ABSTRACT: The availability and use of pornography has become almost ubiquitous among adults and adolescents. Consumption of pornography is associated with many negative emotional, psychological, and physical health outcomes. These include increased rates of depression, anxiety, acting out and violent behavior, younger age of sexual debut, sexual promiscuity, increased risk of teen pregnancy, and a distorted view of relationships between men and women. For adults, pornography results in an increased likelihood of divorce which is also harmful to children. The American College of Pediatricians urges healthcare professionals to communicate the risks of pornography use to patients and their families and to offer resources both to protect children from viewing pornography and to treat individuals suffering from its negative effects.
Pornography may be defined as “the depiction of erotic behavior (sexual display in pictures or writing) that is intended to cause sexual excitement” in the viewer.1 Over the past decade there has been a large increase in the pornographic material that is available to both adults and children. Mainstream pornography use has grown common because it is accessible, affordable, and anonymous. It is accessible because it is just a few keystrokes away on the Internet. It is affordable because many online sites offer free pornography to lure viewers to their web sites. Other sites simply post third party videos and do not charge the viewer for web traffic. It is anonymous because it can be viewed in the privacy of a person’s home. There is no longer a need to visit an adult book store or the local XXX theatre.
While the exact amount of revenue that the pornography industry generates in this country is unclear, the Internet filtering service Covenant Eyes estimates the 2012 U.S. revenue to be around $8 billion.2 It is estimated that since 2007, revenue has declined by 50%3, but this decline is likely due to the availability of more free online pornography and not to a total decline in pornography usage. In 2008, the Internet and marketing firm Hitwise reported that globally 40,634 web sites distributed pornography.4
Who Consumes Pornography and Why Pediatricians Must Take Notice
A 2014 Barna Group survey revealed the following demographic data regarding pornography use by American adults:5
Among males 18-30 years old, 79% viewed pornography once per month and 63% viewed pornography greater than once per week.
Among males 31-49 years old, 67% viewed pornography once per month and 38% viewed pornography greater than once per week.
Among males 50-68 years old, 49% viewed pornography once per month and 25% viewed pornography greater than once per week.
Among females 18-30 years old, 34% viewed pornography once per month and 19% viewed pornography more than once per week.
Among females 31-49 years old, 16% viewed pornography once per month and 8% viewed pornography greater than once per week.
Among females 50-68 years old, 5% viewed pornography once per month and 0% viewed pornography greater than once per week.
Demographic data is similar among younger age groups. A 2008 article in the Journal of Adolescent Research revealed that 67% of young men and 49% of young women found pornography acceptable.6 Pornography exposure for children and adolescents has become almost ubiquitous. In a 2010 survey of English students between 14 to 16 years old, almost one third claimed that their first exposure to Internet pornography was at 10 years old or younger.7 In a 2011 survey, 31% of adolescent boys admitted visiting web sites that were intended as Adult Only.8 A large survey of American young people revealed that 51% of males and 32% of females claimed to have viewed pornography for the first time before they were 13 years old.9 In a 2012 Australian study of pornography use, men who were frequent pornography users said that their first exposure was between the ages of 11 to 13 years old.10 Similar findings were recorded in a 2009 study in the Journal of Adolescent Health which found that 85% of adolescent males and 50% of adolescent females had been exposed to pornographic material.11 Clearly, pornography has become pervasive throughout modern American society. Research, however, is only beginning to delineate its impact upon children, adolescents, and adults.
Grade school children are sometimes exposed to pornography accidentally when they view material on the Internet.12 They may also come into contact with a parent’s or close adult’s pornographic material.13 Sexual predators have purposefully exposed young children to pornography for the purpose of grooming the children for sexual exploitation.14 Pornography exposure at these young ages often results in anxiety for the child.15 Children also report feelings of disgust, shock, embarrassment, anger, fear, and sadness after viewing pornography.16 These children can suffer all of the symptoms of anxiety and depression. They may become obsessed with acting out adult sexual acts that they have seen, and this can be very disruptive and disturbing to the child’s peers who witness or are victimized by this behavior. Children under twelve years old who have viewed pornography are statistically more likely to sexually assault their peers.17 In sum, children exposed to pornographic material are at risk for a broad range of maladaptive behaviors and psychopathology.
Effects of Pornography Exposure and Use
The effects of pornography exposure upon older adolescents and young adults were recorded in a series of studies conducted by Dolf Zillman and Jennings Bryant in the 1980’s. There are several factors that make the Zillman/Bryant studies noteworthy. First, they were controlled randomized studies dealing with objective exposure to pornographic material, as opposed to convenience sample surveys about pornography exposure and attitudes. Second, they were conducted before the age of Internet pornography, so the participants would likely have had less exposure to pornography compared to the average young adult today. These studies involved recruiting college students and non-college students from the community. Subjects in the experimental group viewed pornographic material for a period of six weeks, while the control group was exposed to more common movie and television content over the same period of time. Afterwards, participants were asked a series of questions to evaluate their attitudes regarding relationship and family issues.18
- Male subjects demonstrated increased callousness toward women.
- Subjects considered the crime of rape less serious.
- Subjects were more accepting of non-marital sexual activity and non-coital sexual practices such as oral and anal sex.
- Subjects became more interested in more extreme and deviant forms of pornography.
- Subjects were more likely to say they were dissatisfied with their sexual partner.
- Subjects were more accepting of sexual infidelity in a relationship.
- Subjects valued marriage less and were twice as likely to believe marriage may become obsolete.
- Men experienced a decreased desire for children, and women experienced a decreased desire to have a daughter.
- Subjects showed a greater acceptance of female promiscuity.
There is evidence that society’s acceptance of pornography creates unique problems for women. The use of pornography can result in violent and sexually aggressive attitudes towards women. Men who consume pornography are more likely to adopt rape myth ideology, which is that women cause rape or actually enjoy rape or sexual assault.21,22 There is strong evidence that exposure to violent pornography is associated with sexually aggressive behaviors in both adolescent23 and adult males.24 It is common for pornographic movies to portray male vs. female verbal and physical aggression as well as sexual acts that are overtly degrading to women.25 For young people, viewing sexually explicit web sites increased the likelihood of having more than one sexual partner in the last three months and for using alcohol and drugs during sexual activity.26 The recent phenomenon of teenage sexting (the sending of sexually explicit photos, images, text messages or e-mails using a mobile device) has been linked with pornography exposure.27 For women, viewing pornography may result in sexual manipulation by a male partner. This is evident by the increased participation in anal sex by women who have viewed pornography despite the data that the majority of women consider anal sex unpleasant.28
Internet pornography addiction is an emerging issue that neuroscientists are just beginning to study. A recent primary research article in JAMA Psychiatry shows that pornography consumption is associated with decreased brain volume in the right striatum, decreased left striatum activation, and lower functional connectivity to the prefrontal cortex.29 The article showed that high pornography consumption is associated with smaller grey matter volume in the viewers, and is associated with downregulation of the brain’s response to erotic material. These neural changes in the brains of pornography users do not prove causation but they are similar to the changes seen in brains of individuals addicted to cocaine, alcohol, and methamphetamines, and this association is one more way regular pornography use mirrors the use of addictive drugs.30 This scientific data is consistent with the observed findings in a 2012 Australian study of pornography showing 20% of regular pornography users preferred the excitement of viewing pornography over being sexually intimate with a real person.31 The observation that male pornography users become addicted to their cyber-sexual activity and lose interest in actual women has obvious deleterious effects on relationships and society at large.
Pornography use by adolescents and young adults often leads to a distorted view of sexuality and its role in fostering healthy personal relationships. These distortions include the overestimation of the prevalence of sexual activity in the community, the belief that sexual promiscuity is normal, and the belief that sexual abstinence is unhealthy.32 These perspectives are likely to make it more difficult for young people to form lasting, meaningful relationships with the opposite sex, which will ultimately result in more anxiety, depression, and overall life dissatisfaction.33
Pornography has a negative effect on marriage and long term cohabitating couples, making them more vulnerable to divorce or dissolution, and this in turn has negative health effects for the children involved.34 The use of pornography in the context of the marriage is largely confined to the husband; the wife being an occasional co-participant, reluctantly accepting the pornography use or being completely unaware of the husband’s personal use of pornography.35 Women who have husbands or male partners who view pornography feel betrayed. Women see pornography as a form of sexual objectification of women. When women view the pornography their partners are viewing they can develop a lower self-esteem, feelings of inadequacy, and begin to feel sexually undesirable.36 The more a woman perceives her husband or boyfriend using pornography, the more negative the woman rates her relationship in general and the lower she rates her overall sexual satisfaction.37 This occurs because a significant percentage of male pornography viewers will develop a preference for the fantasy world of pornography over actual sexual activity with their partners.38 Pornography can reinforce the concept of physical domination of the man over the woman and can increase aggressive and violent behaviors against women.39,40 In 2002, the American Academy of Matrimonial Lawyers reported that 56% of all divorces involved one party having an obsessive interest in pornographic web sites.41 Men who use pornography and women who accept pornography are more likely to accept marital infidelity and cohabitation42 which ultimately destabilizes families.
Children suffer many negative effects due to modern society’s exposure to and acceptance of pornography. These negative effects include mental disturbance and unrest for the young school age child, including acting out and violent behavior. Because of its harmfulness to children, pornography must never be used as a tool to teach children human sexuality. For older adolescents and young adults, pornography teaches a false narrative regarding human sexuality and how men and women form healthy sexual relationships. This makes it more difficult for young men and women to form authentic, stable relationships. For parents, pornography is divisive resulting in a decreased quality of marriage and increasing the likelihood of divorce and separation which has been well documented to be harmful to children.
Pediatricians should be equipped to discuss with parents both how and why to prevent pornography exposure for both children and parents. Because the Internet is the primary medium for pornography exposure, home computers should be located in public spaces (not in a child’s bedroom), and equipped with Internet filtering and monitoring software to reduce exposure. There are a variety of parental controls and filtering systems available to parents, and some current software vendors offer filtering and monitoring of smart phones which are now the primary technology used by adolescents to access the Internet. Also, there are software services which offer the ability to create accountability partnerships so as to increase the success of breaking free from pornography addiction. Pediatricians and pediatric healthcare providers should understand the negative impact that widespread use of pornography is having on today’s children and their parents and how they can help stop this destructive influence on the family.
Primary Author: L. David Perry, MD, FCP