Studies Find Escalation (and Habituation) in Porn Users

Compulsive porn users often describe escalation in their porn use that takes the form of greater time viewing or seeking out new genres of porn. New genres that induce shock, surprise, violation of expectations or even anxiety can function to increase sexual arousal, and in porn users whose response to stimuli is growing blunted due to overuse, this phenomenon is extremely common.

Norman Doidge MD wrote about this in his book The Brain That Changes Itself:

The current porn epidemic gives a graphic demonstration that sexual tastes can be acquired. Pornography, delivered by high-speed Internet connections, satisfies every one of the prerequisites for neuroplastic change…. When pornographers boast that they are pushing the envelope by introducing new, harder themes, what they don’t say is that they must, because their customers are building up a tolerance to the content. The back pages of men’s risque magazines and Internet porn sites are filled with ads for Viagra-type drugs—medicine developed for older men with erectile problems related to aging and blocked blood vessels in the penis. Today young men who surf porn are tremendously fearful of impotence, or “erectile dysfunction” as it is euphemistically called. The misleading term implies that these men have a problem in their penises, but the problem is in their heads, in their sexual brain maps. The penis works fine when they use pornography. It rarely occurs to them that there may be a relationship between the pornography they are consuming and their impotence.

And here’s the 2017 evidence from PornHub that real sex is decreasingly interesting to porn users. Porn isn’t enabling people to find their “real” tastes; it’s driving them beyond normal into extreme novelty and “unreal” genres:

It appears that the trend is moving more toward fantasy than reality. ‘Generic’ porn is being replaced with fantasy specific or scenario specific scenes.  Is this as a result of boredom or curiosity? One thing is certain; the typical ‘in-out, in-out’ no longer satisfies the masses, who are clearly looking for  something different” notes Dr Laurie Betito.

Employing various methodologies and approaches various studies have reported habituation to “regular porn” along with escalation into more extreme and unusual genres:


FIRST STUDY: To date only one study has directly asked problematic porn users about escalation: “Online sexual activities: An exploratory study of problematic and non-problematic usage patterns in a sample of men” (2016). The study reports escalation, as 49% of the men reported viewing porn that was not previously interesting to them or that they once considered disgusting. An excerpt:

Forty-nine percent mentioned at least sometimes searching for sexual content or being involved in OSAs that were not previously interesting to them or that they considered disgusting.

This Belgian study also found problematic Internet porn use was associated with reduced erectile function and reduced overall sexual satisfaction. Yet problematic porn users experienced greater cravings (OSA’s = online sexual activity, which was porn for 99% of subjects). Interestingly, 20.3% of participants said that one motive for their porn use was “to maintain arousal with my partner.” An excerpt:

This study is the first to directly investigate the relationships between sexual dysfunctions and problematic involvement in OSAs. Results indicated that higher sexual desire, lower overall sexual satisfaction, and lower erectile function were associated with problematic OSAs (online sexual activities). These results can be linked to those of previous studies reporting a high level of arousability in association with sexual addiction symptoms (Bancroft & Vukadinovic, 2004; Laier et al., 2013; Muise et al., 2013).


SECOND STUDY: The Dual Control Model: The Role Of Sexual Inhibition & Excitation In Sexual Arousal And Behavior,” 2007. Indiana University Press, Editor: Erick Janssen, pp.197-222.  In an experiment employing video porn, 50% of the young men couldn’t become aroused or achieve erections with porn (average age was 29). The shocked researchers discovered that the men’s erectile dysfunction was,

 related to high levels of exposure to and experience with sexually explicit materials.

The men experiencing erectile dysfunction had spent a considerable amount of time in bars and bathhouses where porn was “omnipresent,” and “continuously playing.” The researchers stated:

Conversations with the subjects reinforced our idea that in some of them a high exposure to erotica seemed to have resulted in a lower responsivity to “vanilla sex” erotica and an increased need for novelty and variation, in some cases combined with a need for very specific types of stimuli in order to get aroused.


THIRD & FOURTH STUDIES: Both found that deviant (i.e., bestiality or minor) pornography users reported a significantly younger onset of adult pornography use. These studies confirm that early porn use is related to escalation to more extreme material.

1) “Does deviant pornography use follow a Guttman-like progression?” (2013). An excerpt:

Results suggested deviant pornography use followed a Guttman-like progression in that individuals with a younger “age of onset” for adult pornography use were more likely to engage in deviant pornography (bestiality or child) compared to those with a later “age of onset”.

2) “Deviant Pornography Use: The Role of Early-Onset Adult Pornography Use and Individual Differences” (2016). An excerpt:

Results indicated that adult + deviant pornography users scored significantly higher on openness to experience and reported a significantly younger age of onset for adult pornography use compared to adult-only pornography users.


FIFTH STUDY: “Brain Structure and Functional Connectivity Associated With Pornography Consumption: The Brain on Porn” (Kuhn & Gallinat, 2014) – This Max Planck Institute fMRI study found less grey matter in the reward system (dorsal striatum) correlating with the amount of porn consumed. It also found that more porn use correlated with less reward circuit activation while briefly viewing sexual photos. Researchers believe their findings indicated desensitization, and possibly tolerance, which is the need for greater stimulation to achieve the same level of arousal. Lead author Simone Kühn said the following about her study:

That could mean that regular consumption of pornography more or less wears out your reward system. We assume that subjects with a high porn consumption need increasing stimulation to receive the same amount of reward. That would fit perfectly the hypothesis that their reward systems need growing stimulation.

Furthermore, in May, 2016. Kuhn & Gallinat published this review – Neurobiological Basis of Hypersexuality. In the review Kuhn & Gallinat describe their 2014 fMRI study:

In a recent study by our group, we recruited healthy male participants and associated their self-reported hours spent with pornographic material with their fMRI response to sexual pictures as well as with their brain morphology (Kuhn & Gallinat, 2014). The more hours participants reported consuming pornography, the smaller the BOLD response in left putamen in response to sexual images. Moreover, we found that more hours spent watching pornography was associated with smaller gray matter volume in the striatum, more precisely in the right caudate reaching into the ventral putamen. We speculate that the brain structural volume deficit may reflect the results of tolerance after desensitization to sexual stimuli.


SIXTH STUDY:Novelty, conditioning and attentional bias to sexual rewards” (2015). Cambridge University fMRI study reporting greater habituation to sexual stimuli in compulsive porn users. An excerpt:

Online explicit stimuli are vast and expanding, and this feature may promote escalation of use in some individuals. For instance, healthy males viewing repeatedly the same explicit film have been found to habituate to the stimulus and find the explicit stimulus as progressively less sexually arousing, less appetitive and less absorbing (Koukounas and Over, 2000). … We show experimentally what is observed clinically that Compulsive Sexual Behavior is characterized by novelty-seeking, conditioning and habituation to sexual stimuli in males.

FROM THE RELATED PRESS RELEASE:

The researchers found that sex addicts were more likely to choose the novel over the familiar choice for sexual images relative to neutral object images, whereas healthy volunteers were more likely to choose the novel choice for neutral human female images relative to neutral object images.

“We can all relate in some way to searching for novel stimuli online – it could be flitting from one news website to another, or jumping from Facebook to Amazon to YouTube and on,” explains Dr Voon. “For people who show compulsive sexual behaviour, though, this becomes a pattern of behaviour beyond their control, focused on pornographic images.”

In a second task, volunteers were shown pairs of images – an undressed woman and a neutral grey box – both of which were overlaid on different abstract patterns. They learned to associate these abstract images with the images, similar to how the dogs in Pavlov’s famous experiment learnt to associate a ringing bell with food. They were then asked to select between these abstract images and a new abstract image.

This time, the researchers showed that sex addicts where more likely to choose cues (in this case the abstract patterns) associated with sexual and monetary rewards. This supports the notion that apparently innocuous cues in an addict’s environment can ‘trigger’ them to seek out sexual images.

“Cues can be as simple as just opening up their internet browser,” explains Dr Voon. “They can trigger a chain of actions and before they know it, the addict is browsing through pornographic images. Breaking the link between these cues and the behaviour can be extremely challenging.”

The researchers carried out a further test where 20 sex addicts and 20 matched healthy volunteers underwent brain scans while being shown a series of repeated images – an undressed woman, a £1 coin or a neutral grey box.

They found that when the sex addicts viewed the same sexual image repeatedly, compared to the healthy volunteers they experienced a greater decrease of activity in the region of the brain known as the dorsal anterior cingulate cortex, known to be involved in anticipating rewards and responding to new events. This is consistent with ‘habituation’, where the addict finds the same stimulus less and less rewarding – for example, a coffee drinker may get a caffeine ‘buzz’ from their first cup, but over time the more they drink coffee, the smaller the buzz becomes.

This same habituation effect occurs in healthy males who are repeatedly shown the same porn video. But when they then view a new video, the level of interest and arousal goes back to the original level. This implies that, to prevent habituation, the sex addict would need to seek out a constant supply of new images. In other words, habituation could drive the search for novel images.

“Our findings are particularly relevant in the context of online pornography,” adds Dr Voon. “It’s not clear what triggers sex addiction in the first place and it is likely that some people are more pre-disposed to the addiction than others, but the seemingly endless supply of novel sexual images available online helps feed their addiction, making it more and more difficult to escape.” [emphasis added]


SEVENTH STUDY: Exploring the effect of sexually explicit material on the sexual beliefs, understanding and practices of young men: A qualitative survey. An excerpt:

Findings suggest that the key themes are: increased levels of availability of SEM, including an escalation in extreme content (Everywhere You Look) which are seen by young men in this study as having negative effects on sexual attitudes and behaviours (That’s Not Good). Family or sex education may offer some ‘protection’ (Buffers) to the norms young people see in SEM. Data suggests confused views (Real verses Fantasy) around adolescents’ expectations of a healthy sex life (Healthy Sex Life) and appropriate beliefs and behaviours (Knowing Right from Wrong). A potential causal  pathway is described and areas of intervention highlighted.


EIGHTH STUDY: Modulation of Late Positive Potentials by Sexual Images in Problem Users and Controls Inconsistent with “Porn Addiction” (2015)  (Prause et al., 2015.)

The results: compared to controls “individuals experiencing problems regulating their porn viewing” had lower brain responses to one-second exposure to photos of vanilla porn. The lead author, Nicole Prause, claims these results “debunk porn addiction.” If porn use had no effect on Prause et al’s. subjects, we would expect controls and the frequent porn users to have the same LPP amplitude in response to sexual photos. Instead, the more frequent porn users had less brain activation (lower LPP). In reality, the findings of Prause et al. 2015 align perfectly with Kühn & Gallinat (2014), which found that more porn use correlated with less brain activation in response to pictures of vanilla porn.

Prause’s findings also align with Banca et al. 2015 which is #6 above. Moreover, another EEG study found that greater porn use in women correlated with less brain activation to porn. Lower EEG readings mean that subjects are paying less attention to the pictures. Put simply, frequent porn users were desensitized to static images of vanilla porn. They were bored (habituated or desensitized). Five peer-reviewed papers agree with this extensive critique that this study actually found desensitization/habituation in frequent porn users: 1, 2, 3, 4, 5.


NINTH STUDY: Unusual masturbatory practice as an etiological factor in the diagnosis and treatment of sexual dysfunction in young men (2014). One of the 4 case studies in this paper reports on a man with porn-induced sexual problems (low libido, multiple porn fetishes, anorgasmia). The sexual intervention called for a 6-week abstinence from porn and masturbation. After 8 months the man reported increased sexual desire, successful sex and orgasm, and enjoying “good sexual practices. Excerpts from the paper documenting the patient’s habituation and escalation into what he described as more extreme porn genres:

When asked about masturbatory practices, he reported that in the past he had been masturbating vigorously and rapidly while watching pornography since adolescence. The pornography originally consisted mainly of zoophilia, and bondage, domination, sadism, and masochism, but he eventually got habituated to these materials and needed more hardcore pornography scenes, including transgender sex, orgies, and violent sex. He used to buy illegal pornographic movies on violent sex acts and rape and visualized those scenes in his imagination to function sexually with women. He gradually lost his desire and his ability to fantasize and decreased his masturbation frequency.

An excerpt from the paper documents the patient’s recovery from porn-induced sexual problems and fetishes:

In conjunction with weekly sessions with a sex therapist, the patient was instructed to avoid any exposure to sexually explicit material, including videos, newspapers, books, and internet pornography. After 8 months, the patient reported experiencing successful orgasm and ejaculation. He renewed his relationship with that woman, and they gradually succeeded in enjoying good sexual practices.


TENTH STUDY: Is Internet Pornography Causing Sexual Dysfunctions? A Review with Clinical Reports (2016) is an extensive review of the literature related to porn-induced sexual problems. Authored by US Navy doctors, the review provides the latest data revealing a tremendous rise in youthful sexual problems. It also reviews the neurological studies related to porn addiction and sexual conditioning via Internet porn. The doctors include 3 clinical reports of servicemen who developed porn-induced sexual dysfunctions. Two of the three servicemen healed their sexual dysfunctions by eliminating porn use. The third man experienced little improvement as he was unable to abstain from porn use. Here are excerpts about one of the servicemen, who describes his habituation to “soft porn” followed by escalation into more graphic and fetish porn:

A 20-year old active duty enlisted Caucasian serviceman presented with difficulties achieving orgasm during intercourse for the previous six months. It first happened while he was deployed overseas. He was masturbating for about an hour without an orgasm, and his penis went flaccid. His difficulties maintaining erection and achieving orgasm continued throughout his deployment. Since his return, he had not been able to ejaculate during intercourse with his fiancée. He could achieve an erection but could not orgasm, and after 10–15 min he would lose his erection, which was not the case prior to his having ED issues.

Patient endorsed masturbating frequently for “years”, and once or twice almost daily for the past couple of years. He endorsed viewing Internet pornography for stimulation. Since he gained access to high-speed Internet, he relied solely on Internet pornography. Initially, “soft porn”, where the content does not necessarily involve actual intercourse, “did the trick”. However, gradually he needed more graphic or fetish material to orgasm. He reported opening multiple videos simultaneously and watching the most stimulating parts. [emphasis added]


ELEVENTH STUDY: Shifting Preferences In Pornography Consumption (1986)  Six weeks of exposure to nonviolent pornography resulted in subjects having little interest in vanilla porn, electing to almost exclusively watch “uncommon pornography” (bondage, sadomasochism, bestiality). An excerpt:

Male and female students and nonstudents were exposed to one hour of common, nonviolent pornography or to sexually and aggressively innocuous materials in each of six consecutive weeks. Two weeks after this treatment, they were provided with an opportunity to watch videotapes in a private situation. G-rated, R-rated, and X-rated programs were available. Subjects with considerable prior exposure to common, nonviolent pornography showed little interest in common, nonviolent pornography, electing to watch uncommon pornography (bondage, sadomasochism, bestiality) instead. Male nonstudents with prior exposure to common, nonviolent pornography consumed uncommon pornography almost exclusively. Male students exhibited the same pattern, although somewhat less extreme. This consumption preference was also in evidence in females, but was far less pronounced, especially among female students. [emphasis added]


Interesting 2016 study, which apparently did not ask whether tastes changed over time (escalation):

Some of you may remember A Billion Wicked Thoughts and the claim of co-author Ogas that sexual tastes are stable. Here’s an excerpt from an Ogas blog post on Psychology Today:

“There is no evidence that viewing porn activates some kind of neural mechanism leading one down a slippery slope of seeking more and more deviant material, and plenty of evidence suggesting that adult men’s sexual interests are stable.”

However, this new study casts doubt on that assumption with respect to today’s (streaming) internet pornography. Sexually Explicit Media Use by Sexual Identity: A Comparative Analysis of Gay, Bisexual, and Heterosexual Men in the United States. Excerpt from this new study:

The findings also indicated that many men viewed SEM content inconsistent with their stated sexual identity. It was not uncommon for heterosexual-identified men to report viewing SEM containing  male same-sex behavior (20.7%) and for gay-identified men to report viewing heterosexual behavior in SEM (55.0%). It was also not uncommon for gay men to report that they viewed vaginal sex with  13.9%) and without a condom (22.7%) during the past 6 months.

This study, taken together with others mentioned above, debunks the meme that today’s porn users eventually “discover their true sexuality” by surfing tube sites, and then stick to only one genre of porn for the rest of time.

Is Grubbs pulling the wool over our eyes with his “perceived porn addiction” research?

INTRODUCTION

A new concept has recently appeared in a rash of papers and articles: “perceived porn addiction.” It was cooked up by Joshua Grubbs and thoroughly examined in the YBOP analysis: Critique of “Perceived Addiction to Internet Pornography and Psychological Distress: Examining Relationships Concurrently and Over Time” (2015). Here are a few of the headlines birthed from that study:

  • Watching Porn Is OK. Believing In Porn Addiction Is Not
  • Perceived Addiction To Porn Is More Harmful Than Porn Use Itself
  • Believing You Have Porn Addiction Is the Cause of Your Porn Problem, Study Finds

Here we revisit Joshua Grubbs’s work as he continues to publish “perceived porn addiction” papers. In this 2015 press release Grubbs suggests that pornography use itself doesn’t cause any problems:

It doesn’t seem to be the pornography itself that is causing folks problems, it’s how they feel about it,

“Perceived addiction involves a negative interpretation of your own behavior, thinking about yourself, like, ‘I have no power over this’ or ‘I’m an addict, and I can’t control this.’

Grubbs sums up his views in this extraordinary 2016 Psychology Today article, claiming that porn addiction is nothing more than religious shame.

Being labeled “porn addict” by a partner, or even by oneself, has nothing to do with the amount of porn a man views, says Joshua Grubbs, assistant professor of psychology at Bowling Green University. Instead, it has everything to do with religiosity and moral attitudes toward sex. In short, he says, “It’s shame-motivated.”…

….Grubbs calls it “perceived pornography addiction.” “It functions very differently from other addictions.”

If Josuha Grubbs was accurately quoted, the above claims border on propaganda  as we will show that:

  1. Grubbs’s questionnaire assesses only actual porn addiction, not “perceived porn addiction.” That porn addiction doesn’t “function differently from other addictions,” and that Grubbs has not shown that it does. In fact, Grubbs based his questionnaire on (standard) drug addiction questionnaires.
  2. Contrary to his statement above, the amount of porn used is strongly related to scores on Grubbs’s porn addiction questionnaire (CPUI). In fact, Grubbs’s studies reveal that porn addiction (CPUI sections 2 & 3) is far more related to the amount of porn viewed than it is to religiosity.
  3. Moreover, “hours of use” are not a reliable measure of (proxy for) addiction. Previous studies have established that “hours of porn viewed” aren’t linearly correlated with porn addiction scores or symptoms. Many additional variables of use also contribute to the development of a porn addiction.

Beyond these evident challenges to Grubbs’s “porn addiction is only religious shame” claim, his model crumbles when we consider that:

  1. Religious shame doesn’t induce brain changes that mirror those found in drug addicts. Yet there are now 28 neurological studies reporting addiction-related brain changes in compulsive porn users/sex addicts.
  2. All cross-sectional studies report lower rates of compulsive sexual behavior and porn use in religious individuals (study 1, study 2, study 3, study 4, study 5, study 6, study 7, study 8,). This means Grubbs’s sample of religious porn users is inevitably skewed (see below). It also means that “religiosity” does not predict porn addiction.
  3. Many atheists and agnostics develop porn addiction. Two 2016 studies on men who had used porn in the last the last 6 months, or in the last 3 months, reported extraordinarily high rates of compulsive porn use (28% for both studies).
  4. “Perceived addiction” obviously couldn’t induce chronic erectile dysfunction, low libido and anorgasmia in healthy young men. Yet numerous studies link porn use to sexual dysfunctions and lower sexual satisfaction, and ED rates have inexplicably skyrocketed by 1000% in men under 40 since “tube” porn arrived in porn users’ lives.
  5. This 2016 study on treatment-seeking porn addicts found that religiosity did not correlate with negative symptoms or scores on a sex addiction questionnaire.
  6. This 2016 study on treatment-seeking hypersexuals found no relationship between religious commitment and self-reported levels of hypersexual behavior and related consequences.

In the following sections we will address Grubbs’s major claims, look deeper into his data and methodology, and suggest alternative explanations for his claim that religiosity is related to porn addiction. But first let’s start with the 3 pillars upon which Grubbs builds his assorted papers.

For Grubbs’s claims to be valid ALL of these 3 must be true and supported by actual research:

1) The Grubbs Cyber Pornography Use Inventory (CPUI) must assess “perceived porn addiction” rather than actual porn addiction.

  • It does not. The CPUI assesses actual porn addiction, as Grubbs himself stated in his original 2010 paper validating the CPUI (more below). In fact, the CPUI was only validated as an actual porn addiction test, and never as a “perceived addiction” test. With no supporting scientific justification, in 2013, Grubbs unaccountably re-labeled his porn addiction test a “perceived porn addiction” test.
  • Note: In Grubbs’s studies he uses the phrase “perceived addiction” or “perceived porn addiction” to denote the total score on his CPUI test (an actual porn addiction test). This is lost in translation due to the frequent repetition of “perceived addiction,” instead of the accurate, spin-free label: “the Cyber Pornography Use Inventory score.”

2) Grubbs must have found little to no correlation between hours of use and CPUI scores (porn addiction).

  • No again. For example, Grubbs et al. 2015 reveals a strong correlation between hours of use and CPUI scores. From p. 6 of the study:

“Additionally, average daily pornography use in hours was significantly and positively associated with depression, anxiety, and anger, as well as with perceived addiction [total CPUI score].

  • Grubbs’s second 2015 study reported a stronger correlation between CPUI scores and “hours of porn use” than it did between CPUI scores and religiosity.

How could Grubbs claim in Psychology Today that porn addiction “has nothing to do with the amount of porn a man views,” when his studies reveal that quantity of use was “significantly and positively” correlated with CPUI scores?

3) Other studies must have reported that the amount porn used is linearly correlated with symptoms of porn addiction or scores on porn addiction tests.

  • They did not. Other research teams have found that the variable “hours of use” is not linearly correlated with cybersex addiction (or video-gaming addiction). That is, addiction is more reliably predicted by other variables than “hours of use” anyway, so the materiality of Grubbs’s claims is questionable even if his methodology were sound and his claims were accurate. (Not the case.) “Hours of use” is not a reliable proxy for “porn addiction,” so neither correlations with it nor lack of correlations with it can have the vast significance Grubbs presumes.

Most of the Grubbs-generated headlines and claims depend upon all 3 of the above points being true. They are not. We now examine these 3 pillars and the details surrounding Grubbs’s studies and claims.


SECTION 1: The Myth of “Perceived” Porn Addiction:

The Cyber Pornography Use Inventory (CPUI): It’s an actual addiction test.

Important to note:

  • Whenever Grubbs uses the phrase “perceived addiction” he really means the total score on his CPUI.
  • The CPUI is divided into 3 sections, which becomes very important later on as we examine how scores on each section correlate with other variables such as “hours of use” and “religiosity.”
  • Each question is scored using a Likert scale of 1 to 7, with 1 being “not at all,” and 7 being “extremely.”

COMPULSIVITY:

1. I believe I am addicted to Internet pornography.

2. I feel unable to stop my use of online pornography.

3. Even when I do not want to view pornography online, I feel drawn to it

ACCESS EFFORTS:

4. At times, I try to arrange my schedule so that I will be able to be alone in order to view pornography.

5. I have refused to go out with friends or attend certain social functions to have the opportunity to view pornography.

6. I have put off important priorities to view pornography.

EMOTIONAL DISTRESS:

7. I feel ashamed after viewing pornography online.

8. I feel depressed after viewing pornography online.

9. I feel sick after viewing pornography online.

In reality, Grubbs’s Cyber Pornography Use Inventory (CPUI) questionnaire is very similar to many other drug and behavioral addiction questionnaires. Like other addiction tests, the CPUI assesses behaviors and symptoms common to all addictions, such as: the inability to control use; compulsion to use, cravings to use, negative psychological, social and emotional effects; and preoccupation with using. In fact, only 1 of the 9 CPUI questions above even hints at “perceived addiction.”

Yet we are told that a person’s total score for all 9 questions is synonymous with “perceived addiction” rather than addiction itself. Very misleading, very clever, and without any scientific basis. Agnotology fodder, anyone? (Agnotology is the study of culturally induced ignorance or doubt, particularly the publication of inaccurate or misleading scientific data designed to confuse the public about the state of research in a particular field. Big Tobacco is credited with inventing the field of agnotology.)

Note that decades of established addiction assessment tests for both chemical and behavioral addictions rely on similar questions as the CPUI to assess actual, not merely perceived, addiction. CPUI questions 1-6 assess core addiction behaviors as outlined by the 4 Cs, while questions 7-9 evaluate negative emotional states after using porn. Let’s compare the CPUI to a commonly used addiction assessment tool known as the “4 Cs.” The CPUI questions that correlate with the four Cs are noted as well.

  • Compulsion to use (2, 3)
  • Inability to Control use (2, 3, maybe 4-6)
  • Cravings to use (3 especially, but 1-6 could be interpreted as cravings)
  • Continued use despite negative consequences (4-6, perhaps 7-9)

Addiction experts rely on assessment tools like the 4Cs as indicating addiction because neuroscientists have correlated the symptoms those questions with underlying addiction-related brain changes in decades of basic-research studies. See the public policy statement of the American Society of Addiction Medicine. In short, the Grubb’s CPUI is an actual porn addiction test; it was never validated for “perceived addiction.”

The initial 2010 Grubbs study said the CPUI assessed actual porn addiction

In Grubbs’s initial 2010 paper he validated the Cyber-Pornography Use Inventory (CPUI) as a questionnaire assessing actual porn addiction. The phrases “perceived addiction” and “perceived porn addiction” do not appear in his 2010 paper. To the contrary, Grubbs et al., 2010 clearly states in several places that the CPUI assesses genuine porn addiction:

The previously described models proposed for understanding behavioral addictions were the primary theoretical assumptions used to derive the instrument for this study, the Cyber-Pornography Use Inventory (CPUI), patterned after the Internet Sex Screening Test developed by Delmonico (Delmonico & Griffin, 2008). The CPUI design was based on the principle that addictive behavior is characterized by an inability to stop the behavior, significant negative effects as a result of the behavior, and a generalized obsession with the behavior (Delmonico & Miller, 2003).

The CPUI does indeed show promise as an instrument assessing Internet pornography addiction. Whereas previous instruments, such as the ISST, had assessed only broad-spectrum online sexual addiction, this scale did demonstrate promise in specifically assessing Internet pornography addiction. Furthermore, the items on the previously explained Addictive Patterns scale seem to find some level of theoretical support and potential construct validity when compared with the diagnostic criteria for both Substance Dependence and Pathological Gambling, an ICD.

Finally, five of the items on the Addictive Patterns scale from the original Compulsivity scale seem to directly tap into the individual’s perceived or actual inability to stop the behavior in which they are engaging. Inability to stop a problematic behavior under any circumstances is not only an important diagnostic criterion for both SD and PG, but it can also can be thought of as one of the core elements of both addiction, as manifested in SD, and ICDs (Dixon et al., 2007; Potenza, 2006). It seems that it is this inability that creates the disorder.

In a 2013 study Grubbs reduced the number of CPUI questions from 32 (or 39 or 41) to the current 9, and re-labeled his actual, validated porn addiction test as a “perceived porn addiction” test (here’s a 41-question version of the CPUI). He did so without any explanation or justification and proceeded to use the phrase “perceived addiction” 80 times in his 2013 paper.

Let’s be very clear – the CPUI was never validated as an assessment test differentiating actual porn addiction from “perceived porn addiction.” This means the public is relying only on Grubbs’s word that his revised test can differentiate between “perceived porn addiction” and the “actual porn addiction” the CPUI was originally validated to assess. How scientific is it to re-label a validated test as something altogether different without validating the radically altered use of the test?

There’s no historical precedent for a “perceived addiction” assessment test

The two studies Grubbs consistently cites (1, 2) to imply that his concept of “perceived addiction” is established/legitimate were done on smokers, and neither supports the concept of “perceived addiction” as Grubbs uses it. First, neither study suggests, as Grubbs does with porn, that actual cigarette addiction doesn’t exist. Nor did either of those studies claim to have developed a questionnaire that could distinguish or isolate “perceived addiction” from actual addiction. Both studies focused instead on assessing how future success in quitting smoking related to earlier self-reports of addiction.

There is no questionnaire for “perceived addiction” to anything – substance or behavior – including pornography use (regardless of Grubbs’s claims). There’s a good reason ‘Google Scholar’ returns zero results for the following “perceived addictions”:

Other researchers predictably use the CPUI as an actual porn addiction test

Reality check: other researchers describe the CPUI as an actual porn addiction assessment questionnaire (as that’s what it was validated as), and use it as such in their published studies:

  1. An Examination of Internet Pornography Usage among Male Students at Evangelical Christian Colleges (2011)
  2. Questionnaires and scales for the evaluation of the online sexual activities: A review of 20 years of research (2014)
  3. Problematic cybersex: Conceptualization, assessment, and treatment (2015)
  4. Clarifying the Links Among Online Gaming, Internet Use, Drinking Motives, and Online Pornography Use (2015)
  5. Cyberpornography: Time Use, Perceived Addiction, Sexual Functioning, and Sexual Satisfaction (2016)
  6. Examining Correlates of Problematic Internet Pornography Use Among University Student (2016)

The last study above used a longer version of the Grubbs CPUI and an Internet pornography addiction questionnaire derived from the DSM-5 Internet video-gaming addiction criteria. The graphs below show the same subjects scores on the two different porn addiction questionnaires:

——

No surprise: very similar results and distribution for the Grubbs CPUI and the researchers’ DSM-5-based porn addiction questionnaire. If the CPUI could differentiate “perceived addiction” from “actual addiction” the graphs and distributions would be sharply dissimilar. They are not.

Suggestion: whenever you read a Grubbs paper or a Grubbs sound-bite in the media, eliminate the word “perceived” and see how differently it reads – and how it aligns with other research on porn addiction. For example, two sentences from the introduction of a Grubbs’s paper with the word “perceived” deleted:

Addiction to Internet pornography is associated with lower levels of well-being. Recent research has found porn addiction to be related to anxiety, depression, and stress (Grubbs, Stauner, Exline, Pargament, & Lindberg, 2015; Grubbs, Volk et al., 2015).

Eliminate the unsupported claim that the CPUI assesses “perceived porn addiction” and we have completely different study results and no misleading headlines. Again, such actual findings of porn addiction being associated with anxiety, depression and stress align with decades of “actual,” not “perceived,” addiction research. Inability to control use is distressing.


SECTION 2: Claimed Correlations? “Hours of use” and “Religiosity”

Contrary to Grubbs’s claim the amount of porn viewed is significantly related to porn addiction scores (CPUI)

While we will see that “hours of use” is never used as the sole proxy for addiction, media sound-bites claim that Grubbs found no relationship between “hours of porn use” and scores on the porn addiction test (CPUI). This is not the case. Let’s start with Grubb’s 2013 study that decreed (by fiat) the CPUI-9 a “perceived porn addiction” test:

“Scores on the total CPUI-9, the compulsivity subscale, and the access efforts subscale were all associated with increased use of online pornography, indicating that perceived addiction [total CPUI score] is related to greater frequency of use.”

Remember “perceived addiction” is shorthand for the total CPUI score. As described earlier, this 2015 Grubbs study reported a pretty strong correlation between hours of use and CPUI scores. From p. 6 of the study:

“Additionally, average daily pornography use in hours was significantly and positively associated with depression, anxiety, and anger, as well as with perceived addiction [total CPUI score].”

In other words, contrary to the headlines and Grubbs’s claims in the press, subjects’ total CPUI-9 scores were significantly associated with hours of porn use. But how does “average daily pornography use in hours” compare with religiosity? Which is more correlated with the CPUI- total score?

We will use data from a 2015 Grubbs paper (“Transgression as Addiction: Religiosity and Moral Disapproval as Predictors of Perceived Addiction to Pornography“), as it contains 3 separate studies and its provocative title suggests that religiosity causes porn addiction. Table 2 below contains data from 2 separate studies. These data reveal correlations between a few variables (hours of porn use; religiosity) and CPUI scores (entire CPUI-9 and broken down into the 3 CPUI subsections).

Tips for understanding the numbers in the table: zero means no correlation between two variables; 1.00 means a complete correlation between two variables. The bigger the number the stronger the correlation between the 2 variables. If a number has a minus sign, it means there’s a negative correlation between two things. (For example, there’s a negative correlation between exercise and heart disease. Thus, in normal language, exercise reduces the chances of heart disease. On the other hand, obesity has a positive correlation with heart disease.)

Highlighted below are the correlations between total CPUI-9 scores (#1) and “Use In Hours” (#5) and the “Religiosity Index (#6) for two of Grubbs’s studies:

The correlations between total CPUI scores and religiosity:

  • Study 1: 0.25
  • Study 2: 0.35
    • Average: 0.30

The correlations between total CPUI scores and “hours of porn use”:

  • Study 1: 0.30
  • Study 2: 0.32
    • Average 0.31

Shockingly, CPUI-9 scores have a slightly stronger relationship to “hours of porn use” than to religiosity! Put simply “hours of porn use” predicts porn addiction better than does religiosity. Yet the study’s abstract assures us that religiosity is “robustly related to perceived addiction” (CPUI scores). If this is the case, then “hours of porn use” are evidently also “robustly related” to scores on the CPUI. It’s curious how religiosity’s relationship to porn addiction is emphasized, while hours of use is overlooked or hidden by doublespeak.

There’s no other way to say this – Grubbs’s data flat out contradict his claims in the media and in his studies’ abstracts. To refresh your memory, Grubbs’s claims in this Psychology Today feature article:

Being labeled “porn addict” by a partner, or even by oneself, has nothing to do with the amount of porn a man views, says Joshua Grubbs, assistant professor of psychology at Bowling Green University. Instead, it has everything to do with religiosity…

In reality, the opposite is true: porn addiction is more related to hours of use than to religiosity. The next section will reveal that actual “porn addiction,” as measured by CPUI questions 1-6, is far more related to “hours of porn use” than it is to religiosity.

Grubbs’s studies reveal that actual porn addiction is far more related to “hours of porn use” than to religiosity

Grubbs found that porn addiction (CPUI-9 total score) is more strongly correlated with “current hours of porn use” than to religiosity. But you may be thinking, “Grubbs was right about one claim: porn addiction (CPUI scores) is related to religiosity.” Not really. In the next section we will see why this claim is not what it seems.

Sticking with Grubbs’s numbers for now, there is a relationship between actual porn addiction and religiosity. However, it’s far weaker than indicated in the previous section. Just as important, the correlation between actual porn addiction and “hours of porn use” is far stronger than indicated in the previous section.

On closer examination, questions 1-6 of the CPUI-9 assess the signs and symptoms common to all addictions, while questions 7-9 (Emotional Distress) assess guilt, shame and remorse. As a result, “actual addiction” closely aligns with questions 1-6 (Compulsivity & Access Efforts).

Compulsivity:

  1. I believe I am addicted to Internet pornography.
  2. I feel unable to stop my use of online pornography.
  3. Even when I do not want to view pornography online, I feel drawn to it

Access Efforts:

  1. At times, I try to arrange my schedule so that I will be able to be alone in order to view pornography.
  2. I have refused to go out with friends or attend certain social functions to have the opportunity to view pornography.
  3. I have put off important priorities to view pornography.

Emotional Distress:

  1. I feel ashamed after viewing pornography online.
  2. I feel depressed after viewing pornography online.
  3. I feel sick after viewing pornography online.

First, let’s examine the correlations between each of the 3 CPUI subsections and Religiosity. In the following table the three CPUI subsections are numbered 2, 3 and 4, and the Religiosity Index is number 6.

The correlation between Religiosity and Perceived Compulsivity (questions 1-3)

  • Study 1: 0.25
  • Study 2: 0.14
    • Average: 0.195

The correlation between Religiosity and Access Efforts (questions 4-6)

  • Study 1: 0.03
  • Study 2: 0.11
    • Average: 0.07

The correlation between Religiosity and Emotional Distress (questions 7-9)

  • Study 1: 0.32
  • Study 2: 0.45
    • Average: 0.385

The key finding is that religiosity is strongly related (.39) to only the Emotional Distress section of the CPUI-9: questions 7-9, which asks porn users how they feel after viewing porn (ashamed, depressed, or sick). Religion is far less related to the two sub-sections (questions 1-6) that most accurately assess actual porn addiction: Compulsivity (.195) and Access Efforts (.07). Simplified: the shame and guilt questions (7-9) powerfully skew the total CPUI scores upward for religious individuals. Take away the 3 shame questions and the correlation between religiosity and the CPUI drops to a mere 0.13.

Examining the actual-addiction CPUI questions, it’s evident that the 3 “Access Efforts” questions 4-6 assess principal addiction criteria for any addiction: “The inability to stop despite severe negative consequences.” Compulsive use is a hallmark of addiction.

In contrast, question #1 in the Compulsivity section relies on subjective interpretation (“Do I feel addicted?”).

Now, back to those Access Efforts questions 4-6, which assess specific behaviors, not beliefs or feelings. The key takeaway: there’s an extremely weak correlation between Religiosity and the 3 Access Efforts questions (only 0.07). In summary, religiosity has very little relationship with actual porn addiction. (In fact, there’s good reason to suggest there is virtually no relationship as we will see in the next section.)

Next, let’s examine the correlations between each of the 3 CPUI subsections and “Hours of Porn Use.” In the following table the three CPUI subsections are numbered 2, 3 and 4, and “[Porn] Use In Hours” is number 5.

The correlation between “[Porn] Use In Hours” and Perceived Compulsivity (questions 1-3)

  • Study 1: 0.25
  • Study 2: 0.32
    • Average: 0.29

The correlation between “[Porn] Use In Hours” and Access Efforts (questions 4-6)

  • Study 1: 0.39
  • Study 2: 0.49
    • Average: 0.44

The correlation between “[Porn] Use In Hours” and Emotional Distress (questions 7-9)

  • Study 1: 0.17
  • Study 2: 0.04
    • Average: 0.10

This is the exact opposite of what we saw with religiosity. “[Porn] Use In Hours” correlates very strongly with the CPUI questions (1-6), which, again, most accurately assess actual porn addiction (0.365). More importantly, “[Porn] Use In Hours” correlate even more strongly with the CPUI’s core addiction questions 4-6 (0.44). This means that actual porn addiction (as assessed by behaviors) is robustly related to how much porn a person views.

On the other hand, “[Porn] Use In Hours” is weakly related (0.10) to the “Emotional Distress” questions (7-9). These 3 questions ask porn users how they feel after viewing porn (ashamed, depressed, or sick). In summary, actual porn addiction (1-6) is strongly related to the amount of porn viewed, yet shame and guilt (7-9) are not. To put this another way, porn addiction has a whole lot to do with how much porn is viewed, and very little to do with shame (religious or otherwise).

Summary of Grubbs’s actual findings

  1. Total CPUI-9 scores were better correlated with “[Porn] Use In Hours” than with religiosity. This finding directly contradicts claims in the media by Joshua Grubbs.
  2. Removing the 3 “Emotional Distress” questions leads to an even stronger relationship between “[Porn] Use In Hours” and actual porn addiction as assessed by questions 1-6.
  3. Removing the 3 “Emotional Distress” questions (which assess shame and guilt) leads to a much weaker relationship between religiosity and actual porn addiction as assessed by questions 1-6.
  4. A very strong relationship exists between “hours of porn use” and the core addiction behaviors as assessed by the “Access Efforts” questions 4-6. Put simply: porn addiction is very strongly related to amount of porn viewed.
  5. The relationship between “religiosity” and the core addiction behaviors (Access Efforts questions 4-6) is virtually non-existent (0.07). Put simply: addiction-related behaviors, rather than religiosity, predict porn addiction. Religiosity has next to nothing to do with porn addiction.  

Here’s what a more accurate conclusion in Grubbs’s study might have looked like:

Actual porn addiction is robustly related to hours of porn use and very weakly related to religiosity. Hours of porn use is a far better predictor of actual porn addiction than is religiosity. Why religiosity has any relationship to porn addiction is unknown. It could be the result of a skewed sample. When compared to non-religious individuals, a far lower percentage of religious individuals regularly view pornography. Perhaps this skewed sample of “religious porn users” contains a far higher percentage of individuals with pre-existing conditions (OCD, ADHD, depression, bipolar disorder, etc.) or familial/genetic influences commonly associated with addiction.

Finally, a recent study (by a non-Grubbs team) examined the relationships between pornography use and sexual satisfaction/functioning employing the CPUI-9. The study found that the amount of porn used was robustly related to questions 1-6 (0.50), yet not at all related to questions 7-9 (0.03). This means that the amount of porn used is a very strong factor in the development of a porn addiction. On the other hand, shame and guilt were not associated with porn use, and had nothing to do with porn addiction.

Studies recognize that current hours of porn use are not linearly related to porn addiction

As explained above, the amount of porn used is far more related to actual porn addiction than is religiosity. That said, we need to address Grubbs’s insinuation that hours of porn use is synonymous with “real porn addiction.” That is, that the extent of a “genuine porn addiction” is best indicated simply by “current hours of internet porn viewing,” rather than by standard porn addiction tests or by porn-induced symptoms.

The hole in Grubbs’s underpinnings, which you could drive a truck through, is that research on internet porn and videogame use (1, 2, 3, 4, 5, 6, 7, 8) has reported that neither internet addiction sub-type correlates linearly with hours of use. In fact, the variable ‘hours of use’ is an unreliable measure of addiction. Established addiction assessment tools evaluate addiction using multiple other, more reliable factors (such as those listed in the first two sections of the CPUI). The following cybersex addiction studies, which Grubbs omitted, report little relationship between hours and indications of addiction:

1) Watching Pornographic Pictures on the Internet: Role of Sexual Arousal Ratings and Psychological-Psychiatric Symptoms for Using Internet Sex Sites Excessively (2011)

“Results indicate that self-reported problems in daily life linked to online sexual activities were predicted by subjective sexual arousal ratings of the pornographic material, global severity of psychological symptoms, and the number of sex applications used when being on Internet sex sites in daily life, while the time spent on Internet sex sites (minutes per day) did not significantly contribute to explanation of variance in Internet Addiction Test sex score (IATsex). We see some parallels between cognitive and brain mechanisms potentially contributing to the maintenance of excessive cybersex and those described for individuals with substance dependence.”

2) Sexual Excitability and Dysfunctional Coping Determine Cybersex Addiction in Homosexual Males (2015)

“Recent findings have demonstrated an association between CyberSex Addiction (CA) severity and indicators of sexual excitability, and that coping by sexual behaviors mediated the relationship between sexual excitability and CA symptoms. Results showed strong correlations between CA symptoms and indicators of sexual arousal and sexual excitability, coping by sexual behaviors, and psychological symptoms. CyberSex Addiction was not associated with offline sexual behaviors and weekly cybersex use time.”

3) What Matters: Quantity or Quality of Pornography Use? Psychological and Behavioral Factors of Seeking Treatment for Problematic Pornography Use (2016)

According to our best knowledge this study is the first direct examination of associations between the frequency of porn use and actual behavior of treatment-seeking for problematic porn use (measured as visiting the psychologist, psychiatrist or sexologist for this purpose). Our results indicate that the future studies, and treatment, in this field should focus more on impact of porn use on the life of an individual (quality) rather than its mere frequency (quantity), as the negative symptoms associated with porn use (rather than porn use frequency ) are the most significant predictor of treatment-seeking behavior.

Relation between PU and negative symptoms was significant and mediated by self-reported, subjective religiosity (weak, partial mediation) among non-treatment seekers. Among treatment-seekers religiosity is not related to negative symptoms.

4) Examining Correlates of Problematic Internet Pornography Use Among University Student (2016)

Higher scores on addictive measures of internet porn use were correlated with daily or more frequent use of internet porn. However, the results indicate that there was no direct link between the amount and frequency of an individual’s pornography use and struggles with anxiety, depression, and life and relationship satisfaction. Significant correlations to high internet porn addiction scores included an early first exposure to internet porn, addiction to video games, and being male. While some positive effects of internet porn use have been documented in previous literature our results do not indicate that psychosocial functioning improves with moderate or casual use of internet porn.

Thus, from the outset this study and its assertions collapse because its conclusions rest upon equating current hours of use with the level of addiction/problems/distress reported by subjects as a valid measure of addiction.

Why don’t addiction specialists rely solely on hours of use?

Imagine trying to assess the presence of addiction by simply asking, “How many hours do you currently spend eating (food addiction)?” or “How many hours do you spend gambling (gambling addition)?” or “How many hours do you spend drinking (alcoholism)?” To demonstrate how problematic “hours of use” would be as an indicator of addiction, consider alcohol as an example:

  1. A 45-year old Italian man has a tradition of drinking 2 glasses of wine every night with dinner. His meal is with his extended family and it takes 3 hours to complete (lots of yakking). So he drinks for 3 hours a night, 21 hour per week.
  2. A 25 year-old factory worker only drinks on the weekends, but binge drinks both Friday and Saturday night to the point of passing out or getting sick. He regrets his actions and wants to stop, but can’t, drives drunk, gets in fights, is sexually aggressive, etc. He then spends all of Sunday recovering, and feels like crap until Wednesday. However, he spent only 8 hours a week drinking.

Which drinker has a problem? How helpful is applying “hours of use” to gambling addiction? Take these two gamblers;

  1. A retired elementary school teacher who lives in Las Vegas. She and three of her friends regularly spend weekday afternoons on the strip playing nickel slot machines and video-poker at various non-smoking casinos. Afterwards they usually eat dinner at the CircusCircus $9.99 buffet. Total losses could be as high as $5.00, but they often break even. Total time per week – 25 hours.
  2. A 43-year old electrician with 3 teenage kids, who is now living alone in a seedy motel. Betting on the ponies has led to divorce, lost jobs, bankruptcy, inability to pay child support, and the loss of visitation rights. While he only visits the track 3 times a week, about 2 hours each time, his compulsive gambling ruined his life. He can’t stop and is contemplating suicide. Total time gambling per week – 6 hours.

But, you wonder, surely the amount of drug used must equate to the level of addiction? Not necessarily. For example, millions of Americans with chronic pain are users of prescription opioids (Vicodin, Oxycontin) on a regular basis. Their brains and tissues have become physically dependent on them, and immediate cessation of use could cause severe withdrawals symptoms. However, very few chronic pain patients are addicted. Addiction involves multiple well-indentified brain changes that lead to the signs and symptoms experts recognize as addiction. (If the distinction is unclear, I recommend this simple explanation by NIDA.) The vast majority of chronic pain patients would happily throw away their narcotics in exchange for a life free of debilitating pain. This is quite different from true opioid addicts who often risk everything to continue their addiction.

Neither “current hours of use” nor “the amount used” alone can inform us as to who is addicted and who is not. There’s a reason why “continued use despite severe negative consequences” helps experts define addiction, and “current hours of use” does not. Remember, the 3 “Access Efforts” CPUI questions assessed “the inability to stop despite severe negative consequences.” In Grubbs’s data, these questions were the strongest predictors of actual porn addiction.

Bottom line: Grubbs’s claims depend upon “current hours of use” being the sole valid criterion for true addiction. They are not. Even if hours of use were a proxy for addiction, Grubbs’s full studies reveal that “current hours of porn use” is strongly related to total CPUI-9 scores (i.e., “perceived” addiction). More importantly, “hours of porn use” is far more related to actual porn addiction (CPUI questions 1-6) than it is to religiosity.  So Grubbs’s conclusions are both untrue and not based on existing addiction science.

“Current hours of porn use” omits many variables

A secondary methodological problem is that Grubbs assessed porn use by asking subjects about their “current hours of porn use.” That question is troublingly vague. Over what period? One subject may be thinking “How much did I use yesterday?” another “over the last week?” or “on average since I decided to quit viewing because of unwanted effects?” The result is data that are not comparable and cannot be analyzed for the purpose of drawing reliable conclusions, let alone the vast, unsupported conclusions Grubbs draws.

More important, the “current porn use” question, on which the study’s conclusions rest, fails to ask about key variables of porn use: age use began, years of use, whether the user escalated to novel genres of porn or developed unexpected porn fetishes, the ratio of ejaculation with porn to ejaculation without it, amount of sex with a real partner, and so forth. Those questions would likely enlighten us more about who really has a problem with porn use than simply “current hours of use.”


SECTION 3: Is Religiosity Related to Actual Porn Addiction?

Introduction: Anecdotal evidence from sex therapists suggests there are clients who feel addicted to porn, yet view it only occasionally. It’s possible that some of these clients are religious and experience guilt and shame surrounding their occasional porn use. Are these individuals suffering only from “perceived addiction” and not real porn addiction? Perhaps. That said, these individuals want to stop yet they continue to use porn. Whether or not these “occasional porn users” are truly addicted or just feeling guilt and shame, one thing is for sure: the Grubbs CPUI cannot distinguish “perceived addiction” from actual addiction in these individuals or anyone else.

One third of CPUI questions assess remorse and shame, resulting in higher scores for religious individuals

Because the last 3 of the 9 CPUI questions assess guilt, shame and remorse, religious porn users’ CPUI scores tend to be skewed upward. For example, if an atheist and devout Christian have identical scores on CPUI questions 1-6, it’s almost certain that the Christian will end up with far higher CPUI-9 scores, after questions 7-9 are added.

  1. I feel ashamed after viewing pornography online.
  2. I feel depressed after viewing pornography online.
  3. I feel sick after viewing pornography online.

Grubbs’s actual findings are that religious porn users may feel more guilt about porn use (questions 7-9), but they are not any more addicted (questions 4-6).

In the end, all we can take from Grubbs’s studies is that some religious porn users experience regret and shame. No surprise there. Since a much lower percentage of religious individuals use porn, Grubb’s findings tell us nothing about religious people as a whole. The key point: Grubbs is using a skewed sample of religious subjects – the porn using minority – to claim that porn addiction is related to religiosity.

It’s important to note that assessment questionnaires for other types of addiction rarely have questions about guilt and shame. Certainly, none make one third of their questionnaires about guilt and shame. For example, the DSM-5 criteria from Alcohol Use Disorder contain 11 questions. Yet none of the questions assess remorse or guilt after a drinking binge. Nor does the DSM-5 Gambling Addiction questionnaire contain a single question about remorse, guilt or shame. Rather, both of these DSM-5 addiction questionnaires emphasize dysfunctional behaviors, similar to questions 4-6 of the CPUI-9:

  1. At times, I try to arrange my schedule so that I will be able to be alone in order to view pornography.
  2. I have refused to go out with friends or attend certain social functions to have the opportunity to view pornography.
  3. I have put off important priorities to view pornography.

Remember, CPUI questions 4-6 are far more related to current “Hours of Porn Use” than any other factor (0.44). Meaning that “hours of use” is by far the strongest predictor of actual porn addiction in Grubbs’s data. On the other hand, questions 4-6 bore very little relation to “religiosity” (0.07). Meaning that religiosity is not really related to porn addiction. The very small relation between religiosity and actual porn addiction are likely better explained by Grubb’s s skewed sample and other factors discussed below.

Religiosity does NOT predict porn addiction. Not even a wee bit.

In Section 2 we pointed out that “hours of porn use” was more related to total CPUI-9 scores than was religiosity. Or as a researcher might say: “hours of porn use” predicted porn addiction slightly better than did religiosity. We also pointed out that the correlation between actual porn addiction (CPUI questions 4-6) and Religiosity averaged 0.07, while the correlation actual porn addiction (CPUI questions 4-6) and “hours of porn use” was 0.44. To put it another way: “hours of porn use” predicted porn addiction 600+% more strongly than did religiosity.

That said, Grubbs still reports a weak positive relationship between religiosity and core addiction questions 4-6 (0.07). So is Grubbs is right, that religiosity predicts porn addiction? No, religiosity does not predict porn addiction. Quite the opposite. Religious individuals are far less likely to use porn and thus less likely to become porn addicts.

Grubbs’s studies did not use a cross-section of religious individuals. Instead, only current porn users (religious or nonreligious) were questioned. All cross-sectional studies report far lower rates of porn use in religious individuals as compared with non-religious individuals (study 1, study 2, study 3, study 4, study 5, study 6, study 7, study 8). Grubbs’s sample of religious porn users is therefore skewed to the small percentage of religious men using porn. Put simply, religiosity is protective against porn addiction.

As an example, this 2011 study (The Cyber Pornography Use Inventory: Comparing a Religious and Secular Sample) reported the percentage of religious and secular college men who used porn at least once a week:

  • Secular: 54%
  • Religious: 19%

Another study on college aged religious men (I believe it is wrong but I still do it – A comparison of religious young men who do versus do not use pornography, 2010) revealed that:

  • 65% of religious young men reported viewing no pornography in the past 12 months
  • 8.6% reported viewing two or three days per month
  • 8.6% reported viewing daily or every other day

In contrast, cross-sectional studies of college-age men report relatively high rates of porn viewing (US – 2008: 87%, China – 2012: 86%, Netherlands – 2013 (age 16) – 73%).

In short, given that a large majority of college-age, religious men rarely views porn, Grubbs’s targeted sample of “religious porn users” is quite skewed, while his sample of “secular porn users” is fairly representative.

Most young religious porn users say they would rather not watch porn (100% in this above study). So why do they watch? It’s extremely likely that the non-representative sample of “religious porn users” contains a far higher percentage of individuals with pre-existing conditions (OCD, depression, anxiety, ADHD), genetic vulnerabilities, family histories of addiction, or childhood trauma. This hypothesis is supported by studies on treatment seeking porn /sex addicts which reveal no relationship between religiosity and measurements of addiction and religiosity (2016 study 1, 2016 study 2).

In summary, better explanations for the slight relationship between actual porn addiction (questions 4-6) and religiosity are:

  1. Compared to secular porn users, religious porn users represent a much smaller percentage of their demographic. This likely indicates that a higher percentage of this minority (religious porn users) struggle with the pre-existing conditions or comorbidities often present in addicts (i.e. OCD, depression, social anxiety disorder, childhood trauma or sexual abuse, other addictions, ADHD).
  2. Research shows that as the severity of their porn addiction increases, religious individuals often return to religious practices, attend church more often, and become more devout as a way of coping/seeking recovery (see below).

At high levels of porn use religious individuals return to religious practices and religion becomes more important

This 2016 study on religious porn users reported an odd finding that by itself could explain Grubbs’s slight correlation between actual porn addiction and religiosity. The relationship between porn use and religiosity is curvilinear. As porn use increases, religious practice and the importance of religion decrease – up to point. Yet when a religious individual begins using porn once or twice a week this pattern reverses itself: The porn user starts attending church more often and the importance of religion in his life increases. An excerpt from the study:

“However, the effect of earlier pornography use on later religious service attendance and prayer was curvilinear: Religious service attendance and prayer decline to a point and then increase at higher levels of pornography viewing.”

This graph, taken from this study, compares religious service attendance with the amount of porn used:

It seems likely that as religious individuals’ porn use grows increasingly out of control, they return to religion as a means to address their problematic behavior. This is no surprise, as many addiction recovery groups based on the 12-steps include a spiritual or religious component. The author of the paper suggested this as a possible explanation:

…studies of addiction suggest that those who feel helpless in their addiction often elicit supernatural help. Indeed, twelve-step programs that seek to help persons struggling with addictions ubiquitously include teachings about surrendering to a higher power, and a rising number of conservative Christian twelve-step programs make this connection even more explicit.  It could very well be that persons who use pornography at the most extreme levels (i.e., use levels that might be characteristic of a compulsion or addiction) are actually pushed toward religion over time rather than pulled away from it.

This phenomenon of religious porn users returning to their faiths as addiction worsens could easily explain the slight correlation between actual porn addiction and religiosity.

Summary of religiosity and porn use:

  1. Religiosity does not predict porn addiction (perceived or otherwise). Far more secular individuals use porn.
  2. Since a much smaller percentage of religious people use porn, religiosity is evidently protective against porn addiction.
  3. Grubb’s sample taken from the remaining minority of “religious porn users” is quite skewed with respect to religious men, likely resulting in a much higher percentage of the religious sample having comorbidities. As a result religious porn users have higher overall scores on the CPUI and more difficulty controlling use.
  4. As porn use becomes frequent or compulsive, religious porn users return to their faiths. This means that those scoring highest on Grubbs’s CPUI will also score higher on religiosity.

Bottom line: Grubbs reports only a very weak relationship between religiosity and CPUI core addiction questions 4-6 (0.07). This slender correlation is easily explained by a skewed sample and religious porn users returning to their faith as their addiction progresses.


SECTION 4: Grubbs Distorts the Current State of Addiction Research

The validity of internet pornography addiction is addressed in at least three of Joshua Grubbs’s studies (Grubbs et al., 2015; Bradley et al., 2016; Grubbs et al., 2016.) All three papers casually toss aside decades of neuropsychological and other addiction research (and related assessment tools) to attempt to persuade readers that the scientific literature shows that internet porn addiction doesn’t exist (thus supporting the Grubbs claim that all evidence of porn addiction must be “perceived,” not real).

The studies Grubbs cited to dismiss porn addiction

In their opening paragraphs, Grubbs’s three studies mentioned in the previous paragraph demonstrate their profound bias by basing their claim about the nonexistence of internet porn addiction on the papers of two self-proclaimed “internet porn addiction debunkers”: David Ley, author of The Myth of Sex Addiction, and former UCLA researcher Nicole Prause, whose work has been formally criticized in the medical literature for weak methodology and unsupported conclusions. The three papers Grubbs believes debunk porn addiction:

  1. The Emperor Has No Clothes: A Review of the ‘Pornography Addiction’ Model (2014), by David Ley, Nicole Prause & Peter Finn
  2. Sexual Desire, Not Hypersexuality, is Related to Neurophysiological Responses Elicited by Sexual Images (2013), Vaughn R. Steele, Cameron Staley, Timothy Fong, Nicole Prause
  3. Viewing Sexual Stimuli Associated with Greater Sexual Responsiveness, Not Erectile Dysfunction (2015), Nicole Prause & Jim Pfaus

Paper #1 (Ley et al., 2013) is a one-sided propaganda piece by Ley, Prause and their colleague Peter Finn, which claimed to be a review of the porn addiction model. It was not. First, Ley et al. omitted all published studies showing ill effects from porn use on the grounds that they are “merely” correlational. You read that right. Secondly, it cherry-picked random, misleading lines from within studies, failing to report the researchers’ actual opposing conclusions. Third, Ley et al. cited numerous studies that were entirely irrelevant to the claims made. We realize these are very strong assertions, yet they are fully supported and documented in this line-by-line critique. It should be noted that Ley et al. editor, Charles Moser, has long been a vocal critic of porn and sex addiction. Also know that Current Sexual Health Reports has a short and rocky history. It started publishing in 2004, and then went on hiatus in 2008, only to be resurrected in 2014, just in time to feature Ley et al.

Paper #2 (Steele et al., 2013) was an EEG study touted in the media as evidence against the existence of porn addiction. This SPAN Lab study actually lends support to the existence of porn addiction. How so? The study reported higher EEG readings (P300) when subjects were briefly exposed to pornographic photos. Studies show that an elevated P300 occurs when addicts are exposed to cues (such as images) related to their addiction. However, due to methodological flaws the findings are uninterpretable: 1) subjects were heterogeneous (males, females, non-heterosexuals); 2) subjects were not screened for mental disorders or addictions; 3) study had no control group for comparison; 4) questionnaires were not validated for porn addiction. In line with the Cambridge University fMRI studies, this EEG study reported greater cue-reactivity to porn correlated with less desire for partnered sex. Put another way, individuals with more brain activation and cravings for porn preferred to masturbate to porn than have sex with a real person. Study spokesperson Nicole Prause claimed that these porn users merely had high libido, yet the results of the study say the exact opposite (their desire for partnered sex was dropping in relation to their porn use). As neither result matched the study’s headlines, Grubbs perpetuated flawed conclusions of the original authors (the “debunkers of porn addiction”). Four peer-reviewed papers have formally analyzed Steele et al., concluding that its findings are consistent with the porn addiction model it claims to debunk: 1, 2, 3, 4. Also see the extensive critique.

Paper #3 (Prause & Pfaus 2015) was presented by Grubbs as evidence for the positive effects of porn:

…some studies even suggest potentially positive outcomes associated with pornography use (Prause & Pfaus, 2015).

Prause and Pfaus wasn’t a real study and it did not find “positive outcomes” related to porn use. None of the data from the Prause & Pfaus (2015) paper matched the four earlier studies on which it was based. The discrepancies were not small and have not been explained. A comment by researcher Richard A. Isenberg MD, published in Sexual Medicine Open Access, points out several (but not all) of the discrepancies, errors, and unsupported claims. The solitary positive outcome Prause & Pfaus claimed was a slightly higher “subjective arousal rating” after viewing porn in subjects who watched more porn at home. Several problems with this claim:

  1. The more science-based way to interpret this arousal difference is that the men who used more porn experienced greater cravings to use porn. Interestingly, they had less desire for sex with a partner and more desire to masturbate than those who logged fewer hours watching porn.
  2. Prause & Pfaus could not have accurately assessed the subjects’ arousal because:
  • the underlying 4 studies used different types of porn. Two studies used a 3-minute film, one study used a 20-second film, and one study used still images.
  • the underlying 4 studies employed different number scales. One used a 0 to 7 scale, one used a 1 to 7 scale, and one study did not report sexual arousal ratings.

Richard A. Isenberg MD asked Prause & Pfaus to explain how they could claim this result in the absence of supporting data. Neither author has been able to provide a comprehensible answer.

The studies Grubbs omitted

With respect to Grubbs’s bias, it is even more telling that the 3 studies named above omit every neurological and neuropsychological study that found evidence in support of the porn addiction model (over 2 dozen collected here). In addition, Grubbs omitted 10 recent reviews of literature on porn and sex addiction (in the same list). Many of these studies and reviews are by some the top neuroscientists at Yale University, Cambridge University, University of Duisburg-Essen, and the Max Planck Institute. (Some of these were not yet published when Grubbs’s studies went to press, but many were, and were simply ignored.)

Contrast those eminent researchers with Ley and Prause. Ley has no background in neuroscience and had published nothing until Ley et al., 2014. Prause hasn’t been associated with any university for some time, and her claims surrounding her 2 EEG studies have been repeatedly discredited in the peer-reviewed literature (2015: 1, 2, 3, 4. 5., 2013: 1, 2, 3, 4.)

We can speculate that acknowledging the existence of 24 neurological studies and ten reviews of literature supporting the porn addiction model would severely undercut Grubbs’s thesis that porn addiction….

“has everything to do with religiosity and moral attitudes toward sex. In short, he says, “It’s shame-motivated.”…

If “porn addiction is simply shame” how does Grubbs explain away the growing number of neurological studies that have found brain changes in problematic porn users that align with substance addiction? How could shame cause the same brain changes that occur with drug addiction? How could evidence of shame disprove the presence of addiction in brains showing evidence of addiction? It can’t.

Op-ed: Who exactly is misrepresenting the science on pornography?

8 neuroscientists fail to cite a single neuroscience study to support their claims

By Clay Olsen, Gail Dines, Mary Anne Layden, Gary Wilson, Jill Manning, Donald Hilton and John Foubert

Charges of misrepresenting science are serious. We write in response to a recent op-ed’s critique of Fight the New Drug’s scientific claims. Rather than mere “activists” as the op-ed authors labeled us, we represent some 130 years of combined professional experience researching or assisting those impacted by pornography.

While the authors of the earlier op-ed acknowledge “some cause for concern” regarding pornography consumption, nearly half their commentary highlights the “positive effects of sex film use,” while minimizing any serious harm. It is this kind of “balanced view,” they argue, FTND has failed to acknowledge in their work in schools.

Citing only one study, their expansive list of purported benefits from pornography range from “enhancing sex,” to greater “happiness and joy” and improved “comfort with one’s own appearance.” On the basis of a single citation we are asked to believe the production of pornography promotes “higher self-esteem” for performers while its consumption “reduc[es] violence and sexual assaults”—this, without mention of either six studies confirming mental and physical health problems of female performers or a full 50 peer-reviewed studies directly linking porn use to sexual violence.

The authors assert that a more accurate scientific analysis confirms only a “tiny percentage of those who viewed sex films” as having any negative effects—quoting “less than 2 percent of men, less than 0.05 percent of women.” They do so without citation, and without mentioning either the 2016 US study in which 28% of porn users scored at (or above) the cutoff for possible hypersexual disorder, or the 2016 Belgian study in which 28% of porn users self-assessed their porn consumption as problematic (alarmingly high rates, given that users of potentially addictive stimuli are typically among the last to recognize they have problems). Despite this, the authors of the op-ed go on to contend that pornography does “not have even primarily negative effects” and instead “mostly positive effects.”

Passed over are 40 peer-reviewed studies—a preponderance of the evidence to date—linking pornography use to lower relationship or sexual satisfaction (yes, most examined positive effects too). Also disregarded are 17 studies linking porn consumption to sexual problems and lower arousal, 11 studies documenting pornography escalation or habituation and a full 10 scientific reviews that establish serious risks with pornography use.

Such research, these authors argue, ought to be dismissed in a more “balanced” assessment. By contrast, those who disagree with their rosy analysis have, in their words, simply “disregarded the scientific method” or failed to conduct sufficiently “rigorous” studies.

Would that apply to the now 29 published neuroscience studies from universities like Cambridge, Yale and Max Planck exploring patterns in the brains of frequent pornography users? Virtually every neuroscience study has found brain changes consistent with addiction, including 18 studies documenting sensitization or cue-reactivity, eight documenting impaired prefrontal circuits and six documenting desensitization.

How eight neuroscientists could overlook these studies is difficult to understand, especially when over sixty neuroscientists have concluded their own brain data supports pornography’s addictive potential. Indeed, the single team interpreting their data from the brains of porn users otherwise is the one led by the lead author of the op-ed. When five outside reviews published re-analyses of these data, they concluded the team was overlooking evidence of the very habituation and desensitization characterizing all addictive patterns. Contrary to claims of the lead author that her team’s anomalous study had singlehandedly “debunked porn addiction,” the evidence in that study just doesn’t stand up.

Despite this, these authors argue that the real public harm comes not from pornography use, but from insisting publicly that it can be harmful!  To share a message about pornography’s potential harms with youth, they insist, is the true danger—imploring school authorities to ensure youth hear a “balanced” view that also acknowledges pornography’s “positive” effects.

Given how sharply out of line the authors’ proposals are with the preponderance of evidence consistently documenting an array of potential harms associated with pornography consumption, we are compelled to ask:  Who are the activists here?  And, whose interest would be served by passing along these authors’ conclusions to our children?

In light of the documented social, emotional, cognitive, sexual and developmental impacts on youth, we propose it is time to develop a robust, evidenced-based public health approach to educating and protecting youth from pornography’s harm. Our children deserve at least that much.

[For responses to the many additional claims made in this op-ed, see below]

Clay Olsen is CEO and co-founder of Fight the New Drug, and the founder, lead developer and artistic director of Fortify, an educational support community for those facing compulsive pornography issues.

Gail Dines, Ph.D. is a professor of sociology and women’s studies at Wheelock College in Boston, and founding president of Culture Reframed, a public health organization building resilience and resistance in youth to the porn culture.

Mary Anne Layden, Ph D, is the Director of Sexual Trauma and Psychopathology Program and Center for Cognitive Therapy in the Department of Psychiatry at the University of Pennsylvania

Gary Wilson is the creator of YourBrainOnPorn.com and the author of “Your Brain on Porn: Internet Pornography and the Emerging Science of Addiction.”

Jill Manning, Ph.D. is a licensed marital and family therapist, researcher and author based in Colorado. She currently serves on the board of directors for Enough is Enough, a non-profit organization dedicated to making the Internet safer for children and families.

Donald Hilton, MD, is an adjunct associate professor of neurosurgery at the University of Texas Health Science Center at San Antonio and a fellow of the American Association of Neurological Surgeons.

John D. Foubert, Ph.D., is an Endowed Professor of College Student Development at Oklahoma State University and is the author of the new book, How Pornography Harms: What Teens, Young Adults, Parents and Pastors Need to Know.

Addendum: Seven more points of response:

1. Philosophy of science. After contending that FTND is “systematically misrepresenting science” and “disregard[ing] the scientific method” the authors spend a long paragraph walking through principles they claim have been violated, namely:

The scientific method requires forming a falsifiable hypothesis, then creating experiments to disprove this hypothesis. Only if data consistently fail to disprove the hypothesis can one conclude that the hypothesis is supported, not proven.

Got it!  And right on.  We’re following you so far…

They continue, “The FTND letter suggests that (a) there has been rigorous testing seeking to disprove the hypothesis that pornography is addictive or harmful

Yep. There has!

(b) this testing has consistently failed to disprove this hypothesis

Yep. It has!

and (c) no contradictory evidence has been found.”

Not a whole lot. Nope!

It’s baffling why eight neuroscientists would overlook the direction this preponderance of evidence is pointing.

2. Study representativeness. The Op-Ed authors say, “Sex film users were not sampled in any representative way, and the studies ended up with biased samples reporting distress regarding their sex film use.”

In fact, our list of 40 studies correlating porn use with sexual or relationship satisfaction has the only studies that sampled this satisfaction issue in a representative way: both cross-sectional and longitudinal.

3. Addiction language and distress. The authors say, “the conceptualization of behavior as ‘addictive’ has documented significant psychological harm.

Yet the study they reference did not assess the psychological harm done to people who felt their behavior was addictive. Their link goes to a study that found that scores on a porn addiction test related to psychological distress. Simply put, higher levels of porn addiction correlated with higher levels of distress, which is to be expected in problematic users. For a full critique of this study click here.

4. Addiction language and sexual dysfunction. The authors say, “the conceptualization of behavior as ‘addictive’…has caused boys to think they have erectile dysfunction when they do not.”

False again. The link goes to a paper with 4 complex case studies of young men who had erectile dysfunction (not “believed” they had ED as the authors claim). There is no mention of porn use or porn addiction in that paper.

5. Pornography and women’s rights. They say, “Sex-film viewing also has been associated with more egalitarian attitudes….

The study referenced by the authors framed ‘egalitarianism’ as support for: Feminist identification, Women holding positions of power, Women working outside home, and Abortion. Secular populations tend to be more liberal, and have significantly higher rates of porn use than religious populations. This reality produces a stronger correlation between porn use and (what this study defines as) “egalitarianism.”

6. Pornography and higher education/religiosity. The authors say, “Sex-film viewing also has been associated with…higher education, more prayer and religiosity at high use, and are commonly used in sex therapy.”

The link the authors supply addresses only the “egalitarianism” correlation reported by a single study – not the authors’ other claims. Moreover, many studies report opposing results, including studies linking porn to sexist attitudes, objectification and less egalitarianism: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12.

7. Diagnostic Manuals. With respect to the ICD (International Classification of Diseases and Related Health Problems), which the authors mentioned, the important point is that the upcoming ICD-11 proposes a diagnosis for “Compulsive Sexual Behavior Disorder,” the acknowledged “narrower term” for which is “sex addiction.”

Clearly, the international medical field is moving in the direction of the preponderance of the neuroscience and other evidence. Doubt about the validity of pornography addiction as a risk for some users is rapidly fading despite efforts like the current one to kick dust in the eyes of the public. Incidentally, the World Health Organization’s ICD “outranks” the foot-dragging Diagnostic and Statistical Manual (DSM) as a diagnostic guide. The the ICD is the most widely used classification of mental disorders worldwide, and its diagnostic codes are mandated for use in the US and elsewhere by international treaty as opposed to DSM-5 diagnoses, which enjoy no such mandate. Finally, the assertion that our initial reply referred to descriptive codes in the current diagnostic manuals rather than standalone diagnoses is incorrect, as made clear by DSM veteran psychiatrist Richard Krueger, MD.

How to Recognize Biased Articles: They Cite Prause et al. 2015 (falsely claiming it debunks porn addiction), While Omitting Over 20 Neurological Studies Supporting Porn Addiction

Several recent articles and interviews have attempted to pushback at the TIME article (“Porn and the Threat to Virility”) and the Utah resolution declaring internet porn a public health problem (one example).

What might be a few “dead giveaways” that such an article is nothing more than a propaganda piece?

  1. Psychologists David Ley and/or Nicole Prause are cited as “the experts,” while actual top addiction neuroscientists, who have published recent studies on porn users (Voon, Kraus, Potenza, Brand, Laier, Hajela, Kuhn, Gallinat,Klucken, Banca, etc.), are omitted. Neither Ley nor Prause are affiliated with any university, yet “journalists” prefer both over the top neuroscientists at Yale University, Cambridge University, University of Duisburg-Essen, and the Max Planck Institute. Go figure.
  2. The article cites Prause’s lone, anomalous 2015 EEG study as proof porn addiction doesn’t exist, while simultaneously omitting 27 neurological studies and 10 recent reviews of the literature: Current list of brain studies on porn users. (a few articles cite Prause’s 2013 EEG study, which actually lends support to the porn addiction model and porn-induced sexual conditioning)
  3. The article omits the many studies linking porn use/porn addiction to sexual dysfunctions, low libido, less arousal to vanilla porn, less sexual satisfaction and poorer intimate relationships. See this page: Studies linking porn use or porn/sex addiction to sexual dysfunctions, lower brain activation to sexual stimuli, and lower sexual satisfaction

Reality Check Concerning Prause’s 2015 EEG Study (Prause et al., 2015)

Prause’s 2015 EEG study (claiming to debunk porn addiction) actually supports the existence of porn addiction because her team found desensitization in the heavy porn users.

Compared to controls, more frequent porn users had lower brain activation to one-second exposure to photos of vanilla porn. The lead author, Nicole Prause claims these results debunk porn addiction. However, these findings align perfectly with Kühn & Gallinat (2014), which found that more porn use correlated with lower brain activation in response to pictures of vanilla porn (and less gray matter in the dorsal striatum). In other words, the frequent porn users were desensitized to still images and needed greater stimulation than occasional porn users. Five peer-reviewed papers agree with the PSC analysis, namely that what Prause actually found is consistent with the effects of addiction in her study’s subjects:

  1. Neuroscience of Internet Pornography Addiction: A Review and Update – Excerpt critiquing Prause et al., 2015
  2. Neurobiology of Compulsive Sexual Behavior: Emerging Science (2016)
  3. Should compulsive sexual behavior be considered an addiction? (2016) – Excerpt analyzing Prause et al., 2015
  4. Decreased LPP for sexual images in problematic pornography users may be consistent with addiction models. Everything depends on the model. (Commentary on Prause, Steele, Staley, Sabatinelli, & Hajcak, 2015)
  5. Is Internet Pornography Causing Sexual Dysfunctions? A Review with Clinical Reports – Excerpt analyzing Prause et al., 2015

Author of the second critique, neuroscientist Mateusz Gola, summed up it up nicely:

“Unfortunately the bold title of Prause et al. (2015) article has already had an impact on mass media, thus popularizing a scientifically unjustified conclusion.”

What legitimate researcher would ever claim to have debunked an entire field of research and to refute all previous studies with a single EEG study? Not only was the title scientifically unjustified, Nicole Prause claimed her study contained 122 subjects (N). In reality, the study had only 55 subjects who were “experiencing problems regulating their viewing of sexual images”. The subjects were recruited from Pocatello Idaho, which is over 50% Mormon. The other 67 participants were controls.

In a second dubious claim, Prause et al., 2015 stated in both the abstract and in the body of the study:

“These are the first functional physiological data of persons reporting VSS regulation problems”.

This is clearly not the case, as the Cambridge University fMRI study was published nearly a year earlier.

In a third claim Nicole Prause has consistently asserted that Prause et al., 2015 is the largest neuroscience study published on porn addiction. Two problems with this claim:

  1. It’s not a study on porn addiction if it has no porn addicts. This study, and 2 earlier Prause studies (Prause et al., 2013 & Steele et al., 2013) did not assess whether any of the subjects were porn addicts or not. Prause admitted in a an interview that many of the subjects had little difficulty controlling use. All of the subjects would have to have been confirmed porn addicts to permit a legitimate comparison with a group of non-porn addicts. Three of the five peer-reviewed critiques point out this fatal flaw.
  2. HPA axis dysregulation in men with hypersexual disorder (2015) is the largest neuroscience based study to date on “hypersexuals” (67 subjects).  The study assessed the brain’s response to stress by assessing a hormone release by the brain (ACTH), and a hormone controlled by the brain (cortisol). While this study was a published a few months after Prause et al., 2015, Nicole Prause continues to claim her EEG study as the largest.

You Can’t “Debunk Porn Addiction” If Your Subjects Are Not Porn Addicts

The 3 Prause Studies (Prause et al., 2013, Prause et al., 2015, Steele et al., 2013.) all involved the same subjects. Here’s what we know about the “porn addicted users” in Prause’s 3 studies (the “Prause Studies”): They were not necessarily addicts, as they were never assessed for porn addiction. Thus, they can’t legitimately be used to “falsify” anything to do with the addiction model. As a group they were desensitized or habituated to vanilla porn, which is consistent with predictions of the addiction model. Here’s what each study actually reported about the “porn addicted” subjects:

  1. Prause et al., 2013: “Porn addicted users” reported more boredom and distraction while viewing vanilla porn.
  2. Steele et al., 2013: Individuals with greater cue-reactivity to porn had less desire for sex with a partner, but not less desire to masturbate.
  3. Prause et al., 2015: “Porn addicted users” had less brain activation to static images of vanilla porn. Lower EEG readings mean that the “porn addicted” subjects were paying less attention to the pictures.

A clear pattern emerges from the three studies: The “porn addicted users” were desensitized or habituated to vanilla porn, and those with greater cue-reactivity to porn preferred to masturbate to porn than have sex with a real person. Put simply they were desensitized (a common indication of addiction) and preferred artificial stimuli to a very powerful natural reward (partnered sex). There is no way to interpret these results as falsifying porn addiction.

Make no mistake, neither Steele et al., 2013 nor Prause et al., 2015 described these 55 subjects as porn addicts or compulsive porn users. The subjects only admitted to feeling “distressed” by their porn use. Confirming the mixed nature of her subjects, Prause admitted in 2013 interview that some of the 55 subjects experienced only minor problems (which means they were not porn addicts):

“This study only included people who reported problems, ranging from relatively minor to overwhelming problems, controlling their viewing of visual sexual stimuli.”

Besides not establishing which of the subjects were porn addicted, the Prause Studies did not screen subjects for mental disorders, compulsive behaviors, current drug use, or other addictions. This is critically important for any “brain study” on addiction, lest confounds render results meaningless.

In summary, the 3 Prause Studies did not assess whether the subjects were porn addicts or not. The authors admitted that many of the subjects had little difficulty controlling use. All of the subjects would have to have been confirmed porn addicts to permit a legitimate comparison with a group of non-porn addicts.

In 2013 Prause Said That Less Brain Activation Would Indicate Habituation or Addiction

You read that correctly. Prause’s 2015 claim of “debunking porn addiction” represents a flip-flop from her 2013 study’s claim of “debunking porn addiction.”

In her 2013 EEG study and related blog post, Prause admits that reduced brain activation would indicate habituation or addiction, but claimed her subjects didn’t show reduced activation. This claim, however, was groundless as explained here. She had no control group, so she could not compare “porn addicts'” EEG readings to “non-addicts'” readings. As a result, her 2013 study told us nothing about the EEG readings for either healthy individuals or “hypersexuals.”

Finally, in 2015 she added control subjects and published a second study. Sure enough, her “porn addicted” subjects displayed reduced brain activation in comparison to controls – just as would be expected in porn users suffering from habituation or addiction. Undaunted by findings that undermined her 2013 conclusion, she boldly, and without any basis in science, claimed that her corrected findings – which were consistent with the presence of addiction – “dismantled porn addiction.” And this is the talking point these propaganda pieces latch onto, with no support other than Prause’s unfounded claims.

Let’s back up and look more closely at Prause’s views from her 2013 study (Steele et al.):

“Therefore, individuals with high sexual desire could exhibit large P300 amplitude difference between sexual stimuli and neutral stimuli due to salience and emotional content of the stimuli. Alternatively, little or no P300 amplitude difference could be measured due to habituation to VSS.

In 2013, Prause said that porn addicts, when compared to controls, could either exhibit:

  1. higher EEG readings due to cue-reactivity to images, or
  2. lower EEG readings due to habituation to porn (VSS).

Five months before her 2013 EEG study was published, Prause and David Ley teamed up to write this Psychology Today blog post about her upcoming 2013 study (and its unsupported claims). In it they admit that “diminished electrical response” would indicate habituation or desensitization:

“But, when EEG’s were administered to these individuals, as they viewed erotic stimuli, results were surprising, and not at all consistent with sex addiction theory. If viewing pornography actually was habituating (or desensitizing), like drugs are, then viewing pornography would have a diminished electrical response in the brain. In fact, in these results, there was no such response. Instead, the participants’ overall demonstrated increased electrical brain responses to the erotic imagery they were shown, just like the brains of “normal people”…

So, we have 2013 Prause saying “diminished electrical response” would indicate habituation or desensitization. Later, however, in 2015, when Prause added controls for comparison and found evidence of desensitization (common in addicts), she tells us “diminished electrical response” debunks porn addiction. Huh?

In the intervening two years it took Prause to compare her same tired subject data with an actual control group, she executed a complete flip-flop. In 2015, she claimed the evidence of desensitization that she found when she added the control group isn’t evidence of addiction (which she claimed in 2013 it would have been). Instead, evidence of desensitization now (magically) “disproves addiction” (even though it aligns with addiction perfectly). This is inconsistent and unscientific, and suggests that regardless of opposing findings, she will always claim to have “disproven addiction.”

What About Brain Studies That Refute Porn Addiction?

There are none (really). This page lists all the studies assessing the brain structure and functioning of internet porn users. To date, every study offers support for the porn addiction model (including Prause’s two studies just discussed). However, whenever an article claiming to debunk porn addiction cites a study, I expect you will find one of her two EEG studies, or an irresponsible “review” by Prause, Ley and Finn. Here they are for easy reference:

  1. Sexual Desire, not Hypersexuality, is Related to Neurophysiological Responses Elicited by Sexual Images (Steele et al., 2013)
  2. Modulation of Late Positive Potentials by Sexual Images in Problem Users and Controls Inconsistent with “Porn Addiction” (Prause et al., 2015)
  3. The Emperor Has No Clothes: A Review of the ‘Pornography Addiction’ Model, by David Ley, Nicole Prause & Peter Finn (Ley et al., 2014)

Kinsey Institute grad Nicole Prause is the lead author on studies 1 and 2, and is the second author on paper #3. We already saw above that study #2 (Prause et al., 2015) lends support to the porn addiction model. But how does Prause’s 2013 EEG study (Steele et al., 2013), touted in the media as evidence against the existence of porn addiction, actually support the porn addiction model?

This study’s only significant finding was that individuals with greater cue-reactivity to porn had less desire for sex with a partner (but not lower desire to masturbate to porn). Put another way, individuals with more brain activation and cravings for porn would rather masturbate to porn than have sex with a real person. This is typical of addicts, not healthy subjects.

Study spokesman Nicole Prause claimed that frequent porn users merely had high libido, yet the results of the study say something quite different. As Valerie Voon (and 10 other neuroscientists) explained, Prause’s 2013 findings of greater cue-reactivity to porn coupled with lower desire for sex with real partners aligned with their 2014 brain scan study on porn addicts. Put simply, the actual findings of the 2013 EEG study in no way match the unsupported “debunking” headlines. Four peer-reviewed papers expose the truth about this earlier study by Prause’s team: 

As a side note, this same 2013 study reported higher EEG readings (P300) when subjects were exposed to porn photos. Studies consistently show that an elevated P300 occurs when addicts are exposed to cues (such as images) related to their addiction. This finding supports the porn addiction model, as the above peer-reviewed papers explained and psychology professor emeritus John A. Johnson pointed out in a comment under a 2013 Psychology Today Prause interview:

My mind still boggles at the Prause claim that her subjects’ brains did not respond to sexual images like drug addicts’ brains respond to their drug, given that she reports higher P300 readings for the sexual images. Just like addicts who show P300 spikes when presented with their drug of choice. How could she draw a conclusion that is the opposite of the actual results?

Dr. Johnson, who has no opinion on sex addiction, commented a second time under the Prause interview:

Mustanski asks, “What was the purpose of the study?” And Prause replies, “Our study tested whether people who report such problems [problems with regulating their viewing of online erotica] look like other addicts from their brain responses to sexual images.”

But the study did not compare brain recordings from persons having problems regulating their viewing of online erotica to brain recordings from drug addicts and brain recordings from a non-addict control group, which would have been the obvious way to see if brain responses from the troubled group look more like the brain responses of addicts or non-addicts…..

Aside from the many unsupported claims in the press, it’s disturbing that Prause’s 2013 EGG study passed peer-review, as it suffered from serious methodological flaws:

  1. subjects were heterogeneous (males, females, non-heterosexuals);
  2. subjects were not screened for mental disorders or addictions;
  3. study had no control group for comparison;
  4. questionnaires were not validated for porn addiction.

The third paper listed above is not a study at all. Instead, it poses as an impartial “review of the literature” on porn addiction and porn’s effects. Nothing could be farther from the truth. The lead author, David Ley, is the author of The Myth of Sex Addiction and Nicole Prause is its second author. Ley & Prause not only teamed up to write paper #3, they also teamed up to write a Psychology Today blog post about paper #1. The blog post appeared 5 months before Prause’s paper was formally published (so no one could refute it). You may have seen Ley’s blog post with the oh-so-catchy title: “Your Brain on Porn – It’s NOT Addictive”. Ley zealously denies both sex and porn addiction. He has written 20 or so blog posts attacking porn-recovery forums, and dismissing porn addiction and porn-induced ED. He is not an addiction scientist, but rather a clinical psychologist, and like Prause is not associated with any university or research institute. Read more about Ley & Prause and their collaborations here.

The following is a very long analysis of paper #3, which goes line-by-line, showing all the shenanigans Ley & Prause incorporated in their “review”: The Emperor Has No Clothes: A Fractured Fairytale Posing As A Review. It completely dismantles the so-called review, and documents dozens of misrepresentations of the research they cited. The most shocking aspect of the Ley review is that it omitted ALL the many studies that reported negative effects related to porn use or found porn addiction!

Yes, you read that right. While purporting to write an “objective” review, Ley & Prause justified omitting hundreds of studies on the grounds that these were correlational studies. Guess what? Virtually all studies on porn are correlational, even those they cited, or misused. There are, and pretty much will be, only correlational studies, because researchers have no way to prove causation by comparing users with “porn virgins” or by keeping subjects off of porn for extended periods in order compare effects. (Thousands of guys are quitting porn voluntarily on various forums, however, and their results suggest that removing internet porn is the key variable in their symptoms and recoveries.)

Inherent Bias?

It’s unprecedented for a legitimate researcher to claim that their lone anomalous study has debunked a hypothesis supported by multiple neurological studies and decades of relevant research. Moreover, what legitimate researcher would be constantly tweeting that has debunked porn addiction? What legitimate researcher would personally attack young men who run porn-recovery forums? What’s going on here? By her own admission, rejects the concept of porn addiction. For example, a quote from this recent Martin Daubney article about sex/porn addictions:

Dr Nicole Prause, principal investigator at the Sexual Psychophysiology and Affective Neuroscience (Span) Laboratory in Los Angeles, calls herself a “professional debunker” of sex addiction.

In addition, Nicole Prause’s former Twitter slogan suggests she may lack the impartiality required for scientific research:

“Studying why people choose to engage in sexual behaviors without invoking addiction nonsense”

Updates on Nicole Prause’s twitter slogan:

  1. UCLA did not renew Prause’s contract. She hasn’t been affiliated with any university since early 2015.
  2. In October, 2015 Prause’s original Twitter account is permanently suspended for harassment

While many articles continue to describe Prause as a UCLA researcher, she hasn’t been employed by any university since the beginning of 2015. Finally, it’s important to know that the enterprising Prause offered (for a fee) her “expert” testimony against sex addiction and porn addiction. It seems as though Prause is attempting to sell her services to profit from the unsupportable anti-porn addiction conclusions of her two EEG studies (1, 2), even though 9 peer-reviewed analyses say both studies support the addiction model

Interestingly, David Ley also profits from denying sex and porn addiction. At the end of this Psychology Today blog post Ley states:

Disclosure: David Ley has provided testimony in legal cases involving claims of sex addiction.

Ley also makes money selling two books which deny sex and porn addiction (“The Myth of Sex Addiction“, 2012 and “Ethical Porn for Dicks“, 2016). Pornhub is one of the four Amazon.com endorsements listed for Ley’s 2016 book.

Dismantling The Naysayers’ Talking Points

If you want a quick refutation of the naysayers’ pseudoscientific claims that they have “dismantled porn addiction,” watch Gabe Deem’s video: PORN MYTHS – The Truth Behind Addiction And Sexual Dysfunctions.

The following articles cite numerous studies, furnish illustrative examples, and elaborate logical arguments to dismantle many common anti-porn addiction propaganda talking points:

This section collects studies about which many experts have reservations – Questionable & Misleading Studies. In some, the methodology raises concerns. In others, the conclusions appear inadequately supported. In others, the title or terminology used is misleading given the actual study results. Some grossly misrepresent the actual findings.

All the Neuroscience Supports the Porn Addiction Model

Listed below are all the studies assessing the brain structure and functioning of Internet porn users (even the one claiming to have debunked porn addiction). To date every study offers support for the porn addiction model. The results of these 28 studies (and upcoming studies) are consistent with 180+ Internet addiction brain studies, many of which also include internet porn use. All support the premise that internet porn use can cause addiction-related brain changes, as do recent neuroscience-based reviews of the literature:

  1. Neuroscience of Internet Pornography Addiction: A Review and Update (2015). The review also critiques two recent headline-grabbing EEG studies which purport to have “debunked” porn addiction.
  2. Sex Addiction as a Disease: Evidence for Assessment, Diagnosis, and Response to Critics (2015), which provides a chart that takes on specific criticisms and offers citations that counter them.
  3. Neurobiology of Compulsive Sexual Behavior: Emerging Science (2016) Excerpt: “Given some similarities between CSB and drug addictions, interventions effective for addictions may hold promise for CSB, thus providing insight into future research directions to investigate this possibility directly.”
  4. Should Compulsive Sexual Behavior be Considered an Addiction? (2016) Excerpt: “Overlapping features exist between CSB and substance use disorders. Common neurotransmitter systems may contribute to CSB and substance use disorders, and recent neuroimaging studies highlight similarities relating to craving and attentional biases. Similar pharmacological and psychotherapeutic treatments may be applicable to CSB and substance addictions”
  5. Neurobiological Basis of Hypersexuality (2016). Excerpt: “Taken together, the evidence seems to imply that alterations in the frontal lobe, amygdala, hippocampus, hypothalamus, septum, and brain regions that process reward play a prominent role in the emergence of hypersexuality. Genetic studies and neuropharmacological treatment approaches point at an involvement of the dopaminergic system.
  6. Compulsive Sexual Behaviour as a Behavioural Addiction: The Impact of the Internet and Other Issues (2016)  Excerpts: “more emphasis is needed on the characteristics of the internet as these may facilitate problematic sexual behaviour.” and “clinical evidence from those who help and treat such individuals should be given greater credence by the psychiatric community.”
  7. Cybersex Addiction (2015) Excerpts: In recent articles, cybersex addiction is considered a specific type of Internet addiction. Some current studies investigated parallels between cybersex addiction and other behavioral addictions, such as Internet Gaming Disorder. Cue-reactivity and craving are considered to play a major role in cybersex addiction. Neuroimaging studies support the assumption of meaningful commonalities between cybersex addiction and other behavioral addictions as well as substance dependency.
  8. Searching for clarity in muddy water: future considerations for classifying compulsive sexual behavior as an addiction (2016) – Excerpts: We recently considered evidence for classifying compulsive sexual behavior (CSB) as a non-substance (behavioral) addiction. Our review found that CSB shared clinical, neurobiological and phenomenological parallels with substance-use disorders. Although the American Psychiatric Association rejected hypersexual disorder from DSM-5, a diagnosis of CSB (excessive sex drive) can be made using ICD-10. CSB is also being considered by ICD-11.
  9. Is Internet Pornography Causing Sexual Dysfunctions? A Review with Clinical Reports (2016) – An extensive review of the literature related to porn-induced sexual problems. Involving US Navy doctors, the review provides the latest data revealing a tremendous rise in youthful sexual problems. It also reviews the neurological studies related to porn addiction and sexual conditioning via Internet porn. The doctors provide 3 clinical reports of men who developed porn-induced sexual dysfunctions.
  10. Integrating psychological and neurobiological considerations regarding the development and maintenance of specific Internet-use disorders: An Interaction of Person-Affect-Cognition-Execution model (2016) – A review of the mechanisms underlying the development and maintenance of specific Internet-use disorders, including “Internet-pornography-viewing disorder”. The authors suggest that pornography addiction (and cybersex addiction) be classified as internet use disorders and placed with other behavioral addictions under substance-use disorders as addictive behaviors.

See Questionable & Misleading Studies for highly publicized papers that are not what they claim to be.

See this page for the many studies linking porn use to sexual problems and decreased sexual & relationship satisfaction

“Brain Studies” (fMRI, MRI, EEG, Neuro-endocrine):

  1. Brain Structure and Functional Connectivity Associated With Pornography Consumption: The Brain on Porn (2014) – This Max Planck Institute fMRI study found less gray matter in the reward system (dorsal striatum) correlating with the amount of porn consumed. It also found that more porn use correlated with less reward circuit activation while briefly viewing sexual photos. Researchers believed their findings indicated desensitization, and possibly tolerance, which is the need for greater stimulation to achieve the same high. The study also reported that more porn viewing was linked to poorer connections between the reward circuit and prefrontal cortex.
  2. Neural Correlates of Sexual Cue Reactivity in Individuals with and without Compulsive Sexual Behaviours (2014) – The first in a series of Cambridge University studies found the same brain activity pattern as seen in drug addicts and alcoholics. It also found that porn addicts fit the accepted addiction model of wanting “it” more, but not liking “it” more. The researchers also reported that 60% of subjects (average age: 25) had difficulty achieving erections/arousal with real partners, yet could achieve erections with porn.
  3. Enhanced Attentional Bias towards Sexually Explicit Cues in Individuals with and without Compulsive Sexual Behaviours (2014) – The second Cambridge University study. An excerpt: “Our findings of enhanced attentional bias… suggest possible overlaps with enhanced attentional bias observed in studies of drug cues in disorders of addictions. These findings converge with recent findings of neural reactivity to sexually explicit cues in [porn addicts] in a network similar to that implicated in drug-cue-reactivity studies and provide support for incentive motivation theories of addiction underlying the aberrant response to sexual cues in [porn addicts].
  4. Novelty, Conditioning and Attentional Bias to Sexual Rewards (2015) – Another Cambridge University fMRI study. Compared to controls porn addicts preferred sexual novelty and conditioned cues associated porn. However, the brains of porn addicts habituated faster to sexual images. Since novelty preference wasn’t pre-existing, porn addiction drives novelty-seeking in an attempt to overcome habituation and desensitization.
  5. Neural Substrates of Sexual Desire in Individuals with Problematic Hypersexual Behavior (2015) – This Korean fMRI study replicates other brain studies on porn users. Like the Cambridge University studies it found cue-induced brain activation patterns in sex addicts which mirrored the patterns of drug addicts. In line with several German studies it found alterations in the prefrontal cortex which match the changes observed in drug addicts. What’s new is that the findings perfectly matched the prefrontal cortex activation patterns observed in drug addicts: Greater cue-reactivity to sexual images, yet inhibited response to other normal stimuli.
  6. Sexual Desire, not Hypersexuality, is Related to Neurophysiological Responses Elicited by Sexual Images (2013) – This EEG study was touted in the media as evidence against the existence of porn addiction. Not so. This SPAN Lab study, like #7 below, actually lends support to the existence of porn addiction. How so? The study reported higher EEG readings (P300) when subjects were briefly exposed to pornographic photos. Studies consistently show that an elevated P300 occurs when addicts are exposed to cues (such as images) related to their addiction. However, due to methodological flaws the findings are uninterpretable: 1) subjects were heterogeneous (males, females, non-heterosexuals); 2) subjects were not screened for mental disorders or addictions; 3) study had no control group for comparison; 4) questionnaires were not validated for porn addiction. In line with the Cambridge University brain scan studies, this EEG study reported greater cue-reactivity to porn correlated with less desire for partnered sex. To put another way – individuals with more brain activation and cravings for porn would rather masturbate to porn than have sex with a real person. Study spokesman Nicole Prause claimed that porn users merely had high libido, yet the results of the study say something quite different. Four peer-reviewed papers expose the truth: 1, 2, 3, 4. Also see the extensive YBOP critique.
  7. Modulation of Late Positive Potentials by Sexual Images in Problem Users and Controls Inconsistent with “Porn Addiction” (2015) – Another SPAN Lab EEG study comparing the 2013 subjects from the above study to an actual control group (yet suffered from the same methodological flaws named above). The results: compared to controls porn addicts had less response to one-second exposure to photos of vanilla porn. The lead author, Nicole Prause, claims these results “debunk porn addiction”. However, these findings align perfectly with Kühn & Gallinat (2014), which found that more porn use correlated with less brain activation in response to pictures of vanilla porn. Another EEG study found that greater porn use in women correlated with less brain activation to porn. Put simply, frequent porn users were desensitized and needed greater stimulation to achieve the same buzz. See this extensive YBOP critique. Five peer-reviewed papers agree with YBOP: 1, 2, 3, 4. 5
  8. HPA axis dysregulation in men with hypersexual disorder (2015) – The Hypothalamus-Pituitary-Adrenal (HPA) axis is the central player in our stress response. Addictions alter the brain’s stress circuits leading to a dysfunctional HPA axis. This study on sex addicts (hypersexuals) found altered stress responses that mirror drug addiction.
  9. Compulsive sexual behavior: Prefrontal and limbic volume and interactions (2016) – Compared to healthy controls CSB subjects (porn addicts) had increased left amygdala volume and reduced functional connectivity between the amygdala and dorsolateral prefrontal cortex DLPFC. Reduced functional connectivity between the amygdala and the prefrontal cortex aligns with substance addictions. It is thought that poorer connectivity diminishes the prefrontal cortex’s control over a user’s impulse to engage in the addictive behavior. This study suggests that drug toxicity may lead to less gray matter and thus reduced amygdala volume in drug addicts. The amygdala is consistently active during porn viewing, especially during initial exposure to a sexual cue. Perhaps the constant sexual novelty and searching and seeking leads to a unique effect on the amygdala in compulsive porn users. Alternatively, years of porn addiction and severe negative consequences is very stressful – and chronic social stress is related to increased amygdala volume. Study #8 above found that “sex addicts” have a overactive stress system. Could the chronic stress related to porn/sex addiction, along with factors that make sex unique, lead to greater amygdala volume?
  10. Increased sensitivity to erotic reward cues in subjects with compulsive sexual behaviors (2015) – (In the press) This upcoming fMRI study compared reward center activity of controls to compulsive porn users. Compared to controls compulsive porn users had far greater reward center activity and attentional bias when exposed to sexual cues. Both findings align with the two Cambridge studies (above), and the accepted model of addiction – incentive sensitization.
  11. Can pornography be addictive? An fMRI study of men seeking treatment for problematic pornography use (2016) – (in the press) Excerpts: Men with and without problematic porn sue (PPU) differed in brain reactions to cues predicting erotic pictures, but not in reactions to erotic pictures themselves, consistent with the incentive salience theory of addictions. This brain activation was accompanied by increased behavioral motivation to view erotic images (higher ‘wanting’). Ventral striatal reactivity for cues predicting erotic pictures was significantly related to the severity of PPU, amount of pornography use per week and number of weekly masturbations. Our findings suggest that like in substance-use and gambling disorders the neural and behavioral mechanisms linked to anticipatory processing of cues relate importantly to clinically relevant features of PPU. These findings suggest that PPU may represent a behavioral addiction and that interventions helpful in targeting behavioral and substance addictions warrant consideration for adaptation and use in helping men with PPU.
  12. Altered Appetitive Conditioning and Neural Connectivity in Subjects With Compulsive Sexual Behavior (2016) – A German fMRI study replicating two major findings from Voon et al., 2014 and Kuhn & Gallinat 2014. Main Findings: The neural correlates of appetitive conditioning and neural connectivity were altered in the CSB group. According to the researchers, the first alteration – heightened amygdala activation – might reflect facilitated conditioning (greater “wiring” to previously neutral cues predicting porn images). The second alteration – decreased connectivity between the ventral striatum and the prefrontal cortex – could be a marker for impaired ability to control impulses. Said the researchers, “These [alterations] are in line with other studies investigating the neural correlates of addiction disorders and impulse control deficits.” The findings of greater amygdalar activation to cues (sensitization) and decreased connectivity between the reward center and the prefrontal cortex (hypofrontality) are two of the major brain changes seen in substance addiction. In addition, 3 of the 20 compulsive porn users suffered from “orgasmic-erection disorder”.
  13. Compulsivity across the pathological misuse of drug and non-drug rewards (2016) – A Cambridge University study comparing aspects of compulsivity in alcoholics, binge-eaters, video game addicts and porn addicts (CSB). Excerpts: CSB subjects were faster to learning from rewards in the acquisition phase compared to healthy volunteers and were more likely to perseverate or stay after either a loss or a win in the Reward condition. These findings converge with our previous findings of enhanced preference for stimuli conditioned to either sexual or monetary outcomes, overall suggesting enhanced sensitivity to rewards (Banca et al., 2016).
  14. Preliminary investigation of the impulsive and neuroanatomical characteristics of compulsive sexual behavior (2009) – Primarily sex addicts. Study reports more impulsive behavior in a Go-NoGo task in sex addicts (hypersexuals) compared to control participants. Brain scans revealed that sex addicts had greater disorganized prefrontal cortex white matter. This finding is consistent with hypofrontality, a hallmark of addiction.

The above studies are all the “brain studies” published (or in the press) on internet porn users.

Together these brain studies found:

  1. The 3 major addiction-related brain changes: sensitization, desensitization, and hypofrontality.
  2. More porn use correlated with less grey matter in the reward circuit (dorsal striatum).
  3. More porn use correlated with less reward circuit activation when briefly viewing sexual images.
  4. More porn use correlated with disrupted neural connections between the reward circuit and prefrontal cortex.
  5. Addicts had greater prefrontal activity to sexual cues, but less brain activity to normal stimuli (matches drug addiction).
  6. 60% of compulsive porn addicted subjects in one study experienced ED or low libido with partners, but not with porn: all stated that internet porn use caused their ED/low libido.
  7. Enhanced attentional bias comparable to drug users. Indicates sensitization (a product of DeltaFosb).
  8. Greater wanting & craving for porn, but not greater liking. This aligns with the accepted model of addiction – incentive sensitization.
  9. Porn addicts have greater preference for sexual novelty yet their brains habituated faster to sexual images. Not pre-existing.
  10. The younger the porn users the greater the cue-induced reactivity in the reward center.
  11. Higher EEG (P300) readings when porn users were exposed to porn cues (which occurs in other addictions).
  12. Less desire for sex with a person correlating with greater cue-reactivity to porn images.
  13. More porn use correlated with lower LPP amplitude when briefly viewing sexual photos: indicates habituation or desensitization.
  14. Dysfunctional HPA axis which reflects altered brain stress circuits, which occurs in drug addictions (and greater amygdala volume, which is associated with chronic social stress).

Neuro-Psychological Studies on Porn Users (with excerpts):

  1. Watching Pornographic Pictures on the Internet: Role of Sexual Arousal Ratings and Psychological-Psychiatric Symptoms for Using Internet Sex Sites Excessively (2011)Results indicate that self-reported problems in daily life linked to online sexual activities were predicted by subjective sexual arousal ratings of the pornographic material, global severity of psychological symptoms, and the number of sex applications used when being on Internet sex sites in daily life, while the time spent on Internet sex sites (minutes per day) did not significantly contribute to explanation of variance in IATsex score. We see some parallels between cognitive and brain mechanisms potentially contributing to the maintenance of excessive cybersex and those described for individuals with substance dependence
  2. Pornographic picture processing interferes with working memory performance (2013)Some individuals report problems during and after Internet sex engagement, such as missing sleep and forgetting appointments, which are associated with negative life consequences. One mechanism potentially leading to these kinds of problems is that sexual arousal during Internet sex might interfere with working memory (WM) capacity, resulting in a neglect of relevant environmental information and therefore disadvantageous decision making. Results revealed worse WM performance in the pornographic picture condition of the 4-back task compared with the three remaining picture conditions. Findings are discussed with respect to Internet addiction because WM interference by addiction-related cues is well known from substance dependencies.
  3. Sexual Picture Processing Interferes with Decision-Making Under Ambiguity (2013) Decision-making performance was worse when sexual pictures were associated with disadvantageous card decks compared to performance when the sexual pictures were linked to the advantageous decks. Subjective sexual arousal moderated the relationship between task condition and decision-making performance. This study emphasized that sexual arousal interfered with decision-making, which may explain why some individuals experience negative consequences in the context of cybersex use.
  4. Cybersex addiction: Experienced sexual arousal when watching pornography and not real-life sexual contacts makes the difference (2013)The results show that indicators of sexual arousal and craving to Internet pornographic cues predicted tendencies towards cybersex addiction in the first study. Moreover, it was shown that problematic cybersex users report greater sexual arousal and craving reactions resulting from pornographic cue presentation. In both studies, the number and the quality with real-life sexual contacts were not associated to cybersex addiction. The results support the gratification hypothesis, which assumes reinforcement, learning mechanisms, and craving to be relevant processes in the development and maintenance of cybersex addiction. Poor or unsatisfying sexual real life contacts cannot sufficiently explain cybersex addiction.
  5. Cybersex addiction in heterosexual female users of internet pornography can be explained by gratification hypothesis (2014)Results indicated that Internet porn users rated pornographic pictures as more arousing and reported greater craving due to pornographic picture presentation compared with non-users. Moreover, craving, sexual arousal rating of pictures, sensitivity to sexual excitation, problematic sexual behavior, and severity of psychological symptoms predicted tendencies toward cybersex addiction in porn users. Being in a relationship, number of sexual contacts, satisfaction with sexual contacts, and use of interactive cybersex were not associated with cybersex addiction.
  6. Empirical Evidence and Theoretical Considerations on Factors Contributing to Cybersex Addiction From a Cognitive Behavioral View (2014) Previous work suggests that some individuals might be vulnerable to CA, while positive reinforcement and cue-reactivity are considered to be core mechanisms of CA development. In this study, 155 heterosexual males rated 100 pornographic pictures and indicated their increase of sexual arousal. Moreover, tendencies towards CA, sensitivity to sexual excitation, and dysfunctional use of sex in general were assessed. The results of the study show that there are factors of vulnerability to CA and provide evidence for the role of sexual gratification and dysfunctional coping in the development of CA.
  7. Prefrontal control and internet addiction: a theoretical model and review of neuropsychological and neuroimaging findings (2015)Consistent with this, results from functional neuroimaging and other neuropsychological studies demonstrate that cue-reactivity, craving, and decision making are important concepts for understanding Internet addiction. The findings on reductions in executive control are consistent with other behavioral addictions, such as pathological gambling. They also emphasize the classification of the phenomenon as an addiction, because there are also several similarities with findings in substance dependency.  Moreover, the results of the current study are comparable to findings from substance dependency research and emphasize analogies between cybersex addiction and substance dependencies or other behavioral addictions.
  8. Implicit associations in cybersex addiction: Adaption of an Implicit Association Test with pornographic pictures. (2015)Recent studies show similarities between cybersex addiction and substance dependencies and argue to classify cybersex addiction as a behavioral addiction. In substance dependency, implicit associations are known to play a crucial role. Results show positive relationships between implicit associations of pornographic pictures with positive emotions and tendencies towards cybersex addiction, problematic sexual behavior, sensitivity towards sexual excitation as well as subjective craving.
  9. Symptoms of cybersex addiction can be linked to both approaching and avoiding pornographic stimuli: results from an analog sample of regular cybersex users (2015)Results showed that individuals with tendencies toward cybersex addiction tended to either approach or avoid pornographic stimuli. Additionally, moderated regression analyses revealed that individuals with high sexual excitation and problematic sexual behavior who showed high approach/avoidance tendencies, reported higher symptoms of cybersex addiction. Analogous to substance dependencies, results suggest that both approach and avoidance tendencies might play a role in cybersex addiction.
  10. Getting stuck with pornography? Overuse or neglect of cybersex cues in a multitasking situation is related to symptoms of cybersex addiction (2015)Individuals with tendencies towards cybersex addiction seem to have either an inclination to avoid or to approach the pornographic material, as discussed in motivational models of addiction. The results of the current study point towards a role of executive control functions, i.e. functions mediated by the prefrontal cortex, for the development and maintenance of problematic cybersex use (as suggested by Brand et al., 2014). Particularly a reduced ability to monitor consumption and to switch between pornographic material and other contents in a goal adequate manner may be one mechanism in the development and maintenance of cybersex addiction.
  11. Trading Later Rewards for Current Pleasure: Pornography Consumption and Delay Discounting (2015)Study 1: Participants completed a pornography use questionnaire and a delay discounting task at Time 1 and then again four weeks later. Participants reporting higher initial pornography use demonstrated a higher delay discounting rate at Time 2, controlling for initial delay discounting. Study 2:  Participants who abstained from pornography use demonstrated lower delay discounting than participants who abstained from their favorite food. The finding suggests that Internet pornography is a sexual reward that contributes to delay discounting differently than other natural rewards. It is therefore important to treat pornography as a unique stimulus in reward, impulsivity, and addiction studies and to apply this accordingly in individual as well as relational treatment.
  12. Sexual Excitability and Dysfunctional Coping Determine Cybersex Addiction in Homosexual Males (2015) Recent findings have demonstrated an association between CyberSex Addiction (CA) severity and indicators of sexual excitability, and that coping by sexual behaviors mediated the relationship between sexual excitability and CA symptoms. The aim of this study was to test this mediation in a sample of homosexual males. Questionnaires assessed symptoms of CA, sensitivity to sexual excitation, pornography use motivation, problematic sexual behavior, psychological symptoms, and sexual behaviors in real life and online. Moreover, participants viewed pornographic videos and indicated their sexual arousal before and after the video presentation. Results showed strong correlations between CA symptoms and indicators of sexual arousal and sexual excitability, coping by sexual behaviors, and psychological symptoms. CA was not associated with offline sexual behaviors and weekly cybersex use time. Coping by sexual behaviors partially mediated the relationship between sexual excitability and CA. The results are comparable with those reported for heterosexual males and females in previous studies and are discussed against the background of theoretical assumptions of CA, which highlight the role of positive and negative reinforcement due to cybersex use.
  13. Subjective Craving for Pornography and Associative Learning Predict Tendencies Towards Cybersex Addiction in a Sample of Regular Cybersex Users (2016)There is no consensus regarding the diagnostic criteria of cybersex addiction. Some approaches postulate similarities to substance dependencies, for which associative learning is a crucial mechanism. In this study, 86 heterosexual males completed a Standard Pavlovian to Instrumental Transfer Task modified with pornographic pictures to investigate associative learning in cybersex addiction. Additionally, subjective craving due to watching pornographic pictures and tendencies towards cybersex addiction were assessed. Results showed an effect of subjective craving on tendencies towards cybersex addiction, moderated by associative learning.  Overall, these findings point towards a crucial role of associative learning for the development of cybersex addiction, while providing further empirical evidence for similarities between substance dependencies and cybersex addiction
  14. Exploring the Relationship between Sexual Compulsivity and Attentional Bias to Sex-Related Words in a Cohort of Sexually Active Individuals (2016) – This study replicates the findings of this 2014 Cambridge University study that compared the attentional bias of porn addicts to healthy controls. The new study differs: rather than comparing porn addicts to controls, the new study correlated scores on a sex addiction questionnaire to the results of a task assessing attentional bias (explanation of attentional bias). The study described two key results: 1) Higher sexual compulsivity scores correlated with greater interference (increased distraction) during the attentional bias task. This aligns with substance abuse studies. 2) Among those scoring high on sexual addiction, fewer years of sexual experience were related to greater attentional bias. The authors concluded that this result could indicate that more years of “compulsive sexual activity” lead to greater habituation or a general numbing of the pleasure response (desensitization). An excerpt from the conclusion section: “One possible explanation for these results is that as a sexually compulsive individual engages in more compulsive behaviour, an associated arousal template develops and that over time, more extreme behaviour is required for the same level of arousal to be realised. It is further argued that as an individual engages in more compulsive behaviour, neuropathways become desensitized to more ‘normalised’ sexual stimuli or images and individuals turn to more ‘extreme’ stimuli to realise the arousal desired.”

Critique of: Letter to the editor “Prause et al. (2015) the latest falsification of addiction predictions”

Introduction – In response to neuroscientist Matuesz Gola’s critical analysis of their 2015 EEG study (Prause et al., 2015), Prause et al. wrote their own letter to the editor, entitled, “Prause et al. (2015) the latest falsification of addiction predictions,” which we will refer to as the “Reply to Gola.” (Interestingly, the editor’s original “accepted manuscript” of the Reply to Gola listed only Nicole Prause as the author, so it’s unclear if her co-authors participated in crafting the Reply to Gola, or whether it was a solo effort by Prause.)

Certainly, most of the Reply to Gola is devoted to defending Prause’s interpretations. Back in 2015 Prause made over-the-top claims that her team’s anomalous study had singlehandedly “debunked porn addiction.” What legitimate researcher would ever claim to have “debunked” an entire field of research and to have “falsified” all previous studies with a single EEG study?

Now, in 2016, the Reply to Gola’s closing paragraph puts forward an equally unwarranted assertion that a handful of papers, spearheaded by Prause’s single EEG study, falsify “multiple predictions of the addiction model.”

In Section #1 below we debunk the falsification claim by revealing what the papers cited in the Reply to Gola actually found (and did not find), as well as bringing to light the many relevant studies omitted. In Section #2 below, we examine other unsupported claims and inaccuracies in the Reply to Gola. Before we begin, here are links to the pertinent items:


SECTION ONE: Debunking the Prause et al. Claimed Falsification of The Addiction Model

This is the closing paragraph where Prause et al. summarizes the evidence purporting to falsify the porn addiction model:

“In closing, we highlight the Popperian falsification of multiple predictions of the addiction model using multiple methods. Most addiction models require that addicted individuals exhibit less control over their urge to use (or engage in the behavior); those reporting more problems with viewing sexual images actually have better control over their sexual response (replicated by Moholy, Prause, Proudfit, Rahman, & Fong, 2015; first study by Winters, Christoff, & Gorzalka, 2009). Addiction models typically predict negative consequences. Although erectile dysfunction is the most commonly suggested negative consequence of porn use, erectile problems actually are not elevated by viewing more sex films (Landripet & Štulhofer, 2015; Prause & Pfaus, 2015; Sutton, Stratton, Pytyck, Kolla, & Cantor, 2015). Addiction models often propose that the substance use or behavior is used to ameliorate or escape negative affect. Those reporting problems with sex films actually reported less negative affect at baseline/pre-viewing than controls (Prause, Staley, & Fong, 2013). Meanwhile, two more compelling models have received more support since the publication of Prause et al. (2015). These include a high sex drive model (Walton, Lykins, & Bhullar, 2016) supporting the original high-drive hypothesis (Steele, Prause, Staley, & Fong, 2013). Parsons et al. (2015) have suggested that high sex drive may represent a subset of those reporting problems. Also, distress related to viewing sex films has been shown to be most strongly related to conservative values and religious history (Grubbs et al., 2014). This supports a social shame model of problem sex film viewing behaviors. The discussion should move from testing the addiction model of sex film viewing, which has had multiple predictions falsified by independent laboratory replications, to identifying a better fitting model of those behaviors.”

Before we address each of the above assertions, it’s important to reveal what Prause et al. chose to omit from the so-called “falsification”:

  1. Studies on actual porn addicts. You read that right. Of all the studies cited, only one contained a group of porn addicts, and 71% of those subjects reported severe negative effects. Bottom line: You cannot falsify “porn addiction” if the studies you cite don’t investigate porn addicts.
  2. All the neurological studies published on porn users and sex addicts – because all support the addiction model. This page lists 28 neuroscience-based studies (MRI, fMRI, EEG, Neurospych, Hormonal) providing strong support for the addiction model.
  3. All the peer-reviewed reviews of the literature – because all support the porn addiction model. Here are 10 literature reviews by some of the top neuroscientists in the world, supporting the porn addiction model.
  4. 17 studies linking porn use/sex addiction to sexual problems. The first 3 studies in the list demonstrate causation, as participants eliminated porn use and healed chronic sexual dysfunctions.
  5. Over 30 studies linking porn use to less sexual and relationship satisfaction.
  6. All the many studies on adolescents, which report porn use is related to poorer academics, more sexist attitudes, more aggression, poorer health, poorer relationships, lower life satisfaction, viewing people as objects, increased sexual risk taking, less condom use, greater sexual violence, greater sexual coercion, less sexual satisfaction, lower libido, greater permissive attitudes, and a whole lot more. (In short, ED is not the “most commonly suggested negative consequence of porn use” as claimed in the Reply to Gola below.)

In the Reply to Gola, Prause et al. attempt to falsify each of the following Claims (“predictions”) relating to the addiction model. The relevant excerpts and supporting studies from the Reply to Gola are given in full, followed by comments.


Claim 1: The inability to control use despite negative consequences.

PRAUSE: “Most addiction models require that addicted individuals exhibit less control over their urge to use (or engage in the behavior); those reporting more problems with viewing sexual images actually have better control over their sexual response (replicated by Moholy, Prause, Proudfit, Rahman, & Fong, 2015; first study by Winters, Christoff, & Gorzalka, 2009)”

The 2 studies cited falsified nothing as they did not assess if subjects had trouble controlling their porn use. Most importantly, neither study started by assessing who was or wasn’t a “porn addict.” How can you debunk the porn addiction model if you don’t begin by assessing subjects with clear evidence of (what addiction experts define as) addiction? Let’s briefly examine what the 2 studies actually assessed and reported, and why they falsify nothing:

Winters, Christoff, & Gorzalka, 2009 (Dysregulated Sexuality and High Sexual Desire: Distinct Constructs?):

  • The purpose of this study was to see if men could dampen their self-reported sexual arousal while watching sex films. The important findings: the men best at suppressing sexual arousal were also best at making themselves laugh. The men least successful at suppressing sexual arousal were generally hornier than the rest. These findings have nothing to do with actual porn addicts’ “inability to control use despite severe negative consequences.”
  • This online anonymous survey did not assess who was and who wasn’t a “porn addict,” because the assessment tool was the “Sexual Compulsivity Scale” (SCS). The SCS isn’t a valid assessment test for Internet-porn addiction or for women, so the study’s findings do not apply to internet porn addicts. The SCS was created in 1995 and designed with uncontrolled sexual relations in mind (in connection with investigating the AIDS epidemic). The SCS says:

“The scale has been shown to predict rates of sexual behaviors, numbers of sexual partners, practice of a variety of sexual behaviors, and histories of sexually transmitted diseases.”

Moholy, Prause, Proudfit, Rahman, & Fong, 2015 (Sexual desire, not hypersexuality, predicts self-regulation of sexual arousal):

  • This study, like the above study, did not assess which participants were or were not “porn addicts.” This study relied upon the CBSOB, which has zero questions about Internet porn use. It only asks about “sexual activities,” or if subjects are worried about their activities (e.g., “I am worried I am pregnant,” “I gave someone HIV,” “I experienced financial problems”). Thus any correlations between scores on the CBSOB and ability to regulate arousal are not relevant to many internet porn addicts, who do not engage in partnered sex.
  • Like the Winters study above, this study reported that hornier participants had a harder time down-regulating their sexual arousal while watching porn. Prause et al. are right: this study replicated Winters, et al., 2009: hornier people have higher sexual desire. (Duh)
  • This study has the same fatal flaw seen in other Prause-team studies: The researchers chose vastly different subjects (women, men, heterosexuals, non-heterosexuals), but showed them all standard, possibly uninteresting, male+female porn. Put simply, the results of this study were dependent on the premise that males, females, and non-heterosexuals do not differ in their response to a set of sexual images. This is clearly not the case.

Even though neither study identified which participants were porn addicts, the Reply to Gola seems to claim that actual “porn addicts” should be the least able to control their sexual arousal while viewing porn. Yet why would the Reply to Gola’s authors think porn addicts should have “higher arousal’ when Prause et al., 2015 reported that “porn addicts” had less brain activation to vanilla porn that did controls? (Incidentally, another EEG study also found that greater porn use in women correlated with less brain activation to porn.) The findings of Prause et al. 2015 align with Kühn & Gallinat (2014), which found that more porn use correlated with less brain activation in response to pictures of vanilla porn.

Prause et al. 2015’s EEG findings also align with Banca et al. 2015, which found faster habituation to sexual images in porn addicts. Lower EEG readings mean that subjects are paying less attention to the pictures. The more frequent porn users were probably bored by vanilla porn shown in the lab. Moholy & Prause’s compulsive porn users did not “have better control over their sexual response.” Instead, they had become habituated or desensitized to static images of vanilla porn.

It is not uncommon for frequent porn users to develop tolerance, which is the need for greater stimulation in order to achieve the same level of arousal. A similar phenomenon occurs in substance abusers who require bigger “hits” to achieve the same high. With porn users, greater stimulation is often achieved by escalating to new or extreme genres of porn.

New genres that induce shock, surprise, violation of expectations or even anxiety can function to increase sexual arousal, which often flags in those who overuse internet porn. A recent study found that such escalation is very common in today’s internet porn users. 49% of the men surveyed had viewed porn that “was not previously interesting to them or that they considered disgusting.” In sum, multiple studies have reported habituation or escalation in frequent porn users – an effect entirely consistent with the addiction model.

Key point: This entire claim in the Reply to Gola rests upon the unsupported prediction that “porn addicts” should experience greater sexual arousal to static images of vanilla porn, and thus less ability to control their arousal. Yet the prediction that compulsive porn users or addicts experience greater arousal to vanilla porn and greater sexual desire have repeatedly been falsified by several lines of research:

  1. 17 studies link porn use to lower sexual arousal or sexual dysfunctions with sex partners.
  2. 18 studies falsify the claim that sex and porn addicts “have high sexual desire” (more below).
  3. Multiple studies correlate porn use with lower sexual satisfaction.

In summary:

  • The two studies cited have nothing to do with porn addicts’ inability to control use despite negative consequences.
  • The two studies cited did not identify who was or wasn’t a porn addict, so can tell us nothing about “porn addiction.”
  • Those subjects who scored higher on the sex addiction questionnaire (not porn addiction) did not “control their arousal better” while viewing vanilla porn. They were very likely bored by the vanilla porn (i.e., desensitized, which is an addiction-related brain change).

Claim 2: Addicts use the substance or behavior to escape negative emotions

PRAUSE: “Addiction models often propose that the substance use or behavior is used to ameliorate or escape negative affect. Those reporting problems with sex films actually reported less negative affect at baseline/pre-viewing than controls (Prause, Staley, & Fong, 2013).”

While addicts often do use to escape negative affect (emotions), once again the Reply to Gola cites as support a study that has nothing to do with falsifying the above addiction prediction. Prause, Staley & Fong 2013 did not examine this phenomenon at all. Here’s what it actually reported:

“Unexpectedly, the VSS-P group exhibited significantly less coactivation of positive and negative affect to the sexual film than VSS-C.”

Translation: the so-called “porn addicts” (VSS-P group) had less emotional reaction to porn than did the control group (VSS-C). Put simply, “porn addicts” experienced less emotional response to both sexual and neutral films. Key point: Prause’s 2013 study used the same subjects as Prause et al., 2015, which is the very same 2015 EEG study that found less brain activation to static images of vanilla porn.

There’s a very simple explanation for the “more frequent porn users” having less emotional response to viewing vanilla porn. Vanilla porn no longer registered as all that interesting. The same goes “more frequent porn users” reactions to the neutral films – they were desensitized. Prause, Staley, & Fong, 2013 (also called Prause et al., 2013) has been thoroughly critiqued here.

A few patterns emerge in the Reply to Gola’s claims of falsification:

  1. The studies cited have nothing to do with the falsification of the porn addiction model.
  2. Prause often cites her own studies.
  3. The 3 Prause Studies (Prause et al., 2013, Prause et al., 2015, Steele et al., 2013.) all involved the same subjects.

Here’s what we know about the “porn addicted users” in Prause’s 3 studies (the “Prause Studies“): They were not necessarily addicts, as they were never assessed for porn addiction. Thus, they can’t legitimately be used to “falsify” anything to do with the addiction model. As a group they were desensitized or habituated to vanilla porn, which is consistent with predictions of the addiction model. Here’s what each study actually reported about the “porn addicted” subjects:

  1. Prause et al., 2013: “Porn addicted users” reported more boredom and distraction while viewing vanilla porn.
  2. Steele et al., 2013:  Individuals with greater cue-reactivity to porn had less desire for sex with a partner, but not less desire to masturbate.
  3. Prause et al., 2015: “Porn addicted users” had less brain activation to static images of vanilla porn. Lower EEG readings mean that the “porn addicted” subjects were paying less attention to the pictures.

A clear pattern emerges from the three studies: The “porn addicted users” were desensitized or habituated to vanilla porn, and those with greater cue-reactivity to porn preferred to masturbate to porn than have sex with a real person. Put simply they were desensitized (a common indication of addiction) and preferred artificial stimuli to a very powerful natural reward (partnered sex). There is no way to interpret these results as falsifying porn addiction.

You cannot falsify the porn addiction model if your “porn addicts” are not really porn addicts.

A major flaw in the Prause Studies is that no one knows which, if any, of Prause’s subjects were actually porn addicts. This is why there are often quotation marks around “porn addicts” in our descriptions of these 3 studies. The subjects were recruited from Pocatello, Idaho via online advertisements requesting people who were “experiencing problems regulating their viewing of sexual images.” Pocatello, Idaho is over 50% Mormon, so many of the subjects may feel that any amount of porn use is a serious problem.

In a 2013 interview Nicole Prause admits that a number of her subjects experienced only minor problems (which means they were not porn addicts):

“This study only included people who reported problems, ranging from relatively minor to overwhelming problems, controlling their viewing of visual sexual stimuli.”

Again, the questionnaire employed in the 3 studies to assess “porn addiction” (Sexual Compulsivity Scale) was not validated as a screening instrument for porn addiction. It was created in 1995 and designed with uncontrolled sexual relations (with partners) in mind, in connection with investigating the AIDS epidemic. The SCS says:

“The scale has been should [shown?] to predict rates of sexual behaviors, numbers of sexual partners, practice of a variety of sexual behaviors, and histories of sexually transmitted diseases.”

Moreover, the Prause Studies administered the questionnaire to the female subjects. Yet the SCS’s developer warns that this tool won’t show psychopathology in women,

“Associations between sexual compulsivity scores and other markers of psychopathology showed different patterns for men and women; sexual compulsivity was associated with indexes of psychopathology in men but not in women.”

Besides not establishing which of the subjects were porn addicted, the Prause Studies did not screen subjects for mental disorders, compulsive behaviors, or other addictions. This is critically important for any “brain study” on addiction, lest confounds render results meaningless. Another fatal flaw is that the Prause study subjects were not heterogeneous. They were men and women, including 7 non-heterosexuals, but were all shown standard, possibly uninteresting, male+female porn. This alone discounts any findings. Why? Study after study confirms that men and women have significantly different brain responses to sexual images or films. This is why serious addiction researchers match subjects carefully.

In summary,

  • The study cited in the Reply to Gola (Prause et al., 2013) has nothing to do with assessing a porn addicts’ motivations for using porn. It certainly does not assess the extent to which porn addicts use porn to escape negative feelings.
  • The Prause Studies did not assess whether the subjects were porn addicts or not. The authors admitted that many of the subjects had little difficulty controlling use. All of the subjects would have to have been confirmed porn addicts to permit a legitimate comparison with a group of non-porn addicts.
  • All valid brain studies must have homogeneous subjects for accurate comparisons. Since the Prause Studies did not, the results are unreliable, and cannot be used to falsify anything.

Claim: Porn addicts simply have a “high sex drive”

PRAUSE: Meanwhile, two more compelling models have received more support since the publication of Prause et al. (2015). These include a high sex drive model (Walton, Lykins, & Bhullar, 2016) supporting the original high-drive hypothesis (Steele, Prause, Staley, & Fong, 2013). Parsons et al. (2015) have suggested that high sex drive may represent a subset of those reporting problems.

The claim that porn and sex addicts simply have “high sexual desire,” has been falsified by 18 recent studies. In fact, Nicole Prause stated in this Quora post that she no longer believes that “sex addicts” have high libidos:

“I was partial to the high sex drive explanation, but this LPP study we just published is persuading me to be more open to sexual compulsivity.”

No matter what any study has reported it’s important to address the spurious claim that “high sexual desire” is mutually exclusive with porn addiction. Its irrationality becomes clear if one considers hypotheticals based on other addictions. (For more, see this critique of Steele, Prause, Staley, & Fong, 2013 High desire’, or ‘merely’ an addiction? A response to Steele et al., 2013). For example, does such logic mean that being morbidly obese, unable to control eating, and being extremely unhappy about it, is simply a “high desire for food?”

Extrapolating further, one must conclude that alcoholics simply have a high desire for alcohol, right? The fact is that all addicts have “high desire” for their addictive substances and activities (called “sensitization“), even when their enjoyment of such activities declines due to other addiction-related brain changes (desensitization). However, it doesn’t annul their addiction (which remains a pathology).

Most addiction experts consider “continued use despite negative consequences” to be the prime marker of addiction. After all, someone could have porn-induced erectile dysfunction and be unable to venture beyond his computer in his mother’s basement due to porn’s effects on his motivation and social skills. Yet, according to these researchers, as long as he indicates “high sexual desire,” he has no addiction. This paradigm ignores everything known about addiction, including symptoms and behaviors shared by all addicts, such as severe negative repercussions, inability to control use, cravings, etc.

Let’s look more closely at the 3 studies cited in support of the above “high desire” claim:

1. Steele, Prause, Staley, & Fong, 2013 (Sexual desire, not hypersexuality, is related to neurophysiological responses elicited by sexual images):

We discussed this study above (Steele et al., 2013). In 2013 spokesperson Nicole Prause made two unsupported public claims about Steele et al., 2013:

  1. That subjects’ brain response differed from those seen in other types of addicts (cocaine was the example)
  2. That frequent porn users merely had “high sexual desire.”

Claim #1) The study reported higher EEG readings when subjects were briefly exposed to pornographic photos. Studies consistently show that an elevated P300 occurs when addicts are exposed to cues (such as images) related to their addiction. This finding supports the porn addiction model, as peer-reviewed papers explained ( 1, 2, 3, 4.) and psychology professor emeritus John A. Johnson pointed out in a comment under a 2013 Psychology Today Prause interview:

“My mind still boggles at the Prause claim that her subjects’ brains did not respond to sexual images like drug addicts’ brains respond to their drug, given that she reports higher P300 readings for the sexual images. Just like addicts who show P300 spikes when presented with their drug of choice. How could she draw a conclusion that is the opposite of the actual results?”

Dr. Johnson, who has no opinion on sex addiction, commented critically a second time under the Prause interview:

Mustanski asks, “What was the purpose of the study?” And Prause replies, “Our study tested whether people who report such problems [problems with regulating their viewing of online erotica] look like other addicts from their brain responses to sexual images.”

But the study did not compare brain recordings from persons having problems regulating their viewing of online erotica to brain recordings from drug addicts and brain recordings from a non-addict control group, which would have been the obvious way to see if brain responses from the troubled group look more like the brain responses of addicts or non-addicts…..

Claim #2) Study spokesperson Nicole Prause claimed that porn users merely had “high sexual desire,” yet the study reported greater cue-reactivity to porn correlating with less desire for partnered sex. To put another way, individuals with greater brain activation to porn would rather masturbate to porn than have sex with a real person. That’s not “high sexual desire.” An excerpt from a critique of Steele et al. taken from this 2015 review of the literature:

Moreover, the conclusion listed in the abstract, “Implications for understanding hypersexuality as high desire, rather than disordered, are discussed” [303] (p. 1) seems out of place considering the study’s finding that P300 amplitude was negatively correlated with desire for sex with a partner. As explained in Hilton (2014), this finding “directly contradicts the interpretation of P300 as high desire” [307]. The Hilton analysis further suggests that the absence of a control group and the inability of EEG technology to discriminate between “high sexual desire” and “sexual compulsion” render the Steele et al. findings uninterpretable [307].

Bottom line: The findings of Steele et al., 2013 actually falsify the assertions made in the Reply to Gola.

2. Parsons et al., 2015 (Hypersexual, Sexually Compulsive, or Just Highly Sexually Active? Investigating Three Distinct Groups of Gay and Bisexual Men and Their Profiles of HIV-Related Sexual Risk):

Like nearly every study cited in the Reply to Gola, this study failed to assess which subjects were, in fact, porn addicted. It employed two questionnaires that asked only about sexual behaviors: the “Sexual Compulsivity Scale” (discussed above), and the “Hypersexual Disorder Screening Inventory.” Neither questionnaire contained a single item about internet porn use, so this study can tell us nothing about internet porn addiction.

While Parsons et al., 2015 only concerns itself with sexual behaviors in gay and bisexual men, its findings actually falsify the claim that “sex addiction is merely high sexual desire.” If high sexual desire and sex addiction were the same, there would only be one group of individuals per population. Instead, this study reported several distinct sub-groups, yet all groups reported similar rates of sexual activity.

Emerging research supports the notion that sexual compulsivity (SC) and hypersexual disorder (HD) among gay and bisexual men (GBM) might be conceptualized as comprising three groups—Neither sexually compulsive nor hypersexual; Sexually compulsive only, and Both sexually compulsive and hypersexual—that capture distinct levels of severity across the SC/HD continuum. Nearly half (48.9 %) of this highly sexually active sample was classified as Neither SC nor HD, 30 % as SC Only, and 21.1 % as Both SC and HD. While we found no significant differences between the three groups on reported number of male partners, anal sex acts….

Simplified: High sexual desire, as measured by sexual activity, tells us very little about whether a person is a sex addict or not. The key finding here is that sex addiction is not the same as “high sexual desire.”

3. Walton, Lykins, & Bhullar, 2016 (Beyond Heterosexual, Bisexual, and Homosexual A Diversity in Sexual Identity Expression):

Why this “letter to the editor” is cited remains a mystery. It’s not a peer-reviewed study and it has nothing to do with porn use, porn addiction, or hypersexuality. Are the authors of the Reply to Gola padding their citation count with irrelevant papers?

In summary:

  • The three studies cited did not assess whether any subject was porn addicted or not. As a result, they can tell us little about the claim that porn addicts simply have high sexual desire.
  • Steele, Prause, Staley, & Fong, 2013 reported that greater cue-reactivity to porn was related to less desire for sex with a partner. This falsifies the claim that porn addicts have high sexual desire.
  • Parsons et al., 2015 reported that sexual activity was unrelated to measures of hypersexuality. This falsifies the claim that “sex addicts” simply have high sexual desire.
  • Walton, Lykins, & Bhullar, 2016 is a letter to the editor that has nothing to do with the subject at hand.

Claim: Erectile dysfunction is the most commonly suggested negative consequence of porn use.

PRAUSE: Addiction models typically predict negative consequences. Although erectile dysfunction is the most commonly suggested negative consequence of porn use, erectile problems actually are not elevated by viewing more sex films (Landripet & Štulhofer, 2015; Prause & Pfaus, 2015; Sutton, Stratton, Pytyck, Kolla, & Cantor, 2015).

The claim that “erectile dysfunction is the most common negative consequence of porn use” is without support. It’s a straw man argument as:

  1. No peer-reviewed paper has ever claimed that erectile dysfunction is the #1 consequence of porn use.
  2. The #1 consequence of porn use has never been described in a peer-reviewed paper (and probably never will be).
  3. This claim limits itself to the consequences of porn use, which is not the same as the consequences of porn addiction.

How could erectile dysfunction be the #1 negative consequence of porn use when the female half of the population is omitted? If any sexual problem were the number one consequence of porn use it would have to be low libido or anorgasmia, so as to include females.

In any case, only one of the three studies cited actually identified which subjects, if any, were porn addicted: Sutton, Stratton, Pytyck, Kolla, & Cantor, 2015. Indeed, this is the only study cited in the entire Reply to Gola that identifies any study participants as porn addicts. The two other studies cited here (Landripet & Štulhofer, 2015; Prause & Pfaus, 2015) tell us nothing about the relationship between porn addiction and erectile dysfunction because neither assessed whether any subject was porn addicted or not. Sound familiar?

So, let’s first examine the only relevant study cited in the Reply to Gola.

Sutton, Stratton, Pytyck, Kolla, & Cantor, 2015 (Patient Characteristics by Type of Hypersexuality Referral: A Quantitative Chart Review of 115 Consecutive Male Cases):

It’s a study on men (average age 41.5) seeking treatment for hypersexuality disorders, such as paraphilias and chronic masturbation or adultery. 27 were classified as “avoidant masturbators,” meaning they masturbated (typically with porn use) one or more hours per day or more than 7 hours per week. 71% of the compulsive porn users reported sexual functioning problems, with 33% reporting delayed ejaculation (often a precursor to porn-induced ED).

What sexual dysfunction do 38% of the remaining men have? The study doesn’t say, and the authors have ignored repeated requests for details. Two primary choices for male sexual dysfunction in this age group are ED and low libido. The men were not asked about their erectile functioning without porn. Often men have no idea that they have porn-induced ED if they aren’t having partnered sex and all their climaxes entail masturbation to porn. This means sexual problems might have been higher than 71% in the porn addicts. Why the Reply to Gola cited this study as evidence that “negative consequences” are not associated with porn addiction remains a mystery.

Sutton et al., 2015 has been replicated by the only other study to directly investigate the relationships between sexual dysfunctions and problematic internet porn use. A 2016 Belgian study from a leading research university found problematic internet porn use was associated with reduced erectile function and reduced overall sexual satisfaction. Yet problematic porn users experienced greater cravings. The study also appears to report escalation, as 49% of the men viewed porn that “was not previously interesting to them or that they considered disgusting.”

In fact, 17 studies have replicated this link between porn use/porn addiction and sexual dysfunctions or decreased sexual arousal. The first 3 studies in that list demonstrate causation as participants eliminated porn use and healed chronic sexual dysfunctions. In addition, over 30 studies correlate porn use with lower sexual and relationship satisfaction. Sounds like “negative consequences of porn use” to me.

While “debunking” porn-induced sexual dysfunctions has no bearing on the existence of “porn addiction,” we turn next to examining the first two studies cited above for the claim there’s little relationship between erectile dysfunction and current levels of porn use.

First, it’s important to know that studies assessing young male sexuality since 2010 report historic levels of sexual dysfunctions, and startling rates of a new scourge: low libido. All are documented in this 2016 peer-reviewed paper.

Prause & Pfaus 2015 (Viewing Sexual Stimuli Associated with Greater Sexual Responsiveness, Not Erectile Dysfunction):

Since this cobbled together paper did not identify any subjects as porn addicted, its findings cannot support the claim that the porn addiction model has been falsified. Prause & Pfaus 2015 wasn’t a study at all. Instead, Prause claimed to have gathered data from four of her earlier studies, none of which addressed erectile dysfunction. Additional problem: None of the data of the Prause & Pfaus (2015) paper match the data in the four earlier studies. The discrepancies are not small and have not been explained.

A comment by researcher Richard A. Isenberg MD, published in Sexual Medicine Open Access, points out several (but not all) of the discrepancies, errors, and unsupported claims (a lay critique describes more discrepancies). Nicole Prause & Jim Pfaus made a number of false or unsupported claims associated with this paper.

Many journalists’ articles about this study claimed that porn use led to better erections, yet that’s not what the paper found. In recorded interviews, both Nicole Prause and Jim Pfaus falsely claimed that they had measured erections in the lab, and that the men who used porn had better erections. In the Jim Pfaus TV interview Pfaus states:

“We looked at the correlation of their ability to get an erection in the lab.”

“We found a liner correlation with the amount of porn they viewed at home, and the latencies which for example they get an erection is faster.”

In this radio interview Nicole Prause claimed that erections were measured in the lab. The exact quote from the show:

“The more people watch erotica at home they have stronger erectile responses in the lab, not reduced.”

Yet this paper did not assess erection quality in the lab or “speed of erections.” The paper only claimed to have asked guys to rate their “arousal” after briefly viewing porn (and it’s not clear from the underlying papers that even that actually happened in the case of all subjects). In any case, an excerpt from the paper itself admitted that:

“No physiological genital response data were included to support men’s self-reported experience.”

In a second unsupported claim, lead author Nicole Prause tweeted several times about the study, letting the world know that 280 subjects were involved, and that they had “no problems at home.” However, the four underlying studies contained only 234 male subjects, so “280” is way off.

A third unsupported claim: Dr. Isenberg wondered how it could be possible for Prause & Pfaus 2015 to have compared different subjects’ arousal levels when three different types of sexual stimuli were used in the 4 underlying studies. Two studies used a 3-minute film, one study used a 20-second film, and one study used still images. It’s well established that films are far more arousing than photos, so no legitimate research team would group these subjects together to make claims about their responses. What’s shocking is that in their paper Prause & Pfaus unaccountably claim that all 4 studies used sexual films:

“The VSS presented in the studies were all films.”

This statement is false, as clearly revealed in Prause’s own underlying studies.

A fourth unsupported claim: Dr. Isenberg also asked how Prause & Pfaus 2015 compared different subjects’ arousal levels when only 1 of the 4 underlying studies used a 1 to 9 scale. One used a 0 to 7 scale, one used a 1 to 7 scale, and one study did not report sexual arousal ratings. Once again Prause & Pfaus inexplicably claim that:

“Men were asked to indicate their level of “sexual arousal” ranging from 1 “not at all” to 9 “extremely.”

This too is false as the underlying papers show. In summary, all the Prause-generated headlines about porn improving erections or arousal, or anything else, are unwarranted. Prause & Pfaus 2015 also claimed they found no relationship between erectile functioning scores and the amount of porn viewed in the last month. As Dr. Isenberg pointed out:

“Even more disturbing is the total omission of statistical findings for the erectile function outcome measure. No statistical results whatsoever are provided. Instead the authors ask the reader to simply believe their unsubstantiated statement that there was no association between hours of pornography viewed and erectile function. Given the authors’ conflicting assertion that erectile function with a partner may actually be improved by viewing pornography the absence of statistical analysis is most egregious.”

In the Prause & Pfaus response to the Dr. Isenberg critique, they once again failed to provide any data to support their “unsubstantiated statement.” As this analysis documents, the Prause & Pfaus response not only evades Dr. Isenberg’s legitimate concerns, it contains several new misrepresentations and several transparently false statements. Finally, a review of the literature by seven US Navy doctors commented on Prause & Pfaus 2015:

“Our review also included two 2015 papers claiming that Internet pornography use is unrelated to rising sexual difficulties in young men. However, such claims appear to be premature on closer examination of these papers and related formal criticism. The first paper contains useful insights about the potential role of sexual conditioning in youthful ED [50]. However, this publication has come under criticism for various discrepancies, omissions and methodological flaws. For example, it provides no statistical results for the erectile function outcome measure in relation to Internet pornography use. Further, as a research physician pointed out in a formal critique of the paper, the papers’ authors, “have not provided the reader with sufficient information about the population studied or the statistical analyses to justify their conclusion” [51]. Additionally, the researchers investigated only hours of Internet pornography use in the last month. Yet studies on Internet pornography addiction have found that the variable of hours of Internet pornography use alone is widely unrelated to “problems in daily life”, scores on the SAST-R (Sexual Addiction Screening Test), and scores on the IATsex (an instrument that assesses addiction to online sexual activity) [52, 53, 54, 55, 56]. A better predictor is subjective sexual arousal ratings while watching Internet pornography (cue reactivity), an established correlate of addictive behavior in all addictions [52, 53, 54]. There is also increasing evidence that the amount of time spent on Internet video-gaming does not predict addictive behavior. “Addiction can only be assessed properly if motives, consequences and contextual characteristics of the behavior are also part of the assessment” [57]. Three other research teams, using various criteria for “hypersexuality” (other than hours of use), have strongly correlated it with sexual difficulties [15, 30, 31]. Taken together, this research suggests that rather than simply “hours of use”, multiple variables are highly relevant in assessment of pornography addiction/hypersexuality, and likely also highly relevant in assessing pornography-related sexual dysfunctions.”

The US Navy paper highlighted the weakness in correlating only “current hours of use” to predict porn-induced sexual dysfunctions. The amount of porn currently viewed is just one of many variables involved in the development of porn-induced ED. These may include:

  1. Ratio of masturbation to porn versus masturbation without porn
  2. Ratio of sexual activity with a person versus masturbation to porn
  3. Gaps in partnered sex (where one relies only on porn)
  4. Virgin or not
  5. Total hours of use
  6. Years of use
  7. Age started using porn
  8. Escalation to new genres
  9. Development of porn-induced fetishes (from escalating to new genres of porn)
  10. Level of novelty per session (i.e. compilation videos, multiple tabs)
  11. Addiction-related brain changes or not
  12. Presence of hypersexuality/porn addiction

The better way to research this phenomenon, is to remove the variable of internet porn use and observe the outcome, which was done in the Navy paper and in two other studies. Such research reveals causation instead of fuzzy correlations open to varying interpretation. My site has documented a few thousand men who removed porn and recovered from chronic sexual dysfunctions.

Landripet & Štulhofer 2015 (Is Pornography Use Associated with Sexual Difficulties and Dysfunctions among Younger Heterosexual Men? A Brief Communication):

As with Prause & Pfaus, 2015, this “Brief Communication” failed to identify any subjects as porn addicted. With no porn addicts to assess it cannot falsify the “negative consequences” of porn addiction. The Reply to Gola claimed that Landripet & Štulhofer, 2015 found no relationships between porn use and sexual problems. This is not true, as documented in both this YBOP critique and the US Navy review of the literature:

A second paper reported little correlation between frequency of Internet pornography use in the last year and ED rates in sexually active men from Norway, Portugal and Croatia [6]. These authors, unlike those of the previous paper, acknowledge the high prevalence of ED in men 40 and under, and indeed found ED and low sexual desire rates as high as 31% and 37%, respectively. In contrast, pre-streaming Internet pornography research done in 2004 by one of the paper’s authors reported ED rates of only 5.8% in men 35–39 [58]. Yet, based on a statistical comparison, the authors conclude that Internet pornography use does not seem to be a significant risk factor for youthful ED. That seems overly definitive, given that the Portuguese men they surveyed reported the lowest rates of sexual dysfunction compared with Norwegians and Croatians, and only 40% of Portuguese reported using Internet pornography “from several times a week to daily”, as compared with the Norwegians, 57%, and Croatians, 59%. This paper has been formally criticized for failing to employ comprehensive models able to encompass both direct and indirect relationships between variables known or hypothesized to be at work [59]. Incidentally, in a related paper on problematic low sexual desire involving many of the same survey participants from Portugal, Croatia and Norway, the men were asked which of numerous factors they believed contributed to their problematic lack of sexual interest. Among other factors, approximately 11%–22% chose “I use too much pornography” and 16%–26% chose “I masturbate too often” [60].

As the Navy doctors described, this paper found a pretty important correlation: Only 40% of the Portuguese men used porn “frequently,” while the 60% of the Norwegians used porn “frequently.” The Portuguese men had far less sexual dysfunction than the Norwegians. With respect to the Croats, Landripet & Štulhofer, 2015 acknowledge a statistically significant association between more frequent porn use and ED, but claim the effect size was small. However, this claim may be misleading according to an MD who is a skilled statistician and has authored many studies:

Analyzed a different way (Chi Squared), … moderate use (vs. infrequent use) increased the odds (the likelihood) of having ED by about 50% in this Croatian population. That sounds meaningful to me, although it is curious that the finding was only identified among Croats.

In addition, Landripet & Stulhofer 2015 omitted two significant correlations, which one of the authors presented to a European conference. He reported a significant correlation between erectile dysfunction and “preference for certain pornographic genres”:

“Reporting a preference for specific pornographic genres were significantly associated with erectile (but not ejaculatory or desire-related) male sexual dysfunction.”

It’s telling that Landripet & Stulhofer chose to omit this significant correlation between erectile dysfunction and preferences for specific genres of porn from their paper. It’s quite common for porn users to escalate into genres that do not match their original sexual tastes, and to experience ED when these conditioned porn preferences do not match real sexual encounters. As we and the US Navy pointed out above, it’s very important to assess the multiple variables associated with porn use – not just hours in the last month, or frequency in the last year.

The second significant finding omitted by Landripet & Stulhofer 2015 involved female participants:

“Increased pornography use was slightly but significantly associated with decreased interest for partnered sex and more prevalent sexual dysfunction among women.”

A significant correlation between greater porn use and decreased libido and more sexual dysfunction seems pretty important. Why didn’t Landripet & Stulhofer 2015 report that they found significant correlations between porn use and sexual dysfunction in women, as well as a few in men? And why hasn’t this finding been reported in any of Stulhofer’s many studies arising from these same data sets? His teams seem very quick to publish data they claim debunks porn-induced ED, yet very slow to inform women about the negative sexual ramifications of porn use.

Finally, Danish porn researcher Gert Martin Hald’s formal critical comments echoed the need to assess more variables (mediators, moderators) than just frequency per week in the last 12 months:

The study does not address possible moderators or mediators of the relationships studied nor is it able to determine causality. Increasingly, in research on pornography, attention is given to factors that may influence the magnitude or direction of the relationships studied (i.e., moderators) as well as the pathways through which such influence may come about (i.e., mediators). Future studies on pornography consumption and sexual difficulties may also benefit from an inclusion of such focuses.

Bottom line: All complex medical conditions involve multiple factors, which must be teased apart. In any case, Landripet & Stulhofer’s statement that, “Pornography does not seem to be a significant risk factor for younger men’s desire, erectile, or orgasmic difficulties” goes too far, since it ignores all the other possible variables related to porn use that might be causing sexual performance problems in users – including escalation to specific genres, which they found, but omitted in the “Brief Communication.”

Before confidently claiming that we have nothing to worry about from internet porn, researchers still need to account for the very recent, sharp rise in youthful ED and low sexual desire, and the many studies linking porn use to sexual problems.


Claim: Religious porn users have slightly more distress about their porn use than atheists.

PRAUSE: Also, distress related to viewing sex films has been shown to be most strongly related to conservative values and religious history (Grubbs et al., 2014). This supports a social shame model of problem sex film viewing behaviors.

Here the Reply to Gola’s attempt to debunk porn addiction drifts even farther from the target. What are we to make of a seemingly obvious finding that deeply religious individuals experience a bit more distress about their porn use than do atheists? How does this finding falsify the porn addiction model? It doesn’t. Moreover, the study cited did not concern itself with “distress related to sex film viewing.

That said, several lay articles about the Joshua Grubbs studies (“perceived addiction studies”) have tried to paint a very misleading picture of what his perceived addiction studies actually reported and what these findings mean. In response to these spurious articles, YBOP published this extensive critique of the claims made in the perceived addiction studies and in the related misleading articles.

Grubbs et al., 2014 (Transgression as Addiction: Religiosity and Moral Disapproval as Predictors of Perceived Addiction to Pornography):

The reality of this study:

  1. This study failed to identify who was and was not a porn addict, so it’s not relevant to assessing the porn addiction model.
  2. Contrary to the Reply to Gola’s assertion above, this study was not concerned with “distress related to sex film viewing.” The word “distress” is not in the study’s abstract.
  3. Contrary to the Reply to Gola and the Grubbs et al., 2014 conclusion, the strongest predictor of porn addiction was actually hours of porn use, not religiosity! See this extensive section with the study’s tables, the correlations, and what the study actually found.
  4. When we break down the Grubbs’s porn addiction questionnaire (CPUI-9), the relationship between “religiosity” and the core addiction behaviors (Access Efforts questions 4-6) is virtually non-existent. Put simply: religiosity has next to nothing to do with actual porn addiction.
  5. On the other hand, a very strong relationship exists between “hours of porn use” and the core addiction behaviors as assessed by the “Access Efforts” questions 4-6. Put simply: Porn addiction is very strongly related to amount of porn viewed.

The Reply to Gola, bloggers like David Ley, and even Grubbs himself, seem to be endeavoring to construct a meme that religious shame is the “real” cause of porn addiction. Yet it’s simply not true that the “perceived addiction” studies are evidence of this trendy talking point. Again, this extensive analysis debunks the “porn addiction is only religious shame” claim. The meme crumbles when we consider that:

  1. Religious shame doesn’t induce brain changes that mirror those found in drug addicts. In contrast, there are now 28 neurological studies reporting addiction-related brain changes in compulsive porn users/sex addicts.
  2. The perceived addiction studies did not use a cross-section of religious individuals. Instead, only current porn users (religious or nonreligious) were questioned. All cross-sectional studies report far lower rates of compulsive sexual behavior and porn use in religious individuals (study 1, study 2, study 3, study 4, study 5, study 6, study 7, study 8,).
    • This means Grubbs’s sample of “religious porn users” is relatively tiny and inevitably skewed towards individuals with pre-existing conditions or underlying issues.
    • It also means that “religiosity” does not predict porn addiction. Instead, religiosity apparently protects one from developing a porn addiction.
  3. Many atheists and agnostics develop porn addiction. Two 2016 studies on men who had used porn in the last the last 6 months, or in the last 3 months, reported extraordinarily high rates of compulsive porn use (28% for both studies).
  4. Being religious doesn’t induce chronic erectile dysfunction, low libido and anorgasmia in healthy young men. Yet numerous studies link porn use to sexual dysfunctions and lower sexual satisfaction, and ED rates have inexplicably skyrocketed by 1000% in men under 40 since “tube” porn captured porn viewers’ attention beginning at the end of 2006.
  5. This 2016 study on treatment-seeking porn addicts found that religiosity did not correlate with negative symptoms or scores on a sex addiction questionnaire. This 2016 study on treatment-seeking hypersexuals found no relationship between religious commitment and self-reported levels of hypersexual behavior and related consequences.
  6. Research shows that as the severity of their porn addiction increases, religious individuals often return to religious practices, attend church more often, and become more devout as a way of coping/seeking recovery (think 12 Steps). This alone could account for any relationship between porn addiction and religiosity.

In summary:

  • Both the Reply to Gola assertion and the single study cited have nothing to with the porn addiction model.
  • The 2014 Grubbs “perceived addiction” study actually found porn addiction was more strongly correlated with the amount of porn viewed than with religiosity.
  • There’s no evidence that religious “shame” induces addiction-related brain changes, and yet these changes have repeatedly been found in problematic porn users’ brains.
  • There’s much evidence that religiosity actually protects individuals from porn use and thus porn addiction.
  • Grubbs’s sample of “religious porn users” is not cross-sectional, and therefore inevitably skewed towards higher rates of genetic predispositions or underlying issues.
  • Two recent studies reported no relationship between porn addiction and religiosity in men seeking treatment.

SECTION TWO: Critique of a Few Selected Claims

Introduction

In this section we examine a few of the unsupported assertions and false statements put forth in the Reply to Gola. While it’s tempting to challenge the Reply to Gola line by line, its major weakness is that its arguments are specious. They fail to address the content of the YBOP critique or the 5 peer-reviewed analyses of Prause et al. 2015 (including Matuesz Gola’s): 1, 2, 3, 4. 5. All 5 expert analyses agree that Prause et al., 2015 actually found desensitization or habituation, which is consistent with the addiction model.

The following assertions of the Reply to Gola relate to Mateusz Gola’s concerns about the Prause et al., 2015 methodological flaws. Several major flaws in this and the other Prause Studies leave any study results and associated claims in serious doubt:

  1. Subjects were not screened for porn addiction (potential subjects only answered a single question).
  2. Questionnaires used did not ask about porn use and were not valid for assessing “porn addiction.”
  3. Subjects were heterogeneous (males, females, non-heterosexuals).
  4. Subjects were not screened for confounding psychiatric conditions, drug use, psychotropic medications, drug addictions, behavioral addictions, or compulsive disorders (any single one of which is exclusionary).

Reply To Claim: Prause et al., 2015 employed “proper” methodology in recruiting and identifying which subjects were porn addicts and Voon et al., 2014 did not.

Nothing could be further from the truth, as the Prause et al. methodology failed on every level, while Voon et al. employed meticulous methodology in the recruitment, screening and assessment of its “porn addicted” subjects (Compulsive Sexual Behaviors subjects).

A little background. Prause compared the average EEG readings of 55 “porn addicts” to the average EEG readings of 67 “non-addicts.” Yet the validity of Prause et al., 2015 would be entirely dependent on comparing the brain activation patterns of a group of porn addicts to a group of non-addicts. For Prause’s claims of falsification and the resulting dubious headlines to be legitimate, all of Prause’s 55 subjects would have to have been actual porn addicts. Not some, not most, but every single subject (as Voon’s were). All signs point to a good number of the 55 Prause subjects being non-addicts. An excerpt from Steele et al., 2013 describes the entire selection process and exclusion criteria employed in the 3 Prause Studies (Prause et al., 2013Steele et al., 2013, Prause et al., 2015):

“Initial plans called for patients in treatment for sexual addiction to be recruited, but the local Institutional Review Board prohibited this recruitment on the grounds that exposing such volunteers to VSS could potentiate a relapse. Instead, participants were recruited from the Pocatello, Idaho community by online advertisements requesting people who were experiencing problems regulating their viewing of sexual images.”

That’s it. The only criterion for inclusion was answering yes to a single question: “Are you experiencing problems regulating your viewing of sexual images.” The first noticeable error involves the screening question used, which asks only about viewing sexual images, and not about viewing internet porn, especially streaming videos (which appear to be the form of porn causing the most severe symptoms).

A much bigger flaw is that the Prause Studies did not screen potential subjects by using a sex or porn addiction questionnaire (as Voon et al. did). Nor were potential subjects asked whether porn use had negatively affected their lives, whether they considered themselves addicted to porn, or whether they experienced addiction-like symptoms (as Voon et al. did).

Make no mistake, neither Steele et al., 2013 nor Prause et al., 2015 described these 55 subjects as porn addicts or compulsive porn users. The subjects only admitted to feeling “distressed” by their porn use. Confirming the mixed nature of her subjects, Prause admitted in 2013 interview that some of the 55 subjects experienced only minor problems (which means they were not porn addicts):

“This study only included people who reported problems, ranging from relatively minor to overwhelming problems, controlling their viewing of visual sexual stimuli.”

Compounding the failure to screen subjects for actual porn addiction, the 3 Prause Studies chose to ignore standard exclusion criteria normally employed in addiction studies to prevent confounds. The Prause Studies did not:

  • Screen subjects for psychiatric conditions (an automatic exclusion)
  • Screen subjects for other addictions (an automatic exclusion)
  • Ask subjects if they were using psychotropic medications (often exclusionary)
  • Screen subjects for those currently using drugs (automatic exclusion)

Voon et al., 2014 did all the above and much more to ensure they were investigating only homogeneous, porn addicted subjects. Yet Prause et al., 2015 admitted they employed no criteria for excluding subjects:

“As hypersexuality is not a codified diagnosis and we were expressly prohibited from recruiting patients, no thresholds could be used to empirically identify problem users”

It appears that in Prause’s view simply answering the single-question ad met the exclusion criteria for the Prause Studies. This brings us to Matuesz Gola’s concern about Prause’s subjects not being porn addicts, as they only viewed an average of 3.8 hours of porn per week, while Voon’s subjects viewed 13.2 hours per week:

Mateusz Gola: “It is worthy to notice that in Prause et al. (2015) problematic users consume pornography in average for 3.8 h/week it is almost the same as non-problematic pornography users in Kühn and Gallinat (2014) who consume in average 4.09 h/week. In Voon et al. (2014) non-problematic users reported 1.75 h/week and problematic 13.21 h/week (SD = 9.85) – data presented by Voon during American Psychological Science conference in May 2015.”

The hours of porn use per week for each study:

  • Voon et al: 13.2 hours (all were porn addicts)
  • Kuhn & Gallinat: 4.1 hours (none were porn addicts)
  • Prause et al: 3.8 hours (no one knows)

Gola also pondered how Prause’s 55 subjects could possibly be porn addicts (for purpose of “falsifying porn addiction”) when they watched less porn than the Kühn & Gallinat, 2014 non-addicts. How in the world can all of the Prause subjects be “porn addicts” when none of the Kühn & Gallinat subjects are porn addicts? However they are labeled, subjects have to be comparable across studies before you can claim to have “falsified” competing research. This is elementary science procedure.

So, how did Prause & company address the many gaping holes in their subjects’ recruitment and assessment process? By attacking the meticulous methodology of Voon et al., 2014! First, the description of recruitment process, assessment criteria for porn addiction, and exclusion criteria excerpted from Voon et al., 2014 (also see Schmidt et al., 2016 & Banca et al., 2016):

“CSB subjects were recruited via internet-based advertisements and from referrals from therapists. Age-matched male HV were recruited from community-based advertisements in the East Anglia area. All CSB subjects were interviewed by a psychiatrist to confirm they fulfilled diagnostic criteria for CSB (met proposed diagnostic criteria for both hypersexual disorder [Kafka, 2010; Reid et al., 2012] and sexual addiction [Carnes et al., 2007]), focusing on compulsive use of online sexually explicit material. This was assessed using a modified version of the Arizona Sexual Experiences Scale (ASES) [Mcgahuey et al., 2011], in which questions were answered on a scale of 1–8, with higher scores representing greater subjective impairment. Given the nature of the cues, all CSB subjects and HV were male and heterosexual. All HV were age-matched (±5 years of age) with CSB subjects. Subjects were also screened for compatibility with the MRI environment as we have done previously [Banca et al., 2016; Mechelmans et al., 2014; Voon et al., 2014]. Exclusionary criteria included being under 18 years of age, having a history of SUD, being a current regular user of illicit substances (including cannabis), and having a serious psychiatric disorder, including current moderate-severe major depression or obsessive-compulsive disorder, or history of bipolar disorder or schizophrenia (screened using the Mini International Neuropsychiatric Inventory) [Sheehan et al., 1998]. Other compulsive or behavioral addictions were also exclusions. Subjects were assessed by a psychiatrist regarding problematic use of online gaming or social media, pathological gambling or compulsive shopping, childhood or adult attention deficit hyperactivity disorder, and binge-eating disorder diagnosis. Subjects completed the UPPS-P Impulsive Behavior Scale [Whiteside and Lynam, 2001] to assess impulsivity, and the Beck Depression Inventory [Beck et al., 1961] to assess depression. Two of 23 CSB subjects were taking antidepressants or had comorbid generalized anxiety disorder and social phobia (N = 2) or social phobia (N = 1) or a childhood history of ADHD (N = 1). Written informed consent was obtained, and the study was approved by the University of Cambridge Research Ethics Committee. Subjects were paid for their participation.”

“Nineteen heterosexual men with CSB (age 25.61 (SD 4.77) years) and 19 age-matched (age 23.17 (SD 5.38) years) heterosexual male healthy volunteers without CSB were studied (Table S2 in File S1). An additional 25 similarly aged (25.33 (SD 5.94) years) male heterosexual healthy volunteers rated the videos. CSB subjects reported that as a result of excessive use of sexually explicit materials, they had lost jobs due to use at work (N = 2), damaged intimate relationships or negatively influenced other social activities (N = 16), experienced diminished libido or erectile function specifically in physical relationships with women (although not in relationship to the sexually explicit material) (N = 11), used escorts excessively (N = 3), experienced suicidal ideation (N = 2) and using large amounts of money (N = 3; from £7000 to £15000). Ten subjects either had or were in counselling for their behaviours. All subjects reported masturbation along with the viewing of online sexually explicit material. Subjects also reported use of escort services (N = 4) and cybersex (N = 5). On an adapted version of the Arizona Sexual Experiences Scale [43], CSB subjects compared to healthy volunteers had significantly more difficulty with sexual arousal and experienced more erectile difficulties in intimate sexual relationships but not to sexually explicit material (Table S3 in File S1).”

The Reply to Gola excerpt attacking Voon et al., 2014:

“Gola notes that hours of film consumption appeared lower in our participants than in two other studies of problem erotica use. We pointed this out in our paper (paragraph beginning “The problem group reported significantly more…”). Gola argues that our sample of problem users reported fewer hours of sex film viewing than the problem sample from Voon et al. (2014). However, Voon et al. specifically recruited for participants high in sexual shame, including advertisements on shame-based websites about sex-film use, “treatment-seeking” men despite “porn” use not being recognized by the DSM-5, and with funding by a television show framed as the “harms” of “porn”. Those who adopt addiction labels have been shown to have a history of socially conservative values and high religiosity (Grubbs, Exline, Pargament, Hook, & Carlisle, 2014). It is more likely that the Voon et al. (2014) sample is characterized by high sexual shame in online communities that encourage reporting of high use. Also, “porn” use was assessed during a structured interview, not a standardized questionnaire. Thus, the psychometrics and implicit biases inherent in a structured interview are unknown. This makes it difficult to compare sex film use measures between studies. Our strategy for identifying groups is consistent with widely-cited work demonstrating the importance of distress criterion in sexual difficulties (Bancroft, Loftus, & Long, 2003).”

This is nothing more than a web of easily debunked false statements and unwarranted claims calculated to divert the reader’s attention away from Prause’s deficient screening process. We start with:

Reply to Gola: However, Voon et al. specifically recruited for participants high in sexual shame, including advertisements on shame-based websites about sex-film use, “treatment-seeking” men despite “porn” use not being recognized by the DSM-5, and with funding by a television show framed as the “harms” of “porn.”

First, the Reply to Gola supplies no evidence to support the claim that participants experienced “high sexual shame” or were recruited from so-called “shame based websites.” This is nothing more than baseless propaganda. On the other hand, the Prause Studies recruited subjects from Pocatello, Idaho which is over 50% Mormon. It’s very likely that Prause’s religious subjects experienced shame or guilt in relationship to their porn use, in contrast to Voon’s subjects recruited publicly in the UK.

Second, many of Voon’s participants were seeking treatment for porn addiction and referred by therapists. What better way is there to ensure porn-addicted subjects? It’s very odd that the Reply to Gola would spin this as a negative (rather than an unarguable strength), when the Prause Studies wanted to use only “treatment seeking” sex addicts, but were prohibited by the university review board. Taken from the first Prause EEG study:

Steele et al., 2013:Initial plans called for patients in treatment for sexual addiction to be recruited, but the local Institutional Review Board prohibited this recruitment on the grounds that exposing such volunteers to VSS could potentiate a relapse.”

Third, the Reply to Gola stoops to an outright lie by claiming that Voon et al. 2014 was funded by a “television show.” As clearly stated in Voon et al., 2014, the study was funded by “Wellcome Trust“:

Voon et al., 2014: Funding: Funding provided by Wellcome Trust Intermediate Fellowship grant (093705/Z/10/Z). Dr. Potenza was supported in part by grants P20 DA027844 and R01 DA018647 from the National Institutes of Health; the Connecticut State Department of Mental Health and Addiction Services; the Connecticut Mental Health Center; and a Center of Excellence in Gambling Research Award from the National Center for Responsible Gaming. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.”

This is followed by more false and misleading statements. For example, the Reply to Gola throws in another untruth about the Voon et al. recruitment/assessment methodology:

Reply to Gola: Also, “porn” use was assessed during a structured interview, not a standardized questionnaire.

False. In screening potential subjects Voon et al., 2014 used four standardized questionnaires and employed an extensive psychiatric interview. The following is a shortened description of the screening process taken from Banca et al., 2016 (CSB is Compulsive Sexual Behaviors):

Voon et al., 2014: CSB subjects were screened using the internet sex screening test (ISST; Delmonico and Miller, 2003) and an exhaustive experimenter-designed questionnaire which included items pertaining to age of onset, frequency, duration, attempts to control use, abstinence, patterns of use, treatment and negative consequences. CSB participants were interviewed by a psychiatrist to confirm they fulfilled two sets of diagnostic criteria for CSB (proposed diagnostic criteria for Hypersexual Disorder; criteria for sexual addiction; Carnes et al., 2001; Kafka, 2010; Reid et al., 2012), focusing on compulsive use of online sexually explicit material.  These criteria emphasize failure to cut down or control sexual behaviors, including consumption of pornography, despite social, financial, psychological and academic or vocational problems. Detailed description of CSB symptoms are described in Voon et al. (2014).

It’s shocking that the Reply to Gola would dare to compare the virtually nonexistent screening procedure used in the Prause Studies (subjects answered a single-question advertisement) with the exhaustive, expert screening procedures used for Voon et al., 2014:

  1. Internet Sex Screening Test, Delmonico and Miller, 2003
  2. Interviewed by a psychiatrist who used criteria for sexual addiction from the 3 most widely used questionnaires: Carnes et al., 2001; Kafka, 2010; Reid et al., 2012)
  3. Extensive investigator-designed questionnaire on details including age of onset, frequency, duration, attempts to control use, abstinence, patterns of use, treatment and negative consequences.

Incidentally, this process was merely the screening to confirm the existence of porn addiction; Voon et al. didn’t stop there. More questionnaires and interviews excluded those with psychiatric conditions, drug or behavioral addictions, OCD or compulsive disorders, and current or past substance abusers. The researchers in the Prause Studies did none of this.

Finally, the Reply to Gola regurgitates the unsupported claim that porn addiction is nothing more than religious shame,

Reply to Gola: “Those who adopt addiction labels have been shown to have a history of socially conservative values and high religiosity (Grubbs, Exline, Pargament, Hook, & Carlisle, 2014).”

The claimed correlation between porn addiction and religiosity was addressed above and thoroughly debunked in this extensive analysis of the Joshua Grubbs material.


Reply to Gola evades serious flaw in Prause et al., 2015: Unacceptable diversity of subjects

Critiques of Nicole Prause’s controversial EEG studies (Steele et al., 2013, Prause et al., 2015) have raised grave concerns about the diverse nature of the “distressed” porn using subjects. The EEG studies included males and females, heterosexuals and non-heterosexuals, yet the researchers showed them all standard, possibly uninteresting, male+female porn. This matters, because it violates standard procedure for addiction studies, in which researchers select homogeneous subjects in terms of age, gender, orientation, even similar IQ’s (plus a homogeneous control group) in order to avoid distortions caused by such differences.

In other words, the results of the 2 EEG studies were dependent on the premise that males, females, and non-heterosexuals are no different in their brain responses to sexual images. Yet study after study confirms that males and female have significantly different brain responses to sexual images or films. Gola knew this and mentioned this fatal flaw in a note:

Mateusz Gola: “It is worthy to notice that the authors present results for male and female participants together, while recent studies shows that sexual images ratings of arousal and valence differs dramatically between genders (see: Wierzba et al., 2015).”

In an evasive maneuver, the Reply to Gola ignores this elephant in the room: Male and female brains respond quite differently to sexual imagery. Instead, the Reply to Gola informs us that both men and women become aroused by sexual imagery, and other irrelevant fun facts:

“Gola claims that data for men and women should not be presented together, because they do not respond to the same sexual stimuli. Actually, men and women’s preferences for sexual stimuli overlap heavily (Janssen, Carpenter, & Graham, 2003). As we described, the images were pretested to equate subjective sexual arousal in both men and women. “Sexual” images from the International Affective Picture System were supplemented, because they are processed as romantic rather than sexual by both men and women (Spiering, Everaerd, & Laan, 2004). More importantly, research has shown that differences in sexual arousal ratings attributed to gender are better understood as attributable to sexual drive (Wehrum et al., 2013). Since sexual desire was a predictor in the study, it was not appropriate to segment the sexual arousal reports by the known confound: gender.”

The above response has nothing to do with Mateusz Gola’s criticism: When viewing the exact same porn male and female brains exhibit very different brain wave (EEG) and blood flow (fMRI) patterns. For example, this EEG study found that women had far higher EEG readings than men when viewing the same sexual pictures. You can’t average together male and female EEG readings, as the Prause Studies did, and end up with anything meaningful. Nor can you compare the brain responses of a mixed group to the brain responses of another mixed group, as the Prause Studies did.

There’s a reason why none of the published neurological studies on porn users (except for Prause’s) mixed males and females. Every single neurological study involved subjects who were all the same sex and same sexual orientation. Indeed, Prause herself stated in an earlier study (2012) that individuals vary tremendously in their response to sexual images:

“Film stimuli are vulnerable to individual differences in attention to different components of the stimuli (Rupp & Wallen, 2007), preference for specific content (Janssen, Goodrich, Petrocelli, & Bancroft, 2009) or clinical histories making portions of the stimuli aversive (Wouda et al., 1998).”

“Still, individuals will vary tremendously in the visual cues that signal sexual arousal to them (Graham, Sanders, Milhausen, & McBride, 2004).”

A 2013 Prause study stated:

“Many studies using the popular International Affective Picture System (Lang, Bradley, & Cuthbert, 1999) use different stimuli for the men and women in their sample.”

Large variations are to be expected with a sexually diverse group of subjects (males, females, non-heterosexuals), rendering comparisons and conclusions of the type made in the Prause Studies unreliable.

A collection of studies confirming that male and female brains respond very differently to the same sexual imagery:

In summary, the Prause Studies suffered from serious methodological flaws that call into question the studies’ results and the authors’ claims about “falsifying” the porn addiction model:

  1. Subjects were heterogeneous (males, females, non-heterosexuals)
  2. Subjects were not screened for porn addiction, mental disorders, substance use, or drug and behavioral addictions
  3. Questionnaires were not validated for porn addiction or porn use

Analysis of “Perceived Effects of Pornography on the Couple Relationship: Initial Findings of Open-Ended, Participant-Informed, Bottom-Up Research” (2016)

COMMENTS: Is the intention behind this study to (attempt to) counter the many studies that show porn use has negative effects on relationships? The two main problems with this study are:

  1. It does not contain a representative sample. Whereas most studies show that a tiny minority of porn users’ partners use porn, in this study 95% of the women used porn on their own. And 85% of the women had used porn since the beginning of the relationship (in some cases for years). Those rates are higher than in college-aged men! In other words, the researchers appear to have skewed their sample to produce the results they were seeking.
  • Reality: Cross-sectional data from the largest US survey (General Social Survey) reported that only 2.6% of women had visited a “pornographic website” in the last month. Data from 2000, 2002, 2004. For more see –  Pornography and Marriage
  1. The study used “open ended” questions where the subject could ramble on and on about porn. Then the researchers read the ramblings and decided, after the fact, what answers were “important,” and how to present (spin?) them in their paper. Then the researchers then had the gall to suggest that all the other studies on porn and relationships, which employed more established, scientific methodology and straightforward questions about porn’s effects were flawed. Is this really science?

In reality, large cross sectional studies and the only longitudinal study all find significant negative effects related to porn use.

A bit more. There were 430 participants and who provided a total of 3963 responses to 42 open-ended questions about the effects of pornography use on their couple relationship. The researchers identified 66 “themes,” with each theme represented by between 621 and 5 individual responses. Despite these fatal flaws and despite the negative effects reported by some of their sample, the researchers claimed porn’s impact was overwhelmingly positive.

A few excerpts from the study showing that some couples reported significant negative effects from porn use:

  • Porn Replaces Partner: 90 Responses involved the perception that pornography was replacing or was in competition with partnered sex. Some responses provided a rationale by mentioning that pornography is easier, more interesting, more arousing, more desirable, or more gratifying than sex with a partner. Alternatively, some porn users pointed out their partners’ may feel like they are in competition with pornography
  • Decreased Arousal Response: 71 Responses discussed how pornography use is desensitizing, decreases the ability to achieve or maintain sexual arousal, or to achieve orgasm. Note as above, it can was sometimes difficult to differentiate true arousal responses from sexual interest responses so there is overlap with Decreases Interest in Sex
  • Sexual Desensitization (subtheme): 17 of 71 Responses that specifically described desensitization as the effect of pornographyuse. Often the context is vague, making it difficult to infer much meaning from surrounding context. In other places it is explicitly connected to impaired sexual arousal
  • Addiction: 60 Responses revolved around too much use,‘‘reliance’’ or dependence on pornography, pornography using being obsessive, or becoming a sex addict. The reliance and dependence terminology suggests theoretical connections with decreased sexual interest and arousal as well as desensitization, though this terminology was used infrequently in discussions of addiction in this sample
  • Loss of Intimacy or Love: 42 Responses concerned a loss of intimacy or love. There was some diversity in this category of responses. Some indicated that pornography makes sex more recreational and less about love or closeness, while others said that their partner does not like their porn use, which creates a distance in the relationship. A couple of comments suggest that distancing is a function of the discrepancy between desired pornography-inspired behavior and actual sexual behavior with a partner. Finally, at least one participants suggested that porn use contributes to a fear of intimacy
  • Mistrust: 29 Responses discussed how pornography use contributes to mistrust or damaged trust
  • Reinforces Stereotypes About Sex and Gender: 28 Responses were concerned pornography’s perpetuation of sexism, contribution to male domination or degradation of women, or reinforcement of sexual objectification
  • Damaged Relationship: 28 Responses described how pornography use damages or puts strain on relationships, marriages and sex life. There was some discussion of how people want less sex from a partner because the partner uses pornography
  • Relationship Dissolution: 23 Responses involved how pornography use contributes or may contribute to relationship dissolutions. The reasons that were offered for this consequence were diverse: porn contributes to infidelity or is perceived as possible infidelity, porn use negatively impacts sexual behavior, or porn use leads to a loss of interest in having sexual relations with the current partner
  • Less Enjoyment of Real Sex: 17 Responses suggested that pornography makes real sex more boring, more routine, less exiting, or less enjoyable. A minority of responses described a loss of intimacy, or loving component of having sex together
  • Less Satisfied with Partner: 17 Responses indicated that pornography use lowers interest in, or satisfaction with, or desire for, or attraction to a sexual partner. Partners feel like they are in competition with porn or porn stars

 

Arch Sex Behav. 2016 Jul 8. 

Kohut T1, Fisher WA2,3, Campbell L2.

Abstract

The current study adopted a participant-informed, “bottom-up,” qualitative approach to identifying perceived effects of pornography on the couple relationship. A large sample (N = 430) of men and women in heterosexual relationships in which pornography was used by at least one partner was recruited through online (e.g., Facebook, Twitter, etc.) and offline (e.g., newspapers, radio, etc.) sources. Participants responded to open-ended questions regarding perceived consequences of pornography use for each couple member and for their relationship in the context of an online survey. In the current sample of respondents, “no negative effects” was the most commonly reported impact of pornography use. Among remaining responses, positive perceived effects of pornography use on couple members and their relationship (e.g., improved sexual communication, more sexual experimentation, enhanced sexual comfort) were reported frequently; negative perceived effects of pornography (e.g., unrealistic expectations, decreased sexual interest in partner, increased insecurity) were also reported, albeit with considerably less frequency. The results of this work suggest new research directions that require more systematic attention.

KEYWORDS: Pornography; Relationship quality; Relationship satisfaction; Relationships; Sexual satisfaction; Sexually explicit material

“Is Internet Pornography Causing Sexual Dysfunctions? A Review with Clinical Reports” – Excerpt analyzing Steele et al., 2013

Excerpt analyzing Steele et al., 2013:


A 2013 EEG study by Steele et al. reported higher P300 amplitude to sexual images, relative to neutral pictures, in individuals complaining of problems regulating their Internet pornography use [48]. Substance abusers also exhibit greater P300 amplitude when exposed to visual cues associated with their addiction [148]. In addition, Steele et al. reported a negative correlation between P300 amplitude and desire for sex with a partner [48]. Greater cue reactivity to Internet pornography paired with less sexual desire for partnered sex, as reported by Steele et al., aligns with the Voon et al. finding of “diminished libido or erectile function specifically in physical relationships with women” in compulsive Internet pornography users [31]. Supporting these findings, two studies assessing sexual desire and erectile function in “hypersexuals” and compulsive Internet pornography users reported associations between measures of hypersexuality, and reduced desire for partnered sex and sexual difficulties [15,30]. Additionally, the 2016 survey of 434 men who viewed Internet pornography at least once in the last three months reported that problematic use was associated with higher levels of arousabilty, yet lower sexual satisfaction and poorer erectile function [44]. These results should be viewed in light of the multiple neuropsychology studies that have found that sexual arousal to Internet pornography cues and cravings to view pornography were related to symptom severity of cybersex addiction and self-reported problems in daily life due to excessive Internet pornography use [52,53,54,113,115,149,150]. Taken together, multiple and varied studies on Internet pornography users align with the incentive-salience theory of addiction, in which changes in the attraction value of an incentive correspond with changes in activation of regions of the brain implicated in the sensitization process [31,106]. To sum up, in alignment with our hypothesis, various studies report that greater reactivity toward pornographic cues, cravings to view, and compulsive pornography use are associated with sexual difficulties and diminished sexual desire for partners.

“Is Internet Pornography Causing Sexual Dysfunctions? A Review with Clinical Reports” – Excerpt analyzing Prause et al., 2015

Excerpt analyzing Prause et al., 2015


A 2015 EEG study by Prause et al. compared frequent viewers of Internet pornography (mean 3.8 h/week) who were distressed about their viewing to controls (mean 0.6 h/week) as they viewed sexual images (1.0 s exposure) [130]. In a finding that parallels Kühn and Gallinat, frequent Internet pornography viewers exhibited less neural activation (LPP) to sexual images than controls [130]. The results of both studies suggest that frequent viewers of Internet pornography require greater visual stimulation to evoke brain responses when compared with healthy controls or moderate Internet pornography users [167,168]. In addition, Kühn and Gallinat reported that higher Internet pornography use correlated with lower functional connectivity between the striatum and the prefrontal cortex. Dysfunction in this circuitry has been related to inappropriate behavioral choices regardless of potential negative outcome [169]. In line with Kühn and Gallinat, neuropsychological studies report that subjects with higher tendency towards cybersex addiction have reduced executive control function when confronted with pornographic material [53,114].

Decreased LPP for sexual images in problematic pornography users may be consistent with addiction models. Everything depends on the model. (Commentary on Prause, Steele, Staley, Sabatinelli, & Hajcak, 2015) by Matuesz Gola PhD. (2016)


Biol Psychol. 2016 May 24. pii: S0301-0511(16)30182-X. doi: 10.1016/j.biopsycho.2016.05.003.

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  • 1Swartz Center for Computational Neuroscience, Institute for Neural Computations, University of California San Diego, San Diego, USA; Institute of Psychology, Polish Academy of Science, Warsaw, Poland. Electronic address: mgola@ucsd.edu.

Internet technology provides affordable and anonymous access to a wide range of pornography content (Cooper, 1998). Avail-able data show that 67.6% of male and 18.3% of female Danish young adults (18–30 years old) use pornography on the regular weekly basis (Hald, 2006). Among USA college students 93.2% of boys and 62.1% of girls were watching online pornography before age of 18 (Sabina, Wolak, & Finkelhor, 2008). For the majority of users, pornography viewing plays a role in entertainment, excitement, and inspiration (Rothman, Kaczmarsky, Burke, Jansen, & Baughman, 2014) (Häggström-Nordin, Tydén, Hanson,& Larsson, 2009), but for some, frequent pornography consumption is a source of suffering (about 8% out of users according to Cooper et al., 1999) and becomes a reason for seeking treatment (Delmonico and Carnes, 1999; Kraus, Potenza, Martino, & Grant,2015; Gola, Lewczuk, & Skorko, 2016; Gola and Potenza, 2016). Due to its widespread popularity and conflicting clinical observations, pornography consumption is an important social issue, garnering much attention in the media, (e.g., high-profile movies: “Shame” by McQueen and “Don Jon” by Gordon-Levitt) and from politicians(e.g., UK prime minister David Cameron’s 2013 speech on pornography use by kids), as well as neuroscience research (Steele, Staley, Fong, & Prause, 2013; Kühn and Gallinat, 2014; Voon et al., 2014). One of the most frequently asked questions is: whether pornography consumption can be addicting?

The finding of Prause, Steele, Staley, Sabatinelli, & Hajcak, (2015) published in the June issue of Biological Psychology delivers interesting data on this topic. The researchers showed that men and women reporting problematic pornography viewing (N = 55),1 exhibited lower late positive potential (LPP – an event related potential in EEG signaling associated with significance and subjective silence of the stimuli) to sexual images as compared with non-sexual images, when compared with the responses of controls. They also show that problematic pornography users with higher sexual desire have smaller LPP differences for sexual and non-sexual images. The authors concluded that: “This pattern of results appears inconsistent with some predictions made by addiction models” (p. 196) and announced this conclusion in the article’s title: “Modulation of late positive potentials by sexual images in problem users and controls inconsistent with “porn addiction””.

Unfortunately, in their article, Prause et al. (2015) did not explicitly define which model of addiction they were testing. Presented results when considered in relation to the most established models either do not provide clear verification of the hypothesis that problematic pornography use is an addiction (like in case of Incentive Salience Theory; Robinson and Berridge, 1993; Robinson, Fischer, Ahuja, Lesser, & Maniates, 2015) or support this hypothesis (like in case of Reward Deficiency Syndrome; Blum et al., 1996; 1996; Blum, Badgaiyan, & Gold, 2015). Below I explain it in details.

Correspondence address: Swartz Center for Computational Neuroscience, Institute for Neural Computations, University of California San Diego, 9500 Gilman Drive, San Diego, CA 92093-0559, USA. E-mail address: mgola@ucsd.edu

1 It is worthy to notice that the authors present results for male and female participants together, while recent studies shows that sexual images ratings of arousal and valence differs dramatically between genders (see: Wierzba et al., 2015)

2 This guess is supported by fact that references used in Prause et al. (2015) also refer to IST (i.e. Wölfling et al., 2011

Why theoretical framework and clear hypothesis matter

Based on the multiple uses of the term “cue-reactivity” by the authors we may guess that the authors have in mind Incentive Salience Theory (IST) proposed by Robinson and Berridge (Berridge, 2012; Robinson et al., 2015).2 This theoretical frame-work distinguishes two basic components of motivated behavior − “wanting” and “liking”. The latter is directly linked to the experienced value of the reward, while the former is related to the expected value of the reward, typically measured in relation to a predictive cue. In terms of Pavlovian learning, reward is an unconditioned stimulus (UCS) and cues associated with this reward through learning are conditioned stimuli (CS). Learned CSs acquire incentive salience and evoke “wanting”, reflected in motivated behavior (Mahler and Berridge, 2009; Robinson & Berridge, 2013). Thus they acquire similar properties as the reward itself. For example domesticated quail willingly copulate with a terrycloth object (CS) previously paired with the opportunity to copulate with a female quail (UCS), even if a real female is available (Cetinkaya and Domjan, 2006)

According to IST, addiction is characterized by increased “wanting” (elevated cue-related reactivity; i.e. higher LPP) and decreased “liking” (diminished reward-related reactivity; i.e. lower LPP). In order to interpret data within the IST framework researchers must clearly disentangle cue-related “wanting” and reward-related “liking.” Experimental paradigms testing both processes introduce separate cues and rewards (i.e. Flagel et al., 2011; Sescousse, Barbalat, Domenech, & Dreher, 2013; Gola, Miyakoshi, & Sescousse, 2015). Prause et al. (2015) instead use a much simpler experimental paradigm, wherein subjects passively view different pictures with sexual and non-sexual content. In such simple experimental design the crucial question from the IST perspective is: Do the sexual images play the role of cues (CS) or rewards (UCS)? And therefore: does the measured LPP reflect “wanting” or “liking”?

The authors assume that sexual images are cues, and there-fore interpret decreased LPP as a measure of diminished “wanting.”Diminished “wanting” with respect to cues would indeed be inconsistent with the IST addiction model. But many studies show that sexual pictures are not mere cues. They are rewarding in them-selves (Oei, Rombouts, Soeter, van Gerven, & Both, 2012; Stoléru,Fonteille, Cornélis, Joyal, & Moulier, 2012; reviewed in: Sescousse, Caldú, Segura, & Dreher, 2013; Stoléru et al., 2012). Viewing sexual images evokes ventral striatum (reward system) activity (Arnowet al., 2002; Demos, Heatherton, & Kelley, 2012; Sabatinelli, Bradley,Lang, Costa, & Versace, 2007; Stark et al., 2005; Wehrum-Osinskyet al., 2014), dopamine release (Meston and McCall, 2005) and both self-reported and objectively measured sexual arousal (review: Chivers, Seto, Lalumière, Laan, & Grimbos, 2010).

The rewarding properties of sexual images may be innate due to the fact that sex (like food) is a primary reward. But even if some-one rejects such innate rewarding nature, rewarding properties of erotic stimuli may be acquired due to Pavlovian learning. Under natural conditions, visual erotic stimuli (such as a naked spouse or pornographic video) may be a cue (CS) for sexual activity leading to the climax experience (UCS) as a result of either dyadic sex or solitary masturbation accompanying pornography consumption. Furthermore in the case of frequent pornography consumption, visual sexual stimuli (CS) are strongly associated with orgasm (UCS)and may acquire properties of reward (UCS; Mahler and Berridge, 2009; Robinson & Berridge, 2013) and then lead to approach (i.e.seeking pornography) and consummatory behaviors (i.e., hours of viewing before reaching climax).

Regardless of innate or learned reward value, studies show that sexual images are motivating in themselves, even without the possibility of climax. Thus they have intrinsic hedonic value for humans (Prévost, Pessiglione, Météreau, Cléry-Melin, & Dreher,2010) as well as rhesus macaques (Deaner, Khera, & Platt, 2005). Their rewarding value may even be amplified in an experimental setting, where a climax experience (natural UCS) is unavailable, as in the Prause et al.’s (2015) study (“participants in this study were instructed not to masturbate during the task”, p. 197). According to Berridge, task context influences reward prediction (Berridge,2012). Thus, as no other pleasure than sexual images was available here, the viewing of pictures was the ultimate reward (rather than simply a cue).

Decreased LPP for sexual rewards in problematic pornography users is consistent with addiction models

Taking all of the above into account we may assume that sexual images in the Prause et al. (2015) study, instead of being cues, might have played the role of rewards. If so, according to the IST framework, lower LPP for sexual vs. non-sexual pictures in problematic pornography users and subjects with high sexual desire indeed reflects diminished “liking”. Such a result is in line with the addiction model proposed by Berridge and Robinson (Berridge, 2012; Robinson et al., 2015). However, to fully verify an addiction hypothesis within IST framework, more advanced experimental studies, disentangling cue and reward are required. A good example of a well designed experimental paradigm was used in studies on gamblers by Sescousse, Redouté, & Dreher (2010). It employed monetary and sexual cues (symbolic stimuli) and clear rewards(monetary wins or sexual pictures). Due to lack of well defined cues and rewards in Prause et al. (2015) study, role of sexual pictures remains unclear and therefore obtained LPP effects are ambiguous within IST framework. For sure conclusion presented in the study’s title “Modulation of late positive potentials by sexual images in problem users and controls inconsistent with “porn addiction” is ungrounded with respect to IST

If we take another popular addiction model – Reward Deficency Syndrome (RDS; Blum et al., 1996, 2015) the data obtained by the authors actually speaks in favor of addiction hypothesis. RDS frame-work assumes that genetic predisposition to lower dopaminergic response for rewarding stimuli (expressed in diminished BOLD and electrophysiological reactivity) is related to sensation-seeking, impulsivity and higher risk of addiction. The authors’ findings of lower LPPs in problematic pornography users is entirely consistent with the RDS addiction model. If Prause et al. (2015) were testing some other model, less well known than IST or RDS, it would be highly desirable to present it briefly in their work.

Final remarks

The study by Prause et al. (2015) delivers interesting data on problematic pornography consumption.3 Yet, due to the lack of clear hypothesis statement which addiction model is tested and ambiguous experimental paradigm (hard to define role of erotic pictures), it is not possible to say if the presented results are against, or in favor of, a hypothesis about “pornography addiction.” More advanced studies with well defined hypotheses are called for. Unfortunately the bold title of Prause et al. (2015) article has already had an impact on mass media,4 thus popularizing scientifically unjustified conclusion. Due to the social and political importance of the topic of the effects of pornography consumption, researchers should draw future conclusions with greater caution.

3 It is worthy to notice that in Prause et al. (2015) problematic users consume pornography in average for 3.8 h/week (SD = 1.3) it is almost the same as non-problematic pornography users in Kühn and Gallinat (2014) who consume in average 4.09 h/week (SD = 3.9). In Voon et al. (2014) problematic users reported 1.75 h/week (SD = 3.36) and problematic 13.21 h/week (SD = 9.85) – data presented by Voon during American Psychological Science conference in May 2015.

4 Examples of titles of popular science articles about Prause et al. (2015):“Porn is not as harmful as other addictions, study claims” (http://metro.co.uk/2015/07/04/porn-is-not-as-harmful-as-other-addictions…), “Your Porn Addiction Isn’t Real” (http://www.thedailybeast.com/articles/2015/06/26/your-porn-addiction-isn…), “Porn ’Addiction’ Isn’t Really Addiction, Neuroscientists Say” (http://www.huffingtonpost.com/2015/06/30/porn-addiction- n7696448.html)

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Critique of: “Is Pornography Use Associated with Sexual Difficulties and Dysfunctions among Younger Heterosexual Men?” (2015)


THE ARTICLE

Study on young men: ED rates of 31%; low libido 37%, but, hey, it can’t be porn

This is an analysis of Is Pornography Use Associated with Sexual Difficulties and Dysfunctions among Younger Heterosexual Men? (A Brief Communication) by Landripet I, Štulhofer A.

The conclusion of this brief paper on young men in Portugal, Croatia and Norway stated that:

Pornography does not seem to be a significant risk factor for younger men’s desire, erectile, or orgasmic difficulties.

Let’s’ examine a few major problems with this overly confident conclusion.

PROBLEM 1: Study reports incredibly high rates of ED & low sexual desire

This simple cross-sectional study comparing a pair of existing databases found rates of ED as high as 31% and rates of ‘low sexual desire’ as high as 37% in men 18-40. Yet the title and abstract mention neither of these findings. Instead, the authors reassure us that “It’s not the porn”, even though the study acknowledges an ED epidemic in young men:

 “Several large-scale epidemiological studies recently pointed to a high prevalence of erectile dysfunction (ED) among younger men.”

What were the ED rates in young men in the new study, which is based on a 2011 questionnaire and another from 2014?

“In Study 1, 14.2–28.3% of participants reported ED” (2011)

“In Study 2, 30.8% of men were classified as having ED” (2014)

Note the continued rise in ED rates even between the 2011 survey and the 2014 survey. Back in 2004, Stulhofer’s research showed that ED rates in men 35-39 were only 5.8%!

This study found the same extraordinarily high rates of unexplained ED in young men found in several other studies. What were ED rates before the Internet? Kinsey (1948) reported less than 3% rate of ED for men under 40, and less than 1% for men 19 and under. The only cross-sectional study of ED rates in American men reported a 5% rate of ED in men ages 18-59. This was based on data from 1992, and one third of the men were over 40. Similarly, a 2002 meta-analysis by Dutch researchers reported that of 6 studies analyzed, 5 found ED rates for men under 40 were approximately 2%. The other one reported rates of 9%.

Also note that in the first survey, “low sexual desire” rates were an alarming 16.3% to 37.4%. How can almost 40% of young men have low libido? Such high rates were unheard of only a few short years ago. For example, in 2004, Italian urologist Carlo Foresta found low-sexual-desire rates of only 1.7% in teens. However, rates had jumped 600% to 10.3% by 2012.

Bottom line: ED rates for men under 40 have increased at least 600% in the last 20 years, and the study’s authors assert that porn is not the cause. What other variable has changed radically in the last 15-20 years?


PROBLEM 2: The only variable assessed was frequency of use in the last 12 months

The authors only assess one variable related to porn use across all subjects: self-reported frequency of use (not hours of use) over the last 12 months. There are several problems with this limited measure:

  1. Frequency of use may have no relationship to hours per week, let alone various other, more relevant, variables of use
  2. It tells us nothing about porn use prior to the last 12 months
  3. It tells us nothing about total porn use over a lifetime

The authors conclude that in their cross-sectional study, using the questions they used, there is little evidence that frequency of porn determines which young men develop sexual dysfunctions. This result is not altogether surprising. In fact, one of the most common questions posed on recovery forums is, “Why did I develop PIED when my friends watch as much (or more) porn than I do?”

Instead of frequency of use, a combination of variables appear to be involved in porn-induced ED. These include:

  1. Total hours of use
  2. Years of use
  3. Age started consistent porn use
  4. Escalation to new genres
  5. Development of porn-induced fetishes (from escalating to new genres of porn)
  6. Ratio of masturbation to porn versus masturbation without porn
  7. Ratio of sexual activity with a person versus masturbation to porn
  8. Gaps in partnered sex (where one relies only on porn)
  9. Virgin or not
  10. Addiction-related brain changes or not
  11. Presence of porn addiction/hypersexuality
  12. Genetics

What other aspects of internet porn use might better explain porn-related sexual dysfunctions? German researchers found that intensity of arousal and number of applications opened were associated with porn-related problems, while time spent watching was not.

Results indicate that self-reported problems in daily life linked to online sexual activities were predicted by subjective sexual arousal ratings of the pornographic material, global severity of psychological symptoms, and the number of sex applications used when being on Internet sex sites in daily life, while the time spent on Internet sex sites (minutes per day) did not significantly contribute to explanation of variance in IATsex score. Personality facets were not significantly correlated with the IATsex score. [emphasis added]

To reiterate, the Germans found that time spent watching porn was not a factor in either porn addiction or the negative consequences of using. Instead it was the number of applications (genres), and one’s response to porn use, that made the difference. That is, a need for novelty and more stimulation. Similarly, hours of use by internet videogamers also do not predict problems. Rather, motives and obsessive passion for gaming are predictive.

In short, criteria for diagnosing problems with internet use need to be broader than hours/frequency of use. This casts doubt of the usefulness and conclusions of the “Brief Communication” under discussion here. Danish porn researcher Gert Martin Hald’s editorial comments echoed the need to assess more variables (mediators, moderators) than just frequency per week in the last 12 months:

Third, the study does not address possible moderators or mediators of the relationships studied nor is it able to determine causality. Increasingly, in research on pornography, attention is given to factors that may influence the magnitude or direction of the relationships studied (i.e., moderators) as well as the pathways through which such influence may come about (i.e., mediators). Future studies on pornography consumption and sexual difficulties may also benefit from an inclusion of such focuses.

Bottom line: All complex medical conditions involve multiple factors which must be teased apart. In any case, the authors’ statement that, Pornography does not seem to be a significant risk factor for younger men’s desire, erectile, or orgasmic difficulties is unsupported, since it ignores all the other possible variables related to porn use that might be causing sexual performance problems in users. Before confidently claiming that we have nothing to worry about from internet porn, one still needs to explain away the very recent, astonishing rise in youthful ED and low sexual desire.


PROBLEM 3: Study excluded virgins and men who hadn’t had intercourse in the last 12 months

The two populations most likely to report porn-induced ED, virgins and men not having sex, were excluded from the survey. It’s not unusual for men with PIED to say they have remained virgins because they cannot achieve strong enough erections to penetrate. Many sexually experienced men say they no longer attempt sex due to PIED.

In other words, this survey wouldn’t pick up new ED in guys who had sex almost a year ago. It also wouldn’t pick up sexual dysfunctions in those who haven’t had sex in the last year, or who have exclusively been using internet porn to climax, or those who are virgins because they can’t get it up without porn. And were these men to be included (and asked if they can masturbate without internet porn), it may well be that a correlation between frequency of porn use and ED/low sexual desire would have appeared.


PROBLEM 4: The study actually found a few correlations between ED and porn use

The abstract doesn’t mention a pretty important correlation: Only 40% of the Portuguese men used porn “frequently”, while the 60% of the Norwegians used porn “frequently”. The Portuguese men had far less sexual dysfunction than the Norwegians.

Elsewhere, the authors acknowledge a statistically significant association between more frequent porn use and ED, but claim the effect size was small. However, this claim may be misleading according to an MD who is a skilled statistician and has authored many studies:

Analyzed a different way (Chi Squared), … moderate use (vs. infrequent use) increased the odds (the likelihood) of having ED by about 50% in this Croatian population. That sounds meaningful to me, although it is curious that the finding was only identified among Croats.

The authors blow this finding off and ignore it in reaching their conclusions, but in Gert Martin Hald’s formal comments about the study he says:

However, in pornography research, the interpretation of “size” may depend as much on the nature of the outcome studied as the magnitude of the relationship found. Accordingly, if the outcome is to be considered “sufficiently adverse” (e.g., sexual aggressive behaviors), even small effect sizes may carry considerable social and practical significance [2].

Landripet and Stulhofer omitted two correlations which they presented to a European conference:

However, increased pornography use was slightly but significantly associated with decreased interest for partnered sex and more prevalent sexual dysfunction among women.

Reporting a preference for specific pornographic genres were significantly associated with erectile, but not ejaculatory or desire-related male sexual dysfunction.

It’s quite telling that Landripet & Stulhofer chose to omit a very significant correlation between erectile dysfunction and preferences for specific genres of porn from their paper. It’s quite common for porn users to escalate into genres that do not match their original sexual tastes, and to experience ED when these conditioned porn preferences do not match real sexual encounters. As pointed out below, it’s very important to assess the multiple variables associated with porn use – not just hours in the last month, or frequency in the last years.


PROBLEM 5: Claiming a 1000% increase in youthful ED can be explained by other factors.

So how do the authors explain the current ED epidemic in men under 40? They suggest the epidemic must arise from he same old factors that existed before the internet.

Epidemiological studies suggest that unhealthy lifestyles, substance abuse, stress, depression, intimacy deficit, and misinformation about sexuality are more likely factors behind male sexual dysfunctions than pornography use.”

The authors are simply quoting earlier studies that suggest smoking, lack of exercise, and drug use may be factors, because those are the historical factors, but this conclusion is difficult to swallow.

First, smoking, obesity, diabetes, and lack of exercise are not major factors for young men. It takes years for these to manifest as organic ED, in the form of cardiovascular disease or nerve dysfunction. Moreover, smoking rates have drastically declined in the last 30 years, and the use of drugs and exercise rates have held steady over recent years. Obesity rates have only increased by 4% over the last 15 years. From the 20110 study, “Erectile dysfunction and correlated factors in Brazilian men aged 18-40 years.”

“Prevalence of ED in 1,947 men was 35.0% (73.7% mild, 26.3% moderate/complete)…. Also, no association was found between ED and smoking, alcoholism, obesity, sedentary life, diabetes, hypertension, cardiovascular disease, hyperlipidemia, depression or anxiety.”

But what about the claim that “misinformation about sexuality” and “intimacy deficits” are now playing a major role in ED? Simply pulled out of the air, an exercise in creative writing.

And why have the authors ignored the research showing evidence of a link porn use and sexual dysfunction? Cambridge University, for example, reported that 60% of their porn-addicted subjects had problems with erections and desire with real partners, but not with porn. In this 2014 case study a man with low libido and anorgasmia healed his both sexual dysfunctions by eliminating porn for 8 months.

We are back to asking “What one major variable influencing sexuality has changed since 1992?” Let me guess: internet porn.

Comment on: “Is Pornography Use Associated with Sexual Difficulties and Dysfunctions among Younger Heterosexual Men?” by Gert Martin Hald PhD (2015)

Link to PubMed version

by Gert Martin Hald

Article first published online: 14 MAY 2015

J Sex Med 2015;12:1140–1141

Surprisingly, given its potential clinical relevance, very few studies have attempted to investigate relationships between pornography consumption and common sexual dysfunctions and problems (in the following referred to as “sexual difficulties”). When having done so, the designs employed have predominantly been case study designs or focus group designs and the method of data collection qualitative. Alternatively, personal or clinical experiences have been utilized. Although important, such studies and experience alone may not be brought to bear on effects of the consumption of pornography. Consequently, the study by Landripet and Stulhofer offers a long and valuable cross-cultural beginning to the quantitative exploration of associations between pornography consumption and sexual difficulties.

More generally, elements of the study by Landripet and Stulhofer reflect critical issues in research on pornography. First, the sample most likely constitutes a non-probability sample. This is characteristic of much of the available research on pornography today [1]. This problem may somewhat be offset by including short, valid, and reliable measures of pornography consumption in future large population based national studies on sexuality and sexual behaviors. Considering the prevalence rates of pornography consumption and the frequency by which pornography is consumed, in particular among men, this seems both highly relevant and high time.

Second, the study finds only one significant association between pornography consumption and the outcomes studied (i.e., erectile dysfunction) and emphasizes that the size (magnitude) of this relationship is small. However, in pornography research, the interpretation of “size” may depend as much on the nature of the outcome studied as the magnitude of the relationship found. Accordingly, if the outcome is to be considered “sufficiently adverse” (e.g., sexual aggressive behaviors), even small effect sizes may carry considerable social and practical significance [2].

Third, the study does not address possible moderators or mediators of the relationships studied nor is it able to determine causality. Increasingly, in research on pornography, attention is given to factors that may influence the magnitude or direction of the relationships studied (i.e., moderators) as well as the pathways through which such influence may come about (i.e., mediators) [1,3]. Future studies on pornography consumption and sexual difficulties may also benefit from an inclusion of such focuses.

Fourth, in  their concluding statement, the authors suggest that a number of factors are more likely related to sexual difficulties than pornography consumption. To better assess this, as well as the relative contribution of each of these variables, the use of comprehensive models able to encompass both direct and indirect relationships between variables known or hypothesized to influence the outcome may be advised [3].

Overall, the study by Landripet and Stulhofer provides first and an interesting cross-cultural and quantitative insights into possible associations between pornography consumption and sexual difficulties. Hopefully comparable future studies may use this as a stepping stone to further advance the research on relationships between pornography consumption and sexual difficulties among both men and women.

Gert Martin Hald, Department of Public Health, University of Copenhagen, Copenhagen, Denmark

References

1  Hald GM, Seaman C, Linz D. Sexuality and pornography. In: Tolman D, Diamond L, Bauermeister J, George W, Pfaus J, Ward M, eds. APA handbook of sexuality and psychology: Vol. 2. Contextual approaches. Washington, DC: American Psychological Association; 2014:3–35.

2  Malamuth NM, Addison T, Koss M. Pornography and sexual aggression: Are there reliable effects and can we understand

them? Annu Rev Sex Res 2000;11:26–91.

3  Rosenthal R. Media violence, antisocial behavior, and the social consequences of small effects. J Soc Issues 1986;42:141–54.

Problematic Porn Use: Quantity vs. Consequences – By Robert Weiss LCSW, CSAT-S

porn addictionA new study by Mateusz Gola, Karol Lewczuk, and Maciej Skorko, published in The Journal of Sexual Medicine, looks at the factors that drive people into treatment for problematic porn use. In particular, Gola and his team wanted to determine if frequency of porn use or consequences related to porn use are more important. Unsurprisingly, as sex addiction treatment specialists like myself and Dr. Patrick Carnes have been stating and writing for more than a decade, when diagnosing and treating porn addicts the amount of porn a person uses is considerably less relevant than his or her porn-related consequences. In fact, Dr. Carnes and I have consistently defined porn addiction based on the following three factors:

  1. Preoccupation to the point of obsession with highly objectified pornographic imagery
  2. Loss of control over the use of pornography, typically evidenced by failed attempts to quit or cut back
  3. Negative consequences related to porn use—diminished relationships, trouble at work or in school, depression, isolation, anxiety, loss of interest in previously enjoyable activities, shame, sexual dysfunction with real world partners, financial woes, legal issues, etc.

As you may have noticed, none of these criteria mention how much porn a person is looking at (or any other quantitative measure). In this respect, porn addiction is like substance abuse disorders, where it’s not how much you drink/use, it’s what drinking and using does to your life.

In recent years, of course, we’ve seen numerous studies linking the amount of porn use to potential negative consequences. But until this recently published research appeared we’ve had little to no scientific support for our claim that consequences (rather than some sort of quantified usage) is the primary measure we should use when identifying and treating pornography addiction.

The Study

Data for the Gola study was collected from March 2014 through March 2015 from a sample of heterosexual male Polish citizens. The test sample of 569 men (mean age 28.71) included 132 men who self-identified as seeking treatment for problematic porn use. (The rest of the sample served as the control group.) “Negative consequences” were identified using a Polish adaptation of the Sexual Addiction Screening Test-Revised (SAST-R), with twenty yes/no questions geared toward assessment of preoccupation, affect, relationship disturbance, and feeling as if one’s sexual behavior is out of control.

The study initially looked at amount of porn use and propensity for seeking treatment, finding a significant correlation. This mirrors earlier research looking (peripherally) at this issue. For instance, studies led by Valerie Voon (Cambridge, UK) and Daisy Mechelmans (Cambridge, UK) found that a non-treatment seeking control group looked at porn approximately 1.75 hours per week, whereas treatment-seeking test subjects looked at porn approximately 13.21 hours per week. However, the Cambridge studies did not consider the relationship between amount of porn use, consequences, and seeking treatment—instead focusing on aspects of neurobiology and cue reactivity.

When Gola’s team adjusted for the full mediation effect of negative consequences, the relationship between amount of porn use and seeking treatment disappeared. Meanwhile, the link between negative consequences and seeking treatment was strong, and it stayed strong relative to multiple potentially mediating factors (age of first porn use, years of porn use, subjective religiosity, and religious practices).

These findings led Gola, Lewczuk, and Skorko to conclude: “Negative symptoms associated with porn use more strongly predict seeking treatment than mere quantity of pornography consumption. Thus, treatment of problematic porn use should address qualitative factors, rather than merely mitigating the frequency of the behavior, because frequency of porn use might not be a core issue for all patients.”

Preaching to the Choir

In some ways, this new research is simply telling us what we already know. If a person is looking at porn and that behavior is impacting his or her life in negative ways, he or she might want/need to do something about it. Conversely, if a person is looking at porn and it’s not causing problems, then he or she probably doesn’t need to make any changes in that area. And this is true regardless of the amount of porn a person is using. So, once again, it’s not the amount of porn a person is using, it’s what porn use is doing to his or her relationships, self-image, and wellbeing that counts.

Still, this study is an important step forward in terms of legitimizing sexual addiction as an official psychiatric diagnosis. After all, the American Psychiatric Association has so far turned a blind eye toward sex/porn addiction, failing to list this very real and debilitating disorder in the DSM-5 despite an APA-commissioned position paper by Harvard’s Dr. Martin Kafka recommending exactly the opposite. And the APA’s only publicly stated reason for doing so appears in the DSM-5’s introduction to the Addictive Disorders section:

Groups of repetitive behaviors, which some term behavioral addictions, with such subcategories as “sex addiction,” “exercise addiction,” or “shopping addiction,” are not included because at this time there is insufficient peer-reviewed evidence to establish the diagnostic criteria and course descriptions needed to identify these behaviors as mental disorders.

In reality, as Dr. Kafka rather eloquently detailed in his position paper, there is more than enough evidence for the APA to officially recognize sex/porn addiction. In fact, many of the disorders currently listed in the DSM-5 (particularly the sex-related disorders) have significantly less supportive evidence. Nevertheless, the APA has opted for “lack of research” (rather than “political/financial pressure from pharmaceutical and insurance companies”) as grounds for its obstinate, behind-the-times stance.

Happily, new research on sex addiction emerges on a relatively regular basis, including this new study from Gola, Lewczuk, and Skorko, which confirms a portion of Dr. Kafka’s recommended diagnostic criteria (and the strikingly similar criteria that sex addiction treatment specialists have been using for many years).

So is the APA likely to move forward with an addendum to the DSM-5 that officially recognizes sex/porn addiction as an identifiable and treatable disorder? Based on just this study, probably not. After all, when it comes to making significant changes to the ways in which clinicians view psychiatric disorders the APA is nearly always late to the party. But as the evidence mounts, the APA will eventually have to concede, acknowledging the growing incidence of porn addiction in all segments of the population. Until then, of course, nothing much changes. Porn addicts hoping to heal will still seek therapy and 12-step recovery, and the clinicians who treat these men and women will do so in the ways they know best, with or without the APA’s recognition and support.

Studies linking porn use/sex addiction to sexual problems, lower arousal to sexual stimuli, and less sexual & relationship satisfaction

Regardless of what you may read in some journalistic accounts, multiple studies reveal a link between porn use and sexual performance problems, relationship and sexual dissatisfaction, and reduced brain activation to sexual stimuli.

Let’s start with sexual dysfunctions. Studies assessing young male sexuality since 2010 report historic levels of sexual dysfunctions, and startling rates of a new scourge: low libido. Documented in this lay article and in this literature review by the US Navy.

Erectile dysfunction rates in very recent studies range from 27 to 33%, while rates for low libido (hypo-sexuality) range from 16% to 37%. The lower ranges are taken from studies involving teens and men 25 and under, while the higher ranges are from studies involving men 40 and under.

Prior to the advent of free streaming porn, cross-sectional studies and meta-analysis consistently reported erectile dysfunction rates of 2-5% in men under 40. That’s nearly a 1000% increase in youthful ED rates in the last 20 years. What variable has changed in the last 15 years that could account for this astronomical rise?

Below are two lists:

  1. List One: Studies linking porn use and porn/sex addiction to sexual problems and lower arousal to sexual stimuli.
  2. List Two: Studies linking porn use to lower relationship or sexual satisfaction.

List One: Studies reporting links between porn use and ED, anorgamsia, low sexual desire, delayed ejaculation, and lower brain activation to sexual images. In addition to the studies below, this page contains articles and videos by about 100 experts (urology professors, urologists, psychiatrists, psychologists, sexologists, MDs) who acknowledge and have successfully treated porn-induced ED and porn-induced loss of sexual desire.

  • The first 3 studies demonstrate causation as participants eliminated porn use and healed chronic sexual dysfunctions:

1) Is Internet Pornography Causing Sexual Dysfunctions? A Review with Clinical Reports (2016) – An extensive review of the literature related to porn-induced sexual problems. Involving US Navy doctors, the review provides the latest data revealing a tremendous rise in youthful sexual problems. It also reviews the neurological studies related to porn addiction and sexual conditioning via Internet porn. The doctors provide 3 clinical reports of men who developed porn-induced sexual dysfunctions. Two of the three men healed their sexual dysfunctions by eliminating porn use. The third man experienced little improvement as he was unable to abstain from porn use. Excerpt:

Traditional factors that once explained men’s sexual difficulties appear insufficient to account for the sharp rise in erectile dysfunction, delayed ejaculation, decreased sexual satisfaction, and diminished libido during partnered sex in men under 40. This review (1) considers data from multiple domains, e.g., clinical, biological (addiction/urology), psychological (sexual conditioning), sociological; and (2) presents a series of clinical reports, all with the aim of proposing a possible direction for future research of this phenomenon. Alterations to the brain’s motivational system are explored as a possible etiology underlying pornography-related sexual dysfunctions. This review also considers evidence that Internet pornography’s unique properties (limitless novelty, potential for easy escalation to more extreme material, video format, etc.) may be potent enough to condition sexual arousal to aspects of Internet pornography use that do not readily transition to real-life partners, such that sex with desired partners may not register as meeting expectations and arousal declines. Clinical reports suggest that terminating Internet pornography use is sometimes sufficient to reverse negative effects, underscoring the need for extensive investigation using methodologies that have subjects remove the variable of Internet pornography use.

2) Male masturbation habits and sexual dysfunctions (2016)It’s by a French psychiatrist who is the current president of the European Federation of Sexology. While the abstract shifts back and forth between Internet pornography use and masturbation, it’s clear that he’s mostly referring to porn-induced sexual dysfunctions (erectile dysfunction and anorgasmia). The paper revolves around his clinical experience with 35 men who developed erectile dysfunction and/or anorgasmia, and his therapeutic approaches to help them. The author states that most of his patients used porn, with several being addicted to porn. The abstract point to internet porn as the primary cause of the problems (keep in mind that masturbation does not cause chronic ED, and it is never given as a cause of ED). Excerpts:

Intro: Harmless and even helpful in his usual form widely practiced, masturbation in its excessive and pre-eminent form, generally associated today to pornographic addiction, is too often overlooked in the clinical assessment of sexual dysfunction it can induce.

Results: Initial results for these patients, after treatment to “unlearn” their masturbatory habits and their often associated addiction to pornography, are encouraging and promising. A reduction in symptoms was obtained in 19 patients out of 35. The dysfunctions regressed and these patients were able to enjoy satisfactory sexual activity.

Conclusion: Addictive masturbation, often accompanied by a dependency on cyber-pornography, has been seen to play a role in the etiology of certain types of erectile dysfunction or coital anejaculation. It is important to systematically identify the presence of these habits rather than conduct a diagnosis by elimination, in order to include habit-breaking deconditioning techniques in managing these dysfunctions

3) Unusual masturbatory practice as an etiological factor in the diagnosis and treatment of sexual dysfunction in young men (2014) – One of the 4 case studies in this paper reports on a man with porn-induced sexual problems (low libido, fetishes, anorgasmia). The sexual intervention called for a 6-week abstinence from porn and masturbation. After 8 months the man reported increased sexual desire, successful sex and orgasm, and enjoying “good sexual practices. This is the first peer-reviewed chronicling of a recovery from porn-induced sexual dysfunctions Excerpts from the paper:

“When asked about masturbatory practices, he reported that in the past he had been masturbating vigorously and rapidly while watching pornography since adolescence. The pornography originally consisted mainly of zoophilia, and bondage, domination, sadism, and masochism, but he eventually got habituated to these materials and needed more hardcore pornography scenes, including transgender sex, orgies, and violent sex. He used to buy illegal pornographic movies on violent sex acts and rape and visualized those scenes in his imagination to function sexually with women. He gradually lost his desire and his ability to fantasize and decreased his masturbation frequency.”

In conjunction with weekly sessions with a sex therapist, the patient was instructed to avoid any exposure to sexually explicit material, including videos, newspapers, books, and internet pornography.

After 8 months, the patient reported experiencing successful orgasm and ejaculation. He renewed his relationship with that woman, and they gradually succeeded in enjoying good sexual practices.

4) The Dual Control Model – The Role Of Sexual Inhibition & Excitation In Sexual Arousal And Behavior (2007) – Newly discovered and very convincing paper from the Kinsey Institute. In an experiment employing video porn, 50% of the young men couldn’t become aroused or achieve erections with porn (average age was 29). The shocked researchers discovered that the men’s erectile dysfunction was,

related to high levels of exposure to and experience with sexually explicit materials.

The men experiencing erectile dysfunction had spent a considerable amount of time in bars and bathhouses where porn was “omnipresent,” and “continuously playing“. The researchers stated:

Conversations with the subjects reinforced our idea that in some of them a high exposure to erotica seemed to have resulted in a lower responsivity to “vanilla sex” erotica and an increased need for novelty and variation, in some cases combined with a need for very specific types of stimuli in order to get aroused.”

5) Neural Correlates of Sexual Cue Reactivity in Individuals with and without Compulsive Sexual Behaviours (2014) – This fMRI study by Cambridge University found cue-reactivity in porn addicts which mirrored sensitization in drug addicts. It also found that porn addicts (CSB) fit the accepted addiction model of wanting “it” more, but not liking “it” more. The researchers also reported that 60% of subjects (average age: 25) had difficulty achieving erections/arousal with real partners as a result of using porn, yet could achieve erections with porn. From the study (CSB is compulsive sexual behaviours – or porn addicts):

CSB subjects reported that as a result of excessive use of sexually explicit materials….. experienced diminished libido or erectile function specifically in physical relationships with women (although not in relationship to the sexually explicit material)”

“Compared to healthy volunteers, CSB subjects had greater subjective sexual desire or wanting to explicit cues and had greater liking scores to erotic cues, thus demonstrating a dissociation between wanting and liking. CSB subjects also had greater impairments of sexual arousal and erectile difficulties in intimate relationships but not with sexually explicit materials highlighting that the enhanced desire scores were specific to the explicit cues and not generalized heightened sexual desire.

6) Online sexual activities: An exploratory study of problematic and non-problematic usage patterns in a sample of men (2016) A Belgian study that found problematic Internet porn use was associated with reduced erectile function and reduced overall sexual satisfaction. Yet problematic porn users experienced greater cravings. The study appears to report escalation, as 49% of the men viewed porn that “was not previously interesting to them or that they considered disgusting.” An excerpt:

This study is the first to directly investigate the relationships between sexual dysfunctions and problematic involvement in OSAs. Results indicated that higher sexual desire, lower overall sexual satisfaction, and lower erectile function were associated with problematic OSAs (online sexual activities). These results can be linked to those of previous studies reporting a high level of arousability in association with sexual addiction symptoms (Bancroft & Vukadinovic, 2004; Laier et al., 2013; Muise et al., 2013).”

In addition, we finally have a study that asks porn users about possible escalation to new or disturbing porn genres. Guess what it found?

Forty-nine percent mentioned at least sometimes searching for sexual content or being involved in OSAs that were not previously interesting to them or that they considered disgusting, and 61.7% reported that at least sometimes OSAs were associated with shame or guilty feelings.”

Note – This is the first study to directly investigate the relationships between sexual dysfunctions and problematic porn use. Two other studies claiming to have investigated correlations between porn use and erectile functioning cobbled together data from earlier studies in an unsuccessful attempt to debunk porn-induced ED. Both were criticized in the peer-reviewed literature: paper 1 was not an authentic study, and has been thoroughly discredited; paper 2 actually found correlations that support porn-induced ED. Moreover, paper 2 was only a “brief communication” that did not report important data.

7) Adolescents and web porn: a new era of sexuality (2015) – An Italian study analyzed the effects of Internet porn on high school students, co-authored by urology professor Carlo Foresta, president of the Italian Society of Reproductive Pathophysiology. The most interesting finding is that 16% of those who consume porn more than once a week report abnormally low sexual desire compared with 0% in non-consumers (and 6% for those who consume less than once a week). From the study, concerning pornography use:

21.9% define it as habitual, 10% report that it reduces sexual interest towards potential real-life partners, and the remaining, 9.1% report a kind of addiction. In addition, 19% of overall pornography consumers report an abnormal sexual response, while the percentage rose to 25.1% among regular consumers.

8) Patient Characteristics by Type of Hypersexuality Referral: A Quantitative Chart Review of 115 Consecutive Male Cases (2015) – Study on men (average age 41.5) with hypersexuality disorders, such as paraphilias and chronic masturbation or adultery. 27 were classified as “avoidant masturbators,” meaning they masturbated (typically with porn use) one or more hours per day or more than 7 hours per week. 71% reported sexual functioning problems, with 33% reporting delayed ejaculation (a precursor to porn-induced ED). What sexual dysfunction do 38% of the remaining men have? The study doesn’t say, and the authors have ignored requests for details. Two primary choices for male sexual dysfunction are ED and low libido. The men were not asked about their erectile functioning without porn. If all their sexual activity involved masturbating to porn, and not sex with a partner, they would never realize they had porn-induced ED.

9)  The effects of sexually explicit material use on romantic relationship dynamics (2016) – As with many other studies, solitary porn users report poorer relationship and sexual satisfaction. Employing the Pornography Consumption Effect Scale (PCES), the study found that higher porn use was related to poorer sexual function, more sexual problems, and a “worse sex life”. An excerpt describing the correlation between the PCES “Negative Effects” on “Sex Life” questions and frequency of porn use:

There were no significant differences for the Negative Effect Dimension PCES across the frequency of sexually explicit material use; however, there were significant differences on the Sex Life subscale where High Frequency Porn Users reported greater negative effects than Low Frequency Porn Users.

10) Altered Appetitive Conditioning and Neural Connectivity in Subjects With Compulsive Sexual Behavior (2016) “Compulsive Sexual Behaviors” (CSB) means the men were porn addicts, because CSB subjects averaged nearly 20 hours of porn use per week. The controls averaged 29 minutes per week. Interestingly, 3 of the 20 CSB subjects suffered from “orgasmic-erection disorder,” while none of the control subjects reported sexual problems.

11) Brain Structure and Functional Connectivity Associated With Pornography Consumption: The Brain on Porn (2014) – A Max Planck study which found 3 significant addiction-related brain changes correlating with the amount of porn consumed. It also found that the more porn consumed the less reward circuit activity in response to brief exposure (.530 second) to vanilla porn. In a 2014 article lead author Simone Kühn said:

We assume that subjects with a high porn consumption need increasing stimulation to receive the same amount of reward. That could mean that regular consumption of pornography more or less wears out your reward system. That would fit perfectly the hypothesis that their reward systems need growing stimulation.”

A more technical description of this study from a review of the literature by Kuhn & Gallinat – Neurobiological Basis of Hypersexuality (2016).

“The more hours participants reported consuming pornography, the smaller the BOLD response in left putamen in response to sexual images. Moreover, we found that more hours spent watching pornography was associated with smaller gray matter volume in the striatum, more precisely in the right caudate reaching into the ventral putamen. We speculate that the brain structural volume deficit may reflect the results of tolerance after desensitization to sexual stimuli.”

12) Sexual Desire, not Hypersexuality, is Related to Neurophysiological Responses Elicited by Sexual Images (2013) – In line with the Cambridge University brain scan studies, this EEG study reported greater cue-reactivity to porn correlated with less desire for partnered sex. To put another way – individuals with more brain activation and cravings for porn would rather masturbate to porn than have sex with a real person. Study spokesman Nicole Prause claimed that porn users merely had high libido, yet the results of the study say something quite different.. The study’s actual findings do not match the concocted headlines. Four peer-reviewed papers expose the truth: 1, 2, 3, 4Read an extensive critique here.

13) Modulation of Late Positive Potentials by Sexual Images in Problem Users and Controls Inconsistent with “Porn Addiction” (2015) – Another SPAN Lab EEG study comparing the 2013 subjects from the above study to an actual control group. The results: compared to controls “compulsive porn users” had less response to photos of vanilla porn. Ignoring all the other studies on this page, lead author Nicole Prause, boldly claims that her results “debunked porn addiction”. What legitimate scientist would claim that their lone anomalous study has debunked an entire field of study?  In reality, the findings of Prause et al. 2015 align perfectly with Kühn & Gallinat (2014), which found that more porn use correlated with less brain activation in response to pictures of vanilla porn. Prause’s findings also align with Banca et al. 2015 which is #4 in this list. Moreover, another EEG study found that greater porn use in women correlated with less brain activation to porn. Lower EEG readings mean that subjects are paying less attention to the pictures. Put simply, frequent porn users were desensitized to static images of vanilla porn. They were bored. Read an extensive critique here. Five peer-reviewed papers have stated that this study actually found desensitization or habituation in frequent porn users – 1, 2, 3, 4, 5.

14) Erectile Dysfunction, Boredom, and Hypersexuality among Coupled Men from Two European Countries (2015) – Survey reported a strong correlation between erectile dysfunction and measures of hypersexuality. The study omitted correlation data between erectile functioning and pornography use. An excerpts

Among Croatian and German men, hypersexuality was significantly correlated with proneness to sexual boredom and more problems with erectile function.

15) Masturbation and Pornography Use Among Coupled Heterosexual Men With Decreased Sexual Desire: How Many Roles of Masturbation? (2015) – Masturbating to porn was related with decreased sexual desire and low relationship intimacy. Excerpts:

“Among men who masturbated frequently, 70% used pornography at least once a week. A multivariate assessment showed that sexual boredom, frequent pornography use, and low relationship intimacy significantly increased the odds of reporting frequent masturbation among coupled men with decreased sexual desire.”

“Among men [with decreased sexual desire] who used pornography at least once a week [in 2011], 26.1% reported that they were unable to control their pornography use. In addition, 26.7% of men reported that their use of pornography negatively affected their partnered sex and 21.1% claimed to have attempted to stop using pornography.”

16) Use of pornography in a random sample of Norwegian heterosexual couples (2009) – Porn use was correlated with more sexual dysfunctions in the man and negative self perception in the female. The couples who did not use porn had no sexual dysfunctions.  A few excerpts from the study:

In couples where only one partner used pornography, we found more problems related to arousal (male) and negative (female) self-perception.

In those couples where one partner used pornography there was a permissive erotic climate. At the same time, these couples seemed to have more dysfunctions.

The couples who did not use pornography… may be considered more traditional in relation to the theory of sexual scripts. At the same time, they did not seem to have any dysfunctions.

Couples who both reported pornography use grouped to the positive pole on the ‘‘Erotic climate’’ function and somewhat to the negative pole on the ‘‘Dysfunctions’’ function.

17) Men’s Sexual Life and Repeated Exposure to Pornography. A New Issue? (2015) – Excerpts:

Mental health specialists should take in consideration the possible effects of pornography consumption on men sexual behaviors, men sexual difficulties and other attitudes related to sexuality. In the long term pornography seems to create sexual dysfunctions, especially the individual’s inability to reach an orgasm with his partner. Someone who spends most of his sexual life masturbating while watching porn engages his brain in rewiring its natural sexual sets (Doidge, 2007) so that it will soon need visual stimulation to achieve an orgasm.

Many different symptoms of porn consumption, such as the need to involve a partner in watching porn, the difficulty in reaching orgasm, the need for porn images in order to ejaculate turn into sexual problems. These sexual behaviors may go on for months or years and it may be mentally and bodily associated with the erectile dysfunction, although it is not an organic dysfunction. Because of this confusion, which generates embarrassment, shame and denial, lots of men refuse to encounter a specialist

Pornography offers a very simple alternative to obtain pleasure without implying other factors that were involved in human’s sexuality along the history of mankind. The brain develops an alternative path for sexuality which excludes “the other real person” from the equation. Furthermore, pornography consumption in a long term makes men more prone to difficulties in obtaining an erection in a presence of their partners.

18) 2014 lecture describing upcoming studies – by Urology professor Carlo Foresta, president of the Italian Society of Reproductive Pathophysiology – The lecture contains the results of longitudinal and cross-sectional studies. One study involved a survey of high school teens (pages 52-53). The study reported that sexual dysfunction doubled between 2005 and 2013, with low sexual desire increasing 600%.

  • The percentage of teens that experienced alterations of their sexuality: 2004/05: 7.2%, 2012/13: 14.5%
  • The percentage of teens with low sexual desire: 2004/05: 1.7%, 2012/13: 10.3% (that’s a 600% increase in 8 years)

Foresta also describes his upcoming study, “Sexuality media and new forms of sexual pathology sample 125 young males, 19-25 years” (Italian name – “Sessualità mediatica e nuove forme di patologia sessuale Campione 125 giovani maschi“). The results from the study (pages 77-78), which used the International Index of Erectile Function Questionnaire, found that regular porn users scored 50% lower on sexual desire domain and 30% lower of the erectile functioning domain.

19) Not peer-reviewed. Here’s a popular article about an extensive analysis of comments and questions posted on MedHelp concerning erectile dysfunction. What’s shocking is that 58% of the men asking for help were 24 or younger. Many suspected that internet porn could be involved in their dysfunction, as described in the results from the study:

EXCERPT: The most common phrase is “erectile dysfunction” – which is mentioned more than three times as often as any other phrase – followed by “internet porn,” “performance anxiety,” and “watching porn.” Clearly, porn is a frequently discussed subject: “I have been viewing internet pornography frequently (4 to 5 times a week) for the past 6 years,” one man writes. “I am in my mid-20s and have had a problem getting and maintaining an erection with sexual partners since my late teens when I first started looking at internet porn.”


List two: Studies reporting correlations between porn use and less sexual or relationship satisfaction:

1) Does Viewing Pornography Reduce Marital Quality Over Time? Evidence from Longitudinal Data (2016) – First longitudinal study on a representative cross-section of married couples. It found significant negative effects of porn use on marriage quality over time.  Excerpt:

This study is the first to draw on nationally representative, longitudinal data (2006-2012 Portraits of American Life Study) to test whether more frequent pornography use influences marital quality later on and whether this effect is moderated by gender. In general, married persons who more frequently viewed pornography in 2006 reported significantly lower levels of marital quality in 2012, net of controls for earlier marital quality and relevant correlates. Pornography’s effect was not simply a proxy for dissatisfaction with sex life or marital decision-making in 2006. In terms of substantive influence, frequency of pornography use in 2006 was the second strongest predictor of marital quality in 2012

2) Associations between young adults’ use of sexually explicit materials and their sexual preferences, behaviors, and satisfaction (2011) – Excerpts:

Higher frequencies of sexual explicit material (SEM) use were associated with less sexual and relationship satisfaction. The frequency of SEM use and number of SEM types viewed were both associated with higher sexual preferences for the types of sexual practices typically presented in SEM. These findings suggest that SEM use can play a significant role in a variety of aspects of young adults’ sexual development processes.

Specifically, higher viewing frequency was associated with less sexual and relationship satisfaction when controlling for gender, religiosity, dating status and the number of SEM types viewed.

Because a substantial proportion of the young adults in this study reported using SEM, the potential implications are especially noteworthy, particularly for young men.

3) Pornography’s Impact on Sexual Satisfaction (1988) – Excerpt:

Male and female students and nonstudents were exposed to videotapes featuring common, nonviolent pornography or innocuous content. Exposure was in hourly sessions in six consecutive weeks. In the seventh week, subjects participated in an ostensibly unrelated study on societal institutions and personal gratifications. [Porn use] strongly impacted self-assessment of sexual experience. After consumption of pornography, subjects reported less satisfaction with their intimate partners—specifically, with these partners’ affection, physical appearance, sexual curiosity, and sexual performance proper. In addition, subjects assigned increased importance to sex without emotional involvement. These effects were uniform across gender and populations.

4) Adolescents’ Exposure to Sexually Explicit Internet Material and Sexual Satisfaction: A Longitudinal Study (2009) – Excerpt:

Between May 2006 and May 2007, we conducted a three-wave panel survey among 1,052 Dutch adolescents aged 13–20. Structural equation modeling revealed that exposure to SEIM consistently reduced adolescents’ sexual satisfaction. Lower sexual satisfaction (in Wave 2) also increased the use of SEIM (in Wave 3). The effect of exposure to SEIM on sexual satisfaction did not differ among male and female adolescents.

5) Individuals who never viewed SEM reported higher relationship quality on all indices than those who viewed SEM alone (2011)Excerpt:

As expected, individuals who did not view SEM (sexually explicit material) at all reported lower negative communication and higher dedication than individuals who viewed SEM alone or both alone and with their partner.

6) Sexual media use and relational satisfaction in heterosexual couples (2010) – Excerpt:

Results revealed that a higher frequency of men’s sexual media use related to negative satisfaction in men, while a higher frequency of women’s sexual media use related to positive satisfaction in male partners. Reasons for sexual media use differed by gender: Men reported primarily using sexual media for masturbation, while women reported primarily using sexual media as part of lovemaking with their partners.

7) Young Adult Women’s Reports of Their Male Romantic Partner’s Pornography Use as a Correlate of Their Self-Esteem, Relationship Quality, and Sexual Satisfaction (2012) – Excerpt:

The purpose of this study was to examine the relationships between men’s pornography use, both frequency and problematic use, on their heterosexual female partner’s psychological and relational well-being among 308 young adult college women. Results revealed women’s reports of their male partner’s frequency of pornography use were negatively associated with their relationship quality. More perceptions of problematic use of pornography was negatively correlated with self-esteem, relationship quality, and sexual satisfaction.

8) Korean Men’s Pornography use, Their Interest in Extreme Pornography, and Dyadic Sexual Relationships (2014) – Excerpt:

Six-hundred eighty-five heterosexual South Korean male college students participated in an online survey. The majority (84.5%) of respondents had viewed pornography, and for those who were sexually active (470 respondents), we found that higher interest in degrading or extreme pornography was associated with the experience of role-playing sexual scenes from pornography with a partner, and a preference for using pornography to achieve and maintain sexual excitement over having sex with a partner.

We found that higher interest in viewing degrading or extreme pornography … has a significant positive … association with sexual concerns.

9) Pornography and the Male Sexual Script: An Analysis of Consumption and Sexual Relations (2014) – Excerpt:

We argue pornography creates a sexual script that then guides sexual experiences. To test this, we surveyed 487 college men (ages 18-29 years) in the United States to compare their rate of pornography use with sexual preferences and concerns. Results showed the more pornography a man watches, the more likely he was to use it during sex, request particular pornographic sex acts of his partner, deliberately conjure images of pornography during sex to maintain arousal, and have concerns over his own sexual performance and body image. Further, higher pornography use was negatively associated with enjoying sexually intimate behaviors with a partner.

10) Adult Social Bonds and Use of Internet Pornography (2004) – Excerpt:

Complete data on 531 Internet users are taken from the General Social Surveys for 2000. Social bonds measures include religious, marital, and political ties. Measures of participation in sexual and drug-related deviant lifestyles, and demographic controls are included. The results of a logistic regression analysis found that among the strongest predictors of use of cyberporn were weak ties to religion and lack of a happy marriage.

11) A Common-Fate Analysis of Pornography Acceptance, Use, and Sexual Satisfaction Among Heterosexual Married Couples (2016) – Excerpt:

Results indicated that the shared variance of pornography acceptance was positively associated with both spouses’ pornography use and that spouses’ pornography use was negatively associated with their own sexual satisfaction.Wives’ pornography use was found to be positively associated with the couple’s shared variance of sexual satisfaction, but pornography use did not significantly mediate the relationship between pornography acceptance and sexual satisfaction.

12) Differences in Pornography Use Among Couples: Associations with Satisfaction, Stability, and Relationship Processes (2016) – Excerpt:

The present study utilized a sample of 1755 adult couples in heterosexual romantic relationships to examine how different patterns of pornography use between romantic partners may be associated with relationship outcomes. While pornography use has been generally associated with some negative and some positive couple outcomes, no study has yet explored how differences between partners may uniquely be associated with relationship well-being. Results suggested that greater discrepancies between partners in pornography use were related to less relationship satisfaction, less stability, less positive communication, and more relational aggression. Mediation analyses suggested that greater pornography use discrepancies were primarily associated with elevated levels of male relational aggression, lower female sexual desire, and less positive communication for both partners which then predicted lower relational satisfaction and stability for both partners.

13) Factors Predicting Cybersex Use and Difficulties in Forming Intimate Relationships among Male and Female Users of Cybersex (2015)Excerpt:

This study used the Cybersex addiction test, Craving for pornography questionnaire, and a Questionnaire on intimacy among 267 participants (192 males and 75 females) mean age for males 28 and for females 25,  who were recruited from special sites that are dedicated to pornography and cybersex on the Internet. Results of regression analysis indicated that pornography, gender, and cybersex significantly predicted difficulties in intimacy and it accounted for 66.1% of the variance of rating on the intimacy questionnaire. Second, regression analysis also indicated that craving for pornography, gender, and difficulties in forming intimate relationships significantly predicted frequency of cybersex use and it accounted for 83.7% of the variance in ratings of cybersex use.

14) Pornography use: who uses it and how it is associated with couple outcomes (2013) – Excerpt:

This study examined associations among pornography use, the meaning people attach to its use, sexual quality, and relationship satisfaction. Participants were couples (N = 617 couples) who were either married or cohabiting at the time the data were gathered. Overall results from this study indicated substantial gender differences in terms of use profiles, as well as pornography’s association with relationship factors. Specifically, male pornography use was negatively associated with both male and female sexual quality, whereas female pornography use was positively associated with female sexual quality.

15) A Love That Doesn’t Last: Pornography Consumption and Weakened Commitment to One’s Romantic Partner (2012) – The study had subjects try to abstain from porn use for 3 weeks. Upon comparing the two groups, those who continued using pornography reported lower levels of commitment than those who tried to abstain. Excerpts:

Study 1 found that higher pornography consumption was related to lower commitment

Study 3 participants were randomly assigned to either refrain from viewing pornography or to a self-control task. Those who continued using pornography reported lower levels of commitment than control participants.

Study 5 found that pornography consumption was positively related to infidelity and this association was mediated by commitment. Overall, a consistent pattern of results was found using a variety of approaches including cross-sectional (Study 1), observational (Study 2), experimental (Study 3), and behavioral (Studies 4 and 5) data.

16) Male Partners’ Perceived Pornography Use and Women’s Relational and Psychological Health: The Roles of Trust, Attitudes, and Investment (2015) – Excerpt:

Results revealed that women’s reports of their male partners’ pornography use were related to less relationship satisfaction and more psychological distress. Results from the moderation analyses indicated that the direct effect of male partners’ perceived pornography use and relationship trust and the conditional indirect effects of male partners’ perceived pornography use on both relationship satisfaction and psychological distress were contingent on relationship investment. These findings indicated that when male partners’ perceived pornography use is high, women who have low or mean levels of relationship investment have less relationship trust. Finally, our results revealed that the relationship between male partners’ perceived pornography use and relational and psychological outcomes exist regardless of women’s own attitudes toward pornography

17) Relationship of love and marital satisfaction with pornography among married university students in Birjand, Iran (2015) – Excerpts:

This descriptive-correlation study was conducted on 310 married students studying at private and public universities in Birjand, in 2012-2013 academic year using random quota sampling method. It appears that pornography has a negative impact on love and marital satisfaction.

18)  Sexual media use and relational satisfaction in heterosexual couples (2011) – Excerpt:

This study assessed how sexual media use by one or both members of a romantic dyad relates to relationship and sexual satisfaction. A total of 217 heterosexual couples completed an Internet survey that assessed sexual media use, relationship and sexual satisfaction, and demographic variables. Results revealed that a higher frequency of men’s sexual media use related to negative satisfaction in men, while a higher frequency of women’s sexual media use related to positive satisfaction in male partners. Reasons for sexual media use differed by gender

19) Wives’ Experience of Husbands’ Pornography Use and Concomitant Deception as an Attachment Threat in the Adult Pair-Bond Relationship (2009)

Evidence is growing that pornography use can negatively impact attachment trust in the adult pair-bond relationship. Analyses uncovered three attachment-related impacts from husbands’ pornography use and deception: (1) the development of an attachment fault line in the relationship, stemming from perceived attachment infidelity; (2) followed by a widening attachment rift arising from wives’ sense of distance and disconnection from their husbands; (3) culminating in attachment estrangement from a sense of being emotionally and psychologically unsafe in the relationship. Overall, wives reported global mistrust indicative of attachment breakdown.

20)  Men’s leisure and women’s lives: The impact of pornography on women (1999) – Excerpt:

The section of the interview where the women discussed their own current or past relationships with men revealed additional insight into the effect of pornography on such relationships. Fifteen of the women were in, or had been in, relationships with men who rented or bought pornography at least on an occasional basis. Of these 15 women, four expressed strong dislike of their husband’s or partner’s leisure time interest in pornography. It was clear that the husbands’ use of pornography affected the wives’ feeling about themselves, their sexual feelings, and their marital relationships in general

21)  From Bad to Worse? Pornography Consumption, Spousal Religiosity, Gender, and Marital Quality (2016) – Excerpts:

I test the above hypotheses using data from Wave 1 of the Portraits of American Life Study (PALS), which was fielded in 2006. PALS is a nationally representative panel survey with questions focusing on a variety of topics….Looking at bivariate correlations, for the full sample, viewing pornography is negatively associated with overall marital satisfaction, suggesting that those who view pornography more often tend to be less satisfied in their marriage than those who view pornography less often or never

22) Pornography and Marriage (2014) – All bad news, and it’s getting worse. The abstract:

We used data on 20,000 ever-married adults in the General Social Survey to examine the relationship between watching pornographic films and various measures of marital well-being. We found that adults who had watched an X-rated movie in the past year were more likely to be divorced, more likely to have had an extramarital affair, and less likely to report being happy with their marriage or happy overall. We also found that, for men, pornography use reduced the positive relationship between frequency of sex and happiness. Finally, we found that the negative relationship between pornography use and marital well-being has, if anything, grown stronger over time, during a period in which pornography has become both more explicit and more easily available.

23) Exploring actor and partner correlates of sexual satisfaction among married couples (2010) – Excerpt:

Using the Interpersonal Exchange Model of Sexual Satisfaction, we consider how infidelity, pornography consumption, marital satisfaction, sexual frequency, premarital sex, and cohabitation are associated with married couples’ sexual satisfaction. Data from 433 couples are analyzed with structural equation models to determine the contributions. Finally, some evidence suggests that pornography consumption is costly for own and spouse’s sexual satisfaction, especially when pornography is used by only one spouse.

24) Sexually explicit media use and relationship satisfaction a moderating role of emotional intimacy? (2016) – The authors attempt to obfuscate their findings in the abstract by stating that once sexual and relationship variables were “controlled for”, they found no link between between porn use and relationship satisfaction. Reality: The study found significant correlations between porn use and poorer relationship & sexual satisfaction in both males and females. Excerpt from discussion section:

For both men and women, significant, yet modest negative zero-order correlations between SEM use and relationship satisfaction were found, indicating that increased SEM use was associated with lower relationship satisfaction across gender.

25) Sex in America Online: An Exploration of Sex, Marital Status, and Sexual Identity in Internet Sex Seeking and Its Impacts (2008) – Excerpt:

This was an exploratory study of sex and relationship seeking on the Internet, based on a survey of 15,246 respondents in the United States Seventy-five percent of men and 41% of women had intentionally viewed or downloaded porn. Men and gays/lesbians were more likely to access porn or engage in other sex-seeking behaviors online compared with straights or women. A symmetrical relationship was revealed between men and women as a result of viewing pornography, with women reporting more negative consequences, including lowered body image, partner critical of their body, increased pressure to perform acts seen in pornographic films, and less actual sex, while men reported being more critical of their partners’ body and less interested in actual sex.

26) Effect of soft core pornography on female sexuality (2016) – Excerpt:

An overall 51.6% of participants who were aware that their husbands were positive watchers reported experiencing negative emotions (depression, jealous), whereas 77% reported changes in their husbands’ attitude. Non-watchers watchers were more satisfied with their sexual life compared with their counterparts. Although watching soft-core pornography had a statistically significant effect on sexual desire, vaginal lubrication, ability to reach orgasm, and masturbation, it had no statistically significant effect on coital frequency. Watching soft-core pornography affects female sexual life by increasing sexual boredom in both men and women, causing relational difficulties.

27) Internet Pornography Consumption and Relationship Commitment of Filipino Married Individuals (2016) – Excerpt:

Internet pornography has many adverse effects, especially to the relationship commitment. The use of pornography directly correlates to a decrease in sexual intimacy. Hence, this might lead to weakening of the relationship of their partner. To find out the relevance of the claim, the researchers aimed to explore the relationship of Internet pornography consumption to the relationship commitment of married individuals in the Philippines. It is revealed that Internet pornography consumption has an adverse effect on the relationship commitment of married Filipino couples. Furthermore, watching porn online weakened the relationship commitment that leads to an unstable relationship. This investigation found out that internet pornography consumption has a nominal negative effect on the relationship commitment of Filipino married individuals.

28) Till Porn Do Us Part? Longitudinal Effects of Pornography Use on Divorce, (2016) – The study used nationally representative General Social Survey panel data collected from thousands of American adults. Respondents were interviewed three times about their pornography use and marital status — every two years from 2006-2010, 2008-2012, or 2010-2014. Excerpts:

Beginning pornography use between survey waves nearly doubled one’s likelihood of being divorced by the next survey period, from 6 percent to 11 percent, and nearly tripled it for women, from 6 percent to 16 percent.  Our results suggest that viewing pornography, under certain social conditions, may have negative effects on marital stability.

Additionally, the researchers found that respondents’ initially reported level of marital happiness played an important role in determining the magnitude of pornography’s association with the probability of divorce. Among people who reported they were “very happy” in their marriage in the first survey wave, beginning pornography viewership before the next survey was associated with a noteworthy increase — from 3 percent to 12 percent — in the likelihood of getting divorced by the time of that next survey.

29) Perceptions of relationship satisfaction and addictive behavior: Comparing pornography and marijuana use (2016) – Excerpt:

This study contributes to the broader literature on how pornography use impacts perceptions of romantic relationships. This study examined if negative outcomes due to a romantic partner’s excessive pornography use are different than negative outcomes produced by other compulsive or addictive behaviors, specifically marijuana use. This study suggests that problematic partner pornography use and problematic partner marijuana use are perceived to similarly impact romantic relationships and contribute to a decrease in relationship satisfaction.

30) Psychological, Relational, and Sexual Correlates of Pornography Use on Young Adult Heterosexual Men in Romantic Relationships (2014) – Excerpt:

Thus, the purpose of this study was to examine theorized antecedents (i.e., gender role conflict and attachment styles) and consequences (i.e., poorer relationship quality and sexual satisfaction) of men’s pornography use among 373 young adult heterosexual men. Findings revealed that both frequency of pornography use and problematic pornography use were related to greater gender role conflict, more avoidant and anxious attachment styles, poorer relationship quality, and less sexual satisfaction. In addition, the findings provided support for a theorized mediated model in which gender role conflict was linked to relational outcomes both directly and indirectly via attachment styles and pornography use.

31) Associations between relational sexual behaviour, pornography use, and pornography acceptance among US college students (2014) – Excerpt:

Using a sample of 792 emerging adults, the present study explored how the combined examination of pornography use, acceptance, and sexual behaviour within a relationship might offer insight into emerging adults’ development. Results suggested clear gender differences in both pornography use and acceptance patterns. High male pornography use tended to be associated with high engagement in sex within a relationship and was associated with elevated risk-taking behaviours. High female pornography use was not associated with engagement in sexual behaviours within a relationship and was general associated with negative mental health outcomes.

32) The effects of sexually explicit material use on romantic relationship dynamics (2016) – Excerpts:

More specifically, couples, where no one used, reported more relationship satisfaction than those couples that had individual users. This is consistent with the previous research (Cooper et al., 1999; Manning, 2006), demonstrating that the solitary use of sexually explicit material results in negative consequences.

With gender effects held constant, individual users reported significantly less intimacy and commitment in their relationships than non-users and shared users.

Overall, how frequently someone views sexually explicit material can have an impact on users’ consequences. Our study found that high frequency users are more likely to have lower relationship satisfaction and intimacy in their romantic relationships.

33) Viewing Sexually-Explicit Materials Alone or Together: Associations with Relationship Quality (2011) –  Excerpt:

This study investigated associations between viewing sexually-explicit material (SEM) and relationship functioning in a random sample of 1291 unmarried individuals in romantic relationships. More men (76.8%) than women (31.6%) reported that they viewed SEM on their own, but nearly half of both men and women reported sometimes viewing SEM with their partner (44.8%).  Individuals who never viewed SEM reported higher relationship quality on all indices than those who viewed SEM alone. Those who viewed SEM only with their partners reported more dedication and higher sexual satisfaction than those who viewed SEM alone. The only difference between those who never viewed SEM and those who viewed it only with their partners was that those who never viewed it had lower rates of infidelity.

34) Cyberpornography: Time Use, Perceived Addiction, Sexual Functioning, and Sexual Satisfaction (2016) – Excerpt:

First, even when controlling for perceived addiction to cyberpornography and overall sexual functioning, cyberpornography use remained directly associated with sexual dissatisfaction. Even though this negative direct association was of small magnitude, time spent viewing cyberpornography seems to be a robust predictor of lower sexual satisfaction.

35) Internet pornography and relationship quality: A longitudinal study of within and between partner effects of adjustment, sexual satisfaction and sexually explicit internet material among newly-weds (2015) – Excerpts:

The data from a considerable sample of newlyweds showed that SEIM use has more negative than positive consequences for husbands and wives. Importantly, husbands’ adjustment decreased SEIM use over time and SEIM use decreased adjustment. Furthermore, more sexual satisfaction in husbands predicted a decrease in their wives’ SEIM use one year later, while wives’ SEIM use did not change their husbands’ sexual satisfaction.

36) More than a dalliance? Pornography consumption and extramarital sex attitudes among married U.S. adults (2014)Excerpts:

This brief report used national panel data gathered from two separate samples of married U.S. adults. Data were gathered from the first sample in 2006 and in 2008. Data were gathered from the second sample in 2008 and in 2010. Consistent with a social learning perspective on media, prior pornography consumption was correlated with more positive subsequent extramarital sex attitudes in both samples, even after controlling for earlier extramarital sex attitudes and nine additional potential confounds.

In total, the results of the present study are consistent with the theoretical premise that pornography consumption leads to the acquisition and activation of sexual scripts, which are then used by many consumers to inform their sexual attitudes (Wright, 2013a; Wright et al., 2012a).

37) Internet Pornography Exposure and Women’s Attitude Towards Extramarital Sex: An Exploratory Study (2013) – Excerpt:

This exploratory study assessed the association between adult U.S. women’s exposure to Internet pornography and attitude towards extramarital sex using data provided by the General Social Survey (GSS).  A positive association between Internet pornography viewing and more positive extramarital sex attitudes was found.

38) Pornography sexual socialization and satisfaction among young men (2010) – Excerpt:

An on-line survey dataset that included 650 young Croatian men aged 18-25 years was used to explore empirically the model. Descriptive findings pointed to significant differences between mainstream and paraphilic SEM users in frequency of SEM use at the age of 14, current SEM use, frequency of masturbation, sexual boredom, acceptance of sex myths, and sexual compulsiveness. Structural equation analyses suggested that negative effects of early exposure to SEM on young men’s sexual satisfaction, albeit small, could be stronger than positive effects.

39) Influence of popular erotica on judgments of strangers and mates (1989) – Excerpt:

In Experiment 2, male and female subjects were exposed to opposite sex erotica. In the second study, there was an interaction of subject sex with stimulus condition upon sexual attraction ratings. Decremental effects of centerfold exposure were found only for male subjects exposed to female nudes. Males who found the Playboy-type centerfolds more pleasant rated themselves as less in love with their wives.

40)  Effects of Prolonged Consumption of Pornography on Family Values (1988) – Excerpt:

Male and female students and nonstudents were exposed to videotapes featuring common, nonviolent pornography or innocuous content. Exposure was in hourly sessions in six consecutive weeks. In the seventh week, subjects participated in an ostensibly unrelated study on societal institutions and personal gratifications. Marriage, cohabitational relationships, and related issues were judged on an especially created Value-of-Marriage questionnaire. The findings showed a consistent impact of pornography consumption. Exposure prompted, among other things, greater acceptance of pre- and extramarital sex and greater tolerance of nonexclusive sexual access to intimate partners. It enhanced the belief that male and female promiscuity are natural and that the repression of sexual inclinations poses a health risk. Exposure lowered the evaluation of marriage, making this institution appear less significant and less viable in the future. Exposure also reduced the desire to have children and promoted the acceptance of male dominance and female servitude. With few exceptions, these effects were uniform for male and female respondents as well as for students and nonstudents.

41)  The Role of Internet Pornography Use and Cyber Infidelity in the Associations between Personality, Attachment, and Couple and Sexual Satisfaction (2017) – Excerpts:

Our results indicated that pornography use is associated with couple and sexual difficulties through increased cyber infidelity.

Pornography use was negatively related to sexual satisfaction for men, but positively for women. In men, pornography use is associated with higher sexual desire, stimulation, and gratification. However, these effects may lead to decreased sexual desire their partner and decreased sexual satisfaction within the couple.

42) Relationship quality predicts online sexual activities among Chinese heterosexual men and women in committed relationships (2016)

In this study, we examined the online sexual activities (OSAs) of Chinese men and women in committed relationships, with a focus on the characteristics of OSAs and the factors prompting men and women with steady partners to engage in OSAs. Almost 89% of the participants reported OSA experiences in the past 12 months even when they had a real-life partner. As predicted, individuals with lower relationship quality in real life, including low relationship satisfaction, insecure attachment, and negative communication patterns, engaged in OSAs more frequently. Overall, our results suggest that variables influencing offline infidelity may also influence online infidelity.


Finally, this anomalous 2016 study is often cited as evidence that porn use offers nothing but benefits to couples: Perceived Effects of Pornography on the Couple Relationship: Initial Findings of Open-Ended, Participant-Informed, “Bottom-Up” Research. (2016).

Two glaring methodical flaws produce meaningless results:

  1. The study does not contain a representative sample. Whereas most studies show that a tiny minority of porn users’ female partners use porn, in this study 95% of the women used porn on their own. And 85% of the women had used porn since the beginning of the relationship (in some cases for years). Those rates are higher than in college-aged men! In other words, the researchers appear to have skewed their sample to produce the results they were seeking.
  • Reality: Cross-sectional data from the largest US survey (General Social Survey) reported that only 2.6% of women had visited a “pornographic website” in the last month. Data from 2000, 2002, 2004. For more see Pornography and Marriage (2014)
  1. The study used “open ended” questions where the subject could ramble on and on about porn. Then the researchers read the ramblings and decided, after the fact, what answers were “important,” and how to present (spin?) them in their paper. Then the researchers then had the gall to suggest that all the other studies on porn and relationships, which employed more established, scientific methodology and straightforward questions about porn’s effects were flawed. How is this method justified?

Despite these fatal flaws several couples reported significant negative effects from porn use, such as:

  • Pornography is easier, more interesting, more arousing, more desirable, or more gratifying than sex with a partner
  • Pornography use is desensitizing, decreases the ability to achieve or maintain sexual arousal, or to achieve orgasm.
  • Some said that specifically described desensitization as the effect of pornography use
  • Some were concerned a loss of intimacy or love.
  • It was suggested that pornography makes real sex more boring, more routine, less exiting, or less enjoyable

For some reason these negative effects did not appear in articles about the study. The lead author’s new website and his attempt at fundraising raise a few questions.

Should compulsive sexual behavior be considered an addiction? (2016): Excerpt analyzing “Prause et al., 2015”

Link to original paper – Should compulsive sexual behavior be considered an addiction? (2016)

COMMENTS: This review, like the other papers, says that Prause et al., 2015 aligns with Kühn & Gallinat, 2014 (Citation 72) which found that more porn use correlated with less brain activation in response to pictures of vanilla porn. In other words, “porn addicts” were either desensitized or habituated, and needed greater stimulation than non-addicts

Excerpt Describing Prause et al., 2015 (Citation 73)


In contrast, other studies focusing on individuals without CSB have emphasized a role for habituation. In non-CSB men, a longer history of pornography viewing was correlated with lower left putaminal responses to pornographic photos, suggesting potential desensitization [72]. Similarly, in an event-related potential study with men and women without CSB, those reporting problematic use of pornography had a lower late positive potential to pornographic photos relative to those not reporting problematic use. The late positive potential is elevated commonly in response to drug cues in addiction studies [73]. These findings contrast to, but are not incompatible with, the report of enhanced activity in the fMRI studies in CSB subjects; the studies differ in stimuli type, modality of measure and the population under study. The CSB study used infrequently shown videos compared to repeated photos; the degree of activation has been shown to differ to videos versus photos and habituation may differ depending on the stimuli. Furthermore, in those reporting problematic use in the event-related potential study, the number of hours of use was relatively low [problem: 3.8, standard deviation (SD) = 1.3 versus control: 0.6, SD = 1.5 hours/week] compared to the CSB fMRI study (CSB: 13.21, SD = 9.85 versus control: 1.75, SD = 3.36 hours/week). Thus, habituation may relate to general use, with severe use potentially associated with enhanced cue-reactivity. Further larger studies are required to examine these differences.”

 

“Neuroscience of Internet Pornography Addiction: A Review and Update” – Excerpt critiquing Prause et al., 2015

Excerpt critiquing Prause et al., 2015:


Another EEG study involving three of the same authors was recently published [309]. Unfortunately, this new study suffered from many of the same methodological issues as the prior one [303]. For example, it used a heterogeneous subject pool, the researchers employed screening questionnaires that have not been validated for pathological internet pornography users, and the subjects were not screened for other manifestations of addiction or mood disorders.

In the new study, Prause et al. compared EEG activity of frequent viewers of Internet pornography with that of controls as they viewed both sexual and neutral images [309]. As expected, the LPP amplitude relative to neutral pictures increased for both groups, although the amplitude increase was smaller for the IPA subjects. Expecting a greater amplitude for frequent viewers of Internet pornography, the authors stated, “This pattern appears different from substance addiction models”.

While greater ERP amplitudes in response to addiction cues relative to neutral pictures is seen in substance addiction studies, the current finding is not unexpected, and aligns with the findings of Kühn and Gallinat [263], who found more use correlated with less brain activation in response to sexual images. In the discussion section, the authors cited Kühn and Gallinat and offered habituation as a valid explanation for the lower LPP pattern. A further explanation offered by Kühn and Gallinat, however, is that intense stimulation may have resulted in neuroplastic changes. Specifically, higher pornography use correlated with lower grey matter volume in the dorsal striatum, a region associated sexual arousal and motivation [265].

It’s important to note that the findings of Prause et al. were in the opposite direction of what they expected [309]. One might expect frequent viewers of Internet pornography and controls to have similar LPP amplitudes in response to brief exposure to sexual images if pathological consumption of Internet pornography had no effect. Instead, the unexpected finding of Prause et al. [309] suggests that frequent viewers of Internet pornography experience habituation to still images. One might logically parallel this to tolerance. In today’s world of high-speed Internet access, it is very likely that frequent consumers of Internet pornography users view sexual films and videos as opposed to still clips. Sexual films produce more physiological and subjective arousal than sexual images [310] and viewing sexual films results in less interest and sexual responsiveness to sexual images [311]. Taken together, the Prause et al., and Kühn and Gallinat studies lead to the reasonable conclusion that frequent viewers of internet pornography require greater visual stimulation to evoke brain responses comparable to healthy controls or moderate porn users.

In addition, the statement of Prause et al. [309] that, “These are the first functional physiological data of persons reporting VSS regulation problems” is problematic because it overlooks research published earlier [262,263]. Moreover, it is critical to note that one of the major challenges in assessing brain responses to cues in Internet pornography addicts is that viewing sexual stimuli is the addictive behavior. In contrast, cue-reactivity studies on cocaine addicts utilize pictures related to cocaine use (white lines on a mirror), rather than having subjects actually ingest cocaine. Since the viewing of sexual images and videos is the addictive behavior, future brain activation studies on Internet pornography users must take caution in both experimental design and interpretation of results. For example, in contrast to the one-second exposure to still images used by Prause et al. [309], Voon et al. chose explicit 9-second video clips in their cue reactivity paradigm to more closely match Internet porn stimuli [262]. Unlike the one-second exposure to still images (Prause et al. [309]), exposure to 9-second video clips evoked greater brain activation in heavy viewers of internet pornography than did one-second exposure to still images. It is further concerning that the authors referenced the Kühn and Gallinat study, released at the same time as the Voon study [262], yet they did not acknowledge the Voon et al. study anywhere in their paper despite its critical relevance.

Neurobiology of Compulsive Sexual Behavior: Emerging Science (2016): Analyzes Prause et al., 2015

COMMENTS: While this paper (below) is only a brief summation, it contains a few key observations. For example, it states that both Prause et al., 2015 and Kuhn & Gallinat, 2014 report a similar finding: greater porn use correlating with greater habituation to porn. Both studies reported lower brain activation in response to brief exposure to photos of vanilla porn. In the following excerpt “Lower late positive-potential” refers to the EEG findings of Prause et al.:

“In contrast, studies in healthy individuals suggest a role for enhanced habituation with excessive use of pornography. In healthy men, increased time spent watching pornography correlated with lower left putaminal activity to pornographic pictures (Kühn and Gallinat, 2014). Lower late positive-potential activity to pornographic pictures was observed in subjects with problematic pornography use.”

Why is this important? Lead author Nicole Prause claimed that her single EEG study debunked “porn addiction”. Five peer-reviewed critiques involving neuroscientists say otherwise.


Neuropsychopharmacology 41, 385-386 (January 2016) | doi:10.1038/npp.2015.300

Shane W Kraus 1, 2, Valerie Voon 3, and Marc N Potenza 2, 4

1 VISN 1 Mental Illness Research Education and Clinical Centers, VA Connecticut Healthcare System, West Haven, CT, USA; 2 Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA;

3 Department of Psychiatry, University of Cambridge, Cambridge, UK;

4 Department of Neurobiology, Child Study Center and CASA Columbia, Yale University School of Medicine, New Haven, CT, USA

E-mail: marc.potenza@yale.edu


Compulsive sexual behavior (CSB) is characterized by craving, impulsivity, social/occupational impairment, and psychiatric comorbidity. Prevalence of CSB is estimated around 3–6%, with a male predominance. Although not included in DSM-5, CSB can be diagnosed in ICD-10 as an impulse control disorder. However, debate exists about CSB’s classification (eg, as an impulsive-compulsive disorder, a feature of hypersexual disorder, an addiction, or along a continuum of normative sexual behavior).

Preliminary evidence suggests that dopamine may contribute to CSB. In Parkinson’s disease (PD), dopamine replacement therapies (Levo-dopa, dopamine agonists) have been associated with CSB and other impulse control disorders (Weintraub et al, 2010). A small number of case studies using naltrexone support its effectiveness at reducing urges and behaviors associated with CSB (Raymond et al, 2010), consistent with the possible opioidergic modification of mesolimbic dopamine function in reducing CSB. Currently, larger, adequately powered, neurochemical investigations and medication trials are needed to further understand CSB.

Incentive motivational processes relate to sexual cue reactivity. CSB vs non-CSB men had greater sex-cuerelated activation of the anterior cingulate, ventral striatum, and amygdala (Voon et al, 2014). In CSB subjects, functional connectivity of this network associated with cue-related sexual desire, thus resonating with findings in drug addictions (Voon et al, 2014). CSB men further show enhanced attentional bias to pornographic cues, implicating early attentional orienting responses as in addictions (Mechelmans et al, 2014). In CSB vs non-CSB PD patients, exposure to pornographic cues increased activation in the ventral striatum, cingulate and orbitofrontal cortex, linking also to sexual desire (Politis et al, 2013). A small diffusion-tensor imaging study implicates prefrontal abnormalities in CSB vs non-CSB men (Miner et al, 2009).

In contrast, studies in healthy individuals suggest a role for enhanced habituation with excessive use of pornography. In healthy men, increased time spent watching pornography correlated with lower left putaminal activity to pornographic pictures (Kühn and Gallinat, 2014). Lower late positive- potential activity to pornographic pictures was observed in subjects with problematic pornography use. These findings, while contrasting, are not incompatible. Habituation to picture cues relative to video cues may be enhanced in healthy individuals with excessive use; whereas, CSB subjects with more severe/pathological use may have enhanced cue reactivity.

Although recent neuroimaging studies have suggested some possible neurobiological mechanisms of CSB, these results should be treated as tentative given methodological limitations (eg, small sample sizes, cross-sectional designs, solely male subjects, and so on). Current gaps in research exist complicating definitive determination whether CSB is best considered as an addiction or not. Additional research is needed to understand how neurobiological features relate to clinically relevant measures like treatment outcomes for CSB. Classifying CSB as a ‘behavioral addiction’ would have significant implications for policy, prevention and treatment efforts; however, at this time, research is in its infancy. Given some similarities between CSB and drug addictions, interventions effective for addictions may hold promise for CSB, thus providing insight into future research directions to investigate this possibility directly.

  1. Kühn S, Gallinat J (2014). Brain structure and functional connectivity associated with pornography consumption: the brain on porn. JAMA Psychiatry 71: 827–834.
  2. Mechelmans DJ, Irvine M, Banca P, Porter L, Mitchell S, Mole TB et al (2014). Enhanced attentional bias towards sexually explicit cues in individuals with and without compulsive sexual behaviours. PloS One 9: e105476.
  3. Miner MH, Raymond N, Mueller BA, Lloyd M, Lim KO (2009). Preliminary investigation of the impulsive and neuroanatomical characteristics of compulsive sexual behavior. Psychiatry Res 174: 146–151.
  4. Politis M, Loane C, Wu K, O’Sullivan SS, Woodhead Z, Kiferle L et al (2013). Neural response to visual sexual cues in dopamine treatment-linked hypersexuality in Parkinson’s disease. Brain 136: 400–411.
  5. Raymond NC, Grant JE, Coleman E (2010). Augmentation with naltrexone to treat compulsive sexual behavior: a case series. Ann Clin Psychiatry 22: 55–62.
  6. Voon V, Mole TB, Banca P, Porter L, Morris L, Mitchell S et al (2014). Neural correlates of sexual cue reactivity in individuals with and without compulsive sexual behaviours. PloS One 9: e102419.
  7. Weintraub D, Koester J, Potenza MN, Siderowf AD, Stacy M, Voon V et al (2010). Impulse control disorders in Parkinson disease: a cross-sectional study of 3090 patients. Arch Neurol 67: 589–595. Neuropsychopharmacology Reviews (2016) 41, 385–386; doi:10.1038/npp.2015.300

Research confirms sharp rise in youthful sexual dysfunctions

Young men today appear to be experiencing a sharp increase in ED (and other sexual dysfunctions) since the advent of streaming internet. All studies assessing young male sexuality since 2010 report historic levels of erectile dysfunction, and startling rates of a new scourge: low libido.

Erectile dysfunction rates ranged from 27 to 33%, while rates for low libido (hypo-sexuality) ranged from 16% to 37%. The lower ranges are taken from studies involving teens and men 25 and under, while the higher ranges are from studies involving men 40 and under.

These high rates are a recent phenomenon, but comparing ED rates in men over time can be challenging. Traditionally, ED rates have been negligible in young men, and did not begin to rise sharply until after age 40. For example, here’s a graph from a Dutch study comparing data from prior to 2004.

The next challenge is to understand the extent to which ED rates have risen. This is thorny because ED rates have been measured using various different instruments in the last 25 years. Some researchers asked a single (yes/no) question and requested those with ED to rate its severity. Others use a 5- or 6-question version of a more recent instrument that employs Likert scales. It’s called the IIEF (The International Index of Erectile Function), and is used widely today. Still other researchers used different questionnaires.

GSSAB ED results over time

We’ll discuss a number of study results that show the upward trend, but let’s start with some of the most irrefutable research. It demonstrates a radical rise in ED rates over a decade using very large samples (which increase reliability). All the men were assessed using the same (yes/no) question about ED, as part of the Global Study of Sexual Attitudes and Behavior (GSSAB), administered to 13,618 sexually active men in 29 countries. That occurred in 2001-2002. A decade later, in 2011, the same “sexual difficulties” (yes/no) question from the GSSAB was administered to 2,737 sexually active men in Croatia, Norway and Portugal. The first group, in 2001-2002, were aged 40-80. The second group, in 2011, were 40 and under.

Based on the findings of prior studies one would predict the older men would have far higher ED scores than the younger men, whose scores should have been negligible. Not so. In just a decade, things had changed radically. The 2001-2002 ED rates for men 40-80 were about 13% in Europe. By 2011, ED rates in young Europeans, 18-40, ranged from 14-28%!

What changed in men’s sexual environment during this time? Well, major changes were internet penetration and access to porn videos (followed by access to streaming porn in 2006, and then smartphones on which to view it). In the 2011 study on Croatians, Norwegians and Portuguese, the Portuguese had the lowest rates of ED and the Norwegians had the highest. In 2013, internet penetration rates in Portugal were only 67%, compared with 95% in Norway.

Historical ED rates

What about other historical rates of ED in peer-reviewed literature using various instruments? First, here are results from the 2 major cross-sectional studies on ED in sexually active American men. Both predated heavy internet penetration.

  1. In the 1940s, the Kinsey report concluded that the prevalence of ED was less than 1% in men younger than 30 years, less than 3% in those 30–45.
  2. A 1999 cross-sectional study (based on data gathered in 1992) published by the Journal of the American Medical Association reported erectile dysfunction rates of only 5%, and low sexual desire in 5%. In that study, the ages of the men surveyed ranged from 18 to 59, so a third of them were over 40, which means the rates for sexually active men under 40 were lower.

In 2002 Dutch researchers did a meta-analysis of 6 high-quality ED studies. All of the studies reviewed from Europe (5) reported ED rates for men under 40 of approximately 2%. The sixth was the one reported immediately above.

Note: Keep in mind that ED rates for all men in every age group are higher than rates for sexually active men. For example, in the 1992 data for sexually active men 18-59, the average ED rate was only 5%. However, the rates for men (both sexually active and not) were 7% in men 18-29, 9% in men 30-39, 11% in men 40-49, and 18% in men 50-59. In order to compare “apples to apples,” we, like most researchers, focus on rates for sexually active men. This unfortunately fails to count ED problems in young men who avoid sex due to porn-induced sexual dysfunctions.

Before we turn back to recent studies, it’s important to understand a bit more about the pathology of erectile dysfunction. ED is usually classified as either psychogenic or organic. Traditionally, psychogenic ED is associated with psychological factors (e.g., depression, stress, or anxiety) while organic ED is attributed to physical conditions (e.g., neurological, hormonal, or anatomical.) The most common diagnosis for guys under 40 is psychogenic ED.

Studies investigating ED risk factors in men under 40 typically fail to find the causes commonly associated with ED in older men, such as smoking, alcoholism, obesity, sedentary life, diabetes, hypertension, cardiovascular disease, and hyperlipidemia. Be very skeptical if you read that the preceding causes of organic ED in older men are also the cause of a sharp rise in youthful ED. It takes years for various lifestyle factors to manifest as vasculogenic or neurogenic ED.

Recent studies on young men

Now, we turn to other recent studies on young men (~40 and under). Using the IIEF-5, a 2012 cross-sectional study of Swiss men aged 18-24 found ED rates of 30%, and a 2010 Brazilian study of men 18-40 reported ED rates of 35%. A 2013 Italian study reported one in four patients seeking help for new onset ED were younger than 40. Astonishingly, the rate of severe ED was nearly 10% higher in younger men than in men over 40. Also, a 2015 paper about 4,211 Italians who sought outpatient help for sexual dysfunction found that compulsive masturbators were younger than the other men and had higher rates of ED (and were likely masturbating to internet porn).

A 2014 study of new diagnoses of ED in active duty servicemen reported that rates had more than doubled between 2004 and 2013. Rates of psychogenic ED increased more than organic ED, and rates of unclassified ED remained relatively stable. A 2014 cross-sectional study of active duty, relatively healthy, male military personnel aged 21-40 found an overall ED rate of 33.2%, using the IIEF-5. About half of them also had PTSD (a known risk factor for ED). In a further military study published in 2015, the researchers found that ED was associated with sexual anxiety and genital self-image, both of which could easily be tied to heavy internet porn use.

The next three studies reveal that abnormally low sexual desire is also cropping up in young men.

  1. A 2014 study on Canadian adolescents reported that 53.5% of males aged 16-21 have symptoms indicative of a sexual problem. Erectile dysfunction was the most common (27%), followed by low sexual desire (24%), and problems with orgasm (11%). The authors were baffled why rates were so high, and were surprised that sexual dysfunction rates for males surpassed females, unlike in earlier published literature.
  2. The same Canadian researchers published a 2-year longitudinal study in 2016, in which they found that, over several checkpoints during the 2 years, the following percentages of 16-21 year old males reported:
    low sexual satisfaction (47.9%)
    low desire (46.2%)
    problems in erectile function (45.3%)
    While females’ sexual problems improved over time the males’ sexual problems did not: “Unlike for male adolescents, we found a clearer picture of improvement over time for female adolescents, suggesting that learning and experience played a role in improving their sexual lives.” And, “The only factor that emerged as a strong predictor was relationship status: Adolescents who were not in a sexual relationship were approximately three times more likely to report a problem in sexual functioning compared to those who were in a sexual relationship.” [All subjects were sexually active, but who would be using the most porn?]
  3. The same Canadian researchers published a 2-year longitudinal study in 2016, in which they found that, over several checkpoints during the 2 years, the following percentages of 16-21 year old males reported:
    1. low sexual satisfaction (47.9%)
    2. low desire (46.2%)
    3. problems in erectile function (45.3%)
  4. A 2015 study on Italian high school seniors (18-19) found that 16% of those who use porn more than once per week  reported abnormally low sexual desire. Non-porn users reported 0% low sexual desire.
  5. A 2014 survey of Croatian men 40 and under reported ED rates of 31% and low sexual desire rates of 37%.

A 2015 study, which asked Canadian men using porn 7 or more hours per week about their sexual functioning, found that 71% had sexual dysfunctions, with 33% reporting difficulty orgasming. Average age 41.5.

Together, these studies suggest a recent increase in ED in men ~40 and under, as well as startling rates of anorgasmia and low sexual desire, starting quite young (as does internet porn use).

None of these studies had young men remove porn use to investigate internet porn’s effects on their sexual performance, despite the fact that its use represents a drastic change in men’s sexual environment in the digital age. However, in this Israeli case series, researchers asked a man with porn-induced low libido and anorgasmia to stop using porn and take a time-out from masturbation. He had escalated through several genres of porn and experienced little desire for partnered sex. An 8-month reboot (avoiding porn) led to normal libido and enjoyable sexual relations.

In line with anecdotal  evidence and peer-reviewed research

Graph showing age of forum participants seeking help for ED

The image to the right appeared in an analysis of ED posts from MedHelp forums. “Nearly 60% of men posting on the forums were under 24 years old. This was a surprising finding for researchers, as erectile dysfunction is generally considered a condition that strikes older men.”

An Irish Times poll asked thousands of readers about ED, and the number of men 24-34 with issues was 28%:


Click on graphics from 2015 Irish Times poll to see ED rates, which show higher rates in young men than in men 35-49!

Hundreds of self-reports of recovery from ED and other sexual dysfunctions after quitting internet porn can be found on these pages:

In addition, the following page links to articles and videos by some 90 experts in the field who recognize and treat Porn-Induced ED: Porn-Induced ED in the Media: Experts who recognize PIED


Already, a handful of studies have correlated use of internet porn and porn addiction with arousal, attraction, and sexual performance problems. Results link its use with diminished libido or erectile function, delayed ejaculation, a preference for using porn to achieve and maintain arousal over having sex with a partner, negative effects on partnered sex, decreased enjoyment of sexual intimacy, and lower brain activation to sexual images:

UPDATE –  Is Internet Pornography Causing Sexual Dysfunctions? A Review with Clinical Reports (2016) – An extensive review of the literature related to porn-induced sexual problems. Involving US Navy doctors, the review provides the latest data revealing a tremendous rise in youthful sexual problems. It also reviews the neurological studies related to porn addiction and sexual conditioning via Internet porn. The doctors provide 3 clinical reports of men who developed porn-induced sexual dysfunctions.

1) The Dual Control Model – The Role Of Sexual Inhibition & Excitation In Sexual Arousal And Behavior (2007) – Newly rediscovered and very convincing. In an experiment employing video porn, 50% of the young men couldn’t become aroused or achieve erections with porn (average age was 29). The shocked researchers discovered that the men’s erectile dysfunction was,

related to high levels of exposure to and experience with sexually explicit materials.

The men experiencing erectile dysfunction had spent a considerable amount of time in bars and bathhouses where porn was “omnipresent,” and “continuously playing“. The researchers stated:

“Conversations with the subjects reinforced our idea that in some of them a high exposure to erotica seemed to have resulted in a lower responsivity to “vanilla sex” erotica and an increased need for novelty and variation, in some cases combined with a need for very specific types of stimuli in order to get aroused.”

2) Neural Correlates of Sexual Cue Reactivity in Individuals with and without Compulsive Sexual Behaviours (2014) – This fMRI study by Cambridge University found sensitization in porn addicts which mirrored sensitization in drug addicts. It also found that porn addicts fit the accepted addiction model of wanting “it” more, but not liking “it” more. The researchers also reported that 60% of subjects (average age: 25) had difficulty achieving erections/arousal with real partners as a result of using porn, yet could achieve erections with porn. From the study (CSB is compulsive sexual behaviours):

“CSB subjects reported that as a result of excessive use of sexually explicit materials…..[they] experienced diminished libido or erectile function specifically in physical relationships with women (although not in relationship to the sexually explicit material)”

“Compared to healthy volunteers, CSB subjects had greater subjective sexual desire or wanting to explicit cues and had greater liking scores to erotic cues, thus demonstrating a dissociation between wanting and liking. CSB subjects also had greater impairments of sexual arousal and erectile difficulties in intimate relationships but not with sexually explicit materials highlighting that the enhanced desire scores were specific to the explicit cues and not generalized heightened sexual desire.”

3) Online sexual activities: An exploratory study of problematic and non-problematic usage patterns in a sample of men (2016) – This Belgian study from a leading research university found problematic Internet porn use was associated with reduced erectile function and reduced overall sexual satisfaction. Yet problematic porn users experienced greater cravings. The study appears to report escalation, as 49% of the men viewed porn that “was not previously interesting to them or that they considered disgusting.” Excerpts:

This study is the first to directly investigate the relationships between sexual dysfunctions and problematic involvement in OSAs. Results indicated that higher sexual desire, lower overall sexual satisfaction, and lower erectile function were associated with problematic OSAs (online sexual activities). These results can be linked to those of previous studies reporting a high level of arousability in association with sexual addiction symptoms (Bancroft & Vukadinovic, 2004; Laier et al., 2013; Muise et al., 2013).”

In addition, we finally have a study that asks porn users about possible escalation to new or disturbing porn genres. Guess what it found?

Forty-nine percent mentioned at least sometimes searching for sexual content or being involved in OSAs that were not previously interesting to them or that they considered disgusting, and 61.7% reported that at least sometimes OSAs were associated with shame or guilty feelings.”

Note –  This is the first study to directly investigate the relationships between sexual dysfunctions and internet porn use. Two other studies claiming to have investigated correlations between porn use and erectile functioning cobbled together data from earlier studies in an unsuccessful attempt to debunk porn-induced ED. Both were criticized in the peer-reviewed literature: paper 1 was not an authentic study, and has been thoroughly discredited; paper 2 actually found correlations that support porn-induced ED. Moreover, paper 2 was only a “brief communication” that did not report important data.

4) Adolescents and web porn: a new era of sexuality (2015) – This Italian study analyzed the effects of Internet porn on high school seniors, co-authored by urology professor Carlo Foresta, president of the Italian Society of Reproductive Pathophysiology. The most interesting finding is that 16% of those who consume porn more than once a week report abnormally low sexual desire compared with 0% in non-consumers (and 6% for those who consume less than once a week). From the study:

“21.9% define it as habitual, 10% report that it reduces sexual interest towards potential real-life partners, and the remaining, 9.1% report a kind of addiction. In addition, 19% of overall pornography consumers report an abnormal sexual response, while the percentage rose to 25.1% among regular consumers.”

5) Patient Characteristics by Type of Hypersexuality Referral: A Quantitative Chart Review of 115 Consecutive Male Cases (2015) – Study on men (average age 41.5) with hypersexuality disorders, such as paraphilias and chronic masturbation or adultery. 27 were classified as “avoidant masturbators,” meaning they masturbated (typically with porn use) one or more hours per day or more than 7 hours per week. 71% reported sexual functioning problems, with 33% reporting delayed ejaculation (a precursor to porn-induced ED). What sexual dysfunction do 38% of the remaining men have? The study doesn’t say, and the authors have ignored requests for details. Two primary choices for male sexual dysfunction are ED and low libido. The men were not asked about their erectile functioning without porn. If all their sexual activity involved masturbating to porn, and not sex with a partner, they might never realize they had porn-induced ED.

6) Altered Appetitive Conditioning and Neural Connectivity in Subjects With Compulsive Sexual Behavior (2016) – “Compulsive Sexual Behaviors” (CSB) means the men were porn addicts, because CSB subjects averaged nearly 20 hours of porn use per week. The controls averaged 29 minutes per week. Interestingly, 3 of the 20 CSB subjects mentioned to interviewers that they suffered from “orgasmic-erection disorder,” while none of the control subjects reported sexual problems.

7) Brain Structure and Functional Connectivity Associated With Pornography Consumption: The Brain on Porn (2014) – A Max Planck study which found 3 significant addiction-related brain changes correlating with the amount of porn consumed. It also found that the more porn consumed the less reward circuit activity in response to brief exposure (.530 second) to vanilla porn. In a 2014 article lead author Simone Kühn said:

We assume that subjects with a high porn consumption need increasing stimulation to receive the same amount of reward. That could mean that regular consumption of pornography more or less wears out your reward system. That would fit perfectly the hypothesis that their reward systems need growing stimulation.”

A more technical description of this study from a review of the literature by Kuhn & Gallinat – Neurobiological Basis of Hypersexuality (2016).

“The more hours participants reported consuming pornography, the smaller the BOLD response in left putamen in response to sexual images. Moreover, we found that more hours spent watching pornography was associated with smaller gray matter volume in the striatum, more precisely in the right caudate reaching into the ventral putamen. We speculate that the brain structural volume deficit may reflect the results of tolerance after desensitization to sexual stimuli.”

8) Sexual Desire, not Hypersexuality, is Related to Neurophysiological Responses Elicited by Sexual Images (2013) – This EEG study was touted in the media as evidence against the existence of porn addiction. Not so. In line with the Cambridge University brain scan studies, this EEG study reported greater cue-reactivity to porn correlated with less desire for partnered sex. To put another way – individuals with more brain activation and cravings for porn would rather masturbate to porn than have sex with a real person. Study spokesman Nicole Prause claimed that porn users merely had high libido, yet the results of the study say something quite different. Three peer-reviewed papers expose the truth: 1, 2, 3. Also see the extensive YBOP critique.

9) Modulation of Late Positive Potentials by Sexual Images in Problem Users and Controls Inconsistent with “Porn Addiction” (2015) – Another Nicole Prause EEG study. This time comparing the 2013 subjects from the above study to an actual control group. The results: compared to controls, “porn addicts” had less response to one-second exposure to photos of vanilla porn. The lead author, Nicole Prause, claimed these results debunk porn addiction. However, these findings align perfectly with Kühn & Gallinat (2014), which found that more porn use correlated with less brain activation in response to pictures of vanilla porn. Put simply, frequent porn users were desensitized and needed greater stimulation to achieve the same buzz. Four peer-reviewed papers say that Prause findings indicate desensitization, and addiction-related phenomenon: 1, 2, 3, 4 (also see this extensive YBOP critique). By the way, another EEG study found that greater porn use in women correlated with less brain activation to porn.

10) Unusual masturbatory practice as an etiological factor in the diagnosis and treatment of sexual dysfunction in young men (2014) – One of the 4 case studies in this paper reports on a man with porn-induced sexual problems (low libido, fetishes, anorgasmia). The sexual intervention called for a 6-week abstinence from porn and masturbation. After 8 months the man reported increased sexual desire, successful sex and orgasm, and enjoying “good sexual practices. This is the first peer-reviewed chronicling of a recovery from porn-induced sexual dysfunctions. Excerpts from the paper:

“When asked about masturbatory practices, he reported that in the past he had been masturbating vigorously and rapidly while watching pornography since adolescence. The pornography originally consisted mainly of zoophilia, and bondage, domination, sadism, and masochism, but he eventually got habituated to these materials and needed more hardcore pornography scenes, including transgender sex, orgies, and violent sex. He used to buy illegal pornographic movies on violent sex acts and rape and visualized those scenes in his imagination to function sexually with women. He gradually lost his desire and his ability to fantasize and decreased his masturbation frequency.”

In conjunction with weekly sessions with a sex therapist, the patient was instructed to avoid any exposure to sexually explicit material, including videos, newspapers, books, and internet pornography.

After 8 months, the patient reported experiencing successful orgasm and ejaculation. He renewed his relationship with that woman, and they gradually succeeded in enjoying good sexual practices.

11) Erectile Dysfunction, Boredom, and Hypersexuality among Coupled Men from Two European Countries (2015) – Survey reported a strong correlation between erectile dysfunction and measures of hypersexuality. The study omitted correlation data between erectile functioning and pornography use, but noted a significant correlation. An excerpt:

Among Croatian and German men, hypersexuality was significantly correlated with proneness to sexual boredom and more problems with erectile function.

12) Masturbation and Pornography Use Among Coupled Heterosexual Men With Decreased Sexual Desire: How Many Roles of Masturbation? (2015) – Masturbating to porn was related with decreased sexual desire and low relationship intimacy. Excerpts:

“Among men who masturbated frequently, 70% used pornography at least once a week. A multivariate assessment showed that sexual boredom, frequent pornography use, and low relationship intimacy significantly increased the odds of reporting frequent masturbation among coupled men with decreased sexual desire.”

“Among men [with decreased sexual desire] who used pornography at least once a week [in 2011], 26.1% reported that they were unable to control their pornography use. In addition, 26.7% of men reported that their use of pornography negatively affected their partnered sex and 21.1% claimed to have attempted to stop using pornography.”

13) Use of pornography in a random sample of Norwegian heterosexual couples (2009) – Porn use was correlated with more sexual dysfunctions in the man and negative self perception in the female. The couples who did not use porn had no sexual dysfunctions. A few excerpts from the study:

In couples where only one partner used pornography, we found more problems related to arousal (male) and negative (female) self-perception.

In those couples where one partner used pornography there was a permissive erotic climate. At the same time, these couples seemed to have more dysfunctions.

The couples who did not use pornography... may be considered more traditional in relation to the theory of sexual scripts. At the same time, they did not seem to have any dysfunctions.

Couples who both reported pornography use grouped to the positive pole on the ‘‘Erotic climate’’ function and somewhat to the negative pole on the ‘‘Dysfunctions’’ function.

14) Lecture describing upcoming studies – by Urology professor Carlo Foresta, president of the Italian Society of Reproductive Pathophysiology – The lecture contains the results of longitudinal and cross-sectional studies. One study involved a survey of high school teens (pages 52-53). The study reported that sexual dysfunction doubled between 2005 and 2013, with low sexual desire increasing 600%.

  • The percentage of teens that experienced alterations of their sexuality: 2004/05: 7.2%, 2012/13: 14.5%
  • The percentage of teens with low sexual desire: 2004/05: 1.7%, 2012/13: 10.3% (that’s a 600% increase in 8 years)

Foresta also describes his upcoming study, “Sexuality media and new forms of sexual pathology sample 125 young males, 19-25 years” (Italian name – “Sessualità mediatica e nuove forme di patologia sessuale Campione 125 giovani maschi“). The results from the study (pages 77-78), which used the International Index of Erectile Function Questionnaire, found that regular porn users scored 50% lower on sexual desire domain and 30% lower of the erectile functioning domain.

15) (not peer-reviewed) Here’s an article about an extensive analysis of comments and questions posted on MedHelp concerning erectile dysfunction. What’s shocking is that 58% of the men asking for help were 24 or younger. Many suspected that internet porn could be involved as described in the results from the study

EXCERPT: The most common phrase is “erectile dysfunction” – which is mentioned more than three times as often as any other phrase – followed by “internet porn,” “performance anxiety,” and “watching porn.”

Clearly, porn is a frequently discussed subject: “I have been viewing internet pornography frequently (4 to 5 times a week) for the past 6 years,” one man writes. “I am in my mid-20s and have had a problem getting and maintaining an erection with sexual partners since my late teens when I first started looking at internet porn.”


Studies reporting relationships between porn use and less sexual or relationship satisfaction:

1) Does Viewing Pornography Reduce Marital Quality Over Time? Evidence from Longitudinal Data (2016) – First longitudinal study on a representative cross-section of married couples. It found significant negative effects of porn use on marriage quality over time.  Excerpt:

This study is the first to draw on nationally representative, longitudinal data (2006-2012 Portraits of American Life Study) to test whether more frequent pornography use influences marital quality later on and whether this effect is moderated by gender. In general, married persons who more frequently viewed pornography in 2006 reported significantly lower levels of marital quality in 2012, net of controls for earlier marital quality and relevant correlates. Pornography’s effect was not simply a proxy for dissatisfaction with sex life or marital decision-making in 2006. In terms of substantive influence, frequency of pornography use in 2006 was the second strongest predictor of marital quality in 2012

2) Associations between young adults’ use of sexually explicit materials and their sexual preferences, behaviors, and satisfaction (2011) – Excerpts:

Higher frequencies of sexual explicit material (SEM) use were associated with less sexual and relationship satisfaction. The frequency of SEM use and number of SEM types viewed were both associated with higher sexual preferences for the types of sexual practices typically presented in SEM. These findings suggest that SEM use can play a significant role in a variety of aspects of young adults’ sexual development processes.

Specifically, higher viewing frequency was associated with less sexual and relationship satisfaction when controlling for gender, religiosity, dating status and the number of SEM types viewed.

Because a substantial proportion of the young adults in this study reported using SEM, the potential implications are especially noteworthy, particularly for young men.

3) Pornography’s Impact on Sexual Satisfaction (1988) – Excerpt:

Male and female students and nonstudents were exposed to videotapes featuring common, nonviolent pornography or innocuous content. Exposure was in hourly sessions in six consecutive weeks. In the seventh week, subjects participated in an ostensibly unrelated study on societal institutions and personal gratifications. [Porn use] strongly impacted self-assessment of sexual experience. After consumption of pornography, subjects reported less satisfaction with their intimate partners—specifically, with these partners’ affection, physical appearance, sexual curiosity, and sexual performance proper. In addition, subjects assigned increased importance to sex without emotional involvement. These effects were uniform across gender and populations.

4) Adolescents’ Exposure to Sexually Explicit Internet Material and Sexual Satisfaction: A Longitudinal Study (2009) – Excerpt:

Between May 2006 and May 2007, we conducted a three-wave panel survey among 1,052 Dutch adolescents aged 13–20. Structural equation modeling revealed that exposure to SEIM consistently reduced adolescents’ sexual satisfaction. Lower sexual satisfaction (in Wave 2) also increased the use of SEIM (in Wave 3). The effect of exposure to SEIM on sexual satisfaction did not differ among male and female adolescents.

5) Individuals who never viewed SEM reported higher relationship quality on all indices than those who viewed SEM alone (2011)Excerpt:

As expected, individuals who did not view SEM (sexually explicit material) at all reported lower negative communication and higher dedication than individuals who viewed SEM alone or both alone and with their partner.

6) Sexual media use and relational satisfaction in heterosexual couples (2010) – Excerpt:

Results revealed that a higher frequency of men’s sexual media use related to negative satisfaction in men, while a higher frequency of women’s sexual media use related to positive satisfaction in male partners. Reasons for sexual media use differed by gender: Men reported primarily using sexual media for masturbation, while women reported primarily using sexual media as part of lovemaking with their partners.

7) Young Adult Women’s Reports of Their Male Romantic Partner’s Pornography Use as a Correlate of Their Self-Esteem, Relationship Quality, and Sexual Satisfaction (2012) – Excerpt:

The purpose of this study was to examine the relationships between men’s pornography use, both frequency and problematic use, on their heterosexual female partner’s psychological and relational well-being among 308 young adult college women. Results revealed women’s reports of their male partner’s frequency of pornography use were negatively associated with their relationship quality. More perceptions of problematic use of pornography was negatively correlated with self-esteem, relationship quality, and sexual satisfaction.

8) Korean Men’s Pornography use, Their Interest in Extreme Pornography, and Dyadic Sexual Relationships (2014) – Excerpt:

Six-hundred eighty-five heterosexual South Korean male college students participated in an online survey. The majority (84.5%) of respondents had viewed pornography, and for those who were sexually active (470 respondents), we found that higher interest in degrading or extreme pornography was associated with the experience of role-playing sexual scenes from pornography with a partner, and a preference for using pornography to achieve and maintain sexual excitement over having sex with a partner.

We found that higher interest in viewing degrading or extreme pornography … has a significant positive … association with sexual concerns.

9) Pornography and the Male Sexual Script: An Analysis of Consumption and Sexual Relations (2014) – Excerpt:

We argue pornography creates a sexual script that then guides sexual experiences. To test this, we surveyed 487 college men (ages 18-29 years) in the United States to compare their rate of pornography use with sexual preferences and concerns. Results showed the more pornography a man watches, the more likely he was to use it during sex, request particular pornographic sex acts of his partner, deliberately conjure images of pornography during sex to maintain arousal, and have concerns over his own sexual performance and body image. Further, higher pornography use was negatively associated with enjoying sexually intimate behaviors with a partner.

10) Adult Social Bonds and Use of Internet Pornography (2004) – Excerpt:

Complete data on 531 Internet users are taken from the General Social Surveys for 2000. Social bonds measures include religious, marital, and political ties. Measures of participation in sexual and drug-related deviant lifestyles, and demographic controls are included. The results of a logistic regression analysis found that among the strongest predictors of use of cyberporn were weak ties to religion and lack of a happy marriage.

11) A Common-Fate Analysis of Pornography Acceptance, Use, and Sexual Satisfaction Among Heterosexual Married Couples (2016) – Excerpt:

Results indicated that the shared variance of pornography acceptance was positively associated with both spouses’ pornography use and that spouses’ pornography use was negatively associated with their own sexual satisfaction.Wives’ pornography use was found to be positively associated with the couple’s shared variance of sexual satisfaction, but pornography use did not significantly mediate the relationship between pornography acceptance and sexual satisfaction.

12) Differences in Pornography Use Among Couples: Associations with Satisfaction, Stability, and Relationship Processes (2016) – Excerpt:

The present study utilized a sample of 1755 adult couples in heterosexual romantic relationships to examine how different patterns of pornography use between romantic partners may be associated with relationship outcomes. While pornography use has been generally associated with some negative and some positive couple outcomes, no study has yet explored how differences between partners may uniquely be associated with relationship well-being. Results suggested that greater discrepancies between partners in pornography use were related to less relationship satisfaction, less stability, less positive communication, and more relational aggression. Mediation analyses suggested that greater pornography use discrepancies were primarily associated with elevated levels of male relational aggression, lower female sexual desire, and less positive communication for both partners which then predicted lower relational satisfaction and stability for both partners.

13) Factors Predicting Cybersex Use and Difficulties in Forming Intimate Relationships among Male and Female Users of Cybersex (2015)Excerpt:

This study used the Cybersex addiction test, Craving for pornography questionnaire, and a Questionnaire on intimacy among 267 participants (192 males and 75 females) mean age for males 28 and for females 25,  who were recruited from special sites that are dedicated to pornography and cybersex on the Internet. Results of regression analysis indicated that pornography, gender, and cybersex significantly predicted difficulties in intimacy and it accounted for 66.1% of the variance of rating on the intimacy questionnaire. Second, regression analysis also indicated that craving for pornography, gender, and difficulties in forming intimate relationships significantly predicted frequency of cybersex use and it accounted for 83.7% of the variance in ratings of cybersex use.

14) Pornography use: who uses it and how it is associated with couple outcomes (2013) – Excerpt:

This study examined associations among pornography use, the meaning people attach to its use, sexual quality, and relationship satisfaction. Participants were couples (N = 617 couples) who were either married or cohabiting at the time the data were gathered. Overall results from this study indicated substantial gender differences in terms of use profiles, as well as pornography’s association with relationship factors. Specifically, male pornography use was negatively associated with both male and female sexual quality, whereas female pornography use was positively associated with female sexual quality.

15) A Love That Doesn’t Last: Pornography Consumption and Weakened Commitment to One’s Romantic Partner (2012) – The study had subjects try to abstain from porn use for 3 weeks. Upon comparing the two groups, those who continued using pornography reported lower levels of commitment than those who tried to abstain. Excerpts:

Study 1 found that higher pornography consumption was related to lower commitment

Study 3 participants were randomly assigned to either refrain from viewing pornography or to a self-control task. Those who continued using pornography reported lower levels of commitment than control participants.

Study 5 found that pornography consumption was positively related to infidelity and this association was mediated by commitment. Overall, a consistent pattern of results was found using a variety of approaches including cross-sectional (Study 1), observational (Study 2), experimental (Study 3), and behavioral (Studies 4 and 5) data.

16) Male Partners’ Perceived Pornography Use and Women’s Relational and Psychological Health: The Roles of Trust, Attitudes, and Investment (2015) – Excerpt:

Results revealed that women’s reports of their male partners’ pornography use were related to less relationship satisfaction and more psychological distress. Results from the moderation analyses indicated that the direct effect of male partners’ perceived pornography use and relationship trust and the conditional indirect effects of male partners’ perceived pornography use on both relationship satisfaction and psychological distress were contingent on relationship investment. These findings indicated that when male partners’ perceived pornography use is high, women who have low or mean levels of relationship investment have less relationship trust. Finally, our results revealed that the relationship between male partners’ perceived pornography use and relational and psychological outcomes exist regardless of women’s own attitudes toward pornography

17) Relationship of love and marital satisfaction with pornography among married university students in Birjand, Iran (2015) – Excerpts:

This descriptive-correlation study was conducted on 310 married students studying at private and public universities in Birjand, in 2012-2013 academic year using random quota sampling method. It appears that pornography has a negative impact on love and marital satisfaction.

18)  Sexual media use and relational satisfaction in heterosexual couples (2011) – Excerpt:

This study assessed how sexual media use by one or both members of a romantic dyad relates to relationship and sexual satisfaction. A total of 217 heterosexual couples completed an Internet survey that assessed sexual media use, relationship and sexual satisfaction, and demographic variables. Results revealed that a higher frequency of men’s sexual media use related to negative satisfaction in men, while a higher frequency of women’s sexual media use related to positive satisfaction in male partners. Reasons for sexual media use differed by gender

19) Wives’ Experience of Husbands’ Pornography Use and Concomitant Deception as an Attachment Threat in the Adult Pair-Bond Relationship (2009)

Evidence is growing that pornography use can negatively impact attachment trust in the adult pair-bond relationship. Analyses uncovered three attachment-related impacts from husbands’ pornography use and deception: (1) the development of an attachment fault line in the relationship, stemming from perceived attachment infidelity; (2) followed by a widening attachment rift arising from wives’ sense of distance and disconnection from their husbands; (3) culminating in attachment estrangement from a sense of being emotionally and psychologically unsafe in the relationship. Overall, wives reported global mistrust indicative of attachment breakdown.

20)  Men’s leisure and women’s lives: The impact of pornography on women (1999) – Excerpt:

The section of the interview where the women discussed their own current or past relationships with men revealed additional insight into the effect of pornography on such relationships. Fifteen of the women were in, or had been in, relationships with men who rented or bought pornography at least on an occasional basis. Of these 15 women, four expressed strong dislike of their husband’s or partner’s leisure time interest in pornography. It was clear that the husbands’ use of pornography affected the wives’ feeling about themselves, their sexual feelings, and their marital relationships in general

21)  From Bad to Worse? Pornography Consumption, Spousal Religiosity, Gender, and Marital Quality (2016) – Excerpts:

I test the above hypotheses using data from Wave 1 of the Portraits of American Life Study (PALS), which was fielded in 2006. PALS is a nationally representative panel survey with questions focusing on a variety of topics….Looking at bivariate correlations, for the full sample, viewing pornography is negatively associated with overall marital satisfaction, suggesting that those who view pornography more often tend to be less satisfied in their marriage than those who view pornography less often or never

22) Pornography and Marriage (2014) – All bad news, and it’s getting worse. The abstract:

We used data on 20,000 ever-married adults in the General Social Survey to examine the relationship between watching pornographic films and various measures of marital well-being. We found that adults who had watched an X-rated movie in the past year were more likely to be divorced, more likely to have had an extramarital affair, and less likely to report being happy with their marriage or happy overall. We also found that, for men, pornography use reduced the positive relationship between frequency of sex and happiness. Finally, we found that the negative relationship between pornography use and marital well-being has, if anything, grown stronger over time, during a period in which pornography has become both more explicit and more easily available.

23) Exploring actor and partner correlates of sexual satisfaction among married couples (2010) – Excerpt:

Using the Interpersonal Exchange Model of Sexual Satisfaction, we consider how infidelity, pornography consumption, marital satisfaction, sexual frequency, premarital sex, and cohabitation are associated with married couples’ sexual satisfaction. Data from 433 couples are analyzed with structural equation models to determine the contributions. Finally, some evidence suggests that pornography consumption is costly for own and spouse’s sexual satisfaction, especially when pornography is used by only one spouse.

24) Sexually explicit media use and relationship satisfaction a moderating role of emotional intimacy? (2016) – The authors attempt to obfuscate their findings in the abstract by stating that once sexual and relationship variables were “controlled for”, they found no link between between porn use and relationship satisfaction. Reality: The study found significant correlations between porn use and poorer relationship & sexual satisfaction in both males and females. Excerpt from discussion section:

For both men and women, significant, yet modest negative zero-order correlations between SEM use and relationship satisfaction were found, indicating that increased SEM use was associated with lower relationship satisfaction across gender.

25) Sex in America Online: An Exploration of Sex, Marital Status, and Sexual Identity in Internet Sex Seeking and Its Impacts (2008) – Excerpt:

This was an exploratory study of sex and relationship seeking on the Internet, based on a survey of 15,246 respondents in the United States Seventy-five percent of men and 41% of women had intentionally viewed or downloaded porn. Men and gays/lesbians were more likely to access porn or engage in other sex-seeking behaviors online compared with straights or women. A symmetrical relationship was revealed between men and women as a result of viewing pornography, with women reporting more negative consequences, including lowered body image, partner critical of their body, increased pressure to perform acts seen in pornographic films, and less actual sex, while men reported being more critical of their partners’ body and less interested in actual sex.


 

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24.        Voon V,  Mole TB,  Banca P,  Porter L,  Morris L,  Mitchell S, et al. Neural correlates of sexual cue reactivity in individuals with and without compulsive sexual behaviours. PloS one. 2014;9(7):e102419. Epub 2014/07/12. doi: 10.1371/journal.pone.0102419. PubMed PMID: 25013940; PubMed Central PMCID: PMCPmc4094516.

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26      Aline Wéry,  J. Billieux  Online sexual activities: An exploratory study of problematic and non-problematic usage patterns in a sample of men.  Computers in Human Behavior.  Volume 56, March 2016, Pages 257–266

27       The Psychophysiology of Sex., Chapter: The Dual-Control Model: The role of sexual inhibition & excitation in sexual arousal and behavior“. Publisher: Indiana University Press, Editors: Erick Janssen, pp.197-222

“Neural Correlates of Sexual Cue Reactivity in Individuals with and without Compulsive Sexual Behaviours” (2014): Excerpt analyzing Steele et al., 2013

Link to full study – Neural Correlates of Sexual Cue Reactivity in Individuals with and without Compulsive Sexual Behaviours” (2014)

Excerpt analyzing “Steele et al., 2013″ (citation 25 is Steele et al.):


Our findings suggest dACC activity reflects the role of sexual desire, which may have similarities to a study on the P300 in CSB subjects correlating with desire [25]. We show differences between the CSB group and healthy volunteers whereas this previous study did not have a control group. The comparison of this current study with previous publications in CSB focusing on diffusion MRI and the P300 is difficult given methodological differences. Studies of the P300, an event related potential used to study attentional bias in substance use disorders, show elevated measures with respect to use of nicotine [54], alcohol [55], and opiates [56], with measures often correlating with craving indices. The P300 is also commonly studied in substance-use disorders using oddball tasks in which low-probability targets are frequently mixed with high-probability non-targets. A meta-analysis showed that substance-use-disordered subjects and their unaffected family members had decreased P300 amplitude compared to healthy volunteers [57]. These findings suggest substance-use disorders may be characterized by impaired allocation of attentional resources to task-relevant cognitive information (non-drug targets) with enhanced attentional bias to drug cues. The decrease in P300 amplitude may also be an endophenotypic marker for substance-use disorders. Studies of event-related potentials focusing on motivation relevance of cocaine and heroin cues further report abnormalities in the late components of the ERP (>300 milliseconds; late positive potential, LPP) in frontal regions, which may also reflect craving and attention allocation [58][60]. The LPP is believed to reflect both early attentional capture (400 to 1000 msec) and later sustained processing of motivationally significant stimuli. Subjects with cocaine use disorder had elevated early LPP measures compared to healthy volunteers suggesting a role for early attentional capture of motivated attention along with attenuated responses to pleasant emotional stimuli. However, the late LPP measures were not significantly different from those in healthy volunteers [61]. The generators of the P300 event-related potential for target-related responses is believed to be the parietal cortex and cingulate [62]. Thus, both dACC activity in the present CSB study and P300 activity reported in a previous CSB study may reflect similar underlying processes of attentional capture. Similarly, both studies show a correlation between these measures with enhanced desire. Here we suggest that dACC activity correlates with desire, which may reflect an index of craving, but does not correlate with liking suggestive of on an incentive-salience model of addictions.


 

“Neuroscience of Internet Pornography Addiction: A Review and Update” – Excerpt critiquing Steele et al., 2013

Link to full paper – “Neuroscience of Internet Pornography Addiction: A Review and Update” (2015)

Excerpt critiquing “Steele et al., 2013″:


An EEG study on those complaining of problems regulating their viewing of internet pornography has reported the neural reactivity to sexual stimuli [303]. The study was designed to examine the relationship between ERP amplitudes when viewing emotional and sexual images and questionnaire measures of hypersexuality and sexual desire. The authors concluded that the absence of correlations between scores on hypersexuality questionnaires and mean P300 amplitudes when viewing sexual images “fail to provide support for models of pathological hypersexuality” [303] (p. 10). However, the lack of correlations may be better explained by arguable flaws in the methodology. For example, this study used a heterogeneous subject pool (males and females, including 7 non-heterosexuals). Cue-reactivity studies comparing the brain response of addicts to healthy controls require homogenous subjects (same sex, similar ages) to have valid results. Specific to porn addiction studies, it’s well established that males and females differ appreciably in brain and autonomic responses to the identical visual sexual stimuli [304,305,306]. Additionally, two of the screening questionnaires have not been validated for addicted IP users, and the subjects were not screened for other manifestations of addiction or mood disorders.

Moreover, the conclusion listed in the abstract, “Implications for understanding hypersexuality as high desire, rather than disordered, are discussed” [303] (p. 1) seems out of place considering the study’s finding that P300 amplitude was negatively correlated with desire for sex with a partner. As explained in Hilton (2014), this finding “directly contradicts the interpretation of P300 as high desire” [307]. The Hilton analysis further suggests that the absence of a control group and the inability of EEG technology to discriminate between “high sexual desire” and “sexual compulsion” render the Steele et al. findings uninterpretable [307].

Finally, a significant finding of the paper (higher P300 amplitude to sexual images, relative to neutral pictures) is given minimal attention in the discussion section. This is unexpected, as a common finding with substance and internet addicts is an increased P300 amplitude relative to neutral stimuli when exposed to visual cues associated with their addiction [308]. In fact, Voon, et al. [262] devoted a section of their discussion analyzing this prior study’s P300 findings. Voon et al. provided the explanation of importance of P300 not provided in the Steele paper, particularly in regards to established addiction models, concluding,

“Thus, both dACC activity in the present CSB study and P300 activity reported in a previous CSB study[303] may reflect similar underlying processes of attentional capture. Similarly, both studies show a correlation between these measures with enhanced desire. Here we suggest that dACC activity correlates with desire, which may reflect an index of craving, but does not correlate with liking suggestive of on an incentive-salience model of addictions.” [262] (p. 7)

So while these authors [303] claimed that their study refuted the application of the addiction model to CSB, Voon et al. posited that these authors actually provided evidence supporting said model.


 

Critique of “Perceived Addiction to Internet Pornography and Psychological Distress: Examining Relationships Concurrently and Over Time” (2015)

Here are a few of the headlines birthed from this new study  by Joshua B. Grubbs, Nicholas Stauner, Julie J. Exline, Kenneth I. Pargament, and Matthew J. Lindberg (Grubbs et al.):

  • Watching Porn Is OK. Believing In Porn Addiction Is Not
  • Perceived Addiction To Porn Is More Harmful Than Porn Use Itself
  • Believing You Have Porn Addiction Is the Cause of Your Porn Problem, Study Finds

In essence the study’s main claim is reported as: “perceived addiction” to pornography is more related to psychological distress than are current daily hours of porn viewing. An excerpt from one of the above articles:

A new study in the journal Psychology of Addictive Behaviors has found that perceived addiction to pornography—that is, “feeling addicted to Internet pornography irrespective of actual pornography use”—is associated with forms of psychological distress including depression, anxiety, anger, and stress. Pornography use itself, the authors found, was “relatively unrelated to psychological distress.”

While the above quote contains inaccuracies which we will explore, let’s take it at face value. The reader is left with the impression that actual porn use is no big deal, but “believing” you are addicted to porn will cause you psychological distress. The take away: It’s perfectly healthy to use porn as long as you don’t believe you are addicted.

Grubbs et al.’s claim, and all the resulting headlines, are built upon this finding: Subjects’ current hours of porn use did not correlate strongly enough (in researchers’ subjective view) with scores on Grubbs’s own porn use questionnaire (the Cyber Pornography Use Inventory “CPUI”). To put it another way, if porn addiction really existed there “should” be, in the authors’ view, a one-to-one relationship between current hours of use and scores on the CPUI. Grubbs et al. also reported that “psychological distress” was related to scores on the CPUI, but not as strongly related to current hours of use.

Here’s the thing: There’s absolutely no scientific basis for declaring the CPUI a measure of “perceived addiction,” and yet that’s what all the inflated headlines rest on! The CPUI was never validated for “perceived” as opposed to “real” addiction.

For Grubbs et al.’s claims and interpretations to be valid, BOTH of the following must be true and supported by actual research:

1) The Cyber Pornography Use Inventory (CPUI) must assess “perceived addiction” to porn but not actual porn addiction.

  • Grubbs himself developed the 9-item CPUI as an inventory of online porn problems, not a “perceived addiction” test. Here he chose to use it in lieu of other validated addiction tests, precisely to create the illusion that he could measure “perceived addiction” rather than addiction. In fact, the CPUI measures the same signs, symptoms and indications of addiction as do standard addiction tests.
  • In the current study, Grubbs et al. use the phrase “perceived porn addiction” synonymously with subjects’ scores on the CPUI, without scientific justification.

2) Internet porn addiction must equal hours of porn viewing.

  • This is refuted by the scientific literature. Internet porn addiction ≠ hours of porn viewing.
  • Shockingly, the Grubbs et al. study reveals there actually was a strong correlation between hours of use and the CPUI! From p. 6 of the study:

“Additionally, average daily pornography use in hours was significantly and positively associated with depression, anxiety, and anger, as well as with perceived addiction.”

With respect to the first point, Grubbs developed his own porn addiction questionnaire (CPUI), and then later capriciously declared that it measures only “perceived addiction to porn” – without demonstrating any justification for his recharacterization. (Really!)

With respect to the second point, previous research teams have found that the variable “hours of use” is not correlated with cybersex addiction (or video-gaming addiction). That is, addiction is more accurately predicted by other variables than “hours of use.” As you can see from the above excerpt, Grubbs actually found a significant correlation between hours of use and psychological distress.

We’ll look at details about why Grubbs et al.’s assumptions are neither true nor supportable below, but here’s how the researchers could have described their actual findings without misleading the public:

“Study finds that porn addiction is strongly related to psychological distress and less strongly (but still) related to current hours of use.”

The cliff notes version: Addiction is related to psychological distress, and so are hours of use. So much for the attention-grabbing, misleading headlines spawned by the study.

The CPUI Assesses Porn Addiction, Not “Perceived Addiction”

This is really simple: Grubbs et al. relabeled Grubbs’s self-created porn addiction test as a “perceived porn addiction” test. However, his Cyber Pornography Use Inventory (CPUI) questionnaire is in fact similar to many other drug and behavioral addiction questionnaires. Like other addiction tests, the CPUI assesses behaviors and symptoms common to all addictions, such as: the inability to control use; compulsion to use, cravings to use, negative psychological, social and emotional effects; and preoccupation with using. In fact, only 1 of the 9 questions below even hints at “perceived addiction.” Yet we are told that a person’s total score for all 9 questions is synonymous with “perceived addiction” rather than addiction itself. Very misleading, very clever, and without any scientific basis. Agnotology fodder, anyone? (Agnotology is the study of culturally induced ignorance or doubt, particularly the publication of inaccurate or misleading scientific data.) Reality check: other researchers describe the CPUI as an actual porn addiction assessment questionnaire, and use it as such in their published studies:

  1. Questionnaires and scales for the evaluation of the online sexual activities: A review of 20 years of research (2014)
  2. Problematic cybersex: Conceptualization, assessment, and treatment (2015)
  3. Examining Correlates of Problematic Internet Pornography Use Among University Student (2016)

The last study above used a longer version of the Grubbs CPUI and an Internet pornography addiction questionnaire derived from the DSM-5 Internet video-gaming addiction criteria. The graphs show the same subjects’ scores on the two different porn addiction questionnaires:

——

No suprise. Very similar results and distribution for the Grubbs CPUI and the “actual” porn addiction questionaire. That’s because the CPUI is an addiction test, invalidating Grubbs’ attempt to relabel it as a “perceived addiction test.”

Note that decades of established addiction assessment tests for both chemical and behavioral addictions rely on similar questions to assess actual, not merely perceived, addiction. Let’s compare the CPUI to a commonly used addiction assessment tool known as the “4 Cs.” The CPUI questions that correlate with the four Cs are noted as well.

  • Compulsion to use (2, 3)
  • Inability to Control use (2, 3, maybe 4-6)
  • Cravings to use (3 especially, but 1-6 could be interpreted as cravings)
  • Continued use despite negative consequences (4-6, perhaps 7-9)

The Cyber Pornography Use Inventory (CPUI) – developed by Grubbs

COMPULSIVITY:

1. I believe I am addicted to Internet pornography.

2. I feel unable to stop my use of online pornography.

3. Even when I do not want to view pornography online, I feel drawn to it

ACCESS EFFORTS:

4. At times, I try to arrange my schedule so that I will be able to be alone in order to view pornography.

5. I have refused to go out with friends or attend certain social functions to have the opportunity to view pornography.

6. I have put off important priorities to view pornography.

EMOTIONAL DISTRESS:

7. I feel ashamed after viewing pornography online.

8. I feel depressed after viewing pornography online.

9. I feel sick after viewing pornography online.

Addiction experts rely on assessment tools like the 4Cs as indicating addiction because neuroscientists have correlated the symptoms those questions address with underlying addiction-related brain changes in decades of basic-research studies. As a medical matter, addiction is a disorder of the brain. It shows up in very specific behaviors, but can’t be assessed from superficial indications such as hours of use. See the public policy statement of the American Society of Addiction Medicine.

In short, the CPUI does a better job at actually identifying that which it purports to differentially diagnose against (actual addiction) than at identifying “perceived addiction,” as Grubbs claims it does.

Finally, we must ask why Grubbs found it necessary to create his own internet porn addiction test. Others, well established and thoroughly validated, were available to him. Might it be that as the author of the CPUI he assumes he has the power to re-label it as a “perceived addiction to porn” test in order to fool readers into believing that all porn addicts are misdiagnosing themselves? Sorry, if it walks like a duck and talks like a duck….

Bottom Line: The CPUI assesses actual porn addiction, not “perceived” porn addiction. Delete the word “perceived” from the study, and every article about it, and you are left with an unsurprising finding: psychological distress is related to perceived porn addiction.

Current Hours of Use Are Not Related To Porn Addiction

Grubbs et al.’s conclusion is largely based on a faulty premise: The extent of a porn addiction is best assessed simply by hours of internet porn viewing. As Grubbs et al. did not find a tight enough correlation (in their view) in their subjects, they concluded their subjects merely had “perceived addiction” instead. Two huge holes in the story render Grubbs et al.’ claim highly suspect.

As described earlier, the first gaping hole is that Grubbs et al. actually found a pretty strong correlation between hours of use and the CPUI! From p. 6 of the study:

“Additionally, average daily pornography use in hours was significantly and positively associated with depression, anxiety, and anger, as well as with perceived addiction.”

Stop the presses! This excerpt directly contradicts all the headlines, which claim that pornography use was NOT strongly correlated with psychological distress or “perceived addiction.” Again, whenever you see the phrase “perceived addiction” it actually denotes the subjects’ total score on the CPUI (which is a porn addiction test).

To say all of this another way: Both psychological distress and CPUI scores were significantly correlated with hours of use. Does any journalist or blogger ever read an actual study?

The second hole in this study’s underpinnings, which you could drive a truck through, is that research on internet porn and videogame use (1, 2, 3, 4, 5, 6, 7, 8) has established that neither addiction correlates with hours of use. The variable ‘hours of use’ is an unreliable measure of addiction, and established addiction assessment tools evaluate addiction using multiple other factors (such as those listed in the CPUI). The following cybersex addiction studies, which Grubbs omitted, report little relationship between hours and indications of addiction:

1) Watching Pornographic Pictures on the Internet: Role of Sexual Arousal Ratings and Psychological-Psychiatric Symptoms for Using Internet Sex Sites Excessively (2011)

“Results indicate that self-reported problems in daily life linked to online sexual activities were predicted by subjective sexual arousal ratings of the pornographic material, global severity of psychological symptoms, and the number of sex applications used when being on Internet sex sites in daily life, while the time spent on Internet sex sites (minutes per day) did not significantly contribute to explanation of variance in Internet Addiction Test sex score (IATsex). We see some parallels between cognitive and brain mechanisms potentially contributing to the maintenance of excessive cybersex and those described for individuals with substance dependence.”

2) Sexual Excitability and Dysfunctional Coping Determine Cybersex Addiction in Homosexual Males (2015)

Recent findings have demonstrated an association between CyberSex Addiction (CA) severity and indicators of sexual excitability, and that coping by sexual behaviors mediated the relationship between sexual excitability and CA symptoms. Results showed strong correlations between CA symptoms and indicators of sexual arousal and sexual excitability, coping by sexual behaviors, and psychological symptoms. CyberSex Addiction was not associated with offline sexual behaviors and weekly cybersex use time.

3) What Matters: Quantity or Quality of Pornography Use? Psychological and Behavioral Factors of Seeking Treatment for Problematic Pornography Use (2016)

According to our best knowledge this study is the first direct examination of associations between the frequency of porn use and actual behavior of treatment-seeking for problematic porn use (measured as visiting the psychologist, psychiatrist or sexologist for this purpose). Our results indicate that the future studies, and treatment, in this field should focus more on impact of porn use on the life of an individual (quality) rather than its mere frequency (quantity), as the negative symptoms associated with porn use (rather than porn use frequency ) are the most significant predictor of treatment-seeking behavior.

Relation between PU and negative symptoms was significant and mediated by self-reported, subjective religiosity (weak, partial mediation) among non-treatment seekers. Among treatment-seekers religiosity is not related to negative symptoms.

4) Examining Correlates of Problematic Internet Pornography Use Among University Student (2016)

Higher scores on addictive measures of internet porn use were correlated with daily or more frequent use of internet porn. However, the results indicate that there was no direct link between the amount and frequency of an individual’s pornography use and struggles with anxiety, depression, and life and relationship satisfaction. Significant correlations to high internet porn addiction scores included an early first exposure to internet porn, addiction to video games, and being male. While some positive effects of internet porn use have been documented in previous literature our results do not indicate that psychosocial functioning improves with moderate or casual use of  internet porn.

Thus, from the outset this study and its assertions collapse because its conclusions rest upon equating current hours of use with the level of addiction/problems/distress reported by subjects as a valid measure of addiction.

Why don’t addiction specialists rely on hours of use? Imagine trying to assess addictions by simply asking, “How many hours do you currently spend eating (food addiction)?” or “How many hours do you spend gambling (gambling addition)?” or “How many hours do you spend drinking (alcoholism)?” To demonstrate how problematic hours of use would be, consider alcohol as an example:

  1. A 45-year old Italian man has a tradition of drinking 2 glasses of wine every night with dinner. His meal is with his extended family and it takes 3 hours to complete (lots of yakking). So he drinks for 3 hours a night, 21 hour per week.
  2. A 25 year-old factory worker only drinks on the weekends, but binge drinks both Friday and Saturday night to the point of passing out or getting sick. He regrets his actions and wants to stop, but can’t, drives drunk, gets in fights, is sexually aggressive, etc. He then spends all of Sunday recovering, and feels like crap until Wednesday. However, he spent only 8 hours a week drinking.

Which drinker has a problem? This is why “current hours of use” alone cannot inform us as to who is addicted and who is not.

Finally, we must ask why Grubbs et al. chose to create the CPUI when other, thoroughly validated addiction tests were readily available.

Bottom line: The study’s claims depend upon “current hours of use” being a valid criterion for true addiction. They are not. Moreover, once you get past the abstract, the full study reveals that “current hours of use” is actually related to both psychological distress and CPUI scores!

“Current Hours of Use” Omits Many Variables

A secondary methodological problem is that Grubbs et al. assessed porn use by asking subjects about their “current hours of porn use.” That question is troublingly vague. Over what period? One subject may be thinking “How much did I use yesterday?” another “over the last week?” or “on average since I decided to quit viewing because of unwanted effects?” The result is data that are not comparable can’t be analyzed for the purpose of drawing reliable conclusions.

More important, the “current porn use” question, on which the study’s conclusions rest, fails to ask about key variables of porn use: age use began, years of use, whether the user escalated to novel genres of porn or developed unexpected porn fetishes, the ratio of ejaculation with porn to ejaculation without it, amount of sex with a real partner, and so forth. Those questions would likely enlighten us more about who really has a problem with porn use than simply “current hours of use.”

Deeper Analysis: Addiction Correlates With Addiction, not Emotional Distress

We have established that the CPUI is in no way a “perceived addiction” test. Instead, the CPUI is an actual porn addiction test assessing 3 categories of compulsive pornography use:

  1. Compulsion to use & Inability to control use
  2. Efforts to use (negative consequences)
  3. Emotional Distress after using (shame, depression, feel sick)

What do the conspicuous headlines claim and the authors assert? That psychological distress about one’s porn addiction is the real problem, rather than the addiction itself. If that were true, we would expect “porn addicts” to score especially high in Emotional Distress category of the CPUI. Not so. From p. 9 of the study:

“In all SEM analyses, emotional distress consistently had the weakest loadings on the latent factor of perceived addiction…… Such a consistent pattern across studies strongly indicates that emotional distress regarding use is not the primary driving factor in the link between perceived addiction and psychological distress.”

Translation: Scores on the CPUI Emotional Distress section were the least related to scores on separate Psychological Distress questionnaires (which measure such things as stress, depression and anger). Put simply, the psychological distress of porn addiction does NOT arise from shame or guilt. Instead, psychological distress arises from the inability to control use despite negative consequences, as measured by CPUI sections 1 and 2. From pg 9 of the study:

By contrast, perceived compulsivity—the direct acknowledgment of feelings of addiction to pornography—was consistently the primary factor driving perceived addiction. Additionally, access efforts [negative consequences] loaded more strongly on perceived addiction than emotional distress regarding use.

Translation: The inability to control use (questions 1-3) coupled with negative consequences (questions 4-6), was more strongly related to “psychological distress.” Put simply, guilt and shame weren’t such a big deal, but inability to control use, the compulsion to watch porn when subjects don’t want to, refusing to go out with friends or attend social functions in order to view pornography, and putting off important priorities to view pornography, are what really upset subjects.

This is a very different reality than readers got from either the misleading headlines or study abstract.

Grubbs Introduction Distorts Current State of the Research

In the introduction and discussion sections Grubbs et al. toss aside decades of neuropsychological and other addiction research (and related assessment tools) to attempt to persuade readers that the scientific literature shows that internet porn addiction doesn’t exist (and that therefore that all evidence of porn addiction must be “perceived,” not real). A new review shows just how farfetched this contention is. See Neuroscience of Internet Pornography Addiction: A Review and Update, which aligns decades of addiction neuroscience research with recent neuroscience and neuropsych studies on porn users themselves. It concludes (logically and scientifically) that internet pornography addiction is quite real, and in fact a subset of internet addiction (based on more than 100 brain studies, as well as hundreds of other relevant studies).

In their opening paragraphs, Grubbs et al. demonstrate their profound bias by basing their claim about the nonexistence of internet porn addiction on the papers of two self-proclaimed “internet porn addiction debunkers”: David Ley, author of The Myth of Sex Addiction, and former UCLA researcher Nicole Prause, whose work has been formally criticized in the medical literature for weak methodology and unsupported conclusions.

For example, Grubbs et al. rely on a one-sided paper by Ley, Prause and their colleague Peter Finn, which claimed to be a review (that is, an impartial analysis of the existing literature). However, it omitted or misrepresented nearly every study that found negative effects of internet porn use, while also ignoring the dozens of recent internet addiction studies demonstrating addiction-related structural brain changes in internet addicts’ brains. (Line-by-line critique can be found here.)

Equaling telling is Grubbs et al.’s omission of every brain scan and neuropsychological study that found evidence in support of the porn addiction model (over a dozen collected here). Instead of hard science from the many omitted studies, the reader is given an overreaching conclusion:

In sum, there is a fair amount of evidence suggesting that many individuals feel addicted to Internet pornography, even in the absence of a clinically verified diagnosis to subsume such a disorder.

Finally, the only neurological study cited by Grubbs as refuting porn addiction (Steele et al.) actually supports the porn addiction model. Steele et al. reported higher EEG readings (P300) when subjects were exposed to porn photos. Studies consistently show that an elevated P300 occurs when addicts are exposed to cues (such as images) related to their addiction. In addition, the study reported that greater cue-reactivity to porn correlated with less desire for partnered sex. As neither result matched the headlines, Grubbs perpetuated the flawed conclusions of the original authors (the “debunkers of porn addiction”).

Conclusion

Given its unsupported conclusions and biased claims about the non-existence of porn addiction, it seems likely that Grubbs et al. designed this study to meet a specific agenda – to re-label porn addiction as “perceived addiction” and persuade readers that porn use is harmless and they need only worry about believing it can harm. Agnotology mission accomplished!

This saying comes to mind: What the abstract giveth, the full study taketh away. The headlines and claims spawned by Grubbs et al. are not even supported by the underlying study. Again,

  1. Both internet gaming and internet porn addiction studies have already established that hours of use do not correlate well with addiction. This fact alone guts this entire study and its misleading headlines.
  2. The Cyber Pornography Use Inventory (CPUI) assesses the signs, symptoms and behaviors of an addiction, not “perceived addiction”. Don’t be fooled; the CPUI was never validated for “perceived” as opposed to “real” addiction.
  3. Grubbs et al.’s study reveals that the “average daily pornography use in hours was significantly and positively associated with depression, anxiety, and anger, as well as with perceived addiction (the CPUI).” This directly contradicts the press claims that say hours of use were not related to CPUI scores or psychological distress.

Any one of the above dismantles this study, but all three mean that this study should be ignored as the work of agnotology that it is.

Research such as this contributes to the ongoing campaign to confuse the public about the reality of internet porn addiction. For example, one frequently sees attempts by Grubbs’s colleagues to conflate internet porn addiction with sex addiction and then sweep both away as “unsupported,” even though the neuropsychological and medical evidence demonstrating internet addiction is already overwhelming. Another tactic is to conflate internet porn addiction with “Hypersexual disorder” and then claim that the DSM-5, by rejecting the latter, has rejected the former. In fact, internet porn addiction was never formally proposed, or evaluated, for inclusion in the DSM-5. It’s time it was, given the mounting evidence that both internet addiction and its subtype internet porn addiction are true addictions.

In the same tradition, Grubbs et al., without justification, now attempt to sweep aside decades of addiction research and assessment tests developed for all kinds of addictions, and substitute their own worldview (that internet porn addiction doesn’t exist and should be recast as “perceived addiction”). Should society and its headline-hungry journalists allow this? You be the judge.

Current List of Brain Studies on Porn Users

Listed below are all the “brain” studies on porn users currently published (or in the press). These study results are consistent with 190+ Internet addiction brain studies, some of which also include internet porn use.

In short, there’s ample (and growing) peer-reviewed scientific support for the addiction model. All support the premise that internet porn use can cause addiction-related brain changes, as do recent neuroscience-based reviews of the literature (no studies have yet to falsify the porn addiction model):

  1. Sex Addiction as a Disease: Evidence for Assessment, Diagnosis, and Response to Critics (2015), which provides a chart that takes on specific criticisms and offers citations that counter them.
  2. For a thorough review of the neuroscience literature related to Internet addiction subtypes, with special focus on internet porn addiction, see – Neuroscience of Internet Pornography Addiction: A Review and Update (2015). Excerpt: “The review leads to the conclusion that Internet pornography addiction fits into the addiction framework and shares similar basic mechanisms with substance addiction. Together with studies on Internet addiction and Internet Gaming Disorder we see strong evidence for considering addictive Internet behaviors as behavioral addiction.” The review also critiques two recent headline-grabbing EEG studies which purport to have “debunked” porn addiction.
  3. Cybersex Addiction (2015) – Excerpts: “In recent articles, cybersex addiction is considered a specific type of Internet addiction. Some current studies investigated parallels between cybersex addiction and other behavioral addictions, such as Internet Gaming Disorder. Cue-reactivity and craving are considered to play a major role in cybersex addiction. Neuroimaging studies support the assumption of meaningful commonalities between cybersex addiction and other behavioral addictions as well as substance dependency.”
  4. Neurobiology of Compulsive Sexual Behavior: Emerging Science (2016) – Excerpt: “Given some similarities between CSB and drug addictions, interventions effective for addictions may hold promise for CSB, thus providing insight into future research directions to investigate this possibility directly.”
  5. Should compulsive sexual behavior be considered an addiction? (2016) – Excerpt: “Overlapping features exist between CSB and substance use disorders. Common neurotransmitter systems may contribute to CSB and substance use disorders, and recent neuroimaging studies highlight similarities relating to craving and attentional biases. Similar pharmacological and psychotherapeutic treatments may be applicable to CSB and substance addictions, although considerable gaps in knowledge currently exist.
  6. Compulsive Sexual Behaviour as a Behavioural Addiction: The Impact of the Internet and Other Issues (2016) Excerpts: “more emphasis is needed on the characteristics of the internet as these may facilitate problematic sexual behaviour.” and “clinical evidence from those who help and treat such individuals should be given greater credence by the psychiatric community.”
  7. Neurobiological Basis of Hypersexuality (2016) – Excerpt: “Taken together, the evidence seems to imply that alterations in the frontal lobe, amygdala, hippocampus, hypothalamus, septum, and brain regions that process reward play a prominent role in the emergence of hypersexuality. Genetic studies and neuropharmacological treatment approaches point at an involvement of the dopaminergic system.
  8. Searching for clarity in muddy water: future considerations for classifying compulsive sexual behavior as an addiction (2016) – Excerpts: “We recently considered evidence for classifying compulsive sexual behavior (CSB) as a non-substance (behavioral) addiction. Our review found that CSB shared clinical, neurobiological and phenomenological parallels with substance-use disorders. Although the American Psychiatric Association rejected hypersexual disorder from DSM-5, a diagnosis of CSB (excessive sex drive) can be made using ICD-10. CSB is also being considered by ICD-11.”
  9. Is Internet Pornography Causing Sexual Dysfunctions? A Review with Clinical Reports (2016)A review of the literature related to porn-induced sexual problems. Involving US Navy doctors, the review provides the latest data revealing a tremendous rise in youthful sexual problems. It also reviews the neurological studies related to porn addiction and sexual conditioning. The doctors provide 3 clinical reports of men who developed porn-induced sexual dysfunctions.
  10. Integrating psychological and neurobiological considerations regarding the development and maintenance of specific Internet-use disorders: An Interaction of Person-Affect-Cognition-Execution model (2016) – A review of the mechanisms underlying the development and maintenance of specific Internet-use disorders, including “Internet-pornography-viewing disorder“. The authors suggest that pornography addiction (and cybersex addiction) be classified as internet use disorders and placed with other behavioral addictions under substance-use disorders as addictive behaviors.

Recent studies assessing brain structure & functioning of Internet porn users and sex addicts (click on name to be taken to original study):

  1. Brain Structure and Functional Connectivity Associated With Pornography Consumption: The Brain on Porn (2014) – This Max Planck Institute fMRI study found less gray matter in the reward system (dorsal striatum) correlating with the amount of porn consumed. It also found that more porn use correlated with less reward circuit activation while briefly viewing sexual photos. Researchers believed their findings indicated desensitization, and possibly tolerance, which is the need for greater stimulation to achieve the same high. The study also reported that more porn viewing was linked to poorer connections between the reward circuit and prefrontal cortex – a common addiction-related brain change.
  2. Neural Correlates of Sexual Cue Reactivity in Individuals with and without Compulsive Sexual Behaviours (2014) – The first in a series of Cambridge University studies found the same brain activity as seen in drug addicts and alcoholics. It also found that porn addicts (CSB subjects) fit the accepted addiction model of wanting “it” more, but not liking “it” more. The researchers also reported that 60% of subjects (average age: 25) had difficulty achieving erections/arousal with real partners, yet could achieve erections with porn.
  3. Enhanced Attentional Bias towards Sexually Explicit Cues in Individuals with and without Compulsive Sexual Behaviours (2014) – The second Cambridge University study. An excerpt: “Our findings of enhanced attentional bias… suggest possible overlaps with enhanced attentional bias observed in studies of drug cues in disorders of addictions. These findings converge with recent findings of neural reactivity to sexually explicit cues in [porn addicts] in a network similar to that implicated in drug-cue-reactivity studies and provide support for incentive motivation theories of addiction underlying the aberrant response to sexual cues in [porn addicts].
  4. Novelty, Conditioning and Attentional Bias to Sexual Rewards (2015) – Compared to controls porn addicts preferred sexual novelty and conditioned cues associated porn. However, the brains of porn addicts habituated faster to sexual images. Since novelty preference wasn’t pre-existing, porn addiction drives novelty-seeking in an attempt to overcome habituation and desensitization.
  5. Neural Substrates of Sexual Desire in Individuals with Problematic Hypersexual Behavior (2015) – This Korean fMRI study replicates other brain studies on porn users. Like the Cambridge University studies it found cue-induced brain activation patterns in sex addicts which mirrored the patterns of drug addicts. In line with several German studies it found alterations in the prefrontal cortex which match the changes observed in drug addicts.
  6. Sexual Desire, not Hypersexuality, is Related to Neurophysiological Responses Elicited by Sexual Images (2013) – This EEG study was touted in the media as evidence against the existence of porn/sex addiction. Not so. This SPAN Lab study, like #7 below, actually lends support to the existence of both porn addiction and porn use downregulating sexual desire. How so? The study reported higher EEG readings (P300) when subjects were briefly exposed to pornographic photos. Studies consistently show that an elevated P300 occurs when addicts are exposed to cues (such as images) related to their addiction. However, due to methodological flaws the findings are uninterpretable: 1) subjects were heterogeneous (males, females, non-heterosexuals); 2) subjects were not screened for mental disorders or addictions; 3) the study had no control group for comparison; 4) the questionnaires were not validated for porn addiction. In line with the Cambridge University brain scan studies, this EEG study also reported greater cue-reactivity to porn correlating with less desire for partnered sex. To put another way – individuals with greater brain activation to porn would rather masturbate to porn than have sex with a real person. Shockingly, study spokesman Nicole Prause claimed that porn users merely had “high libido”, yet the results of the study say something quite different. Four peer-reviewed papers expose the truth: 1, 2, 3, 4Read an extensive critique here.
  7. Modulation of Late Positive Potentials by Sexual Images in Problem Users and Controls Inconsistent with “Porn Addiction” (2015) – Another SPAN Lab EEG study comparing the 2013 subjects from the above study to an actual control group. The results: compared to controls porn addicts had less response to photos of vanilla porn. Ignoring all the other studies on this page, lead author Nicole Prause, boldly claims that her results “debunked porn addiction”. What legitimate scientist would claim that their lone anomalous study has debunked an entire field of study?  In reality, the findings of Prause et al. 2015 align perfectly with Kühn & Gallinat (2014), which found that more porn use correlated with less brain activation in response to pictures of vanilla porn. Prause’s findings also align with Banca et al. 2015 which is #4 in this list. Moreover, another EEG study found that greater porn use in women correlated with less brain activation to porn. Lower EEG readings mean that subjects are paying less attention to the pictures. Put simply, frequent porn users were desensitized to static images of vanilla porn. They were bored. Read an extensive critique here. Five peer-reviewed papers agree with this critique of the study – 1, 2, 3, 4, 5.
  8. HPA axis dysregulation in men with hypersexual disorder (2015) – The Hypothalamus-Pituitary-Adrenal (HPA) axis is the central player in our stress response. Addictions alter the brain’s stress circuits leading to a dysfunctional HPA axis. This study on sex addicts (hypersexuals) found altered stress responses that mirror drug addiction.
  9. Compulsive sexual behavior: Prefrontal and limbic volume and interactions (2016) – Compared to healthy controls CSB subjects (porn addicts) had increased left amygdala volume and reduced functional connectivity between the amygdala and dorsolateral prefrontal cortex DLPFC. Reduced functional connectivity between the amygdala and the prefrontal cortex aligns with substance addictions. It is thought that poorer connectivity diminishes the prefrontal cortex’s control over a user’s impulse to engage in the addictive behavior. This study suggests that drug toxicity may lead to less gray matter and thus reduced amygdala volume in drug addicts. The amygdala is consistently active during porn viewing, especially during initial exposure to a sexual cue. Perhaps the constant sexual novelty and searching and seeking leads to a unique effect on the amygdala in compulsive porn users. Alternatively, years of porn addiction and severe negative consequences is very stressful – and chronic social stress is related to increased amygdala volume. Study #8 above found that “sex addicts” have a overactive stress system. Could the chronic stress related to porn/sex addiction, along with factors that make sex unique, lead to greater amygdala volume?
  10. Can pornography be addictive? An fMRI study of men seeking treatment for problematic pornography use (2016) – (in the press) Excerpts: Men with and without problematic porn sue (PPU) differed in brain reactions to cues predicting erotic pictures, but not in reactions to erotic pictures themselves, consistent with the incentive salience theory of addictions. This brain activation was accompanied by increased behavioral motivation to view erotic images (higher ‘wanting’). Ventral striatal reactivity for cues predicting erotic pictures was significantly related to the severity of PPU, amount of pornography use per week and number of weekly masturbations. Our findings suggest that like in substance-use and gambling disorders the neural and behavioral mechanisms linked to anticipatory processing of cues relate importantly to clinically relevant features of PPU. These findings suggest that PPU may represent a behavioral addiction and that interventions helpful in targeting behavioral and substance addictions warrant consideration for adaptation and use in helping men with PPU.
  11. Ventral striatum activity when watching preferred pornographic pictures is correlated with symptoms of Internet pornography addiction (2016) – Finding #1: Reward center activity (ventral striatum) was higher for preferred pornographic pictures. Finding #2: Ventral striatum reactivity correlated with the internet sex addiction score. Both findings indicate sensitization and align with the addiction model. The authors state that the “Neural basis of Internet pornography addiction is comparable to other addictions.
  12. Altered Appetitive Conditioning and Neural Connectivity in Subjects With Compulsive Sexual Behavior (2016) – A German fMRI study replicating two major findings from Voon et al., 2014 and Kuhn & Gallinat 2014. Compared to controls compulsive porn users had 1) greater conditioned cue-induced activity in the amygdala, while having 2) decreased coupling between the ventral striatum and the prefrontal cortex. Number 1 indicates sensitization, while number 2 indicates hypofronatlity. In addition, 3 of the 20 compulsive porn users suffered from “orgasmic-erection disorder”.
  13. Compulsivity across the pathological misuse of drug and non-drug rewards (2016) – A Cambridge University study comparing aspects of compulsivity in alcoholics, binge-eaters, video game addicts and porn addicts (CSB). Excerpts: CSB subjects were faster to learning from rewards in the acquisition phase compared to healthy volunteers and were more likely to perseverate or stay after either a loss or a win in the Reward condition. These findings converge with our previous findings of enhanced preference for stimuli conditioned to either sexual or monetary outcomes, overall suggesting enhanced sensitivity to rewards (Banca et al., 2016).
  14. Preliminary investigation of the impulsive and neuroanatomical characteristics of compulsive sexual behavior (2009) – Primarily sex addicts. Study reports more impulsive behavior in a Go-NoGo task in sex addicts (hypersexuals) compared to control participants. Brain scans revealed that sex addicts had greater disorganized prefrontal cortex white matter. This finding is consistent with “hypofrontality”, a hallmark of addiction.

Together these brain studies found:

  1. The 3 major addiction-related brain changes: sensitization, desensitization, and hypofrontality.
  2. More porn use correlated with less grey matter in the reward circuit (dorsal striatum).
  3. More porn use correlated with less reward circuit activation when viewing sexual images.
  4. More porn use correlated with disrupted neural connections between the reward circuit and prefrontal cortex.
  5. Addicts had greater prefrontal activity to sexual cues, but less brain activity to normal stimuli (matches drug addiction).
  6. Porn addicts have greater preference for sexual novelty yet their brains habituated faster to sexual images. Not pre-existing.
  7. 60% of compulsive porn addicted subjects in one study experienced ED or low libido with partners, but not with porn: all stated that internet porn use caused their ED/low libido.
  8. Enhanced attentional bias comparable to drug users. Indicates sensitization (a product of DeltaFosb).
  9. Greater wanting & craving for porn, but not greater liking. This aligns with the accepted model of addiction – incentive sensitization.
  10. The younger the porn users the greater the cue-induced reactivity in the reward center.
  11. Higher EEG (P300) readings when porn users were exposed to porn cues (which occurs in other addictions).
  12. Less desire for sex with a person correlating with greater cue-reactivity to porn images.
  13. More porn use related with lower LPP amplitude when viewing sexual photos: indicates habituation or desensitization.
  14. Dysfunctional HPA axis which reflects altered brain stress circuits (and greater amygdala volume, which is associated with chronic social stress).

Neuro-Psychological Studies on Porn Users (with excerpts):

  1. Watching Pornographic Pictures on the Internet: Role of Sexual Arousal Ratings and Psychological-Psychiatric Symptoms for Using Internet Sex Sites Excessively (2011) Results indicate that self-reported problems in daily life linked to online sexual activities were predicted by subjective sexual arousal ratings of the pornographic material, global severity of psychological symptoms, and the number of sex applications used when being on Internet sex sites in daily life, while the time spent on Internet sex sites (minutes per day) did not significantly contribute to explanation of variance in IATsex score. We see some parallels between cognitive and brain mechanisms potentially contributing to the maintenance of excessive cybersex and those described for individuals with substance dependence
  2. Pornographic picture processing interferes with working memory performance (2013)Some individuals report problems during and after Internet sex engagement, such as missing sleep and forgetting appointments, which are associated with negative life consequences. One mechanism potentially leading to these kinds of problems is that sexual arousal during Internet sex might interfere with working memory (WM) capacity, resulting in a neglect of relevant environmental information and therefore disadvantageous decision making. Results revealed worse WM performance in the pornographic picture condition of the 4-back task compared with the three remaining picture conditions. Findings are discussed with respect to Internet addiction because WM interference by addiction-related cues is well known from substance dependencies.
  3. Sexual Picture Processing Interferes with Decision-Making Under Ambiguity (2013) Decision-making performance was worse when sexual pictures were associated with disadvantageous card decks compared to performance when the sexual pictures were linked to the advantageous decks. Subjective sexual arousal moderated the relationship between task condition and decision-making performance. This study emphasized that sexual arousal interfered with decision-making, which may explain why some individuals experience negative consequences in the context of cybersex use.
  4. Cybersex addiction: Experienced sexual arousal when watching pornography and not real-life sexual contacts makes the difference (2013)The results show that indicators of sexual arousal and craving to Internet pornographic cues predicted tendencies towards cybersex addiction in the first study. Moreover, it was shown that problematic cybersex users report greater sexual arousal and craving reactions resulting from pornographic cue presentation. In both studies, the number and the quality with real-life sexual contacts were not associated to cybersex addiction. The results support the gratification hypothesis, which assumes reinforcement, learning mechanisms, and craving to be relevant processes in the development and maintenance of cybersex addiction. Poor or unsatisfying sexual real life contacts cannot sufficiently explain cybersex addiction.
  5. Empirical Evidence and Theoretical Considerations on Factors Contributing to Cybersex Addiction From a Cognitive-Behavioral View (2014) Dysfunctional use of sex mediated the relationship of sexual excitability with cybersex addiction (CA). The results of the study show that there are factors of vulnerability to CA and provide evidence for the role of sexual gratification and dysfunctional coping in the development of cybersex addiction.
  6. Cybersex addiction in heterosexual female users of internet pornography can be explained by gratification hypothesis (2014) Results indicated that Internet porn users rated pornographic pictures as more arousing and reported greater craving due to pornographic picture presentation compared with non-users. Moreover, craving, sexual arousal rating of pictures, sensitivity to sexual excitation, problematic sexual behavior, and severity of psychological symptoms predicted tendencies toward cybersex addiction in porn users. Being in a relationship, number of sexual contacts, satisfaction with sexual contacts, and use of interactive cybersex were not associated with cybersex addiction.
  7. Prefrontal control and internet addiction: a theoretical model and review of neuropsychological and neuroimaging findings (2015)Consistent with this, results from functional neuroimaging and other neuropsychological studies demonstrate that cue-reactivity, craving, and decision making are important concepts for understanding Internet addiction. The findings on reductions in executive control are consistent with other behavioral addictions, such as pathological gambling. They also emphasize the classification of the phenomenon as an addiction, because there are also several similarities with findings in substance dependency.  Moreover, the results of the current study are comparable to findings from substance dependency research and emphasize analogies between cybersex addiction and substance dependencies or other behavioral addictions.
  8. Implicit associations in cybersex addiction: Adaption of an Implicit Association Test with pornographic pictures. (2015) Recent studies show similarities between cybersex addiction and substance dependencies and argue to classify cybersex addiction as a behavioral addiction. In substance dependency, implicit associations are known to play a crucial role. Results show positive relationships between implicit associations of pornographic pictures with positive emotions and tendencies towards cybersex addiction, problematic sexual behavior, sensitivity towards sexual excitation as well as subjective craving.
  9. Symptoms of cybersex addiction can be linked to both approaching and avoiding pornographic stimuli: results from an analog sample of regular cybersex users (2015) Results showed that individuals with tendencies toward cybersex addiction tended to either approach or avoid pornographic stimuli. Additionally, moderated regression analyses revealed that individuals with high sexual excitation and problematic sexual behavior who showed high approach/avoidance tendencies, reported higher symptoms of cybersex addiction. Analogous to substance dependencies, results suggest that both approach and avoidance tendencies might play a role in cybersex addiction.
  10. Getting stuck with pornography? Overuse or neglect of cybersex cues in a multitasking situation is related to symptoms of cybersex addiction (2015)Individuals with tendencies towards cybersex addiction seem to have either an inclination to avoid or to approach the pornographic material, as discussed in motivational models of addiction. The results of the current study point towards a role of executive control functions, i.e. functions mediated by the prefrontal cortex, for the development and maintenance of problematic cybersex use (as suggested by Brand et al., 2014). Particularly a reduced ability to monitor consumption and to switch between pornographic material and other contents in a goal adequate manner may be one mechanism in the development and maintenance of cybersex addiction.
  11. Trading Later Rewards for Current Pleasure: Pornography Consumption and Delay Discounting (2015)Study 1: Participants completed a pornography use questionnaire and a delay discounting task at Time 1 and then again four weeks later. Participants reporting higher initial pornography use demonstrated a higher delay discounting rate at Time 2, controlling for initial delay discounting. Study 2:  Participants who abstained from pornography use demonstrated lower delay discounting than participants who abstained from their favorite food. The finding suggests that Internet pornography is a sexual reward that contributes to delay discounting differently than other natural rewards. It is therefore important to treat pornography as a unique stimulus in reward, impulsivity, and addiction studies and to apply this accordingly in individual as well as relational treatment.
  12. Sexual Excitability and Dysfunctional Coping Determine Cybersex Addiction in Homosexual Males (2015)Recent findings have demonstrated an association between CyberSex Addiction (CA) severity and indicators of sexual excitability, and that coping by sexual behaviors mediated the relationship between sexual excitability and CA symptoms. The aim of this study was to test this mediation in a sample of homosexual males.  Questionnaires assessed symptoms of CA, sensitivity to sexual excitation, pornography use motivation, problematic sexual behavior, psychological symptoms, and sexual behaviors in real life and online. Moreover, participants viewed pornographic videos and indicated their sexual arousal before and after the video presentation. Results showed strong correlations between CA symptoms and indicators of sexual arousal and sexual excitability, coping by sexual behaviors, and psychological symptoms. CA was not associated with offline sexual behaviors and weekly cybersex use time. Coping by sexual behaviors partially mediated the relationship between sexual excitability and CA. The results are comparable with those reported for heterosexual males and females in previous studies and are discussed against the background of theoretical assumptions of CA, which highlight the role of positive and negative reinforcement due to cybersex use.
  13. Subjective Craving for Pornography and Associative Learning Predict Tendencies Towards Cybersex Addiction in a Sample of Regular Cybersex Users (2016)There is no consensus regarding the diagnostic criteria of cybersex addiction. Some approaches postulate similarities to substance dependencies, for which associative learning is a crucial mechanism. In this study, 86 heterosexual males completed a Standard Pavlovian to Instrumental Transfer Task modified with pornographic pictures to investigate associative learning in cybersex addiction. Additionally, subjective craving due to watching pornographic pictures and tendencies towards cybersex addiction were assessed. Results showed an effect of subjective craving on tendencies towards cybersex addiction, moderated by associative learning. Overall, these findings point towards a crucial role of associative learning for the development of cybersex addiction, while providing further empirical evidence for similarities between substance dependencies and cybersex addiction
  14. Exploring the Relationship between Sexual Compulsivity and Attentional Bias to Sex-Related Words in a Cohort of Sexually Active Individuals (2016) – This study replicates the findings of this 2014 Cambridge University study that compared the attentional bias of porn addicts to healthy controls. The new study differs: rather than comparing porn addicts to controls, the new study correlated scores on a sex addiction questionnaire to the results of a task assessing attentional bias (explanation of attentional bias). The study described two key results: 1) Higher sexual compulsivity scores correlated with greater interference (increased distraction) during the attentional bias task. This aligns with substance abuse studies. 2) Among those scoring high on sexual addiction, fewer years of sexual experience were related to greater attentional bias. The authors concluded that this result could indicate that more years of “compulsive sexual activity” lead to greater habituation or a general numbing of the pleasure response (desensitization). An excerpt from the conclusion section: “One possible explanation for these results is that as a sexually compulsive individual engages in more compulsive behaviour, an associated arousal template develops and that over time, more extreme behaviour is required for the same level of arousal to be realised. It is further argued that as an individual engages in more compulsive behaviour, neuropathways become desensitized to more ‘normalised’ sexual stimuli or images and individuals turn to more ‘extreme’ stimuli to realise the arousal desired.”
  15. Mood changes after watching pornography on the Internet are linked to symptoms of Internet-pornography-viewing disorder (2016) – Excerpts: The main results of the study are that tendencies towards Internet Pornography Disorder (IPD) were associated negatively with feeling generally good, awake, and calm as well as positively with perceived stress in daily life and the motivation to use Internet pornography in terms of excitation seeking and emotional avoidance.  Furthermore, tendencies towards IPD were negatively related to mood before and after watching Internet pornography as well as an actual increase of good and calm mood. The relationship between tendencies towards IPD and excitement seeking due to Internet-pornography use was moderated by the evaluation of the experienced orgasm’s satisfaction. Generally, the results of the study are in line with the hypothesis that IPD is linked to the motivation to find sexual gratification and to avoid or to cope with aversive emotions as well as with the assumption that mood changes following pornography consumption are linked to IPD (Cooper et al., 1999 and Laier and Brand, 2014).
  16. Executive Functioning of Sexually Compulsive and Non-Sexually Compulsive Men Before and After Watching an Erotic Video (2017) Exposure to porn affected executive functioning in men with “compulsive sexual behaviors”, but not healthy controls. Poorer executive functioning when exposed to addiction-related cues is a hallmark of substance disorders (indicating both altered prefrontal circuits and sensitization). Excerpts: This finding indicates better cognitive flexibility after sexual stimulation by controls compared with sexually compulsive participants. These data support the idea that sexually compulsive men do not to take advantage of the possible learning effect from experience, which could result in better behavior modification. This also could be understood as a lack of a learning effect by the sexually compulsive group when they were sexually stimulated, similar to what happens in the cycle of sexual addiction, which starts with an increasing amount of sexual cognition, followed by the activation of sexual scripts and then orgasm, very often involving exposure to risky situations.

Analysis of “Modulation of late positive potentials by sexual images in problem users and controls inconsistent with ‘porn addiction’ (2015)”, by SPAN Lab

Published July 2015, we will refer to it as Prause, et al., 2015. Contrary to claims Prause’s 2015 EEG study supports the porn addiction model, as it reports habituation (or desensitization) in the more frequent porn users. To date 5 peer-reviewed analyses by neuroscientists and medical doctors agree with the following critique – that Prause et al., 2015 actually supports the porn addiction model:

  1. Neuroscience of Internet Pornography Addiction: A Review and Update – Excerpt critiquing Prause et al., 2015
  2. Neurobiology of Compulsive Sexual Behavior: Emerging Science (2016)
  3. Should compulsive sexual behavior be considered an addiction? (2016) – Excerpt analyzing Prause et al., 2015
  4. Decreased LPP for sexual images in problematic pornography users may be consistent with addiction models. Everything depends on the model. (Commentary on Prause, Steele, Staley, Sabatinelli, & Hajcak, 2015)
  5. Is Internet Pornography Causing Sexual Dysfunctions? A Review with Clinical Reports – Excerpt analyzing Prause et al., 2015

Hyperbole & Inaccurate Claims

Let’s start with the lead author’s hyperbole. Nicole Prause, boldly claimed on her SPAN lab website that this solitary study “debunks porn addiction”:

What researcher would ever claim to debunk an entire field of research and to refute all previous studies with a single study?

In addition, Nicole Prause claimed her study contained 122 subjects (N). In reality, the study had only 55 subjects who were “experiencing problems regulating their viewing of sexual images”. The subjects were recruited from Pocatello Idaho, which is over 50% Mormon. The other 67 participants were controls.

In another dubious claim, Prause, et al. 2015 stated in both their abstract and in the body of the study:

These are the first functional physiological data of persons reporting VSS regulation problems“.

This is clearly not the case, as the Cambridge fMRI study was published nearly a year ago.

In a third claim Nicole Prause has consistently asserted that Prause et al., 2015 is “the largest neuroscience investigation of porn addiction ever conducted”. It should be noted that compared to brain scan studies, EEG studies are far less expensive per subject. It’s easy to gather a large group of “porn addicted” subjects if you don’t screen the subjects for porn addiction or any exclusionary condition (mental problems, addictions, psychotropic drug use, etc.). A few problems with Prause’s claim:

  1. It’s not a study on porn addiction if it has no porn addicts. This study, and 2 earlier Prause studies (Prause et al., 2013 & Steele et al., 2013) did not assess whether any of the subjects were porn addicts or not. Prause admitted in an interview that many of the subjects had little difficulty controlling use: they were not addicts. All of the subjects would have to have been confirmed porn addicts to permit a legitimate comparison with a group of non-porn addicts. In addition the Prause Studies did not screen subjects for mental disorders, drug use, compulsive behaviors, or other addictions. Three of the five peer-reviewed critiques point out these fatal flaws: 2, 3, 4.
  2. “HPA axis dysregulation in men with hypersexual disorder” (2015) could be considered the largest neuroscience-based study to date on “hypersexuals” (with 67 subjects in treatment for sex addiction, as compared to Prause’s 55 subjects who were upset about their porn use). The study assessed the brain’s response to stress by assessing a hormone release by the brain (ACTH), and a hormone controlled by the brain (cortisol). While this study was a published a few months after Prause et al., 2015, Nicole Prause continues to claim her EEG study as the largest.
  3. Brain Structure and Functional Connectivity Associated With Pornography Consumption: The Brain on Porn (2014) – Could be considered larger than Prause et al., 2015, because it had 64 subjects, and all were carefully screened for exclusionary items such as addictions, substance use, mental disorders, and medical & neurological disorders. The 3 Prause studies did not do this.

Prause et al., 2015 Assessed Brain Wave Activity

Prause, et al. was an Electroencephalography or EEG study. EEG’s measure electrical activity, or brain waves, on the scalp. Although EEG technology has been around for 100 years, debate continues as to what actually causes brain waves, or what specific EEG readings really signify. As a consequence, experimental results may be interpreted in a variety of ways. Spikes in electrical activity are called amplitudes (below).

Researchers believe that certain EEG amplitudes (LPP, P3) may assess attention given to a particular stimulus, such as a picture. Put simply, greater amplitudes indicate the subject is paying greater attention to the visual stimulus presented in the experiment. In the Prause study the stimulus was a one-second exposure to a sexual photo. A few important points:

  1. Greater attention, and the corresponding EEG spike, cannot tell us if the person was sexually aroused or if they were repulsed. A higher spike may just as easily be caused by negative emotions, such as disgust or shock.
  2. Nor can an EEG spike tell us if the brain’s reward circuitry was activated or not. In contrast, other recent studies on porn users by Voon et al., 2014 and Kuhn & Gallinat 2014 used fMRI scanners to pinpoint structural changes and reward circuit activity.

In this study, Prause et al. compared the EEG activity of so called “porn addicts” (average 3.8 hours of porn/week) to controls (average 0.6 hours of porn/week). As expected, both “porn addicts” and controls had greater EEG activity (LPP amplitude) when viewing sexual photos. However, the amplitude was smaller for the “porn addicts.”

Prause et al., 2015 Actually Supports Porn Addiction

Expecting a greater amplitude for “porn addicts”, the authors stated, “This pattern appears different from substance addiction models.” But does that really make sense?

As a researcher friend says, in any study there are results…and there are the researcher’s interpretations. The results are pretty clear: Porn addicts paid less attention to photos of vanilla sex flashed on the screen for one second. This is no surprise to anyone who over-consumes today’s porn.

Prause’s findings of lower LPP amplitudes for “porn addicts” when compared to controls actually aligns with the addiction model, notwithstanding her interpretation that she has “debunked porn addiction.” Her finding indicates both desensitization (or habituation) and tolerance, which is the need for greater stimulation. Both are commonly seen in addicts, and, somewhat alarmingly, have also been recorded in heavy porn users who were not addicts (more below).

Key point: If porn use had no effect on Prause’s subjects, we would expect controls and “porn addicts” to have the same LPP amplitude in response to sexual photos. Instead, Prause’s so-called “porn addicts” had less brain activation (lower LPP) to still images of vanilla porn. I use quotation marks because Prause did not actually employ a screening instrument for internet pornography addicts, so we have no idea whether some, or any, of her subjects were porn addicts. For Prause’s claims of falsification and the resulting dubious headlines to be legitimate, all of Prause’s 55 subjects would have to have been actual porn addicts. Not some, not most, but every single subject. All signs point to a good number of the 55 Prause subjects being non-addicts

The subjects were recruited from Pocatello Idaho via online advertisements requesting people who were “experiencing problems regulating their viewing of sexual images”. Pocatello Idaho is over 50% Mormon, so many of the subjects may feel that any amount of porn use is a serious problem. In a serious methodological flaw, none of the subjects were screened for porn addiction. In another methodological flaw, the ad limited recruitment to participants who had problems with only “sexual images”. Since most compulsive porn users view streaming video clips, did this skew the participants even further?

Make no mistake, neither Steele et al., 2013 nor Prause et al., 2015 described these 55 subjects as porn addicts or compulsive porn users. The subjects only admitted to feeling “distressed” by their porn use. Confirming the mixed nature of her subjects, Prause admitted in 2013 interview that some of the 55 subjects experienced only minor problems (which means they were not porn addicts):

“This study only included people who reported problems, ranging from relatively minor to overwhelming problems, controlling their viewing of visual sexual stimuli.”

Key point: How can you debunk the porn addiction model if many of your “porn addicts” are not really porn addicts?

The Prause et al. finding aligns perfectly with Kühn & Gallinat (2014), which found that more porn use correlated with less brain activation in heavy users (who were not addicts) when exposed to sexual photos (.530 seconds). Said the researchers:

“This is in line with the hypothesis that intense exposure to pornographic stimuli results in a downregulation of the natural neural response to sexual stimuli.”

Kühn & Gallinat also reported more porn use correlating with less reward circuit grey matter and disruption of the circuits involved with impulse control. In this article researcher Simone Kühn, said:

“That could mean that regular consumption of pornography more or less wears out your reward system.”

Kühn says existing psychological, scientific literature suggests consumers of porn will seek material with novel and more extreme sex games.

“That would fit perfectly the hypothesis that their reward systems need growing stimulation.”

Another EEG study found that greater porn use in women correlated with less brain activation to porn. Put simply, those who use more porn may need greater stimulation for the response level seen in lighter consumers, and photos of vanilla porn are unlikely to register as all that interesting. Less interest, equates to less attention, and lower EEG readings. End of story.

Prause et al., 2015 Concedes That Kühn & Gallinat 2014 May Be Right

In the discussion section, Prause et al., 2015 cited Kühn & Gallinat 2014 and offered it as a possible explanation for the lower LPP pattern. She was on the right track, and it’s too bad her interpretation then took a U-turn from her data. Perhaps Prause’s strong biases against porn addiction shaped her interpretations. Her former Twitter slogan suggests she may lack the impartiality required for scientific research:

“Studying why people choose to engage in sexual behaviors without invoking addiction nonsense”

Incidentally, the still images employed by both Kühn and Prause et al. differed significantly from the 9-second “explicit” video clips used in last year’s Cambridge University fMRI study, which found similarities between porn addicts’ brains and those of drug addicts. Those researchers found greater reward center activity in porn addicts in response to the video clips, which is typical of addicts.

Internet porn studies and their interpretation are complicated by the fact that viewing pornographic images (stills or videos) is the addictive behavior, rather than solely a cue. By comparison, viewing images of vodka bottles is a cue for an alcoholic. While that cue may light up her brain more than a control’s brain, the alcoholic needs greater amounts of alcohol to get a buzz. The heavy porn users in the Kühn and Prause studies clearly needed greater stimulation (videos?) to exhibit their buzz. They didn’t respond normally to mere stills. This is evidence of tolerance (and underlying addiction-related brain changes).

Updates on Nicole Prause’s twitter slogan:

  1. UCLA did not renew Prause’s contract. She hasn’t been affiliated with any university since early 2015.
  2. In October, 2015 Prause’s original Twitter account is permanently suspended for harassment.

In Her 2013 EEG Study and a Blog Post Prause States That LESS Brain Activation Would Indicate Habituation or Addiction

Prause claimed that her 2013 EEG study was the first time EEG readings were recorded for so-called “hypersexuals.” Since this was a “first” Prause admits it’s pure speculation as to whether “hypersexuals” should have higher or lower EEG readings than healthy controls:

“Given that this is the first time ERPs were recorded in hypersexuals, and literature on addiction (higher P300) and impulsivity (lower P300) suggest opposite predictions, the direction of the hypersexual effect was specified mainly on theoretical grounds.” [That is, without much basis at all.]

As explained here Prause’s 2013 EEG study had no control group, so it could not compare “porn addicts'” EEG readings to “non-addicts.” As a result, her 2013 study told us nothing about the EEG readings for either healthy individuals or “hypersexuals.” Let’s continue with Prause’s views from 2013:

“Therefore, individuals with high sexual desire could exhibit large P300 amplitude difference between sexual stimuli and neutral stimuli due to salience and emotional content of the stimuli. Alternatively, little or no P300 amplitude difference could be measured due to habituation to VSS.

In 2013, Prause said that porn addicts, when compared to controls, could exhibit:

  1. higher EEG readings due to cue-reactivity to images, or
  2. lower EEG readings due to habituation to porn (VSS).

Five months before her 2013 EEG study was published, Prause and David Ley teamed up to write this Psychology Today blog post about her upcoming study. In it they claim that “diminished electrical response” would indicate habituation or desensitization:

But, when EEG’s were administered to these individuals, as they viewed erotic stimuli, results were surprising, and not at all consistent with sex addiction theory. If viewing pornography actually was habituating (or desensitizing), like drugs are, then viewing pornography would have a diminished electrical response in the brain. In fact, in these results, there was no such response. Instead, the participants’ overall demonstrated increased electrical brain responses to the erotic imagery they were shown, just like the brains of “normal people”…

So, we have 2013 Prause saying “diminished electrical response” would indicate habituation or desensitization. Now, however, in 2015, when Prause found evidence of desensitization (common in addicts), she is telling us “diminished electrical response” debunks porn addiction. Huh?

In the intervening two years it took Prause to compare her same tired subject data with an actual control group, she has done a complete flip-flop. Now, she claims the evidence of desensitization that she found when she added the control group isn’t evidence of addiction (which she claimed in 2013 it would have been). Instead, once again, she insists she has “disproved addiction.” This is inconsistent and unscientific, and suggests that regardless of opposing findings, she will claim to have “disproven addiction.” In fact, unless 2015 Prause rejects the 2013 Prause study and blog post she would be obliged to “invoke addiction nonsense.”

By the way, the above excerpt –“participants’ overall demonstrated increased electrical brain responses to the erotic imagery” – is misleading. Of course it’s normal to have a greater response to sexual pictures than to neutral landscape pictures. However, Prause’s 2013 study had no control group, and it did not compare EEG readings of porn addicts to non-addicts. Once she added the control group, it was evident that arousal in response to erotic imagery is normal and the effect disappeared. Instead, her subjects turned out to be suffering from desensitization, an addiction process. In short, Prause’s 2013 results were meaningless (see below), while her 2015 headlines contradict everything she had previously stated. She claims to disprove addiction while discovering evidence of it.

Poor Methodology Once Again

1) As with Prause’s 2013 EEG study (Steele et al., 2015), the subjects in this study were males, females and possibly “non-heterosexuals”. All evidence suggests Prause used the same subjects for her current study and her 2013 study: the number of females are identical (13) and the total numbers very close (52 vs. 55). If so, this current study also included 7 “non-heterosexuals”. This matters, because it violates standard procedure for addiction studies, in which researchers select homogeneous subjects in terms of age, gender, orientation, even similar IQ’s (plus a homogeneous control group) in order to avoid distortions caused by such differences. This is especially critical for studies like this one, which measured arousal to sexual images, as research confirms that men and women have significantly different brain responses to sexual images or films (Studies: 1, 2, 3,  4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14). This flaw alone calls into question both of Prause’s EEG studies.

2) Prause’s subjects were not pre-screened. Valid addiction brain studies screen out individuals with pre-existing conditions (depression, OCD, other addictions, etc.). This is the only way responsible researchers can draw conclusions about addiction. See the Cambridge study for an example of proper screening & methodology.

3) The two questionnaires Prause relied upon in both EEG studies to assess “porn addiction” are not validated to screen for internet porn use / addiction. The Sexual Compulsivity Scale (SCS) was created in 1995 to measure sexual behavior to help with AIDS-risk assessment, and specifically not validated for females. The SCS says:

“The scale has been should [shown?] to predict rates of sexual behaviors, numbers of sexual partners, practice of a variety of sexual behaviors, and histories of sexually transmitted diseases.”

Moreover, the SCS’s developer warns that this tool won’t show psychopathology in women,

“Associations between sexual compulsivity scores and other markers of psychopathology showed different patterns for men and women; sexual compulsivity was associated with indexes of psychopathology in men but not in women.”

Like the SCS, the second questionnaire (the CBSOB) has no questions about Internet porn use. It was designed to screen for “hypersexual” subjects, and out-of-control sexual behaviors – not strictly the overuse of sexually explicit materials on the internet.

A valid addiction “brain study” must: 1) have homogenous subjects and controls, 2) screen out other mental disorders and other addictions, and 3) use validated questionnaires and interviews to assure the subjects are actually porn addicts. Prause’s two EEG studies on porn users did none of these, yet she drew vast conclusions and published them widely.

Prause History of Claims Unsupported by The Data

Prause, by her own admission, rejects the concept of porn addiction, and believes that porn use can never cause problems. For example a quote from this recent Martin Daubney article about sex/porn addictions:

“Dr Nicole Prause, principal investigator at the Sexual Psychophysiology and Affective Neuroscience (Span) Laboratory in Los Angeles, calls herself a “professional debunker” of sex addiction.”

Such inherent biases may have lead to several claims by Prause, which do not align with her experimental data.

The first example is her 2013 study “Sexual desire, not hypersexuality, is related to neurophysiological responses elicited by sexual images.” Five months before this study was published, Prause released it (only) to psychologist David Ley, who promptly blogged about it on Psychology Today, claiming that it proved pornography addiction didn’t exist. Such claims were not, in fact, supported by the study when published. The following excerpt is taken from this peer-reviewed critique of the study:

‘The single statistically significant finding says nothing about addiction. Furthermore, this significant finding is a negative correlation between P300 and desire for sex with a partner (r=−0.33), indicating that P300 amplitude is related to lower sexual desire; this directly contradicts the interpretation of P300 as high desire. There are no comparisons to other addict groups. There are no comparisons to control groups. The conclusions drawn by the researchers are a quantum leap from the data, which say nothing about whether people who report trouble regulating their viewing of sexual images have or do not have brain responses similar to cocaine or any other kinds of addicts.’

Just as in the current EEG study, Prause claimed her subjects’ brains did not respond like other addicts. In reality, her subjects had higher EEG (P300) readings when viewing sexual images – which is exactly what occurs when addicts view images related to their addiction. Commenting under the Psychology Today interview with Prause’s claims, senior psychology professor emeritus John A. Johnson said:

“My mind still boggles at the Prause claim that her subjects’ brains did not respond to sexual images like drug addicts’ brains respond to their drug, given that she reports higher P300 readings for the sexual images. Just like addicts who show P300 spikes when presented with their drug of choice. How could she draw a conclusion that is the opposite of the actual results? I think it could be due to her preconceptions–what she expected to find.”

This 2015 review of the neuroscience literature on porn addiction went further

The study was designed to examine the relationship between ERP amplitudes when viewing emotional and sexual images and questionnaire measures of hypersexuality and sexual desire. The authors concluded that the absence of correlations between scores on hypersexuality questionnaires and mean P300 amplitudes when viewing sexual images “fail to provide support for models of pathological hypersexuality” [303] (p. 10). However, the lack of correlations may be better explained by arguable flaws in the methodology. For example, this study used a heterogeneous subject pool (males and females, including 7 non-heterosexuals). Cue-reactivity studies comparing the brain response of addicts to healthy controls require homogenous subjects (same sex, similar ages) to have valid results. Specific to porn addiction studies, it’s well established that males and females differ appreciably in brain and autonomic responses to the identical visual sexual stimuli [304,305,306]. Additionally, two of the screening questionnaires have not been validated for addicted IP users, and the subjects were not screened for other manifestations of addiction or mood disorders.

Moreover, the conclusion listed in the abstract, “Implications for understanding hypersexuality as high desire, rather than disordered, are discussed” [303] (p. 1) seems out of place considering the study’s finding that P300 amplitude was negatively correlated with desire for sex with a partner. As explained in Hilton (2014), this finding “directly contradicts the interpretation of P300 as high desire” [307]. The Hilton analysis further suggests that the absence of a control group and the inability of EEG technology to discriminate between “high sexual desire” and “sexual compulsion” render the Steele et al. findings uninterpretable [307].

Finally, a significant finding of the paper (higher P300 amplitude to sexual images, relative to neutral pictures) is given minimal attention in the discussion section. This is unexpected, as a common finding with substance and internet addicts is an increased P300 amplitude relative to neutral stimuli when exposed to visual cues associated with their addiction [308]. In fact, Voon, et al. [262] devoted a section of their discussion analyzing this prior study’s P300 findings. Voon et al. provided the explanation of importance of P300 not provided in the Steele paper, particularly in regards to established addiction models, concluding,

“Thus, both dACC activity in the present CSB study and P300 activity reported in a previous CSB study[303] may reflect similar underlying processes of attentional capture. Similarly, both studies show a correlation between these measures with enhanced desire. Here we suggest that dACC activity correlates with desire, which may reflect an index of craving, but does not correlate with liking suggestive of on an incentive-salience model of addictions. [262]” (p. 7)

So while these authors [303] claimed that their study refuted the application of the addiction model to CSB, Voon et al. posited that these authors actually provided evidence supporting said model.

Bottom line: Four peer-reviewed papers agree with our analysis of Steele et al: The 2013 EEG study actually reported higher EEG readings (P300) when subjects were exposed to sexual photos. A higher P300 occurs when addicts are exposed to cues (such as images) related to their addiction. However, the study had no control group for comparison, which made the findings uninterpretable (as explained above this current study simply found a control group for the 2013 study). In addition, the study reported greater cue-reactivity for porn correlating to less desire for partnered sex. Put simply: The study found greater brain activation for porn and less desire for sex (but not less desire for masturbation). Not exactly what the headlines claimed about porn increasing “sexual desire.”

Similar to Prause’s current study, her second study from 2013 found significant differences between controls and “porn addicts” – “No Evidence of Emotion Dysregulation in “Hypersexuals” Reporting Their Emotions to a Sexual Film (2013).” As explained in this critique, the title hides the actual findings. In fact, “porn addicts” had less emotional response when compared to controls. This is not surprising as many porn addicts report numbed feelings and emotions. Prause justified the title by saying she expected “greater emotional response”, but provided no citation for her dubious “expectation.” A more accurate title would have been: “Subjects who have difficulty controlling their porn use show less emotional response to sexual films“. This finding aligns with Prause’s current EEG study and Kühn & Gallinat (2014), and indicates desensitization.

In Prause’s 2015 paper, “Viewing sexual stimuli associated with greater sexual responsiveness, not erectile dysfunction“, none of paper’s claims are supported by the data provided in the underlying 4 studies. Two critiques, one by a lay person, and another by a medical doctor (peer-reviewed), describe the papers many discrepancies and dubious claims:

As noted in the above analyses, Prause did not measure sexual responsiveness, erections, or brain activation. Instead, porn users gave a number on a single question self-report of “sexual arousal” after viewing visual sexual stimuli. Those in the 2+ hours per week porn use had slightly higher scores after watching porn. This is what one would expect. This tells us nothing about their sexual arousal without porn or their sexual arousal with a partner. And it says nothing about erectile function. It’s hard to say what the title should be as Prause did not release the relevant data, but it appears that an accurate title might be “More porn use makes men hornier.”

Even more surprising, the scores for the young men (average age 23) in her paper indicated erectile dysfunction. Not only are we given no reason why these young men had ED, we are incorrectly told the men “reported relatively good erectile functioning”. We could go on and on about this paper.

In 2014, she openly teamed up with David Ley – author of The Myth of Sex Addiction, who has no background in the neuroscience of addiction or research – to produce a dubious review on the subject of porn addiction: “The Emperor Has No Clothes: A review of the “Pornography Addiction” model.” It is this review that the authors cite for the astonishing proposition that, “The Internet has [not] increased viewing of visual sexual stimuli.” Once again, virtually nothing in Ley & Prause “review” holds up to scrutiny, as this painfully detailed critique reveals – “The Emperor Has No Clothes: A Fractured Fairytale Posing As A Review.”

In summary, the three Prause studies on porn users align with the Cambridge studies and Kühn & Gallinat (2014).

1) Sexual Desire, not Hypersexuality, is Related to Neurophysiological Responses Elicited by Sexual Images (2013)

  • Aligns with the 3 Cambridge studies: All 4 studies found cue-reactivity to porn, or sensitization. In addition, the Prause study reported less sexual desire for a partner correlating with greater cue-reactivity. In a parallel finding, the first Cambridge study reported that 60% of subjects had difficulty achieving erections/arousal with real partners, yet could achieve erections with porn.

2) No Evidence of Emotion Dysregulation in “Hypersexuals” Reporting Their Emotions to a Sexual Film (2013)

3) Modulation of Late Positive Potentials by Sexual Images in Problem Users and Controls Inconsistent with “Porn Addiction” (2015)

  • Aligns with Kühn & Gallinat (2014) in that more porn use correlated to less brain activation in response to sexual photos.
  • Aligns perfectly with 2013 Prause who said that lower EEG amplitudes (compared to controls) would indicate habituation or desensitization.

Wouldn’t it be great if journalists and bloggers actually read studies, and conferred with addiction neuroscientists, before rubber stamping sexologists’ press releases or sound bites? Bottom line: All brain and neuropsychological studies published to date support the existence of porn addiction, including Prause’s.

END OF ORIGINAL CRITIQUE


Analysis of Prause et al., 2015 excerpted from “Neuroscience of Internet Pornography Addiction: A Review and Update, 2015″:

Another EEG study involving three of the same authors was recently published [309]. Unfortunately, this new study suffered from many of the same methodological issues as the prior one [303]. For example, it used a heterogeneous subject pool, the researchers employed screening questionnaires that have not been validated for pathological internet pornography users, and the subjects were not screened for other manifestations of addiction or mood disorders.

In the new study, Prause et al. compared EEG activity of frequent viewers of Internet pornography with that of controls as they viewed both sexual and neutral images [309]. As expected, the LPP amplitude relative to neutral pictures increased for both groups, although the amplitude increase was smaller for the IPA subjects. Expecting a greater amplitude for frequent viewers of Internet pornography, the authors stated, “This pattern appears different from substance addiction models”.

While greater ERP amplitudes in response to addiction cues relative to neutral pictures is seen in substance addiction studies, the current finding is not unexpected, and aligns with the findings of Kühn and Gallinat [263], who found more use correlated with less brain activation in response to sexual images. In the discussion section, the authors cited Kühn and Gallinat and offered habituation as a valid explanation for the lower LPP pattern. A further explanation offered by Kühn and Gallinat, however, is that intense stimulation may have resulted in neuroplastic changes. Specifically, higher pornography use correlated with lower grey matter volume in the dorsal striatum, a region associated sexual arousal and motivation [265].

It’s important to note that the findings of Prause et al. were in the opposite direction of what they expected [309]. One might expect frequent viewers of Internet pornography and controls to have similar LPP amplitudes in response to brief exposure to sexual images if pathological consumption of Internet pornography had no effect. Instead, the unexpected finding of Prause et al. [309] suggests that frequent viewers of Internet pornography experience habituation to still images. One might logically parallel this to tolerance. In today’s world of high-speed Internet access, it is very likely that frequent consumers of Internet pornography users view sexual films and videos as opposed to still clips. Sexual films produce more physiological and subjective arousal than sexual images [310] and viewing sexual films results in less interest and sexual responsiveness to sexual images [311]. Taken together, the Prause et al., and Kühn and Gallinat studies lead to the reasonable conclusion that frequent viewers of internet pornography require greater visual stimulation to evoke brain responses comparable to healthy controls or moderate porn users.

In addition, the statement of Prause et al. [309] that, “These are the first functional physiological data of persons reporting VSS regulation problems” is problematic because it overlooks research published earlier [262,263]. Moreover, it is critical to note that one of the major challenges in assessing brain responses to cues in Internet pornography addicts is that viewing sexual stimuli is the addictive behavior. In contrast, cue-reactivity studies on cocaine addicts utilize pictures related to cocaine use (white lines on a mirror), rather than having subjects actually ingest cocaine. Since the viewing of sexual images and videos is the addictive behavior, future brain activation studies on Internet pornography users must take caution in both experimental design and interpretation of results. For example, in contrast to the one-second exposure to still images used by Prause et al. [309], Voon et al. chose explicit 9-second video clips in their cue reactivity paradigm to more closely match Internet porn stimuli [262]. Unlike the one-second exposure to still images (Prause et al. [309]), exposure to 9-second video clips evoked greater brain activation in heavy viewers of internet pornography than did one-second exposure to still images. It is further concerning that the authors referenced the Kühn and Gallinat study, released at the same time as the Voon study [262], yet they did not acknowledge the Voon et al. study anywhere in their paper despite its critical relevance.


Neurobiology of Compulsive Sexual Behavior: Emerging Science (2016)

Neuropsychopharmacology 41, 385-386 (January 2016) | doi:10.1038/npp.2015.300

Shane W Kraus 1, 2, Valerie Voon 3, and Marc N Potenza 2, 4

An excerpt lumping together Prause et al., 2015 and Kuhn & Gallinat, 2014 as both reporting the same thing: greater porn use correlating with greater habituation to porn. Both studies reported lower brain activation in response to brief exposure to photos of vanilla porn. “Lower late positive-potential” refers to the EEG findings of Prause et al. 2015

In contrast, studies in healthy individuals suggest a role for enhanced habituation with excessive use of pornography. In healthy men, increased time spent watching pornography correlated with lower left putaminal activity to pornographic pictures (Kühn and Gallinat, 2014). Lower late positive potential activity to pornographic pictures was observed in subjects with problematic pornography use.


 

Nothing Adds Up in Dubious Study: Youthful Subjects’ ED Left Unexplained, by Gabe Deem

Published: 3/12/2015 (link to original article)


MAIN ARTICLE

The following study by Nicole Prause & Jim Pfaus claims to have investigated porn-induced erectile dysfunction: “Viewing Sexual Stimuli Associated with Greater Sexual Responsiveness, Not Erectile Dysfunction.” This would be exciting news, if, in fact, the researchers actually gathered data that is essential to investigate porn-induced ED (PIED). Let me start off by making something clear, that I will explain in further detail below; this study doesn’t, and due to its poor design can’t, tell us anything about whether or not today’s high-speed internet porn leads to erectile dysfunction with a partner.

Why can’t this study tell us anything important about the possibility of PIED? Because of what it doesn’t do, and the many, many flaws in what it claims to have done.

What the study doesn’t do:

1) The study doesn’t investigate men complaining of erectile dysfunction. The study doesn’t examine young men with years of porn use and unexplained ED (that is, men for whom organic, below-the-belt problems have been ruled out). Nor does the study investigate porn-induced ED in such men by having them remove porn use and monitor possible changes. In fact, the researchers didn’t even furnish details for their subjects who revealed they had erectile function problems on the IIEF [erectile-function] questionnaire (later). Yet the authors draw far reaching conclusions about the non-existence of porn-induced ED.

2) The study doesn’t study men with porn addiction, or even “heavy” porn users. Just non-compulsive users. From the study’s conclusion:

“These data did not include hypersexual patients. Results are probably best interpreted as limited to men with normal, regular VSS use.”

Translation: The study did not include “hypersexuals”, which is the authors’ term for “porn addicts”. Excluding hypersexuals is a huge weakness, considering that most men with chronic porn-induced ED self-identify as porn addicts. A small minority of men with porn-induced ED do not appear to be addicted, but they usually have a history of years of porn use.

Not only does this study not examine men with chronic ED, it excludes heavy porn users and porn addicts. Nothing like not looking at something if you don’t want to find evidence of it!

3) The college age subjects were not asked about years of porn use! The subjects, as far as I know, could have started using porn merely weeks before the study, or they could have given up their porn watching ways just before the study was conducted after watching for years. Some could have started at age 10, or started in their sophomore year of college, or they could have just broken up with their girlfriend last month, and are now heavy users.

4) The study doesn’t assess actual erections in relation to hours of use, contrary to what its title implies.

The study claims (more below) that men were asked a single question about how aroused they were after they were shown some porn. As the study said,

“No physiological genital response data were included to support men’s self-reported experience.”

To summarize, this study:

  1. Did not assess individuals complaining of erectile dysfunction
  2. Did not include heavy porn users or porn addicts
  3. Did not assess “sexual response” (contrary to the misleading title)
  4. Did not ask men to attempt masturbation without porn (the way to test for porn-induced ED)
  5. Did not have men remove porn to see if erectile functioning eventually improved (the only way to know it’s porn-induced)
  6. Did not ask about years or porn use, age guys started using porn, type of porn, or escalation of use.
  7. Did not ask about delayed ejaculation or anorgasmia (precursors to PIED)

What the study claims to do (link to study):

The claims are almost irrelevant as this jumbled data-salad is not even a true study with subjects chosen for this investigation. Instead, lead author Prause claims to have cannibalized bits and pieces of four of her older studies to construct this ED “study.” However, those four studies were not about erectile dysfunction, nor did any of them report correlations between porn use and erectile function. Far more egregious is that the collective data from those four studies in no way line up with the data claimed for this ED study. The forthcoming details will have you asking, “How in the world did this mess pass peer-review?”

Before I explore the discrepancies, omissions, and sleights of hand the authors employed, you will need a few basics on the study. Using primarily university psychology students (average age 23), the study claimed to examine the relationship between:

  1. Some subjects’ weekly hours of porn use and self-reported arousal after viewing porn in the lab (based on a single question that did not ask about erections), and
  2. Some subjects’ weekly hours of porn use and some subjects’ scores on the International Index of Erectile Function (IIEF).

The authors’ claims for 1 & 2 above are as follows:

  1. Those who used 2+ hours of porn per week reported a somewhat higher sexual arousal score (6/9) than the two lower categories of porn use (5/9).
  2. No significant correlation was found between moderate porn use and erectile function scores on the IIEF.

I dissect the claims under number 1 and number 2 below. With each claim I hark back to the discrepancies and omissions that I will now detail.

A closer look at the study: Missing subjects, omissions, discrepancies & unsupported claims

1) The starting point: We are told that the subjects and data for this ED study were culled from four other studies, which have already been published:

“Two hundred eighty men participated over four different studies conducted by the first author. These data have been published or are under review [33–36],”

As noted, none of the four studies (study 1, study 2, study 3, study 4) assessed the relationship between porn use and erectile dysfunction. Only one study reported erectile functioning scores, for only 47 men.

2) Number of total subjects: Lead author Prause tweeted several times about the study, letting the world know that 280 subjects were involved, and that they had “no problems at home”. However, the four underlying studies contained only 234 male subjects. While 280 appears once in this study’s Table 1 as the number of subjects reporting “intercourse partners last year”, so do the numbers 262, 257, 212 and 127. Yet, none of these numbers match anything reported in the 4 underlying studies, and only 47 men took the erection questionnaire. Contrary to her tweet, the average score (21.4) for erectile function placed these 47 young men, on average, squarely in the mild ED category. Oops.

Prause tweet Jan, 2015

  • Discrepancy 1: 46 subjects appear out of nowhere in the claim of 280 subjects, while the actual number of subjects (234) is found nowhere in the ED study.
  • Discrepancy 2: Subject numbers in Table 1: 280, 262, 257, 212 and 127 – match nothing from the 4 underlying studies.
  • Unsupported claim: Prause tweets that the study involved 280 subjects.
  • Missing: Any explanation of how Prause conjured the number “280” for her subjects.
  • Unsupported claim 2: Prause tweeted they had no problems, but their erection scores indicate ED on average.

3) Number of subjects who took the IIEF (erectile-function test): The ED study claims that 127 men took the IIEF (pg 11 also says 133). However, only one of the four studies reported IIEF scores, and the number of subjects who took it was 47. Where did Prause get the extra 80 men? She doesn’t explain. This study did not assess the erectile functioning of 280 subjects, nor 234, and not even 127. Again, only 47 subjects took the IIEF.

  • Discrepancy: Study claims that 127 subjects took the IIEF, but it’s really 47.
  • Unsupported claim: Prause tweets that 280 subjects were involved.
  • Missing: Any raw data on the mysterious 127

4) Average IIEF score for 47 subjects same as for the missing 80: As described above, only one study, with 47 men, reported an IIEF score. That study only reported a score for the full 15-question IIEF, not the 6-question “erection subscale” reported in the current study. Wherever it came from, the average score for the 6-question erection subscale was 21.4, and indicates “mild erectile dysfunction”. In addition, the current ED study also claims an average IIEF score of 21.4 for the entire 127. Say what? We know the “accounted for” 47 men averaged 21.4, and the 127 averaged 21.4. This means that the 80 missing men had to also average 21.4. What is the probability that happening?

  • Unbelievable coincidence: The average IIEF scores for the 47 men must be the same as the unaccounted for 80 men.
  • Misleading: The average score (21.4) indicates “mild erectile dysfunction”, while the study claims the men had “relatively good erectile function” (maybe relative to a 70-year old man?).
  • Missing: IIEF scores for erection sub-scale on original study.
  • Missing: The IIEF scores for any subject. No raw data, no scatter plot, no graph.

5) Number of subjects for hours/week porn viewing: The ED study claims to have porn viewing data on 136 men. Instead, only 90 subjects, from 2 studies, report hours viewing per week. Where did the authors conjure up 46 extra subjects? In addition, this study claims to correlate hours of porn viewing per week with the IIEF scores, but 90 men (hrs/week) doesn’t match 47 men (IIEF scores).

  • Discrepancy 1: Study claims hrs/week viewing porn data for 136 subjects, but it’s really 90.
  • Discrepancy 2: Study claims to correlate hrs/week porn viewing with IIEF scores, but 90 doesn’t equal 47
  • Unsupported claim: Prause tweets N=280, but the true N=47.
  • Missing: Hours viewed for the subjects. No raw data, no scatter plot, no graph, no mean or standard deviation.
  • Missing: No legitimate data on the correlation between porn use and hours viewed per week.

6) Sexual arousal ratings: On page 8 the authors state that men rated their sexual arousal after viewing porn on a scale from 1 to 9.

“men were asked to indicate their level of “sexual arousal” ranging from 1 “not at all” to 9 “extremely.”

In reality, only 1 of the 4 underlying studies used a 1 to 9 scale. One used a 0 to 7 scale, one used a 1 to 7 scale, and one study did not report sexual arousal ratings. By the way, the study misleads the press, and readers, by implying in its title that erections were measured in the lab and found to be more “responsive” in association with more porn viewing. This did not happen. At best, the scores imply craving or horniness.

  • Discrepancy: Arousal scales in ED paper don’t match arousal scales in 3 underlying studies.
  • Unsupported claim: This study did not assess “sexual responsiveness” or erectile response.
  • Missing: No raw data or scatter plot for the subjects.

7) Stimulus used for sexual arousal ratings: The authors make a big deal about the sexual arousal ratings being slightly higher for the 2 plus hour/ per week group. Wouldn’t a good study use the same stimulus for all subjects? Of course. But not this study. Three different types of sexual stimuli were used in the 4 underlying studies: Two studies used a 3-minute film, one study used a 20-second film, and one study used still images. It’s well established that films are far more arousing than photos. What’s shocking is that in this study Prause claims all 4 studies used sexual films:

“The VSS presented in the studies were all films.”

Absolutely false! Only 2 studies with 90 men reported scores, and 47 of those men viewed only pictures of naked women, not films.

  • Discrepancy 1: Four different studies, and 3 different types of sexual stimuli...but one graph.
  • Discrepancy 2: In the graph below are 136 subjects, yet only 90 subjects actually reported hours of porn/week in any of the underlying studies.
  • Discrepancy 3: The sexual arousal scale is 1 – 7 in the graph below, yet the study said the scale was 1 – 9 (which was claimed to have been used in 1 of the 4 studies)
  • Unsupported claim: Prause claims all 4 studies used films.

Keep in mind that these porn viewing subjects are the same group as in number 5 above, and in the graph under number 1. Both claim 136 men, but the data says otherwise.

8) No data correlating porn use with IIEF scores: What’s the headline news from this study? The authors claim there was no relationship between erectile functioning scores and hours of porn viewed per week. Big news, but no data. All they offer are a few sentences (pg 11-12) reassuring us that no correlation was found. No data, no graph, no scores, nothing. Only an allusion to the mysterious 127 men, 80 of whom are unaccounted for, discussed in 3 and 4 above. From the study:

“Men (N = 127) reported relatively good erectile functioning (see Table 1). Neither the total scale score, nor the erectile subscale score, on the International Index of Erectile Functioning was related to the hours of VSS viewed in the average week.”

  • Missing 1: Any graph or table showing us a correlation between hours of porn viewed/week and IIEF scores.
  • Missing 2: Raw data. Any data.
  • Discrepancy: They appear to claim 127 subjects, yet only 47 men took the IIEF.
  • Misleading: Claiming the men “reported relatively good erectile functioning”, while the average score (21.4) indicates mild ED.

With absolutely nothing in the 4 underlying studies matching the ED study, and with 80 subjects nowhere to be found, excuse me if I don’t take the authors’ word on the lack of correlation with hours of use. To illustrate this point, the study’s conclusion opens with a string of inaccuracies:

“Data from a large sample of men (N = 280) across similar studies were aggregated to test the hypothesis that consuming more VSS was related to erectile problems.”

In just this one sentence, I can identify a host of unsupported claims:

  • “N = 280”: Nope, only 47 men took the IIEF
  • across similar studies“: Nope, the studies were not similar.
  • were aggregated“: Nothing matches the underlying 4 studies
  • to test the hypothesis“: No data were presented for the authors’ hypothesis.

The entire study is like this, with subjects, numbers, methodologies, and claims appearing from nowhere, and unsupported by the underlying studies.


Let’s look more closely at what the researchers claim to have investigated

 

NUMBER 1: Weekly hours of porn use and self-reported arousal after viewing porn in the lab

The researchers claim to have placed 136 participants in three groups based on weekly porn use (graph below). Discrepancy: Weekly porn use is only reported for 90 subjects in 2 studies.

Bar graph

Men were shown porn in the lab, and the study claimed they rated their arousal using a scale of 1 to 9.

  • Discrepancy 1: Only 1 of the 4 underlying studies used a 1 to 9 scale. One used a 0 to 7 scale, one used a 1 to 7 scale, and one study did not report sexual arousal ratings.
  • Discrepancy 2: Apples and oranges: One study used still images, one a 20 second film, two used a 3 minute video.

The bar graph allowed the authors to avoid plotting arousal scores clearly. Thus, readers cannot contemplate variations in self-reported arousal relative to hours of porn use for themselves. The researchers imply that answering a question about “sexual arousal” is solid evidence of erectile function. In fact, there’s a footnote in one study saying that the researchers ignored questionnaire results on “penile erection” because they presumed that “sexual arousal” would gather the same information. However, that is most definitely not a reasonable assumption for guys with porn-induced erectile dysfunction (who are very aroused by porn but can’t get erections with partners), and it may not be true of participants here either.

Another, more legitimate, way to interpret this arousal difference between the two porn-use groups is probably that men in ‘2+ hours per week’ category experienced slightly greater cravings to use porn. Interestingly, they had less desire for sex with a partner and more desire to masturbate than those who logged .01-2 hours watching porn. (Figure 2 in study). This is quite possibly evidence of sensitization, which is greater reward circuit (brain) activation and craving when exposed to (porn) cues. Sensitization can be a precursor to addiction.

Recently, two Cambridge University studies demonstrated sensitization in compulsive porn users. Participants’ brains were hyper-aroused in response to porn video clips, even though they didn’t “like” some of the sexual stimuli more than control participants. In a dramatic example of how sensitization can affect sexual performance, 60% of the Cambridge subjects reported arousal/erectile problems with partners, but not with porn. From the Cambridge study:

“CSB subjects reported that as a result of excessive use of sexually explicit materials…..they experienced diminished libido or erectile function specifically in physical relationships with women (although not in relationship to the sexually explicit material)”

Put simply, a heavy porn user can experience higher subjective arousal (cravings) yet also experience erection problems with a partner. In short, his arousal in response to porn is not evidence of his “sexual responsiveness”/erectile function.

  • Watching more porn will improve erections??

Astoundingly, the authors of the current study suggest that “VSS viewing might even improve erectile functioning.” Their advice is based on arousal and desire scores (not erectile-function scores). This is the worst advice possible if these “aroused” young men are, in fact, becoming sensitized (addicted) to porn. Their porn viewing arousal would not translate to their erectile function during real sex, which tends to decline in those who develop porn-induced ED as their sensitization to porn grows. Such a decline is precisely what the Cambridge subjects reported.

Certainly, viewing porn might improve erections while viewers watch, but the problem for those reporting porn-induced ED is overwhelmingly erectile function with partners. Moreover, there is no evidence in this study that viewing porn, or, as the authors obligingly suggest, a variety of porn, improves erectile function with partners. If this were correct, I would think the 47 young men tested for erectile function would have reported better boners the more porn they watched. Instead, they reported “mild erectile dysfunction” as a group.

It’s worth noting that the Cambridge researchers addressed both compulsive porn users (CSB) and young men with ED while investigating porn addicts’ brains. The current study missed both aspects, while purporting to investigate ED in young porn users.

NUMBER 2: Weekly hours of porn use and scores on a questionnaire entitled the International Index of Erectile Function (IIEF)

Here’s where things get really ugly. The authors claimed that 127 young men completed a questionnaire called the IIEF, a 15-item survey (not a “19-item survey” as the authors state), in which men score their erectile health, desire and sexual satisfaction during masturbation and, primarily, sexual intercourse. Again, no actual penis responses were measured to confirm these self-reported scores. Discrepancy: only 47 men took the IIEF. Note: they also say on page 11 that 133 men took the IIEF. Does it ever end?

IIEF scores from this study

  • The Unknown 59 (sic)

For a moment let’s imagine we are in a parallel universe, and 127 men actually took the IIEF. The authors stated that only 59 had partners with whom they could observe their current erectile health. This makes the number of partnered subjects whose erectile health was actually investigated quite small. Yet these are the only participants who can help researchers understand current erectile function in relation to porn use. Why? Because, as the authors acknowledge, assessing current erectile function is dependent on the availability of a partner.

  • First, many young guys report a rapid decline in erectile health when they try to have sex with a partner after being on their own (with porn use) for a time. So “erectile function” tests based on remembered erectile function with partners would be of little value.
  • Second, men on recovery forums report that porn-induced ED is overwhelmingly likely to occur during partnered sex (or during masturbation without porn, a statistic the researchers didn’t collect) – not with porn. In fact, some guys have dubbed this phenomenon “copulatory impotence.”

So, why aren’t the partnered men who took the IIEF the only subjects included in this study? And why aren’t their data broken out clearly for readers? The researchers tell us that there was no association between viewing hours and erectile function when the partnered participants “were included in analyses.” However, we learn nothing about those claimed analyses, or how they compare with the others. They’re always lumped into larger, un-sourceable numbers, like 280 or 127. Exit the parallel universe and back to more shenanigans.

  • “Mild erectile dysfunction”

Let’s take another look at the IIEF’s “erectile function” subscale. The chart below shows the questions and scoring. (View entire test and subscale.) Possible scores for this subscale range from 1 to 30. For the men who are claimed to have completed this subscale, the mean (average) score was only 21.4 out of a possible 30. On average, they fell well within the “mild erectile dysfunction” category.

Keep in mind that these sorry erectile function scores were self-reported by 23-year old men, none of whom watched porn compulsively. This suggests internet porn, even consumed in a non-compulsive manner, may be having detrimental effects on youthful erections irrespective of (no) correlation with hours used.

In fact, these young men were well below previously established control group scores for much older men. In 1997, the studies conducted to validate the IIEF reported that erectile-function scores averaged 26.9 (average age 58), and 25.8 (average age 55). In short, older men in 1997 – before internet porn – had healthier erections even in middle age than these 23-year olds.

Unlikely coincidence? How could the 47 subjects who took the IIEF have exactly the same average (21.4) as the 80 ghostly subjects no one can find (21.4)?

Moreover, as 21.4 is the average score (for some, indeterminate N), it means that the scores for some participants were lower than 21.4. In fact, the SD (standard deviation) was large (9.8), so there was a wide range of erectile function scores. It’s likely some fell into the “moderate” and “severe” erectile dysfunction categories. However, we don’t know, because data are not provided – which brings me to…

  • Study graphics

Why didn’t the authors in the current study do what conscientious researchers did in a recent study on porn users’ brains, “Brain Structure and Functional Connectivity Associated With Pornography Consumption: The Brain on Porn,” and plot all their data on a graph like that reproduced below? This allows the reader to see clearly that as pornography consumption rises, grey matter in the brain decreases. Why did the authors of this ED study hide individual data in mean scores and simplistic bar graphs?

Kuhn study scatter plot

  • Weekly Use?

The authors offer no support for their assumption that a correlation with weekly porn use is vital to establishing the existence of porn-induced erectile dysfunction, even though all their claims rest on the lack of correlation with weekly use scores. In 2011, German researchers found that porn-related problems correlate not with time spent, but rather with number of sex applications opened during porn sessions. Thus, the absence of a correlation between weekly hours of porn use and ED issues (let alone correlations with their other questionnaire results) isn’t surprising, as novelty (number of clips, tabs open, etc.) appears to be more important than hours.

Moreover, precisely how were “weekly porn use” scores determined? The researchers do not say. Was it simply, “How much porn did you use last week?” If so, there could be new porn users who haven’t had time to develop erectile problems in the “2+ hours” bin. And long-time users with porn-related problems, who had recently decided to cut out porn, perhaps due to sexual dysfunction symptoms, in the “0 hours” bin, making correlations even more unlikely.

Regardless of how the lead author calculated “weekly use,” the most important data are still missing: total porn use and characteristics of use. Participants weren’t asked about years of porn use or age (developmental stage) they began using. Moreover, the researchers didn’t control for other factors that men on recovery forums often find are related to their performance issues: escalation to more extreme material, lengthy periods without partnered sex, need for novel porn, and masturbation only with internet porn.

Under the circumstances, and given the appalling numerical inconsistencies, a lack of correlations is of dubious significance, and the authors’ dismissal of the phenomenon of porn-induced ED unwarranted.

Sexual conditioning: An idea worth exploring

The researchers correctly point out that:

Erections may become conditioned to aspects of VSS [porn] that do not transition easily to real-life partner situations. Sexual arousal may be conditioned to novel stimuli, including particular sexual images, specific sexual films or even non-sexual images. It is conceivable that experiencing the majority of sexual arousal within the context of VSS may result in a diminished erectile response during partnered sexual interactions. Similarly, young men who view VSS expect that partnered sex will occur with themes similar to what they view in VSS. Accordingly, when high stimulation expectations are not met, partnered sexual stimulation may not produce an erection.

Recognizing this possibility, one wonders why the researchers asked only about weekly hours and didn’t ask their participants questions that would have helped reveal a possible link between their porn viewing and sexual conditioning, such as

  • at what age they began viewing porn videos
  • how many years they had viewed it
  • whether their tastes escalated over time to more extreme fetish porn
  • what percentages of their masturbations took place with and without porn.

If they wanted to find important data on porn-induced ED, they might also have asked the young men with low erectile function scores to masturbate both without porn and with it, and compare their experiences. Men with porn-induced ED generally have great difficulty masturbating without porn because they have conditioned their sexual arousal to screens, voyeurism, fetish content and/or constant novelty. Of course the researchers did not do that, because this wasn’t a study specifically looking at the possibility of porn-induced ED.

Growing cause for concern

Highly regarded urologists have already spoken up about the issue of porn-induced ED, including academic urologists, such as Abraham Morgentaler, MD, Harvard urology professor and author, and Cornell urology professor and author Harry Fisch, MD. Said Morgentaler, “It’s hard to know exactly how many young men are suffering from porn-induced ED. But it’s clear that this is a new phenomenon, and it’s not rare.” Fisch writes bluntly that porn is killing sex. In his book The New Naked, he zeroes in on the decisive element: the internet. It “provided ultra-easy access to something that is fine as an occasional treat but hell for your [sexual] health on a daily basis.”

Interestingly, in the last few years a number of studies have reported unprecedented ED in young males, although none have inquired about internet porn use:

  1. Sexual functioning in military personnel: preliminary estimates and predictors. (2014) ED – 33%
  2. Sexual dysfunctions among young men: prevalence and associated factors. (2012) ED – 30%
  3. Erectile dysfunction among male active component service members, U.S. Armed Forces, 2004-2013. (2014) Annual incidence rates more than doubled between 2004 and 2013
  4. Prevalence and characteristics of sexual functioning among sexually experienced middle to late adolescents. (2014) 16-21 year olds:
  • Erectile Dysfunction – 27%
  • Low sexual desire – 24%
  • Problems with orgasm – 11%

Given that internet porn use is now nearly universal in young men, we should be slow to dismiss internet porn use as a potential cause of today’s widespread youthful erectile dysfunction without a very thorough scientific investigation of subjects complaining of it. And slow as well to assume the authors are correct in their surmise that widespread youthful ED is due to “concerns about the partner’s STD status, relationship expectations, and concerns about one’s own attractiveness or penis size.” Those factors have presumably been around for a much longer time than internet porn, and the spike in youthful ED problems is quite recent.

Most importantly, those concerns do not apply to guys who are unable to masturbate without porn, as they aren’t worried about any of those concerns with their own hand.

While it is vital to publish all analyses about the subject of porn-induced sexual dysfunction that are based on solid research, this particular analysis raises a thicket of red flags. Today’s youthful porn users deserve better.

The Bogus Sex Addiction “Controversy” and the Purveyors of Ignorance, by Linda Hatch, PhD

I still sometimes read a newspaper.  Today’s LA Times had the absolutely best article I have seen in years.  It is called “Sowing Doubt About Science” by Michael Hiltzik.

Agnotology, the study of the production of ignorance

The Hiltzik article reports on the work of Robert Proctor, a history of science professor at Stanford specializing in what is called “Agnotology”, the study of the cultural production of ignorance.  This is the investigation of the deliberate sowing of public misinformation and doubt in a scientific area.  I of course saw an immediate application to what I have been calling the “sex addiction deniers”.

Agnotology studies projects such as the tobacco industry’s campaign to cast doubt on the link between smoking and disease.  Hiltzik quotes from an internal tobacco industry memo of 1969 which boldly stated “Doubt is our product.”  Meaning that the goal is not to contribute real evidence but to cast doubt on the existing evidence and create a bogus controversy in which the media then publish both “sides” of the issue as though they had equal weight.

Hiltzik cites other examples of agnotological projects including that of the sugar industry, the vaccination opponents (who rely on ‘a single dishonest and thoroughly discredited British paper’) and climate change deniers. In all of these, bogus doubts have proved extremely hard to dispel.

Sex addiction deniers and their misinformation

The attempt to “scientifically” prove that sex addiction does not exist is relatively new but the deniers of  sex addiction have been around for a long time.  In my previous post on sex addiction deniers I attempted to place them in the historical perspective in which a new phenomenon such as alcoholism is seen initially as a moral failing or a social evil.  Thus any attempt to medicalize the problem is threatening to these deniers because it portends a slippery slope in which people can avoid moral responsibility on the grounds of addiction.  But the traditional sex addiction deniers also come from the opposite direction, namely those who are afraid that identifying something as a sexual problem could result in a kind of morality police, curtailing their own legitimate sexual freedoms.

But more recently a study published by sex researchers at UCLA claimed to have scientific evidence that sex addiction was not an addiction.  This study was criticized up one side and down the other; but still it was a study.  Wasn’t it?

The decline of scientific credibility

The Hiltzik article quotes Norman Wise, a historian of science at UCLA as saying that “The question is the degree to which the commercialization of academic science is increasing public doubt and destroying the public good at the university and at places like the CDC (Centers for Disease Control) such that they no longer look distinctly different from the tobacco industry or Big Pharma.”

So those who have analyzed the UCLA “findings” challenging the whole concept of sex addiction make it clear that as Dr. Donald Hilton concludes:

“To trivialize, minimize, and de-pathologize compulsive sexuality is to fail to understand the central biological role of sexuality in human motivation and evolution. It demonstrates a naiveté with regard to what is now an accepted understanding of current reward neuroscience, in that it pronounces sexual desire as inherent, immutable, and uniquely immune from the possibility of change either qualitatively or quantitatively.”

The earmarks of commercially manufactured ignorance

The earmarks of bogus science in all other fields seem to me to be much the same as those in the recent attempts to prove that sex addiction doesn’t “exist”.

  • They are usually not attempts to prove that something exists (like the Higgs particle) but to prove that something doesn’t exist (like the holocaust).  In general the denials, like the UCLA study on sex addiction, make unjustified assertions that something is not the case.  They make an unproven claim which is sensationalistic but does not really offer much except a denial of connections that are just coming to be understood.
  • Misinformation often plays to fear.  It can be the fear that something is going to harm you (like a vaccination) or the fear of a conspiracy to take something away from you (like cigarettes or sugar).  In the denial of sex addiction there is a kind of conspiracy theory that treatment professionals are out to label you as an addict so that they can make money by curing you.  This was particularly evident in the posting on the website of the UCLA researchers which purported to advise those wrongly labeled as sex addicts of their legal rights.
  • Sowing doubt and promoting a phony controversy is self-serving in some way.  This is obvious in the case of big tobacco and big pharma.  In the case of the anti sex addiction zealots it is apparent that the highly publicized denial of something can easily become a cottage industry.  The claim “Study proves sex addiction doesn’t exist!” gets a lot of attention.  It not only creates a bogus controversy.  Books are written which gain notoriety and research careers are built and supported based in part on the celebrity status conferred on the “denier”.

Hiltzik talks of the “torrent of misinformation washing about the public space”.  A better educated public seems to be the only possible answer.  Hiltzik’s cites one note of hope from Professor Proctor who says: “There is opportunity to expose these things through good journalism, good pedagogy, good scholarship.  You need an educated populace.”

Find Dr. Hatch on Facebook at Sex Addictions Counseling or Twitter @SAResource and at www.sexaddictionscounseling.com 

Rethinking Ogas and Gaddam’s ‘A Billion Wicked Thoughts’

Does Internet porn reveal our sexual desires—or alter them?
 
Fellow “Psychology Today” blogger Leon F. Seltzer recently completed a herculean 12-part blog series on the subject of the Internet and human sexual desire (based on Ogi Ogas and Sai Gaddam’s A Billion Wicked Thoughts, 2011). In his final segment, he did an excellent job of outlining the risks associated with Internet porn use.

However, I hope he will take another look at Ogas and Gaddam’s assumptions and analysis in light of the perils of today’s Internet porn. Specifically, I hope he will reconsider whether A Billion Wicked Thoughts actually delivers what he suggests it does, namely, the “unvarnished truth of [our] sexual preferences and desires.”

It’s quite possible that A Billion Wicked Thoughts delivers something quite different: a snapshot of a moving target of millions of users’ random sexual tastes, many of whom are heavily under the influence of a neurobiological process that Ogas and Gaddam have not considered. That process is tolerance, a physiological process common to brains as they slip into addiction—whereby the user becomes increasingly numb to pleasure (desensitized) and therefore seeks more and more stimulation.

For example, some users search for one video for a few minutes a few times a week. Analyzing their results might yield some meaningful data about porn tastes across the population. Other users open 10+ tabs on a couple of screens and edge to video after video, primarily in search of novelty because the dopamine squirts from novelty produce a drug-like effect in the brain. Obviously, this group will be contributing disproportionately to the search statistics. Moreover, as we’ll see in a moment, their tastes often quickly morph as they pursue novelty any way they can. This limits the value of their data when analyzing fundamental sexual desires across all users.

In other words, the lion’s share of searches could well be coming from a disproportionately small number of users, and yet neither Ogas and Gaddam nor their readers seem to recognize this. The authors’ attempt to draw far-reaching conclusions from the content of such searches is like analyzing a client’s psychological make-up based on whether he became addicted to drugs via sniffing or shooting up. Incidentally, it’s the novelty seekers who have the most serious problems from their porn use according to German researchers. This is consistent with the suggestion that addiction-related brain changes are at work in their brains.

No one knows how many of today’s users are driven by tolerance, but it’s likely the percentage is large enough that Ogas and Gaddam’s data do not, in fact, reveal deep, meaningful patterns about human sexual desire.

I’m grateful to Seltzer for initiating this dialog. Ever since Wicked Thoughts came out, I’ve had reservations about its assumptions. My reply will be divided into two parts. This part addresses the tolerance issue. A subsequent post addresses the Wicked Thoughts’ underlying assumption; namely, that sexual tastes are immutable.

Desensitization and morphing porn tastes

In his book on brain plasticity, The Brain That Changes Itself, psychiatrist Norman Doidge pointed out that,

“Pornography seems, at first glance, to be a purely instinctual matter: sexually explicit pictures trigger instinctual responses, which are the product of millions of years of evolution. But if that were true, pornography would be unchanging. The same triggers, bodily parts and their proportions, that appealed to our ancestors would excite us. This is what pornographers would have us believe, for they claim they are battling sexual repression, taboo, and fear and that their goal is to liberate the natural, pent-up sexual instincts.

But in fact the content of pornography is a dynamic phenomenon that perfectly illustrates the progress of an acquired taste. … The plastic influence of pornography on adults can … be profound, and those who use it have no sense of the extent to which their brains are reshaped by it.

[I have] treated or assessed a number of men who all had essentially the same story. Each had acquired a taste for a kind of pornography that, to a greater or lesser degree, troubled or even disgusted him, had a disturbing effect on the pattern of his sexual excitement, and ultimately affected his relationships and sexual potency. …

When pornographers boast that they are pushing the envelope by introducing new, harder themes, what they don’t say is that they must, because their customers are building up a tolerance to the content. (emphasis added)”

Thus, a heterosexual male might start with nude stills of a favorite movie star. Then, as his brain stops responding to those, he “progresses” to videos of solo sex, vanilla sex, lesbian action, insertions, gang bangs, transexual porn, gay porn, gross porn (however he defines that) and even minor porn. Gay porn users and female porn users report the same phenomenon, with progressions that are equally unsettling to them. A gay man shared this experience under an earlier post:

“I believe I was born gay, my first fantasies were about men and men have always aroused me, whereas women have aroused me very little. I became addicted to internet porn in my late teens. Gay sex to me is very normal and natural. Yet I lost interest in it over time. I became interested in straight porn and found myself increasingly losing interest in the male anatomy and developing a fetish for female genitalia. I had no attraction to it before my porn viewing became excessive. New genres gradually replaced old ones in sexual appeal. To my shock, I started to think that I could potentially be bisexual, so I arranged a meeting with a female escort to test out this possibility.
However, I did not experience much arousal and the situation felt wrong to me. It was completely different to porn.

I decided to stop watching pornography, and after being porn-free for quite some time I can happily say my fetish for women has gone. Gay sex has returned to the norm for me. I can also add that during my porn escalation, transexual porn never became arousing to me in the slightest, despite the fact pre-operative transwomen have a penis. It would be like asking a straight man if he would have sex with a man that had a vagina, which I have to add is something that did appeal to me at one time.”

It’s evident that this type of porn-related progression has little to do with users uncovering their “deepest urges and most uninhibited thoughts” (Ogas and Gaddam’s words). The targets are moving too fast. Rare users even recognize the process while it’s unfolding:

“Porn binges for 4-6 hours the last couple days. On the plus side, it did become more obvious that the transsexual porn is unrelated to my sexuality. After spending 30+ hours over the past 5 days watching porn, transsexual porn started to become boring! I began searching for other more disgusting and shocking stuff.”

So what’s actually going on? Let’s start by distinguishing desensitization from habituation. Satiety (habituation) and a desire for novelty are built right into the mammalian brain and are not pathological. You can’t eat another bite of turkey (satiety), but you feel palpable enthusiasm for pumpkin pie (dopamine released for novel, high-calorie food). The process repeats itself the next day. Obviously, this natural process can leave porn users somewhat vulnerable to overconsuming novel erotica simply because novelty registers as “yes!”

Desensitization, in contrast, is a pathology arising from continued overconsumption. Measurable, physical brain changes (declines in D2 nerve cell receptors) indicate an addiction is in process. Unlike the transitory effects of habituation, desensitization takes time to reverse, in part because it is tied to other stubborn addiction-related brain changes.

Novelty = dopamine

In the case of Internet porn users, the appeal of overconsumption is that it allows the user to override his innate satiety-recovery window. Instead of waiting for his sexual appetite to return naturally he can click to enough stimulation to produce a rush of excitory neurochemicals (such as dopamine and norepinephrine). He achieves arousal that would otherwise be impossible, or more difficult.

Now, his brain perceives all porn that gets him aroused, regardless of content, as valuable because it releases “go get it” neurochemicals. Again, all he needs is novel, shocking material, whether or not it matches his fundamental sexual inclinations. The fallacy in Wicked Thoughts is that only our fundamental tastes can release enough dopamine in our brains to motivate porn use. Nothing could be farther from the truth. Dopamine is dopamine, however you trigger it.

The ScreamThus, escalation to bizarre porn is meaningful primarily because it is a major warning sign of addiction, not because it tells porn addicts (or anyone else) useful information about their innate sexual desires. The deeper one’s addiction, the more desperate the need for this neurochemical relief, in part because normal pleasures are growing less satisfying and cravings more intense.

Worse yet, if a porn user climaxes to something that is not consistent with his underlying sexual orientation and fundamental inclinations, but it releases enough dopamine and norepinephrine in his brain (because it is exciting or even anxiety-producing), his brain will also wire the new stimulus up to his reward circuitry. The next time he encounters any cues related to it, he will find it mysteriously arousing—and today’s therapists will often swiftly assure him he has discovered valuable information about his “deepest urges.” Not so.

Of course, some porn users get their novelty fix by viewing new porn within their preferred genre (i.e., the genre that reflects their fundamental sexual desires). However, many of today’s porn users report that their sexual tastes morph all over the place as their brains grow desensitized. That said, porn addiction dynamics may be somewhat different in men and women.

One-way street?

Those on the escalation treadmill are often horrified to discover that they can no longer climax to their former tastes. Sadly, the more distressing (to them) their new porn choices, the more compelling those choices can become, due to the excitory neurochemicals released by their anxiety about what they’re watching.

Seldom do they figure out that their brain’s desensitization would naturally reverse itself—thereby restoring their dopamine receptors and their responsiveness to their earlier tastes. Why? They dare not cease masturbating even for a few weeks, in part because when they try to stop their libido may drop off alarmingly and they don’t realize it’s a temporary effect of restoring their brains to balance. The word on the street is, “use it or lose it,” and since many are already losing their mojo due to overconsumption, they’re terrified to stop.

In short, the issue for these users is not freedom to pursue their deep desires, but rather alien tastes, which are primarily the product of avoidable neurochemical changes inadvertently brought on by the users themselves. 

It’s happening in part because of superficial analysis that is, frankly, dangerously misleading, not to mention potentially distressing, for porn users caught on this slippery slope:

  1. It wrongly implies that they have no control over their changing tastes.
  2. It misdirects their attention away from the scientific information about the neuroscience of addiction, which they need to understand their circumstances and steer for the results they want.
  3. It encourages them to ignore, or accept and pursue, their escalating tastes as healthy, when they are, for many of today’s users, symptoms of a well established disease process: behavioral addiction.

“Normalizing” addiction

Seltzer writes:

“One of the most helpful things that A Billion Wicked Thoughts accomplishes is normalizing many sexual preferences that to this point may have struck you (and maybe most people) as deviant. Obviously, the more widespread a predilection, the more difficult it is to simply dismiss it as “sick”—especially if there are psychological and biological causes that convincingly explain it.”

What if some of these so-called ‘deviant’ tastes are solely due to addiction and tolerance (the need for stronger stimulation)? If enough people experience evidence of a pathology it may become the norm, but it doesn’t mean their behavior isn’t “sick.”

Addiction epidemics have occurred before in humanity’s history and they did not make the symptoms the addicts suffered “normal” in the sense of “free of pathology.” For example, in the mid-18th century, parts of inner London suffered the world’s first mass epidemic of alcoholism. And in The Compass of Pleasure David Linden recounts a mass addiction to inhaling cheap ether in Ireland in the 1880s.

In the case of Internet porn, is it wise to assume that all we need to know is whether tastes are “normal” or “deviant”basing our answer on statistics rather than physiology? Are we even framing the right question if we ignore the possibility that morphing porn tastes could be driven by a numbed reward circuitry in pursuit of a neurochemical buzz regardless of content?

Reversing engines: evidence that porn tastes are not innate

Most tellingly, users who stop all Internet porn and allow their brains to return to normal sensitivity generally discover that they weren’t on a one-way street after all. Their porn tastes slowly begin to reverse themselves—curiously, in reverse order—all the way back to their earliest tastes. For example, real sex with their partners often becomes arousing (again).

The process is not easy. It generally entails nasty withdrawal symptoms, annoying flashbacks, and often a long period of “libido flatline.” But, for many, it completely restores their true sexual desires, which their porn use no longer reflected. Said one man:

“I used to get turned on by anything remotely feminine when I was 13, but that steadily changed as I watched more and more porn. I started to get anxious about my sexuality because I knew I was straight based on history, but at the same time I could not physically respond to the old cues. Sometimes when I was especially relaxed or drunk, I would respond as I did when younger. It was very confusing because I never had any homosexual fantasies or desires. Giving up masturbation to porn has completely eliminated any doubt, because now my libido is almost too much to handle. I’m more responsive to women, and responded to more by women.”

Superficial analysis harms

The assumptions of Ogas and Gaddam rest on the mistaken conviction that all sexual tastes are unchanging and that no matter how porn is delivered to our brains, our tastes will conform to our innate, unchanging proclivities.

Given that chronic overstimulation via Internet porn is transforming viewers’ sexual tastes, the Ogas and Gaddam snapshot offers little genuine insight into human desire. The most useful application of their data might be to serve as a comparison with similar data from another era, so that the dynamic process of escalation can be measured across the population over time, and the data’s true significance better understood.

The study of human desire will remain superficial and of little use to humans until experts integrate and teach the public how the brain works, how it learns, and how addictions can distort sexual tastes due to desensitization/tolerance.

In my next post I’ll address the key assumption that underlies Ogas and Gaddam’s work, namely, the claim that our sexual tastes are immutable.

‘A Billion Wicked Thoughts’ Is Only A Snapshot: Longitudinal studies are needed to reveal morphing porn tastes

Longitudinal studies are needed to reveal morphing porn tastes 
This post is a response to The Truth about 50 Shades of Grey and Futanari Porn by Ogi Ogas, Ph.D.

We’d like to begin our response to your above post by clarifying some points that you have misunderstood in our post.

1. You’ve completely missed the main concept of our post

As a consequence, most of what you’ve written has nothing to do with our primary point: Porn tastes that have morphed as the consequence of addiction-related brain changes tell us little about such users’ fundamental sexual tastes. Unless research tracks the Internet porn tastes of individual users over years, it cannot possibly refute the point we made in our post. Yours did not.

Addiction-related brain changes occur over time. For example, most of the men whose self-reports we analyze are in their twenties and they have been using porn for 8-12 years.

The 3-month histories you analyzed could not have revealed the phenomenon our post addressed because short histories wouldn’t be sufficient to pick up the kinds of changing tastes users are reporting. Therefore, those who rely on your analysis are not considering an important potential confound: escalation to new genres due to addiction-related brain changes.

Just to clarify, we did not suggest that most men look at lots of different genres in a single session (although some do, as you point out). Our point is that many porn users’ tastes no longer represent their fundamental sexual inclinations.

We don’t doubt that when porn users open a lot of tabs during a session, those tabs are generally related to their fetish-du-jour. However, in our view you should be hesitant to conclude that porn tastes are therefore stable over time.

Incidentally, most all porn searches are a search for novelty. If this weren’t so, users would continue to watch their carefully bookmarked/archived favorites. Many men report compiling massive porn collections…and never watching them because the lure of novelty is so strong. Heavy web-cam use is a perfect example of a novelty fix—although we would point out that the men are still interacting with screens, not people.

Keep in mind that when addiction takes hold of an Internet porn user there are two different ways to escalate: 1) viewing more of one’s preferred genre and 2) viewing novel genres. Seeking (searching), novelty and surprise all release dopamine, quite apart from the dopamine released in response to  erotic themes.

2. You place too much faith in outdated research

You mention the abundant research supporting your conclusions that tastes are unchanging. Has any of it investigated highspeed Internet porn users? We track the research in this area and haven’t seen anything current enough to be relevant, given that the Internet is proving addictive (for some users) in a way that porn of the past was not. (Relevant Internet addiction studies are collected here. Some include porn use.) More important, have you seen any research that follows Internet porn users’ sexual tastes over time?

You are right that we endorse Norman Doidge MD’s view that tolerance is playing a role in today’s porn use. His clients’ experience accords perfectly with self-reports from across the Web. It’s tragic that researchers have been so overconfident of the concept that “sexual tastes are immutable (at least in men)” that they haven’t yet uncovered the dynamic we and Doidge have observed.

However, if you’d like to undertake the necessary research, we’d be happy to refer you to forums across the Web in many countries where men are reporting this morphing-tastes phenomenon with alarming regularity. This research will, however, require questionnaires and analysis free of biased preconceptions.

In fact, reddit/nofap produced a member survey, which found that over 60% of its members’ sexual tastes underwent significant escalation, through multiple porn genres.

Q: Did your tatstes in pornography change?

  • My tastes did not change significantly – 29%
  • My tastes became increasingly extreme or deviant and this caused me to feel shame or stress – 36%
  • My tastes became increasingly extreme or deviant and this did not cause me to feel shame or stress – 27%

3. Snapshots have serious limitations where supernormal stimulation is involved

Your discussion of women is merely another snapshot. Again, we’re not writing about who seeks novelty within a session, or even within a short period. We are talking about an addiction process called tolerance, which occurs over time as the consequence of related brain changes.

The slippery slope of addiction-related tolerance is related to down-regulation of dopamine signaling in the brain and a search for more stimulation. It’s not surprising that women also seek their fixes. Nor is surprising that they prefer a different mix of stimulation. Some have already reported that their porn use has desensitized them too.

Your snapshot model doesn’t explain what many men describe: The inability to get off to one’s current porn genre and the need to move to something unfamiliar to climax…rinse and repeat. Your book simply denies that it can happen—and yet it is happening. As far as we know, only the brain plasticity model explains this now familiar pattern.

You dismiss the concept of desensitization, but research has already shown that it occurs in Internet addicts. See Reduced Striatal Dopamine D2 Receptors in People With Internet Addiction and Reduced Striatal Dopamine Transporters in People with Internet Addiction Disorder Please see this post for other addiction-related brain changes found in Internet addicts: Recent Internet Addiction Studies Include Porn.

4. You have mischaracterized our mindset

We were surprised to read your spin implying that our post was based on moralizing or calling any particular porn “deviant.” That was Seltzer’s word. Our point was that porn tastes, which are morphing due to an addiction process, are a symptom of a pathology—whether vanilla, chocolate or strawberry. After all, the nucleus accumbens registers neurochemical impact, not content.

We know it’s fun to believe you are defending sexual freedom from ‘evil moralizers,’ but lest any readers be misled by your words, here’s that section of our post:

Seltzer writes:

“One of the most helpful things that A Billion Wicked Thoughts accomplishes is normalizing many sexual preferences that to this point may have struck you (and maybe most people) as deviant. Obviously, the more widespread a predilection, the more difficult it is to simply dismiss it as “sick”—especially if there are psychological and biological causes that convincingly explain it.”

What if some of these so-called ‘deviant’ tastes are solely due to addiction and tolerance (the need for stronger stimulation)? If enough people experience evidence of a pathology [escalation] it may become the norm, but it doesn’t mean their behavior isn’t “sick.” [addiction-related]

Addiction epidemics have occurred before in humanity’s history and they did not make the symptoms the addicts suffered “normal” in the sense of “free of pathology.”Not one word of our post was judging particular content. Only the symptom of tolerance was under discussion in this section.

Could you clarify what “moralistic ideas about addiction” might be? We often check our posts with leading addiction experts, and neither we nor they are motivated by a desire to moralize as far as we know.

You also say we lump all erotica together and say it “inevitably provokes a dangerous ‘escalation to bizarre porn.'” This mischaracterizes what we’ve written in our post. The phrase ‘escalation to bizarre porn’ clearly referred to porn addicts, not all porn users. Escalation is a function of brain changes whether someone is overconsuming vanilla or fetish erotica.

Not all brains experience addiction-related brain changes, of course, and this should have been evident from our post. We do stand by our suggestion that for those slipping into addiction, escalation to bizarre porn is most likely a symptom of a pathology rather than an indication of underlying sexual tastes.

We do agree that, prior to highspeed, men’s sexual tastes were more fixed than women’s. We believe that the right research will reveal that Internet porn has weakened that assumption, at least where porn tastes are concerned.

Let’s get to the bottom of the extreme symptoms users are now reporting

Your ‘snapshot’ research could not have revealed the phenomenon we’re pointing to. However, it’s also likely that it was not as widespread back in 2006 when you gathered your data. Only in the last five years have we been hearing self-reports of the severe symptoms we write about: sexual performance problems, morphing sexual tastes, uncharacteristic social anxiety, lack of attraction to 3-D potential mates, and so forth.

It appears that these symptoms are associated with duration of highspeed access and how early in life someone starts using it. We think it wise to warn those, like Seltzer, who rely on your analysis, that your analysis may insufficient for today’s porn users and their caregivers.

If we’re right, then it behooves all of us to stop bickering about the fine points of research that is now six years out of date and did not address the possibility that tolerance might be at work, and start researching the truly alarming symptoms now being widely reported and their fundamental cause.

A good place to begin is with a thorough understanding of the implications of recent addiction neuroscience on the effects of today’s increasingly potent delivery of cyber stimulation. The real issue here may have little to do with erotica and everything to do with novelty-at-a-click. Here’s a user’s own historical account of the remarkable dynamic of Internet porn. It just appeared today.

“Pornography” [was once] little more than Playboy, maybe some softcore stuff on cable access, but for the majority of boys the only way to get that excitement [was] to pause your VCR at JUST THE RIGHT TIME (remember that?? Holy sh*t!! Just thought of it while typing this). Pornography – after a very important Supreme Court ruling – [was] totally protected by the First Amendment, unless it [was]  rape or kiddie porn or something. Now, you have people who hate porn, but take the “I don’t like what you say but I’ll defend to the death your right to say it” mentality, seeing any attempt to infringe pornography as “Un-American”/regressive/repressive/reactionary. Hell, even feminists [begin] to say that porn can be empowering for women (and even the pornstars).

However, nobody thinks ahead to the mid to late 2000’s, when Johnny and Lisa can access every disgusting fetish and -philia in High Definition in a nanosecond with high speed internet access (Oh man… remember waiting like 5 minutes for a single PICTURE to download in the late 90’s??? Damn, writing this is taking me BACK!). Hell, today most MIDDLE SCHOOLERS can access every sick twisted fetish that has ever existed in seconds with a device that they can fit in their f-ing pocket.

A lot of “good” intentions gone wrong. Principles that exist in a vacuum don’t always make sense in the real world, and technology changes things.

Drumroll: An Academic Journal For Porn Fans

Journal of Awesome Studies - spoof coverAcademia prepares to ‘accentuate the positive’ in new porn periodical

If there were ever a human phenomenon in need of serious objective investigation, Internet porn use is surely it. Never has the youthful human brain been battered with so much erotic novelty during such a critical window of sexual development, and cracks are definitely appearing. However, judging from the board of the upcoming Porn Studies Journal, this particular publication will lack the detachment and expertise to fulfill this critical role.
According to HuffPo:

The journal, which is being published by Routledge starting in 2014, will welcome submissions from fields as diverse as criminology, sociology, labor studies and media studies. According to the New York Times, Porn Studies will focus on pornography as it relates to “the intersection of sexuality, gender, race, class, age and ability.” This is definitely XXX-content for the scholarly set.

There is nothing in the list of proposed topics about the adverse effects of Internet porn on users. In fact, all of the 32 board members for the new journal appear to think porn’s benefits far outweigh its costs.

Imagine a “Dietetics Studies Journal” in the Land of the Obese, whose board consists only of the Chairman of the Board of PepsiCo, the CEOs of Nestle and Pillsbury, and a marketing exec from Kraft, and you have a good feel for the bias of the upcoming journal.

23 of the total 32 board members specialize in media and film studies, which suggests that a better name for the journal would be Porn Film Today. None have extensive background in physiology, neuroscience, adolescent development or addiction. Indeed, a mere 3 of the 32 have PhDs in psychology.

Worse yet, none appear to have any clinical experience with the kinds of issues today’s porn can cause—with the exception of Marty Klein, darling of the Adult Video Network. AVN honored Klein with his own porn star page to show its gratitude.

It should. Klein has repeatedly emphasized porn’s harmlessness. See, for example, his post, Fourteen Ways to Observe Pornography Awareness Week. One of the 14 is, “Memorize this fact: using porn does NOT cause brain damage, erectile dysfunction, or loss of sexual interest in one’s mate.” Brain damage is a red herring — although addiction-related brain changes can be stubborn to reverse. Many self-reports of users, however, document porn-related ED and loss of attraction to real partners (as well as reversal of these symptoms after giving up porn use).

A closer look at the editors and editorial board

The new journal’s board is overwhelmingly composed of artists and theorists who think Internet porn is the greatest thing since the invention of “talkies.” Here’s a sprinkling of the talent the new journal will tap, beginning with its editors, Smith and Attwood.

  • Clarissa Smith – In a recent “Intelligence Squared” debate, Smith, representing the pro-porn side, announced that “Pornography is good for us.”
  • Fiona Attwood and Clarissa Smith were co-authors of a survey of people who “use and enjoy porn.” Alas, the press then predictably glosses over such limitations, misleading readers that an objective study has concluded that “porn is great.”
  • Australian board member Kath Albury, did her own dodgy survey with fellow board member Alan McKee in 2008, funded in part by actual pornography businesses. “The authors claim that the harm of pornography is negligible and is, in any case, outweighed by the expressed pleasure of its users.
  • Alan McKee – “Pornography is actually good for you in many ways.”
  • Violet Blue – Blue says you should think of erotica as a tool in a woman’s sexual arsenal. “It can be as reliable as a woman’s vibrator.” (Link not included: NSFW.)
  • Meg Barker  – “Most of my research has been conducted within sexual communities, focusing on bisexuality, BDSM, and open non-monogamy.”
  • Tristan Taormino – Pornographic film maker and actress, creator of “Rough Sex #2” and “House of Ass,” among others.

Expect this bunch to churn out the erotic equivalent of food studies entitled, “The Life-Enhancing Aspects of Deep-Fried Banana Splits.” Why? Because the Porn Studies Journal board members have made it their mission to accentuate the positive and eliminate the negative, just like the old song advised.

Who is not on the board?

Although many porn users across the web are complaining of severe symptoms from overconsumption of Internet porn, including escalation to extreme material, withdrawal misery, delayed ejaculation and erectile dysfunction, there’s not one behavioral-addiction specialist or urologist among the new journal’s dozens of colorful board members. In fact, it seems likely that this board is so focused on what’s going on between our legs that they will have little use for gathering data on porn’s effects between our ears.

The New York Times announced the new journal in its “Arts” section. However Internet porn that’s wreaking the most havoc today is not about culture, the niceties of erotic film making, or anything that happened before high-speed. It’s about delivery of unending novelty and screens—not sex. It’s about free porn tube sites, that is, multiple open tabs of 3-minute clips of the most explosive segments of countless hi-def videos. It’s about escalation to increasingly taboo (in the user’s view) porn.
Above all, it’s about the effects of this kind of unparalleled brain-training on adolescent brains, and related problems. These including unaccustomed social anxiety, concentration and motivation problems, widespread youthful sexual performance problems and consequent problems using condoms.

Listen for these dubious talking points

One thing is for sure: A journal whose editors will not ask questions that would uncover the symptoms of addiction or sexual conditioning certainly will not find evidence of either. Indeed, judging from the talking points we hear repeatedly from folks on the Porn Studies Journal board, you can expect them to largely ignore the unsettling phenomena in the preceding paragraph in favor of the following distractions:

  1. Lots of porn is made by amateurs (or at least made to appear that it is made by amateurs), so we can all disregard the tube-site, gonzo-porn phenomenon.
  2. Becoming dependent upon a screen to become aroused is every bit as much “healthy sex” as is human erotic interaction.
  3. Sexual minorities can only learn how to have sex by watching Internet porn, so porn access for kids is vital. (However, Austrian film maker Gregor Schmidinger is asking whether early Internet porn use is leading to weak erections among some gay users.)
  4. The rise in popularity of so-called ‘Mummy Porn‘, including books such as the Fifty Shades of Grey trilogy, is a step forward for humankind.
  5. Telling kids that there is “good porn” and “bad porn” will head off any problems for youthful porn users, a proposal Marty Klein refers to by the euphemism porn literacy.

Basically, this journal seems poised to tell us what we already know: Porn users like porn (at least until it causes life-wrecking symptoms).” If academics survey fraternity parties and yell, “Anyone here like beer?” We hypothesize that the collective response will be an overpowering “Hell yes!” But would such a survey tell us anything about the benefits or harms of binge drinking?

Petition to journal’s publisher

If you would like Routledge (the publisher of the new journal) to instate a more objective board, or, in the alternative, change the new journal’s title to something more accurate, you can sign this petition.
The petition’s creators say,

“It is imperative that a journal titled Porn Studies creates space for critical analyses of porn from diverse and divergent perspectives. Our hope is that you will change the composition of the editorial board, confirm the journal’s commitment to a heterogeneous interrogation of the issues embedded in porn and porn culture, and ensure that diverse perspectives are represented – on the board and also in the essays published in the journal. Failing that, we ask that you change the name to reflect and make evident the bias of its editors (Pro-Porn Studies) and create another journal … (for instance, Critical Porn Studies).”

UK article about new journal