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Is Internet Pornography Causing Sexual Dysfunctions? A Review with Clinical Reports

DOI:10.3390/bs6030017
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Brian Y Park
Brian Y Park
Brian Y Park
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Gary Wilson at Southern Oregon University
Gary Wilson
  • Southern Oregon University
Jonathan Berger at Naval Medical Center San Diego
Jonathan Berger
Matthew Christman
Matthew Christman
Matthew Christman
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Abstract

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.
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... In a study conducted in 1999, ED and low sexual desire rate was 5%, respectively. By 2011, ED rates have increased to 14-28% in European men between 18-40 years [4]. The following research paper has been formulated to explain the increase in pornography statistics and its impact on physiological, social, and emotional aspects ...
... Hypersexual behavior is generally referred to as Compulsive Sexual Behavior (CSB). However, more recent definitions of CSB usually refer to multiple sexual behaviors that can be compulsive: the most commonly reported being masturbation, followed by compulsive use of pornography, promiscuity, compulsive cruising, and multiple relationships (22-76%) [4]. Anxiety disorders, mood disorders, substance use disorders, and sexual dysfunction have all been linked to hypersexual behavior. ...
... It was shown that more than half of the study participants who had noticed a substantial drop in libido over the previous six months of the evaluation had used pornographic materials at least once a week. [19] A study in 2015 on high school students discovered a correlation between frequent porn consumption and poor sexual desire [4]. ...
Physiological, Psychosocial and Substance Abuse Effects of Pornography Addiction: A Narrative Review
Article
  • Jan 2023
Internet pornography provides explicit content in various forms and can progress from habit to addiction. The consumption of online porn has risen due to the general use of current technology. The main reasons people consume it are sexual arousal and sexual enhancement. We planned this review study to identify the reasons for online pornography utilization, the mechanisms involved in its addiction, and its physiological, emotional, behavioral, social, and substance abuse effects. After a detailed literature search using PubMed Central and Google Scholar, four case studies and nine original articles from 2000 to 2022 were included. The main findings of the literature demonstrated that watching porn was most frequently done out of boredom, for sexual gratification, and to pick up new fashion and behavior ideas from these movies. In all facets of the users' lives, negative consequences were seen. Due to the explosion of new technologies, online pornography has risen to an alarming level, which has very injurious effects on societies and individuals. Therefore, it is high time to get rid of this addiction to protect our lives from its harmful effects.
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... • Berkembangnya internet dan mudahnya mengakses konten tanpa harus ketahuan siapa yang menggunakannya (Cooper, et al., 2000;Demetrovics, et al., 2008;Grubbs, et al., 2010;Mead, 2016;Park, et al., 2016;Pizzol, 2015;Walker, et al., 2015;Wilson, 2014) • Pembelajaran sosial, dan memiliki role model untuk melihat pornografi, seperti keluarga dan teman sebayanya (Crooks & Bauer, 2013;Lehmiller, 2018) • Memiliki masalah mental seperti kesepian, penarikan diri dari lingkungan social, self-esteem rendah dan depresi (Demetrovics, et al., 2008;Park, et al., 2016) • Kurangnya Pendidikan seksual dan pemberian edukasi tentang pornografi khususnya di internet (Albury, 2014;Watson & Smith, 2012) • (Fernandez, 2017;Grubbs, et al., 2015). CPUI-9 yang merupakan versi pendek dan digunakan untuk mengukur persepsi seseorang terhadap adiksi pornografi. ...
... • Berkembangnya internet dan mudahnya mengakses konten tanpa harus ketahuan siapa yang menggunakannya (Cooper, et al., 2000;Demetrovics, et al., 2008;Grubbs, et al., 2010;Mead, 2016;Park, et al., 2016;Pizzol, 2015;Walker, et al., 2015;Wilson, 2014) • Pembelajaran sosial, dan memiliki role model untuk melihat pornografi, seperti keluarga dan teman sebayanya (Crooks & Bauer, 2013;Lehmiller, 2018) • Memiliki masalah mental seperti kesepian, penarikan diri dari lingkungan social, self-esteem rendah dan depresi (Demetrovics, et al., 2008;Park, et al., 2016) • Kurangnya Pendidikan seksual dan pemberian edukasi tentang pornografi khususnya di internet (Albury, 2014;Watson & Smith, 2012) • (Fernandez, 2017;Grubbs, et al., 2015). CPUI-9 yang merupakan versi pendek dan digunakan untuk mengukur persepsi seseorang terhadap adiksi pornografi. ...
PENGEMBANGAN OBJECTIVE STANDARD SETTING (OSS) INSTRUMEN CYBER-PORNOGRAPHY USE INVENTORY (Objective Standard setting in Cyber Pornography Use Inventory: A Standard setting Procedure With Rasch Model on Psychological Assessment)
Thesis
  • Aug 2021
Deciding cut score in assessment and psychological scale had been taking into consideration to mental health professional in determining abnormality symptom within individual. Although, many studies employed category derived from statistical method to set the standard, there is another method namely objective standard setting (OSS) which frequently used in educational setting which one of them is performance test. The present study investigates OSS as an improved criterion-referenced method to set the cut score in psychological assessment and scale. To demonstrate how OSS can be employed in psychological setting, we used Cyber Pornography Use Inventory (CPUI) which measure perceived addiction of pornography. Using OSS, perceived addiction of pornography were established with clear content-related description of individual cyber pornography use classification.
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... É uma patologia típica de homens mais velhos devido ao maior acometimento de distúrbios orgânicos nessa faixa etária. No entanto, nos últimos anos tem sido notada uma inversão na prevalência da doença, sendo o número de jovens acometidos um crescente exponencial (BRIAN et al., 2016). A Organização Mundial da Saúde (OMS) define o termo vício em pornografia como "transtorno de comportamento sexual compulsivo" incluindo este na categoria de transtornos de controle de impulso. ...
... Dessa forma, os profissionais diminuem as chances de equívocos, como os incorretos diagnósticos de "ansiedade de desempenho" e a prescrição errônea de fármacos desnecessários. Além disso, a perda de ereções noturnas e de ereções espontâneas são outros indicativos de disfunção sexual associada ao vício (BRIAN et al., 2016). ...
Disfunção erétil em jovens causada por pornografia
Article
  • Jan 2023
Este trabalho, através de revisão bibliográfica, investiga a associação entre o uso de pornografia e o crescente aumento nas taxas de disfunção erétil, em um contexto onde fatores tradicionais não sofreram variações suficientes para justificar a grandeza dessa elevação.As alterações relacionadas ao sistema de recompensa se apresentam como fator chave na elucidação do aumento da taxa de disfunções sexuais, por meio da diminuição da sensibilidade do indivíduo frente aos prazeres reais e da formação de mecanismos que levam ao vício e a compulsão. A partir da análise e reflexões sobre a bibliografia é possível considerar que existe uma estreita relação de causa e consequência entre pornografia e disfunção erétil em homens com idade inferior a 40 anos. A elevação da incidência do distúrbio tem, como uma das razões de seu agravamento,a proliferação de grandes sites da indústria pornográfica, que busca atender as demandas específicas dos usuários. Relatórios clínicos tem apontado a superação do vício por meio da reinicialização, onde o sujeito se abstém da pornografia por um dado período de tempo. Entretanto, mais estudos se fazem necessários na elaboração de eficazes métodos diagnósticos e de tratamentos farmacológicos.
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... Se ha demostrado empíricamente que la pornografía influye en la formación de la identidad sexual en la adolescencia (Tolman et al., 2015) así como en conductas de riesgo como son la promiscuidad o evitar el uso del preservativo . Además, aumenta el riesgo de agresión sexual en población joven (Dawson et al., 2019;Wright y Tokunaga, 2016) y de violencia psicológica en las relaciones de pareja (Huntington et al., 2021), disminuyendo al mismo tiempo la satisfacción sexual (Zillmann y Bryant, 1988;Park et al., 2016;Willoughby et al., 2016;Wright y Tokunaga, 2018;. De esta manera, la pornografía tiene una gran repercusión en la esfera sexual de las personas jóvenes. ...
Estudio sobre pornografía en las Illes Balears: acceso e impacto sobre la adolescencia, derecho internacional y nacional aplicable y soluciones tecnológicas de control y bloqueo.
Book
Full-text available
  • Mar 2023
PARA CITAR: Milano, V. (Dir.) (2023) Estudio sobre pornografía en las Illes Balears: acceso e impacto sobre la adolescencia, derecho internacional y nacional aplicable y soluciones tecnológicas de control y bloqueo. Institut Balear de la Dona. PARA CITAR EL DIAGNÓSTICO: Ballester, L., Sedano, S., Aznar-Martínez, B., Cabellos, A., Lorente-De-Sanz, J., y Nadal, M. (2023). Diagnóstico sobre acceso, consumo e implicaciones de la nueva pornografía en línea en las Islas Baleares. En Milano, V. (Dir.), Estudio sobre pornografía en las Islas Baleares: acceso e impacto sobre la adolescencia, derecho internacional y nacional aplicable y soluciones tecnológicas de control y bloqueo. (pp. 28-287). Institut Balear de la Dona.
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... 13 Důsledkem takového jednání mohou být erektilní dysfunkce vyvolané pornem (angl. porn-induced erectile dysfunction, PIED), o nichž publikoval odborný článekPark et al. (2016). Jedním ze způsobů, jak se zotavit z PIED, je -vyjma abstinence -tzv. ...
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... Another survey indicated that from 2008 to 2018, virginity among American men under age 30 rose from around 8% to 27% (Ingraham, 2019). A variety of male-driven factors could contribute to this sexual marginalization of some men, such as decreased testosterone levels (Travison et al., 2007), porn use (Park et al., 2018), and the use of digital media (Sansone et al., 2017). In terms of femaledriven factors, sex ratio studies suggest that to understand why women to an increasing extent discriminate against low-status males, we must consider evolved mate preference mechanisms. ...
An evolutionary case for polygyny to counter demographic collapse
Article
Full-text available
  • Feb 2023
Sex ratio theory suggests why mating practices have become dysfunctional in the West and other regions. Spain, Japan, and over 20 other nations are on course to have their populations halved by 2100, dramatically aging their citizenry. Experts and opinion makers warn that a demographic collapse cannot be absorbed by our current social order; Elon Musk proclaims this to be "the biggest threat to human civilization." Statistics from the Nordic countries-the world's most gender-equal region-indicate that subjective perceptions of the sex ratio in modern environments drive singledom and low reproduction. Scandinavia has the world's highest occurrence of one-person households: 43-46%. In the past decade, the Norwegian fertility rate dropped from 2.0 to 1.5. Sex ratio studies suggest that women's perception of there being few acceptable partners activates a polygynous mindset, which in prosperous, monogamous societies drives promiscuity to the detriment of pair-bonding. More than 6 million years of hominin evolution under promiscuous, polygynous, and monogamous regimes shaped mate preferences that evoke different cultural and behavioral responses as environments change. The Church's imposition of lifelong monogamy contributed to the emergence of the modern world, but if this world's gender-equal societies no longer motivate reproduction, being more open to polygyny could be worth considering as a means for increasing fertility. This article makes this case by exploring hominin mating from our last common ancestor with chimpanzees-through the genus Homo's forager and agricultural periods-to modern Scandinavians. In the past millennium, mating practices have coevolved with the emergence of modernity, necessitating frequent cultural updates. An evolutionary analysis of Nordic works of literature illuminates the ways in which ideological narratives influence reproductive norms. The insights gleaned are considered in the context of people's perceived sex ratio.
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Functional Symptoms in the Genitourinary System in Children and Adolescents
Chapter
  • Mar 2023
This chapter focuses on the dysfunctions in the genitourinary system which are commonly manifested in children and adolescents. The functioning of the urinary system is strongly influenced by emotional states, particularly feelings like anxiety and tension, shame and fear. Urinary frequency is the excessively repeated urination in small quantities due to a perception by the child of a need to urinate after very short intervals. This is often related to fear, stress, and anxiety. Functional urinary retention is seen commonly in children and adolescents who may be afraid of urinating in public settings like a school or where the urination process could be heard. Similarly the genital organs and the sexual life of adolescents can be plagued by a number of emotions, going from desire, curiosity and need for experimentation, to feeling pressured and fear of those experiences. These tensions often manifest in the form of vaginismus and inability to reach orgasm, to premature ejaculation and erectile dysfunction in male adolescents. Masturbation, while a normal process, may become excessive when it is practiced to relieve constant tension and anxiety. General lines of evaluation and intervention are described for each dysfunction and in general. A complex understanding of the child and his or her circumstances and psychological multimodal interventions for the individual’s situation are recommended.KeywordsIrritable bladderUrinary frequencyUrinary urgencyUrinary retentionParuriaGenital dysfunctionVaginismusUnexplained pelvic painPremature ejaculationErectile dysfunctionAnorgasmiaExcessive masturbation
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Pornography and Its Impact on Adolescent/Teenage Sexuality
Article
  • Mar 2023
Adolescents/Teenagers are exposed to pornography due to a variety of factors and it is accepted as a process of sexual exploration/normal development of sexuality. However, early exposure to pornography and unregulated/excess exposure to pornography during the formative years of adolescence has been seen to have various long-term deleterious effects on sexual maturation, sexual behavior, Internet addiction, and overall personality development. To safeguard the growing minds of the teens from the harmful effects of pornography, few rules/regulations have been passed in India as well as banning of porn sites. However, there are very limited research on the impact of pornography on various aspects of adolescents’ growth and development. This mini-review covers the issues pertinent to the effect of pornography with regard to adolescent sexuality.
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Influence of a Partner’s Pornography Consumption on a Christian Woman’s Sexuality: A Qualitative Exploration
Article
  • Mar 2023
The present study examines how a partner’s Problematic Pornography Use impacts the overall sexual experience of the Christian woman. Using a qualitative phenomenological approach, we explored the intersection of gender, religion, and sexuality with 21 women of faith (the majority of whom had sought out mental health treatment) to better understand how the Christian woman’s sexuality shifts in response to her husband’s consumption of pornography. Three major themes emerged from the data: Discovery Impacts Desire, I Am Not Enough, and Sexually Disenfranchized. We discuss important implications for clinicians and clergy that promote the emotional, physical, and sexual safety of women.
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In love with machines: The bioethical debate about sexual automation
Article
Full-text available
  • Oct 2021
A few companies around the world are now developing and selling sex robots. Questions such as “how will relationships with robots’ impact human relations in the future” emerge when technologies are used to meet the social and emotional needs of individuals. Considering that technology and design have embedded values and biases, this article surveys the use of sex robots from a bioethical perspective. Relationships with robots and computational systems, like Artificial Intelligence, are a possibility for many people around the world. We present questions raised by the voices in favor of robot sex, and against it. Beyond a binary polarization, the bioethical perspective recalls the Foucaultian concepts of biopolitics and biopower to situate the problems with the mechanization of intimate relationships. We argue that sex robots offer the opportunity to review old patterns regarding gender, inequality, and health.
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Clinical Characteristics of Men Interested in Seeking Treatment for Use of Pornography
Article
Full-text available
  • Jun 2016
Background and aims This study examined the prevalence of, and factors associated with, men’s interest in seeking treatment for use of pornography. Methods Using an Internet-based data-collection procedure, we recruited 1,298 male pornography users to complete questionnaires assessing demographic and sexual behaviors, hypersexuality, pornography-use characteristics, and current interest in seeking treatment for use of pornography. Results Approximately 14% of men reported an interest in seeking treatment for use of pornography, whereas only 6.4% of men had previously sought treatment for use of pornography. Treatment-interested men were 9.5 times more likely to report clinically significant levels of hypersexuality compared with treatment-disinterested men (OR = 9.52, 95% CI = 6.72–13.49). Bivariate analyses indicated that interest-in-seeking-treatment status was associated with being single/unmarried, viewing more pornography per week, engaging in more solitary masturbation in the past month, having had less dyadic oral sex in the past month, reporting a history of seeking treatment for use of pornography, and having had more past attempts to either “cut back” or quit using pornography completely. Results from a binary logistic regression analysis indicated that more frequent cut back/quit attempts with pornography and scores on the Hypersexual Behavior Inventory – Control subscale were significant predictors of interest-in-seeking-treatment status. Discussion and conclusions Study findings could be used to inform current screening practices aimed at identifying specific aspects of sexual self-control, impulsivity, and/or compulsivity associated with problematic use of pornography among treatment-seeking individuals.
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Does Viewing Pornography Reduce Marital Quality Over Time? Evidence from Longitudinal Data
Article
Full-text available
Numerous studies have examined the connection between pornography viewing and marital quality, with findings most often revealing a negative association. Data limitations, however, have precluded establishing directionality with a representative sample. This study is the first to draw on nationally representative, longitudinal data (2006–2012 Portraits of American Life Study) to test whether more frequent pornography use influences marital quality later on and whether this effect is moderated by gender. In general, married persons who more frequently viewed pornography in 2006 reported significantly lower levels of marital quality in 2012, net of controls for earlier marital quality and relevant correlates. Pornography’s effect was not simply a proxy for dissatisfaction with sex life or marital decision-making in 2006. In terms of substantive influence, frequency of pornography use in 2006 was the second strongest predictor of marital quality in 2012. Interaction effects revealed, however, that the negative effect of porn use on marital quality applied to husbands, but not wives. In fact, post-estimation predicted values indicated that wives who viewed pornography more frequently reported higher marital quality than those who viewed it less frequently or not at all. The implications and limitations of this study are discussed.
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What matters: quantity or quality of pornography use? Psychological and behavioral factors of treatment-seeking for problematic pornography use.
Article
Full-text available
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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Subjective Craving for Pornography and Associative Learning Predict Tendencies Towards Cybersex Addiction in a Sample of Regular Cybersex Users
Article
  • Jul 2016
There is no consensus regarding the diagnostic criteria of cybersex addiction. Some approaches postulate similarities to substance dependencies, for which associative learning is a crucial mechanism. In this study, 86 heterosexual males completed a Standard Pavlovian to Instrumental Transfer Task modified with pornographic pictures to investigate associative learning in cybersex addiction. Additionally, subjective craving due to watching pornographic pictures and tendencies towards cybersex addiction were assessed. Results showed an effect of subjective craving on tendencies towards cybersex addiction, moderated by associative learning. Thus, these findings indicate that such interactions might be crucial for the development of cybersex addiction.
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A Longitudinal Study of Problems in Sexual Functioning and Related Sexual Distress Among Middle to Late Adolescents
Article
  • Jun 2016
Purpose: Rates of sexual dysfunctions are high among adults, but little is known about problems in sexual functioning among adolescents. We completed a comprehensive assessment of problems in sexual functioning and related distress over a 2-year period among adolescents (16-21 years). Methods: A sample of 405 adolescents completed five online surveys over 2 years. The main outcome measures were clinical cutoff scores on the International Index of Erectile Function and Premature Ejaculation Diagnostic Tool for male adolescents and the Female Sexual Function Index for female adolescents. A secondary outcome was clinical levels of distress. Results: The majority of sexually active adolescents (78.6% of the male and 84.4% of the female) reported a sexual problem over the course; rates did not differ significantly by gender. Common problems for males were low sexual satisfaction (47.9%), low desire (46.2%), and problems in erectile function (45.3%). Common problems for females were inability to reach orgasm (59.2%), low satisfaction (48.3%), and pain (46.9%). Models predicting problems over time showed increased odds among those not in a sexual relationship. Odds of reporting a distressing sexual problem decreased over time for female but not male adolescents. Conclusions: Problems in sexual functioning emerge early in individuals' sexual lives, are often distressing, and appear not to fluctuate over time. Additional efforts to identify key factors linked to onset will help elucidate possible mechanisms.
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Neurobiological Basis of Hypersexuality
Chapter
Until now, hypersexuality has not found entry into the common diagnostic classification systems. However it is a frequently discussed phenomenon consisting of excessive sexual appetite that is maladaptive for the individual. Initial studies investigated the neurobiological underpinnings of hypersexuality, but current literature is still insufficient to draw unequivocal conclusions. In the present review, we summarize and discuss findings from various perspectives: neuroimaging and lesion studies, studies on other neurological disorders that are sometimes accompanied by hypersexuality, neuropharmacological evidence, genetic as well as animal studies. Taken together, the evidence seems to imply that alterations in the frontal lobe, amygdala, hippocampus, hypothalamus, septum, and brain regions that process reward play a prominent role in the emergence of hypersexuality. Genetic studies and neuropharmacological treatment approaches point at an involvement of the dopaminergic system.
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Altered Appetitive Conditioning and Neural Connectivity in Subjects With Compulsive Sexual Behavior
Article
Introduction: There has been growing interest in a better understanding of the etiology of compulsive sexual behavior (CSB). It is assumed that facilitated appetitive conditioning might be an important mechanism for the development and maintenance of CSB, but no study thus far has investigated these processes. Aim: To explore group differences in neural activity associated with appetitive conditioning and connectivity in subjects with CSB and a healthy control group. Methods: Two groups (20 subjects with CSB and 20 controls) were exposed to an appetitive conditioning paradigm during a functional magnetic resonance imaging experiment, in which a neutral stimulus (CS+) predicted visual sexual stimuli and a second stimulus (CS-) did not. Main outcome measures: Blood oxygen level-dependent responses and psychophysiologic interaction. Results: As a main result, we found increased amygdala activity during appetitive conditioning for the CS+ vs the CS- and decreased coupling between the ventral striatum and prefrontal cortex in the CSB vs control group. Conclusion: The findings show that neural correlates of appetitive conditioning and neural connectivity are altered in patients with CSB. The increased amygdala activation might reflect facilitated conditioning processes in patients with CSB. In addition, the observed decreased coupling could be interpreted as a marker for impaired emotion regulation success in this group.
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Compulsive sexual behaviour as a behavioural addiction: The impact of the internet and other issues
Article
  • Mar 2016
The issue of sex addiction as a behavioural addiction has been much debated. However, there is little face validity for co-occurring behavioural addictions, and more emphasis is needed on the characteristics of the internet as these may facilitate problematic sexual behaviour.
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