Effects of Pornography Use and Demographic Parameters on Sexual Response during Masturbation and Partnered Sex in Women

Abstract

The effect of pornography on sexual response is understudied, particularly among women. A multinational, community-based sample of 2433 women at least 18 years of age completed a 42-item, opt-in questionnaire collecting information on demographic and sexual history characteristics, use of pornography during masturbation, frequency of pornography use, and sexual response parameters. Pornography use and average frequency were compared across demographic variables. We also examined how pornography frequency predicted differences in self-reported arousal difficulty; orgasmic difficulty, latency, and pleasure; and the percent of sexual activities ending in orgasm during both masturbation and partnered sex. On average, women using pornography were younger, and reported more interest in sex. Pornography frequency differed significantly by menopausal status, sexual orientation, anxiety/depression status, number of sexual partners, and origin of data collection. During masturbation, more frequent pornography use predicted lower arousal difficulty and orgasmic difficulty, greater pleasure, and a higher percentage of masturbatory events leading to orgasm. Frequency of pornography use predicted only lower arousal difficulty and longer orgasmic latencies during partnered sex, having no effect on the other outcome variables. Pornography use frequency did not predict overall relationship satisfaction or sexual relationship satisfaction. Overall, more frequent pornography use was generally associated with more favorable sexual response outcomes during masturbation, while not affecting most partnered sex parameters. Several demographic and relationship covariates appear to more consistently and strongly predict orgasmic problems during partnered sexual activity than pornography use.

Full text

International Journal of
Environmental Research
and Public Health
Article
Effects of Pornography Use and Demographic
Parameters on Sexual Response during Masturbation
and Partnered Sex in Women
Sean M. McNabney 1, Krisztina Hevesi 2and David L. Rowland 1, *
1Department of Psychology, Valparaiso University, Valparaiso, IN 46383, USA; sean.mcnabney@valpo.edu
2Department of Psychology and Education, Eötvös Loránd University, 1075 Budapest, Hungary;
dr.hevesi.kriszta@gmail.com
*Correspondence: david.rowland@valpo.edu; Tel.: +1-219-464-5446
Received: 24 March 2020; Accepted: 28 April 2020; Published: 30 April 2020


Abstract:
The effect of pornography on sexual response is understudied, particularly among women.
A multinational, community-based sample of 2433 women at least 18 years of age completed a 42-item,
opt-in questionnaire collecting information on demographic and sexual history characteristics, use of
pornography during masturbation, frequency of pornography use, and sexual response parameters.
Pornography use and average frequency were compared across demographic variables. We also examined
how pornography frequency predicted differences in self-reported arousal difficulty; orgasmic difficulty,
latency, and pleasure; and the percent of sexual activities ending in orgasm during both masturbation and
partnered sex. On average, women using pornography were younger, and reported more interest in sex.
Pornography frequency differed significantly by menopausal status, sexual orientation, anxiety/depression
status, number of sexual partners, and origin of data collection. During masturbation, more frequent
pornography use predicted lower arousal difficulty and orgasmic difficulty, greater pleasure, and a higher
percentage of masturbatory events leading to orgasm. Frequency of pornography use predicted only
lower arousal difficulty and longer orgasmic latencies during partnered sex, having no effect on the
other outcome variables. Pornography use frequency did not predict overall relationship satisfaction or
sexual relationship satisfaction. Overall, more frequent pornography use was generally associated with
more favorable sexual response outcomes during masturbation, while not affecting most partnered sex
parameters. Several demographic and relationship covariates appear to more consistently and strongly
predict orgasmic problems during partnered sexual activity than pornography use.
Keywords:
pornography; masturbation; partnered sex; sexual activity; sexual response; arousal;
orgasm; orgasmic difficulty; orgasmic pleasure
1. Introduction
With the advent of, and increasing access to, the internet and other private media forms such as
DVD, traditional barriers to sexually explicit materials such as public stigma and societal restriction
have weakened considerably, and the viewing of pornography has become commonplace [
1
,
2
]. In a
comprehensive analysis of General Social Survey (GSS) data from 18,225 women in the United States,
Wright and colleagues [
3
] observed that pornography use has remained largely consistent among
US women ages 18–30 from the period 1973 to 2010, with approximately one in three viewing a
pornographic movie within a year of completing the survey. Other sources of sexually explicit media
have also been evaluated in recent years. For example, cross-cultural analysis of web traffic on PornHub
(https://www.pornhub.com) has indicated that women users comprised about 29% of visitors to the site
in the United States and Canada during 2018, with this percentage having increased in recent years [
4
].
Int. J. Environ. Res. Public Health 2020,17, 3130; doi:10.3390/ijerph17093130 www.mdpi.com/journal/ijerph

Int. J. Environ. Res. Public Health 2020,17, 3130 2 of 16
Social restriction on access to pornography is predicated on the assumption that pornography imparts
negative effects to individuals and thus to society at large. For years, these effects had been framed as moral
or religious issues—ones involving temptation, sin, depravity, and the consequences of self-indulgence,
promiscuity, and infidelity to the family unit [
5
,
6
]. More recently, these negative consequences have found
secular parallels, often ones involving psychological health and social welfare. Such purported detrimental
consequences include effects on an individual’s sexual response [
7
] and relationship satisfaction [
8
],
the potential for addiction [
9
–
11
], objectification of (particularly) women
[12,13]
, and encouragement of
high-risk sexual behaviors [
14
,
15
]. On the other hand, pornography might also serve less sinister purposes,
such as having an educational function for individuals having little understanding of sexual practices
and behavior [
16
,
17
], or an erotic/arousal function for both men and women during masturbation [
18
].
Couples, too, may use pornography as a means of heightening both their sexual interest/desire and arousal
during or preceding partnered sex [
19
]. Because our study focused on the relationship of pornography
use in two major domains, orgasmic response and relationship satisfaction, we review these two outcomes
in greater detail.
1.1. Pornography Use, Sexual Relationship Satisfaction, and Relationship Quality
A recent meta-analysis of 50 studies has provided evidence for a curvilinear association between
frequency of pornography use and sexual relationship satisfaction, with detrimental effects to satisfaction
occurring only after exceeding a particular threshold of use in men but not women [
20
]. Interestingly,
no significant relationship was observed between pornography frequency and intrapersonal satisfaction,
assessed by measures such as body satisfaction, self-esteem, and sexual self-esteem. A survey of 1513
young adults in the U.S. (nearly 62% women) also supported a curvilinear association between greater
pornography viewing and decreased sexual satisfaction—this time for both men and women—but the
acceleration of the curve was more pronounced for men [
8
]. Decrements to sexual relationship satisfaction
were also more pronounced for individuals not currently in a romantic relationship and those identifying
as religious.
Not all studies have supported a straightforward interpretation between pornography use and
sexual relationship satisfaction. In a convenience sample of 803 adults, cluster analyses revealed significant
differences between participants using pornography primarily for recreation, those individuals
emotionally or psychologically distressed about their pornography use, and compulsive users [
21
].
Recreational, non-compulsive users—with women comprising 78% of this cluster—reported greater
sexual satisfaction and lower sexual avoidance compared to the other two profiles. Moreover, in a
survey of 1291 adults in the United States, those who viewed pornography together with their partner
reported significantly higher sexual satisfaction and greater relationship dedication than respondents
who only watched pornographic content alone [
22
]. With regard to self-perception of potential benefits
and problems arising from pornography consumption, Danish women and men attributed generally
positive effects of pornography on sex life, attitudes toward sex, and life in general [
23
]. Interestingly,
women reported slightly fewer negative effects of pornography use compared to their male counterparts.
1.2. Pornography Use, Sexual Education, and Pleasure
Under some circumstances, pornography use may contribute to sexual knowledge among women.
Research carried out on a sample of 68 undergraduate heterosexual women revealed that exposure to
pornographic films depicting concomitant clitoral stimulation throughout penile-vaginal, oral-penile,
and hand-penile sexual behaviors increased participants’ inclusion of these techniques to their repertoire
of activities during partnered sex [
24
], although it did not necessarily improve orgasmic consistency.
This finding is supported by an earlier survey of 833 undergraduate students, in which more accurate
conceptual knowledge of the clitoris was correlated with a higher frequency of orgasm during masturbation,
but it was not associated with greater orgasmic frequency during partnered sex [25].
Researchers have also noted the potential for pornography to impart sexual techniques or behaviors
that pose a risk to psychological health. For example, thematic content analysis of 50 commercially

Int. J. Environ. Res. Public Health 2020,17, 3130 3 of 16
popular pornography films revealed that some films did not depict explicit verbal indicators of consent to
sexual activity, and nonverbal indicators were not consistently salient [
26
]. In a similar vein, a survey of
140 heterosexual women in South Korea illustrated that the perception of pornography as a reliable source
of sexual information was negatively correlated with the frequency of condom use during partnered
sex [
27
], as was earlier initial exposure to pornography among Croatian young adults [
28
]. Recent
reports have also supported a correlation between exposure to pornography depicting condom-less
anal intercourse (“barebacking”) and unprotected anal sex between men [
29
,
30
], thus increasing the
risk of HIV and infection. The prevalence of condom use for anal intercourse among male–female
dyads also tends to be lower than that reported for penile–vaginal intercourse [
31
–
33
], even within the
same individuals/couples, and this finding may be associated in part to depictions of condom-less anal
intercourse in sexually explicit media.
1.3. Pornography Use and Sexual Response/Orgasm in Women
Sexual response, pleasure, and orgasm in women are affected by many factors, one critically important
factor being the type of sexual activity—whether masturbatory or with the partner. Specifically, the majority
of women are able to masturbate to orgasm, but a significant portion (as high as 30%–40%) report
orgasmic difficulty (OD) during partnered sex, especially when penile–vaginal intercourse constitutes
the primary form of stimulation [
34
–
37
]. Furthermore, masturbatory activity per se has minimal
enhancing effects on sexual pleasure and orgasmic response during partnered sex, unless the stimulatory
activities during masturbation are transferred to activities during partnered sex [
38
]. One common
type of stimulatory activity used primarily during masturbation, though much less frequently during
partnered sex, is that of erotic/pornographic media. Specifically, pornography is often used by women
to increase arousal and pleasure during masturbation, but its absence during partnered sex might
deprive these women of an important and habitual source of sexual stimulation, thereby making it
more difficult for them to become aroused and reach orgasm.
1.4. Aims of the Current Study
In this study, we broadly addressed the issue of the relationship between pornography use and
sexual response. Specifically, (1) we describe differences in pornography use based on a number of
demographic, personal, and sexual response variables. We then asked how pornography use during
masturbation might positively or negatively affect sexual/orgasmic responsivity (2) during masturbation
and (3) during partnered sex, indicated by a number of outcome indices, including difficulty becoming
aroused, difficulty reaching orgasm, orgasmic pleasure, orgasmic latency, and percent of time reaching
orgasm. We further asked (4) whether pornography use during masturbation was related to the woman’s
sexual and overall relationship satisfaction with her partner. As we assessed these relationships,
we (5) controlled for the independent effects of a number of covariates known for affecting sexual
response, including anxiety/depression [
39
–
41
], menopausal status [
42
], and a number of health and
demographic factors, including ongoing medical issues, age [43], and education level [44,45].
Due to a primarily data-driven approach in this study, we did not formulate specific hypotheses a
priori. Nevertheless, we approached our analyses with several expectations based upon prior literature,
including assumptions that the frequency of pornography use would differ relative to particular
demographic and sexual history variables, that pornography frequency use might predict women’s
current sexual relationship satisfaction, and that pornography use would impact orgasmic outcomes
related to masturbation differently than orgasmic outcomes during partnered sex.
2. Materials and Methods
2.1. Participants
Participants for this study were drawn from a community-based sample of 2433 women
≥
18 years
of age (mean age =28.72, SEM =0.201, range =18–95) in a current or recent (
≤
12 months ago) sexual

Int. J. Environ. Res. Public Health 2020,17, 3130 4 of 16
relationship through three approaches. The first consisted of 966 women in the USA visiting one of 12
online postings on reddit.com, with promotion through social media (including Facebook postings),
word-of-mouth, listservs, media announcements, and posted fliers. The second approach consisted of
1043 women visiting comparable online forums and promotions in Hungary or visiting the Hungarian
research group’s webpage. The third approach consisted of 424 women enrolled in a professional
degree program at a major university in Hungary who volunteered to take a pencil-and-paper version
of the survey. Completion of the online version of the questionnaire occurred through self-selection,
indicating a need for women ages 18+to fill out a survey pertaining to sexual health/functioning.
Participation in the pencil-and-paper survey was voluntary, as students in various courses could elect
to use questionnaire completion as one of several options to fulfill a course requirement.
2.2. Survey Questionnaire
As part of the survey development, a pilot was conducted with three focus groups of women,
one from the USA (n=13, mean age =27), and two from Hungary comprised of students from
professional psychology (n=13, mean age =20) and students from non-professional disciplines
(n=9,
mean age =22
). Groups reviewed survey items, commented on their relevance, suggested
response categories, appraised overall item face-validity, ensured clarity of the items, and assessed the
time required for survey completion [
46
]. For Hungarian participants, the survey was translated to
Hungarian by a professional translator and then back-translated by a second translator to English to
ensure preservation of meaning.
The first seven questions of the 42-item, investigator-derived survey consisted of demographic
information including age, menopausal status, level of education, and any ongoing/chronic medical
conditions. The second portion examined factors relevant to respondents’ sexual histories over the past
9–12 months, such as self-rated importance of sex, number of current sexual partners, sexual orientation,
sexual relationship satisfaction, overall relationship satisfaction, and frequency of partnered sexual
activity ending in orgasm. This section also assessed masturbatory practices, including frequency of
masturbation and use of pornography/erotic materials during masturbation. The third survey section
evaluated parameters related to the sexual response cycle, including sexual desire, difficulty becoming
aroused during masturbation and partnered sex, and insufficient production of vaginal lubrication.
When applicable, questions were drawn from the Female Sexual Function Index (FSFI), which has
been extensively validated for both clinical and non-clinical populations [
47
–
49
]. The final section
of the survey assessed orgasmic response during both masturbation and partnered sex, examining
factors such as type/methods of stimulation, derived pleasure, estimated latency to orgasm, difficulty
reaching orgasm, and perceived reasons (attributions) for such difficulty during either masturbatory or
partnered sexual activities.
2.2.1. Outcome Measures
Five sexual outcomes during partnered sex and masturbation (separately) were included for
analysis: sexual arousal difficulty, orgasmic difficulty, likelihood of reaching orgasm, orgasmic latency,
and orgasmic pleasure. Sexual arousal difficulty was assessed on a 5-point scale, with 1 =almost never,
5=almost always. Likelihood of reaching orgasm was assessed on a continuous 100-point visual analog
scale (1 =never, 100 =always). Orgasmic latency, assessed beginning with physical stimulation and the
woman’s intention of trying to move toward orgasm, was measured on a 1–7 scale,
with 1 =1–5 min
,
2=6–10 min
, 3 =11–15 min, 4 =16–20 min, 5 =21–30 min, 6 =
≥
30 min, 7 =I do not reach orgasm [
50
].
Orgasmic pleasure was measured on a 0–5 scale, with 0 =I do not reach orgasm during partnered
sex, 1 =not pleasurable or satisfying, 5 =very pleasurable or satisfying [
51
]. Orgasmic difficulty was
measured on a 1–6 scale, with 1 =almost never, 5 =almost always, 6 =I do not reach orgasm [
52
,
53
].
For all measures, respondents were asked to use their current or most recent sexual partner as their
reference, or the past 6–12 month timeframe (e.g., for masturbation). In addition to these outcomes, we
assessed respondents’ overall relationship satisfaction and sexual relationship satisfaction (e.g., “How

Int. J. Environ. Res. Public Health 2020,17, 3130 5 of 16
satisfied are you with your primary sexual relationship, that is, with the sexual relationship you consider
to be most significant to you?”) during the previous 12 months, both of which were measured using
5-point scales where 1 =not at all satisfied, 5 =very satisfied. The precise wording for each of the above
items is included in Appendix A: Supplementary Information on the Survey Questionnaire (Table A1,
Table A2).
2.2.2. Predictor Covariates
Pornography use—its presence, absence, and frequency—along with scaling and/or categories for
all other predictor covariates (including origin-of-data, whether online (Hungary or USA), or onsite), are
described in detail in Table 1. For some variables, category frequencies were low (e.g., non-heterosexual
orientations), thus resulting in combining categories.
Table 1. Demographic characteristics for participants and their relationship to pornography use.
Variables
N(%) Comparison of Pornography Use 1
Demographic Variable Mean (SEM) Test Statistic 2p-Value Effect Size 3
Level of Education
High school or equivalent 201 (8.3%) 2.87 (0.125) r =0.035 0.106 N/A
Skill certification/technical degree 686 (28.3%) 2.56 (0.062)
Some college 433 (17.9%) 3.31 (0.080)
Undergraduate (bachelor’s) degree 669 (27.6%) 2.87 (0.064)
Graduate/post-baccalaureate study 435 (17.9%) 2.80 (0.077)
Menopausal Status
Pre-menopausal 2174 (92%) 2.88 (0.036) t (2118) =3.590 <0.001 0.156
Peri- or post-menopausal 189 (8%) 2.44 (0.116)
Current/Ongoing Medical Issues
No 1965 (83.1%) 2.83 (0.037) t (2176) =−0.647 0.518 −0.028
Yes 398 (16.8%) 2.89 (0.080)
Persistent Anxiety/Depression
No 1841 (77.8%) 2.74 (0.038) t (2176) =−5.799 <0.001 −0.249
Yes 524 (22.1%) 3.22 (0.073)
Sexual Orientation
Heterosexual 1948 (85.4%) 2.70 (0.036) t (475.516) =−11.087 <0.001 −1.017
Non-heterosexual 334 (14.6%) 3.66 (0.078)
Current Sexual Partner
No current sexual partner 431 (18.9%) 2.91 (0.083) A,B FW(2304.285) =5.851 0.003 0.006
1 partner 1717 (75.3%) 2.79 (0.038) B
2 or more partners 133 (5.8%) 3.29 (0.148) A
Origin of Data Collection
Online survey, United States 966 (39.7%) 3.61 (0.050) AFW(2959.943) =178.799 <0.001 0.136
Online survey, Hungary 1043 (42.9%) 2.34 (0.046) B
Pencil-and-paper questionnaire, Hungary 424 (17.4%) 2.63 (0.081) C
Pornography Use during Masturbation
I do not masturbate 132 (5.9%) —
No 802 (35.8%) 1.71 (0.042) t (1805.470) =−34.904 <0.001 −1.490
Yes 1307 (58.3%) 3.64 (0.036)
Frequency of Pornography Use
I do not use erotic materials 751 (34.5%) — — — —
Only several times each year 185 (8.5%)
Less than once a month 332 (15.2%)
Several times a month 508 (23.3%)
Several times per week 368 (16.9%)
Multiple times per day 34 (1.6%)
The names of the demographic variables are represented with bold font.
1
Evaluated as frequency of pornography
use, where 0 =I do not use erotic materials, 1 =only several times a year, 2 =less than once a month, 3 =several
times a month, 4 =several times a week, 5 =several times a day.
2
For demographic variables with two response
categories, independent-sample t-tests were computed. For demographic variables with more than two response
categories, one-way Welch’s ANOVA tests (F
W
) were computed with Games–Howell post-hoc analyses. Significant
differences (
α
=0.01) between subgroups are denoted by different superscripts (A,B,C).
3
Effect sizes are reported
as Cohen’s d values (for independent-sample t-tests) or partial
η2
values (for ANOVAs). Interpretation using
absolute values for Cohen’s d are as follows: 0.2 (small effect), 0.5 (medium/intermediate effect), 0.8 (large effect).
Interpretation of effect sizes using partial
η2
values are as follows: 0.01 (small effect), 0.06 (medium/intermediate
effect), 0.14 (large effect).

Int. J. Environ. Res. Public Health 2020,17, 3130 6 of 16
2.3. Procedure
The final version of the anonymous survey took approximately 20 min to complete. Project approval
was obtained from the Institutional Review Boards at the investigators’ universities in both Hungary
and the United States. Informed consent was given by participants, with their needing to check boxes
attesting (i) to their being
≥
18 years old, and (ii) to their informed consent prior to accessing the survey.
Respondents were notified that they could end participation in the study at any point by closing the
questionnaire (no data were saved until final submission of the survey).
2.4. Design and Analytic Strategy
Preliminary comparisons across demographic and sexual response variables were made with t
or comparable tests, with
α
=0.01 due to the number of comparisons. Then, eight separate ordinal
regression analyses and two logistic quasi-binomial regressions for orgasm percent (see [
54
]) were carried
out to understand how pornography use, along with several key demographic, lifestyle, and sexual
history variables, accounted for variance in five outcome variables related to sexual response and
performance: arousal difficulty, orgasmic difficulty, orgasmic latency, orgasmic pleasure, and percentage
of time reaching orgasm. These outcome measures were assessed separately for masturbation and
partnered sexual activity, hence five analyses for masturbation and five for partnered sex. Our goal in
running this number of multiple regression analyses was to determine whether pornography use was
broadly and consistently associated with sexual response parameters in women by discerning patterns of
repeating significant covariates, and for this reason we retained
α
at 0.05 for these analyses. Two final
ordinal regressions were carried out using sexual relationship satisfaction and overall relationship
satisfaction as outcome variables.
Assessing Collinearity through Bivariate Correlations
As a preliminary step, to control for collinearity among the outcome variables and between predictor
covariates, Spearman rank-order correlations were evaluated, with removal of one of the pair of variables
showing correlations
≥
0.60 [
55
], unless otherwise noted. While moderate associations were observed
among the outcome variables, the only pair of variables meeting the 0.60 threshold for collinearity was
orgasmic difficulty and the percentage of time reaching orgasm during partnered sex (
rs=0.731
,
p<0.01
).
We ultimately decided to retain regression analyses for both outcome variables, despite their relatively
strong association. In contrast, none of the associations between predictor covariates reached the 0.60
threshold for collinearity. Thus, all the predictor covariates were retained in the regression analyses.
3. Results
3.1. Aim 1: Sample Subgroups, Pornography Use, and Differences between Users and Non-Users
Characteristics and group sizes for all predictor covariates are presented in Table 1. Participants
were typically well-educated (27.6% completing a college bachelor’s degree and 28.3% acquiring
postsecondary technical instruction/skill certification), premenopausal (92%), and currently involved
in a sexual relationship (81.1% had one or more sexual partners).
Pornography use during masturbation was higher in specific subgroups, including premenopausal
(vs. peri- or postmenopausal) women; women reporting persistent anxiety or depression over the
past 6–12 months; non-heterosexual women; women having two or more partners; and US women
(vs. Hungarian women).
Sexual history and response variables comparing masturbation and partnered sex activities are
presented in Table 2. Women who use pornography during masturbation tend to be younger, indicate
a higher interest in sex, masturbate more frequently, have lower arousal difficulty during masturbation,
are more likely to reach orgasm during masturbation, and have longer latencies during masturbation.
They also have greater difficulty reaching orgasm during partnered sex and greater distress regarding
orgasmic difficulty during partnered sex.

Int. J. Environ. Res. Public Health 2020,17, 3130 7 of 16
Table 2.
Comparison of women’s sexual response outcomes based upon whether or not they engage in
pornography use during masturbation.
Variables Yes No
p-Value 1Effect Size 2
Sexual History and Response Outcomes NMean (SEM) NMean (SEM)
Sexual History Variables
Age 1303 27.76 (0.242) 793 30.64 (0.394) <0.001 0.335
Importance of Sex 1306 4.01 (0.027) 797 3.91 (0.036) 0.028 −0.110
Interest in Sex 1300 4.27 (0.024) 800 4.04 (0.034) <0.001 −0.245
Overall Relationship Satisfaction 1078 4.07 (0.029) 663 4.09 (0.037) 0.619 0.024
Sexual Relationship Satisfaction 1081 3.87 (0.033) 668 3.95 (0.041) 0.114 0.076
Masturbation Outcomes
Frequency of Masturbation 1305 4.83 (0.051) 799 3.81 (0.069) <0.001 −0.589
Percent Masturbation Ending in Orgasm 1299 90.54 (0.627) 791 86.66 (0.925) 0.001 −0.180
Arousal Difficulty 1289 1.73 (0.028) 764 1.87 (0.040) 0.005 0.147
Orgasmic Difficulty (OD) 1291 1.56 (0.029) 763 1.66 (0.040) 0.031 0.111
Orgasmic Latency (OL) 1265 2.27 (0.041) 751 2.08 (0.053) 0.004 −0.145
Orgasmic Pleasure (OP) 1264 3.76 (0.033) 754 3.74 (0.044) 0.676 −0.021
Self-Distress Regarding Masturbatory OD 1258 1.18 (0.046) 747 1.04 (0.053) 0.041 −0.098
Partnered Sex Outcomes
Frequency of Partnered Sex 1242 6.47 (0.044) 768 6.43 (0.057) 0.511 0.001
Percent Partnered Sex Ending in Orgasm 1240 62.67 (0.945) 769 66.42 (1.129) 0.011 0.123
Arousal Difficulty 1227 1.79 (0.030) 750 1.78 (0.039) 0.798 −0.011
Orgasmic Difficulty (OD) 1211 2.85 (0.046) 757 2.66 (0.057) 0.009 −0.118
Orgasmic Latency (OL) 1222 3.72 (0.052) 766 3.52 (0.067) 0.016 −0.108
Orgasmic Pleasure (OP) 1193 3.81 (0.048) 746 3.90 (0.058) 0.231 0.059
Self-Distress Regarding Partnered Sex OD 1192 3.47 (0.045) 745 3.14 (0.055) <0.001 −0.230
Partner Distress Regarding Partnered Sex OD
1185 3.63 (0.045) 742 3.49 (0.060) 0.062 −0.096
1
To compare the effect of pornography disuse/use on sexual history and outcome variables, independent-sample
t-tests were computed, using
α
=0.01 due to the number of comparisons.
2
Effect sizes are reported as absolute
values of Cohen’s d and are as follows: 0.2 (small effect), 0.5 (medium/intermediate effect), 0.8 (large effect).
3.2. Aim 2: Relationship of Use of Pornography to Masturbation Outcome Variables
Table 3depicts the results of the five regression analyses for the masturbation outcome variables,
with use of pornography significantly related to all five. Specifically, during masturbation, more
frequent use of pornography was related to less difficulty becoming aroused, less orgasmic difficulty,
longer orgasmic latencies, greater orgasmic pleasure, and higher percent of time reaching orgasm.
Table 3.
Ordered logistic regression results for predicting arousal difficulty and orgasmic difficulty,
latency, and pleasure during masturbation. Fractional response regression results for predicting the
percent of time reaching orgasm during masturbation.
Regression Covariates Arousal Difficulty Orgasmic Difficulty Orgasmic Latency Orgasmic Pleasure Orgasm Percent
Predictor Coefficient (SE) Coefficient (SE) Coefficient (SE) Coefficient (SE) Coefficient (SE)
Level of Education −0.133 (0.036) *** −0.120 (0.039) ** −0.113 (0.035) ** 0.058 (0.034) 0.461 (0.261)
Menopausal Status 0.419 (0.173) * 0.086 (0.183) 0.218 (0.159) −0.288 (0.157) 0.202 (0.248)
Ongoing Medical Issues 0.045 (0.116) −0.184 (0.124) −0.057 (0.112) −0.149 (0.111) 0.012 (0.165)
Ongoing Anxiety or Depression −0.183 (0.110) −0.337 (0.117) ** −0.201 (0.108) 0.140 (0.107) −0.395 (0.153) **
Sexual Orientation 0.027 (0.128) −0.111 (0.137) −0.241 (0.124) 0.040 (0.124) 0.192 (0.191)
Sexual Relationship Satisfaction −0.080 (0.033) * −0.078 (0.036) * −0.002 (0.032) 0.001 (0.032) 0.047 (0.057)
Number of Sexual Partners 0.027 (0.123) −0.005 (0.134) −0.278 (0.119) * 0.084 (0.118) −0.177 (0.209)
Frequency of Pornography Use −0.174 (0.030) *** −0.099 (0.032) ** 0.101 (0.029) *** 0.146 (0.028) *** 0.180 (0.044) ***
Origin of Data Collection 10.475 (0.106) *** 0.225 (0.116) 0.216 (0.102) * −0.808 (0.102) *** 0.377 (0.161) *
Note: Significant predictors indicated by: * p<0.05, ** p<0.01, *** p<0.001.
1
For these regression analyses, the two
Hungarian samples (online and onsite) have been combined into a single group for comparison with the online
USA sample.
3.3. Aim 3: Relationship of Use of Pornography during Masturbation to Partnered Sex Outcome Variables
Table 4depicts the results of the five regression analyses for the partnered sex outcome variables,
with use of pornography significantly related toonly two of the five, namely arousal difficulty and orgasmic
latency. Specifically, those women who used pornography more frequently also reported less difficulty
becoming sexually aroused and longer latenciesduring partnered sex.

Int. J. Environ. Res. Public Health 2020,17, 3130 8 of 16
Table 4.
Ordered logistic regression results for predicting arousal difficulty and orgasmic difficulty,
latency, and pleasure during partnered sexual activity. Fractional response regression results for
predicting the percent of time reaching orgasm during partnered sexual activity.
Regression Covariates Arousal Difficulty Orgasmic Difficulty Orgasmic Latency Orgasmic Pleasure Orgasm Percent
Predictor Coefficient (SE) Coefficient (SE) Coefficient (SE) Coefficient (SE) Coefficient (SE)
Level of Education 0.017 (0.036) −0.149 (0.034) *** −0.130 (0.033) *** 0.095 (0.036) ** 0.631 (0.144) ***
Menopausal Status −0.069 (0.161) 0.466 (0.151) ** 0.361 (0.148) * −0.465 (0.169) ** 0.217 (0.130)
Ongoing Medical Issues −0.038 (0.118) 0.099 (0.109) 0.064 (0.109) −0.073 (0.119) 0.233 (0.092) *
Ongoing Anxiety or Depression −0.371 (0.112) ** −0.213 (0.106) −0.208 (0.107) 0.177 (0.114) −0.127 (0.088)
Sexual Orientation −0.041 (0.134) 0.169 (0.124) −0.010 (0.125) −0.048 (0.135) 0.025 (0.102)
Sexual Relationship Satisfaction −0.388 (0.034) *** −0.427 (0.032) *** −0.310 (0.032) *** 0.581 (0.036) *** 0.505 (0.032) ***
Number of Sexual Partners 0.793 (0.123) *** 0.496 (0.117) *** 0.228 (0.118) −0.788 (0.127) *** 0.224 (0.119)
Frequency of Pornography Use −0.092 (0.030) ** 0.004 (0.028) 0.056 (0.028) * 0.047 (0.030) 0.026 (0.024)
Origin of Data Collection 1−0.014 (0.109) 0.299 (0.101) ** −0.031 (0.102) −0.317 (0.111) 0.417 (0.088) ***
Note: Significant predictors indicated by: * p<0.05, ** p<0.01, *** p<0.001.
1
For these regression analyses, the two
Hungarian samples (online and onsite) have been combined into a single group for comparison with the online
USA sample.
3.4. Aim 4: Pornography Use and Sexual and Overall Relationship Satisfaction
Table 5shows the relationship between pornography use during masturbation and both
sexual relationships satisfaction and overall relationship satisfaction (for participants’ stated primary
relationship). Frequency of pornography use was not related to either partner–relationship variable.
Table 5.
Ordered logistic regression results for predicting overall relationship satisfaction and sexual
relationship satisfaction.
Regression Covariates Relationship Satisfaction Sexual Satisfaction
Predictor Coefficient (SE) Coefficient (SE)
Level of Education 0.012 (0.037) −0.025 (0.036)
Menopausal Status −0.044 (0.164) −0.131 (0.162)
Ongoing Medical Issues −0.046 (0.119) 0.264 (0.116) *
Ongoing Anxiety or Depression 0.588 (0.116) *** 0.507 (0.114) ***
Sexual Orientation −0.086 (0.135) 0.125 (0.132)
Number of Sexual Partners −0.118 (0.148) 0.122 (0.151)
Frequency of Pornography Use −0.046 (0.031) 0.015 (0.030)
Origin of Data Collection 10.556 (0.110) *** −0.014 (0.107)
Note: Significant predictors indicated by: * p<0.05, *** p<0.001.
1
For these regression analyses, the two Hungarian
samples (online and onsite) have been combined into a single group for comparison with the online USA sample.
3.5. Aim 5: Role of Demographic and Personal Covariates
Several other covariates were consistently related to the sexual response outcome variables during
masturbation and partnered sex.
Education level. Most consistent was participants’ education level, which was significantly related
to three of five outcomes during masturbation, and four of five outcomes during partnered sex.
Specifically, during masturbation, lower education levels were associated with greater arousal difficulty,
greater orgasmic difficulty, and longer latencies to orgasm. During partnered sex, lower education
levels were associated with greater orgasmic difficulty, longer latencies to orgasm, lower orgasmic
pleasure, and lower percent of times reaching orgasm. Education level was, however, not related to
either sexual or overall relationship satisfaction.
Sexual relationship satisfaction predicted arousal difficulty and orgasmic difficulty during masturbation,
and strongly affected all sexual response parameters during partnered sex. Specifically, greater sexual
relationship satisfaction was associated with lower arousal and orgasmic difficulties during masturbation,
and lower arousal and orgasmic difficulties, shorter latencies to orgasm, greater orgasmic pleasure,
and greater percent of time reaching orgasm during partnered sex.

Int. J. Environ. Res. Public Health 2020,17, 3130 9 of 16
Self-reported anxiety and depression was related to greater orgasmic difficulties and percent of times
reaching orgasm during masturbation, and greater arousal difficulty during partnered sex. Anxiety
and depression were both associated with lower sexual and overall relationship satisfaction.
Number of sexual partners was related only to shorter orgasmic latency during masturbation, and was
related to three of five sexual outcome measures during partnered sex. Specifically, having more
sexual partners was associated with greater arousal difficulty, greater orgasmic difficulty, and lower
orgasmic pleasure.
Other regression covariates showed substantially less consistency or were sporadic in predicting
sexual outcome variables during masturbation and/or partnered sex. For example, being peri- or post-
menopausal was associated with greater arousal difficulty during masturbation, and greater orgasmic
difficulty, longer orgasmic latencies, and lower orgasmic pleasure during partnered sex. Having an
ongoing medical issue was minimally related to the outcome measures, being associated only with
lower percent of time reaching orgasm during partnered sex. Sexual orientation was not associated
with any of the masturbation or partnered sex outcomes.
3.6. Origin of Data
All regression analyses controlled for the origin of data, whether from U.S. vs. Hungarian women.
In doing so, the various effects of pornography use occurred despite differences in the origin of the data.
However, U.S. and Hungarian women differed in several ways worth mentioning. In general, U.S.
women reported more difficulties with, and lower positive outcomes regarding, orgasmic response
during masturbation. US women also reported greater orgasmic difficulty during partnered sex as
well as lower relationship satisfaction.
4. Discussion
Research pertaining to pornography has traditionally been conducted from three perspectives.
First, pornography use has been evaluated in relation to couples’ relationship satisfaction, often under
the assumption that greater reliance upon erotic materials during masturbation is associated with
poorer relationship outcomes [
8
,
20
,
22
]. Second, pornography has been studied from a neurobehavioral
perspective to determine whether individuals who report “compulsive” use exhibit neurophysiologic or
epigenetic alterations that typify models of addiction [
11
,
56
,
57
]. Third, content analyses of pornographic
materials have been conducted to examine the extent to which exposure to beneficial/educational
(e.g., providing clitoral stimulation during partnered sex), risky (e.g., condom-less sexual activity),
or demeaning (e.g., lack of verbal consent during intercourse, sexual aggression, etc.) sexual scripts
might increase the preponderance or social acceptability of such behaviors [
24
,
26
,
27
,
58
,
59
]. Despite the
insights gained from these approaches, few studies have analyzed putative direct effects of pornography
use on the sexual response cycle, including arousal and orgasmic parameters, comparing masturbatory
and partnered sexual activities.
In stark contrast to prior research findings and public opinion, we did not find strong empirical
support for the hypothesis that pornography use is consistently associated with greater sexual dysfunction
or relationship dissatisfaction. In all five regression analyses related to masturbation, more frequent
pornography use predicted greater ease of becoming aroused and reaching orgasm, longer latencies to
orgasm, greater pleasure upon orgasm, and a higher percentage of masturbatory events leading to orgasm.
Among the same parameters for partnered sexual activity, more frequent pornography use predicted
greater ease becoming aroused and longer latencies, but no significant associations, either positive or
negative, were observed for any of the other outcomes in the regression analyses. Overall, women’s use
of pornography to enhance orgasmic response and pleasure was strongly supported by our findings, yet
pornography use during masturbation appeared to have no deleterious effects on sexual functioning
during partnered sex. Indeed, it was actually associated with lower arousal difficulty during partnered sex.
Furthermore, no associations were observed between pornography use frequency and general relationship
satisfaction or sexual relationship satisfaction with one’s primary partner in the previous 12 months.

Int. J. Environ. Res. Public Health 2020,17, 3130 10 of 16
In these respects, our results highlight the potential positive effects that pornography use might have
for women’s enjoyment of sex. Furthermore, to the extent that pornography use might represent greater
openness to using less conventional strategies for enhancing their sexual experience, it may reflect one of
a number of techniques that differentiate women who use pornography from women who do not [
38
,
60
].
As a therapeutic consideration, women who viewed pornography reported significantly greater
distress when they were unable to reach orgasm during partnered sexual activity. Moreover, there was
a trend (p=0.062) for these women to more strongly endorse the belief that their sexual partners were
distressed by their orgasmic difficulty compared to participants who did not report pornography use.
Several possibilities might account for these findings. One interpretation relies upon the observation
that the vast majority of mass-produced pornographic content devalues the contours of a romantic
relationship—including foreplay and a gradual buildup to sexual activity—and emphasizes the sexual
act itself, with orgasm often portrayed most vividly [
18
,
61
,
62
]. In this view, repeated exposure to erotic
materials might shift a woman’s experience of sexual pleasure from a nonlinear model emphasizing
intimacy and sexual satisfaction [
63
–
65
] toward a more goal-directed, orgasm-centric perspective.
Alternatively, since respondents who indicated using pornography also indicated greater interest in
sex, failure to reach orgasm may elicit stronger disappointment for them than for individuals who
perceive sex as less important or captivating. Experimental research designs examining OD-related
distress when exposed to different subgenres of pornographic content (e.g., between mainstream and
feminist materials [62]) might help to clarify the direction and scope of these associations.
While frequency of pornography use did not consistently predict orgasmic problems, several of the
covariates in our regression models were associated with disruption of sexual functioning. For example,
ongoing anxiety/depression was associated with difficulty reaching orgasm and a lower percent of
time reaching orgasm during masturbation, and greater difficulty becoming aroused during partnered
sexual activity. Moreover, greater anxiety/depression predicted lower relationship satisfaction and
sexual satisfaction. These findings align with prior research demonstrating that anxiety and depression
may increase the individual’s cognitive distraction or negative affect [
66
,
67
], both of which can shift
attention away from sexual behaviors or partner cues and onto competing, non-erotic stimuli [
41
,
68
–
70
].
Education also emerged as a consistent predictor in our regression models, as higher levels
of educational attainment were associated with less arousal difficulty during masturbation; greater
orgasmic pleasure and a higher likelihood of orgasm during partnered sex; and less difficulty reaching
orgasm and shorter latencies to orgasm across both masturbation and partnered sex. These findings
are consonant with prior reports where educational attainment was associated with greater orgasmic
functioning and a lower likelihood of experiencing sexual problems [
71
,
72
], even when controlling
for other demographic variables such as underlying medical issues. One common interpretation of
this relationship is that more educated (and thus literate in many cultures) women are more aware of
their sexuality, sexual issues, and sexual choices, and thus able to better articulate their sexual desires
to their partner and to prioritize their own pleasure as an integral component of meaningful sexual
relationships [
73
]. Yet, while such relationships within emerging nations may not be surprising, the fact
that similar relationships are found in highly literate societies as well is notable.
Finally, we observed a relatively consistent effect from the data collection site, as recruitment from
Hungary was associated with a greater likelihood of reaching orgasm during partnered sex, as well as
less difficulty becoming aroused, shorter latencies, and greater pleasure during masturbation. Somewhat
surprisingly, these predictions occurred in the regression models despite an association between the
collection sites in Hungary and lower general relationship satisfaction relative to respondents in the
USA. Ongoing work in this field that incorporates multinational sampling can help determine the extent
to which cross-cultural differences in pornography use and attitudes toward masturbation translate
into meaningful differences during partnered sexual activity [4].

Int. J. Environ. Res. Public Health 2020,17, 3130 11 of 16
Strengths and Limitations
Our study included a relatively robust sample size with wide distribution, a common benefit of
online/non-online survey data [
46
]. Moreover, the cross-cultural nature of our study sample—with
respondents from both the United States and Hungary—allowed us to compare the frequency of
pornography use between two Westernized countries. Since topics related to sexual identity and
behavior are often perceived as sensitive, the anonymity of an online approach, including participants’
ability to complete the questionnaire in a private location of their choosing, may have facilitated more
candid responses and reduced issues pertaining to social desirability [
74
]. Finally, by designing two
survey questions to measure pornography use as both a dichotomous and a scaled variable, we were
better equipped to capture the complex relationships between pornography, the empirically derived
covariates, and sexual response outcomes.
Despite the strengths of this research design, we also acknowledge its restrictions and potential
limitations. First, the cross-sectional nature of the study generally precluded establishing the direction
of associations between pornography use and sexual function. While more frequent pornography use
predicted greater ease reaching orgasm during masturbation and higher arousal during partnered sexual
activity, for example, we cannot determine whether respondents are using pornography to achieve
these desired outcomes or, alternatively, whether participants who report greater sexual functioning
are more motivated to seek out arousing stimuli—including pornographic media. Longitudinal study
designs could also demonstrate whether the frequency of pornography use tends to remain consistent
across the life course or when fluctuations most commonly occur.
Another limitation is the inability of our questionnaire to distinguish between multiple reasons for
pornography use, such as to enhance/augment pleasure (approach motivation) or to compensate for
decreased intimacy with one’s partner (avoidance motivation). Similar to prior reports on masturbation [
36
]
and partnered sex [
75
,
76
], one might reasonably hypothesize that underlying motivations for and attitudes
toward pornography use could differentially affect sexual response. Finally, our questionnaire did not
distinguish between women who were satisfied with their pornography use and those who either felt
distressed about using pornography or addicted to such materials (e.g., [
21
]). Multiple reports have
demonstrated that the perception of pornography addiction or compulsivity, rather than pornography use
frequency itself, may be a stronger predictor of sexual dysfunction among both men and women [77,78].
5. Conclusions
In our multinational, cross-sectional survey of pornography use and sexual response in women,
higher frequency of pornography use predicted greater sexual functioning across all outcome variables
during masturbation, yet had no deleterious effects on sexual outcomes during partnered activity.
Across masturbation and partnered sex, lower levels of educational attainment and the presence of
ongoing anxiety or depression were the two most consistent predictors of orgasmic dysfunction in
the regression models. Greater sexual relationship satisfaction, in contrast, was associated with more
favorable outcomes during partnered sex. Taken together, these findings suggest that the frequency
of pornography use per se does not contribute to sexual problems during partnered sex., However,
it could well be that a subset of women use erotic materials to compensate for psychosocial factors
(e.g., dissatisfaction in one’s sexual relationships, ongoing anxiety or depression) that independently
impinge upon sexual responsivity.
Author Contributions:
Conceptualization, D.L.R., K.H., and S.M.M.; methodology, D.L.R.; formal analysis, S.M.M.
and D.L.R.; resources, D.L.R. and K.H.; writing—original draft preparation, S.M.M. and D.L.R.; writing—review
and editing, D.L.R., S.M.M., and K.H. All authors have read and agreed to the published version of the manuscript.
Funding: This research received no external funding.
Conflicts of Interest: The authors declare no conflict of interest.

Int. J. Environ. Res. Public Health 2020,17, 3130 12 of 16
Appendix A. Supplementary Information on the Survey Questionnaire
Below we have provided additional information on the questionnaire items relevant to our
regression analyses, including the empirically derived covariates (Table A1) and the outcome variables
of interest (Table A2).
Table A1. Survey questions for the regression covariates.
Variable Name Survey Question Values/Levels
Level of Education What is your highest level of
education completed?
1=High school
2=Skill/technical certification
3=Some college
4=Undergraduate degree
5=Graduate/post-bac. study
Menopausal Status Are you currently . . . ?
1=Before menopause
2=Going through menopause
3=After menopause
4=N/A (e.g., ovaries removed)
Medical Issues
Do you have ongoing medical issues for which
you are being treated?
0=No
1=Yes
Anxiety/Depression Are you currently suffering from ongoing/
persistent (>6 months) anxiety or depression?
0=No
1=Yes
Sexual Orientation What is your sexual orientation?
1=Heterosexual
2=Homosexual
3=Bisexual
4=Asexual
5=Other (please describe)
Sexual Relationship
Satisfaction
How satisfied are you with your primary
sexual relationship, that is, with the sexual
relationship you consider to be most
significant to you?
0=I do not have a sexual relationship
at this time
1–5 scale; higher numbers correspond
to greater satisfaction
Number of Sex Partners Do you currently have a sexual partner?
0=I do not have a sexual partner
1=I have one sexual partner
2=I have two or more sexual partners
Frequency of
Pornography Use
About how often do you use erotic materials
(e.g., print, video, Internet, audio)?
0=Never
1=Only several times a year
2=Less than once a month
3=Several times a month
4=Several times a week
5=Multiple times per day
Table A2. Survey questions for the outcome variables.
Variable Name Survey Question(s) 1Values/Levels
Arousal Difficulty
Do you have difficulty becoming or feeling
sexually aroused during masturbation 2/
sex with your partner?
0=I do not masturbate/have sex
1–5 scale; higher numbers correspond to
greater difficulty
Orgasmic Difficulty
If you masturbate/when you have sex with
your partner, do you ever have problems
reaching orgasm?
0=I do not masturbate/have sex
1–5 scale; higher numbers correspond to
greater difficulty
Orgasmic Latency
If you masturbate/have sex with your
partner and are able to reach orgasm, about
how long does it take for you, on average,
from the time that you begin
genital stimulation?
0=I do not masturbate/have sex
1=1–5 min
2=6–10 min
3=11–15 min
4=16–20 min
5=21–30 min
6=Longer than 30 min
7=I do not reach orgasm

Int. J. Environ. Res. Public Health 2020,17, 3130 13 of 16
Table A2. Cont.
Variable Name Survey Question(s) 1Values/Levels
Orgasmic Pleasure
If you masturbate/have sex with a partner,
how pleasurable or satisfying would you
rate your typical orgasm?
0=I do not reach orgasm
1–5 scale; higher numbers correspond to
greater pleasure
Orgasm Percent
Estimate how often sexual activity with
your partner/masturbation ends in orgasm
for you by placing an X on the line below.
If you have not had any sexual activities
with a partner/do not masturbate, select
N/A (not applicable).
0–100% (visual analog scale)
Overall Relationship
Satisfaction
Beyond sexual issues, how satisfied overall
are you with your primary relationship,
that is, with the relationship you consider to
be most significant to you?
0=I do not have a relationship at this time
1–5 scale; higher numbers correspond to
greater satisfaction
Sexual Relationship
Satisfaction
How satisfied are you with your primary
sexual relationship, that is, with the sexual
relationship you consider to be most
significant to you?
0=I do not have a sexual relationship at
this time
1–5 scale; higher numbers correspond to
greater satisfaction
1
The questionnaire provides separate items for orgasmic parameters during masturbation and partnered sexual
activity, but they are summarized together in this table due to their analogous coding.
2
In all relevant questions,
masturbation is defined in the context of being “alone, without your partner present” to distinguish it as a solitary
activity (i.e., not mutual masturbation, etc.).
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