Content uploaded by Alejandro Villena
Author content
All content in this area was uploaded by Alejandro Villena on Jul 09, 2019
Content may be subject to copyright.
18
PSICOSOMÁTICA
Y PSIQUIATRÍA
www.psicosomaticaypsiquiatria.com
9 / AÑO 2019
MAYO • JUNIO • JULIO
ISSN 2565-0564
Psicosom. psiquiatr. 2019;9:18-25
ARTÍCULO ORIGINAL
ORIGINAL ARTICLE
Recibido: 5/02/2019. Aceptado: 02/04/2019
Alejandro Villena Moya1, Carlos Chiclana Actis2
1Psicólogo General Sanitario. Coordinador de la Unidad de Sexología Clínica y Salud Sexual. 2Médico-Psiquiatra, PhD. Director Médico.
Correspondencia: Dr. Carlos Chiclana. Avenida Filipinas 52 6ºB, 28003 Madrid.
E-mail: alejandrovillena@doctorcarloschiclana.com Tlf.: 915340574
CONSEQUENCE OF PORNOGRAPHY USE:
BRIEF REPORT
CONSECUENCIAS DEL CONSUMO DE PORNOGRAFÍA:
BREVE REPORTE
LEER
A.Villena y C. Chiclana
Consequence of pornography use: Brief Report
19
www.psicosomaticaypsiquiatria.com
PSICOSOMÁTICA
Y PSIQUIATRÍA
Psicosom. psiquiatr. 2019;9:18-24.
9 / AÑO 2019
MAYO • JUNIO • JULIO
ABSTRACT
Introduction: Despite the various investigations carried out to date, the debate on the possible harmful
consequences of pornography remains open. There are different opinions on the possible negative or positive
consequences of its use. Some authors argue that these consequences are measured by other variables such
as attachment, sex education or personality traits, which will determine their magnitude.
Method: The objective of this study is to obtain a brief and general approximation to the type of consumption
of a Spanish-Speaking population (N=3.700), through a short survey, in order to meet a starting point that allows
us to continue the research in this eld.
Results: The results highlight that 30- 45% of the participants could be suffering some difculties derived
from pornography use in different areas (Family, Social, Academic or Work), being unable to stop looking at
pornography and using pornography as emotional regulation strategy. A large percentage of participants (55-
70%) do not suffer any consequences. Only 7,06% of the subjects spent more money on online sex material
than they had planned.
Conclusions: It would be interesting to conduct an in-depth evaluation of the possible effects of pornogra-
phy use and the variables that mediate this process, such as sexual education, personality traits, morality or
attachment.
Keywords: Pornography; Sexuality; Sexual Relationships; Online Sexual Activity.
RESUMEN
Introducción: A pesar de las diversas investigaciones realizadas hasta la fecha, el debate sobre las posibles
consecuencias perjudiciales de la pornografía sigue abierto. Existen diferentes opiniones sobre las posibles con-
secuencias negativas o positivas de su uso. Algunos autores sostienen que estas consecuencias se miden por
otras variables como el apego, la educación sexual o los rasgos de personalidad, que determinarán su magnitud.
Método: El objetivo de este estudio es obtener una breve y general aproximación al tipo de consumo de una
población de habla hispana (N=3.700), a través de una breve encuesta, con el n de conocer un punto de partida
que nos permita continuar la investigación en este campo.
Resultados: Los resultados ponen de maniesto que entre el 30-45% de los participantes podrían estar
sufriendo algunas dicultades derivadas del uso de la pornografía en diferentes ámbitos (familiar, social, aca-
démico o laboral), siendo incapaces de dejar de ver la pornografía y de utilizar la pornografía como estrategia
de regulación emocional. Un gran porcentaje de participantes (55- 70%) no sufre ninguna consecuencia. Sólo el
7,06% de los sujetos gastaron más dinero en material de sexo en línea de lo que habían planeado.
Conclusiones: Sería interesante realizar una evaluación en profundidad de los posibles efectos del uso
de la pornografía y de las variables que intervienen en este proceso, como la educación sexual, los rasgos de
personalidad, la moralidad o el apego.
Palabras clave: Pornografía; Sexualidad; Relaciones sexuales; Actividad sexual en línea.
A.Villena y C. Chiclana
Consequence of pornography use: Brief Report
20
www.psicosomaticaypsiquiatria.com
PSICOSOMÁTICA
Y PSIQUIATRÍA
Psicosom. psiquiatr. 2019;9:18-24.
9 / AÑO 2019
MAYO • JUNIO • JULIO
INTRODUCTION
The consumption of online pornography worldwide totals
more than 26,500 million annual visits (Kamaruddin, Rahman
& Handiyani, 2018).
The United States is at the top of the world ranking and
Spain is among the top 20. According to Ollero (2016) 3 out
of 4 Spaniards consume online pornography. The money this
generates exceeds the combined revenues of sports indus-
tries such as soccer, baseball or basketball, or the joint billing
of television stations such as NBC, CBS or ABC (Stoner &
Hughes, 2010).
CONSEQUENCES OF THE CONSUMPTION
OF PORNOGRAPHY
Since the 1970s, there have been several studies that
show that the consumption of pornography produces harmful
consequences, facilitating aggressive behaviour in the sexual
sphere, favouring gender stereotypes and sexual roles (the
content of pornography is mostly focused on men, and wo-
men are usually treated as an object), promoting promiscuity,
generating family conflicts and producing sexual dysfunctions
(Brown, Amoroso & Ware, 1976; Wright, Tokunaga & Kraus,
2015; Doornwaard, van Den Eijnden, Baamsm Vanwesenbeeck
& Ter Bogt 2016; Park et al., 2016; Fisher & Kohut, 2017).
It has been observed how regular pornography consump-
tion is even capable of altering the brain’s chemical structure,
specically the frontostriatal connections, which play a role
in the development of intimacy with others (Struhers, 2010).
PPU also could cause negative consequences that could
be considered as a behavioural problem, such as difcul-
ty refraining from use and problems with sexual thoughts
(Cooper, Delmonico, Grifn-Shelley & Mathy, 2004; Orzack
& Ross, 2000).
There are also several studies that state that the con-
sumption of pornography does not have any harmful conse-
quences on the person using it (Garcia S. 2013; Vandenbosch
& Eggermont 2015). Furthermore, Kvalem, Træen, Lewin &
Stulhofer (2014) show in their results that pornography can
have positive effects on men’s sexual self-esteem. Other stu-
dies claim that the influence of pornography consumption is
mediated by attachment style (Gouvernet et al. 2017; Maas,
Vasilenko, & Willoughby, 2018).
However, pornography addiction is still not recognized as
an independent diagnostic entity in manuals par excellence
even though there is a great deal of scientic literature that
considers it a new addiction without substance.
Potenza, Gola, Voon, Kor & Kraus (2017) argue that there
were several pros and cons to including Compulsive Sexual
Behaviour in the International Classication of Diseases 11
(ICD-11) as an impulsive pathology rather than addictive one.
On the other side, Prause, Janssen, Georgiadis, Finn & Pfaus
(2017) argue that there is still not enough data supporting
that excessive or frequent sexual activity should be consider
as an addiction. Finally, ICD-11 included CSB as an impulsive
control disorder (Krause et al. 2018).
Regardless of its classication, the fact that CSB is inclu-
ded in ICD-11 allows for greater visibility of people suffering
from uncontrolled sexual pathologies and facilitates the evo-
lution of research and treatment for a better understanding
of this population.
EMPIRICAL STUDY
OBJECTIVES
The objective of this study is to obtain a brief and general
approximation to the type of pornography use in the gene-
ral Spanish-Speaking population, through a brief survey, to
meet a starting point that allows us to further the research
in this eld.
METHOD
A short survey of only 8 items (Table 1) on pornography
use and its possible impact on people’s lives was carried
out. It was distributed through various media outlets such as
national newspapers, television and radio, as well as on social
networks such as Twitter, Instagram, LinkedIn and Facebook.
The sample size (N) consisted of 3,700 subjects.
ETHICS COMMITTEE AND INFORMED CONSENT
After evaluating with the Ethic Committee (Dr. Carlos
Chiclana, Madrid) and the Direction of the Dale Una Vuelta
Association (through which the survey was disseminated), we
have decided that because there is no type of data that com-
promises the condentiality of the person who participates in
the research and no population at risk of those mentioned in
the Declaration of Helsinki, it was not necessary to use this
procedure for the participants of this Brief Report. In addition,
A.Villena y C. Chiclana
Consequence of pornography use: Brief Report
21
www.psicosomaticaypsiquiatria.com
PSICOSOMÁTICA
Y PSIQUIATRÍA
Psicosom. psiquiatr. 2019;9:18-24.
9 / AÑO 2019
MAYO • JUNIO • JULIO
in accordance with the Ofcial Spanish Data Protection Law
(RGDP, 2018) and the Institutional Guidelines of our Country,
as there is no sociodemographic data on the participants it
is not necessary the use of a formal informed consent. The
informed consent was implied through survey completion
RESULTS
The results according to the survey are shown below in
Table 1.
DISCUSSION
According to the results extracted from the brief survey,
different aspects of interest for discussion are highlighted.
In the rst place, it can be observed that 40.77% of the
participants report to have had a negative impact in the per-
sonal, social, labour or academic sphere due to the use of
pornography. This data indicates the existence of a possible
problematic use in a big percentage of Spanish-Speaking
population and also that the viewing of pornography, like other
behavioural problems, can produce a similar deterioration or
discomfort in different areas.
For some authors, the use of pornography can be consi-
dered as a new behavioural addiction due to the similarity of
the characteristics of the person who consumes it and the
impact it has on their lives. In addition, alterations in reward
systems have been observed in brain structures, dysfunc-
tions that link addictive behaviour to addictive substances
disorders (Orzack & Ross, 2000; Cooper et al., 2004; Gola et
al. 2017).
Some authors afrm that problematic pornography use is
not an addiction, but is instead caused by moral attitudes and
different ways of understand sexuality, influenced by cultu-
ral aspects (Humprheys, 2017). Here we have an interesting
focus research trying to understand why people consider
pornography use as a problem in their lives and why others
do not consider it a problem. Is it only because of a moral
attitude? Are the negative consequences the only item to
consider pornography use as a problem?
The next result that attracts attention is that approxi-
mately 36,02% of the subjects spend more than 5 hours per
week online for sexual purposes, using pornography as a
reward. This can be related to the symptoms of dependence,
tolerance and habituation (Voros, 2009), which are observed
in the prototypical prole of the addict. Walton (2017) gives
another explanation, stating that there is a “Sexhavior Cycle”
of hypersexuality which can potentially explain the neuropsy-
chology and maintenance cycle of hypersexuality. For this
author “the sexhavior cycle” suggests that, for some hyper-
sexual persons, high sexual arousal may temporarily and
adversely impact cognitive processing (cognitive abeyance)
and explain a repeated pattern of psychological distress when
interpreting one’s sexual behaviour (sexual incongruence)”.
Also, the compulsive model of hypersexuality can explain the
need to act out and spend higher amounts of time in sexual
activity to reduce anxiety or distress (Chiclana, Contreras,
Carrilles & Rama, 2015).
Table 1. Brief Survey Results
Yes No
Online pornography has once interfered
with certain aspects of my life: family,
social, academic, work. 40,77% 59,23%
I spend more than ve hours a week
using my computer or smartphone for
sexual purposes 36,07% 63,98%
I’ve spent more money on online sex
material than I’ve planned. 7,06% 92,94%
I use online pornography to experiment
with different aspects of sexuality, such
as sex games in which couples are tied or
other variations.
31,95% 68,05%
I have my own website that contains
some sexual material or pornographic
content stored on my computer 23,58% 76,42%
Sometimes I use pornography as a
reward for getting something, like ni-
shing a job, after a stressful day, etc. 45,42% 54,58%
When I can’t access sexual content
material online I feel anxious, angry or
disappointed. 30,74% 69.26%
I feel like I can’t stop looking at porno-
graphy. 38,38% 61,62%
Online pornography has once interfered
with certain aspects of my life: family,
social, academic, work. 40,77% 59,23%
A.Villena y C. Chiclana
Consequence of pornography use: Brief Report
22
www.psicosomaticaypsiquiatria.com
PSICOSOMÁTICA
Y PSIQUIATRÍA
Psicosom. psiquiatr. 2019;9:18-24.
9 / AÑO 2019
MAYO • JUNIO • JULIO
It is characteristic of people with addictions to invest
more time than planned in everything that surrounds addic-
tive behaviour, occupying a time that could be useful for their
professional or personal development and yet is diminished
by the need to consume. Such material instead of promo-
ting healthy behaviours, hinders the proper development of
a human dimension as important as sexuality.
The following result refers to the economic expenditure
of the participants in web pages of pornographic content.
It can be seen that only 7,06% invest money in this type of
pages. This can be due to the triple A (Accessibility, Afforda-
bility and Anonymity) of which Stoner & Hughes (2010) speak,
specically the affordability of the pornography, because with
a simple click it is possible to have access to any type of
sexually explicit content without any cost.
Following the brief survey, the results show that 31.95% of
the 3,700 participants used pornography to experiment with
different aspects of sexuality, such as sexual games involving
the couple or other variants. This shows that some individuals
can learn to behave sexually through what they observe in
pornography. Perhaps in this percentage of the participants
may exist a lack of social and educational resources with re-
gard to sexual relations and sexuality in general. This can lead
to an extrapolation of all kinds of misogynistic, aggressive
and degrading practices towards real sexual intercourse, as
has been seen in various publications (Malamuth, Addison &
Koss, 2000; Vega & Malamuth, 2007). It would be of interest
to further investigate in this regard the possibility that porno-
graphy may impose a model of power and submissiveness
that trivializes aggression in the sexual area and may fosters
stereotypes and gender roles as other authors have said (To,
Iu Kan & Ngai, 2015).
We can also observe how 23.58% of the subjects have
their own favourite online pornographic site on their compu-
ter, something that makes us think about the normalization
on the viewing of pornography and, in turn, the necessity
to have it accessible in case of need to consume (Orzack &
Ross, 2000). Another explanation could be that some users
get bored easily of a specic material and need to change
websites in order to get a more extreme, different, sophis-
ticate stimuli.
Another signicant nding of this rst short survey is
that 45.42% of the participants sometimes use pornography
as reinforcement for having achieved something, or after a
stressful day. This should indicate that the purpose of these
consumers of pornography is more a dysfunctional strategy
to celebrate a success or recover from failure, that is to say, to
regulate emotionally. An explanation could be found in Reid,
Bramen, Anderson & Cohen (2014) where patients suffering
from hypersexuality have lower levels of emotional regulation
or in Reid, Carpenter, Spackman & Willes (2008) where the
hypersexual patients experience more negative affects as
depression, alexithymia and vulnerability to stress.
Finally, it should be noted that in reference to the symp-
toms of anxiety, a significant percentage (30,74%) of the
subjects presented anxious symptoms when they could
not access pornography. These results can be paralleled
with those of Duffy, Dawson & Das Nair (2016). Both results
maintain that the malaise that the abstinence of pornography
can produce is similar to the syndrome of abstinence that
happens with other addictions. The last result obtained goes
in this same line, showing that 29.82% of the subjects feel
that they cannot stop looking at pornography.
CONCLUSIONS
According to the results, we have observed that porno-
graphy can have a negative impact in different areas of the
lives of some of participants of the study. Furthermore, they
can feel angry or disappointed when they cannot access
online pornography, sometimes they feel that they cannot
stop looking at pornography or that they use pornography
as an emotional regulator. It would be interesting to continue
investigating the percentage that has some difculties with
pornography use, in order to know more about which the
specic problem areas are and how these problems vary in
different proles of age, gender, occupation, personality and
other variables.
It is not clear yet what kind of people would be more
affected by the pornography use and what people can use
pornography as a recreational use without any problems.
It is important, therefore, to consider the viewing of por-
nography when evaluating and dealing with patients who
come to the clinic requesting help for problems in the sexual
function, since the frequency of viewing of this material may
be interfering in the development of healthy life and sexuality.
It’s true that after more than 50 years of scientic re-
search and several empirical demonstrations of the harmful
consequences of pornography use in people’s lives, it is time
to start acting. We need to get in-depth knowledge of what is
A.Villena y C. Chiclana
Consequence of pornography use: Brief Report
23
www.psicosomaticaypsiquiatria.com
PSICOSOMÁTICA
Y PSIQUIATRÍA
Psicosom. psiquiatr. 2019;9:18-24.
9 / AÑO 2019
MAYO • JUNIO • JULIO
happening with pornography use and why people can make
a problematic use or even be addicted to such material.
The trivialization of the viewing of pornography in which
the current society is immersed tries to avoid the problem.
However, this produces greater ignorance and a worse hand-
ling of the problematic situations that can derive from this
use.
This study presents interesting data that support the
existing theories about the possible negative impact of por-
nography on the consumer.
LIMITATIONS OF THE STUDY AND RECOMMENDATIONS
This study is intended to be the rst in a series of articles
on the possible consequences of the use of pornography,
therefore only these rst 8 items have been considered to
provide a starting point for further research. There are some
limitations to consider, such as the lack of some socio-de-
mographic information (age, sex, sexual education or gender
perspective) and empirical data.
It is important to continue investigating the impact of por-
nography on the different areas of functioning of individuals.
A desirable eld would be the purpose of pornography-use in
regard to the adaptive or maladaptive regulation of emotional
states of the person.
It is of interest to develop new evaluation tools that allow
us to establish a cut-off point between problematic and res-
ponsible use in Spanish-Speaking population, to encourage
the emergence of pornography addiction as a new entity in
diagnostic manuals par excellence.
It would also be interesting to estimate how pornography
is affecting the ability to relate, due to the lack of human
contact that such viewing favours and the total extinction of
the affective nature of the sexual relationship.
DECLARATION OF AUTHORSHIP,
GOOD PRACTICES AND TRANSFER OF RIGHTS
1) Funding: No funding has been obtained for this project.
2) Contribution: Authors A and B designed the study and wrote
in the protocol. Author A wrote and collected the survey data
and author B revised and corrected it.
3) Conflict of interest: The authors declare that there is no con-
flict of interest.
BIBLIOGRAPHY
1. Brown, M., Amoroso, D. M., & Ware, E. E. (1976). Behavioral effects of viewing
pornography. The Journal of social psychology, 98(2), 235-245.
2. doi: http://dx.doi.org/10.1080/00224545.1976.9923394
3. Charles P. Samenow (2010) A Biopsychosocial Model of Hypersexual Di-
sorder/Sexual Addiction, Sexual Addiction & Compulsivity, 17:2, 69-81, doi:
10.1080/10720162.2010.481300
4. Chiclana, C., Contreras, M., Carrilles, S. , & Rama D. (2015). Sexual Addiction:
Independent entity or comorbid symptom?. Cuadernos de medicina psico-
somática y psiquiatria de enlace, (115), 19-26.
5. Cooper, A., Delmonico, D. L., Griffin-Shelley, E., & Mathy, R. M. (2004).
Online sexual activity: an examination of potentially problematic beha-
viors. Sexual Addiction & Compulsivity, 11, 129e143. doi: http://dx.doi.
org/10.1080/10720160490882642.
6. Doornwaard, S. M., van Den Eijnden, R. J., Baams, L., Vanwesenbeeck, I., &
Ter Bogt, T. F. (2016). Lower psychological well-being and excessive sexual
interest predict symptoms of compulsive use of sexually explicit internet
material among adolescent boys. Journal of youth and adolescence, 45(1),
73-84. doi: 10.1007/s10964-015-0326-9.
7. Duffy, A., Dawson, D. L., & Das Nair, R. (2016). Pornography addiction in adults:
A systematic review of denitions and reported impact. The journal of sexual
medicine, 13(5), 760-777. doi: https://doi.org/10.1016/j.jsxm.2016.03.002
8. Fisher, W. A., & Kohut, T. (2017). Pornography Viewing: Keep Calm and
Carry On. The Journal of Sexual Medicine, 14(3), 320-322. doi: 10.1016/j.
jsxm.2017.01.003
9. Garcia, S. (2013). A Content Analysis of Intimacy and Aggression in Por-
nographic Films: From 1990-2010 (Doctoral dissertation, Texas Woman s
University).
10. Gola, M., Wordecha, M., Sescousse, G., Lew-Starowicz, M., Kossowski, B.,
Wypych, M., Makeig, S., Potenza, M. N. & Marchewka, A. (2017). Can porno-
graphy be addictive? An fMRI study of men seeking treatment for problematic
pornography use. Neuropsychopharmacology, 42(10), 2021.
11. Gouvernet, B., Rebelo, T., Sebbe, F., Hentati, Y., Yougbare, S., Combaluzier,
S., & Rezrazi, A. (2017). Is pornography pathogen by itself? Study of the
role of attachment proles on the relationship between pornography and
sexual satisfaction. Sexologies, 26(3), e27-e33. doi: https://doi.org/10.1016/j.
sexol.2016.10.002
12. Humphreys, K. (2017). Of moral judgments and sexual addictions. Addiction,
113(3), 387-388. doi: https://doi.org/10.1111/add.14066
13. Kafka, M.P. (2010). Hypersexual Disorder: A Proposed Diagnosis for DSM-V.
Archives of Sexual Behaviour,39, 377-400. doi: 10.1007/s10508-009-9574-7.
14. Kamaruddin, N., Rahman, A. W. A., & Handiyani, D. (2018). Pornography addic-
tion detection based on neurophysiological computational approach. Indone-
sian Journal of Electrical Engineering and Computer Science, 10(1), 138-145.
15. Kraus, S. W., Krueger, R. B., Briken, P., First, M. B., Stein, D. J., Kaplan, M. S.,
Voon, V., Abdo, Carmita H. N., Grant, J. E., Atalla, E. & Reed, G. M. (2018).
Compulsive sexual behaviour disorder in the ICD‐11. World Psychiatry, 17(1),
109-110.
16. Kvalem, I. L., Træen, B., Lewin, B., & Štulhofer, A. (2014). Self-perceived
effects of internet pornography use, genital appearance satisfaction, and
sexual self-esteem among young scandinavian adults. Cyberpsychology:
Journal of Psychosocial Research on Cyberspace, 8(4). doi: http://dx.doi.
org/10.5817/CP2014-4-4
A.Villena y C. Chiclana
Consequence of pornography use: Brief Report
24
www.psicosomaticaypsiquiatria.com
PSICOSOMÁTICA
Y PSIQUIATRÍA
Psicosom. psiquiatr. 2019;9:18-24.
9 / AÑO 2019
MAYO • JUNIO • JULIO
17. Maas, M. K., Vasilenko, S. A., & Willoughby, B. J. (2018). A Dyadic Approach
to Pornography Use and Relationship Satisfaction Among Heterosexual
Couples: The Role of Pornography Acceptance and Anxious Attachment.
The Journal of Sex Research, 1-11. doi: https://doi.org/10.1080/002244
99.2018.1440281
18. Malamuth, N. M., Addison, T., & Koss, M. (2000). Pornography and sexual
aggression: Are there reliable effects and can we understand them?. Annual
review of sex research, 11(1), 26-91.
19. Mick, T. M., & Hollander, E. (2006). Impulsive-compulsive sexual be-
havior. CNS spectrums, 11(12), 944-955. doi: https://doi.org/10.1017/
S109285290001513
20. Ollero, D. J. (8 de Enero de 2016). Así se consume porno en España. El Mundo.
Retrieved from: http://www.elmundo.es/f5/2016/01/07/568e9806ca4741b-
d398b45a0.html
21. Orzack, M. H., & Ross, C. J. (2000). Should virtual sex be treated like other
sex ad- dictions? Sexual Addiction & Compulsivity, 7, 113e125. doi:http://
dx.doi.org/10.1080/ 10720160008400210
22. Park, B. Y., Wilson, G., Berger, J., Christman, M., Reina, B., Bishop, F., Klam & Doan,
A. P. (2016). Is Internet pornography causing sexual dysfunctions? A review
with clinical reports. Behavioral Sciences, 6(3), 17. doi:10.3390/bs6030017.
23. Potenza, M. N., Gola, M., Voon, V., Kor, A., & Kraus, S. W. (2017). Is exces-
sive sexual behaviour an addictive disorder?. The Lancet Psychiatry, 4(9),
663-664.
24. Reid, R. C., Carpenter, B. N., Spackman, M., & Willes, D. L. (2008). Alexithy-
mia, emotional instability, and vulnerability to stress proneness in patients
seeking help for hypersexual behavior. Journal of Sex & Marital Therapy,
34(2), 133-149.
25. Reid, R. C., Bramen, J. E., Anderson, A., & Cohen, M. S. (2014). Mindfulness,
emotional dysregulation, impulsivity, and stress proneness among hyper-
sexual patients. Journal of Clinical Psychology, 70(4), 313-321.
26. Stoner, J. R., & Hughes, D. M. (2010). The Social Costs of Pornography, New
Jersey: Witherspoon Institute.
27. Struthers, W. M. (2010). Wired for intimacy: How pornography hijacks the
male brain. InterVarsity Press.
28. To, S. M., Iu Kan, S. M., & Ngai, S. S. Y. (2015). Interaction effects between
exposure to sexually explicit online materials and individual, family, and ex-
trafamilial factors on Hong Kong high school students’ beliefs about gender
role equality and body-centered sexuality. Youth & Society, 47(6), 747-768.
doi: https://doi.org/10.1177/0044118X13490764
29. Vandenbosch, L., & Eggermont, S. (2015). The role of mass media in adoles-
cents’ sexual behaviors: Exploring the explanatory value of the three-step
self-objectication process. Archives of Sexual Behavior, 44(3), 729-742.
doi: 10.1007/s10508-014-0292-4
30. Vega, V., & Malamuth, N. M. (2007). Predicting sexual aggression: The role of
pornography in the context of general and specic risk factors. Aggressive
Behavior, 33(2), 104-117. doi: 10.1002/ab.20172
31. Voros, F. (2009). The invention of addiction to pornography. Sexologies, 18(4),
243-246. doi: https://doi.org/10.1016/j.sexol.2009.09.007
32. Walton, M. T., Cantor, J. M., Bhullar, N., & Lykins, A. D. (2017). Hypersexuality:
A critical review and introduction to the “sexhavior cycle”. Archives of Sexual
Behavior, 46(8), 2231-2251.
33. Wright, P. J., Tokunaga, R. S., & Kraus, A. (2015). A meta-analysis of pornogra-
phy consumption and actual acts of sexual aggression in general population
studies. Journal of Communication. doi:10.1111/jcom.12201.