Red Herring: Hook, Line, and Stinker

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Red Herring: Hook, Line, and Stinker
DOI: 10.1002/sm2.70
A red herring is not a delicacy that we have had the pleasure of
trying, but we are fond of its use as an English idiom. In our
“Viewing Sexual Stimuli Associated with Greater Sexual Respon-
siveness, Not Erectile Dysfunction”, we speculate that viewing
erotic films might resemble such a fish/idiom with respect to
causing erectile dysfunction (ED). The letter writer weaves a
nefarious tale of “gays”, “missing data”, and “egregious” problems
in our original study [1]. This sounds like a good read indeed, if
any of the problems had actually occurred.
No questions were raised about the strong finding that the
more men viewed sex films at home the stronger sexual desire
they reported for their partner. In fact, this result was described
as “hardly novel”. Also, no questions were raised about the poor
literature published in this area. We were pleased to find that our
original report was replicated and extended by a recent indepen-
dent laboratory study that examined male sexual function even
more broadly [2]. Hence, we seem to agree that viewing sex films
at home does not inexorably impair the desire for one’s
partner, and is in need of further research that actually tests such
claims.
The letter writer begins by stating that “the Internet has lead
[sic] to a host of . . . problems for our patients”, but cites five
studies that do not contrast sexual stimulation on the Internet
from other forms of visual sexual stimulation. This statement is
contradicted by data showing that VHS was responsible for a
larger change in sex film viewing than the Internet [3]. To make
this more accessible for nonscientists, we have created an acces-
sible application that plots data from the General Social Survey for
you and welcome its distribution [4].
The author describes “discrepancies” in participant counts, but
no discrepancies exist. Table 1 shows all 280 participants, includ-
ing the subsample with International Index of Erectile Function
(IIEF) scores.
Secondary analysis affords two benefits. First, participants who
had to be excluded from published studies because of problems with
some measures (e.g., high blink rate in electroencephalography
studies, failure to complete a computer task as instructed) do not
need to be excluded when a secondary analysis does not require
those affected measures. Hence, many participant counts for this
study should be, and are, higher than those available for analysis in
the initial publications. Second, we are able to include question-
naire measures that had to be described only briefly in previous
publications. Full descriptions of every single questionnaire admin-
istered are commonly excluded from publications for many not-so-
sinister reasons. Questionnaires (such as the IIEF) typically are
described thoroughly in the publications that introduce the ques-
tionnaires. Repeating the entirety of those original descriptions
would be redundant (and exceed word limits). Sometimes, authors
are asked during the peer-review process to remove descriptions of
questions, because the questions and their answers are straightfor-
ward and pertain in an obvious way to the overall hypotheses being
tested. In our analysis, we used IIEF data from every participant for
whom we also had a complete report of the average hours of erotica
viewed weekly and the completed IIEF. This is important for
statistical power (as we reported in the article).
The author of the letter also made a false statistical statement:
“Results from different Likert scales are not poolable [sic]”. Of
course they are! In fact, there are at least three different methods
to pool them. The first method (actually encompassing many
possibilities) is to normalize the scores (e.g., z-scores, T-scores,
percentile rank, etc). The second method is to use “scale” as a
covariate. The third is to provide evidence that participants were
using the scale in a consistent way theoretically, such as similar
variance without using the top two or bottom two scores (see e.g.,
[5,6]).
The author also made a false statement that stimuli varied
between studies and this was not “controlled”. We assessed and
controlled the stimuli as stated in our original article (“sexual
arousal reported did not differ by film length, so data were col-
lapsed across studies for this analysis”, p. E4).
Finally, again contrary to the author’s claims, there were not
“four gay” men in any study. All participants were required to be
attracted to the opposite sex, as stated in the original article (“All
reported attraction to women” p. 3). It seems the author remains
unaware of the well-replicated studies showing that self-identity
often differs from behaviors, fantasy/attraction, and/or relation-
ship desires in both men and women. Also, this thing called
“bisexual” exists. We recommend an excellent review of this
research and topic by Diamond [7] and more recently van Anders
[8]. Hence, all stimuli were appropriate for the female sex attrac-
tion reported by the men tested.
We describe the hours-viewed parameter in two places in the
study, and included its distribution (“strongly positively skewed” p.
4) and bin counts (“0 (n = 25), up to 2 (n = 56), or more than 2
(n = 55) hours”). We now add the range of 0–25 hours per week.
Of course, the skew (4.7) was, as we originally reported, high.
Finally, the mean hours of viewing was 1.5 hours, which is in the
range of experience of 46.4% of men in one large study [9].
The author claims we did not adequately describe the sex film
viewing variable. We described that variable at least 13 places in
the article (“weekly average” in abstract; “reported the average
number of hours they consumed VSS per week” on p. 3; “amount
of VSS viewed weekly” and “Hours of VSS viewing per week” and
“hours of VSS in the average week” on p. 4; “amount of VSS
viewed during the week” and “hours of VSS consumed in the
average week” and “hours of VSS viewed in the typical week” and
“hours of VSS viewed in the average week” and “hours of VSS
being consumed in the average week” and “hours of VSS viewed in
the average week” on p. 5; “Hours viewing sexual stimuli per week
on average” in Figure 1; “hours of VSS viewed weekly” on p. 6).
The question was exactly as described, “How much time per week
did you spend using pornography during the past month?” with
the response box including the descriptor “hours” for which they
could indicate partial hour(s).
© 2015 The Author. Sexual Medicine published by Wiley Periodicals, Inc.
on behalf of International Society for Sexual Medicine.
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License,
which permits use, distribution and reproduction in any medium, provided the original work is properly cited and
is not used for commercial purposes.
Sex Med **;**:**–**

Assessing current average hours per week is consistent with
other studies of the level of sexual film use. For example, Hald and
Malamuth [10] used one item from four time-related measures
described as the “average time of use in minutes per week during
the past year” (p. 102). Kühn and Gallinat [11] included “hours on
average spent with pornographic material during the week” as
their only predictor in quantifying porn use in relation to brain
structure and function (p. 828). Rosser et al. [12] examined “fre-
quency and duration measures of SEM consumption of any kind in
the last 3 months . . .” which were combined “to create an index of
the hours per week dedicated to SEM consumption” (p. 1491).
Further, the hours per week of online sexual activities was the only
use variable that differentiated problem and nonproblem users in
an early study [13] and the amount of use continues to be included
in recent conceptualizations of “problem” use (“Hypersexual Dis-
order is associated with increased time engaging in sexual fantasies
and behaviors” [14], p. 385). Other scientists have used less
detailed measures of engagement (“e.g., “Approximately how
many times in the past 30 days have you viewed pornography?”,
p.72 [15]; partner viewing frequency as “6 (always), 5 (usually), 4
(often), 3 (sometimes), 2 (rarely), and 1 (never).” [16]). Thus, our
approach, which exceeds the measures of many investigations, is
commonly used and has been demonstrated to differentiate pro-
posed clinical groups. Although we appreciate a good drama, “the
porn use data is [sic] uninterpretable”, is a bit emotional for mea-
sures that represent the current state of the science. Also, one
should remember that the data “are”.
The author cites two studies as evidence that we should have
assessed “total pornography usage, age of onset, presence of esca-
lation, and extent of sexual activity with partner”. The first study
actually demonstrates the opposite. Specifically, “Even when con-
trolling for Internet addiction, we found a negative association
between PHs and the right caudate GM volume (r =−0.336,
P < .01); similarly, the association was still significant when con-
trolling for sex addiction” (p. E4).
11
This means that more in-depth
assessment than the hours of weekly consumption added nothing
to the prediction. Further, those authors actually did not analyze
any of the variables independently (age of onset, presence of esca-
lation, sexual activity with a partner). The second study cited is
quite puzzling, as those scientists assessed only age of onset (“Only
15 items from the Online Pornography Survey, which focused on
the respondent’s age of onset for online pornography use, were
included in this study”, p. 1998) [17]. Finally, a new study has
expanded our initial results to show that neither the frequency of
viewing over a year nor changes in the frequency of use were
related to erectile problems [2]. Hence, the complaint was not
actually supported and was not warranted.
We followed the example of Kuhn and Gallinat [11] and chose
to examine men not reporting problems in their use of erotica. We
state this at least twice in the article (“Nontreatment-seeking men”
in the abstract; “The current study investigated erectile difficulties
in a non-patient sample”, p. E3), then spend the better part of a
paragraph (beginning “Finally, it is worth reiterating that these
data did not include hypersexual patients”) discussing this deci-
sion. Our use of nontreatment-seeking men was clearly described
and is consistent with previous studies. Also, it is an appropriate
test of the notion that sex film use leads inexorably to erectile
problems. Had we tested men who reported erectile problems, and
especially men who may well have had their porn use identified by
a therapist as the “cause” of their ED raising anxiety around sex
film use and masturbation, the claim could be falsely reified. As
many independent studies have now demonstrated, the main vari-
able that differentiates those identifying as sexually “addicted” is
primarily religiosity and conservative values [18,19], so such a
sample would introduce a known sample bias.
The author also asks that we introduce a statistical error by
reporting nonsignificant statistics for the partnered analysis. The
only reason to include nonsignificant statistics would be to inter-
pret P values, which reflects a misunderstanding of P values. A P
value cannot be directly interpreted [20]. Hence, one common
practice is to not facilitate this error by reporting nonsignificant
values (or only report P = not significant). We now reveal our
grand conspiracy to hide these results by admitting that, well,
actually, neither the total IIEF score (P = 0.2) nor the erectile
functioning subscale (P = 0.6) were near P < 0.05.
We also recognize that we stated in one place that the IIEF was
a “19-item” (p. E3) scale. The scale actually is a 15-item scale. We
profusely apologize for this gross oversight, although the scores,
results, and conclusions were accurate and indicative of normal
erectile function (cp., controls from table V [21]).
The author further describes our announcement of the
accepted publication using social media as “boastful pre-
publication promotion . . . most egregious”. As both authors are
federally funded scientists, we are mandated by our governments
to disseminate our research findings. This includes mandatory
sections in our grant submissions describing our methods of out-
reach. Facebook, Twitter, and similar social media are overwhelm-
ingly where the public receives its scientific information [22]. In
fact, the International Society for the Study of Women’s Sexual
Health at their annual meeting in 2015 hosted a seminar on
“Social Media in Sexual Medicine” instructed by Robert Miller.
Thus, our use of these media is supported, progressive, entirely
appropriate, and will continue. The Twitter handle for those who
would like to follow research updates from one of our laboratories
is @NicolePrause. Thank you for the opportunity to share our
research more broadly (and some statistics cartoons, for which the
first author also has a fondness).
We want to thank the letter writer for giving us the opportu-
nity to offer additional details of our report, which has now been
largely replicated by another independent laboratory focused on
porn use and problems of sexual functioning in men [2]. We
further point out that the author did not dispute the finding that
more viewing of sex films is associated with increased desire for sex
with a partner. We note that this finding is inconsistent with the
concept of “porn addiction” and especially claims that use of sex
films desensitizes erectile function, which in turn generalizes to a
Table 1 Participant counts
Source
Prause and
Pfaus
Moholy
et al.
Prause, Staley,
and Fong
Prause, Staley,
and Roberts
Prause, Moholy,
and Staley
Moholy and
Prause
(under review)
Male participants* 280 104 53 20 51 52
Participants with partners
†
59 48 0 0 11 0
Participants with IIEF scores
‡
127 92 0 0 35 0
*Participants across studies actually total 290, but 10 had no measures relevant for this analysis and were excluded. All participants correct as originally reported.
†
All participants correct as originally reported.
‡
Of the 133 men who started the IIEF, six failed to answer one or more of the items. Rather than impute, these missing values were excluded from analysis. Hence,
all participants are correct as originally reported.
2 Letter to the Editor
Sex Med **;**:**–** © 2015 The Author. Sexual Medicine published by Wiley Periodicals, Inc.
on behalf of International Society for Sexual Medicine.

decreased arousal and desire for partnered sex. Watching sex films
does not impair, and may enhance, the desire to be sexual with a
partner. Fishing in a different pond thus appears appropriate.
Nicole Prause, PhD* and James Pfaus, PhD
†
*Psychology, University of California, Los Angeles, Los Angeles, CA,
USA;
†
Psychology, Concordia University, Montreal, QC, Canada
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Letter to the Editor 3
Sex Med **;**:**–**© 2015 The Author. Sexual Medicine published by Wiley Periodicals, Inc.
on behalf of International Society for Sexual Medicine.