Actual and Desired Masturbation Frequency, Sexual Distress, and Their Correlates

Abstract

We investigated the prevalence of problematic masturbation using different criteria. We also investigated if masturbation-related distress was associated with sexual abuse history, family attitudes towards sexuality during childhood, and depression and anxiety symptoms. Here, 12,271 Finnish men and women completed a survey reporting masturbation frequency, desired masturbation frequency, sexual distress, childhood sexual abuse, sex-positive family background, as well as depression and anxiety symptoms. Among both sexes, those whose masturbation frequency did not match with desired frequency experienced more sexual distress. Different conceptualizations of problematic masturbation resulted in different proportions of individuals categorized as having it (i.e., 8.3% of men and 2.7% of women experienced self-perceived problematic masturbation, that is masturbating more than they desired and experiencing sexual distress; 2% of men and 0.6% of women masturbated more frequently than average and meanwhile experienced self-perceived problematic masturbation; 6.3% of men and 2.1% of women masturbated less frequently than average but still experienced self-perceived problematic masturbation). Moreover, among both sexes, self-perceived problematic masturbation was positively associated with childhood sexual abuse, depression, and anxiety, while negatively associated with a sex-positive family background. Our results point to the complexity of defining problematic masturbation. Causes of sexual distress related to masturbation need to be carefully examined case by case to choose an appropriate clinical approach.

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Archives of Sexual Behavior (2023) 52:3155–3170
https://doi.org/10.1007/s10508-023-02641-3
ORIGINAL PAPER
Actual andDesired Masturbation Frequency, Sexual Distress, andTheir
Correlates
SijiaHuang1 · ThomasJ.Nyman1 · PatrickJern2 · PekkaSanttila1,3
Received: 18 April 2022 / Revised: 1 June 2023 / Accepted: 2 June 2023 / Published online: 26 June 2023
© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2023
Abstract
We investigated the prevalence of problematic masturbation using different criteria. We also investigated if masturbation-
related distress was associated with sexual abuse history, family attitudes towards sexuality during childhood, and depression
and anxiety symptoms. Here, 12,271 Finnish men and women completed a survey reporting masturbation frequency, desired
masturbation frequency, sexual distress, childhood sexual abuse, sex-positive family background, as well as depression and
anxiety symptoms. Among both sexes, those whose masturbation frequency did not match with desired frequency experienced
more sexual distress. Different conceptualizations of problematic masturbation resulted in different proportions of individuals
categorized as having it (i.e., 8.3% of men and 2.7% of women experienced self-perceived problematic masturbation, that
is masturbating more than they desired and experiencing sexual distress; 2% of men and 0.6% of women masturbated more
frequently than average and meanwhile experienced self-perceived problematic masturbation; 6.3% of men and 2.1% of women
masturbated less frequently than average but still experienced self-perceived problematic masturbation). Moreover, among
both sexes, self-perceived problematic masturbation was positively associated with childhood sexual abuse, depression, and
anxiety, while negatively associated with a sex-positive family background. Our results point to the complexity of defining
problematic masturbation. Causes of sexual distress related to masturbation need to be carefully examined case by case to
choose an appropriate clinical approach.
Keywords Masturbation· Sexual distress· Compulsive sexual behavior· Finnish
Introduction
Masturbation (i.e., self-stimulation of one’s own genital
organs for purposes of sexual gratification) is a common sex-
ual practice worldwide (Carvalheira & Leal, 2013; Das, 2007;
Gerressu etal., 2008; Richters etal., 2014). People engage
in solo masturbation for physical pleasure, as well as mutual
masturbation to add variation to partnered sex. Regardless of
its frequency, some individuals report stress associated with
masturbation (Derbyshire & Grant, 2015; Grant etal., 2014;
Reid etal., 2010; Spenhoff etal., 2013; Walton etal., 2017).
Masturbation may also cause problems in sexual relation-
ships. However, what constitutes problematic masturbation
is ill-conceived and more research addressing the impact of
masturbation and its correlates is needed. We investigated
different ways of defining problematic masturbation (i.e.,
whether self-perceived, associated with significant distress,
or having an above-average frequency), examined associated
factors, and then discussed what kinds of interventions may
be most appropriate in different situations.
Masturbation
Masturbation involves the manipulation of one’s own genital
organs, typically the penis or clitoris, for purposes of sexual
gratification (American Psychiatric Association, 2013). The
act is usually accompanied by sexual fantasies or erotic lit-
erature, pictures, or videos and may also include the use of
mechanical devices (e.g., a vibrator) or self-stimulation of
other body parts, such as the anus or nipples. Masturbation
is a common sexual behavior with, for example, 60% of men
* Sijia Huang
sh5072@nyu.edu
1 Faculty ofArts andSciences, NYU Shanghai, 1555 Century
Avenue, Pudong New Area, Shanghai200122, China
2 Department ofPsychology, Faculty ofArts, Psychology,
andTheology, Åbo Akademi University, Turku, Finland
3 NYU-ECNU Institute forSocial Development, NYU
Shanghai, Shanghai, China

3156 Archives of Sexual Behavior (2023) 52:3155–3170
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and 36.5% of women engaging in it over the preceding month
in a US sample (Herbenick etal., 2023). The corresponding
figures in a UK 16–44-year-old sample were 73% and 37%
(Gerressu etal., 2008). Similar prevalence rates have been
found in other regions (Carvalheira & Leal, 2013; Richters
etal., 2014) with lower prevalence reported, for example, in
China where 13% of women and 35% of men had masturbated
in the preceding year (Das etal., 2009). Women generally
report less masturbation than men.
Given that masturbation is common, it is crucial to
understand its role in psychological well-being. Historically,
masturbation has been prohibited in many religions and
cultures given its sole focus on pleasure (Buaban, 2021;
Bullough, 2003; Chakrabarti etal., 2002). Recently, this
has changed. Masturbation is now considered an important
pathway for adolescents to learn about their bodies and sexual
responsiveness (Atwood & Gagnon, 1987).
Compulsive Sexual Behavior
Compulsive sexual behavior, also called hypersexuality or sex
addiction, involves difficulties controlling sexual impulses,
which may cause psychological distress and problems in
relationships and interference with regular life (Derbyshire
& Grant, 2015; Grant etal., 2014; Reid etal., 2010; Spenhoff
etal., 2013; Walton etal., 2017). The prevalence is between
2 and 6% depending on definitions (Coleman, 1992; Kuzma
& Black, 2008; Malandain etal., 2020; Odlaug etal., 2013).
The prevalence is believed to be higher in men than women
and among sex offenders and sexual minorities (Carnes,
2013; Hanson & Morton-Bourgon, 2005; Kafka, 1997; Kelly
etal., 2009; Kingston & Bradford, 2013; Kuzma & Black,
2008). For example, a Swedish study found 2% prevalence for
women and a 5% for men (Ross etal., 2012). However, how
to define compulsive sexual behavior is unclear as is whether
it is a helpful diagnostic category. Clearly, it is difficult to
estimate prevalence if there is disagreement concerning the
definition (Walton etal., 2017). Yet, scholars also report
concerns regarding standardized definitions. For example,
since evidence concerning the etiology of compulsive
sexual behavior is unclear, diagnoses may pathologize
normal behavior (Walton etal., 2017) and may be misused
in legal settings (Goodman, 2001; Halpern, 2011; Walton
etal., 2017). At the moment, the International Statistical
Classification of Diseases and Related Health Problems-11
(ICD-11) has a diagnosis of “compulsive sexual behavior
disorder,” whereas the Diagnostic and Statistical Manual
of Mental Disorders-Fifth Edition does not (American
Psychiatric Association, 2013; World Health Organization,
2019).
The Difficulty intheDiagnosis ofCompulsive Sexual
Behavior: ICD‑11 vs. DSM‑5
According to ICD-11 (World Health Organization, 2019),
compulsive sexual behavior disorder is described as “a
persistent pattern of failure to control intense, repetitive
sexual impulses or urges resulting in repetitive sexual
behavior.” Symptoms associated with compulsive sexual
behavior disorder may include constantly engaging in the
same sexual activities over and over again and that this has
become a major obstacle to maintaining a normal daily life
and healthy relationships; having troubles in regulating
oneself and reducing the repetitive behavior; triggering
significant distress about the sexual behavior; causing
difficulties in functioning in other important areas of life;
and those symptoms usually last for a fair amount of time
(e.g. 6months or more) (World Health Organization, 2019).
The Sexual and Gender Identity Disorders Work Group1
submitted a proposal to include hypersexuality in DSM-5,
but this was rejected (Grant etal., 2014). Rather, compulsive
sexual behavior may be considered as a subcategory of other
related mental disorders, specifically impulsive control
disorder or a type of addiction.
The Typology ofHypersexuality andProblematic
Masturbation
Given that the clinical presentation of individuals who
seek professional help for sexually compulsive behavior
is diverse, Cantor etal. (2013) proposed a typology. Six
types were suggested, including Paraphilic Hypersexuality,
Avoidant Masturbation, Chronic Adultery, Sexual Guilt, the
Designated Patient, and a situation better accounted for as
a symptom of another condition (Cantor etal., 2013). For
example, paraphilic hypersexuality involves the patient
reporting high frequencies of one or more sexual behaviors
and related distress, along with subclinical paraphilic
interests (Cantor etal., 2013). Another subtype is avoidant
masturbation in which the patient complains about spending
an inordinate time viewing pornography and masturbating
(Cantor etal., 2013). This may also be a coping mechanism
to avoid a task or a chore (Cantor etal., 2013). Both types
involve incapability of controlling sexual activities, or
specifically masturbation, that has caused marked distress
1 Sexual and Gender Identity Disorders Work Group: a work group
of qualified specialists who are experts in issues regarding sexual dys-
function, gender identity disorders, and hypersexuality, that gives criti-
cal appraisals of the relevant diagnoses that appeared in the DSM-IV
(or earlier), along with proposed suggestions for reform and revision.
Reference: Zucker, K. J. (2009). Reports from the DSM-V Work
Group on Sexual and Gender Identity Disorders. Archives of Sexual
Behavior, 39(2), 217–220. https:// doi. org/ 10. 1007/ s10508- 009- 9548-9

3157Archives of Sexual Behavior (2023) 52:3155–3170
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or other dysfunction in life. According to population-based
research in Denmark, 8% of men and 10% of women reported
feeling ashamed that they masturbate, and about 20 to 30
percent of them also did not want their partner to know that
they masturbate (Frisch etal., 2019). This means that distress
or worries about masturbation is not rare. Also, sexual guilt
type involves relatively low frequency of specific sexual
behavior but self-labeling as being hypersexual together with
severe distress (Cantor etal., 2013). Based on the above, three
dimensions should be considered when assessing compulsive
sexual behavior: the frequency of engaging in the behavior,
the ability to control it, and the severity of related distress.
In the present study, we specifically investigated problematic
masturbation by measuring masturbation frequency, desired
masturbation frequency, and sexual distress, expecting to
unveil subtypes.
Etiology
Childhood Trauma
Compulsive sexual behavior disorder is related to high
rates of childhood traumas (World Health Organization,
2019). Parenting style impacts people’s attitudes towards
masturbation (Kaestle & Allen, 2011; Klukas etal., 2021).
Young adults are likely to interpret silence as a disapproval of
masturbation (Kaestle & Allen, 2011). For example, Klukas
etal. (2021) found that university students who had not
discussed masturbation with their parents had more negative
attitudes than those who had discussed it. Klukas etal. also
investigated parenting styles, the amount of support a child
received, and the amount of control applied by the parents.
Children who grew up with low support and high control
parents (i.e., authoritarian parenting) reported more negative
attitudes toward masturbation (Klukas etal., 2021; Maccoby
& Martin, 1983). Also, individuals with compulsive sexual
behavior often come from dysfunctional families with
87% reporting disengaged parents and 77% rigid families
(Augustine Fellowship, 1986). Hence, experiences of
problematic parenting during one’s childhood may lead to
maladaptive relationships with sexual behavior in adulthood.
Childhood abuse is another factor potentially contributing
to compulsive sexual behavior. A US study found that among
those who have compulsive sexual behavior, 22% reported
childhood physical abuse history and 31% reported sexual
abuse history (Black etal., 1997). These prevalence rates
are higher than the rate in the general population (US
Department of Health and Human Services, 2013). In the
case of sexual abuse, sexual behavior in adulthood may be a
way of re-enacting what happened in the abusive situation,
as a way of forming control and taking back what has been
exploited (Giugliano, 2006; Gold & Heffner, 1998; Hall,
2011; Krupnick & Horowitz, 1981). Overall, emotionally
disturbing experiences at an early stage of life seems to be
a risk factor for compulsive sexual behavior presented in
adulthood.
The Current Study
The present study aimed to assess problematic masturbation
in the Finnish population, using different criteria, and
to discuss how to define problematic masturbation. We
investigated the prevalence rates when defining problematic
masturbation by individuals who masturbated more than they
desired or when they experienced sexual distress about their
behavior. We also looked at whether the participants’ actual
masturbation frequency was above the average masturbation
frequency of the general population. We also investigated
if masturbation-related distress was associated with sexual
abuse history, family attitudes towards sexuality during
childhood, and depression and anxiety symptoms. We
hypothesized that first, different definitions of problematic
masturbation would result in different proportions of people
experiencing problematic masturbation, suggesting different
classification and diagnosis standards of compulsive sexual
behavior. Second, masturbation-related distress would be
positively associated with sexual abuse history, negative
family attitudes, higher levels of depression and anxiety
symptoms. Ultimately, we wanted to provide insights for
clinical practice.
Method
Participants
The present study was based on a sample consisting of 12,271
Finnish twins and their siblings between 18 and 49years of
age (men, n = 4322, M = 29.26years, SD = 6.68 and women
n = 7949, M = 28.92, SD = 6.80). The twins were part of
the Genetics of Sex and Aggression project that aimed to
investigate human sexuality related phenotypes, including
sexual function, sexual behavior and its variations, and
aggressive behavior. A number of psychometric instruments
were also used to measure behaviors and attitudes related to
eating, and psychopathology such as anxiety and depression.
Participants were ascertained from the Central Population
Registry of Finland, which is a government-based registry
including personal information of all Finnish citizens, and
they responded to questions via a survey. Two separate data
collections were undertaken: the first one was conducted in
2005 (n = 3163, men n = 1175, women n = 1988) and the

3158 Archives of Sexual Behavior (2023) 52:3155–3170
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second one in 2006 (n = 9108, men n = 3147, women n =
5961). More details of the data collection procedures can be
found in Johansson etal. (2013).
The following instruments used in the present study
were available for participants from both data collections:
Masturbation Frequency, Desired Masturbation Frequency,
Childhood Trauma Questionnaire, and Brief Symptom
Inventory. Sexual Distress Scale and Sexual History and
Adjustment Questionnaire were only available for the second
data collection. This means that the analyses involving
questions about sexual distress and family history interest
included 9108 participants whereas all the other analyses
included the complete (male and/or female) sample.
Measures
All questions were asked in Finnish of the participants and
had been translated from psychometric measures which
were originally in English. For the measures specifically
created for the present study, the Finnish questions were
back-translated into English for the purposes of the present
manuscript.
Masturbation Frequency andDesired Masturbation
Frequency
Individuals were asked how frequently they engaged in
masturbation and their ideal masturbation frequency using
an eight-point response scale taken from Derogatis Sexual
Function Inventory, where “0” was “not at all,” “1” was “less
than once per month,” “2” was “1–2 times per month,” “3”
was “once per week,” “4” was “2–3 times per week,” “5”
was “4–6 times per week,” “6” was “once per day,” “7” was
“2–3 times per day,” and “8” was “more than 4 times per day”
(Derogatis & Melisaratos, 1979).
We created a variable labeled as “Gap between Actual
and Desired Masturbation Frequency” (henceforth Gap),
calculated as Desired Masturbation Frequency minus
Masturbation Frequency. If the value is below zero, it
suggests that one masturbates more than one desires, whereas
if the value is above zero, it suggests that one masturbates less
than one desires. The value indicates the level of discrepancy
between the desired frequency and the actual frequency. A
dichotomous variable was also created so that if the value
was below zero, then it was regarded as masturbating more
than desired, while the rest was regarded as masturbating as
much or less than desired.
Sexual Distress Scale
Both male and female participants’ sexual distress was
measured by seven gender-neutral items from the Female
Sexual Distress Scale, measuring in past 30days, including
today: “How often did you feel anxious about your
sexuality?,” “How often did you feel guilty about your sexual
difficulties?,” “How often did you feel stressed about sex?,”
“How often did you feel sexually inadequate?,” “How often
did you feel regrets about your sexuality?,” “How often did
you feel embarrassed about sexual problems?,” and “How
often did you feel dissatisfied with your sex life?” (Carpenter
etal., 2015; Derogatis etal., 2002). Participants rated on
a five-point Likert scale where “0” was “never,” “1” was
“rarely,” “2” was “occasionally,” “3” was “often,” and “4”
was “always” (Carpenter etal., 2015; Derogatis etal., 2002).
Studies among women have shown that the Female Sexual
Distress Scale has high test–retest reliability and a strong
internal consistency coefficient (Cronbach’s alpha) ranging
from 0.86 to 0.90s, as well as a good discriminant validity
(Bae etal., 2006; Carpenter etal., 2015; Derogatis etal.,
2002, 2008). Since questions in the Female Sexual Distress
Scale are not always formulated in a gender-specific context,
it has been applied to male samples and has revealed similar
reliability and validity in differentiating men with and without
sexual distress (Santos-Iglesias etal., 2020). Thus, we used
the Sexual Distress Scale both for men and women for our
study. Cronbach's alpha of the current sample was 0.89.
As the level of distress is a crucial measure to determine
whether the behavior is significant to cause mental health
concern, we decided to use a cutoff point to differentiate those
who were troubled by their sexuality and those who were
not. According to Derogatis etal. (2002, 2008), a criterion
score of ≥ 15 was suggested as a cutoff to validly distinguish
the presence of sexual distress in the 12-item reduced scale.
Applying it to the 7-item scale, 8.75 is the cutoff score.
However, this would lead to too many participants categorized
as experiencing sexual distress (i.e., 25.6% of men and 35.2%
of women). Instead, we categorized those who scored one
standard deviation above the mean as sexually distressed
individuals on our 7-item scale, since those were the people
who reported a remarkably higher distress level compared
with the average. In this case, men (M = 5.9, SD = 4.98, n
= 3064) who scored above 10.88 and women (M = 7.03, SD
= 5.44, n = 5871) who scored above 12.46 were regarded as
experiencing sexual distress. It resulted in the same size (i.e.,
17.1%) of both genders defined as having sexual distress.
Self‑Perceived Problematic Masturbation
Combining information from the two dichotomous variables
Gap and Experienced Sexual Distress, we created a new
variable: Self-Perceived Problematic Masturbation with four
groups: “masturbation frequency as or less than desired, no
sexual distress,” “masturbation frequency more than desired,
no sexual distress,” “masturbation frequency as or less than
desired, sexual distress,” and “masturbation frequency more
than desired, sexual distress.”

3159Archives of Sexual Behavior (2023) 52:3155–3170
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Sexual Abuse Subscale oftheChildhood Trauma
Questionnaire (CTQ)
We used the subcategory of sexual abuse from the Childhood
Trauma Questionnaire, which contains five questions about
childhood sexual abuse (Bernstein etal., 2003). For example,
participants were asked if they were touched in a sexual way,
if someone tried to make them do sexual things, etc., and
they reported on a five-point Likert-type scale with response
options ranging from “1” = “never” to “5” = “very often”
(Bernstein etal., 2003). Studies have shown that the CTQ
Sexual Abuse subscale has high reliability and validity with
test–retest reliability coefficients ranging from. 79 to. 86 and
a Cronbach’s alpha ranging from. 66 to. 92 (Liebschutz etal.,
2018). A higher score indicates that one has experienced
more frequent sexual abuse during one’s childhood. In this
study, the Cronbach's alpha of CTQ Sexual Abuse was 0.89.
Sex‑Positive Family Background
Seven items from the Sexual History and Adjustment
Questionnaire were used to evaluate parental attitudes
towards sexuality that participants experienced in their
family before they were 16years old, including the degree
of comfort they felt in talking about sexual matters with
their mother and father, how they would characterize their
mother’s and father’s attitude toward sexuality when they
were growing up, “Overall, how well do you feel that your
upbringing prepared you to deal with issues of sexuality and
sexual relationships?,” ''How often do you remember issues
of sexuality being discussed in your home when you were
growing up?,” and “In general, how often was there physical
contact/affection displayed in your family?” (Fisher etal.,
2013). We also added a question about childhood experiences
with nudity: “In your family, what was the attitude like
towards nudity during your childhood?” Participants
responded to all the questions on a five-point Likert scale with
response options ranging from “1” = “extreme discomfort/
negative” to “5” = “extreme comfort/positive” for questions
about comfortableness and attitudes; or “1” = “almost never”
to “5″ = “very often” for questions about frequency (Fisher
etal., 2013). The subscale of Overall Attitudes, including
Maternal Attitudes Subscale and Paternal Attitudes Subscale,
has revealed a Cronbach’s alpha of 0.78 (Fisher etal.,
2013). The mean of the eight questions was computed and
coded as Sex-Positive Family Background, where a higher
value suggested a more positive family background about
sexuality. In this study, Cronbach's alpha of Sex-Positive
Family Background in the Sexual History and Adjustment
Questionnaire was 0.82.
We did a factor analysis to test the scale appropriateness.
The inter-item correlations varied between 0.21 and 0.62 and
were all significant. KMO was 0.82 and Bartlett's Test of
Sphericity was significant χ2(28) = 23,167.13, p < .001.
Scree plot indicated the presence of one factor (Eigenvalue
3.67 when the next Eigenvalue was 1.10) that captured 45.9%
of the variance. All factor loadings exceeded 0.58 with the
highest loading item being "How often do you remember
issues of sexuality being discussed in your home when you
were growing up?" These results demonstrate that the scale
was unidimensional and usable.
Depression andAnxiety intheBrief Symptom Inventory
(BSI)
Lastly, we assessed participants’ depression and anxiety symp-
toms by using the Brief Symptom Inventory (Derogatis, 1993).
Six questions were asked to evaluate depression: for example,
“During the past 7days, how much were you feeling hope-
less about the future?” and another six questions were asked
to evaluate anxiety, for example “During the past 7days, how
much were you distressed by nervousness or shakiness inside?”
(Derogatis, 1993). Participants reported from a five-point Likert
scale with response options ranging from “0” = “not at all” to
“4” = “extremely.” Previous research provided proof for good
internal consistency reliability and validity (Conoley & Kramer,
1989; Derogatis, 1993). Higher scores indicated more symp-
toms of depression and anxiety. In this study, the Cronbach's
alpha of BSI Depression was 0.84 and BSI Anxiety was 0.85.
Statistical Analyses
Statistical analyses proceeded in three stages via SPSS for
Mac (Version 28): First, since the sample contains data
from twins and their siblings, we conducted Generalized
Estimating Equations (GEE) accounting for dependencies
of responses of members of the same family. Using GEE,
we examined gender differences in masturbation frequency,
desired masturbation frequency, and sexual distress. Second,
we evaluated the percentage of participants experiencing
problematic masturbation when using different assessments
by conducting descriptive analyses and GEE. Third, we
investigated if masturbation-related distress was dependent
on related factors (i.e., sexual abuse, family attitudes
towards sexuality during childhood, depression, and anxiety
symptoms) using Pearson correlations and GEE.
Results
Demographic Information
Table1 presents the general characteristics of the sample.

3160 Archives of Sexual Behavior (2023) 52:3155–3170
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Masturbation Frequency
A GEE was conducted to compare the two genders regarding
masturbation frequency. The results showed that men (M =
3.18, SD = 1.80, n = 4322) masturbated more than women
(M = 1.62, SD = 1.45, n = 7949), Wald χ2(1) = 2207.10, p
< .001. Table2 presents the exact masturbation frequency
distributions among men and women.
Table3 presents the desired masturbation frequency
distributions among men and women.
Gap Between Actual andDesired Masturbation
Frequency
A GEE was conducted to compare gender differences in the
gap of masturbation frequency between actual and desired
levels. The results showed that men (M = -0.47, SD = 1.26,
n = 3987) scored lower than women (M = -0.01, SD = 0.85,
n = 7432), Wald χ2(1) = 428.40, p < .001. Sixty-two point
three percent of men (n = 3987) reported a balanced level of
masturbation, meaning that they masturbated as frequently
as they desired, while 30.2% of them reported masturbating
more than they wanted and 7.5% reported masturbating less
than they wanted. On the other hand, 76.2% of women (n =
7432) reported a balanced level of masturbation, meaning
that they masturbated as frequently as they desired, while
11.9% of them reported masturbating more than they wanted
and 11.9% reported masturbating less than they wanted.
Table4 presents the exact response distributions among men
and women on this variable.
A GEE was conducted to compare differences of the
masturbation frequency between those who masturbated
more than desired and those who did not. The results showed
that among men, those who masturbated more than desired
reported higher masturbation frequency (M = 3.71, SD =
1.53, n = 2781) compared with the rest (M = 3.01, SD = 1.84,
n = 1206), Wald χ2(1) = 151.32, p < .001. Among women,
those who masturbated more than desired also reported
higher masturbation frequency (M = 2.5, SD = 1.36, n =
882) compared with the rest (M = 1.52, SD = 1.42, n = 6550),
Wald χ2(1) = 374.82, p < .001.
Sexual Distress
A GEE was conducted to compare gender differences on the
continuous sexual distress variable. The results showed that
women (M = 7.03, SD = 5.44, n = 5871) experienced higher
sexual distress than men (M = 5.9, SD = 4.98, n = 3064),
Wald χ2(1) = 92.45, p < .001.
Another GEE was conducted to compare differences in
sexual distress between those who masturbated more than
desired and those who did not. The results showed that men
who masturbated more than desired reported higher level of
sexual distress (M = 7.75, SD = 5.46, n = 883) compared
with the rest (M = 5.17, SD = 4.57, n = 2065), Wald χ2(1)
= 154.04, p < .001. Similar results were found in women
as well so that those who masturbated more than desired
reported higher level of sexual distress (M = 8.28, SD = 5.34,
n = 673) compared with the rest (M = 6.89, SD = 5.43, n =
5069), Wald χ2(1) = 40.00, p < .001.
A GEE was conducted to compare the effect of the dis-
crepancy between masturbation frequency and desired mas-
turbation frequency on sexual distress. As shown in Fig.1a,
for men, Pairwise Contrasts indicated that the mean scores of
sexual distress of those who masturbated more than desired
(M = 7.75, SD = 5.46, n = 883), as well as those who mas-
turbated less than desired (M = 7.17, SD = 5.93, n = 133),
were significantly higher compared to those who reported a
balanced masturbation frequency (M = 5.03, SD = 4.44, n =
1932) [Wald χ2(2) = 178.34.00, p < .001]. For women, as
shown in Fig.1b, all three groups differed from each other
[Wald χ2(2) = 202.49, p < .001]. Post Hoc comparisons
indicated that the mean scores of sexual distress of those who
masturbated more than desired (M = 8.28, SD = 5.34, n =
673), significantly differed from those who masturbated less
than desired (M = 9.62, SD = 5.81, n = 636). Both groups
also significantly differed from those who reported a bal-
anced masturbation frequency (M = 6.49, SD = 5.26, n =
4433). This shows that for both men and women, sexual dis-
tress may come from masturbating more than one desires, but
also from not meeting the desired frequency.
Among those men who masturbated frequently (i.e., more
than once per day), 26 out of 90 (i.e., 28.9%) experienced sex-
ual distress, and among those women who masturbated fre-
quently (i.e., more than once per day), 3 out of 13 (i.e., 20.1%)
Table 1 General characteristics
of the sample Demographic information Men (n = 4322) Women (n = 7949)
Age M = 29.26, SD = 6.68 M = 28.92, SD = 6.80
Relationship status 70.72% has a partner 79.24% has a partner
Number of brothers and sisters in addition to the
twin sibling M = 2.28, SD = 2.13 M = 2.05, SD = 1.85
Age of first-time sex M = 18.00, SD = 3.18 M = 17.34, SD = 2.76
Number of sexual partners within the past year M = 1.84, SD = 4.23 M = 1.47, SD = 1.78

3161Archives of Sexual Behavior (2023) 52:3155–3170
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experienced sexual distress. This means that frequent masturba-
tion is not necessarily associated with sexual distress.
Different Definitions ofProblematic Masturbation
Three dimensions of problematic masturbation assessment
are determined by the following variables: the frequency of
engaging in the behavior, determined by the discrepancy
between masturbation frequency of the individual and the
average masturbation frequency of the sample; the ability
to control it, determined by the discrepancy between
masturbation frequency and desired masturbation frequency;
and the severity of related distress, determined by the score
of sexual distress scale. As shown in Table5, different
assessments of problematic masturbation (i.e., masturbating
more than one desired or not, experiencing sexual distress
or not, the masturbation frequency being above average
frequency or not) resulted in different percentages of
individuals that could be categorized as having problematic
masturbation.
The Association betweenGender andProblematic
Masturbation
A series of GEE were performed to assess the relationship
between gender and problematic masturbation. First, there
was a significant association between gender and self-per-
ceived problematic masturbation, Wald χ2(1, n = 8690) =
5.42, p = .020, where 8.3% men and 2.7% women reported
self-perceived problematic masturbation. There was also a
significant association between gender and those who mas-
turbated less than average but still experienced sexual dis-
tress, Wald χ2(1, n = 4464) = 23.33, p < .001, where among
those whose masturbation frequency was less than average,
11.5% men and 15.3% women reported experiencing sexual
distress. Third, there was a significant association between
gender and those who masturbate less than average but still
had self-perceived problematic masturbation, Wald χ2(1, n =
4333) = 30.43, p < .001, where among those whose mastur-
bation frequency was less than average, 6.3% men and 2.1%
women reported self-perceived problematic masturbation.
Table 2 Distribution of masturbation frequency among men and women
Masturbation
frequency Men (%) (n = 4322) Women (%) (n = 7949)
Not at all 9.2 26.9
Less than once/month 11.1 27.2
1–2 times/month 14.2 19.8
Once/week 18.4 13.5
2–3 times/week 25.5 9.1
4–6 times/week 11.1 2.5
once/day 8.1 0.8
2–3 times/day 2.1 0.2
> 4 times/day 0.3 0.0
Table 3 Distribution of desired masturbation frequency among men and
women
Desired masturbation frequency Men (%) (n =
3987) Women (%)
(n = 7432)
Not at all 16.9 29.5
Less than once/month 13.0 24.2
1–2 times/month 13.3 18.9
Once/week 20.0 14.4
2–3 times/week 20.1 9.5
4–6 times/week 8.0 2.2
Once/day 6.5 1.2
2–3 times/day 1.5 0.1
> 4 times/day 0.6 0.0
Table 4 Distribution of gap
among men and women
If the value is below zero, it sug-
gests that one masturbates more
than one desires, whereas if the
value is above zero, it suggests
that one masturbates less than
one desires. The value indicates
the level of discrepancy between
the desired frequency and the
actual frequency. If the value is
zero, it means that one mastur-
bates as frequently as one desires
Gap Men (%)
(n = 3987) Women (%)
(n = 7432)
− 8 0.0 0.0
− 7 0.0 0.0
− 6 0.4 0.0
− 5 0.8 0.1
− 4 2.2 0.3
− 3 4.4 1.1
− 2 8.3 2.9
− 1 14.1 7.5
0 62.3 76.2
1 5.2 8.0
2 1.4 2.7
3 0.5 0.8
4 0.3 0.3
5 0.1 0.0
6 0.0 0.1
7 0.0 0.0
8 0.10 0.0

3162 Archives of Sexual Behavior (2023) 52:3155–3170
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The Association betweenMasturbation Frequency
Below orAbove Average andProblematic
Masturbation
Two GEE were performed to assess the relationship between
those who masturbated below or above average and sexual
distress, as well as self-perceived problematic masturbation,
separately examining men and women. The results showed
that among men, there was a significant association between
masturbation frequency below or above average and sexual
distress, Wald χ2(1, n = 3064) = 160.61, p < .001. There
was also a significant association between masturbation fre-
quency below or above average and self-perceived problem-
atic masturbation, Wald χ2(1, n = 2948) = 79.23, p < .001.
Among women, there was a significant association between
masturbation frequency below or above average and sexual
distress, Wald χ2(1, n = 5871) = 65.58, p < .001. Addition-
ally, there was a significant association between masturba-
tion frequency below or above average and self-perceived
problematic masturbation, Wald χ2(1, n = 5742) = 22.98,
p < .001.
Influences ofRelated Factors onSelf‑perceived
Problematic Masturbation
A series of GEE were computed to analyze how self-
perceived problematic masturbation related to sexual
abuse, sex-positive family background, depression and
anxiety symptoms. As shown in Table6, for both sexes,
self-perceived problematic masturbation was positively
associated with sexual abuse, depression, and anxiety, while
negatively associated with sex-positive family background.
a. Men b. Women
Fig. 1 Mean of sexual distress scale among men and women with
different discrepancies between masturbation frequency and desired
masturbation frequency. Note: “MF > Desired” refers to masturbation
frequency more than desired; “Balanced” refers to masturbation fre-
quency as desired; “MF < Desired” refers to masturbation frequency
less than desired. *Indicated that there was a significant difference
between two groups
Table 5 Frequencies of problematic masturbation among men and women using different definitions
Definition of problematic masturbation Men (%) Women (%)
Masturbation frequency more than desired 30.2
(n = 3987) 11.9
(n = 7432)
Self-perceived problematic masturbation (i.e., masturbation frequency more than desired and
experiencing sexual distress) 8.3
(n = 2948) 2.7
(n = 5742)
Masturbation frequency above average, experiencing self-perceived problematic masturbation 2
(n = 2948) 0.6
(n = 5742)
Masturbation frequency below average, experiencing self-perceived problematic masturbation 6.3
(n = 2948) 2.1
(n = 5742)

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Next, a series of GEE were conducted to compare how
different subgroups in self-perceived problematic mastur-
bation were affected by different related factors (i.e., sexual
abuse, sex-positive family background, depression and anxi-
ety symptoms) differently. For men, the results revealed that
Sexual Abuse [Wald χ2(3, 2905) = 15.32, p = .002], Sex-
Positive Family Background [Wald χ2(3, 2942) = 30.92, p
< .001], Depression [Wald χ2(3, 2906) = 330.31, p < .001],
and Anxiety [Wald χ2(3, 2906) = 183.99, p < .001] all had
different levels in the subgroups of self-perceived problem-
atic masturbation (see Fig.2a–d). For women, similar results
were found that Sexual Abuse [Wald χ2(3, 5733) = 37.42, p
< .001], Depression [Wald χ2(3, 5668) = 430.95, p < .001],
and Anxiety [Wald χ2(3, 5650) = 272.10, p < .001] had sig-
nificantly different levels in the subgroups of self-perceived
problematic masturbation (see Fig.2e–g).
Lastly, we conducted a series of GEE among those whose
masturbation frequency was below average, comparing
if related factors especially had negative effects on them.
As shown in Table7, Sex-Positive Family Background,
Depression, and Anxiety had significantly negative effects
on self-perceived problematic masturbation among both men
and women.
Discussion
We found that those who masturbated more than desired
reported higher masturbation frequency, although men
reported a generally higher masturbation frequency and expe-
rienced less sexual distress compared with women. Also, for
both men and women, those who masturbated more or less
than desired turned out to experience more sexual distress
compared to those whose masturbation frequency was as
desired. Importantly, different conceptualizations of prob-
lematic masturbation (i.e., whether defined by masturbating
more than one desired or not, experiencing sexual distress
or not, the masturbation frequency being above average fre-
quency or not) resulted in different proportions of individuals
categorized as having problematic masturbation. Moreover,
self-perceived problematic masturbation was positively asso-
ciated with childhood sexual abuse, depression and anxiety
symptoms, while negatively associated with sex-positive
family background.
Different Assessments ofProblematic Masturbation
The prevalences we found were generally within the range of
the prevalence rates of compulsive sexual behavior found in
previous literature (Coleman, 1992; Kuzma & Black, 2008;
Malandain etal., 2020; Odlaug etal., 2013). Yet different
assessment criteria seem to categorize different people as
having problematic masturbation.
Masturbation Frequency
For both sexes, associations between masturbation frequency
below or above average and sexual distress, and between mas-
turbation frequency below or above average and self-perceived
problematic masturbation suggest that masturbation frequency
below or above average is a strong predictor of whether one
experiences sexual distress. It also strongly predicts whether
one perceives oneself to be masturbating in a problematic way.
As identified by Cantor etal. (2013), one feature of paraphilic
hypersexuality is that the client would report extremely high
frequencies of one or more sexual behaviors, and it is sufficient
to lead to distress. Our findings are in line with this result
that frequency is an important dimension in the assessment of
problematic masturbation.
The Ability toControl Masturbation
We also found that masturbating more than one desired is
associated with a higher level of sexual distress. Masturbating
more than one desired suggests poor behavioral control
resulting in feelings of concern or anxiety about one’s
sexuality. However, for both men and women, those who
masturbated less than desired also reported experiencing
more sexual distress than those who masturbated as they
desired. For women, those who masturbated less than desired
actually experienced even more sexual distress than those
who masturbated more than desired. It seems important
that one’s sexual practices match with one’s desire since the
balance is related to better sexual mental health by and large.
The Severity ofRelated Distress
Gender as a Predictor of Sexual Distress: Consistent with
previous literature, women in our study reported a lower
masturbation frequency compared with men (Das, 2007;
Das etal., 2009; Gerressu etal., 2008). However, women
experienced more sexual distress. Significant associations
between gender and self-perceived problematic masturba-
tion, between gender and those who masturbated less than
average but still experienced sexual distress, and between
gender and those who masturbate less than average but still
had self-perceived problematic masturbation, all suggest that
women are more likely to experience more sexual distress.
This means that the exact masturbation frequency may not
play a decisive role. Instead, how people perceive their mas-
turbation frequency is central. As demonstrated in previous
research, masturbation remains highly stigmatized (Coleman,
2003; Hogarth & Ingham, 2009; Kaestle & Allen, 2011; Shi-
bley Hyde & Jaffee, 2000). College students widely indicated
shame, awkwardness, and guilt associated with masturba-
tion (Kaestle & Allen, 2011). Particularly, studies showed

3164 Archives of Sexual Behavior (2023) 52:3155–3170
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that attitudes towards masturbation are more prohibitory
among women than men, which means that women com-
monly reported more internalized guilt and negative feelings
about masturbation (Fahs & Frank, 2014; Fahs & Swank,
2013; Kaestle & Allen, 2011). Women may be socialized in
a way that they generally feel distressed about their sexuality,
regardless of the frequencies of sexual activities. As such,
distress associated with masturbation may be primarily a
maladaptation in the thinking process.
Psychological Interpretation as a Predictor of Sexual
Distress: Importantly, among those masturbating more than
once per day, only 28.9% of men and 20.1% of women expe-
rienced sexual distress, whereas some participants whose
masturbation frequency was less than average still reported
self-perceived problematic masturbation. This suggests that
the psychological interpretation of people’s masturbation
behavior is essential. Some people masturbate often but do
not regard this as problematic. On the other hand, some do
not necessarily have a high masturbation frequency, but they
may consider themselves masturbating too much and thus
fall in the problematic masturbation category. Similar cases
were reported in Cantor etal. (2013) study in that clients
categorized into the “sexual guilt” type present self-labels
of hypersexuality but lack any overt behavioral extremes. In
fact, their frequencies of sexual behaviors are within group
norms around their age (Cantor etal., 2013). In this situation,
self-reported sexual distress should be taken into considera-
tion in the assessment since the thinking process towards
each individual’s behavior matters in affecting their mental
health. More importantly, evaluating both the reported dis-
tress and frequency is essential.
Furthermore, Cantor etal. (2013) also suggested the
existence of “the designated patient,” meaning that referrals
are instigated not by the client, but by the client’s romantic
Table 6 Correlations between masturbation frequency, desired mas-
turbation frequency, gap between actual and desired masturbation
frequency, sexual distress, sexual abuse history, sex-positive family
background, depression, and anxiety for men (in the below diagonal,
n = 4322) and women (in the above diagonal, n = 7949)
**Correlation is significant at the 0.01 level (2-tailed)
*Correlation is significant at the 0.05 level (2-tailed)
a MFre: The frequency of masturbation. The higher the number is, the more frequent the masturbation
b DMFre: The desired frequency of masturbation. The higherthe number is, the more frequent one wishes to masturbate
c Gap: The value of desired masturbation frequency subtracts masturbation frequency (i.e. Gap between Actual and Desired Masturbation
Frequency). If the value is below zero, it suggests that one masturbates more than one desires, and the lower the number is, the larger
discrepancy it implies. If the value is above zero, it suggests that one masturbates less than one desires, and the higher the number is, the larger
discrepancy it implies
d SDS: The summary variable of the Sexual Distress Scale. The higher the number is, the more sexual distress one has experienced in the past
30days
e SfPPM: Self-Perceived Problematic Masturbation, defined by Masturbation Frequency More Than Desired Dichotomous plus those who scared
one Standard Deviation above the Mean in Sexual Distress Scale. The value 0 suggests that one masturbates as frequent as one desires and does
not experience sexual distress; the value 1 suggests that one masturbates more than one desires and does not experience sexual distress; the value
10 suggests that one masturbates as frequent as one desires, and experiences sexual distress; the value 11 suggests that one masturbates more
than one desires, and experiences sexual distress
f SexAbu: The question about childhood sexual abuse “I believe that I was sexually abused” in Childhood Trauma Questionnaire. The higher the
number is, the more frequent one believes that one was sexually abused
g SPFB: Sex-Positive Family Background–the summary variable of Parental Attitudes Items in Sexual History and Adjustment Questionnaire.
The higher the number is, the more positive parental attitudes towards sexuality one experienced during childhood (before the age of 16)
h Depre: The subcategory of Depression in Brief Symptom Inventory. The higher the number is, the more severe depression symptoms one shows
in the past seven days
i Anxi: The subcategory of Anxiety in Brief Symptom Inventory. The higher the number is, the more severe anxiety symptoms one shows in the
past seven days
Men\women MFreaDMFrebGapcSDSdSfPPMeSexAbufSPFBgDeprehAnxii
MFre 1 .835** − .237** .119** .069** .046** .028 .161** .114**
DMFre .766** 1 .336** .138** .056** .045** .040* .155** .118**
Gap − .257** .424** 1 .038* − .022 − .001 .021 − .003 .016
SDS .238** .092** − .201** 1 .759** .092** − .164** .399** .329**
SfPPM .181** .009 − .242** .791** 1 .089** − .129** .311** .259**
SexAbu .013 .006 − .011 .080** .082** 1 − .095** .104** .109**
SPFB .069** .106** .056* − .112** − .092** − .067** 1 − .175** − .143**
Depre .208** .126** − .099** .474** .385** .112** − .171** 1 .722**
Anxi .114** .057** − .069** .384** .316** .121** − .122** .705** 1

3165Archives of Sexual Behavior (2023) 52:3155–3170
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a. Sexual Abuse (Men)
b
. Sex-Positive Family Background (Men)
c. Depression (Men)
d. Anxiety (Men)
e. Sexual Abuse (Women) g. Anxiety (Women)
Fig. 2 Mean of related factors among men and women in different
subgroups of self-perceived problematic masturbation. Note: “MF
≤ Desired No SD” refers to masturbation frequency as or less than
desired and has no sexual distress. “MF > Desired NO SD” refers to
masturbation frequency more than desired and has no sexual distress.
“MF ≤ Desired SD” refers to masturbation frequency as or less than
desired and has sexual distress. “MF > Desired SD” refers to mastur-
bation frequency more than desired and has sexual distress.*Indicated
that there was a significant difference between two groups

3166 Archives of Sexual Behavior (2023) 52:3155–3170
1 3
partner. In our study, although we did not measure if the par-
ticipants’ self-perception of problematic masturbation was
initiated by themselves or not, it is possible that some partici-
pants heard complaints from their partners and thereafter felt
concerned about their sexual behavior. An underlying mes-
sage may be that their partner was expressing frustration that
they were unhappy with their sex life and felt disturbed when
realizing that those clients would rather masturbate them-
selves than have sex with them. When assessing problematic
masturbation, it is also paramount to ask about the origins of
the related sexual distress and figure out if there are external
influential factors that prompt clients to seek treatment.
Above all, as Cantor etal. (2013) synthesizes the typol-
ogy, “no single model applies to all clients presenting with
or complaining of hypersexuality” (p. 884). Different assess-
ment criteria presented in our study open room for a more
in-depth discussion about how to understand and diagnose
problematic masturbation.
Etiology
Childhood Trauma
Our results showed that childhood trauma was associated
with self-perceived problematic masturbation in adulthood.
Traumatic childhood experience is known to be related
to problems in relationships, emotions, and behaviors in
adulthood (Diehl etal., 2019; Kizilok, 2021). Childhood
sexual abuse may be especially relevant for compulsive
sexual activities since survivors may indulge themselves in
frequent sex as a way of coping with traumatic memories
(Giugliano, 2006; Gold & Heffner, 1998; Hall, 2011;
Krupnick & Horowitz, 1981). In contrast, growing up in
a sex-positive family background is likely to be beneficial
because if parents feel uncomfortable talking about sex or
respond negatively to adolescent masturbation, this may
contribute to misunderstanding of masturbation and make it
a major source of sexual distress (Coleman, 2003; Gagnon,
1985; Kaestle & Allen, 2011). In sum, negative sex-related
experiences at an early age are likely to contribute to negative
interpretations of masturbatory behavior at later stages.
Depression andAnxiety Symptoms
Associations between self-perceived problematic mastur-
bation and depression and anxiety symptoms indicate that
problematic masturbation may be related to the mood states
of individuals. One possible explanation is that depressed
or stressed individuals are more likely to experience dis-
tress in various aspects of life, and this may include distress
about their sexuality. Or it may be that they are anxious
about other areas in life, and that excessive masturbation is
f. Depression (Women)
Fig. 2 (continued)
Table 7 Means, standard
deviations, and generalized
estimating equations statistics
for men and women whose
masturbation frequency was
below average
a. SPPM: Self-Perceived Problematic Masturbation, defined by Gap between Actual and Desired
Masturbation Frequency plus those who scored one Standard Deviation above the Mean in Sexual Distress
Scale
Variable SPPMaNO SPPM GEE
M SD n M SD n Wald χ2df p
a. Men
Sexual abuse 1.08 0.27 58 1.03 0.18 1282 1.52 1 .218
Sex-positive family background 2.28 0.61 1302 2.51 0.64 60 8.34 1 .004
Depression 8.03 6.24 1289 3.24 3.51 60 35.40 1 <.001
Anxiety 1.24 5.54 1291 1.1 2.91 60 22.40 1 <.001
b. Women
Sexual abuse 1.22 0.61 33 1.11 0.44 2890 1.13 1 .288
Sex-positive family background 2.19 0.63 34 2.49 0.69 2935 7.69 1 .006
Depression 8.18 5.26 34 4.56 4.2 2891 17.16 1 <.001
Anxiety 5.56 4.47 34 3.55 3.86 2885 6.82 1 .009

3167Archives of Sexual Behavior (2023) 52:3155–3170
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a coping mechanism for them to deal with stress or nega-
tive life events. For instance, people with compulsive sexual
behavior may have mood regulation issues that masturbation
is a method to escape from bad feelings. Likewise, as Cantor
etal. (2013) notices, avoidant masturbators reported feelings
of anxiety or dysthymia. Some found masturbation could
soothe such negative emotions, whereas some reported that
masturbation could result in anxiety or depression (Cantor
etal., 2013). Thus, it is also important to check clients’ mood
regulation and general mental health status, recognizing other
stressors that cause sexual distress and self-perceived prob-
lematic masturbation.
Looking particularly into those who masturbated below
average, related factors were also associated with negative
impacts. The environment one grows up in is likely to
have a fundamental influence on one’s perspective toward
sexuality. In this case, while the masturbation frequency is in
fact less than average frequency, but self-perceiving having
problematic masturbation, a crucial contributing factor is
that the environment at an early age may not contribute to
accepting one’s sexual desire, interest, or previous sexual
experiences. Indeed, as Mark and Haus (2019) acknowledge,
one’s culture has a large impact on one’s development of
healthy sexuality. In clinical practice, it is important to
carefully explore the causes of one’s compulsive sexual
behavior. Different causes may provide insights for therapists
to determine whether the problematic behavior has more to
do with the absolute frequency, which may include the use of
medications or interventions to reduce the excessive behavior.
Or the problematic behavior is more self-perceived that does
not include a high frequency but is accompanied by high
distress. In this case, treatment has to work on adjusting the
thinking process, making peace with oneself, and ultimately
reducing sexual distress.
Strengths, Limitations, andFuture Research
This study has several strengths. First, our study has a large
sample size that was representative of the general Finn-
ish population. Second, we had measures for participants’
masturbation frequency, desired masturbation frequency,
sexual distress, childhood trauma, depression, and anxiety
symptoms. When possible, we used the latest scales with
established reliability and validity (Derogatis & Melisaratos,
1979; Conoley & Kramer, 1989; Derogatis, 1993; Derogatis
etal., 2002; Bernstein etal., 2003; Fisher etal., 2013Carpen-
ter etal., 2015). Third, our findings have important impli-
cations for the debate about diagnosing compulsive sexual
behavior and for treatment approaches. While Cantor etal.
(2013) presents specific cases for clients who seek treatment,
we employed a different approach by using a large dataset but
came to similar results.
Nevertheless, the study has a few limitations. First, mastur-
batory behavior was only measured by the actual frequency
and desired frequency of masturbation. We did not ask about
participants’ exact practices during their masturbation, so
whether idiosyncratic techniques in masturbation influence
problematic masturbation was unknown. For instance, view-
ing pornography while masturbating may make a difference
as the background literature suggests that excessive consump-
tion of pornography may be a risk factor for developing sex
addiction, including problematic masturbation (Cantor etal.,
2013). Higher pornography use is also associated with more
frequent masturbation (Fischer & Træen, 2022). Specifically,
if pornography use is not consistent with one’s moral beliefs,
it is likely to be associated with greater psychological dis-
tress and self-perceived problems around pornography use
(Grubbs & Perry, 2019).
Besides, the Sexual Distress Scale targeted the
participant’s general distress and anxiety of sexuality, instead
of specifically focusing on the distress associated with
masturbation. Future research should investigate the impact
of specific masturbation behaviors and the relation to the
use of pornography and associated distress, rather than only
measuring frequency and distress in general. Additionally,
as Buaban (2021) and Bullough (2003) claim, religious
beliefs are a common moderator of sexual attitudes and
behaviors. In the current study, we did not include measures
about religious background, which should be covered in
future studies. In the third place, data of the current sample
was collected more than a decade ago. People’s attitudes
towards sex and sexual practices may have changed and new
data collection is in need. Lastly, the study did not include
interventions and the etiology analyses were based on
correlations between variables. Therefore, no conclusions
can be made for causations, which means that the detailed
causes of self-perceived problematic masturbation require
further longitudinal studies on the same participants over
years. Causational studies are of vital importance because
this field is understudied. Further findings of etiology could
provide more insights for clinical treatment.
Conclusion
Due to the stigma and misunderstandings, masturbation may
have the potential to elicit overwhelming guilt and pressure
in individuals. Our results indicate that self-perceived prob-
lematic masturbation may come from masturbating more
than one desires, high masturbation frequency, and merely
experiencing significant distress about one’s sexuality regard-
less of actual masturbation frequency. Further, self-perceived
problematic masturbation is related to childhood trauma (i.e.,
childhood sexual abuse and/or sex-negative family back-
ground), depression and anxiety symptoms. Future research

3168 Archives of Sexual Behavior (2023) 52:3155–3170
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concerning idiosyncratic masturbation, use of pornography,
and causational studies are warranted.
Author's Contribution Conceptualization: SH, PS; Methodology: PS;
Planning and completing original data collections: PS, PJ; Formal
analysis and investigation: SH, PS; Writing—original draft preparation:
SH; Writing—review and editing: TN, PJ, PS; Funding acquisition: PJ,
PS; Resources: PJ, PS; Supervision: TN, PS.
Funding The original data collections were funded by Grants No.
210298, 212703, 136263, and 138291 from the Academy of Finland;
and a Center of Excellence Grant No. 21/22/05 from the Stiftelsen för
Åbo Akademi Foundation.
Declarations
Conflict of interest The authors declare no conflict of interest.
Ethical Approval Research plans for data collections were conducted in
accordance with the Declaration of Helsinki and were approved by the
Departmental or University level Research Ethics Committees at Åbo
Akademi University, as appropriate.
Informed Consent Informed consent was obtained from all the partici-
pants involved in the study.
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