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The Potential Associations of Pornography Use with Sexual Dysfunctions: an Integrative Literature Review of Observational Studies

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The Potential Associations of Pornography Use with Sexual Dysfunctions: an Integrative Literature Review of Observational Studies Journal of Clinical Medicine Review The Potential Associations of Pornography Use with Sexual Dysfunctions: An Integrative Literature Review of Observational Studies Aleksandra Diana Dwulit and Piotr Rzymski * Department of Environmental Medicine, Poznan University of Medical Sciences, 60-806 Poznan, Poland * Correspondence: [email protected]; Tel.: +48-61854-7604 Received: 30 May 2019; Accepted: 24 June 2019; Published: 26 June 2019 Abstract: This paper reviews the associations between pornography use and sexual dysfunction based on evidence from observational studies. The existing data in this regard mostly derive from cross-sectional investigations and case reports. There is little if no evidence that pornography use may induce delayed ejaculation and erectile dysfunction, although longitudinal studies that control for confounding variables are required for a full assessment. The associations between pornography use and sexual desire may differ between women and men although the existing data is contradictory and causal relationships cannot be established. The strongest evidence is available for the relation of pornography use with decreased sexual satisfaction, although the results of prospective studies are inconsistent. The paper outlines future research prospects beneficial in understanding the nature of associations between pornography use and sexual dysfunctions in men and women. Keywords: pornography; sexual dysfunction; erectile dysfunction; delayed ejaculation; sexual desire; sexual satisfaction 1. Introduction The existing literature provides a number of varying descriptions of the term pornography. According to the Final Report of the Attorney General’s Commission on Pornography, it can be defined as any material that is predominantly sexually explicit and intended primarily for the purpose of sexual arousal [1]. Currently, pornography represents an important economic venture [2,3]. Its greatest development has occurred along with the emergence of computer technologies and the expansion of the Internet [4,5]. Due to a high sense of anonymity and almost unrestricted access, the Internet has become the most important medium of dissemination of pornographic content (known as online pornography), particularly in the form of images and videos [6,7]. The ease, arousal strength, and diversity with which pornography can be reached online indicates that it may operate as a supernormal stimulus [8]. According to various epidemiological studies, a relatively large number of adults have been exposed to pornography [9–12]. Recent representative surveys demonstrate that in developed countries with unrestricted Internet access, such as the United States and Australia, the majority of men (64–70%) and approx. one quarter/third (23–33%) of women are using pornography [13,14]. However, the number of pornography users is also relatively high in developing countries—recent surveys have shown that over half of students in Ethiopia and Bangladesh have been exposed to it [11,15]. The extensive use of pornography is also supported by data provided by Pornhub, one of the largest online pornographic websites, which clearly indicate that it is primarily men that are associated with content of this type (74%), and that the number of visitors to pornographic sites is growing from year to year (Figure1). Some men deal with pornography on a regular, daily basis [ 16]. At the same time, the J. Clin. Med. 2019, 8, 914; doi:10.3390/jcm8070914 www.mdpi.com/journal/jcm J. Clin. Med. 2019, 8, x FOR PEER REVIEW 2 of 17 J. Clin. 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