ChapterPDF Available

Abstract

Among behavioral addictions, problematic Internet use and online pornography consumption are often cited as possible risk factors for sexual dysfunction, often with no definite boundary between the two phenomena. Online users are attracted to Internet pornography because of its anonymity, affordability, and accessibility, and in many cases its usage could lead users through a cybersex addiction: in these cases, users are more likely to forget the “evolutionary” role of sex, finding more excitement in self-selected sexually explicit material than in intercourse.
163
© Springer International Publishing AG, part of Springer Nature 2018
E. A. Jannini, A. Siracusano (eds.), Sexual Dysfunctions in Mentally Ill Patients,
Trends in Andrology and Sexual Medicine, https://doi.org/10.1007/978-3-319-68306-5_15
D. Mollaioli (*) · E. A. Jannini
Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
e-mail: daniele.mollaioli@gmail.com; eajannini@gmail.com
A. Sansone · F. Romanelli
Department of Experimental Medicine, University of Rome Sapienza, Rome, Italy
15
Sexual Dysfunctions intheInternet Era
DanieleMollaioli, AndreaSansone, FrancescoRomanelli,
andEmmanueleA.Jannini
15.1 Introduction
Low sexual desire, reduced satisfaction in sexual intercourse, and erectile dysfunction
(ED) are increasingly common in young population. In an Italian study from 2013, up
to 25% of subjects suffering from ED were under the age of 40 [1], and in a similar study
published in 2014, more than half of Canadian sexually experienced men between the
age of 16 and 21 suffered from some kind of sexual disorder [2]. At the same time,
prevalence of unhealthy lifestyles associated with organic ED has not changed signi-
cantly or has decreased in the last decades, suggesting that psychogenic ED is on the rise
[3]. The DSM-IV-TR denes some behaviors with hedonic qualities, such as gambling,
shopping, sexual behaviors, Internet use, and video game use, as “impulse control disor-
ders not elsewhere classied”—although these are often described as behavioral addic-
tions [4]. Recent investigation has suggested the role of behavioral addiction in sexual
dysfunctions: alterations in neurobiological pathways involved in sexual response might
be a consequence of repeated, supernormal stimuli of various origins.
15.2 Online Pornography andSexual Dysfunctions
Among behavioral addictions, problematic Internet use and online pornography
consumption are often cited as possible risk factors for sexual dysfunction, often
without denite boundary between the two phenomena [5, 6]. Since 2007, mounting
164
evidence has suggested that Internet pornography might be a risk factor for sexual
dysfunctions, including low libido and impaired erectile and orgasmic functions [7].
Case series have provided the rst hints in these regards; however, more solid evi-
dence has emerged from longitudinal studies in married couples. Pornography con-
sumption has been considered one of the strongest predictors of poor marital quality
[8]—and, therefore, of poor sexual health. Studies aimed to directly assess the role
of Internet pornography use and male sexual dysfunction have described an associa-
tion between the two phenomena [9, 10]. Sexual dysfunctions typically manifest in
physical relationships with women and more rarely in relation to sexually explicit
material; unsurprisingly, abstinence from “cybersex” and from masturbation has
been proposed as a treatment, although evidence in support is still lacking.
Sexually explicit material is widely available on the Internet, often at no cost and
virtually without any controls for age, therefore providing a plausible reason for the
rapid increase in a condition most frequently associated with aging. It should come as
no surprise that pornography is the most common among the chief reasons for compul-
sive Internet use [11] and that cybersex is the third largest economic sector on the
Internet. Besides being freely available, Internet pornography features a seemingly end-
less supply of contents, providing novelty and freedom of choice: in these regards, it is
signicantly different from printed material, as any user is able to quickly access new
videos and scenes, or even genres. In short, users are attracted to Internet pornography
because of its anonymity, affordability, and accessibility—the “Triple A Engine” [12].
The extreme ease in nding the adult material is also accompanied by a strict cate-
gorical organization of porn videos: alongside the giants of porn online such as
Pornhub, YouPorn, and RedTube, there are a whole series of smaller sites that aggre-
gate videos, categorizing them by type of sexual act, the age of the actors, the video
quality (amateur or professional), the sexual orientation, and the body and sexual pref-
erences. This categorization has generated a sort of a constantly evolving encyclopedia
of porn, directing the user toward increasingly specic and rened tastes (Table15.1).
Table 15.1 Most researched porn categories
Amateur Amputee Anal Animal
Asian Babe Bareback BBW
BDSM Big Ass Bisexual Bizarre
Black/ebony Blowjob Bondage Bukkake
Casting Cheating Cheerleaders Creampie
Cuckold Deepthroat Dildo Doggy style
Double penetration Exhibitionist Extreme Facial
Feet FemDom Fetish Fisting
Gangbang Gay Gloryhole Granny
Group Hairy Handjob Hardcore
Hentai Homemade Interracial Ladyboy
Latin Lesbian Lingerie Lolita
Massage Mature Masturbating/solo Masturbation
Mature Menstrual Midget Milf/mom
Oral Sex Orgy Pantyhose/Stockings Pissing
POV (Point of View) Pregnant Public Reality
Schoolgirl Shaving Shemale Skinny
Slave Small tits Smoking Solo
Squirt Squirting Straight Submale
Sucking Teens Threesome Torture
Transsexual Upskirt Vampire Vintage
Vintage Voyeur Wet Young
D. Mollaioli et al.
165
Internet pornography use shares many similarities with substance addiction
[13], such as the activation of the same reward circuitry in the basolateral amyg-
dala, the anterior cingulate area, and the nucleus accumbens [14]. Upregulation
of the truncated splice variants (ΔFosB) of the Finkel-Biskis-Jinkins (FBJ)
murine osteosarcoma viral oncogene homolog B (FosB) in the nucleus accum-
bens has been observed following both sexual stimuli and substance abuse; over-
expression of the ΔFosB is necessary and sufcient for many of the neural
adaptations commonly observed in addiction. This process allows hypersensiti-
zation to stimuli while possibly facilitating compulsive behaviors. Internet por-
nography use triggers dopamine bursts in the reward circuitry of the brain, which
increase the sense of well-being associated with masturbation while at the same
providing the neurobiological grounds for addiction; not all subjects respond to
external stimuli in the same way, but those who are predisposed to harmful or
obsessive behaviors are more likely to become addicted to pornography. Users
are more likely to forget the “evolutionary” role of sex, nding more excitement
in self-selected sexually explicit material than in intercourse: sexual condition-
ing might be the missing link between the impaired sexual function during part-
nered sexual interactions and the increased arousal coming from Internet adult
movies [15]. Failure to meet sexual expectations, together with the inability to
obtain more stimulation by a simple “click”, may lead to a decline in dopamine
in the mesolimbic pathway, ultimately resulting in loss of interest for intercourse
and sexual dysfunction.
The increase in the vision of online pornographic content has developed a still
unsolved debate among scientists about the negative and positive effects of viewing
pornography on the users.
15.3 Negative Aspects ofPornography onSexual Quality
ofLife
From a negativistic perspective, the increased access to online pornography has
been accompanied by growing concerns that may negatively affect personal, sexual,
and relational health and well-being [16, 17]. The cybersex addiction represents the
most frequent form between all the Internet addictions [16, 18].
The main feature of porn addiction is the compulsive pursuit of sexual pleasure
that the user tries to achieve when masturbating through the viewing of adult con-
tent. Individuals suffering from porn addiction are completely absorbed by their
stereotyped sexual practices: the interest is directed exclusively to nd the most
self-suitable porn content, dedicating up to several hours in researching, viewing,
and classifying the erotic material; the sexual behavior is characterized by compul-
sive masturbation, with the intention of reaching ejaculation (one or more times) to
relieve sexual tension [10].
Sutton etal. found that men affected by hypersexual behavior and compulsive
masturbation in association with frequent pornography use, presented also sexual
dysfunctions, reporting mostly difculties reaching orgasm during sexual inter-
course [19]. Anxiety about sexual performance may impel further reliance on por-
nography as a sexual outlet [20].
15 Sexual Dysfunctions intheInternet Era
166
In these people the addictive consumption of pornographic material worsens sex-
ual health with a progressive interruption of sexual intimacy with the partner [21, 22].
Several studies have reported that porn addiction can negatively impact on atti-
tudes and sexual life, diminishing satisfaction and increasing cases of indelity and
occasional relationships with different partners[1620]. It could also contribute to
an early debut of sexual activity in adolescence, exposing teens to an experience of
sexual “failure” that over time could evolve to a sexual dysfunction, like loss of
libido, erectile dysfunction (ED) and premature ejaculation (PE) for men, and prob-
lems in sexual desire and orgasm in women [21, 22].
Moreover, porn movies rarely contemplate the condom use, giving a negative
message especially among young viewers about the right ways to approach to sexu-
ality, with a potential increased risk of sexually transmitted diseases (STD) [17].
The severity of the effects seems to be correlated with the years of use: males
who started using cybersex at a younger age are less likely to prefer partnered sex.
The effects of sexual conditioning have similarly been described regarding risky
sexual behaviors: subjects accustomed to more extreme videos are more frequently
involved in similar acts, such as unprotected anal intercourse. It is likely, although
yet unproven, that precocious exposure to pornography might have deleterious
effects on sexual development during puberty: this is alarming, considering that
Internet pornography use is increasingly accepted as an ordinary behavior [23].
Although this aspect is poorly studied, several studies report that pornography,
especially the violent one, reproduces negative feminine and masculine models in
which woman is represented only as a “puppet” under the man control, emphasizing
psychological, physical, and sexual violence toward women [17, 22].
15.4 Positive Aspects ofPornography onSexual Quality ofLife
Although it is a common opinion that cybersex addiction can generate negative
outcomes from both psychological and sexual, more and more researchers point out
that pornography could also be an important therapeutic instrumental in sexological
treatments [2426]. According to some studies, the vision of pornographic material
would act by improving the sexual fantasies through normalization and facilitating
the willingness to explore them [24, 27]. Pornography in some respects could even
improve the sexual life of men and women by reducing the feeling of unease about
sex and encouraging sexual expression [28].
For example, it could be used in an early phase of psychoeducation for male and
female sexuality, at a later stage of treatment (e.g., in the case of female hypoactive
sexual desire), or in couple therapy [2427]. In favor of this perspective, it has been
highlighted that the viewing porn by women improves their sexual satisfaction in
real life as well as being a useful way to better investigate the eld of female sexual-
ity [2427].
Pornography could be a valuable aid in the sexual eld for people with disabili-
ties and those who have some dysfunction with a strong anxious component since it
has been seen that pornography acts on the dysfunction through a reduction of anxi-
ety associated with sexual activity [11].
D. Mollaioli et al.
167
Finally, online pornography lends itself very efciently to frequency studies [28, 29].
Although there is no certainty about gender and psychopathological conditions at the
base of network access, online porn allows to evaluate a very large population, classify-
ing subjects according to specic and well-dened sexual interests, from the most trivial
to the rarest (Table15.1), so as to build tables of frequency otherwise not compiled.
15.5 Sexual Dysfunctions andOther Behavioral Addiction
Gaming is closely associated with cybersex as both are potentially addicting media.
Given the widespread availability of gaming devices, including tablets, smart-
phones, and laptops, video games reach all ages, genders, and demographics [30];
for many people, playing is a means for connecting with other players or for escap-
ing from the boredom of everyday life. However, excessive use of video games
might have serious consequences for everyday life: players might be more con-
cerned with the game than with routine activities, including personal hygiene, work,
and social interaction. On this basis, despite the small prevalence of health issues
related to gaming, the American Psychiatric Association has suggested that video
game addiction might be worth investigating and has thus led Internet gaming
disorder as a “condition requiring further study” in the DSM 5.
Video game addiction, being a relatively novel issue, is still mostly unknown in
regards to both its pathogenesis and its evolution. Although overexpression of ΔFosB
has not been documented in gamers, several mechanisms might provide an explana-
tion for the addictive nature of gaming [31]. Compulsion loops, i.e., designed chains
of activities that will be repeated to gain a neurochemical reward (such as dopamine
release), are among often used by designers in order to keep players attached to the
game (“grinding”); a similar phenomenon (“chasing losses”) has been described in
gambling, as the player will keep playing in the often unlikely event of winning. Brain
functional changes have been discovered via PET imaging in Internet gaming addic-
tion [32], suggesting that loss of control and similar compulsive behaviors observed in
gamers might be associated with dysregulation in D2 receptors and glucose metabo-
lism. Downregulation and reduced expression of D2 receptors have both been associ-
ated with erectile dysfunction and reduced libido, therefore suggesting that excessive
use of gaming might have negative effects on sexual health. However, at the present
time, there is little evidence suggesting a causative association between gaming and
sexual dysfunction; some authors have in fact suggested that video game addiction
might be a consequence of other mental issues, rather than a risk factor per se [33].
To the present date, no studies have adequately addressed whether Internet and
video game use should be considered risk factors for sexual dysfunction or if there
are “threshold” values for their consumption; likewise, little is known regarding
individual response to these stressors. The only study assessing the impact of video-
games on male sexual health has found a signicantly reduced prevalence of prema-
ture ejaculation among gamers, together with reduced sexual desire [34]. These
ndings, however, are far from conclusive and deserve further validation. Genetic
bases for addiction have been recently described [35] and might be involved in the
pathogenesis of sexual dysfunctions.
15 Sexual Dysfunctions intheInternet Era
168
15.6 Internet-Based Therapy forSexual Dysfunctions
The use of the Internet as a clinical intervention space for male and female sexual
dysfunction has a relatively short history. Above all in recent years, the use of the
Internet in clinical practice has proved effective in resolving certain psychopatholo-
gies, such as anxiety and depressive disorders [3638]. To a lesser extent, these
interventions have also become available in the treatment of sexual dysfunction.
The network tool has advantages over face-to-face contact [39]:
It can guarantee anonymity in the initial phases of the intervention, allowing many
individuals to face the problem without fear of being judged or discovered.
No need for a coexistence of the patient and the doctor in the same space or time.
The asynchronous nature of the contact between client and therapist can in some
cases be a valuable service for those who have difculty attending face-to-face
meetings due to physical or geographical constraints or for reasons related to
work.
Clinical treatment is followed daily directly in the real-life environment, skip-
ping the stage where improvements are only present during the therapy session.
The patient may feel more active and responsible in therapy, attributing to him-
self and not to the doctor any improvements in sexual functioning, resulting in
increased self-esteem.
Although the use of Internet therapy as a potential treatment for sexual dysfunc-
tion has often been encouraged [4042], only few scientic contributions are sur-
prisingly present in the literature. Most of the studies describing the results of online
sexual therapy are without a control sample [4345].
Among these, one of the most famous online programs in the eld of sexology is
“Sexpert.” Although initial research has shown promising positive effects of the use
of “Sexpert” in the modication of sexual behavior, the results have never been
published [46].
Internet-based therapy is founded on the theoretical models of psychopathology
and sexual dysfunction [38, 39]. Usually, online interventions are organized in a
website, containing informative material and individual and couple exercises, struc-
tured in a temporal way. In addition, one or more contacts with a sexual health
professional are also provided.
Studies on the Internet-based sexual therapy (IBST) for male erectile dysfunc-
tion suggest substantial equality in treatment efcacy compared to face-to-face
therapies [26, 44, 47, 48].
In the study, men with ED treated with IBST reported improvements (similar to
waiting list group) on erectile function, sexual desire, sexual satisfaction, and self-
condence between pretreatment and posttreatment and were to be largely main-
tained until 3 and 6months after treatment termination [26] (Fig.15.1a).
Similarly, men with PE and treated with IBST reported improvements in ejacula-
tory control, sexual desire, and satisfaction between pretreatment and posttreatment
and were maintained until 6months follow-up [26] (Fig.15.1b).
D. Mollaioli et al.
169
25
20
15
10
25
20
15
10
10
8
6
4
10
8
6
4
Pre-
treatment
Pre-
treatment
Erectile functioning
Premature ejaculation
Sexual desire
Sexual desire
Sexual self-confidence
Sexual self-confidence
Overall sexual satisfaction
Overall sexual satisfaction
Post-
treatment
Post-
treatment
Follow-up 3
month
Follow-up 3
month
Follow-up 6
month
Follow-up 6
month
a
b
Fig. 15.1 (a) Sexual
functioning at
pretreatment,
posttreatment, and
follow-up assessment at 3
and 6months
posttreatment in
participants with ED
(means±SEM) [26]. (b)
Sexual functioning at
pretreatment,
posttreatment, and
follow-up assessment at 3
and 6months
posttreatment in
participants with PE
(means±SEM) [26]
15 Sexual Dysfunctions intheInternet Era
170
In the studies investigating IBST for female sexual dysfunctions, we found simi-
lar results of male studies.
In these studies [4951], improvements were reported after posttreatment in
sexual functioning, intimacy, and relational quality of life (with better communica-
tion and emotional intimacy). Posttreatment gains regarding sexual and relational
functioning were generally maintained until follow-up assessment [49, 51].
Curiously, no signicant improvements were reported in anxiety or mood [50]:
this is because these interventions are extremely focused on targeted problem areas,
such as sexual and relational.
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... Accordingly, some scholars have reported that the alleged negative effects of porn use on sexual quality or functioning lack robustness (Grubbs & Gola, 2019;Landripet & Štulhofer, 2015) and that these effects could sometimes be positive (Bőthe et al., 2021). It has even been suggested that porn use could serve as a therapeutic tool to treat hypoactive sexual disorder (Mollaioli, Sansone, Romanelli, & Jannini, 2018) or help couples suffering from sexual dissatisfaction (Watson & Smith, 2012). ...
... ii) increasing porn use could help women to improve their sexual lives(Mollaioli et al., 2018). ...
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Background We examined whether young men and women differ in the relation between porn use and sexual performance (sexual self-competence, sexual functioning, and partner-reported sexual satisfaction). Methods We conducted a three-wave longitudinal study (spanning 2015-16-17) that involved a very large number of men and women in their early 20s (100 000 + French-speaking individuals; 4000 + heterosexual couples). Results The results revealed a twofold phenomenon. Among men, a higher frequency of porn use (wave 1) and increased porn use over time (waves 1–3) were associated with lower levels of sexual self-competence, impaired sexual functioning, and decreased partner-reported sexual satisfaction. In contrast, among women, higher and increasing frequencies of porn use were associated with higher levels of sexual self-competence, improved sexual functioning, and enhanced partner-reported sexual satisfaction (for some aspects). Conclusions The findings reveal the irony that porn – a male-dominated industry that targets a male-dominated audience – is associated with the erosion of the quality of men's sex lives and the improvement of women's sex lives.
... Recent reviews have outlined evidence suggesting that pornography use may negatively impact an individual's sexual wellbeing, which included sexual dysfunctions, in addition to anxiety surrounding one's sexual performance and compulsive pornography use [60]. However, this review also provided numerous examples of positive effects of pornography use on the quality of an individual's sexual life, some of which are directly contradictory to the negative effects already described, such as using pornography to reduce anxiety in sexual encounters and increasing women's sexual satisfaction. ...
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Purpose of Review Pornography use is a common recreational activity in most developed nations with unrestricted internet access. As public awareness of pornography’s popularity has grown, so have concerns about potentially deleterious effects of pornography. One domain of particular concern has been the impact of pornography use and online sexual behaviors on sexual wellbeing. Over recent years, a number of studies have examined how pornography use relates to sexual wellbeing. The present work seeks to review such literature, with a particular focus on the effects of pornography on sexual functioning and sexual satisfaction. To this end, a systematic review of recent research (within the past 5 years) was conducted. Recent Findings A total of 44 articles were included in the systematic review. In some situations, pornography use is associated with greater sexual functioning and greater sexual satisfaction, and in other cases it seems to be associated with lower sexual functioning and lower sexual satisfaction. Specifically, mere pornography use itself was most often not associated with sexual functioning in either direction, but self-reported problematic use of pornography was consistently associated with more sexual functioning problems. Summary Collectively, results suggest a nuanced understanding of the effects of pornography on sexual wellbeing, with the context of and perceptions about pornography use being extremely important in predicting whether or not pornography has negative effects.
... sexting, sex chats, webcams, role playing) (Cooper et al., 2004). Online sexual networks are usually easy-to-reach and are pragmatically organized by sexual category, sexual preferences, and age (Mollaioli et al., 2018). ...
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The aim of this study was to investigate the connection of problematic online dating (POD), problematic social media (PSM), and problematic online sexual behaviors (POSB), with body esteem and sexuality. Previous research focused either on the impact of media on body esteem, or the impact of body esteem on sexuality. Yet, online media tends to be sexually self-objectifying, requiring more studies on their impact on body esteem and sexuality. In this study, a sample of 825 participants aged between 18 and 54 years old (M = 25, SD = 9.7), with 80% female participants, completed an online survey assessing POD, PSM, POSB, sex addiction, cognitive distractions during sexual intercourse, body esteem, sexual desire, sexual esteem, sexual depression, and sexual preoccupation. POD, PSM, and POSB were significantly correlated (r = 0.14, r = 0.35, r = 0.18). POD was linked to sexual depression (β = 0.10, p < 0.001), PSM was linked to body esteem (β = − 0.17, p < 0.001) and to cognitive distractions (β = 0.19, p < 0.001), and POSB was linked to sexual esteem (β = 0.14, p < 0.001). The mediation model indicated a significant indirect effect of body esteem and cognitive distractions between PSM and sexual depression (β = 0.15, Z = 4.39, p < 0.001), and for PSM and sexual esteem (β = − 0.13, Z = − 3.78, p < 0.001). This study highlighted the importance of studying outcomes of POD, PSM, and POSB on real-life sexual experiences, and to what extent body esteem and cognitive distractions were implicated. Further research is necessary on the impact of POD on sexual well-being and use of online sexual activities in diverse SM platforms.
... Yet another literature review highlights studies where men who frequently consume pornography report sexual dysfunctions, mainly difficulties achieving orgasm with a partner. In a study on men with hypersexuality disorders, 71% of men who chronically masturbated to pornography reported sexual functioning problems (Mollaioli, Sansone, Romanelli, & Jannini, 2018). Delayed ejaculation was reported by 33% (Sutton, Stratton, Pytyck, Kolla, & Cantor, 2014). ...
... Even if two empirical studies reported positive associations between pornography use and some components of sexual well-being, many indicators have not yet been studied in couples, such as sexual function and sexual distress. However, individuals' pornography use has been associated with sexual dysfunctions in crosssectional studies using single occasion self-report measures [47,48]. Given the small number of studies focusing on other components of sexuality than sexual satisfaction, no definitive conclusions can be drawn concerning how pornography may be associated with sexuality in a romantic relationship. ...
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Purpose of Review Pornography use is a common sexual activity for men and women engaged in a romantic relationship. The objective of this literature review was to highlight the current state of research on the associations between pornography use and relational and sexual well-being in mixed-sex couples, with a particular focus on the context of use. Recent Findings Overall, findings are mixed, and studies are plagued by methodological shortcomings precluding causal assertions. Nevertheless, research indicates that men’s pornography use is negatively associated with relational well-being and sexual satisfaction, whereas women’s use is unrelated to relational indicators and unrelated to, or positively associated with, sexual satisfaction. The context in which pornography is used (e.g., alone or with the partner) moderates these associations. Summary This review suggests that pornography use may be positively related, negatively related, or unrelated to couples’ well-being. The sex of the user and the context of use may in part explain this variability in correlates of pornography use.
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Substance addiction (or drug addiction) is a neuropsychiatric disorder characterized by a recurring desire to continue taking the drug despite harmful consequences. Non-substance addiction (or behavioral addiction) covers pathological gambling, food addiction, internet addiction, and mobile phone addiction. Their definition is similar to drug addiction but they differ from each other in specific domains. This review aims to provide a brief overview of past and current definitions of substance and non-substance addiction, and also touches on the topic of diagnosing drug addiction and non-drug addiction, ultimately aiming to further the understanding of the key concepts needed for a foundation to study the biological and psychological underpinnings of addiction disorders.
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Background: Video gaming is an increasingly popular activity in contemporary society, especially among young people, and video games are increasing in popularity not only as a research tool but also as a field of study. Many studies have focused on the neural and behavioral effects of video games, providing a great deal of video game derived brain correlates in recent decades. There is a great amount of information, obtained through a myriad of methods, providing neural correlates of video games. Objectives: We aim to understand the relationship between the use of video games and their neural correlates, taking into account the whole variety of cognitive factors that they encompass. Methods: A systematic review was conducted using standardized search operators that included the presence of video games and neuro-imaging techniques or references to structural or functional brain changes. Separate categories were made for studies featuring Internet Gaming Disorder and studies focused on the violent content of video games. Results: A total of 116 articles were considered for the final selection. One hundred provided functional data and 22 measured structural brain changes. One-third of the studies covered video game addiction, and 14% focused on video game related violence. Conclusions: Despite the innate heterogeneity of the field of study, it has been possible to establish a series of links between the neural and cognitive aspects, particularly regarding attention, cognitive control, visuospatial skills, cognitive workload, and reward processing. However, many aspects could be improved. The lack of standardization in the different aspects of video game related research, such as the participants' characteristics, the features of each video game genre and the diverse study goals could contribute to discrepancies in many related studies.
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Due to explosive growth in technology and internet usage in the last few years internet gaming disorder (IGD) has manifested as rapidly growing public health problem mainly affecting the teen and pre-teen population worldwide. It has a negative impact upon physical, psychological, social and occupational functioning of the affected individual often leading to severe consequences. It was only recently that it has been recognized as a separate diagnosable disorder in DSM 5. Not much data is available regarding the exact prevalence and the various sociodemographic, clinical and other risk factors in order to identify the individuals vulnerable to develop this disorder, especially in the developing countries like India. According to a recent report India ranks 22nd in the list of highest revenue generating countries from gaming related businesses, thus highlighting the magnitude of risk faced by Indian population. The aim of this review is to provide an insight about the disorder, to identify the risk factors and clinical features, to understand the effect of IGD upon the psychological and physical health with special focus on neural changes and to provide information on the various upcoming preventive and treatment strategies.
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Traditional factors that once explained men's sexual difficulties appear insufficient to account for the sharp rise in erectile dysfunction, delayed ejaculation, decreased sexual satisfaction, and diminished libido during partnered sex in men under 40. This review (1) considers data from multiple domains, e.g., clinical, biological (addiction/urology), psychological (sexual conditioning), sociological; and (2) presents a series of clinical reports, all with the aim of proposing a possible direction for future research of this phenomenon. Alterations to the brain's motivational system are explored as a possible etiology underlying pornography-related sexual dysfunctions. This review also considers evidence that Internet pornography's unique properties (limitless novelty, potential for easy escalation to more extreme material, video format, etc.) may be potent enough to condition sexual arousal to aspects of Internet pornography use that do not readily transition to real-life partners, such that sex with desired partners may not register as meeting expectations and arousal declines. Clinical reports suggest that terminating Internet pornography use is sometimes sufficient to reverse negative effects, underscoring the need for extensive investigation using methodologies that have subjects remove the variable of Internet pornography use. In the interim, a simple diagnostic protocol for assessing patients with porn-induced sexual dysfunction is put forth.
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The present paper gives an overview of the methodology and results of the first decade of research into Internet-based interventions for women’s sexual dysfunction. The interventions, retrieved in a literature search, were mostly well grounded on common theoretical models of sexual dysfunction and psychological disorders, and most ingredients of the interventions were theory-informed. Most interventions offered Web-based therapeutic content within a more or less preprogrammed structure. Most of these also offered prescheduled and/or participant-initiated contact with a sexual health care professional. Comparative effect studies showed improvements in sexual functioning as well as relational functioning at the point of termination of the intervention period. Improvements at posttreatment were generally maintained for several months after termination of the active intervention period. The results of this review seem to warrant further development of Internet-based interventions for women’s sexual dysfunctions.
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Introduction: Attitudes toward masturbation are extremely varied, and this practice is often perceived with a sense of guilt. Aim: To evaluate the prevalence of ego-dystonic masturbation (EM), defined as masturbation activity followed by a sense of guilt, in a clinical setting of sexual medicine and the impact of EM on psychological and relational well-being. Methods: A series of 4,211 men attending an andrology and sexual medicine outpatient clinic was studied retrospectively. The presence and severity of EM were defined according to ANDROTEST items related to masturbation, determined by the mathematical product of the frequency of masturbation and the sense of guilt after masturbation. Main Outcome Measures: Clinical, biochemical, and psychological parameters were studied using the Structured Interview on Erectile Dysfunction, ANDROTEST, and modified Middlesex Hospital Questionnaire. Results: Three hundred fifty-two subjects (8.4%) reported any sense of guilt after masturbation. Subjects with EM were younger than the remaining sample (mean age ± SD = 51.27 ± 13.43 vs 48.31 ± 12.04 years, P < .0001) and had more psychiatric comorbidities. EM severity was positively associated with higher free-floating (Wald = 35.94, P < .001) and depressive (Wald = 16.85, P < .001) symptoms, and subjects with a higher EM score reported less phobic anxiety (Wald = 4.02, P < .05) and obsessive-compulsive symptoms (Wald = 7.6, P < .01). A higher EM score was associated with a higher alcohol intake. Subjects with EM more often reported the partner's lower frequency of climax and more problems achieving an erection during sexual intercourse. EM severity was positively associated with worse relational and intrapsychic domain scores. Conclusion: Clinicians should consider that some subjects seeking treatment in a sexual medicine setting might report compulsive sexual behaviors. EM represents a clinically relevant cause of disability, given the high level of psychological distress reported by subjects with this condition, and the severe impact on quality of life in interpersonal relationships.
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Context The revolution of digital technologies constitutes a new setting for the patient–physician relationship and provides patients with a scenario of privacy and universal access to a vast amount of information. However, there is little information on how digital resources are used and what their advantages and disadvantages are. Objectives To explore the scope of the scientific research on the use of digital technology related to men's sexual disorders and to analyze the primary sources of digital information related to this field. Acquisition of evidence Systematic searches of the scientific literature, websites (10 first results in each google search) and mobile applications (apps). The searches combined the keywords “web” and “app” with “erectile dysfunction”, “premature ejaculation”, “Peyronie”, “male hypogonadism”, and “infertility”. Websites and apps were assessed for quality according to predefined indicators. Synthesis of evidence The qualitative analysis of the scientific literature included 116 manuscripts; 47% were clinical studies based on online survey, 9% dealt with digital treatments, 11% with quality/safety of digital healthcare environment, 3% with digital activity, 21% with patient empowerment, and 9% with online drug selling. Of 50 websites assessed for quality, 29 (58%) scored 4 or 5 on a 5-point Likert scale. The app search yielded 40 apps; only 3 of them (8%) reported the identity of a health center or healthcare professional involved. Conclusions Patients and healthcare professionals may benefit from digital resources related to men's sexual disorders; however, a strong commitment by the scientific and healthcare community is essential to increase the quality of these resources.
Article
Background Videogame use is increasingly prevalent in people of all ages, and despite the wide amount of scientific evidence proving a role for electronic entertainment in human health, there is no evidence about the relation between use of videogames and sexual health. Aim To investigate the association between use of videogames and male sexual health. Methods We administered the two validated questionnaires, the Premature Ejaculation Diagnostic Tool (PEDT) and the International Index of Erectile Function (IIEF-15), to men 18 to 50 years old recruited through social networks and specific websites. In addition to the questionnaires, volunteers were asked to provide information on their gaming habit and lifestyle. Outcomes An extended version of the IIEF-15 and PEDT, including data about gaming habits and relevant lifestyles. Results From June 18, 2014 through July 31, 2014, 599 men 18 to 50 years old completed the questionnaires. One hundred ninety-nine men reported no sexual activity during the previous 4 weeks; four records were rejected because of inherent errors. The remaining 396 questionnaires were analyzed, with 287 “gamers” (playing >1 hour/day on average) and 109 “non-gamers” providing all the required information. We found a lower prevalence of premature ejaculation in gamers compared with non-gamers (mean PEDT score = 3.57 ± 3.38 vs 4.52 ± 3.7, P < .05, respectively). Analysis of the IIEF-15 showed no significant differences between gamers and non-gamers in the domains of erectile function, orgasmic function, and overall satisfaction. Median scores for the sexual desire domain were higher for non-gamers (median score [interquartile range] 9 [8–9] vs 9 [8–10], respectively; P = .0227). Clinical Implications These results support the correlation between videogame use and male sexual health. Compared with non-gamers, men playing videogames for more than 1 hour/day were less likely to have premature ejaculation but more likely to have decreased sexual desire. Strengths and Limitations This is the first study aimed to assess male sexual health in gamers. We identified an association between PEDT and IIEF scores and videogame use; however, these findings require validation through interventional studies. Furthermore, volunteers were recruited through social networks, thus increasing the risk of recruitment bias. Conclusion To our knowledge, this is the first observational study investigating the link between electronic entertainment and male sexuality, specifically for ejaculatory response and sexual desire. Sansone A, Sansone M, Proietti M, et al. Relationship Between Use of Videogames and Sexual Health in Adult Males. J Sex Med 2017;XX:XXX–XXX.
Article
Although playing of Internet games may lead to Internet gaming disorder (IGD), most game-users do not develop problems and only a relatively small subset experiences IGD. Game playing may have positive health associations, whereas IGD has been repeatedly associated with negative health measures, and it is thus important to understand differences between individuals with IGD, recreational (non-problematic) game use (RGU) and non-/low-frequency game use (NLFGU). Individuals with IGD have shown differences in neural activations from non-gamers, yet few studies have examined neural differences between individuals with IGD, RGU and NLFGU. Eighteen individuals with IGD, 21 with RGU and 19 with NFLGU performed a color-word Stroop task and a guessing task assessing reward/loss processing. Behavioral and functional imaging data were collected and compared between groups. RGU and NLFGU subjects showed lower Stroop effects as compared with those with IGD. RGU subjects as compared to those with IGD demonstrated less frontal cortical activation brain activation during Stroop performance. During the guessing task, RGU subjects showed greater cortico-striatal activations than IGD subjects during processing of winning outcomes and greater frontal brain during processing of losing outcomes. Findings suggest that RGU as compared with IGD subjects show greater executive control and greater activations of brain regions implicated in motivational processes during reward processing and greater cortical activations during loss processing. These findings suggest neural and behavioral features distinguishing RGU from IGD and mechanisms by which RGU may be motivated to play online games frequently yet avoid developing IGD.
Article
Using pornography through the Internet is now a common activity even if associated sexual outcomes, including sexual satisfaction, are highly variable. The present study tested a two-step sequential mediation model whereby cyberpornography time use is related to sexual satisfaction through the association with, in a first step, perceived addiction to cyberpornography (i.e., perceived compulsivity, effort to access, and distress toward pornography) and with, in a second step, sexual functioning problems (i.e., sexual dysfunction, compulsion, and avoidance). These differential associations were also examined across gender using model invariance across men and women. A sample of 832 adults from the community completed self-report online questionnaires. Results indicated that 51 percent of women and 90 percent of men reported viewing pornography through the Internet. Path analyses showed indirect complex associations in which cyberpornography time use is associated with sexual dissatisfaction through perceived addiction and sexual functioning problems. These patterns of associations held for both men and women.