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What matters: quantity or quality of pornography use? Psychological and behavioral factors of treatment-seeking for problematic pornography use.


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Introduction: Pornography has become popular with Internet technology. For most people, pornography use (PU) is entertainment; for some, it can result in seeking treatment for out-of-control behavior. Previous studies have suggested that PU can influence sexual behaviors, but the direct relation between frequency of PU and treatment-seeking behaviors has not been examined. Aims: To investigate whether individuals seeking treatment as a consequence of their problematic PU do so because of their quantity of pornography consumption or because of more complex psychological and behavioral factors related to PU, such as the severity of negative symptoms associated with PU and/or subjective feeling of loss of control over one's behavior. Methods: A survey study was conducted of 569 heterosexual Caucasian men 18 to 68 years old, including 132 seeking treatment for problematic PU (referred by psychotherapists after their initial visit). Main outcomes measures: The main outcome measures were self-reported PU, its negative symptoms, and actual treatment-seeking behavior. Results: We tested models explaining sources of seeking treatment for problematic PU with negative symptoms associated with PU and additional factors (eg, onset and number of years of PU, religiosity, age, dyadic sexual activity, and relationship status). Seeking treatment was significantly, yet weakly, correlated solely with the frequency of PU (r = 0.21, P < .05) and this relation was significantly mediated by negative symptoms associated with PU (strong, nearly full mediation effect size; k(2) = 0.266). The relation between PU and negative symptoms was significant and mediated by self-reported subjective religiosity (weak, partial mediation; k(2) = 0.066) in those not seeking treatment. Onset of PU and age appeared to be insignificant. Our model was fairly fitted (comparative fit index = 0.989; root mean square error of approximation = 0.06; standardized root mean square residual = 0.035) and explained 43% of the variance in treatment-seeking behavior (1% was explained by frequency of PU and 42% was explained by negative symptoms associated with PU). Conclusion: Negative symptoms associated with PU more strongly predict seeking treatment than mere quantity of pornography consumption. Thus, treatment of problematic PU should address qualitative factors, rather than merely mitigating the frequency of the behavior, because frequency of PU might not be a core issue for all patients. Future diagnostic criteria for problematic PU should consider the complexity of this issue.
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What Matters: Quantity or Quality of Pornography Use? Psychological
and Behavioral Factors of Seeking Treatment for Problematic
Pornography Use
Mateusz Gola, PhD,
Karol Lewczuk, MA,
and Maciej Skorko, MA
Introduction: Pornography has become popular with Internet technology. For most people, pornography use
(PU) is entertainment; for some, it can result in seeking treatment for out-of-control behavior. Previous studies
have suggested that PU can inuence sexual behaviors, but the direct relation between frequency of PU and
treatment-seeking behaviors has not been examined.
Aims: To investigate whether individuals seeking treatment as a consequence of their problematic PU do so
because of their quantity of pornography consumption or because of more complex psychological and behavioral
factors related to PU, such as the severity of negative symptoms associated with PU and/or subjective feeling of
loss of control over ones behavior.
Methods: A survey study was conducted of 569 heterosexual Caucasian men 18 to 68 years old, including 132
seeking treatment for problematic PU (referred by psychotherapists after their initial visit).
Main Outcomes Measures: The main outcome measures were self-reported PU, its negative symptoms, and
actual treatment-seeking behavior.
Results: We tested models explaining sources of seeking treatment for problematic PU with negative symptoms
associated with PU and additional factors (eg, onset and number of years of PU, religiosity, age, dyadic sexual
activity, and relationship status). Seeking treatment was signicantly, yet weakly, correlated solely with the
frequency of PU (r ¼0.21, P<.05) and this relation was signicantly mediated by negative symptoms associated
with PU (strong, nearly full mediation effect size; k
¼0.266). The relation between PU and negative symptoms
was signicant and mediated by self-reported subjective religiosity (weak, partial mediation; k
¼0.066) in those
not seeking treatment. Onset of PU and age appeared to be insignicant. Our model was fairly tted
(comparative tindex¼0.989; root mean square error of approximation ¼0.06; standardized root mean square
residual ¼0.035) and explained 43% of the variance in treatment-seeking behavior (1% was explained by
frequency of PU and 42% was explained by negative symptoms associated with PU).
Conclusion: Negative symptoms associated with PU more strongly predict seeking treatment than mere quantity
of pornography consumption. Thus, treatment of problematic PU should address qualitative factors, rather than
merely mitigating the frequency of the behavior, because frequency of PU might not be a core issue for all
patients. Future diagnostic criteria for problematic PU should consider the complexity of this issue.
J Sex Med 2016;13:815e824. Copyright 2016, International Society for Sexual Medicine. Published by Elsevier
Inc. All rights reserved.
Key Words: Hypersexual Behavior; Psychotherapy; Treatment Seeking; Pornography; Problematic Sexual
The development of broadband Internet technology has pro-
vided an accessible, affordable, and anonymous access to a wide
range of pornography content.
Analysis of data obtained from a
representative sample of 688 young (18- to 30-year-old) het-
erosexual Danish citizens showed that 67.6% of men and 18.3%
of women use pornography on a regular basis (minimum once
per week).
Furthermore, a study of 563 American college
Received October 2, 2015. Accepted February 26, 2016.
Swartz Center for Computational Neuroscience, Institute for Neural Com-
putations, University of CaliforniaeSan Diego, San Diego, CA, USA;
Institute of Psychology, Polish Academy of Science, Warsaw, Poland;
Department of Psychology, University of Warsaw, Warsaw, Poland
Copyright ª2016, International Society for Sexual Medicine. Published by
Elsevier Inc. All rights reserved.
J Sex Med 2016;13:815e824 815
students showed that 93.2% of men and 62.1% of women had
been watching online pornography before 18 years of age.
most users, viewing pornography provides entertainment,
excitement, and inspiration,
but for some, frequent pornog-
raphy use (PU) is a source of suffering (8% of 9177 users
) and a
reason to seek treatment.
PU, accompanied by masturbation,
also is the most common behavior in men, meeting the criteria of
hypersexual disorder
proposed by Kafka
for the Diagnostic
and Statistical Manual of Mental Disorder, Fourth Edition.
Because the concept of hypersexual disorder was not accepted
by the American Psychiatric Association owing to insufcient
experimental data,
currently, there are no universally
recognized diagnostic criteria for various out-of-control sexual
behaviors (eg, problematic PU, excessive masturbation, use of
paid sexual services, frequent risky casual sex, etc). Researchers
studying these behaviors use many different norms for discrim-
ination of so-called clinical and control subjects. By analyzing
studies on out-of-control sexual behaviors,
one can see an
attempt to dene these behaviors based on quantity (ie, amount
of PU
or number of sexual partners
) or through the role
and consequences of sexual behavior (ie, qualityof PU).
Quantitative norms for human sexual behaviors are very
difcult (if possible) to dene. Problematic PU also might be
difcult to dene through quantitative aspects. Our clinical
experience shows that subjects seeking treatment for problematic
PU exhibit high variability of PU quantity. This variability also is
visible in recent experimental studies. Voon et al
Mechelman et al
reported 1.75 hours per week (SD ¼3.36) of
PU for the control group and 13.21 hours per week (SD ¼9.85;
information presented by Voon et al during the American Psy-
chological Science conference in 2015) for subjects meeting
hypersexual disorder criteria.
However, Prause et al
0.6 hour per week of PU (SD ¼1.5) for control subjects and 3.8
hours per week (SD ¼1.3) for subjects labeled hypersexual
(subjects were not examined for hypersexual disorder criteria but
for self-reported problematic PU). Kühn and Gallinat
that individuals using pornography for 0 to 19.5 hours per week
(mean ¼4.09 hours per week, SD ¼3.9) do not meet the
problematic PU criteria set by the Internet Sex Screening Test.
In our opinion, these data suggest that the mere frequency of PU
might be only weakly associated with self-perceived problems
and treatment-seeking behaviors.
During the long-lasting debates on the nature of out-of-control
sexual behaviors (for reviews, see Kor et al
and Ley et al
Short et al
specically about pornography), most denitions
have focused on the subjective experience of the individual, such as
impact on everyday life, negative consequences, role of the
behavior in mood regulation,
or perceived lack of control
and distress.
Recent studies have shown that frequent PU is
negatively related to the enjoyment of sexually intimate behaviors
with a partner
and positively associated with frequent distraction
by sexual thoughts,
frequency of masturbation, and sexual
boredom in the relationship.
Some data have shown that such
boredom can be compensated by the increase in different sexual
behaviors, with their contents related directly to the scripts
watched in pornographic videos.
Although we need to be
careful about causal interpretations, because these studies show
only correlations, each of such negative symptoms related to PU
could play a crucial role in seeking treatment.
These observations bring up the question of whether individuals
seeking treatment for problematic PU do so because of excessive
consumption of pornography (quantity) or because of more
complex psychological and behavioral factors related to PU,
such as associated habits, their functions, negative conse-
quences, and/or subjective feelings of loss of control over ones
behavior. To address this question, we propose a theoretical
mediation model (Figure 1). This simple model assumes that
high frequency of PU can lead to treatment-seeking behaviors
(path A) or negative symptoms (mediator) that consequently
lead to treatment-seeking behavior (path B). To analyze the
pattern of mutual relations between measured variables, one can
use path analysis.
This statistical procedure tests whether a
gathered set of data ts well with a created a priori complex
theoretical model of causal relations between particular vari-
ables. The analysis is done by conducting simultaneous mul-
tiple linear regressions and presented graphically using path
diagrams (Figures 2 and 3).
Taking advantage of path analysis methodology, we explored
the roles of other variables suggested in the literature as poten-
tially important for problematic PU. Studies on addictive
behaviors, such as substance abuse
and pathologic gambling,
have indicated that the age of onset of the behavior is related to
the severity of symptoms and places individuals at higher risk of
comorbid disorders. Similar correlations have been found for the
duration of such an addictive behavior.
For these reasons, we
nd it important to verify what role symptom severity and
behavior duration play in problematic PU.
Recent publications on PU have suggested religiosity as
having an important role for self-perceiving problematic PU.
However, the nature of this relation remains unclear. Grubbs
et al
demonstrated that in college students and adults
(not seeking treatment), self-perceived addiction to Internet
pornography was positively associated with religiosity, but
religiosity was unrelated to the actual amount of PU. Martyniuk
et al
presented contradictory results, showing a negative relation
to the amount of PU in female students and a positive relation
in male students. According to our understanding, the factor of
religiosity could mediate a relation between PU and perceived
negative symptoms (Figure 3). Usually, religious norms depict
PU and extramarital sexual activity as morally reprehensible;
therefore, people who are more religious might perceive their
PU as having more morally troubling consequences. In other
words, we propose that religiosity can amplify the experienced
consequences of PU (Figure 3).
Moreover, we argue that age should be considered because
studies have shown decreasing sexual desire and activity with
J Sex Med 2016;13:815e824
816 Gola et al
advancing age.
Changes in the frequency of PU across an
individuals lifespan remain mostly unknown. Baumgartner et al
showed a comparable, and stable, rate of risky sexual online
behaviors across a group of 18- to 88-year-old men, but they did
not report on overall PU. Even if the age factor is not correlated
directly with PU, it is associated with decreased dyadic sexual
which indicates a possible link to a higher frequency of
PU as a form of compensatory behavior. Furthermore, dyadic
sexual activity might be related to the availability of a sexual
partner, because those in a partnership probably have greater
sexual activity than those not in a partnership. For this reason,
dyadic activity also should be controlled. To address our research
question, we tested our a priori dened model (Figures 1 and 2)
and then extended it with additional, potentially signicant vari-
ables (Figure 3).
Data Acquisition
Data were collected from March 2014 through March 2015
fromasampleofPolishcitizens through an online-based sur-
vey. It took 1 year to acquire a sufcient number (N ¼132)
of subjects seeking treatment for problematic PU. To do this,
we asked 23 professional therapists (17 psychologists and psy-
chotherapists, 4 psychiatrists, and 2 sexologists) to refer their
most recent patients declaring problematic PU to the survey.
Subjects not looking for treatment were recruited through
social media advertisements. Upon entering the survey,
respondents received informed consent information. The study
materials and protocol were approved by the ethical committee
of the Institute of Psychology, Polish Academy of Sciences
(Warsaw, Poland).
Data reported in this publication were gathered from a sample
569 heterosexual Caucasian white men (mean age ¼28.71 years;
SD ¼6.36). Sexual orientation was controlled by the Polish
adaptation of the Kinsey Sexual Orientation Scale.
who obtained values of 0 (exclusively heterosexual) or 1 (pre-
dominantly heterosexual, only incidentally homosexual) of 7 on
the scale were classied as heterosexual. The sample included 132
subjects identied as seeking treatment for problematic PU.
Collaborating therapists referred 119 treatment seekers, and 13
individuals who reported previously seeking treatment for
extensive PU were acquired during the recruitment for the
nonetreatment-seeking cohort. Pairwise observations with
missing data were excluded (overall response rate ¼89%),
providing a slightly different nal number of participants for each
variable (Table 1).
Seeking treatment for problematic PU was the main mea-
surement (contact with psychologist, psychiatrist, or sexologist
who directed a patient to the survey). For control purposes,
within the survey for non-treatment seekers, we asked whether
the subject had ever used any kind of help because of sexual
behavior. If the subject responded yes,we asked additional
questions regarding the type of, and reason for, help. Frequency
of PU was measured as the declared average number of minutes
per week spent on PU during the past month. Negative symp-
toms were assessed by a Polish adaptation of the Sexual Addic-
tion Screening TesteRevised (SAST-R
), which measures (i)
preoccupation, (ii) affect, (iii) relationship disturbance by sexual
behaviors, and (iv) the feeling of losing control over sexual
behavior. The questionnaire consists of 20 items with yes-or-no
response options. It is important to note that, except for
measuring the four factors mentioned earlier, some items of the
SAST-R refer to suffering from ones sexual behavior (ie, Do you
ever feel bad about your sexual behavior? Have you felt degraded
Figure 2. Path analysis model showing standardized path
coefcients tested with 95% biased-corrected condence intervals
(**P.001; *P<.05). The standardized coefcient (within pa-
rentheses) represents the direct effect of frequency of pornography
use on seeking treatment before accounting for mediation through
negative symptoms associated with pornography use.
Figure 1. Model used to explain the role of quantity and quality of
pornography use in individuals seeking treatment for problematic
pornography use. Path A indicates a simple correlation of the
amount of pornography use and seeking treatment. Path B
describes the scenario in which pornography use can lead to
negative consequences and then seeking treatment.
J Sex Med 2016;13:815e824
Seeking Treatment for Problematic Use of Pornography 817
by your sexual behaviors? When you have sex, do you feel
depressed afterward?). The overall score for each participant was
calculated by aggregating the score from all items. Internal
consistency of the questionnaire in our study was very high
(Cronbach a¼0.90). Because analysis of the latent structure of
pornography addiction symptoms was not the direct aim, the
overall score in the SAST-R questionnaire was treated as an
observed variable.
Age of respondents was expressed in years, onset of PU was
measured as the declared age at which respondents started viewing
explicit sexual pictures or videos, and number of years of PU was
calculated from the onset of PU and the current age of the
respondent. Subjective religiosity was measured on a Likert-type
scale with anchors at 0 (denitely no) and 4 (denitely yes)
using the following question: Do you consider yourself a religious
person? People who had values higher than 0 on this scale were
asked additional questions about their religious practices,
measured by the declared average amount of time spent (minutes
per week) on religious or spiritual practices such as prayers,
participation in services and rituals, spiritual reading, mediations,
etc. We also asked for time elapsed since the last dyadic sexual
activity using an ordinal scale from 0 to 7 (0 ¼today; 1 ¼
yesterday; 2 ¼past 3 days; 3 ¼past 7 days; 4 ¼past 30 days; 5 ¼
past 3 months; 6 ¼>90 days ago; 7 ¼I have never had sex with
other person). Subjects were asked to select the most accurate
response. Relationship status was measured as a declaration of
being in a relationship (formal or informal; yes ¼1, no ¼0).
Statistical Analysis
Using path analysis, we tested the signicance of all indirect
and direct relations within the models, estimating the effect of
each specic mediator, and simultaneously controlling for the
Figure 3. Path analysis of the extended model showing standardized path coefcients tested with 95% biased-corrected condence
intervals (**P.001; *P<.05). Standardized coefcients (within parentheses) represent direct effects before accounting for indirect
pathways. Bold arrows represent the relation between frequency of PU and seeking treatment and its mediation through negative
symptoms associated with PU (from the basic model presented in Figures 1 and 2). The remaining paths represent effects introduced in our
extended model. Dashed lines indicate paths that were deleted from the nal model and solid lines represent paths that remained in the
nal model. Relationship status is a dummy variable (1 ¼in relationship, 0 ¼not in relationship). PU ¼pornography use.
J Sex Med 2016;13:815e824
818 Gola et al
inuence of other mediators. Moreover, this approach provided
the big pictureof analyzed relations instead of presenting the
results in a fragmented manner. Analyses were performed with
using maximum likelihood estimation, with
correlation matrix as the input.
To take into account
non-normal distribution of some variables, we estimated the
signicance of standardized coefcients using 5,000 bootstrap
iterations. The signicance of the indirect effects also was tested
with 95% biased-corrected bootstrapped condence intervals, as
proposed by MacKinnon.
Goodness of t of a particular
model was tested and a good t was indicated when there was a
non-signicant test result within the c
test, a comparative t
index (CFI) value greater than 0.95, a root mean square error of
approximation (RMSEA) lower than 0.06, and a standardized
root mean square residual (SRMR) lower than 0.08.
We used
full-information maximum likelihood analysis to verify relations
with missing data, because this method provides more reliable
results than pairwise deletion in such cases.
By default, we were
not using full-information maximum likelihood because it does
not allow for bootstrapping.
We begin with presenting the results of the analysis of the
basic model related to our a priori formulated hypothesis
(Figures 1 and 2). Descriptive statistics and correlation matrices
for all variables used in the analyses are presented in Table 1.We
used a point-biserial correlation coefcient in the dummy-coded
variable (seeking treatment and relationship status).
The basic model (Figure 1) was used to test whether negative
symptoms mediate (path B in Figure 1) a direct effect (path A) of
frequency of PU on seeking treatment. Results showed that
frequency of PU was directly related to seeking treatment
(estimate ¼0.21, P<.001). This relation became negative,
weak, and only marginally signicant (estimate ¼0.07 [95%
bias corrected interval ¼0.14 to 0.01], P¼.046) after
accounting for the mediation effect of negative symptoms. Full-
information maximum likelihood analysis showed that after,
accounting for the mediation effect, this relation did not reach a
signicant level (estimate ¼0.04, P¼.292).
The indirect pathway from frequency of PU to seeking treat-
ment for negative symptoms was signicant (0.28 [0.23e0.34]).
The mediation effect was strong, with a large effect size
¼0.266; k
, as proposed by Preacher and Kelley
Because our basic model is a saturated model (all potential paths
between variables have been specied and all degrees of freedom
have been exhausted), its goodness of tbydenition is ideal.
In the second step, we extended our basic model and introduced
four parallel mediators of a relation between PU and negative
symptoms (onset and number of years of PU, subjective religiosity,
and religious practices; Figure 3). We estimated the signicance of
each mediation path with user-dened estimates. Neither onset nor
number of years of PU was signicant (0.000 [0.000 to 0.000]
for the two comparisons). Instead, this effect was mediated by
subjective religiosity (0.001 [0.000e0.002]), but not by religious
practices (0.000 [0.000e0.000]). Mediation through subjective
religiosity was signicant but rather weak (effect size k
Moreover, the relation between subjective religiosity and negative
symptoms was signicant only for the nonetreatment-seeking
group (estimate ¼0.27, P<.001); we did not nd such a relation
among treatment-seekers (estimate ¼0.00).
Table 1. Descriptive statistics and correlation coefcients for all variables included in the analysis
Variable n Mean SD 1 2 3 4 5 6 7 8 9
1. Negative symptoms (0e20) 561 7.28 5.25 1
2. Frequency of pornography
consumption (min/wk)
428 229.86 252.46 0.41
3. Subjective religiosity (0e4) 476 1.53 1.50 0.40
0.11* 1
4. Religious practices (min/wk)
280 140.09 192.99 0.20
0.11 0.34
5. Years of pornography
531 13.40 6.13 0.03 0.03 0.11* 0.02 1
6. Age at onset of pornography
consumption (y)
528 15.42 3.46 0.08 0.01 0.01 0.04 0.19
7. Age (y) 568 28.71 6.36 0.00 0.01 0.11* 0.04 0.81
8. Time elapsed since last dyadic
sexual activity (0e7)
536 3.22 2.25 0.42
0.19* 0.14
0.06 0.18
9. Seeking treatment
(1 ¼yes, 0 ¼no)
569 132 yes 437 no 0.65
0.14* 0.08 0.07 0.05 0.29
10. Relationship status
(1 ¼in relationship, 0 ¼not
in relationship)
559 329 yes 231 no 0.27
0.12* 0.10* 0.07 0.20* 0.11* 0.25
Question about religious practices was asked only to those participants who stated that they are religious in the previous question (subjective
J Sex Med 2016;13:815e824
Seeking Treatment for Problematic Use of Pornography 819
The direct relation between subjectsage and frequency of PU
was insignicant. Although the indirect pathway through the
time elapsed from last dyadic sexual activity was signicant
(0.03 [0.03 to 0.01]), this effect disappeared after the
inclusion of relationship status in the model (0.01 [0.02 to
0.00], P¼.239). Older subjects were in relationships more often
(r ¼0.25) and being in a relationship was predictive of a shorter
time since the last dyadic sexual activity (estimate ¼0.58).
Furthermore, subjects reporting a longer time since the last
dyadic sexual activity were using pornography more frequently
(estimate ¼0.15).
In the next analysis, we compared two nested models: (i)
unconstrained, which consisted of all analyzed paths (all regres-
sion paths shown in Figure 3), and (ii) constrained, in which
insignicant paths were constrained to 0. This procedure enabled
us to check whether insignicant paths (such as onset of PU,
number of years of PU, path between religious practices and
negative symptoms, direct effect of age on frequency of PU, and
time since last sexual activity) added any informative value to the
model (if yes, then analyzed models should differ signicantly).
Fit indices for the unconstrained model (c
P<.001, CFI ¼0.293, RMSEA ¼0.33, SRMR ¼0.168)
and the constrained model (c
¼1916.74, P<.001,
CFI ¼0.292, RMSEA ¼0.30, SRMR ¼0.170) at this stage of
analysis did not differ signicantly (c
¼9.31, P¼.231), so we
removed the insignicant paths from the nal version of the
extended model. We also deleted a signicant path from fre-
quency of PU to religious practices. This path was part of an
insignicant mediation between frequency of PU and negative
symptoms, with no rationale for leaving it in the model. Deleted
paths are shown with dashed arrows in Figure 3. Goodness of
t of our model at this stage was reected by the indices
(CFI ¼868; RMSEA ¼0.016, SRMR ¼0.13). We added three
covariances to the model: (i) between residual error terms of
negative symptoms and time elapsed since the last dyadic sexual
activity (r ¼0.23); (ii) between error terms of negative symptoms
and relationship status (r ¼0.23); and (iii) between error terms
of subjective religiosity and time elapsed since the last dyadic
sexual activity (r ¼0.28). These relations are in line with pre-
vious studies but because they were not central to any of our
main hypotheses, we did not include them in our earlier analysis.
The conceptual justication for including those relations in our
model (along with corresponding literature review) is elaborated
in the Discussion. Predictors of seeking treatment in our nal
model (negative symptoms and frequency of PU) explained 43%
of its variance. However, the strength of the two predictors in our
model was drastically different: 42% of variance in seeking
treatment was explained by negative symptoms and only 1% was
explained by frequency of PU. Fit indices for the nal model
indicated overall good t(c
¼14.96, P¼0.01, CFI ¼0.989,
RMSEA ¼0.06, SRMR ¼0.035).
Because the main purpose of our study was to determine the
predictive strength of problematic PU (quantity of PU or nega-
tive symptoms associated with PU) for seeking treatment, ana-
lyses were performed on the entire group of subjects (seeking and
not seeking treatment). We also compared the two groups
(Table 2). These groups differed in all variables except number of
years of PU and age.
According to our a priori predictions, PU can lead to negative
symptoms and the severity of these symptoms can lead to seeking
treatment (Figure 1, path B). The frequency of PU alone was not a
signicant predictor of seeking treatment for problematic PU
when controlling for negative symptoms associated with PU
(Figure 2). Such a weak relation had been indirectly suggested
by previous studies on pornography users. Cooper et al
Table 2. Descriptive statistics and mean comparison of variables used in models depending on seeking treatment (yes or no)*
N Mean SD Minimum Maximum
Yes No Yes No Yes No Yes No Yes No
1. Negative symptoms (0e20) 129 432 13.55 5.41
3.96 3,99 1 0 19 19
2. Frequency of pornography
consumption (min/wk)
89 339 333.08 202.76
300.13 231.35 2 2 1,680 1,833
3. Subjective religiosity (0e4) 112 364 2.48 1.23
1.39 1.42 0 0 4 4
4. Religious practices (min/wk) 109 171 172.70 119.31
189.95 192.59 1 1 1,200 1,200
5. Years of pornography consumption 130 401 14.29 13.11 7.13 5.74 3 0 39 40
6. Age of onset of pornography
consumption (y)
128 400 14.98 15.56
3.51 3.43 7 5 29 29
7. Age (y) 131 437 29.24 28.55 7.71 5.89 19 17 68 52
8. Time elapsed since last dyadic
sexual activity (0e7)
125 411 4.96 3.42
2.20 2.13 0 0 7 7
P<.001; signicant difference in mean score between groups as assessed by Mann-Whitney U-test.
*Relationship status (0 ¼not in relationship, 1 ¼in relationship) differed depending on the seeking of treatment (yes or no) as assessed by c
¼14.67, P<.001). Of treatment seekers, 57 subjects were in a relationship and 72 were not in a relationship. Of those not seeking treatment, 272
were in a relationship and 159 were currently not engaged in any kind of intimate relationship.
J Sex Med 2016;13:815e824
820 Gola et al
showed that, among subjects engaging in online sexual activities
(not only PU, but also sex chats), 22.6% of 4,278 light users
(<1 hour per week) reported an interference of their online sexual
activity in many areas of their everyday lives, whereas 49% of 764
heavy users (>11 hours per week) never experienced such
In the second step of data analysis, we extended our model by
testing four parallel mediators of a relation between PU and
negative symptoms (onset and number of years of PU, subjective
religiosity, and religious practices; Figure 3). Effects of onset and
numbers of years of use reported in studies on substance abuse
and pathologic gambling
appeared insignicant in our dataset.
Lack of such ndings could suggest a potentially lower longitu-
dinal impact of PU on functioning than substance abuse or
pathologic gambling. This result also could be related to the
methodologic limitations of our study. We calculated number of
years of PU as the difference between onset of PU and the
subjectscurrent age. It is possible that some subjects were using
pornography for only a limited time from their onset; thus, this
measurement presented in our analyses could be inaccurate.
Future studies should investigate the number of years of regular
PU. Another possible limitation is that, for negative symptoms,
we used the SAST-R because it was the only questionnaire for
hypersexual behavior assessment available in the Polish lan-
This questionnaire was designed to measure a wide
spectrum of negative consequences related not only to PU but
also to other sexual behaviors. The obtained signicant relation
between frequency of PU and SAST-R scores shows that, among
other sexual behaviors, it measures the negative symptoms
related to PU. However, the SAST-R is not specic to only
solitary sexual activity. For future research, we predict that the
application of more specic and sensitive measurement tools
could help uncover signicant mediating effects of onset and
duration of PU.
We expected greater religiosity to amplify self-perceived
problematic PU as reported in previous studies.
assumption appeared to be true for subjective religiosity
measured as a declaration of the level of importance of religion in
an individuals life (Figure 3). Interestingly, careful examination
showed that this effect was signicant only in those not seeking
treatment. In those seeking treatment, religiosity was not related
to negative symptoms. Religious practices were insignicant
mediators (Figure 3), which was surprising because actual reli-
gious practice could be a better measurement of religiosity then
mere declaration. These results emphasize the previously
mentioned role of religiosity in sexual behaviors and indicate the
need for further studies on this topic. The relation between
religiosity and PU and between religiosity and self-perceived
addiction had been investigated only in nonetreatment-seeking
Thus, our novel nding of no such relation in
treatment-seeking subjects is very interesting but needs to be
replicated in future studies in subjects in treatment for prob-
lematic PU.
We also examined the role of respondentsage and time
elapsed since the last dyadic sexual activity in the context of PU.
Age was an insignicant predictor of frequency of PU, as was the
time elapsed since the last dyadic sexual activity. The latter
variable was related to the subjectsrelationship status. Subjects
in relationships (formal or informal) were characterized by
shorter time since the last dyadic sexual activity, and this variable
was negatively related to frequency of PU. Between-group
comparison (Table 2) clearly showed that subjects seeking
treatment for problematic PU in general were less likely to be in a
relationship, declare a longer time since their last dyadic sexual
activity, use pornography more frequently, and experience more
severe negative symptoms. The direction of those relations
needs further investigations. On the one hand, difculties within
relationships can be a cause of lower availability of dyadic sexual
activity, which could lead to more frequent PU and solitary
sexual activities, causing negative symptoms. On the other hand,
frequent PU and negative symptoms could be the cause of dif-
culties in relationships and dyadic sexual activity, as suggested
by Carvalheira et al
and Sun et al.
Analysis of the extended version of our model showed three
relations (correlations of error terms) that we did not include in
our a priori formulated hypothesis, although we mentioned them
in the Introduction. First, severity of negative symptoms asso-
ciated with PU was related to a lower probability of having an
intimate relationship. This result agrees with previous research
indicating that excessive PU could be related to social isolation,
difculties with nding an intimate partner, and
maintaining a relationship.
Because we showed a signicant
correlation between frequency of PU and negative symptoms
associated with PU (Figure 2), those negative consequences
probably contribute to the difculties in creating long-lasting
intimate relationships.
The causality of this relation is
unclear, but it can be hypothesized that problematic PU and
difculties with intimate relationships have a bidirectional rela-
tion and reinforce each other. Second, we found a related positive
relation between negative symptoms and time elapsed since the
last dyadic sexual activity. Compared with those not seeking
treatment (Table 2), problematic pornography users were char-
acterized by greater severity of negative symptoms associated with
PU and lower chances of having intimate relationships and
dyadic sexual activity (Table 2 and Figure 3). Recent studies have
shown that frequent PU is negatively related to the enjoyment of
sexually intimate behaviors with a partner
and positively
associated with frequency of masturbation and sexual boredom in
the relationship.
The causality of relations between frequency
of dyadic sexual activity and negative symptoms has to be
Third, our study found a positive relation between subjective
religiosity and time elapsed since the last sexual activity.
Although the results of some previous studies that focused on
relations between religiosity and sexual activity are not entirely
with our results, most studies have suggested that
J Sex Med 2016;13:815e824
Seeking Treatment for Problematic Use of Pornography 821
non-religious individuals report having more sexual experi-
and earlier onset of sexual activity.
These differences
are observable especially in individuals who see religious and
conservative values as central to their life
and therefore can be
more apparent in relatively conservative societies with strong
religious traditions, such as Poland, where the sample was
recruited (see also Martyniuk et al
). The discussed relations
denitely deserve systematic investigation for their contribution
to sexual addiction in future studies.
To the best of our knowledge, this study is the rst direct
examination of associations between the frequency of PU and
actual seeking of treatment for problematic PU (measured as
visiting the psychologist, psychiatrist, or sexologist for this pur-
pose). Our results indicate that future studies, and treatment, in
this eld should focus more on the impact of PU on the life of an
individual (quality) rather than its mere frequency (quantity),
because the negative symptoms associated with PU (rather than
PU frequency ) are the most signicant predictors of treatment-
seeking behavior. From the perspective of the obtained results,
we postulate that factors such as negative behavioral consequences
associated with PU should be considered in dening, and recog-
nizing, problematic PU (and perhaps other out-of-control sexual
behaviors). We also suggest further investigation of the role of
quality of sexual life in intimate relationships in patients with
problematic PU and possible factors causing difculties in creating
satisfactory relationships.
We are grateful to all psychotherapists, sexologists, and psy-
chiatrists who directed their patients to our internet surveys and
the team of for promoting our studies. We are
also grateful to Bradly Stone for signicant language improve-
ment of this manuscript.
Corresponding Author: Mateusz Gola, PhD, Swartz Center for
Computational Neuroscience, Institute for Neural Computa-
tions, University of CaliforniaeSan Diego, 9500 Gilman Drive,
San Diego, CA 92093-0559, USA. Tel: þ1-858-500-2554;
ofce tel: þ1-858-822-7543; E-mail:
Conict of Interest: The authors report no conicts of interest.
Funding: This study was supported by the National Science
Centre of Poland OPUS grant, 2014/15/B/HS6/03792
(M. Gola). Dr Mateusz Gola is also supported by the Polish
Ministry of Science grant Mobility Plus (1057/MOB/2013/0).
Category 1
(a) Conception and Design
Mateusz Gola
(b) Acquisition of Data
Mateusz Gola; Maciej Skorko
(c) Analysis and Interpretation of Data
Mateusz Gola; Karol Lewczuk
Category 2
(a) Drafting the Article
Mateusz Gola; Karol Lewczuk; Maciej Skorko
(b) Revising It for Intellectual Content
Mateusz Gola; Karol Lewczuk
Category 3
(a) Final Approval of the Completed Article
Mateusz Gola; Karol Lewczuk; Maciej Skorko
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... The same review found a correlation between pornography use and weak or troubled family relations. Gola et al. (2016) found that negative symptoms associated with pornography use predict seeking treatment stronger than simply the quantity of pornography consumption. Researchers argued that frequency might not be a core issue in problematic pornography use. ...
... Authors suggest that problematic porn use and its adverse effects might be better explained by motivation than the frequency of porn use. Gola et al. (Gola et al., 2016) came to a similar conclusion. In their study, negative symptoms associated with porn use predicted seeking treatment more strongly than the mere quantity of porn consumption. ...
Full-text available
Research indicates that men and women have different preferences and patterns of sexual behavior and the use of pornographic content. It is commonly found that men use porn more frequently. A recent study found sex differences in motivations behind porn use. Authors speculated that different motivations might lead to different outcomes. The presented study aimed to compare sex differences in the associations between pornography use, sexual satisfaction, and occurrence of psychological symptoms between high and low pornography users sampled from the general population. A sample of 179 participants between the ages of 18 to 37 completed the questionnaire containing questions about demographic data, manner, and frequency of porn use and two psychometric scales: the General Functioning Scale GFQ-58 (assessing broad psychological symptoms) and the Sexual Satisfaction Scale SSC. In general, females in the study obtained higher scores on the General Functioning Scale, presenting more psychological symptoms. Still, when considering the frequency and manner of porn use, it is men in which increased porn use was found to be associated with psychological symptoms. Presented data provide evidence that men and women might have different motivations, leading to varying outcomes of porn use. This further supports the hypothesis that it is not porn that is inherently harmful, but rather why and how you use it.
... Yet, these potential help-seeking groups mentioned above have not been explored among adolescents. It is well documented that the human brain experiences several major morphological and functional changes during adolescence (Giedd et al., 1999;Giedd, 2004). In particular, the frontal cortex of the brain, which is important for higher-order cognitive functions (e.g., the ability to inhibit impulses, weighing consequences of decisions, prioritizing, and strategizing), does not fully mature until the mid-to-late twenties (Giedd, 2004;Hilton, 2021;Johnson, Blum, & Giedd, 2009) whereas the reward system (e.g., nucleus accumbens) is hypersensitive in early adolescence (Doremus-Fitzwater, Varlinskaya, & Spear, 2010;Ernst, Pine, & Hardin, 2006). ...
... In the other two groups, sexual compulsivity was the strongest predictor, which is consistent with previous findings (Kraus, Martino, & Potenza, 2016;Öberg, Hallberg, Kaldo, Dhejne, & Arver, 2017). The frequency of pornography use was at the edge of the symptom network among IC and PPU groups, which is in line with previous findings among treatment-seeking and not treatment-seeking groups of men (Bőthe, Lonza, et al., 2020), corroborating previous findings suggesting that negative symptoms, such as out of control use, or worsening intimate relationship could be better predictors of patients' treatment-seeking willingness than the quantity of pornography use (Gola, Lewczuk, & Skorko, 2016). To summarize, frequency of use should be considered when assessing PPU, but not in itself, as qualitative indicators, such as pornography craving and sexual compulsivity might be more accurate when identifying adolescents with objective behavioral dysregulation in relation to pornography use. ...
Full-text available
Background and aims Little data exist on exploring the subgroups and characteristics of problematic pornography use (PPU) in help-seeking adolescents. The aims of the study were to classify the subgroups among help-seeking male adolescents, explore their similarities and differences, and uncover their core symptoms. Methods A total of 3,468 Chinese male adolescents ( M age = 16.64 years, SD = 1.24) who were distressed about their pornography use were recruited. The Problematic Pornography Consumption Scale, the Brief Pornography Screen Scale, and Moral Disapproval of Pornography Use were used to classify them. The General Health Questionnaire, the Pornography Craving Questionnaire, and the Sexual Compulsivity Scale were used to investigate participants' negative consequence related to their pornography use; and the Online Sexual Activity Questionnaire (OSAs) and time spent on pornography use every week were considered as quantitative indicators. Results Help-seeking male adolescents could be divided into 3 profiles, namely, self-perceived problematic (SP, n = 755), impaired control (IC, n = 1,656), and problematic use groups (PPU, n = 1,057). Frequency of OSAs was important for the identification of SP individuals, while negative consequences were more effective in identifying individuals with objective dysregulated behavior. Salience and mood modification were shared by all groups; however, in addition to this, the SP and PPU groups also showed withdrawal symptoms. Discussion and conclusion This study's results provide support for the presence of different profiles of help-seeking individuals and information on potential intervention targets among adolescents which is lacking in the literature.
... Moreover, important sociodemographic characteristics including age and gender seem to be significantly related to problematic sexual behavior Kürbitz & Briken, 2021;Lewczuk, Szmyd, Skorko, & Gola, 2017;Studer, Marmet, Wicki, & Gmel, 2019), thus we also planned to include these indicators as adjusted factors in our analysis. Furthermore, previous studies also showed that problematic sexual behaviors can be significantly affected by being in an intimate relationship (Kumar et al., 2021;, and higher sexual behavior frequency, including higher consumption of pornography was linked to higher PPU and CSBD symptom severity (Chen et al., 2022;Gola, Lewczuk, & Skorko, 2016;Lewczuk, Glica, Nowakowska, Gola, & Grubbs, 2020;Lewczuk, Lesniak, Lew-Starowicz, & Gola, 2021; see also: Bőthe, Tóth-Király, Potenza, Orosz, & Demetrovics, 2020), we also included these additional factors in our analysis. This allowed us to investigate whether the relationships between withdrawal symptoms and tolerance on one side, and CSBD and PPU symptoms on the other, are not accounted for by the relationship that problematic sexual behavior symptoms have with these factors. ...
Full-text available
Background The addiction model of compulsive sexual behavior disorder (CSBD) and problematic pornography use (PPU) predicts the presence of withdrawal symptoms and increased tolerance for sexual stimuli in the disorder phenotype. However, clear empirical evidence supporting this claim has largely been lacking. Methods In the preregistered, nationally representative survey ( n = 1,541, 51.2% women, age: M = 42.99, SD = 14.38), we investigated the role of self-reported withdrawal symptoms and tolerance with respect to CSBD and PPU severity. Results Both withdrawal and tolerance were significantly associated with the severities of CSBD ( β = 0.34; P < 0.001 and β = 0.38; P < 0.001, respectively) and PPU ( β = 0.24; P < 0.001 and β = 0.27; P < 0.001, respectively). Of the 21 withdrawal symptom types investigated, the most often reported symptoms were frequent sexual thoughts that were difficult to stop (for participants with CSBD: 65.2% and with PPU: 43.3%), increased overall arousal (37.9%; 29.2%), difficult to control level of sexual desire (57.6%; 31.0%), irritability (37.9%; 25.4%), frequent mood changes (33.3%; 22.6%), and sleep problems (36.4%; 24.5%). Conclusions Changes related to mood and general arousal noted in the current study were similar to the cluster of symptoms in a withdrawal syndrome proposed for gambling disorder and internet gaming disorder in DSM-5. The study provides preliminary evidence on an understudied topic, and present findings can have significant implications for understanding the etiology and classification of CSBD and PPU. Simultaneously, drawing conclusions about clinical importance, diagnostic utility and detailed characteristics of withdrawal symptoms and tolerance as a part of CSBD and PPU, as well as other behavioral addictions, requires further research efforts.
... An online survey estimated the lifetime prevalence of pornography viewing to be approximately 92-98% for men and 50-91% for women (2). Although pornography viewing is a form of entertainment for most people, some individuals develop subjective symptoms and negative consequences as a result of problematic participation in this activity (3,4). This problematic Internet pornography use (PIPU) . ...
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Attentional bias plays a vital role in the occurrence and development of addictive behaviors. However, little is known about attentional processes in problematic Internet pornography use (PIPU), and previous studies have reported mixed results. The current study examined the components of attentional processing to sexual stimuli using an exogenous cueing task designed to differentiate between attentional engagement and disengagement. Two different stimulus presentation times (100 and 500 ms) were used to present the pornographic and neutral images to differentiate the early and late stages of attentional bias. Individuals with high (n = 40) and low (n = 40) PIPU tendencies were compared. The results demonstrated that individuals with high tendencies toward PIPU showed enhanced attentional engagement with pornographic stimuli in the early stage of attentional processing (100 ms), followed by attentional avoidance in the late stages of attentional processing (500 ms). Moreover, the severity of PIPU symptoms was positively correlated with attentional engagement scores in the short picture-time trials (100 ms) and weakly negatively correlated with attentional disengagement scores in the long picture-time trials (500 ms). This approach–avoidance pattern of attentional biases is in line with a recent theoretical model that emphasizes that appetitive and aversive motivational processes jointly determine attentional bias.
... However, for some people, pornography use can become problematic and contribute to perceptions of being addicted Lewczuk et al., 2021;Lewczuk, Wójcik, et al., 2022) as well as negative consequences in other areas of life. This phenomenon is often studied under the label of problematic pornography use (PPU) (de Alarcón et al., 2019;Gola et al., 2016;Kraus et al., 2020;Lewczuk et al., 2017). However, as PPU is not recognized as a formal diagnostic unit, no universally adopted definition of PPU exists (Fernandez & Griffiths, 2021). ...
Full-text available
Previous studies have shown that specific attitudes related to moral convictions can have an important role in the development and maintenance of problematic sexual behavior symptoms. However, although other types of attitudes, like sexual attitudes, are potentially highly relevant, they have not yet been studied in this role. We investigated how four dimensions of sexual attitudes: Permissiveness, Birth Control, Communion and Instrumentality, contribute to problematic pornography use (PPU) and hypersexual disorder (HD) symptoms, controlling for religiosity, sex, age and relationship status. The study was administered through an online questionnaire and based on a representative sample of n = 1036 (Mage = 43.28, SD = 14.21; 50.3% women) Polish adult citizens. When adjusting for other variables, higher sexual Permissiveness positively predicted HD and PPU among both men (HD: β = .26, p < .001; PPU: β = .22, p < .001) and women (HD: β = .44, p < .001; PPU: β = .26; p < .001). Sexual Instrumentality positively, although weakly, contributed to HD severity among men (β = .11, p < .05). Attitudes reflecting higher support for responsible sexuality (Birth Control subscale) negatively and weakly predicted HD among women (β = – .11, p < .05). Permissiveness was also the only sexual attitude dimension that consistently predicted a higher frequency of sexual activity among men and women. Based on the cutoff criteria proposed by the authors of the used screening instruments (≥ 53 points for the Hypersexual Behavior Inventory and ≥ 4 points for the Brief Pornography Screen), the prevalence of being at risk for HD was 10.0% (men: 11.4%, women: 8.7%) and for PPU was 17.8% (men: 26.8%, women: 9.1%). Our results point to a significant contribution of sexual attitudes to problematic sexual behavior symptoms, which was not encapsulated by the previously studied influence of religious beliefs, although most of the obtained relationships were relatively weak. Particularly, a consistent link between permissive attitudes and both HD and PPU among men and women may indicate that permissive attitudes can potentially contribute to the development and maintenance of problematic sexual behavior. The prevalence of being at risk for PPU (and to some degree HD) in the current representative sample was high. Such results raise questions about the appropriateness of the proposed cutoff criteria and the risk of overpathologizing normative sexual activity, if the cutoff thresholds are not tailored adequately. The results have implications for the assessment, diagnosis and theory of problematic sexual behavior.
While perceived addiction and religiosity have been key contextual factors in understanding the link between pornography use and personal distress, these contextual factors have been explored less in the relational literature. Using a large nonprobability convenience sample from the United States, a moderated mediation model of the association between pornography use alone and two key indicators of relationship quality (relationship satisfaction and relationship stability) was explored. Results suggested that both general and aggressive pornography use alone were associated with less relationship satisfaction and relationship stability even when accounting for a range of potentially confounding variables. Perceived addiction partially mediated these associations, while both religiosity and gender moderated them. Generally, higher religiosity and being male were linked to compounding negative associations between pornography use and lower relationship quality. Findings suggest the importance of considering both religiosity and perceived addiction as important contextual factors when studying associations between pornography use and both relational and individual outcomes.
Although empirical literature into sex addiction has flourished in the last two decades, the lack of universal agreement, and diagnostic criteria within such studies was reflected in the paucity of treatment provisions for those experiencing compulsive sexual behaviors. Since its ultimate inclusion in the International Classification of Diseases-11 (ICD-11), Compulsive Sexual Behavior Disorder (CSBD) provides a solid foundation in which gold-standard treatment interventions can be designed and implemented. This chapter will provide a theoretical overview of this issue, its biological basis, co-morbidities, prevalence rates, assessment approaches and treatment approaches reported in the literature. While research in CSBD has accelerated and there is evidence that examines the lasting consequences of the disorder, the field has been has subjected to a number of treatment barriers. The implications of these are further discussed.KeywordsCompulsive sexual behavior disorderCompulsive sexual behaviorHypersexualitySex addiction treatmentTreatment interventionsBehavioral addictions
Although there is growing clinical interest in problematic pornography use (PPU), few studies focus on differences between men and women. The purpose of this study was to examine gender differences in the effects of pornographic media and personality traits on the PPU. Participants were a community sample of 502 men and 509 women, who completed an online questionnaire. Pornographic video, low self-control, and Fun Seeking affected the PPU for men and women. For women, Reward Responsiveness and Drive are also related to the severity of PPU. Gender differences should be considered when considering treatment and prevention of problematic pornography use.
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The Time Perspective (TP) theory (i.e., the psychological experience regarding time) was often examined in association with different addictive behaviors, and the different TPs (i.e., Past Positive, Past Negative, Present Hedonistic, Present Fatalistic, and Future TPs) demonstrated different relationship patterns with them. However, most studies were conducted in relation to substance use-related disorders, leaving crucial knowledge gaps concerning the associations between TPs and potential behavioral addictions. The aim of the present study was to examine the associations between the five TP dimensions, hypersexuality, and problematic pornography use (PPU), considering potential gender differences. Participants from two independent samples (N1 = 554; N2 = 453) completed a self-report survey on TPs and sexual behaviors. Structural equation modeling results indicated that the Present Hedonistic TP had a positive, moderate, and the Future TP had a negative, weak association with hypersexuality in both samples. Only the Present Hedonistic TP had a significant, positive, weak-to-moderate association with PPU across the samples. The explained variances of the models were higher in case of hypersexuality (28 and 27%, respectively), than in case of PPU (1 and 14%, respectively). No significant gender differences were observed. In line with previous findings concerning other predictors of hypersexuality and PPU, the results of the present study suggest that hypersexuality and PPU may differ from each other in terms of their TP background. Yet, present hedonism, which is related to impulsivity, may play an important role in both problematic sexual behaviors, suggesting that interventions focusing on this TP might be successful in reducing hypersexuality and PPU.
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Objectives: Addictive sexual behaviours are gaining more and more attention from researchers. There are actually 25 different questionnaires for assessing the level of loss of control over sexual. The main aim of this work was to make such an adaptation of the Sexual Addiction Screening Test-Revised (SAST-R; the most popular and questionnaire). behaviours (LoCoSB). None of them have been adapted and validated in a Polish language version. Methods: For the purpose of psychometric features examination and validation of the Polish version of SAST-R (SAST-PL-M), we recruited 116 heterosexual men receiving psychological treatment due to LoCoSB and meeting the criteria for hypersexual disorder. The control group consisted of 442 heterosexual males having never looked for any psychological or psychiatric help due to LoCoSB. Results: SAST-PL-M has high reliability (Cronbach's alpha = 0.904) and good filtering characteristics for identification of people who are potentially experiencing difficulty with control over sexual behaviours (the ROC curve for a threshold of 5 out of a maximum 20 points is characterised by a sensitivity of 99.1% and a specificity of 78.3%). Conclusions: SAST-PL-M can be used as an efficient screening test for symptoms of LoCoSB in clinical and research setups. Results below 5 points indicate a high probability of no problems, while more than 5 points can indicate the need for additional clinical interviews. SAST-PL-M results may be successfully referred to the results of SAST-R when used with heterosexual male populations for research purposes.
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Research on the processing of sexual stimuli has proved that such material has high priority in human cognition. Yet, although sex differences in response to sexual stimuli were extensively discussed in the literature, sexual orientation was given relatively little consideration, and material suitable for relevant research is difficult to come by. With this in mind, we present a collection of 200 erotic images, accompanied by their self-report ratings of emotional valence and arousal by homo- and heterosexual males and females (n = 80, divided into four equal-sized subsamples). The collection complements the Nencki Affective Picture System (NAPS) and is intended to be used as stimulus material in experimental research. The erotic images are divided into five categories, depending on their content: opposite-sex couple (50), male couple (50), female couple (50), male (25) and female (25). Additional 100 control images from the NAPS depicting people in a non-erotic context were also used in the study. We showed that recipient sex and sexual orientation strongly influenced the evaluation of erotic content. Thus, comparisons of valence and arousal ratings in different subject groups will help researchers select stimuli set for the purpose of various experimental designs. To facilitate the use of the dataset, we provide an on-line tool, which allows the user to browse the images interactively and select proper stimuli on the basis of several parameters. The NAPS ERO image collection together with the data are available to the scientific community for non-commercial use at
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The study aimed to compare pornography use of students in two culturally different European countries – Poland and Germany, and to investigate associations with religiosity, sexual myths, and sex taboos. Data were collected in an online survey among German (n = 1303) and Polish (n = 1135) university students aged 18-26 years. Polish students were more religious, showed a greater acceptance of sexual myths, and reported a higher level of sex taboos in their origin families. Polish students were younger at their first contact with pornography, while German students used pornographic materials more often. Results suggested a link between sociocultural background, especially religiosity, and pornography engagement. The relationship between pornography use and religiosity was ambiguous. On the one hand, attending church was negatively associated with age at first contact and pornography use. On the other hand, the association of intrinsic religiosity with pornography use proved to be contradictory: it was correlated with a lower frequency of pornography use for females and with a higher frequency for males. The agreement with common sexual myths was related to a higher frequency of pornography use. There was no association between the level of sex taboos and pornography use.
Previous studies examining the relationship between religion and the sexual attitudes and behaviors of college students, including contraceptive use, have yielded conflicting results. Based on a large, representative survey of college students, this study used a more comprehensive and multidimensional measure of religion while controlling for gender, age, and ethnicity. Religious affiliation, attitudes toward premarital sexual intercourse, and student perceptions of the influence of religion on their sexual behaviors were significantly related to a student's probability of engaging in sexual intercourse. Religiosity (strength of beliefs and religious service attendance) was significantly related to attitudes toward premarital sexual intercourse. Religiosity and religious affiliation were significant in distinguishing between contraceptive methods used by sexually active students.
The purpose of this study was to explore the relationship between pornography use and sexual behavior in young adults from two culturally different countries. Data were collected in an online survey among German (n=1303; G) and Polish (n=1135; P) university students aged 18-26 years. Pornography use was associated with engaging in a greater variety of sexual activities (e.g. sexual role playing, using sex toys; G>P) rather than with a high number of sex partners or condom use consistency. The differences between the samples were found primarily for females (in anal sex experience and age at the first sexual intercourse; G>P). Free download:
Although the initiation of sexual behavior is common among adolescents and young adults, some individuals express this behavior in a manner that significantly increases their risk for negative outcomes including sexually transmitted infections. Based on accumulating evidence, we have hypothesized that increased sexual risk behavior reflects, in part, an imbalance between neural circuits mediating approach and avoidance in particular as manifest by relatively increased ventral striatum (VS) activity and relatively decreased amygdala activity. Here, we test our hypothesis using data from seventy 18- to 22-year-old university students participating in the Duke Neurogenetics Study. We found a significant three-way interaction between amygdala activation, VS activation, and gender predicting changes in the number of sexual partners over time. Although relatively increased VS activation predicted greater increases in sexual partners for both men and women, the effect in men was contingent on the presence of relatively decreased amygdala activation and the effect in women was contingent on the presence of relatively increased amygdala activation. These findings suggest unique gender differences in how complex interactions between neural circuit function contributing to approach and avoidance may be expressed as sexual risk behavior in young adults. As such, our findings have the potential to inform the development of novel, gender-specific strategies that may be more effective at curtailing sexual risk behavior. Copyright © 2015 the authors 0270-6474/15/358896-05$15.00/0.