ORIGINAL RESEARCH & REVIEWS

PARAPHILIAS

Pornography Addiction: An Exploration of the Association Between

Use, Perceived Addiction, Erectile Dysfunction, Premature (Early)
Ejaculation, and Sexual Satisfaction in Males Aged 18-44 Years
Georgina Whelan, MClinPsyc, M SexHealth, and Jac Brown, PhD, MClinPsyc

ABSTRACT

Introduction: The way men consume pornography changed over the last decade, with increased numbers of men
presenting with self-perceived Internet pornography (IP) addiction and related sexual dysfunction. A lack of consen-
sus and formal recognition in the DSM-5 lead to a variety of definitions of IP addiction. Currently, the majority of
evidence linking IP addiction and sexual dysfunction was derived from consumers, case studies, and qualitative
research. Where empirical measures were used, researchers found mixed outcomes in sexual response. Inconclusive
data appeared to relate to the conflation of IP use and self-perceived IP addiction, and normal variations in sexual
response with clinical diagnosis of sexual dysfunction. Thus, further empirical clarification is required to assess the
impact of both IP use and self-perceived IP addiction, on men’s sexual function.
Aims: This study has 3 aims: First, to assess if there is an association between IP use alone and erectile dysfunc-
tion (ED), premature (early) ejaculation (EE) and sexual satisfaction (SS); Second, to assess whether there is an
association between self-perceived IP addiction and ED, EE and SS. Third, to assess whether IP use or self-per-
ceived IP addiction uniquely predicts ED, EE, SS in men.
Method: Correlation and regression analysis was conducted on a cross-sectional sample of 942 heterosexual men
aged 18-44 years who participated in an online survey sourced from Reddit IP subgroups.
Main Outcome Measures: Cyber-Pornography Use Inventory; International Index Erectile Dysfunction; The
Checklist for Early Ejaculation Symptoms; New Sexual Satisfaction Scale; Depression Anxiety Stress Scale-21.
Results: There was no evidence for an association between IP use with ED, EE, or SS. However, there were small
to moderate positive correlations between self-perceived IP addiction and ED, EE and sexual dissatisfaction. Further,
self-perceived IP addiction uniquely predicted increased ED, EE and individual sexual dissatisfaction. Contrary to
expectations, self-perceived IP addiction did not predict sexual dissatisfaction with one’s sexual partner.
Conclusion: These results suggest that IP use alone does not predict sexual dysfunction. Rather, self-perception
of increased IP addiction was related to negative sexual outcomes. Thus, we concluded that subjective interpreta-
tion of ones IP use was a contributor to IP related sexual problems in our sample of males who share IP on social
media sites. We recommend that clinicians consider self-perceived IP addiction as a possible contributing factor
to sexual dysfunction. Whelan G, Brown J. Pornography Addiction: An Exploration of the Association
Between Perceived Addiction, Erectile Dysfunction, Premature (Early) Ejaculation, and Sexual Satisfaction
in Males Aged 18-44 Years. J Sex Med 2021;18:1582−1591.
Copyright © 2021 The Authors. Published by Elsevier Inc. on behalf of the International Society for Sexual
Medicine. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/
by-nc-nd/4.0/).
Key Words: Internet Pornography Addiction; Internet Pornography Use; Erectile (Problems) Dysfunction; Pre-
mature (Early) Ejaculation; Sexual Satisfaction

Received August 19, 2020. Accepted June 23, 2021.
Macquarie University, Department of Psychology, North Ryde, Australia
Copyright © 2021 The Authors. Published by Elsevier Inc. on behalf of the
International Society for Sexual Medicine. This is an open access article
under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-
nc-nd/4.0/).
https://doi.org/10.1016/j.jsxm.2021.06.014

1582 J Sex Med 2021;18:1582−1591

The Association of IP Use, Self-Perceived IP Addiction and Sexual Function
INTRODUCTION
The introduction of free Pornhub-style Internet sites in 2007,
dramatically changed the way men consume pornography: men
now access an instant stream of endlessly novel, niched, and indexed
IP on their smart phone or electronic device.1 Alongside this social
change, clinicians noticed increased numbers of young men self-pre-
senting for treatment for self-perceived IP addiction, who also
described sexual problems related to their IP use.2 Empirical
research into IP addiction and sexual dysfunction is in its infancy,
with the majority of evidence linking IP use and sexual dysfunction
coming from clinicians, consumers and correlational studies. A lack
of standardized, epidemiologically validated scales to investigate
online sexual addiction made quantitative research difficult and
resulted in a shortage of scientific data and mixed findings.3 Diver-
sity of outcomes appeared to be influenced in 2 ways: First, a lack
of consensus on the definition of IP addiction, which conflated IP
use and IP addiction.4−6 Second, the use of global sexual response
measures versus specific diagnostic scales, which conflated tempo-
rary problems with sexual dysfunction, both of which may contrib-
ute to men’s distress about IP use and their sexual function.7 Thus,
there is a need for further research into the impact of IP addiction
on sexual function using empirical measures of IP addiction and sex-
ual dysfunction specific scales.
What Is Internet Pornography (IP) Addiction?
Despite lack of formal recognition in the DSM-5,8 early empiri-
cal research reported on the existence of IP addiction as: compul-
sive use of IP,9−11 inability to stop despite negative
consequences,12−16 and psychological distress about IP use.17−20
Although The World Health Association recently recognized com-
pulsive sexual behavior as a disorder in the ICD-11,21 historical
lack of consensus on the existence of IP addiction led researchers to
define IP addiction in multiple ways: hours of use,22,23 behavioral
addiction,24−28 a subtype of generalized hypersexuality,12,29 and
self-perceived IP addiction.18,20,30 Early researchers’ conceptualiza-
tions of IP addiction focused on frequency of use, with 11 hours
per week identified as the cut off for negative life outcomes.22
However, successive researchers failed to replicate findings of an
association between hours of use and negative life outcomes.6,18,30
Instead, a pattern of distinct user profiles emerged: men who were
distressed about their IP use demonstrated more psychosocial
problems compared to compulsive users, whilst recreational IP
users demonstrated little interference with life domains.10,17,22,31
This led Grubs and colleagues to define IP addiction as the propen-
sity of the individual to self-label as addicted, regardless of actual
pornography use. They operationalized IP addiction with the
Cyber Pornography Use Inventory (CPUI) to include 3 domains:
compulsivity (lack of control of IP use), access efforts (IP interfer-
ence with everyday life), and emotional distress (guilt, shame, and
regret).18,30 In the absence of consensus on a standardized defini-
tion of IP addiction, and in line with previous research, we made a
distinction between men who frequently watch IP from men who
fit the above definition of self-perceived addiction. Similar to the
J Sex Med 2021;18:1582−1591
1583
above research demonstrating increased negative life outcomes for
men with self-perceived IP addiction, we reason those men with
self-perceived IP addiction may demonstrate increased sexual prob-
lems compared to frequent IP users.
IP Addiction and Sexual Dysfunction
On review of the last 20 years of literature, qualitative research-
ers found IP viewing was associated with both positive32−36 and
negative sexual outcomes.35,37−40 Recently, clinicians focused on
increased incidence of young men presenting with ED and postu-
lated modern IP consumption as the cause.2 Despite academic
debate on whether prevalence of ED actually increased,41 con-
sumer evidence for the association of IP and sexual problems is for-
midable. IP induced sexual dysfunction was well documented in
case studies and voiced by hundreds of thousands of young male
members on social media site, NoFap, who chronicled their experi-
ence of genital desensitization, delayed or early ejaculation, ED,
sexual dissatisfaction, and disinterest in partnered sexual activity
due to compulsive IP use and resolution with abstinence.2,41−45
Thus, growing qualitative evidence supplied by clinicians and con-
sumers suggesting a link between sexual dysfunction and IP addic-
tion appeared to warrant further empirical examination of self-
perceived IP addiction and sexual dysfunction.
Since 2015, quantitative researchers examined the association
of IP use and sexual dysfunction, with mixed findings. Hours of IP
use and sexual dysfunction was assessed in 2 large scale population
studies with researchers reporting insufficient evidence of an associ-
ation between ED with increased hours of IP use.23 Similarly, in a
smaller study, researchers found no association between hours of
IP use and erectile problems/ED and in fact found increased sexual
arousal to pornography videos, increased desire for sex with their
partner, and increased masturbation in men who watched IP more
frequently.46 Further, evidence of different user profiles was dem-
onstrated by different sexual outcomes: researchers found highly
distressed non-compulsive IP users reported more sexual problems
and dissatisfaction than both compulsive and recreational users;
compulsive users had less sexual problems than recreational users,
but were more sexually dissatisfied. The researchers concluded that
distress about IP addiction had greater impact on sexual function
and satisfaction than frequency of IP use alone, whilst compulsive
IP use may have protective benefits by way of practice effects.20
These studies advanced evidence for an association between self-
perceived IP addiction and sexual dysfunction, over IP use alone.
However, the finding where preliminary as sexual function was
measured with a global screening questionnaire, which assessed
sexual function with single item questions over 1 week duration,
which is insufficient to define sexual dysfunction. Thus, our
research aims to extend assessment of the impact of self-perceived
IP addiction on sexual function by using specific sexual dysfunc-
tion assessment scales.
Aims
To summarize, there appears to be a distinction between men
with self-perceived IP addiction and recreational or frequent IP users
1584 Whelan and Brown

in current research, with men with self-perceived IP addiction dem-
onstrating increased negative sexual outcomes. In our research we
aim to advance understanding of the relationship of IP on men’s
sexual function in 3 ways. First, we aim to replicate the findings
that IP use alone is not associated with ED. We also expand the def-
inition of IP use to include both the frequency (how often), and
duration (how long one watches IP per session) to address qualita-
tive evidence that men who watch IP for longer periods may
become desensitized compared to those who watch frequently but
for short periods (eg, under 15 minutes).2,43,45 We also extend the
assessment of sexual function to include EE and SS, distinguishing
between individual and partner SS. Second, we aim to confirm that
self-perceived IP addiction is associated with negative sexual out-
comes and extend research by moving from global screening meas-
ures of sexual response to using specific sexual dysfunction measures
of ED and EE and SS. Third, we aim to assess whether self-per-
ceived IP addiction predicts ED, EE, or individual and partner-spe-
cific SS, while controlling for variables previously associated with
sexual dysfunction, such co-morbid sexual dysfunction, SS, and
depression, anxiety and stress.47−50
METHODS
Definition of IP
Previous researchers have reported that sex web cams, sex chat
sites and sexual hook up sites are similar to viewing sexual videos.51
Thus we defined IP to include all Internet websites containing sex-
ual content accessed via smartphone, tablet or computer.
Participants and Procedure
The key task was to find a non-clinical group of high fre-
quency male IP users, without them feeling labelled as IP
addicted. We sought respondents from the world where IP use
was seen as a normal, everyday activity. It could be argued that
this is a biased sample, but we believe it is a much more represen-
tative sample of IP users than if we had advertised independently
for IP use. A cross-sectional cohort of 2003 men participated in
an anonymous on-line survey that was advertised to Reddit social
media groups whose sole function was to share IP from April-
June 2017.52 The time frame was chosen to correspond with the
confines of a larger study. Answers were forced response, with a
completion rate of 1348 men or 67%. Inclusion criteria required
males to be 18 years or older and sexually active in the last year.
Consistent with other online research, the majority (80.4%) of
men were from western countries (USA, UK, Canada, Australia)
with the others from European and Asian countries (19.6%).
(See Table 1 for other personal characteristics). For the purpose
of this paper, only heterosexual males who were aged between
18-44 years were included in the analysis N = 942. We elimi-
nated 14 men who were aged above 44 years to avoid skewing
the data. When using Reddit websites to obtain a broad range of

Table 1. Demographic characteristics.

Demographics N = 942 Sex behavior N = 942 IP viewing N = 942
Age: Masturbation: Freq IP:
18−24 54.8% 1/wk 6.3% <1/wk 3.3%
(516) (30) (21)
25−34 34% 2−3/wk 29.1% 1−3/wk 23.5%
(320) (274) (221)
35−44 11.3% 4−6/wk 31.5% 4−6/wk 28.1%
(106) (297) (264)
Education: 1/d 20.4% 1/d 21.9%
Primary 1.9% (192) (206)
(18) 2−3/d 14.8% 2−3/d 19%
Second 34.1% (139) (179)
(217) ≥4/d 1.1% ≥4/d 4.2%
Post-sec. 4.9% (10) (40)
(46) Sex w person: (n = 707) Duration. IP:
Tertiary 54.1% 1−2/mo 38.9% 0−15 mins 27.3%
(510) (275) (256)
Postgrad 15% 1/wk 18.7% 15−30 mins 36.4%
(141) (132) (343)
Relationship: 2−3/wk 28.1% 30-60 mins 23.6% ins
None 24.9% (199) (222)
(235) 4−6/wk 9.6% 60-120 mins 8.9%
Casual 15.8% (68) (84)
(149) 1/d 2.7% 120−180 mins 2.2%
Monog. 48.3% (1. 2% (21)
(455) n = 14 (2%) >180 mins 1.7(16)
Affairs 4.6% n = 16
(43)
Open/poly 6.2%
(60)

J Sex Med 2021;18:1582−1591

The Association of IP Use, Self-Perceived IP Addiction and Sexual Function
IP users, we were limited by the people that responded to the
survey. All men provided consent and confirmed age: anonymity
was guaranteed. Ethics approval was provided by Macquarie
University Ethics Review Committee.
Measures
Cyber-Pornography Use Inventory (CPUI-9). The CPUI-9 is an
abridged version of the CPUI, developed to target IP addiction.
The CPUI-9 demonstrated robust factor structure, reliability in
cross-sectional adult samples and in longitudinal data, with all 3
subscales demonstrating robust predictors of distress.30 The
CPUI-9 was not validated against a definition of IP addiction or
self-perceived IP addiction as there was lack of consensus on the
definition of IP addiction. The CPUI-9 was chosen as it assessed
the 3 dimensions previously identified by empirical research.9−20
The 3 dimensions were assessed over the last 6 months. Perceived
Compulsivity: the extent one feels unable to self-regulate pornog-
raphy use; Access Efforts: the extent one feels they are allowing
pornography to interfere with their everyday lives; and Emotional
Distress: the extent one feels guilt, shame and regret in the wake
of their use. Participants rated items from 1 (not at all) to 7
(extremely). Total score calculated with higher scores indicating
increased self-perceived IP addiction: subscales can be used indi-
vidually or collectively summated.30 Internal consistency was
reported as ranging from 0.68−0.91.17,20 In the present study,
the CPUI-9 showed good internal consistency (total scale Cron-
bach a = 0.88; subscale range a = 0.73−0.90) was calculated.
International Index of Erectile Function-5 (IIEF-5).53 The IIEF-5
received extensive psychometric and cross-cultural validation for
assessing erectile function in both clinical and research settings.53,54
Participants responded on a 5-point scale from 1 (never) to 5
(always), with low scores indicating erectile problems. Scores indi-
cating severity of ED exist.53−55 As the IIEF-5 was only validated
in men who had intercourse over the last 6 months, only men
who had engaged in sexual intercourse in the last 6 months were
included in the analysis.56 In previous studies the IIEF-5 was
shown to be reliable with Cronbach a ranges from 0.73 and
above, and test-retest ranges from r = 0.68−0.84.53,54 In the pres-
ent study, it was demonstrated that the IIEF-5 had good internal
consistency (Cronbach a range = 0.92).
The Checklist for Early Ejaculation Symptoms (CHEES).57 The
CHEES is a new 5-item composite measure of EE, adapted
from the 3 most validated premature (early) ejaculation instru-
ments, to include an additional item that assesses ejaculation
latency times (ELTs) to comply with the DSM-5 criteria of
ELTs of within 1 minute.58 Researchers demonstrated equal
construct validity with the existing 3 measures of premature
ejaculation, and high correlations with imputed and non-
imputed stopwatch measures of ELTs (r = 0.84).57 A 5 point
scale from 1 (very good) to 5 (very poor) was used to anchor
answers with higher scores indicating EE. Cut off scores were
validated as ≥17 indicative of EE. The CHEES was chosen to
address well documented concern that the existing 3 measures
J Sex Med 2021;18:1582−1591
1585
only rely on subjective indicators of EE (eg, ejaculation-related
distress) and over diagnosed normally-functioning men.58−61 In
the current study the CHEES was assessed in men who had
sexual activity with a partner in the last 6 months. The CHEES
was shown to have reasonable internal consistency (Cronbach
a = 0.64−0.86).57 The internal consistency for our study was
a = 0.76.
New Sexual Satisfaction Scale (NSSS).62 The NSSS is a 20-
item instrument that measures individual and partner specific SS
and was chosen as it was a composite measure of validated SS
measures, addressed previous limitations and received the stron-
gest psychometric support for a bidimensional measure of SS.63
The NSSS has two 10-item subscales: 1) Individual SS (SS-Self)
assesses: arousal, orgasm, pleasure, concentration, perception,
emotional reaction, body function, and mood after sex. 2) Part-
ner SS (SS-Partner) assesses: give and take, emotional exchange,
partners initiation, orgasm, pleasure, creativity, availability, vari-
ety, and frequency of sexual activities, as well as an assessment of
partner meeting respondent’s sexual needs. Each item was
answered on a 5-point scale from 1 (not at all) to 5 (extremely)
with an assessment period of 6 months. Total scores calculated
with higher scores indicating greater satisfaction. This instrument
was found to be valid and reliable in cross-sectional samples and
cultural groups and discriminated between clinical and non-clini-
cal populations.62 The NSSS was shown to have good internal
consistency (SS-Self a = 0.91−0.93; SS-Partner a = 0.90
−0.94.)62 The internal consistency for our study for both SS-
Self and SS-Part was Cronbach a = 0.92.
Depression Anxiety Stress Scale-21 (DASS).64 The DASS-21
has been internationally validated to screen for Depression (7-
items); Anxiety (7-items); and Stress (7-items) in cross-sectional
samples and diverse cultural groups.65−69 Participants rated their
experiences, over the last week, on a 4-point scale ranging from:
0 (never) to 3 (always). The scale was found to have good inter-
nal consistency (Depression a = 0.82−0.94; Anxiety a = 0.87
−0.90; Stress a = 0.9−0.93).67 Good internal consistency was
demonstrated in our study with Cronbach ranges: Depression
a = 0.92; Anxiety a = 0.78: Stress a = 0.85.
Frequency and Duration of IP Use: Operationalization of IP
use in previous research is varied. However, frequency was usu-
ally assessed with a single categorical item based on either how
often a man viewed IP or the total estimated time a man spent
viewing. In this study, we expanded previous researchers’ fre-
quency items to assess average viewing time per sitting.23 Partici-
pants were asked: Over the past 6 months, on average, how often
did you view IP? 0; 1/mo; 2/mo; 1/wk; 2−3/wk; 4−6/wk; 1/d; 2
−3/d; ≥ 4/d. Duration of IP viewing was assessed with the item:
Over the past 6 months, on average, how long did you spend viewing
IP each time: <5 min, 5−15 min, 15−30 min, 30−1 h, 1−2 h, 2
−3 h, 3−4 h, >4 h. A six-month period was chosen as prior
research indicated that self-perceived IP addiction may arise in
the absence of recent IP use and to be consistent with other
measures.30
1586 Whelan and Brown

RESULTS Table 2. Mean and SD for variables.

Underlying Assumptions Outcome scales n Mean (SD)
We used SPSS (24) package. Following preliminary analysis Addict: Total 942 19.19
using T test, Bivariate scatter plots, Histograms, Q−Q plots, var- (10.04)
iable skew and kurtosis all values were normally validated. Hier- Addict: Compuls 942 8.43
archical Multiple Regression was performed with and without (5.02)
logarithm transformations, and there were no statistical differen- Addict: Effort 942 4.00
ces between raw scores versus transformed scores: Raw data was (3.34)
used for statistical assumption compliance. The IIEF-5; CHEES Addict: distress 942 5.23
(3.34)
and DASS-21-Anxiety scores were leptokurtic and negatively
ED 696 22.37
skewed in keeping with low rates of ED, EE and anxiety in the
(3.11)
general population.50,58,64 Heteroscedasity was questioned in the EE 707 9.43
ED and EE variables so we performed Bootstrapping to ensure (3.18)
validity. There was no difference between Listwise and Pairwise SS-Self 942 36.2
results: Thus, Listwise analyses were reported. Homoscedasity (9.34)
was assessed by visual inspection of a plot of studentized residuals SS-Part 707 33.68
versus unstandardized predicted values. Due to the small num- (9.34)
bers of men who met diagnostic cut off scores for ED and EE, Depression 942 5.13
we analyzed outcomes scores as continuous variables. (5.25)
Anxiety 942 3.28
(3.46)
Stress 942 5.14
Preliminary Analysis (4.27)
Independent T-test and One-Way ANOVA, using robust
measures (Welch and Games Howell with P < .05) were per-
formed to test whether a difference existed in outcome meas- Our sample was largely not concerned by their IP use
ures between men who were in relationships vs men who with the majority of men (82.3%) reporting low scores on
were single. Pearson’s correlations at 95% CI were used to self-perceived IP addiction (see Table 2 for outcome varia-
examine associations between variables. Bonferroni correction bles). One way ANOVA found no difference in relationship
was applied to an analysis to correct for number of correla- status and self-perceived IP addiction, except for men who
tions. Hierarchical multiple regression analysis was run with were in open/poly-amorous relationships who had less self-
CPUI-9 subscales and total scores; both total score and sub- perceived IP addiction than all other men (M = 15.93, SD
scales were significant, thus only total scores were reported. 7.23 vs single M = 19.56, SD 10, P = .02; monogamous
Standardized residuals were inspected and met acceptable M = 18.93, SD = 9.79, P = .03; secret affairs M = 20.44, SD
parameters. There was no multi-collinearity within the data 9.08, P = .04). ED: Using the recommended cut off score of
or in the model with VIF and tolerance rating with normal ≤21,55 the majority of men (72%) had no erection problems,
limits and variance proportions distributed across different however similar to other studies a total of 27.4% indicated
dimensions. Independence of residuals was achieved with all mild ED or worse.41,47,50 One way ANOVA demonstrated
Durbin Watson scores close to 2. Results were analyzed for that men who were single had reduced erectile function to
outliers and no individual participant had undue influence as men who were in a monogamous relationship or open/poly-
all leverage values <0.2, Cooks distance and DFBETAS <1. amorous relationship (M = 21.4, SD 3.71 vs monogamous
M = 22.66, SD 2.93, P = .002; open/polyamorous M = 22.88,
SD 2.42, P = .005). EE: almost all men (95.6%) had scores
Descriptive Statistics that corresponded to a low probability of EE, while 3.3%
Details on demographics and sex related variables are found in had scores indicative of EE. There was no difference between
Table 1. and confirm our sample as high frequency IP viewers EE scores in men with different relationship status. SS: Most
with majority (67.8%) viewing IP ≥4/wk. One way ANOVA men reported moderate or higher individual SS (77.5%) and
found that that men in a monogamous relationship had twice partner SS (64.2%). One-way ANOVA found men who were
the amount of partner sexual activity compared to those who single demonstrated reduced individual satisfaction compared
were single (M = 4.33, SD 1.42 vs M = 2.88, SD = 1.41, P < to men in monogamous and open/poly-amorous relationships
.001), whilst men who had secret affairs accessed IP more fre- (single M = 34.81, SD 7.96 vs monogamous M = 38.44, SD
quently than those in monogamous relationships (M = 6.20, 7.3, P < .001; open/poly M = 39.56, SD 5.6, P < .001) and
SD = 1.32, P = .008). There was no difference in relationship sta- greater partner satisfaction in men in acknowledged open/
tus for duration of IP use or masturbation. poly-amorous relationships (M = 38.3, SD 9.34, vs single

J Sex Med 2021;18:1582−1591

The Association of IP Use, Self-Perceived IP Addiction and Sexual Function
Table 3. Correlations for outcome variables N = 696.
Freq use Durat use Addict: total
ED -0.053 -0.066 -0.358*
EE -0.047 -0.042 0.297*
SS-self -0.076 -0.077 -0.387*
SS-part -0.075 -0.064 -0.231*
Correlation significant at the Bonferroni value P < .01 level bootstrapped 10,000 samples 95%CI
*
M = 32.2, SD 8.66, P < .001; monogamous M = 33.7,
SD = 9.57, P < .001; secret affairs M = 32.14, SD 7.06,
P = .005).
Aim 1: IP Use Was Not Associated with Sexual
Function
As expected, frequency of IP use was not associated with ED
or EE. However contrary to consumer and clinical descriptions,
frequency of IP use was also not associated with SS (individual or
partner-specific). Contrary to consumer descriptions, duration of
IP use was not associated with ED or EE, or individual or partner
specific sexual dissatisfaction (See Table 3.)
Aim 2: Self-Perceived IP Addiction Was Associated
with Sexual Function
Consistent with expectations, self-perceived IP addiction
revealed small to modest correlations with sexual function.
Increased self-perceived IP addiction was associated with
increased ED (r = -0.358), increased EE (r = 0.297), and sexual
dissatisfaction with self (r = -0.387) and partner (r = -0.231) (See
Table 3.)
Aim 3: Self-Perceived Addiction Predicts Sexual
Function
Following correlation analysis, 4 hierarchical regression analy-
sis were performed to test for the unique contribution of self-per-
ceived IP addiction on ED, EE, SS-Self and SS-Part. Variables
identified in prior research were entered first. Accordingly, fre-
quency and duration of IP use were added, then ED, EE, SS-
Self, SS-Part, followed by DASS-21 subscales, and finally per-
ceived IP addiction. Frequency and duration of IP use, Stress,
and Anxiety failed to predict sexual outcomes in all 4 regressions
analyses and were removed from the final models.
Self-Perceived IP addiction and ED: As predicted, the
addition of self-perceived IP addiction to the model led to
a small statistically significant increase in R2 = 0.01, F (4,
691) = 14.09, P < .001 and showed that erection problems
were predicted by decreased SS-Self, increased SS-Part,
increased depression and increased self-perceived IP addic-
tion with 40.3% of the variance explained by the final
model.
Self-Perceived IP addiction and EE: As expected, self-perceived
IP addiction distinctively predicted EE and demonstrated a small
statistically significant increase in R2 = 0.02, F (1,
J Sex Med 2021;18:1582−1591
1587
Addict: comp Addict: effort Addict: distress
-0.321* -0.260* -0.260*
0.253* 0.198* 0.198*
-0.318* -0.249* -0.249*
-0.198 -0.180 -0.180
703) = 17.98, P < .001. The final model demonstrated that
decreased SS (Self and Part) and increased self-perceived IP
addiction predicted EE, with 39% of variance explained by the
final model.
Self-Perceived IP addiction and SS-Self: As expected, self-per-
ceived IP addiction predicted individual sexual dissatisfaction
demonstrating a small statistically significant increase in
R2 = 0.01, F (1, 690) = 10.20, P = .001. The final model demon-
strated that individual sexual dissatisfaction was predicted by
decreased satisfaction with one’s partner, increased erection prob-
lems, increased early ejaculation, increased depression and
increased self-perceived IP addiction; the full model accounted
for 61.8% of the variance.
Self-Perceived IP addiction and SS-Part: Contrary to expecta-
tions, there was no evidence of self-perceived IP addiction pre-
dicting partner SS. After accounting for other variables,
the change in R2 < 0.001, F (1,691) = 0.19, P = .663 was not
significant.
DISCUSSION
IP Use and Sexual Function
Our study builds on early empirical research into the asso-
ciation between IP use and self-perceived IP addiction and
sexual function, distinguishing between IP use (both fre-
quency and duration), and self-perceived IP addiction. Our
study provided further empirical evidence that simply watch-
ing “a lot of porn” or “watching porn for long durations”
was not associated with ED. We expanded this research to
EE and SS and again found no association between frequency
or duration of IP use and EE or individual and partner SS.
Further we provided evidence that self-perceived IP addiction
was associated with, and predicted, negative sexual outcomes.
We concluded that increased frequency and duration of IP
use alone is insufficient to explain the development of IP
related sexual problems. Rather, self-perception of IP use as
compulsive, life interfering, and distressing was associated
with self-reported decrease in sexual function and individual
sexual dissatisfaction.
Self-Perceived IP Addiction and Sexual Function
We demonstrated that men with self-perceived IP addic-
tion can develop sexual problems regardless of their amount
1588
of IP use. In our study we found that increased ED was pre-
dicted by low individual SS, higher partner SS, higher levels
of depression, and higher levels self-perceived IP addiction.
Here we found a subgroup of men who self-described their
IP use as compulsive, life interfering, and distressing, who
experienced low mood and erection problems and were sexu-
ally dissatisfied with themselves, but not their partners. These
results are consistent with well-established research describing
co-morbidity of depression and ED,70 and previous studies
demonstrating the negative impact of viewing IP on men’s
self-appraisal,71 negative comparison of men’s penis size with
IP actors,72 and self-perceived poor sexual performance com-
pared to IP actors.73 The finding that men with increased
erection problems reported increased SS with their partners,
and decreased SS with themselves, may reflect a shift in IP
towards promoting masculine achievement with female
orgasm.74 As such, men with increased depression and self-
perceived IP addiction may feel guilt/shame about their sex-
ual performance and focus their attention towards pleasing
their partner with manual or oral sexual activity.75 Being
able to sexually satisfy their partner may help to reduce feel-
ings of sexual inadequacy; however, it may also exacerbate
erection problems by prioritising a partner’s sexual needs
over their own. Thus, we suggest that self-perceived IP addic-
tion may create unfavourable comparisons with real life sex-
ual experiences, which reduces men’s erectile function,
mood, and individual SS, and contributes to a shift in focus
towards sexually pleasuring their partner to compensate for
self-perceived poor sexual performance, to the detriment of
their sexual arousal and erectile function.
Reflecting on our findings on EE, we found that decreased
individual and partner SS and self-perceived IP addiction pre-
dicted increased EE. Despite only 3.3% of men in our sample
meeting clinical diagnostic criteria for EE, self-perceived IP
addiction appeared to result in increased distress and frustra-
tion about EE along with individual and partner dissatisfac-
tion. These findings are reflected in a literature review that
highlighted 2 main issues for men with ejaculation problems:
frustration at self-perceived lack of control of ejaculation
latency time (regardless of actual ejaculatory latency time),
and a belief that their partners were sexually dissatisfied (with
consistent overestimates of partners distress).76 The self-per-
ception of inadequate ejaculatory latency/control and individ-
ual dissatisfaction may be due to IP promotion of male sexual
prowess with lengthy intercourse. Interestingly, researchers
found that women are more dissatisfied with a man’s preoccu-
pation with ejaculatory control, than they are by intercourse
duration, as focusing on ejaculation time results in the neglect
of their sexual needs.77 Thus, in contrast to men who develop
ED, men with increased EE concerns may experience frustra-
tion, rather than low mood, and focus more on lasting longer
than pleasing their partner, which is sexually dissatisfying for
both themselves and their partner. As there was no previous
Whelan and Brown
research into self-perceived IP addiction and EE, our interpre-
tation of these results is speculative.
We do not know of other researchers who have examined self-
perceived IP addiction and SS, distinguishing between individual
and partner satisfaction using empirical measures. In our results,
we noted that self-perceived IP addiction uniquely predicted
individual sexual dissatisfaction, in the context of ED, EE and
depression. The co-occurrence of sexual dysfunction, depression,
and general sexual dissatisfaction are well established in the litera-
ture.78 The unique predictor of self-perceived IP addiction and
individual sexual dissatisfaction confirms extensive research asso-
ciating IP use and general sexual dissatisfaction.79 However, the
finding that self-perceived IP addiction did not predict partner
sexual dissatisfaction, appears to contradict case studies and No
Fap consumer complaints of reduced satisfaction with real life
partners. This contradiction may be related to our specific sample
who were selected due to recent access to real life partners. Cer-
tainly, in our sample, single men demonstrated higher ED and
individual sexual dissatisfaction scores compared to those in a
relationship, which is consistent with previous researchers find-
ings that single men have higher levels of ED and sexual dissatis-
faction compared to those in relationships.50,80 Thus, in our
sample, self-perceived IP addiction may not directly impact on
partner-specific dissatisfaction due to access to regular sexual
activity, which may mitigate negative comparison effects by pro-
viding real life experience.
Limitations
Despite limitations of available empirical measures, there are
some therapeutic principles that are worth investigating when
working with clients that are perhaps more universal than the
anecdotal methods currently being used. The CPUI-9 was
recently criticized by researchers as an invalid measure of sexual
addiction due to possible inflation or deflation of scores related
to one’s moral disapproval of IP use (distress subscale).82 How-
ever, we believe that distress (shame, guilt, regret) may not just
reflect moral disapproval, but may represent the fact that IP con-
tent can escalate to extreme deviations from real life sexual expe-
rience. As such, one does not have to be religious or particularly
moral to be disturbed by escalating IP content. Although distress
about IP content may not be an essential symptom for IP addic-
tion, we believe that it is precisely the disconnect between IP
content and real-life experiences, which can impact men’s sexual
function. Although we are not assessing prevalence, or making
clinical diagnosis of IP addiction, a further criticism of our
research may be that men in our sample are IP addicted, but are
yet to realize. Future researchers may wish to address this limita-
tion by assessing years of IP use, to see if self-perceived IP addic-
tion increased over time. In regard to empirical measures of
sexual function, the IIEF-5 and CHEES are limited to assessing
men with recent real life sexual activity and do not distinguish
between individual and partner specific sexual dysfunction.
J Sex Med 2021;18:1582−1591
The Association of IP Use, Self-Perceived IP Addiction and Sexual Function
Further empirical research would benefit from measures that
expand assessment to men who are not recently sexually active
and across sexual contexts (global vs partner-specific). A further
limitation of our study was inability to identify how much the
responder was influenced by their own perceptions versus their
partner’s perceptions of their IP use and its impacts on their sex-
ual function. At this stage of empirical development this distinc-
tion would be hard to establish. As with any research, the results
may be skewed by self-selection bias.81 Accordingly, our results
cannot be generalized and reflect our particular sample of men.
Future research may consider whether there is stronger evidence
of the interaction of self-perceived IP addiction and sexual dys-
function in clinical samples. Finally, we believe the use of forced
response was a limitation of our study as it was likely to have con-
tributed to uncompleted responses in the sample.
CONCLUSION
To conclude, consistent with previous findings, there was
insufficient evidence of an association between frequency or
duration of viewing IP and ED, EE or individual or partner SS.
However, increased scores on self-perceived IP addiction pre-
dicted increased ED, EE and individual sexual dissatisfaction in
sexually active young men aged 18−44 years who share IP on
social media sites. Our findings add to empirical research on IP
addiction and sexual dysfunction and highlight the need for clini-
cians to screen for self-perceived IP addiction in young men pre-
senting for treatment of sexual dysfunction.
Corresponding Author: Georgina Whelan, MClinPsyc; M
SexHealth, Macquarie University, Department of Psychology,
North Ryde, Australia, Tel: 61439077439; Fax:
+61285881234; E-mail: georgewhelan@sexualpsychology.com.
au
Conflict of Interest: The authors report no conflicts of interest.
Funding: None.
STATEMENT OF AUTHORSHIP
G.W. Conceptualization, Investigation, Writing − Original
Draft, and Revision, Resources. G.W and J.B Review & Editing,
of resubmissions J.B. Methodology, and Supervision.
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