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The impact of pornography on gender-based

violence, sexual health and well-being: What
do we know?

Article in Journal of epidemiology and community health · May 2015

DOI: 10.1136/jech-2015-205453 · Source: PubMed


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3 authors, including:

Megan S C Lim Elise Carrotte

Burnet Institute SANE Australia


Some of the authors of this publication are also working on these related projects:

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JECH Online First, published on May 28, 2015 as 10.1136/jech-2015-205453

The impact of pornography on commonly in pornography; a content ana-

lysis found that 28% of scenes include sex
between three or more people.12 The
gender-based violence, sexual health increasing popularity of heterosexual anal

and well-being: what do we know? sex, which many women report disliking,
has also been attributed anecdotally to its
depiction in pornography where it fea-
Megan S C Lim,1,2 Elise R Carrotte,1 Margaret E Hellard1,2 tures in 15–42% of scenes.10–12 17
Importantly all of these behaviours are
associated with increased risk of STIs.
INTRODUCTION people at greater risk of the negative The current state of evidence is limited
As Internet access and literacy increases, effects of viewing pornography (if they to correlation and does not demonstrate a
pornography has become highly access- exist) than older adults? In this paper, we causal relationship where viewing porn
ible, cheap and diverse. Online pornog- explore the most commonly cited con- leads to an increase in sexual risk behav-
raphy use is common in the USA, with cerns over online pornography by provid- iour. Existing studies have significant lim-
nearly 9 out of 10 men and 1 out of 3 ing evidence, if available, to support or itations in being unable to determine
women aged 18–26 reporting accessing refute these concerns. causality; many have major study design
pornography online.1 In June 2013, legal flaws, including lack of a control group
pornographic websites received more SEXUAL RISK BEHAVIOUR for comparison, lack of longitudinal
UK-based traffic than social networks, Studies have described young people follow-up to determine temporality of
shopping, news and media, email, finance, incorporating ideas inspired by pornog- exposures and behaviours and limited
gaming and travel websites.2 For example, raphy into their real-life sexual experi- ability to control for confounding factors.
popular pornography website ‘pornhub’ ences.5–9 By itself, this need not be Different studies are difficult to compare
received 79 billion video views in 2014.3 problematic. If, however, online pornog- due to inconsistent measurements and
Increased access to pornography online raphy is the primary source of a young definitions of pornography. Studies have
has been accompanied by rising concerns person’s sexual education, and they do also tended to use non-representative
that it negatively impacts health and well- not recognise that pornography is fantasy samples (eg, convenience samples of uni-
being, particularly with regard to young and not designed to be educational, then versity students), and as a consequence
people. These concerns include that it may be giving unhealthy educational have low external validity.15 Therefore,
viewing any sexually explicit material messages. Given the lack of standardised the direction of the relationship is not
erodes morals and that specific types of and quality formal sexual education in certain; while pornography may influence
pornography, such as that depicting vio- most countries, this is a real concern. behaviour, sexual experience may also
lence against women, leads to increased Only 2–3% of heterosexual pornography influence pornography viewing and both
violence against women in real life. Even online includes any condom use.10–12 sets of behaviours may be strongly driven
in the case of non-violent pornography, Condom use was shown to be more by other common factors such as sensa-
there is anxiety that people view pornog- common in pornography depicting men tion seeking and age of sexual maturity.18
raphy as ‘real’ rather than fantasy and that having sex with men (MSM), with one
this negatively influences attitudes and study reporting condom use in 78% of acts VIOLENCE AND GENDER
real-life sexual behaviour, particularly of anal sex.12 Non-use of condoms in Between 37% and 88% of mainstream
when people’s sexual experience is sexual intercourse is a key factor in HIV pornographic scenes include acts of phys-
limited such as in adolescence.4 Other and sexually transmitted infections (STIs) ical aggression (mostly gagging and spank-
concerns include the scarcity of condom risk. Importantly, several studies demon- ing), most commonly towards female
use in pornography (both for diminishing strate that viewing unprotected anal inter- actors with the scene usually suggesting
condom use as a social norm and for the course is negatively associated with condom that the recipient was a willing partici-
risks to the health of performers), impacts use among MSM; researchers have mea- pant.19 20 Women are also more likely
on body image (including trends in pubic sured a correlation between the proportion than men to be depicted as submissive
hair removal and labiaplasty), and the of pornography featuring sex without during sex and as exploited or manipu-
harms of pornography addiction. condoms and the likelihood of engaging in lated into sexual activity.10 20
Despite the myriad of fears about unprotected anal intercourse.13 14 The evi- Despite copious research into the phe-
online pornography, questions remain dence among heterosexuals is both limited nomenon over many decades, the direct
over its actual harm. Do viewers really and inconsistent.15 The near absence of evidence for how viewing violent pornog-
imitate pornography in their own lives condoms from heterosexual pornography raphy impacts on gender-based violence is
and does this negatively influence their makes it difficult to demonstrate such a inconclusive. Experimental studies which
health and well-being? Does watching vio- relationship. involve exposing men to violent pornog-
lence in pornography lead to misogyny Research on the relationships between raphy have demonstrated an increase in
and gender-based violence? Are young pornography consumption and other sexual aggression;21 however, the artifici-
sexual behaviours continues, and the ality of the experimental setting limits the
majority show some significant correla- validity of these findings in real-world
Centre for Population Health, Burnet Institute, tions. Increased pornography viewing has situations. A meta-analysis of non-
Melbourne, Victoria, Australia; 2School of Population been associated with younger sexual experimental studies revealed a significant
Health and Preventive Medicine, Monash University,
Melbourne, Victoria, Australia debut, higher numbers of partners and association between pornography use
Correspondence to Dr Megan S C Lim, Centre for
casual sex partners.9 15 16 Certain sexual ( particularly of violent pornography) and
Population Health, Burnet Institute, 85 Commercial Rd, risk behaviours that are not widely attitudes supporting violence against
Melbourne, VIC 3004, Australia; practised among heterosexuals occur women.22 This association cannot be
Lim MSC, et al. J Epidemiol Community Health Month 2015 Vol 0 No 0 1
Copyright Article author (or their employer) 2015. Produced by BMJ Publishing Group Ltd under licence.

interpreted as causation, however, as men to date has primarily relied on subjective including systematic review, longitudinal
with a disposition towards violence assessments. Watson and Smith4 reviewed research, and experimental studies into the
against women are more likely to seek out literature relating to the personal, relational various effects of pornography in repre-
violent pornography.23 Ecological data and social value of pornography, stating sentative samples of adolescents.
from many countries show that the popu- that use of pornography may diminish Despite the importance of clarifying the
lation rate of rape has decreased signifi- sexual anxiety and dysfunction, encourage impact of pornography, several factors
cantly while pornography use has sexual expression and provide entertain- indicate that it will always be extremely
significantly increased.21 This has led ment and satisfaction. Pornography has difficult to provide conclusive evidence.
some researchers to hypothesise that been associated with more open views First, due to the sensitive nature of the
exposure to violent pornography is cathar- towards sex and sexuality. For example, topic, asking adolescents about pornog-
tic, diverting sexual aggression away from pornography use has been correlated with raphy and getting parental consent to do
real-life violence.21 Ecological data, acceptance of homosexuality among US so poses ethical problems. However, given
however, are a very weak form of evi- men28 and may allow non-heterosexual that pornography viewing typically begins
dence, as changes at a national level over young people to explore and learn about from a young age (a median age of
time may be driven by a multitude of their sexuality in a way that they are not 14 years in our unpublished study), it is
other societal factors. able to from mainstream culture. vital that research does include adoles-
Australian29 and Danish30 adults have self- cents before they begin this behaviour.
SEXUAL WELL-BEING reported that pornography has significantly Another key problem is that viewing
There are many reports about the adverse more positive than negative effects, such as pornography is so common in our society
impacts of pornography on relationships, an improved sex life, feeling more comfort- that studies often have no meaningful
sexual enjoyment and well-being, but evi- able and open-minded about sex and being control groups, limiting the quality of the
dence is predominantly limited to per- more attentive to their partner’s sexual research. Even studies investigating porn-
sonal anecdotes or surveys with subjective pleasure. Similarly, in a sample of 245 US ography and outcomes in a dose–response
measures. For example, a common com- students, viewing pornography was asso- design suffer from a lack of clarity regard-
plaint from young heterosexual women is ciated with a willingness to explore new ing cut-off values for problematic use.
a feeling of subservience to male pleasure, sexual behaviours and reported to be a The impact of pornography on sexual and
being pressured or being expected to do source of empowerment for the viewer, relationship well-being will be particularly
things their male partners had seen in building confidence among the female par- difficult to determine given the lack of
pornography (such as anal intercourse and ticipants in particular.31 Furthermore, there objective methods to measure these.
ejaculation onto the female’s face).7 9 is a rising interest in more positive forms of Finally, a causal relationship between
Women’s pornography use is under- pornography, for example ‘feminist pornog- pornography viewing and outcomes is dif-
represented in research, but surveys of raphy’ and ‘sex-positive pornography’ ficult to prove as both behaviours must
couples in heterosexual partnerships show which emphasise the real sexual pleasure of surely be mediated by the choice to watch
that men viewing pornography is asso- female performers, represent diversity, pornography—for example, those people
ciated with decreased sexual satisfaction display sexual consent and agency and more interested in sex and with stronger
for both partners while the female partner provide ethical working environments for sexual desires are more likely to both
viewing pornography is associated with performers.32 engage in sexual behaviour and to watch
increased sexual satisfaction for both It should be noted that some of these pornography.
partners.24 25 identified possible benefits are in direct Another difficulty in obtaining high-
Research also suggests that excessive use contradiction with the possible harms quality evidence about the negative or posi-
of pornography among men can lead to a described above. Sample or study design tive health and social impacts of pornog-
reliance on pornography to maintain sexual differences may play a role in this contra- raphy is the rapidly changing environment
arousal and consequently, loss of enjoyment diction; however, it is also likely that and medium in which it is consumed.
during sex with a partner.8 26 Although pornography does not influence all indivi- Near-instant on-demand access to billions
pornography addiction is not listed as an duals in the same way. Further research is of pornographic videos from a handheld
addictive disorder in the American needed to identify factors which may device is likely to have a very different
Psychiatric Association’s Diagnostic and mediate the impact. impact than a sexually explicit magazine
Statistical Manual of Mental Disorders kept under the bed. Furthermore, research
(Fifth edition), many do believe in its exist- DISCUSSION on previous generations of young people
ence. For example, studies have shown that Online pornography is extremely common may not be relevant to the current gener-
pornography viewing is associated with in modern society, but its impact on sexual ation, who are now typically exposed to a
brain changes similar to those observed in health and well-being remains uncertain. high volume of diverse and explicit pornog-
addiction and that pornography addiction The available evidence suggests that porn- raphy before they have had the chance to
is often associated with sexual dysfunc- ography does affect our behaviour, some- test and develop their own sexual practices
tion.26 27 Worryingly this research also times in problematic ways. However, it is and relationships.
showed that adolescents take longer than also likely that for many people, viewing What responses could we implement if
adults to recover from pornography addic- pornography has no adverse effects and pornography is found to be unhealthy?
tion, which the authors attribute to the may even have beneficial outcomes. Some attempts at legislation have been
younger age of pornography exposure.26 Research to date has produced mixed made; examples include international
results and has overlooked some key efforts to eliminate child pornography
BENEFITS OF PORNOGRAPHY groups, particularly young women. As our and nationwide internet provider blocks
There are many advocates for the benefits commentary has identified several on any material deemed explicit (eg, in
of pornography and a growing, albeit common flaws in methodology, there is a China). In most countries, pornography is
limited, body of supporting evidence that need to conduct further research, technically restricted to viewing by adults
2 Lim MSC, et al. J Epidemiol Community Health Month 2015 Vol 0 No 0

aged over 18 years; however, these restric- J Epidemiol Community Health 2015;0:1–3. lifestyles, and self-rated health among male
tions are widely ignored and near- doi:10.1136/jech-2015-205453 adolescents in Sweden. J Dev Behav Pediatr
impossible to enforce. 17 Rogala C, Tyden T. Does pornography influence
California, one of the world’s largest REFERENCES young women’s sexual behavior? Womens Health
1 Carroll JS, Padilla-Walker LM, Nelson LJ, et al.
pornography-producing jurisdictions, Generation XXX: pornography acceptance and use
Issues 2003;13:39–43.
recently made the decision to mandate 18 Sinkovic M, Stulhofer A, Bozic J. Revisiting the
among emerging Adults. J Adolesc Res
association between pornography use and risky
condom use in all films—not to reduce 2008;23:6–30.
sexual behaviors: the role of early exposure to
the potential for harm to viewers, but to 2 Arthur C. Porn sites get more internet traffic in UK
pornography and sexual sensation seeking. J Sex Res
protect adult film workers. This was a than social networks or shopping. The Guardian 27
July 2013.
clear evidence-based response; performers 2013/jul/26/porn-sites-internet-traffic-uk.
19 Bridges AJ, Wosnitzer R, Scharrer E, et al. Aggression
are at risk of extremely high rates of STIs, and sexual behavior in best-selling pornography
3 Pornhub. 2014 Year in Review. Secondary 2014
videos: a content analysis update. Violence Against
including HIV.33 Less clearly evidence Year In Review 2015.
Women 2010;16:1065–85.
based was the recent ruling for pornog- 6WN6xycYc
20 Klaassen MJ, Peter J. Gender (In) equality in internet
4 Watson MA, Smith RD. Positive porn: educational,
raphy introduced in the UK, which medical, and clinical uses. Am J Sex Educ
pornography: a content analysis of popular
banned depicting behaviours, including pornographic internet videos. J Sex Res Published
Online First: 24 Nov 2014.
spanking, fisting, face-sitting and female 5 Tyden T, Rogala C. Sexual behaviour among young
21 Fisher WA, Kohut T, Di Gioacchino LA, et al.
ejaculation. Critics of this ruling contend men in Sweden and the impact of pornography. Int J
Pornography, sex crime, and paraphilia. Curr
that the list of behaviours was chosen STD AIDS 2004;15:590–3.
Psychiatry Rep 2013;15:362.
6 Smith M. Youth viewing sexually explicit material
based on moral judgement rather than evi- online: addressing the elephant on the screen.
22 Hald GM, Malamuth NM, Yuen C. Pornography and
dence of the negative health impacts of attitudes supporting violence against women:
Sex Res Soc Policy 2013;10:62–75.
revisiting the relationship in nonexperimental studies.
viewing these behaviours. 7 Crabbe M, Corlett D. Eroticising inequality.
Aggress Behav 2010;36:14–20.
Evidence is also needed to inform technology, pornography and young people. DVRCV
23 Malamuth NM, Hald GM, Koss M. Pornography,
Q 2010;3:1–6.
policy and practice regarding education 8 Bridges A, Johnason J, Ezzell M. Pornography and
individual differences in risk and men’s acceptance of
about pornography. Young people are violence against women in a representative sample.
the male sexual script: an analysis of consumption
Sex Roles 2012;66:427–39.
watching pornography more frequently and sexual relations. Arch Sex Behav Published
24 Poulsen FO, Busby DM, Galovan AM. Pornography
and from a younger age; it is becoming an Online First: 3 Dec 2014.
use: who uses it and how it is associated with
entrenched part of their sexual develop- 9 Stenhammar C, Ehrsson YT, Akerud H, et al. Sexual
couple outcomes. J Sex Res 2013;50:72–83.
and contraceptive behavior among female university
ment. This suggests that education on this students in Sweden—repeated surveys over a
25 Bridges AJ, Morokoff PJ. Sexual media use and
topic is essential. Education may involve relational satisfaction in heterosexual couples.
25-year period. Acta Obstet Gynecol Scand
Personal Relationships 2011;18:562–85.
improving media literacy, such as building 2015;94:253–9.
26 Wilson G. Your brain on porn: internet pornography
understanding of concepts including the 10 Vannier SA, Currie AB, O’Sullivan LF. Schoolgirls and
and the emerging science of addiction.
soccer moms: a content analysis of free “teen” and
reality and fantasy of sex depicted in “MILF” online pornography. J Sex Res 2014;51:
Commonwealth Publishing, 2014.
pornography, expectations for real-life sex 27 Kuhn S, Gallinat J. Brain structure and functional
connectivity associated with pornography
and consent. However, quality education 11 Gorman S, Monk-Turner E, Fish JN. Free adult
consumption. JAMA Psychiatry 2014;71:827–34.
requires a strong evidence base, which is internet web sites: how prevalent are degrading
28 Wright PJ. Pornography consumption, cocaine use,
not yet established for pornography. The acts? Gender Issues 2010;27:131–45.
and casual sex among U.S. adults. Psychol Rep
12 Grudzen CR, Elliott MN, Kerndt PR, et al. Condom
most important question still to be use and high-risk sexual acts in adult films:
answered is whether pornography’s risks 29 McKee A. The relationship between attitudes towards
a comparison of heterosexual and homosexual films.
women, consumption of pornography, and other
to adolescents are greater than those that Am J Public Health 2009;99(Suppl 1):S152–6.
demographic variables in a survey of 1,023
have been inadequately demonstrated for 13 Nelson KM, Simoni JM, Morrison DM, et al. Sexually
consumers of pornography. Int J Sex Health
explicit online media and sexual risk among men
adults. who have sex with men in the United States. Arch
30 Hald GM, Malamuth NM. Self-perceived effects of
Sex Behav 2014;43:833–43.
Contributors MSCL and ERC conducted the literature pornography consumption. Arch Sex Behav
14 Traeen B, Hald GM, Noor SW, et al. The relationship
review; all authors contributed to writing and editing 2008;37:614–25.
between use of sexually explicit media and sexual
the manuscript. 31 Weinberg MS, Williams CJ, Kleiner S, et al.
risk behavior in men who have sex with men:
Pornography, normalization, and empowerment.
Competing interests None declared. exploring the mediating effects of sexual self-esteem
Arch Sex Behav 2010;39:1389–401.
Provenance and peer review Commissioned; and condom use self-efficacy. Int J Sex Health
32 Taormino T, Penley C, Parrenas Shimizu C, et al.
externally peer reviewed. 2014;26:13–24.
The feminist porn book. The politics of producing
15 Harkness EL, Mullan BM, Blaszczynski A. Association
To cite Lim MSC, Carrotte ER, Hellard ME. pleasure. New York: Feminist Press at the City
between pornography use and sexual risk behaviors
J Epidemiol Community Health Published Online First: University of New York, 2013.
in adult consumers: a systematic review.
[ please include Day Month Year] doi:10.1136/jech- 33 Kluger N. [Sexually transmitted diseases and other
Cyberpsychol Behav Soc Netw 2015;18:59–71.
2015-205453 risks in the adult film industry]. Ann Dermatol
16 Mattebo M, Tyden T, Haggstrom-Nordin E, et al.
Venereol 2014;141:122–9.
Pornography consumption, sexual experiences,

Lim MSC, et al. J Epidemiol Community Health Month 2015 Vol 0 No 0 3

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