and the health consequences.[94]

Danish criminologist Berl Kutchinsky's Studies on Pornography and sex crimes in Denmark (1970), a scientific report ordered by the Presidential Commission on Obscenity and Pornography, found that the legalizing of pornography in Denmark had not resulted in an increase of sex crimes.[102] In 1998 Milton Diamond from the University of Hawaii noted that in Japan, the number of reported cases of child sex abuse dropped markedly after the ban on sexually explicit materials was lifted in 1969; however, in Denmark and Sweden, there was a very slight increase in reported rapes after the liberalization of their pornography laws during the same time period, which scientists attribute to a higher awareness of what amounts to sex abuse.[103]

Some researchers argue that there is a correlation between pornography and a decrease of sex crimes.[104][13][105] The effects of Pornography: An International Perspective was an epidemiological study which found that the massive growth of the pornography industry in the United States between 1975 and 1995 was accompanied by a substantial decrease in the number of sexual assaults per capita - and reported similar results for Japan.[103]

In 1986, a review of epidemiological studies by Neil M. Malamuth found that the quantity of pornographic material viewed by men was positively correlated with degree to which they endorsed sexual assault.[106] Malamuth's work describes Check (1984), who found among a diverse sample of Canadian men that more exposure to pornography led to higher acceptance of rape myths, violence against women, and general sexual callousness. In another study, Briere, Corne, Runtz and Neil M. Malamuth, (1984) reported similar correlations in a sample involving college males. On the other hand, the failure to find a statistically significant correlation in another previous study led Malamuth to examine other interesting correlations, which took into account the information about sexuality the samples obtained in their childhood, and pornography emerged as the second most important source of information.[106] Malamuth's work has been criticized by other authors, however, such as Ferguson and Hartley (2009) who argue Malamuth has exaggerated positive findings and has not always properly discussed null findings.[98] In a Quartz publication, Malamuth argued that porn is like alcohol: "whether it's bad for you depends on who you are" (stating that it increases violence in a few people, not in most people; it makes most people more relaxed).[107]

The White Ribbon, symbolizing a movement against violence done to women

A 2019 study from the Archives of Sexual behavior on Teen Dating Violence (TDV) found that both males and females are perpetrators in different regards. Males would more often engage in Sexual TDV, while females would more often engage in Physical and Emotional TDV. The Study mentions the analysis of two separate frameworks. One is the Confluence model of Sexual aggression, in which it details porn being the one that influences boys to be sexually aggressive. It works significantly towards the males that have fragile masculinity and the ones that are more sexually promiscuous.[108] The other framework is the script acquisition, activation, application model (3AM) of sexual media socialization. This framework suggests that behavior towards sexual encounters is acquired through "scripts" that people get from viewing pornographic content. These actions, often negative, will then be mirrored. This will result in more sexual and Teen Dating Violence[109][110]

## Effects on relationships

The consumption of pornography has various impacts in different areas of a relationship. Pornography can influence an individual's relationship through a number of channels, including overall relationship satisfaction, communication within a relationship, and setting boundaries within that said relationship.

Pornography's impact on relationship satisfaction comes under scrutiny, as findings range from negative correlations, to positive effects. Pornography consumption is correlated with less relationship satisfaction, sexual satisfaction, and less sexual desire for their partner in men.[78][76][83] Researchers have concluded this could be because the ever-changing value of pornography and its regularity makes it difficult for a female partner to compete. Some research reports positive findings for women who consume pornography more regularly, including increased relationship satisfaction and decreased distress.[19][76]

### Relationship satisfaction

The research on the correlation between pornography use and relationship satisfaction is varied. While some believe pornography consumption leads people to become less satisfied in their relationships, others believe it can have the opposite effect. Pornography consumption tends to result in lower levels of satisfaction in long-term, heterosexual relationships. Most of the current research is correlational, indicating a connected but non-causal relationship; however, one major trend that gets affected is the rate of divorce. Couples who increase their consumption of pornography are nearly twice as likely to divorce than couples who do not consume pornographic content, with the rate rising from 5% to 11%.[111] Also, married adults who watch porn are twice as likely to be divorced after 6 years than married adults who do not watch porn.[112] One thing that lessens the probability is the frequency of pornography consumption. More frequent pornography consumption is negatively associated with relationship satisfaction. Individuals who report more frequent use of pornography within a relationship also report low levels of satisfaction in their relationships.[78]

However, many reject the idea that pornography is inherently harmful to relationship satisfaction. Joint pornography consumption within a relationship has been connected to increased levels of relationship satisfaction for both partners. Couples who consumed pornography together expressed more satisfaction with their relationships than couples in which only one individual used pornography.[75] This suggests that there is more at play than simply the consumption of pornography, such as the role of honesty and partner perception. Individuals whose partners are honest about their own pornography consumption tend to feel more satisfied in their relationships, to a point. There is evidence for an "honesty threshold," indicating that the relationship between honesty and pornography is not linear, and partners do not want to hear every detail about the other's pornography habits.[113] This indicates that, although honesty and disclosure is important for pornography consumption, there seems to be a threshold of helpful honesty that, once surpassed, may cause more harm. In addition, when women consume pornography, they report lower levels of distress than their counterparts.[75] While women often consume pornography less often than men, men are fairly accurate at perceiving their partner's pornography consumption. Women, on the other hand, are less accurate at perceiving their male partner's pornography use.[19]

Some research suggests that there is no connection between relationship satisfaction and pornography use. A study of two independent male samples found no relationship between pornography and relationship satisfaction in their first sample. when the second sample was introduced, they found a negative correlation between Pornography and Satisfaction.[78] Conversely, other studies found no relationship whatsoever between joint pornography use and satisfaction. When analyzing couples and their pornography consumption over the course of one month, researchers found no correlation between relationship satisfaction and pornography use.[76]

Wright and Herbenick (2022) suggest that White men (as research subjects) are almost entirely responsible for the statistical depreciation of relationship satisfaction due to pornography use.[114] Women and Men of other races do not have this problem.[114]

### Communication

Communication is a vital component of any healthy relationship, and many researchers question how pornography may impact the ability of a couple to communicate openly. Honesty has been shown to be a mitigator in relationship effects regarding pornography consumption. Couples who are honest about their pornography consumption report greater satisfaction than couples dealing with their concealed pornography use.[113] Pornography consumption among couples leads to improved communication about sexual desires, and increased openness in communication.[75] Conversely, active concealment of pornography habits can lead to less openness in communication and trust within the relationship.[75][113]

Another important aspect is the communication of affection within relationships. Affection Exchange Theory establishes the inherent role of affection within romantic relationships. Even in the role of survival, reproduction, and sexual selection.[25] Trait attachment is positively associated with relationship satisfaction. Individuals who score higher in trait attachment report feeling and expressing greater sexual desire for their partners, compared to individuals who score lower.[16][25] Some evidence indicates that the connection between Affection Exchange Theory and sexual desire is, in fact, stronger than the connection to relationship satisfaction, suggesting that sexual desire may have a crucial moderating role between the two.[25] While this study found no correlation between pornography consumption and trait affection, researchers noted that increased feelings of guilt were related to lower levels of sexual desire for one's partner. This is somewhat indicative of partner-imposed or communicated guilt, or possibly reflecting an effect of the sexual scripts of pornography creating unrealistic expectations that lead to overall relationship and sexual dissatisfaction.[16]

### Pornography mirroring and consent

The Symbol of Consent

One important aspect when talking about communication is the presence of Consent. Engaging in affirmative consent has ultimately become the standard when getting people involved in any sexual activity.[115] Individuals who watch pornograpy would be more likely to mirror the scenes that are present in pornographic scenes, yet seem to forget that most pornographic content that are posted on sites are done and shot with prior consent by the actors. This mirroring act could inspire harm and violence in intimate settings [116]

The presence of sexual consent is used in issues regarding force reduction, coercion, sexual assault and even sexual miscommunication.[117] The most identifiable form of consent is the presence of expressed agreement. In the case of pornography consumption and wanting to try out the scenes present, an individual must provide verbal affirmative consent before continuing with the activity.[115]

However, research suggests that consent is not so easily applied in real life situations. A consent study done by Willis and Smith in 2021 examined how an individual's sexual behavior relates to the level of consent.[118] The study found that women are more often the target of non-consensual activity and that almost one-third of the sample collected for the study had experienced at least one of the sexual behaviors listed in the study, without consent. Individuals who consume more pornography with non-consensual imagery, such as substance driven sexual intercourse are more likely to engage in sexual activities with the same non-consensual methods. affirmative consent is not asked or done due to a couple more reasons such as embarrassment, fear and rejection from their partners[119]

## Pornographic effects on adult film performers

Because the creation of pornography involves unsimulated sex, usually without condoms (barebacking), pornographic actors have been found to be particularly vulnerable to sexually transmitted diseases.[120][121][122] In 2004-2008 a study was done by the American Public Health Association regarding STDs in adult film industry companies from California . The association found that 18%-26% of those working in the industry are infected annually with Gonorrhea or Chlamydia. Of those infected, about 72% are women, and 25% of those women are diagnosed with reinfections.

The AIDS Healthcare Foundation tried several times to have California's Department of Industrial Relations, Division of Occupational Safety and Health's Appeals Board force companies in the pornography industry to treat actors and actresses as employees subject to occupational safety and health regulation. The first notable HIV outbreaks were in 1998, 2004, and 2010. Each of these outbreaks follows the same procedure. They first halt all filming. At the same time, their workers are being tested for STDs. The main issue with this procedure is those who are infected but do not show symptoms and have false negatives on tests are still contagious after filming starts again.[123] In a 2014 case brought against Treasure Island Media, an administrative judge ruled that the company had to comply with the regulations.[124]

### Famous cases

In 2013, former pornographic actress Sunny Leone quit the industry and became a mainstream icon in the Hindi film industry, after her exit, films were made that exploited sexuality, sensuality and her image.[125]

pornhub logo

One of the more famous recent cases is the exit of Mia Khalifa. Similar to Leone, Khalifa is a former pornographic actress who was signed with the popular porn site, Pornhub. Khalifa made her exit from the porn industry in January 2015. After her retirement from the industry, She was open about the mistreatment and sexual exploitation of the performers.[126] Khalifa struggled with finances being frozen by the company, earning just a small sum from her whole adult star career.[127] Khalifa also mentioned that she would often be forced to do certain scenes and that her partner convinced her to be involved in the industry.

## See also

* Meese Report, 1986 U.S. Attorney General's Commission on Pornography
* Pornographication
* President's Commission on Obscenity and Pornography, 1969, United States
* Stanley v. Georgia, U.S. Supreme Court case that established a right to pornography
* Williams Committee, 1979 UK Committee on Obscenity and Film Censorship
* Religious views on pornography
* Sexual ethics
* Victorian morality

## References

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2. ↑ Duffy, Athena; Dawson, David L.; das Nair, Roshan (1 May 2016). "Pornography Addiction in Adults: A Systematic Review of Definitions and Reported Impact". The Journal of Sexual Medicine 13 (5): 760–777. doi:10.1016/j.jsxm.2016.03.002. ISSN 1743-6109. PMID 27114191. http://eprints.lincoln.ac.uk/23086/1/23086 Duffy - Porn Addiction Review 2017 repository.pdf.
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17. ↑ 17.0 17.1 Simon, William; Gagnon, John H. (April 1986). "Sexual scripts: Permanence and change". Archives of Sexual Behavior 15 (2): 97–120. doi:10.1007/bf01542219. ISSN 0004-0002. PMID 3718206. http://dx.doi.org/10.1007/bf01542219.
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19. ↑ 19.0 19.1 19.2 19.3 19.4 19.5 19.6 19.7 Carroll, Jason S.; Busby, Dean M.; Willoughby, Brian J.; Brown, Cameron C. (2017-04-03). "The Porn Gap: Differences in Men's and Women's Pornography Patterns in Couple Relationships" (in en). Journal of Couple & Relationship Therapy 16 (2): 146–163. doi:10.1080/15332691.2016.1238796. ISSN 1533-2691. https://www.tandfonline.com/doi/full/10.1080/15332691.2016.1238796.
20. ↑ Bennett, Margaret; LoPresti, Brittny J.; McGloin, Rory; Denes, Amanda (2019-10-20). "The Desire for Porn and Partner?: Investigating the Role of Scripts in Affectionate Communication, Sexual Desire, and Pornography Consumption and Guilt in Young Adults' Romantic Relationships" (in en). Western Journal of Communication 83 (5): 647–667. doi:10.1080/10570314.2018.1564934. ISSN 1057-0314. https://www.tandfonline.com/doi/full/10.1080/10570314.2018.1564934.
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25. ↑ 25.0 25.1 25.2 25.3 25.4 25.5 Floyd, K. (2015). Affection exchange theory. In C. R. Berger & M. E. Roloff (Eds.), The international encyclopedia of interpersonal communication (pp. 24–31). Malden, MA: Wiley Blackwell. doi:10.1002/9781118540190.wbeic139
26. ↑ 26.0 26.1 26.2 American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (Fifth ed.). Arlington, VA: American Psychiatric Publishing. pp. 481, 797–798. ISBN 978-0-89042-555-8. https://archive.org/details/diagnosticstatis0005unse/page/481. "Thus, groups of repetitive behaviors, which some term behavioral addictions, with such subcategories as "sex addiction," "exercise addiction," or "shopping addiction," are not included because at this time there is insufficient peer-reviewed evidence to establish the diagnostic criteria and course descriptions needed to identify these behaviors as mental disorders."
27. ↑ Stein, Dan J.; Hollander, Eric; Rothbaum, Barbara Olasov (31 August 2009). Textbook of Anxiety Disorders. American Psychiatric Pub. pp. 359–. ISBN 978-1-58562-254-2. https://books.google.com/books?id=quQY1R8vsZcC&pg=PA359. Retrieved 24 April 2010.
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29. ↑ The British Psychological Society, "Response to the American Psychiatric Association: DSM-5 Development", 2001 [1]
30. ↑ Ley, David J. (10 July 2014). The Myth of Sex Addiction. Rowman & Littlefield. p. 2. ISBN 9781442213050. https://books.google.com/books?id=YlBQ8G56X7YC&q=Myth+of+addiction+ley.
31. ↑ Bridges, Ana J.; Morokoff, Patricia J. (2010-12-22). "Sexual media use and relational satisfaction in heterosexual couples". Personal Relationships 18 (4): 562–585. doi:10.1111/j.1475-6811.2010.01328.x. ISSN 1350-4126. http://dx.doi.org/10.1111/j.1475-6811.2010.01328.x.
32. ↑ Coon, Dennis; Mitterer, John O.; Martini, Tanya S. (5 December 2016). Psychology: Modules for Active Learning. Cengage Learning. pp. 413–414. ISBN 978-1-337-51708-9. https://books.google.com/books?id=oPS5DQAAQBAJ&pg=PA414.
33. ↑ Kraus, Shane W; Voon, Valerie; Potenza, Marc N (2015-09-22). "Neurobiology of Compulsive Sexual Behavior: Emerging Science". Neuropsychopharmacology 41 (1): 385–386. doi:10.1038/npp.2015.300. ISSN 0893-133X. PMID 26657963.
34. ↑ Prause, Nicole; Steele, Vaughn R.; Staley, Cameron; Sabatinelli, Dean; Hajcak, Greg (2015). "Modulation of late positive potentials by sexual images in problem users and controls inconsistent with 'porn addiction'". Biological Psychology 109: 192–199. doi:10.1016/j.biopsycho.2015.06.005. PMID 26095441.
35. ↑ "ASAM Definition of Addiction". 19 April 2011. http://www.asam.org/quality-practice/definition-of-addiction.
36. ↑ 36.0 36.1 36.2 36.3 Gola, Mateusz; Wordecha, Małgorzata; Sescousse, Guillaume; Lew-Starowicz, Michał; Kossowski, Bartosz; Wypych, Marek; Makeig, Scott; Potenza, Marc N. et al. (September 2017). "Can Pornography be Addictive? An fMRI Study of Men Seeking Treatment for Problematic Pornography Use". Neuropsychopharmacology (Springer Nature) 42 (10): 2021–2031. doi:10.1038/npp.2017.78. ISSN 0893-133X. OCLC 815994337. PMID 28409565. PMC 5561346. https://www.nature.com/articles/npp201778.pdf. Retrieved 1 August 2021.
37. ↑ "AASECT Position on Sex Addiction". April 2018. https://www.aasect.org/position-sex-addiction. "AASECT 1) does not find sufficient empirical evidence to support the classification of sex addiction or porn addiction as a mental health disorder, and 2) does not find the sexual addiction training and treatment methods and educational pedagogies to be adequately informed by accurate human sexuality knowledge."
38. ↑ Schiffer, Boris; Peschel, Thomas; Paul, Thomas; Gizewski, Elke; Forsting, Michael; Leygraf, Norbert; Schedlowski, Manfred; Krueger, Tillmann H.C. (November 2007). "Structural brain abnormalities in the frontostriatal system and cerebellum in pedophilia" (in en). Journal of Psychiatric Research 41 (9): 753–762. doi:10.1016/j.jpsychires.2006.06.003. PMID 16876824. https://linkinghub.elsevier.com/retrieve/pii/S0022395606001166.
39. ↑ Watts, Clark; Hilton, Donald L. (2011). "Pornography addiction: A neuroscience perspective" (in en). Surgical Neurology International 2 (1): 19. doi:10.4103/2152-7806.76977. ISSN 2152-7806. PMID 21427788.
40. ↑ Castro-Calvo, J.; Cervigón-Carrasco, V.; Ballester-Arnal, R.; Giménez-García, C. (2021-06-01). "Cognitive processes related to problematic pornography use (PPU): A systematic review of experimental studies". Addictive Behaviors Reports 13: 100345. doi:10.1016/j.abrep.2021.100345. ISSN 2352-8532. PMID 33948482.
41. ↑ "ICD-11 for Mortality and Morbidity Statistics 6C72 Compulsive sexual behaviour disorder". https://icd.who.int/browse11/l-m/en#/http%3A%2F%2Fid.who.int%2Ficd%2Fentity%2F1630268048.
42. ↑ 42.0 42.1 Martinez-Gilliard, Erin (2023). Sex, Social Justice, and Intimacy in Mental Health Practice: Incorporating Sexual Health in Approaches to Wellness. Taylor & Francis. p. unpaginated. ISBN 978-1-000-84578-5. https://books.google.com/books?id=Y1yqEAAAQBAJ&pg=PT113. Retrieved 5 March 2023. "'Sex addiction' is also referred to as a diagnosis or presenting problem. Sex addiction is not a diagnosis in the DSM-5-TR and identified as Compulsive Sexual Behavior in the ICD-11 rather than an issue of addiction."
43. ↑ Dhuffar-Pottiwal, Manpreet (2022). Pontes, Halley M.. ed. Behavioral Addictions: Conceptual, Clinical, Assessment, and Treatment Approaches. Studies in Neuroscience, Psychology and Behavioral Economics. Springer International Publishing. p. 163. ISBN 978-3-031-04772-5. https://books.google.com/books?id=chuKEAAAQBAJ&pg=PA163. Retrieved 27 July 2023. "Given that we do not yet have definitive information on whether the processes involved in the onset and maintenance of the disorder are equivalent to substance abuse disorders, gambling, and gaming (Kraus et al. 2016), CSBD is not included in the grouping of disorders due to substance and addictive behaviors, but rather in that of impulse control disorders (Kraus et al. 2018)."
44. ↑ Bowman, Todd (2022). Reclaiming Sexual Wholeness: An Integrative Christian Approach to Sexual Addiction Treatment. Zondervan Academic. p. 161. ISBN 978-0-310-09311-4. https://books.google.com/books?id=9NFTEAAAQBAJ&pg=PA161. Retrieved 27 July 2023.
45. ↑ Ley, David J. (24 January 2018). "Compulsive Sexual Behavior Disorder in ICD-11". https://www.psychologytoday.com/blog/women-who-stray/201801/compulsive-sexual-behavior-disorder-in-icd-11.
46. ↑ Sassover, Eli; Weinstein, Aviv (29 September 2020). "Should compulsive sexual behavior (CSB) be considered as a behavioral addiction? A debate paper presenting the opposing view". Journal of Behavioral Addictions (Akademiai Kiado Zrt.) 11 (2): 166–179. doi:10.1556/2006.2020.00055. ISSN 2062-5871. PMID 32997646.
47. ↑ a verified Counsellor or Therapist (18 January 2021). "Do I have compulsive sexual behaviour?". https://www.counselling-directory.org.uk/memberarticles/do-i-have-compulsive-sexual-behaviour. ""Materials related to the ICD-11 make very clear that CSBD is not intended to be interchangeable with 'sex addiction', but rather is a substantially different diagnostic framework." ICD-11. World Health Organization."
48. ↑ Neves, Silva (2021). Compulsive Sexual Behaviours: A Psycho-Sexual Treatment Guide for Clinicians. Taylor & Francis. p. 14. ISBN 978-1-000-38710-0. https://books.google.com/books?id=31olEAAAQBAJ&pg=PT14. Retrieved 26 March 2022. "materials in ICD-11 make very clear that CSBD is not intended to be interchangeable with sex addiction, but rather is a substantially different diagnostic framework"
49. ↑ Prause, Nicole; Binnie, James (22 February 2023). "Iatrogenic effects of Reboot/NoFap on public health: A preregistered survey study". Sexualities (SAGE Publications): 136346072311570. doi:10.1177/13634607231157070. ISSN 1363-4607. https://openresearch.lsbu.ac.uk/download/af044dbeb36aefcdb593641a18267139b810bb745d21ca4e8881f5e40472d2e8/1373447/Submission_Sexualities_12.13.2022.pdf.
50. ↑ American Psychiatric Association (2022). "Conditions for Further Study". Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR(tm)). G - Reference,Information and Interdisciplinary Subjects Series. American Psychiatric Association Publishing. p. 916. ISBN 978-0-89042-576-3. https://books.google.com/books?id=PIGizgEACAAJ. "Excessive use of the Internet not involving playing of online games (e.g., excessive use of social media, such as Facebook; viewing pornography online) is not considered analogous to Internet gaming disorder, and future research on other excessive uses of the Internet would need to follow similar guidelines as suggested herein. Excessive gambling online may qualify for a separate diagnosis of gambling disorder."
51. ↑ American Psychiatric Association (2022). "Substance-Related and Addictive Disorders". Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR(tm)). G - Reference,Information and Interdisciplinary Subjects Series. American Psychiatric Association Publishing. p. 543. ISBN 978-0-89042-576-3. https://books.google.com/books?id=PIGizgEACAAJ. "In addition to the substance-related disorders, this chapter also includes gambling disorder, reflecting evidence that gambling behaviors activate reward systems similar to those activated by drugs of abuse and that produce some behavioral symptoms that appear comparable to those produced by the substance use disorders. Other excessive behavioral patterns, such as Internet gaming (see “Conditions for Further Study”), have also been described, but the research on these and other behavioral syndromes is less clear. Thus, groups of repetitive behaviors, sometimes termed behavioral addictions (with subcategories such as “sex addiction,” “exercise addiction,” and “shopping addiction”), are not included because there is insufficient peer-reviewed evidence to establish the diagnostic criteria and course descriptions needed to identify these behaviors as mental disorders."
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65. ↑ Lev-Ari, Lilac; Baumgarten-Katz, Inbar; Zohar, Ada H. (2014). "Show Me Your Friends, and I Shall Show You Who You Are: The Way Attachment and Social Comparisons Influence Body Dissatisfaction" (in en). European Eating Disorders Review 22 (6): 463–469. doi:10.1002/erv.2325. ISSN 1099-0968. PMID 25257536. https://onlinelibrary.wiley.com/doi/abs/10.1002/erv.2325.
66. ↑ van den Brink, Femke; Smeets, Monique A. M.; Hessen, David J.; Woertman, Liesbeth (2016-07-01). "Positive Body Image and Sexual Functioning in Dutch Female University Students: The Role of Adult Romantic Attachment" (in en). Archives of Sexual Behavior 45 (5): 1217–1226. doi:10.1007/s10508-015-0511-7. ISSN 1573-2800. PMID 25778405. PMC 4863903. https://doi.org/10.1007/s10508-015-0511-7.
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121. ↑ Grudzen, CR; Meeker, D; Torres, J; Du, Q; Andersen, RM; Gelberg, L (February 2013). "HIV and STI risk behaviors, knowledge, and testing among female adult film performers as compared to other California women". AIDS and Behavior 17 (2): 517–22. doi:10.1007/s10461-011-0090-0. PMID 22101890.
122. ↑ Goldstein, BY; Steinberg, JK; Aynalem, G; Kerndt, PR (July 2011). "High Chlamydia and gonorrhea incidence and reinfection among performers in the adult film industry". Sexually Transmitted Diseases 38 (7): 644–8. doi:10.1097/OLQ.0b013e318214e408. PMID 21844714.
123. ↑ Grosskurth, H. (1999-04-01). "From Mwanza and Rakai to Beijing and Moscow? STD control and HIV prevention". Sexually Transmitted Infections 75 (2): 83–85. doi:10.1136/sti.75.2.83. ISSN 1368-4973. PMID 10448357. PMC 1758185. http://dx.doi.org/10.1136/sti.75.2.83.
124. ↑ Fitz-Gerald, Sean (January 27, 2014). "Condoms Required for CA Porn Performers: Judge". NBC Southern California. http://www.nbclosangeles.com/news/local/California-Judge-Issues-Landmark-Ruling-on-Unprotected-Porn-242117921.html.
125. ↑ Prasad, Satyendra Kumar; Siri, V. Shanti (April 2019). "Sunny Leone: Sensation, Objectification and Body Genre". Language in India 19 (4): 382–389. https://search-ebscohost-com.lib-proxy.fullerton.edu/login.aspx?direct=true&db=cms&AN=172028837&site=ehost-live&scope=site.
126. ↑ Adegoke, Yomi (2019-08-15). "Why are people silent about the abuses and exploitation in porn?" (in en-GB). The Guardian. ISSN 0261-3077. https://www.theguardian.com/commentisfree/2019/aug/15/why-are-people-silent-about-the-abuses-and-exploitation-in-porn.
127. ↑ Horton, Alex (2019-08-21). "Mia Khalifa is among the world's most-watched women. Yet the porn industry is keeping the profits." (in en-US). Washington Post. ISSN 0190-8286. https://www.washingtonpost.com/business/2019/08/16/mia-khalifa-is-among-worlds-most-watched-women-yet-porn-industry-is-keeping-profits/.

## Further reading

* Kutchinsky, Berl (1999). Law, pornography, and crime: The Danish experience. Oslo, Norway: Pax Forlag.
* Hald, Gert Martin (2007). Pornography Consumption - a study of prevalence rates, consumption patterns, and effects. Aarhus Universitet, Denmark: Psykologisk Institut.
* Hald, Gert Martin; Malamuth, Neil (2008). "Self-Perceived Effects of Pornography Consumption". Sexual Addiction & Compulsivity: The Journal of Treatment & Prevention 19 (1–2): 99–122. doi:10.1080/10720162.2012.660431. PMID 17851749.

## External links

* Report of the Surgeon General's Workshop on Pornography and Public Health, United States Public Health Service, Office of the Surgeon General, August 4, 1986

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