Sexual Behaviors and Violence in Pornography: Systematic Review and Narrative Synthesis of Video Content Analyses
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JOURNAL OF MEDICAL INTERNET RESEARCH Carrotte et al Review Sexual Behaviors and Violence in Pornography: Systematic Review and Narrative Synthesis of Video Content Analyses Elise R Carrotte1, BPsych (Hons), MPsych; Angela C Davis1,2, PhD, BA (Hons); Megan SC Lim1,2,3, PhD, BBiomedSci (Hons) 1Burnet Institute, Melbourne, Australia 2Monash University, Melbourne, Australia 3University of Melbourne, Melbourne, Australia Corresponding Author: Megan SC Lim, PhD, BBiomedSci (Hons) Burnet Institute 85 Commercial Rd Melbourne, 3004 Australia Phone: 61 0385062403 Email: [email protected] Abstract Background: Owing to increasing access to Web-based pornography and concerns about its impact on viewers, many researchers have attempted to systematically analyze the content of pornography. Objective: We aimed to systematically review the results of quantitative content analyses of video-based pornography and identify the degree to which the following behaviors are depicted: (1) sexual behaviors and themes, (2) condom use during sexual behaviors, and (3) aggression and violence. Methods: Inclusion criteria for article eligibility were (1) peer-reviewed publications, (2) articles in the English language, (3) articles describing a quantitative content analysis of video pornography, and (4) articles quantitatively examining at least one variable of interest. Results: A total of 23 studies met the eligibility criteria. Studies varied in scope and definitions of behavioral variables. Condom use was rare, although more commonly depicted in gay male pornography (36%-64% videos) compared with heterosexual pornography (2%-3% videos). Normative sexual behaviors were most frequently depicted in pornography samples (eg, vaginal intercourse in 48%-90% and fellatio in 52%-90% of heterosexual videos; fellatio in 66%-100% and anal intercourse in 70%-80% of gay male videos). Extreme acts of violence (1%-3% videos) and rape (0%-6% videos) were relatively rare. However, more subtle forms of aggression, such as spanking (5%-75% videos), were more common, and unequal sexual relations (eg, domination) were also common. Although estimates varied by study, dominating and violent behaviors were nearly always directed toward women. Conclusions: Condom nonuse and gender inequalities are common in pornography, which has implications for the development of healthy sexual relationships among pornography viewers. Higher quality research, including study replication and consistent methodological choices, is needed. (J Med Internet Res 2020;22(5):e16702) doi: 10.2196/16702 KEYWORDS pornography; content analysis; sexual media; sexual violence; sexual behavior have periodically emerged over history as social and sexual Introduction norms shift. For example, some earlier concerns related to the Background controversy of depicting nudity and sexual acts in an uncensored manner, whereas more recently concerns in some areas have Pornography, in various forms, has existed throughout human shifted to ªextremeº or ªhard-coreº violence and its impact on history. Different concerns about the content of pornography https://www.jmir.org/2020/5/e16702 J Med Internet Res 2020 | vol. 22 | iss. 5 | e16702 | p. 1 (page number not for citation purposes) XSL·FO RenderX JOURNAL OF MEDICAL INTERNET RESEARCH Carrotte et al the viewer. These concerns have driven studies of pornographic been associated with stronger attitudes supporting violence content and informed their analytical framework. against women [15]. In the internet age, pornography use is more popular and In response to these arguments, several studies have attempted accessible than ever before; for example, in one survey of young to quantify what pornography depicts in order to determine the people aged 15 to 29 years, 100% of young men and 81% of messages viewers may be internalizing. These content analyses, young women had ever viewed pornography [1]. With which aim to be systematic and replicable analyses of media consideration of its nearly ubiquitous nature, pornography is [16], have ranged in scope, methodology, and complexity. This argued to influence the sexual socialization of its viewers, means that there are various results which can inform policy, impacting upon beliefs of what is normal and desirable in sexual but also risk being misinterpreted. For example, one content contexts [2]. Young people have reported that viewing analytic study [17] reported that 88% of pornographic scenes pornography can allow exploration and education around depicted physical aggression in their analysis; this statistic is sexuality via exposure to new and appealing behaviors [3,4]. frequently used in articles and opinion pieces arguing that Regardless, it is most likely that pornography's effect on the pornography is violent and harmful [18,19]. However, other viewer, be it positive or negative, are at least partially impacted studies have found much smaller estimates of physical violence, by the types of behaviors that they are viewing [2]. such as 13% of internet videos [20] or 1% of video and DVD scenes [21]. This relates to differences in sampling methodology Research has found links between pornography use and potential (eg, sampling ªpopularº pornography, subgenres, or different harms. For example, a large body of research indicates that mediums) and issues with behavioral definitions (eg, only coding pornography use is associated with greater unsafe sexual aggressive acts that researchers interpret as being nonconsensual practices and more sexual partners [5,6], and condomless sex [22]). Therefore, there is a need to systematically synthesize among men who have sex with men [7]. Around half of men content analyses of pornography to provide more accurate who have sex with men have reported perceptions that estimates of behaviors depicted in pornography. pornography has contributed to their engagement in ªriskierº sexual behaviors, while over 90% have fantasized about Objectives engaging in similar acts to those seen in pornography [7]. Young This systematic review aimed to review and synthesize the people have reported a perception that pornography impacts results of content analysis study designs that quantitatively their sexual relationships, including influencing their analyzed content of video-based pornography. The outcomes understandings of what is normal and desirable, leading to measured were the frequency with which the following types pressure from partners to perform certain acts (eg, young women of behaviors are depicted: (1) sexual behaviors and themes, (2) have reported feeling pressured to engage in anal intercourse condom use, and (3) aggression and violence. with their male partners [8]). Many individuals have expressed concerns that with the rise of Methods the internet, pornography is becoming more extreme as well as more accessible. Estimates indicate that while 18% of Study Design adolescents have been exposed to affection-themed pornography, This systematic review was conducted in accordance with 18% have been exposed to pornography with themes of Cochrane methodologies [23]. Methods and results are presented dominance, and 10% have been exposed to violent pornography, in accordance with the Preferred Reporting Items for Systematic with exposure to more extreme genres increasing with age [9]. Reviews and Meta-Analyses statement [24]. A protocol was With consideration of the abundance of free pornography developed by the authors prior to the study to guide the search currently available, pornography producers have described a and data extraction; this protocol has not been published. competitive climate in which films must show increasingly extreme or niche acts across multiple mediums in order to stand Eligibility Criteria out from other pornography films and appeal to as many sexual Inclusion criteria for article eligibility were (1) peer-reviewed desires as possible [10]. In qualitative research, young people publication in an academic journal; (2) English language; (3) have described acts that some people would describe as described a quantitative content analysis of video pornography, degrading or violent as being common and normalized in and (4) quantitatively examined at least one variable of interest pornography, such as ejaculating on women's faces and (Table 1). A quantitative content analysis was understood to be apparently nonconsensual bondage, dominance, and an analysis ªwhich involves the creation and use of sadomasochism (BDSM) [11,12]. Frequency of pornography pre-determined categories for the purpose of understanding and use and the number of pornography genres viewed have both describing media messages in a way that can be counted and been associated with higher sexual preferences for types of quantifiedº [25]. Quantitative content analyses were chosen sexual practices presented in pornography [6]. Of particular over qualitative or narrative approaches as they are the most concern, a recent meta-analysis has found that using common type of content analysis and the use of systematic pornography is associated with increased sexual aggression for categories allows relatively easy comparison [25]. Video both men and women, with stronger associations for verbal than pornography is understood here as video-based material physical aggression [13]. The relationship between sexual containing the explicit display of sexual organs or activity, aggression perpetration and intentional exposure to pornographic intended to stimulate sexual excitement, thereby eliminating material appear to be stronger