ABCDEFGHIJKLMNOPQRSTUVWXYZAAABACADAEAF
1
Study Study TypePredictorEffectsDefinitions & Measures for Pornography and UsePlain Language Summary Study ContextSample SizeStrengths and Limitations Notes
2
Lin et al., 2020longitudinal (Taiwan)sexually explicit media exposureearlier onset of first sexual intercourse (first sexual act before age 17)Sexually explicit media exposure was assessed with one item "Have you ever seen any of the following adult-only or restricted (R-rated) media?”.
Participants were given a list of six media modalities: websites, magazines, comic books, novels, films, and other.		Pornography exposure in adolescence has lasting effects

Exposure to pornography as a teen has harmful consequences that can last more than 10 years. Teenagers exposed to pornography were more likely to have their first sexual act before age 17, contract sexually transmitted infections (e.g., gonorrhea) and have an unplanned or teen pregnancy. The negative consequences of pornography exposure persist at least until young adult years, the study found.		 longitudinal study (Taiwan Youth Project) with 10-wave measurements: the first wave in 7th grade (mean age = 13.3) and the 10th in emerging adulthood (mean age = 24.3)2054this study has causal implications (i.e. exposure to pornography leads to more risky sexual behavior which in turn leads to sexually transmitted infections and unplanned or teen preganancy A related report of survey data from heterosexual adult men in the U.S. (Wright et al., 2019) showed that pornography use predicted condom nonuse only when men perceived that pornography was a primary source of information about sex. When men did not perceive that pornography was a primary source of sexual information, their rate of condom use was unrelated to how much or how little they consumed pornography.

However, collectively, these results are consistent with the public health position that pornography can be a risk-factor for condomless sex.
3
unsafe sex (e.g., inconsistent condom use)
4
more sexual partners (i.e., high partner change rate)
5
sexually transmitted infections (STIs; e.g., gonorrhea) [by association with risky sexual behavior]
6
unplanned or teen pregnancy [by association with risky sexual behavior]
7
Bőthe et al., 2020aonline survey; large samplepornography use (problematic and high-frequency)depressive symptomsProblematic pornography use for the past six months was assessed with with the Problematic Pornography Consumption Scale and covered salience (e.g. importance given to pornography), tolerance, mood modification, withdrawal, relapse, and conflict.

Florin's note: PPCS, the questionnaire used to measure problematic pornograhpy use, has been criticised in a recent review for "the inclusion of factors that are not supported within the academic literature; tolerance (in term of amount consumed) and withdrawal" (Binnie & Reavey, 2020, p.14).

Frequency of pornography use was also measured on a 10-point scale (1= “never”, 10 = “6 or 7 times a week”).		Out of control pornography use affects mental health, relationships and happiness

Out of control pornography use makes people more likely to have depressive symptoms, low self-esteem and doubt their ability to succeed in life.

Out of control pornography use can also make one feel socially excluded and less psychologicall happy overall in terms of a sense of freedom, belongingness and competence in one's life. 		3 nonclinical samples recruited from general websites and a pornography site (study 1: N = 14,006; study 2: N = 483; study 3: N = 672)15161Self-report cross-sectional methods have possible biases that should be considered when interpreting findings (eg, social desirability bias), and causality cannot be inferred from cross-sectional studies. However, the present research included 3 studies and involved large community samples and visitors of a pornography website. According to the present study, frequency of pornography use should not be considered as a sufficient indicator of problematic pornography use in itself as the number of people with nonproblematic high-frequency pornography use (19-29% of individuals) was 3-6 times higher than that with problematic high-frequency use (3-8% of individuals). The results suggest that individuals with problematic pornography use use pornography frequently; however, frequency of pornography use may not always be problematic.
8
pornography use (problematic and high-frequency)lower self-esteem
9
pornography use (problematic and high-frequency)relatedness frustration (e.g. feelings of exclusion from the group one wants to belong to)
10
pornography use (problematic and high-frequency)lower relatedness satisfaction (e.g. feeling that the people one cares about also care about him/her)
11
pornography use (problematic and high-frequency)competence frustration (e.g. serious doubts about whether one can do things well)
12
pornography use (problematic and high-frequency)overall deprecated psychological well-being (i.e. frustration in basic psychological needs of autonomy, relatedness, and competence)
13
Gola et al., 2017neuroscience/ fMRI studyproblematic pornography useaddiction-like effects (similar to substance and gambling addictions); extended time spent watching pornography, more frequent masturbation
meeting criteria of hypersexual disorder (Hypersexual Disorder Screening Inventory); other questionnaire measurements were used for independent verification of screening accuracy:

Average pornography consumption per week
Longest time of pornography consumption in 1 day
Average frequency of masturbation per week
Max number of masturbations in 1 day
Sex Addiction Screening Test—Revised (SAST-R)
Brief Pornography Screener (BPS)
Sexual Arousability Inventory (SAI) 		Pornography can get you addicted

Men having problems with controlling their pornography use have brain patterns similar to those seen in gambling and substance addicts. The intense craving for pornographic material seems to be reponsible for problems associated with pornography use such as extended time spent watching pornography.		functional magnetic resonance imaging (fMRI) study among 28 heterosexual males seeking treatment for problematic pornography use and 24 heterosexual males without problematic pornography use28control group study; no serious limitations foundMen with problematic pornography use showed increased reactivity for cues predicting erotic (but not monetary) rewards. In problematic pornography use subjects, this brain activation was accompanied by measures suggesting increased behavioral motivation to view erotic images (higher ‘wanting’). Brain reactivity for cues signaling erotic pictures (but not for erotic pictures per se) was significantly related to severity of compulsive sexual behavior, amount of pornography use per week, and frequency of masturbation. 

The findings suggest similarities between problematic pornography use and addictions and an important role for learned cues in problematic pornography use. Identifying pornography-related triggers and targeting the dissociation of learned cues from problematic behaviors may be useful in the treatment of problematic pornography use.

Lack of between-group differences in compulsivity (measured with the Obsessive Compulsive Inventory—Revised), speaks against conceptualization of problematic pornography use within an OCD framework.

Currently, there is an active scientific discussion about whether compulsive sexual behaviour disorder can constitute the manifestation of a behavioural addiction. For ICD‐11, a relatively conservative position has been recommended, recognizing that we do not yet have definitive information on whether the processes involved in the development and maintenance of the disorder are equivalent to those observed in substance use disorders, gambling and gaming (kraus et al., 2018).
14
Perry, 2020survey, nationally representative samplemasturbationnegatively associated with relational happiness for men and womenParticipants were first asked if they had ever masturbated (Yes or
No). Those who answered that they had ever masturbated were then asked, “When did you last masturbate?” Responses ranged from 1 = Today to 9 = Over a year ago. 		Maturbating to porn? Your relationship may suffer

Two large surveys from U.S. found that masturbation has a significant negative impact on relationships for both men and women. Masturbation seems to be more harmful for relationships than porn alone.
results from two US national surveys: the 2012 New Family Structures Study (NFSS; N = 1,977) and the 2014 Relationships in America survey (RIA; N = 10,106)12083The data collected was not dyadic, i.e. the study did not include both partners in the couple, only one.
15
pornography useslight positive association with relational happiness (once masturbation and gender differences are accounted for)Survey 1: “During the past year, how often did you view pornographic materials (such as internet sites, magazines, or movies)?” Response options ranged from 1 = Never to 6 = Every day or almost every day.

Survey 2: measured pornography-viewing frequency in terms of participants’ last time intentionally viewing it “When did you last intentionally look at pornography?” Participants could answer 1 = Today to 10 = I’ve never intentionally looked at pornography.		Other studies have frequently found that the pornography use of one romantic partner may have consequences for relationship satisfaction if the other partner feels betrayed or morally offended.
16
Grubbs et al., 2019cross-sectional sample + online U.S. nationally representative sample + a 1-year, 4-wave longitudinal samplepornography useno evidence of causal links between any pornography variables and erectile dysfunction;

consistent evidence of an association between self-reported problematic use and the presence of erectile dysfunction (men with erectile dysfunction are morel likely to engage in problematic pornography use)		Pornography use was assessed via responses to 2 questions (e.g. “On average, I estimate that I spend _ minutes viewing pornography online per day”). Participants also reported their frequency of pornography use over the past year (i.e. “In the past 12 months, how often have you viewed pornography alone (ie, without a partner)?”—on a scale of 1 (never) to 8 (once daily or more))Does porn cause erectile dysfunction? Probably not

A recent study found little to no evidence of relationship between the mere use of pornography and erectile dysfunction.

However, the study did find that having erectile functioning problems can make you more likely to use porn.

There was no proof of pornography causing erectile functioning problems in this particular study. 		3 samples of sexually active men who also used pornography were collected: a cross-sectional sample of undergraduate men in the United States (n = 147), an online sample of men derived from a larger sample that was matched to U.S. nationally representative norms (n = 297), and a 1-year, 4-wave longitudinal sample of adult men derived from an online convenience sample (Mechanical Turk: time 1, n = 433; time 2, n = 223; time 3, n = 202; time 4, n = 196)1508The work relied exclusively on self-report methods, and did not control for medical covariates that may be related to the experience of ED.

Systematically examined the links between self-reported problematic use of pornography and ED, and it did so in a variety of samples, using both cross-sectional and longitudinal methods.
17
Vaillancourt-Morel et al., 2020 (in-press)35-day dyadic (couple) daily diary studypornography usefor women, regardless of partner’s sex, using pornography was associated with their own and their partner’s higher sexual desire and with higher odds of partnered sexual activityPornography use was defined as: “intentionally looking at or listening to (1)
pictures or videos of nude individuals, (2) pictures of videos in which people are having sexual activities, or (3) written or audio material that describes people having sexual activities.”

One item was used to assess pornography use: “Did you use pornography in the last 24 hours?” with three response choices: “no, not at all,” “yes, once,” and “yes, more than once.” (the authors recoded this item as a dichotomous variable with 0 = no pornography use and 1 = pornography use). 		Watching porn? Your sex life might suffer

Watching porn can affect life in a couple: when men watch more porn, their partners have lower sexual desire and they are less likely to have sex with their partner.

Relationship satisfaction was not affected by porn use in this study.
dyadic daily diary study with mixed-sex and same-sex couples (N = 217 couples)434generalizability of the results is potentially limited by using a convenience sample of relatively young couples with little ethnic diversity (e.g. the associations with pornography use may be different in couples together for a longer period)
18
for men, regardless of partner’s sex, using pornography was associated with their partner’s lower sexual desire
19
for men coupled with women, with lower odds of partnered sexual activity
20
pornography use was unrelated to relationship satisfaction (for all participants)
21
Tokunaga et al., 2020meta-analysis (quantitative studies) pornography usecondomless sex: higher levels of pornography consumption were associated with an higher likelihood of engaging in condomless sexMeta-analysis; selection of studies for the meta-analysis included a criteria for a study to report a quantitative assessment of exposure to pornography. The following are representative assessments: Sinkovic et al. (2013) asked how frequently respondents viewed sexually explicit pornographic media, such as movies and video clips; Peter and Valkenburg (2011b) asked respondents if they had viewed sexually explicit pornographic materials, such as online videos and pictures of people having sex; and Braithwaite, Givens, et al. (2015) asked respondents how frequently they viewed pornography online, in movies, and in magazines.Watching more porn leads to unsafe sex
Watching more porn leads to increased sexual risk, shows an analysis of studies from 18 countries with more than 35,000 participants.

The analysis found that pornography drives up participants' excitment too high resulting in more unsafe sex, especially if the pornographic material viewed featured sex without condoms (which is the case with most porn on the internet).

meta-analytic findings; results were based on 45 reports spanning two decades; data from 18 countries, with a participant total of over 35,000, were located35000high generalizability the type of pornography content consumed moderated the pornography use–condomless sex relationship: viewing pornography that does not show condoms was associated with an increased risk for having sex without condoms, whereas consuming pornography showing condoms was unrelated to sexual risk
22
Berger et al., 2019survey (military personnel)pornography use (with masturbation)erectile dysfunction: men who prefer masturbation with pornography to partnered sex have a significantly increased risk of sexual dysfunction; rates of erectile dysfunction were lowest in those preferring partnered sex without pornography (22.3%) and increased significantly when pornography was preferred over partnered sex (78%)The extent of potential addiction to pornography was measured with two previously validated tools: the pornography craving questionnaire and the obsessive passion scale.

To gauge volume of pornography consumption, respondents were also asked details regarding frequency of pornography use and duration of viewing episodes. To assess preferences for pornography, participants were asked about the use of porn as it relates to choices between partnered sex and masturbation.

The authors have not separated viewing pornography and masturbation; i.e. they have used the terms “using pornography” and “viewing pornography” to include the act of masturbation as well.

Computer and phone pornographic images viewing were most common in both sexes. 		Young guys prefering to masturbate to porn at higher risk for sexual dysfunction

Young men who prefer masturbation with pornography over partnered sex have a significantly higher risk of sexual dysfunction, shows a survey among 518 people working in military services. Porn and sexual dysfunction were more common in young men in this study. Erectile dysfunction issues were lowest (22.3%) in those preferring partnered sex without pornography and increased to 78% when pornography was preferred over partnered sex.
survey among military personnel (N = 510; 86.1%, 439/510 men); most participants were active duty military.510causation cannot be implied based on this study altough there are reports of men regaining normal sexual function after discontinuation of excessive pornography use (current study, p. 5); erectile dysfunction can also be a side effect of PTSD in military personnel (Moisson et al., 2019)
23
Bőthe et al., 2020bnon-clinical, survey; large sample



problematic pornography usesexual function problems in males and females (moderate association)Pornography was defined as material (e.g., text, picture, video) that (1) creates or elicits sexual feelings or thoughts and (2) contains explicit exposure or descriptions of sexual acts involving the genitals, such as vaginal or anal intercourse, oral sex, or masturbation.

Problematic Pornography Consumption Scale (PPCS) was used as a measure of problematic pornography use. The scale includes six factors (salience; tolerance; mood modification, conflict, withdrawal, and relapse), each with three items concerning past-six-month use of pornography. Respondents indicate answers on a seven-point scale (1 = “never”; 7 = “all the time”).

Florin's note: PPCS, the questionnaire used to measure problematic pornograhpy use, has been criticised in a recent review for "the inclusion of factors that are not supported within the academic literature; tolerance (in term of amount consumed) and withdrawal" (Binnie & Reavey, 2020, p.14).		Out of control porn use can cause sexual function problems

Out of control porn use (not necessarly frequent) has been linked to sexual function problems in both men and women in a study with more than 14,500 participants.

males and females (N = 14,581 participants; females = 4,352; 29.8%)14581Self-report methods used prone to biases (e.g., underreporting and overreporting). Causality cannot be inferred. frequency of pornography use (in contrast to problematic pornography use) had negative, weak links to sexual function problems in males and females
24
Miller et al., 2019experimentpornography usepast exposure to pornography affects men’s perceptions of the likelihood of women engaging in, and enjoying, “porn-like” sexPornography use was defined for participants as “Any kind of material that aims to create or enhance sexual feelings or thoughts in the audience and, at the same time contains: 1) explicit depictions of genitals, and/or 2) clear and explicit depictions of sexual acts such as vaginal intercourse, anal intercourse, oral sex, masturbation etc.”

Participants were asked whether they had viewed pornography ever and in the last six
months.

Frequency of pornography use over the last six months was then assessed via an 8-point scale (where 1 = less than monthly and 8 = more than once a day). Average viewing session length over the last six months was assessed using a 6-point scale (where 1 = less than 5 min and 6 = greater than 60 min). These two items were z-standardized and averagedto create an index of level of pornography use.

Specific to this study: Whether participants had viewed pornography depicting “taxi drivers having sex with their passengers” or “bosses having sex with their employees” at any point, and in the last six months (outside of the experiment), was also assessed.		Porn can cause men to distortedly see women as more likley to engage in porn-like sex

In a new study, men that have watched reality-like porn in the past (e.g. taxi driver and sex with work collegue scenarios) judged women to be more likely to engage in porn-like sex, providing evidence that pornography can distort men’s views and sexual expectations and have a negative impact on the lives of both men and women.		Participants (N = 418) were either exposed to non-pornographic control videos or pornographic videos in which a male taxi driver has sex with a female passenger.

Participants’ perceptions of the likelihood of women engaging in various sexual practices commonly depicted in pornography (e.g., unprotected sex with a stranger, rough sex) were then assessed across two vignettes. In the first vignette, a male taxi driver propositions a female passenger. In the second, a male boss propositions a female employee. The study was administered online to maximize ecological validity.		418non-probabilistic sample (limits generalization)convenience sample (clinicians were recruited from local continuing education conferences and meetings that targeted practitioners in the community); the sample included school psychologists and other clinicians who see predominantly adolescents; the present study did not assess for clinician’s amount of specific training related to sex addiction or problematic pornography use
25
Short et al., 2016survey (clinicians)pornography usePreoccupation with sexual activityAs this was a survey with specialized participants (mental health professionals) problematic pornography use was not defined. Nearly half of the sample (48.8%; N = 90) reported that they had seen clients presenting with problematic pornography use. Clinicians describe the dangers of porn

More than 180 clinicians seeing patients with porn and sex related problems responded to a survey showing that porn and sexual addictions can easily get out of control and produce serious consequences such as affecting everyday activities, relationships and even causing financial problems. 		mental health professionals/clinicians (N = 183) reported on problems and characteristics associated with sex addiction and pornography use observed in their practice183No causal relationship can be astablished; for example, is unclear if problematic pornopgraphy use leads to anxiety or if anxiety leads to pornography usage or if they both merely correspond with a third variable (e.g., lack of a satisfying marriage). Further, the results of the study may suggest that pornography use only exacerbates existing problems or vulnerabilities. The majority of clinicians endorsed the belief that sex addiction is a valid diagnosis (70.1%). However, this belief was stronger among non-specialist therapists (72.2 %) than among therapists who specialize in sexual disorders (40%).
26
Recurrent failures to control sexual activity/behaviors
27
Interference in everyday activities
28
Sexual activity or behavior that lasts longer than intended
29
Continuation of sexual activity/behavior despite negative consequences
30
Need for more sexual activity/behavior to obtain desired result
31
Physical or psychological distress if unable to act on sexual thoughts (i.e., anxiety, depression)
32
Thoughts about quitting or attempts to quit acting on sexual thoughts/behaviors that are unsuccessful
33
Interference with relationships
34
Financial problems related to the cost of sexual activity/material
35
(less frequent) Legal charges due to sexual activity or behaviors
36
Sniewski & Farvid, 2020qualitative (men)pornography useSecrecy and Silence: e.g. keeping use hidden from close friends, family members, and partnersfrequency, duration, patterns of use, triggers for use, feelings and emotions after use, reasons for problematic self-perception, and past attempts at reducing or quitting pornography (the authors did not report quantitative data)Porn forces men to hide in shame

New study provides an in-depth account of men's problems with pornography use. Participants talked about the secrecy around their issue and the need to keep it hidden from close friends, family members, and partners, the difficulties in attemtps to reduce or abstain from viewing pornography and using pornography as a way of escaping, and avoiding stressful feelings.

One participant, called Michael (23 years old), recalls: "After I masturbate, I feel depleted. No motivation. I do not feel crisp. I do not want to do anything, just feeling low and depleted. People are talking to you but you cannot really answer. And the more I masturbate, the less crisp I feel. I do not think masturbation makes me the best version of myself."		15 heterosexual men were recruited via advertising, social media outreach, and word of mouth to take part in interviews about their self-perceived problematic pornography consumption habits15Limited generalization.
37
Losing Control: e.g. difficulties curbing, reducing, or ceasing their pornography use when there was an attempt to reduce or abstain from viewing
38
Eschewing Discomfort: e.g. using pornography as a way of blunting, escaping, and avoiding uncomfortable or stressful feelings
39
Pornography as a Sexual Influencer: e.g. pornography influencing various aspects of their sexuality and sexual experiences in an undesirable way
40
Dickenson et al., 2018survey, U.S. nationally representative sample compulsive sexual behaviour (perceived difficulty controlling one’s sexual feelings, urges, and behavior)distress (feeling ashamed of sexual behavior, engaging in sexual behavior as a means of emotion regulation)The current study assessed the prevalence of CSBD in the United States by administering the Compulsive Sexual Behavior Inventory–13 (CSBI-13).

Authors: The CSBI-13 was designed as a screening instrument to assess the severity of impulsive and compulsive sexual behavior. CSBI-13 items parallel the proposed criteria of CSBD. 		Porn damages the lives of almost 10% of us

In a nationally representative study, 8.6% of indiduals (7.0% of women and 10.3% of men) had a clinical-level of distress and/or impairment due to difficulty controlling sexual feelings, urges, and behaviors. 		2325 adults (1174 [50.5%] female; mean age, 34.0 years; 201 [8.6%] met the clinical screen cut point of a score of 35 or higher on the Compulsive Sexual Behavior Inventory2325the authors state that the instrument used in this study to measure compulsive sexual behavior (CSBI-13) parallels the proposed criteria of CSBD but this does not seem to be the case as CSBI-13 includes items measuring "engaging in sexual behavior as a means of emotion regulation", which is not a CSBD criteria in the ICD-11 (see https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f1630268048 )
41
psychosocial impairment (social, interpersonal, and occupational consequences) associated with such behavior.the study did not assess additional causes of distress about participants’ sexual behavior beyond lack of control, which limited the ability to interpret the meaning of the high prevalence rate
42
Engel et al., 2019online survey; large samplehypersexual behaviorfantasies of sexual coercion: 59% of men and 18% of women Hypersexual Disorder (Hypersexual Behavior Inventory-19), symptoms of problematic cybersex (s-IATsex), as well as questions characterizing participants sexually, including fantasies and actual sexual coercive behaviors.Out of control pornography use linked to more violent sexual fantesies and acts

Out of control pornography use has been linked to sexually coercive fantasies and behaviors. Compulsive pornography use also increases the risk of depression and problematic cybersex. 		online survey, N = 1,194 (n = 564 women) participats: completed measures including self-report questionnaires to assess depressive symptoms (PHQ-9), HD (HBI-19), symptoms of problematic cybersex (s-IATsex), as well as questions characterizing participants sexually, including fantasies and actual sexual coercive behaviors1194large sample size; causal conclusions cannot be drawn from the data; the sample used in this study is not representative of the general population: the weblink to the study was posted among others in forums for individuals with levels of hypersexual disorder symptom severity
43
acts of sexual coercion: 21% of men and 4% of women
44
depressive symptoms
45
Castro-Calvo et al., 2020survey, large community samples (Spain)compulsive sexual behaviormore depressive symptomsCSBD signs and symptoms were assessed through three scales: the Hypersexual Behavior Inventory, the Sexual Compulsivity Scale and the Sexual Addiction Screening Test (SAST);

The authors used a composite index of CSBD symptoms developed ad hoc for this research including a selection of items from these three scales measuring the following symptoms: Loss of control, Neglect, Unable to stop, Continued engagement despite interference, Coping and Preoccupation. 		Younger males more at risk for out of control sexual behavior and associated mental health issues

Almost 9% (8.96) of individuals were found to meet clinical critaria for out of control sexual behavior in a large study in Spain. Young males were more likely to be affected and experience depressive and anxious symptoms, and poorer self-esteem due to out of control sexual behavior. 		two independent community samples: sample 1 included 1,581 university students (females = 56.9%; mean age = 20.58) whereas sample 2 comprised 1,318 community members (females = 43.6%; mean age = 32.37)2899this is a correlational study and therefore, does not address whether CSBD determines the emergence of the sexual and clinical profile typically observed in this condition or, on the contrary, the presence of certain previous psychological configurations (e.g. emotional problems) increases the vulnerability to develop CSBD
46
more anxious symptoms
47
poorer self-esteem
48
Sinke et al., 2020neuroscience / fMRI studyhypersexual behaviorpoorer mental performance (working memory): patients with compulsive sexual behaviour show slowed reaction times when presented with pornographic distractors; decrease of performance was related to pornography consumption in the last weekHypersexual Behavior Inventory and the revised version of the Sexual Addiction Screening Test (SAST-R) were used to assess hypersexual behaviour.

Also, a semi-structured interview was conducted accessing participants’ sexual characteristics (included items about total sexual outlet (TSO) differentiated by masturbation and experienced with a partner, consumption of pornography, relationship status, and number of sexual partners in the past year).		If porn is a problem, your brain will suffer too

In a fMRI/ neuroscientific study, people with excessive sexual behavior (e.g. high use of pornography) had worse memory performance and brain processing compared to healthy individuals.

using functional magnetic resonance imaging (fMRI) with a letter n-back task with neutral or pornographic pictures in the background was employed in 38 patients and 31 healthy controls38participant inclusion criteria were defined according to Kafka’s criteria for hypersexual behavior which do not directly translate to ICD-11 criteria
49
Kjellgren et al., 2019clinical and treatment-seeking sample (Sweden)hypersexual behaviorbuying sexual serviceCSBD symptom severity was measured by the Sexual Addiction Screening Test (SAST) (covers Affect Disturbance, Relationship Disturbance, Preoccupation, Loss of Control, Associated Features).

Severity of problematic pornography use was assessed using the Brief Pornography Screener (5 items: You find yourself using pornography more than you want to. You have attempted to “cut back” or stop using pornography, but were unsuccessful. You find it difficult to resist strong urges to use pornography. You find yourself using pornography to cope with strong emotions (e.g., sadness, anger, loneliness, etc.).You continue to use pornography even though you feel guilty about it.)

Pornography use characteristics (not used in diagnosis): pornography use (onset of first pornography use, if ever watched pornography), frequency of use (e.g. In the last week, how much time did you spend watching erotic or pornographic materials in minutes?), number of times masturbating during the last week, loss of control over sexual behavior (time spent watching pornography, excessive masturbation, paid sexual services, excessive fantasizing and focusing on sexual behavior, Internet chats, webcams, other).
Out of control pornography use has deep concequences but treatment works

Men seeking help for out of control pornography use at a clinic in Sweded described a myriad of problems associated with their condition including spending extended time watching pornography (some entire days or nights), escalating from using pornography to purchasing sexual services and feelings of anxiety, fear, guilt and shame as well as damaging effects of their relationships.

At the same time, treatment and therapy worked and significantly improved their symptoms and problems. 		27 males and 1 female (mean age = 40.3 years) who
sought help from specialized units within social welfare in Sweden		28small sample size (intervention/treatment study) not possible to assess whether respondents are representative of the clients with hypersexual behavior undergoing treatment at the units; quantitative data were collected through both interviews and self-report forms
50
extended time spent watching pornography: 4 hr or more daily on sex
sites; some respondents stated that their Internet pornography use involved entire days or entire nights
51
escalation: shifting from “soft core” pornography to pornography with humiliating content (or even zoophilic, or incestuous sexual acts)
52
escalation: moving from Internet pornography use to the purchase of sexual services
53
becoming more obsessive in the use of Internet pornography (among those who stopped buying sexual services)
54
purchasing sex
55
losing control of hypersexual behavior
56
feelings of anxiety, sadness, guilt and shame
57
damaged their relationship with their partner
58
fear and secrecy: e.g. children finding out about their behavior and the negative effects this would have
59
Mecham et al., 2019near US nationally representative online sample (survey study) + an additional online sample (experiment) pornography use dehumanizationPornographic material was defined for participants as “videos, magazines, internet websites, images, books, etc. that describe people having sex, show clear pictures of nudity or people having sex, or show a movie or audio that describes people having sex.”

Participants then indicated how often they viewed pornographic materials on a 5-point scale labeled: never (1), rarely (2), occasionally (3), frequently
(4), or very frequently (5).
Porn makes people less moral

A large survey and one experiment prove that viewing pornography causes people to behave less ethical. Pornography seems to dehumanise others and thus make one more likelly to behave morally wrong towards them. Unethical behavior has been linked to criminal behavior.		survey: 1000 adults recruited via Qualtrics (paid panel)

experiment: 199 adults recruited via MTurk 		1199provides both correlational and causal evidence; results should generalize to the U.S. adult population
60
unethical behavior
61
Kowalewska et al., 2019clinical and treatment-seeking sample (Poland)compulsive sexual behaviorlower sexuality-related esteemCSBD symptom severity was measured by the SAST (Affect Disturbance, Relationship Disturbance, Preoccupation, Loss of Control, Associated Features).

Severity of problematic pornography use was assessed using the Brief Pornography Screener (5 items: You find yourself using pornography more than you want to. You have attempted to “cut back” or stop using pornography, but were unsuccessful. You find it difficult to resist strong urges to use pornography. You find yourself using pornography to cope with strong emotions (e.g., sadness, anger, loneliness, etc.).You continue to use pornography even though you feel guilty about it.)

Pornography use characteristics were also measured (altough not used in diagnosis): pornography use (onset of first pornography use, if ever watched pornography), frequency of use (e.g. In the last week, how much time did you spend watching erotic or pornographic materials in minutes?), number of times masturbating during the last week, loss of control over sexual behavior (time spent watching pornography, excessive masturbation, paid sexual services, excessive fantasizing and focusing on sexual behavior, Internet chats, webcams, other).
Compulsive use of porn has negative effects on human sexuality

People who have trouble controlling their sexual urges are more likely to be anxious, depressed and fearful and less in control of their sexuality. Moreover, intense sexual urges affect people's self-esteem and sexual satisfaction. 		Polish men seeking treatment for CSBD
compared with men (N = 208) from the Polish general population		72no causal relationship can be implied
62
lower sexual control
63
higher (sexuality-related) anxiety and depression
64
lower couple sexual satisfaction
65
fear of (sexual) relationships
66
pornography usehigher sexual preocuppation
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100