School of Nursing
Online Journal

Pornography and Youth: What effects does excess pornography consumption have on mental or sexual health outcomes in youth?

Benjamin Rowley

Introduction

New Zealand children are being born into a society with free and easy access to the seemingly infinite world of the internet. This raises the question of what effects this may have on our youth who could be influenced by what they are exposed to online. A growing public health concern is that internet pornography may influence young people’s understanding of which sexual behaviours are normal and acceptable as there is now easy access to an unrestricted range of freely available sexually explicit content online (Wright, Sun, Steffen & Tokunaga, as cited in Lim, Agius, Carrotte, Vella & Hellard, 2017). A study of 941 young Australians found 100% of young men and 82% of young women had viewed pornography with 84% of men found to be viewing on a weekly basis (Lim et al., 2017). With use of internet pornography becoming more socially acceptable and normalised, it is important to develop an understanding of the systemic impacts of porn use on the development of youth, as this age group is considered to be most susceptible to sexually explicit content (Owens, Behun, Manning & Reid, 2012).

Opinions on the harms of porn are divided and debates around the subject are controversial and highly emotive (Bryant, 2010). Literature reviews have found multiple studies demonstrating associations between viewing pornography and a range of problems such as poor sexual functioning or increased negative emotions such as guilt or loneliness. Other studies have found positive associations such as increased quality of life and improved sexual functioning (Albright; Baltazar et al.; Doring; Manning; Twohigh et al.; Yoder et al.; as cited in Levin, Lillis & Hayes, 2012).

As of 2012, 85% of New Zealanders aged 15 to 24 had internet access at home and thus access to pornography (Stats NZ, 2012). A recent review of sexual education in New Zealand found that pornography was discussed alongside sexual education in fewer than half of secondary schools across the country (Education Review Office, 2018). Any findings on the potential risks of internet pornography use could easily be applied to youth in New Zealand.

PECOT

Utilisation of the PECOT model led to the formation of the following clinical question: What effects does excess pornography consumption have on mental or sexual health outcomes in youth? Breaking down this question into specific key words with assistance from the PECOT model allowed a thorough research of the available literature to be undertaken in an attempt to answer this question (Schneider, Whitehead, LoBiondo-Wood & Haber, 2013). The aim of this essay is to conduct a literature review to answer this question and then provide recommendations as to how nurses may be able to address these findings in their own practice around mental and sexual health.

Mental Health

From a review of the available literature, several studies were found demonstrating associations between pornography use and poor mental health outcomes. It was found in a cross-sectional study of 157 undergraduate college males that viewing pornography was significantly related with depression, anxiety, stress and poor social functioning (Levin et al., 2012). A longitudinal study looking at pornography consumption and psychomatic and depressive symptoms in Swedish adolescents also found links between porn use and depression, but a causal link remains unknown (Mattebo, Tydén, Häggström-Nordin, Nilsson & Larsson, 2018). Correlations between problematic internet pornography use and anxiety were found once again in a study looking into clinician’s beliefs, observations and treatment effectiveness regarding sexual addiction and internet pornography. It was again unclear on whether problematic pornography use leads to anxiety or if anxiety leads to problematic porn use or if it is that they both correspond with a third unknown variable (Short, Wetterneck, Bistricky, Shutter & Chase, 2016).

Links have been found between pornography consumption and poor mental health outcomes, but researchers are unsure if it is pornography causing poor mental health outcomes or whether individuals use pornography to cope with already manifested psychosocial problems. This appeared to be a common theme throughout the research. A study conducted by Doornwaard, van den Eijnden, Baams, Vanwesenbeeck and ter Bogt (2016) of 331 Dutch boys suggests that both psychological well-being factors and sexual interests contribute to the development of compulsive internet pornography. Again, it may not be pornography causing poor mental health outcomes, but instead poor mental health leading to increased use of pornography. Levin et al. (2012) states that “Although frequent viewing tends to be associated with psychosocial problems in general, the relationship is complex and other factors may be key to understanding when viewing becomes problematic.” (p. 176).

Those who view pornography for the purpose of escaping life’s stressors may encounter a harmful pattern of use whereas the frequency of the viewing is not an issue, but the function of viewing is. Commonly reported reasons for viewing pornography include viewing to manage one’s self-esteem or to reduce stress (Baltazar et al.; Cooper, Galbreath & Becker; Paul & Shim, as cited in Levin et al., 2012). Levin et al. (2012) explains that engaging in viewing to cope with such problems may paradoxically increase negative emotions. Viewing could turn into a negatively reinforcing habit as it provides temporary relief despite negative consequences. A cyclical relationship between pornography consumption and psychosocial issues could then develop (Levin et al., 2012).

It may be that there are specific sub-types of users at risk for developing problematic pornography viewing traits. At-risk subtypes may consist of individuals who demonstrate poor psychological well-being and tend to engage in online sexual activities in response to anxious or depressive emotions (Doornwaard et al., 2016). This at risk population may experience feelings of depression and diminished self-esteem as they experience adverse consequences of their use which could lead to additional use to cope with such emotions. Similar to what was mentioned in other studies, these at-risk individuals may find that poor psychological well-being and compulsive porn use may reinforce each other over time (Cooper et al., as cited in Doornwaard et al., 2016).

One study found participants reporting pornography use as having a positive influence on their well-being. A Canadian study utilizing an explorative qualitative approach to understand young Canadian’s perspectives of pornography use found that many users felt pornography had benefited them as it had provided them with an inclusive, non-judgemental and safe environment to explore their sexuality (Hare, Gahagan, Jackson & Steenbeek, 2014). They felt their sexual interests were normalised due to the wide range of pornography categories available online which led them to feeling more confident about expressing their sexuality to others. Women in the study reported feeling less guilty about wanting to engage in sexual activity (Hare et al., 2014). Participants reported using pornography to de-stress and mentioned that it provided an alternative to engaging in sexual activities with real human counterparts which is a process which can involve social judgement and rejection (Hare et al., 2014). A few participants did report that extensive pornography use became problematic due to the time wasted as well as the physical and mental exertion it required. Significant portions of their life could be spent using pornography which they felt could hinder their progress in achieving a balanced life and relationships with others (Hare et al., 2014).

There appears to be substantial evidence demonstrating associations between pornography use and poor mental health outcomes but there is also evidence showing some people find benefits from use. It may be that occasional pornography use could bring benefits to some users while there may also be at risk users who find that viewing pornography may exacerbate already present mental health problems. These at-risk users may descend into a harmful pattern of compulsive use to cope with negative emotions. Other factors and variables need to be accounted for in these studies to assist in determining causality between pornography and mental health problems (Doornwaard et al., 2016; Hare et al., 2014; Levin et al., 2012; Short et al., 2016).

Sexual Health

Another concern regarding use of pornography is that it may encourage unsafe sexual practices as pornography usually depicts behaviours that are of high risk to sexual health. It was found that only 2-3% of heterosexual encounters in online pornography involved condom use (Gorman, Monk-Turner & Fish; Vannier, Currie & O’Sullivan, as cited in Lim et al., 2017). A study conducted on young Australians use of pornography concluded that viewing pornography was not associated with differences in sexual risk behaviour. They did discover that pornography use was associated with sex at a younger age and that among women, those who viewed porn frequently were more likely to have ever had anal sex (Lim et al., 2017). This could still be considered as a risky sexual behaviour as penetrative anal sex has a higher risk of spreading STIs compared to other sexual activities (NHS, n.d.). These findings support the idea that young people may be using porn to guide their real life sexual experiences (Svedin, Åkerman & Priebe; Rothman, Kaczmarsky, Burke, Jansen & Baughman, as cited in Lim et al., 2017). A study on the perceptions of pornography as sexual information using an English sample found those who perceived pornography as a source of sexual information and were not in a monogamous relationship were more likely to engage in condomless sex. This may be because perceiving pornography as a source of sexual information increases the likelihood of using pornography as a referent for real-life sexual experiences thus viewers would be more likely to not use condoms as they are rarely used in pornography (Wright, Miezan, Sun & Steffen, 2019). Efforts to increase condom use to prevent the spread of STIs may be jeopardised by the pornography industry which commonly promotes unsafe sexual practices which users often end up incorporating into their own sexual experiences (Tydén & Rogala, 2004).

There was a common finding of sexual dysfunctions being associated with pornography use among the research available. A review of literature by Park et al. (2016) found several studies demonstrating associations between pornography use and sexual performance problems such as difficulty orgasming, diminished libido or erectile function and decreased enjoyment of sexual intimacy. ED has traditionally been viewed as a condition of older age and is associated with factors such as smoking, alcoholism and obesity. Park et al. (2016) discovered that this was no longer true. In 2001-2002, before online pornography sites were widely available, rates for erectile dysfunction in older men aged 40 to 80 in Europe were around 13%. By 2011, after the introduction of online pornography streaming websites, ED rates in Europeans aged 18 to 40 ranged from 14 to 28%. Many of the contributing factors mentioned above in men with ED under 40 were absent. A 2014 Canadian study also found 53.5% of males aged 16 to 21 had symptoms indicative of a sexual dysfunction (Nicolosi et al.; Landripet & Štulhofer; O’Sullivan, Brotto, Byers, Majerovich & Wuest, as cited in Park et al., 2016). An Italian study of 1565 male high-school students demonstrated further evidence of pornography use being associated with sexual dysfunctions as it was found that among moderate users of pornography (less than once a week), 14% had some form of sexual dysfunction. This rose to 25.1% among regular consumers (more than once a week) (Pizzol, Bertoldo & Foresta, 2016).

Other research found that high exposure to pornography can result in an increased need for more extreme or specialised material to achieve similar levels of arousal gained from softer material. This suggests that internet pornography may be responsible for a number of sexual difficulties in males due to conditioned expectations within pornography that are not met in sexual activity with a real-life partner. When a user conditions their sexual arousal to pornography, sex with real partners may register as not meeting expectations leading to decreased sexual arousal (Janssen & Bancroft as cited in Park et al., 2016). The review of literature by Park et al. (2016) concludes that men viewing large amounts of pornography are more likely to rely on pornography to remain sexually aroused and may prefer it to intimate sexual relations with real-life partners. They are also more likely to integrate pornographic ideas into their own sexual experiences.

The above studies suggest that pornography consumption is associated with adverse effects on sexual functioning and may pose a risk to sexual health. Many users become reliant on pornography for sexual satisfaction and end up preferring it over their real-life partners. Users may find themselves implementing acts they have seen through pornography into their real-life sexual experiences which can include no condom use or anal sex which are both risk factors for transmission of STIs (Lim et al., 2016; Park et al., 2016; Pizzol et al., 2016; Wright et al., 2019).

Implications for Nursing & Recommendations

• 1. Sexual Education

The findings from the literature review have large implications for sexual education moving forward. It is important that we begin to develop a deeper understanding of the systemic impacts that exposure to pornography has on the development of young people so that we can begin to inform health policies and develop improved sexual education programmes in response to the normalisation and increased use of such material (Lim et al., 2017; Owens et al., 2012). Education must be given early as if youth are exposed to pornography before receiving objective sexual education, this may negatively affect their first sexual experiences. All findings from the literature review illustrate the importance of providing youth with factual information about sexuality to counter the messages presented in pornography (Wallmyr & Wellin, 2006). Pornography should be included in discussions about sexual education to ensure youth are informed on the differences between fictional sexual fantasy and real-world sexual relationships (Baams et al.; Grudzen et al., as cited in Wright et al., 2019). Approaching sexual education from a social, cultural and health perspective may be necessary to directing youth towards safe and responsible use of sexually explicit material and would assist them in making healthier decisions regarding their sexual health (Pizzol et al., 2016). Nurses would play an important role in providing appropriate sexual education to youth by utilising these strategies and could advocate for changes to be made to New Zealand’s current sexual health education curriculum.

• 2. Screening Tools and Treatment Protocols

As there is evidence to say that there may be a distinguished population of at risk users, health professionals need to be able to identify those most at risk to developing compulsive viewing habits so that early interventions can be implemented. Development of screening and treatment protocols that meet individual needs of at risk users and a knowledge of risk factors contributing to problematic viewing can increase awareness among health professionals. Open discussion about problematic use of pornography may lead to earlier detection of at risk individuals (Doornwaard et al., 2016). Problematic viewing also needs to be conceptualised because current research does not well define what problematic viewing may present as (Levin et al., 2012).

Acknowledging individual’s differences when it comes to their perspectives and feelings around pornography use is crucial. Treating youth as a homogenous group could mean the specificity of ways in which pornography consumption can influence sexual health will be lost (Hare et al., 2014). Counselling and discussion around pornography need to be adjusted and individualised to help shape sexual health interventions which accommodate to everyone (Mattebo et al., 2018).

• 3. Further Longitudinal and Qualitative Research

Multiple studies recommend that further longitudinal studies should be completed to investigate the causality of associations between pornography use and sexual and mental health (Doornwaard et al., 2016; Levin et al., 2012; Lim et al., 2017; Mattebo et al., 2018). For example, an intervention study in which subjects remove the variable of pornography would help better establish whether pornography is a causative factor for sexual dysfunctions (Park et al., 2016). It is also thought that more qualitative or person-centred studies could be completed to offer richer data sources which provide more information on the perspective of users. Nurses would be able to greatly contribute towards further research and discussion of this topic and any findings would support the healthy development of youth while reducing the risk potential for negative effects related to pornography consumption (Doornwaard et al., 2016; Owens et al., 2012).

Conclusion

Limited longitudinal research on pornography consumption means a definitive causal relationship between pornography and poor mental or sexual health outcomes cannot yet be identified. However, there is evidence from what is available which shows at least some association between the variables which should call for further research and action on the topic. It is clear that a small population of individuals are experiencing problems such as anxiety, low self-esteem, erectile dysfunction and decreased sexual satisfaction alongside regular pornography consumption. As the rate, manner and type of exposure to sexually explicit material has changed from the pre-internet generation, there becomes a need for further research on the long-term outcomes of viewing pornography (Owens et al., 2012). There is a need for a remodelling of the way sexual education is delivered to youth to account for the change’s technology has brought upon society. Pornography clearly plays an important part in the development of young people’s sexuality therefore it is essential that discussion around pornography is included in sexual education curriculum. Effective screening and treatment protocols should also be developed to assist those who are suffering from problematic viewing. Registered nurses will be able to contribute towards this area with their extensive knowledge of health promotion and ability to conduct research. They will be able to provide education and advocate for and participate in further research and awareness around this emerging problem.

References

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