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Comment on: Is Pornography Use Associated with Sexual Difficulties and Dysfunctions among Younger Heterosexual Men?

Comment on: Is Pornography Use Associated with Sexual
Difficulties and Dysfunctions among Younger Heterosexual Men?
Surprisingly, given its potential clinical relevance,
very few studies have attempted to investigate rela-
tionships between pornography consumption and
common sexual dysfunctions and problems (in
the following referred to as “sexual difficulties”).
When having done so, the designs employed have
predominantly been case study designs or focus
group designs and the method of data collection
qualitative. Alternatively, personal or clinical expe-
riences have been utilized. Although important,
such studies and experience alone may not be
brought to bear on effects of the consumption
of pornography. Consequently, the study by
Landripet and Stulhofer offers a long and valuable
cross-cultural beginning to the quantitative explo-
ration of associations between pornography con-
sumption and sexual difficulties.
More generally, elements of the study by
Landripet and Stulhofer reflect critical issues in
research on pornography. First, the sample most
likely constitutes a non-probability sample. This is
characteristic of much of the available research on
pornography today [1]. This problem may some-
what be offset by including short, valid, and reli-
able measures of pornography consumption in
future large population based national studies on
sexuality and sexual behaviors. Considering the
prevalence rates of pornography consumption and
the frequency by which pornography is consumed,
in particular among men, this seems both highly
relevant and high time.
Second, the study finds only one significant
association between pornography consumption
and the outcomes studied (i.e., erectile dysfunc-
tion) and emphasizes that the size (magnitude) of
this relationship is small. However, in pornogra-
phy research, the interpretation of “size” may
depend as much on the nature of the outcome
studied as the magnitude of the relationship found.
Accordingly, if the outcome is to be considered
“sufficiently adverse” (e.g., sexual aggressive
behaviors), even small effect sizes may carry con-
siderable social and practical significance [2].
Third, the study does not address possible mod-
erators or mediators of the relationships studied
nor is it able to determine causality. Increasingly,
in research on pornography, attention is given to
factors that may influence the magnitude or direc-
tion of the relationships studied (i.e., moderators)
as well as the pathways through which such influ-
ence may come about (i.e., mediators) [1,3]. Future
studies on pornography consumption and sexual
difficulties may also benefit from an inclusion of
such focuses.
Fourth, in their concluding statement, the
authors suggest that a number of factors are more
likely related to sexual difficulties than pornogra-
phy consumption. To better assess this, as well as
the relative contribution of each of these variables,
the use of comprehensive models able to encom-
pass both direct and indirect relationships between
variables known or hypothesized to influence the
outcome may be advised [3].
Overall, the study by Landripet and Stulhofer
provides first and an interesting cross-cultural and
quantitative insights into possible associations
between pornography consumption and sexual dif-
ficulties. Hopefully comparable future studies may
use this as a stepping stone to further advance the
research on relationships between pornography
consumption and sexual difficulties among both
men and women.
Gert Martin Hald
Department of Public Health, University of
Copenhagen, Copenhagen, Denmark
Statement of Authorship
Category 1
(a) Conception and Design
Gert Martin Hald
(b) Acquisition of Data
(c) Analysis and Interpretation of Data
Category 2
(a) Drafting the Article
Gert Martin Hald
J Sex Med 2015;12:1140–1141 © 2015 International Society for Sexual Medicine
(b) Revising It for Interllectual Content
Gert Martin Hald
Category 3
(a) Final Approval of the Completed Article
Gert Martin Hald
1 Hald GM, Seaman C, Linz D. Sexuality and pornography. In:
Tolman D, Diamond L, Bauermeister J, George W, Pfaus J,
Ward M, eds. APA handbook of sexuality and psychology: Vol.
2. Contextual approaches. Washington, DC: American Psycho-
logical Association; 2014:3–35.
2 Malamuth NM, Addison T, Koss M. Pornography and sexual
aggression: Are there reliable effects and can we understand
them? Annu Rev Sex Res 2000;11:26–91.
3 Rosenthal R. Media violence, antisocial behavior, and the social
consequences of small effects. J Soc Issues 1986;42:141–54.
Editorial Comment 1141
J Sex Med 2015;12:1140–1141
... Recent research in the area of SEM usage has mostly focused on proximal outcomes such as sexual satisfaction (Peter & Valkenburg, 2009;Stulhofer, Bu sko & Landripet, 2010;Yucel & Gassanov, 2010;Zillmann & Bryant, 1988), sexual dysfunctions (Hald, 2015;Landripet & Stulhofer, 2015), extra-relational attitudes and behaviors (e.g. Emmers-Sommer, Hertlein, & Kennedy, 2013;Lambert, Negash, Stillman, Olmstead, & Fincham, 2012;Maddox et al., 2011;Wright, Tokunaga, & Bae, 2014) and sexist and sexually aggressive attitudes (Hald & Malamuth, 2015;Hald, Malamuth, & Lange, 2013) and has investigated the role of SEM use in couples' relationship satisfaction primarily as a side effect. ...
... Alternatively, it is possible that the association between SEM use and relationship satisfaction is more indirect in nature, i.e. mediated by one or more variables that we have controlled for in this study (Hald, 2015). If this is the case, then it may still be highly relevant to target SEM in both clinical practice and research related to relationship satisfaction, but in a way different from that done in the current study. ...
... Despite these limitations, this study's findings contribute to research on SEM use and relationship satisfaction by directly investigating the association between the two while controlling for a large array of relevant covariates identified in the literature. Following recent suggestions by Hald (2015), the study explored a specific and clinically relevant moderator, namely emotional intimacy, indicating that higher SEM use may be significantly associated with lower relationship satisfaction only among men who report lower levels of emotional intimacy with their partner. Note 1. ...
Using a cross-sectional questionnaire design and a sample of 2284 coupled Croatian adults, this study investigated the association between Sexually Explicit Media (SEM) use and relationship satisfaction. Further, possible moderation of emotional intimacy on the relationship between SEM use and relationship satisfaction was investigated. Controlling for sociodemographic, psychosexual and relationship variables, no significant association between SEM use and relationship satisfaction was found. However, among men, a moderating effect of emotional intimacy was found. Thus, higher SEM use was found to be significantly associated with lower relationship satisfaction only among men who reported lower levels of emotional intimacy with their partner.
... Furthermore, arguments have been made for pornography influencing substance use, sexual compulsivity, and risky sexual behaviors (Carroll et al., 2008;Hald, Seaman, & Linz, 2014). Alternatively, pornography has also been credited with improving sex lives (sexual satisfaction, awareness of positions or acts, increasing sex drive, etc.) (Peter & Valkenburg, 2009;Stulhofer et al., 2010;Yucel & Gassanov, 2010;Zillmann & Bryant, 1988), decreasing attitudes supporting sexual violence (Hald et al., 2013;Hald & Malamuth, 2015), and improving assessment of common sexual dysfunctions (Hald, 2015;Landripet & Stulhofer, 2015). Most research focuses on the impact of pornography on heterosexual consumers and not sexual minoritized individuals. ...
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Research suggests individuals may learn sexual attitudes and behaviors from consuming pornography. Sexual minoritized individuals (e.g. gay, lesbian, bisexual) are more likely to use online sources to learn about their identity. Therefore, the content of free online pornographic videos is important to examine. Yet there is limited research on the depiction of sexual minoritized women in pornography. This study compared the frequencies of sexual behaviors and aggression in Heterosexual (n = 594), Lesbian (n = 108), and Bisexual (n = 105) pornographic scenes. Compared to Heterosexual scenes, Bisexual scenes contained higher frequencies of sexual behaviors including fellatio, penile-vaginal sex, and anal sex. Lesbian scenes had the most depictions of female orgasm when compared to Bisexual and Heterosexual scenes, while Bisexual scenes had more depictions of male orgasm when compared to Heterosexual. There was no statistical difference in aggression toward women among categories; Bisexual scenes, however, had more depictions of aggression against men than Heterosexual scenes. These findings suggest binegative myths like hypersexuality are present in pornography.
... Although correlations in the range of −0.12 to −0.14 would be considered "small" in relation to Cohen's (1992) effect size guidelines, other factors (e.g., the commonality of predictors and severity of outcomes) should also be considered when determining the importance of an effect of any particular magnitude (Rosenthal, 1986;Rosnow & Rosenthal, 2003). Indeed, Hald (2015) posits that the small (in magnitude) effect sizes commonly observed across the pornography research literature warrant consideration as these effects may still have large social and practical repercussions if outcomes are sufficiently adverse. This is especially relevant given the high prevalence of pornography use among men (Hald, 2006). ...
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Pornography use, preference for “porn‐like” sex, masturbation, and sexual and relationship satisfaction were assessed among two samples of men (NStudy 1 = 326, NStudy 2 = 335). Frequent pornography use was associated with sexual dissatisfaction, greater preference for porn‐like sex, and more frequent masturbation in both studies. Pornography use was associated with relationship dissatisfaction in Study 2 only. The data did not support the notion that pornography negatively impacts sexual or relationship satisfaction via preference for porn‐like sex. In fact, it may bolster sexual satisfaction by promoting sexual variety. The data were consistent with a model in which pornography negatively, indirectly affects sexual and relationship satisfaction via masturbation frequency. Pornography use may have multiple opposing influences on sexual satisfaction.
... 41 This pattern of activity was associated with sexual dissatisfaction but was not related to sexual dysfunction, a result that disconfirms our hypothesis and might seem counterintuitive. As Hald 42 suggested, very few studies have investigated the relation between pornography use and common sexual dysfunctions. Our result is in line with those from such studies in men reporting that a higher frequency of pornography use is not associated with erectile dysfunction and might even improve desire and arousal. ...
Introduction Although findings concerning sexual outcomes associated with cyberpornography use are mixed, viewing explicit sexual content online is becoming a common activity for an increasing number of individuals. Aim To investigate heterogeneity in cyberpornography-related sexual outcomes by examining a theoretically and clinically based model suggesting that individuals who spend time viewing online pornography form three distinct profiles (recreational, at-risk, and compulsive) and to examine whether these profiles were associated with sexual well-being, sex, and interpersonal context of pornography use. Methods The present cluster-analytic study was conducted using a convenience sample of 830 adults who completed online self-reported measurements of cyberpornography use and sexual well-being, which included sexual satisfaction, compulsivity, avoidance, and dysfunction. Main Outcomes Measures Dimensions of cyberpornography use were assessed using the Cyber Pornography Use Inventory. Sexual well-being measurements included the Global Measure of Sexual Satisfaction, the Sexual Compulsivity Scale, the Sexual Avoidance Subscale, and the Arizona Sexual Experiences Scale. Results Cluster analyses indicated three distinct profiles: recreational (75.5%), highly distressed non-compulsive (12.7%), and compulsive (11.8%). Recreational users reported higher sexual satisfaction and lower sexual compulsivity, avoidance, and dysfunction, whereas users with a compulsive profile presented lower sexual satisfaction and dysfunction and higher sexual compulsivity and avoidance. Highly distressed less active users were sexually less satisfied and reported less sexual compulsivity and more sexual dysfunction and avoidance. A larger proportion of women and of dyadic users was found among recreational users, whereas solitary users were more likely to be in the highly distressed less active profile and men were more likely to be in the compulsive profile. Conclusion This pattern of results confirms the existence of recreational and compulsive profiles but also demonstrates the existence of an important subgroup of not particularly active, yet highly distressed consumers. Cyberpornography users represent a heterogeneous population, in which each subgroup is associated with specific sexual outcomes.
... That seems overly definitive, given that the Portuguese men they surveyed reported the lowest rates of sexual dysfunction compared with Norwegians and Croatians, and only 40% of Portuguese reported using Internet pornography "from several times a week to daily", as compared with the Norwegians, 57%, and Croatians, 59%. This paper has been formally criticized for failing to employ comprehensive models able to encompass both direct and indirect relationships between variables known or hypothesized to be at work [59]. Incidentally, in a related paper on problematic low sexual desire involving many of the same survey participants from Portugal, Croatia and Norway, the men were asked which of numerous factors they believed contributed to their problematic lack of sexual interest. ...
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Traditional factors that once explained men's sexual difficulties appear insufficient to account for the sharp rise in erectile dysfunction, delayed ejaculation, decreased sexual satisfaction, and diminished libido during partnered sex in men under 40. This review (1) considers data from multiple domains, e.g., clinical, biological (addiction/urology), psychological (sexual conditioning), sociological; and (2) presents a series of clinical reports, all with the aim of proposing a possible direction for future research of this phenomenon. Alterations to the brain's motivational system are explored as a possible etiology underlying pornography-related sexual dysfunctions. This review also considers evidence that Internet pornography's unique properties (limitless novelty, potential for easy escalation to more extreme material, video format, etc.) may be potent enough to condition sexual arousal to aspects of Internet pornography use that do not readily transition to real-life partners, such that sex with desired partners may not register as meeting expectations and arousal declines. Clinical reports suggest that terminating Internet pornography use is sometimes sufficient to reverse negative effects, underscoring the need for extensive investigation using methodologies that have subjects remove the variable of Internet pornography use. In the interim, a simple diagnostic protocol for assessing patients with porn-induced sexual dysfunction is put forth.
Background Although problematic pornography use (PPU) will soon be diagnosable through the International Classification for Diseases, 11th revision, its clinical profile remains contentious. The current study assessed whether PPU may be characterized by various symptoms sometimes observed among online recovery forums that currently lack empirical assessment, such as heightened cognitive-affective issues following pornography use and sexual dysfunction with partners as a result of escalating use. Method Cross-sectional surveys were completed by male PPUs ( N = 138, mean age = 31.75 years, standard deviation = 10.72) recruited via online recovery communities and Amazon Mechanical Turk. Multiple regression analysis was performed using the Problematic Pornography Use Scale as the dependent variable and variables of interest (Arizona Sexual Experiences Scales modified for partnered sex and pornography use, Brunel Mood Scale, Social Interaction Anxiety Scale, and the Tolerance subscale from the Problematic Pornography Consumption Scale) and potential confounders (eg, comorbid psychopathology) as independent variables. Results Current levels of pornography use, indicators of tolerance and escalation, greater sexual functioning with pornography, and psychological distress were uniquely associated with PPU severity, while cognitive-affective issues after pornography use, impulsivity and compulsivity were not. Although sexual dysfunction did not predict PPU severity, nearly half the sample indicated sexual dysfunction with intimate partners. Conclusions The present findings suggest that PPU may be characterized by tolerance and escalation (as per substance addiction models), greater sexual responsivity toward pornography, and psychological distress. Meanwhile, the high rate of partnered sexual dysfunction observed suggests that PPU might be somewhat separable from other forms of compulsive sexual behavior.
Using pornography through the Internet is now a common activity even if associated sexual outcomes, including sexual satisfaction, are highly variable. The present study tested a two-step sequential mediation model whereby cyberpornography time use is related to sexual satisfaction through the association with, in a first step, perceived addiction to cyberpornography (i.e., perceived compulsivity, effort to access, and distress toward pornography) and with, in a second step, sexual functioning problems (i.e., sexual dysfunction, compulsion, and avoidance). These differential associations were also examined across gender using model invariance across men and women. A sample of 832 adults from the community completed self-report online questionnaires. Results indicated that 51 percent of women and 90 percent of men reported viewing pornography through the Internet. Path analyses showed indirect complex associations in which cyberpornography time use is associated with sexual dissatisfaction through perceived addiction and sexual functioning problems. These patterns of associations held for both men and women.
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In response to some recent critiques, we (a) analyze the arguments and data presented in those commentaries, (b) integrate the findings of several metaanalytic summaries of experimental and naturalistic research, and (c) conduct statistical analyses on a large representative sample. All three steps support the existence of reliable associations between frequent pornography use and sexually aggressive behaviors, particularly for violent pornography and/or for men at high risk for sexual aggression. We suggest that the way relatively aggressive men interpret and react to the same pornography may differ from that of nonaggressive men, a perspective that helps integrate the current analyses with studies comparing rapists and nonrapists as well as with cross-cultural research.
This paper shows in practical, quantitative, yet intuitive terms just what the social consequences are likely to be of the “small effects” typically found in research on media violence and antisocial behavior. Estimates are provided for how well we can predict (a) adult antisocial behavior from childhood antisocial behavior; (b) current antisocial behavior from current exposure to media violence; (c) subsequent antisocial behavior from earlier exposure to media violence, adjusting for earlier levels of antisocial behavior; and (d) how much we can decrease antisocial behavior by means of special intervention. Although proportions of variance accounted for appeared low, the practical consequences associated with these estimates were found to be substantial.
APA handbook of sexuality and psychology: Vol. 2. Contextual approaches
  • Hald GM
  • Seaman C
  • Linz D