Brief report: private pleasures and the damage done: asking the unasked question about consumption of online pornography

Abstract

The domestication of the Internet has invigorated debate about the harms of pornography. The difference between pre-Internet and online pornography is not in any straightforward sense only one of degree. Compared to pre-Internet pornography, speed, and ease of access to an extensive range of pornographic content, along with the consumption of pornography in a virtual context, have introduced new prudential risks. In this Brief Report I restrict my focus to the impact on sexual health and on personal relationships and summarise the relevant research. Drawing on a psychoanalytically informed conceptual framework, I argue that the online medium changes, in prudentially significant ways, the consumer’s relationship to the sexual materials by providing a virtual space within which sexual desire is gratified quickly and non-reflectively, undermining the consumer’s capacity a) to mentalise their sexual desire and that of the other and b) to evaluate the prudential risks associated with the consumption of online pornography. The risks are especially significant for the digital generation whose sexual development is now more likely to be shaped by online pornography. I conclude by outlining one key practice implication arising from the research.

Keywords:

• online pornography
• sexuality
• harm
• mentalisation of sexual desire

For many, pornography use is a private activity, rarely openly discussed or examined. Between liberal permissiveness and moral outrage, resides the everyday difficulty of grappling with our sexual nature and its shadows. As psychoanalytic clinicians we are well placed to appreciate this complexity, but I suggest that mostly we don’t routinely assess pornography use in our young or adult patients. Perhaps this partly reflects the trend towards the desexualisation of contemporary psychoanalysis that has been noted by several authors (e.g., Green, 1995). In this Brief Report I propose that we should ask about pornography use and explain why it matters.

The domestication of the Internet and the introduction of the smartphone have invigorated the debates around pornography because technological developments have made it instantly accessible yet even more hidden. In 2023 Pornhub averaged 13 billion visits each month.¹ Pornography sites receive more visitors than Netflix, Amazon, and Twitter combined. The online medium has resulted in more and earlier consumption of online pornography. Between 60–80% of adult men use pornography on a regular basis (Ballester-Arnal et al., 2023). In 2023 Pornhub reported that women comprise 37% of its users and in research studies approximately 3% of women report problematic use (Baranowski et al., 2019).

Like in every other aspect of the digital world, the new sexual climate brings both benefits and harms. There are positive effects of pornography consumption such as greater self-acceptance and lower levels of shame and anxiety towards personal sexual orientation or preferences (Pathmendra et al., 2023). However, there are also concerns about the negative effects of pornography on sexual desire, sexual function, and the quality of intimate relationships.

In the UK, the All-Party Parliamentary Group’s recent inquiry into pornography highlighted the scale and nature of online pornography depicting sexual violence. For many years concerns have been raised about the impact on children and young people of early exposure to online pornography. For the digital generation specifically, online pornography is the new context for sexual curiosity and experimentation and, as such, it seems reasonable to propose that it plays a role in the development of sexuality. The ethical concern with respect to young people relates not only to the impact on their wellbeing at a given juncture in time, but also on their ‘well-becoming’ (Graf & Schweiger, 2017, p. 39).

The 2023 report by the UK’s Children’s Commissioner² found that young people are frequently exposed to coercive and degrading sexual acts online. The average age at which children first see pornography is 13. By age nine, 10% had seen pornography, 27% had seen it by age 11 and half of children who had seen pornography had seen it by age 13. This research also found that 79% had encountered violent pornography before the age of 18. Young people expressed concern about the implications of violent pornography on their understanding of the difference between sexual pleasure and harm. Indeed, this report found that frequent users of pornography are more likely to engage in physically aggressive sex acts.

For these reasons, we should welcome the significant steps the Government is taking to better protect children and young people through the Online Safety Act 2023 that will become law in the UK some time in 2024. It’s long overdue. Since its invention, the Internet has had little-to-no regulation. And in the years since, it has embedded itself in every facet of daily life. The Act will ensure that pornography providers, as well as user-to-user providers which allow pornography, will need to use effective age verification or age estimation systems to prevent children from encountering pornography on their service. This will prove challenging to implement and we should expect that it won’t be long before ways to circumvent such systems will be developed, so we still need to consider how we help children and young people to reflect on their encounters with pornography. Moreover, the Act does not make any provision for over 18-year-olds who can continue to access materials considered to be ‘legal but harmful’. Meanwhile, the UK Independent Pornography Review, overseen by Baroness Gabby Bertin, and with which I have had some involvement, is undertaking a comprehensive assessment of the legislation, regulation, and enforcement of online and offline pornographic content. It will make recommendations in due course. As we await these findings, I want to draw attention to this issue by providing a very concise overview of the research and its implications in the service of improving patient care in our work as psychoanalytic clinicians.

The harms of online pornography

Technologically mediated sexual experience introduces new risks. Research over the past twenty years suggests that online pornography poses a sexual health risk as well as undermining the pro-social nature of sex. While the existence of ‘pornography addiction’ is disputed,³ there is consensus that clinically we observe ‘Problematic Pornography Use’ where the use is ‘compulsive’, and this is correlated with a range of problems. The anonymity and accessibility of online pornography are thought to be related to its addictive potential (Griffiths, 2012).

Prior to the proliferation of online pornography sites⁴ the average rate of sexual dysfunctions in men under 40, such as erectile dysfunction (ED) and low sexual desire, was low, estimated at around 2% in 1999 and 5% in 2002. It has since increased enormously to 20%-40% (Jacobs et al., 2021; Park et al., 2016). Studies that have looked beyond the prevalence rates of these problems, have found a correlation between pornography use and erectile dysfunction, low libido, difficulty orgasming (Carvalheira et al., 2015; Wéry & Billieux, 2016), and a preference for pornography over actual sex with a partner (Pizzol et al., 2016; Sun et al., 2015).

Increased pornography viewing has been associated with sexual intercourse at a younger age, higher numbers of partners and casual sex partners (Livingstone & Smith, 2014). However, increasingly, there is a growing concern that the overall trend amongst millennials is towards having less sex (Twenge et al., 2015), with one study of 18–20-year olds identifying a strong link between the consumption of online pornography and a withdrawal from actual sexual relationships (Pizzol et al., 2016). At this point in time, we can only speculate about the meaning of such trends. We need more longitudinal empirical and specifically psychoanalytic research to understand what is happening in the internal world. It is probable, however, that such trends reflect the way in which the easily accessible option of technologically mediated sexuality all too readily leans into the narcissistic pull of a more remote and hence less relational sexuality.

Other research has noted the impact of online pornography on body image and self-esteem, with trends showing more young women opting for pubic hair removal to look pre-pubescent and for labiaplasty, which some young women explicitly link to viewing pornography (Hamori, 2016; Kalampalikis & Michala, 2023). Amongst boys too, negative preoccupation with the appearance of their body has been correlated with exposure to online pornography and the body ideals implicitly promoted by the male pornography actors (Vandenbosch & Eggermont, 2012, 2013).

Consuming online pornography is correlated with distorted sexual knowledge which reinforces perceptions of gender inequality (Donevan et al., 2022; Gassó & Bruch-Granados, 2021). Sexual coercion, abuse, and negative gender attitudes on the part of young boys is significantly associated with consumption of online pornography. It is also correlated with an increased probability of sexting (Stanley et al., 2018a, 2018b; Ybarra et al., 2011). People who use pornography report specific sexual beliefs, for example that ‘rough sex’ is common (e.g., sex involving strangulation) (Wright et al., 2022), thus normalizing victimization and degradation of girls and women.

Recently concern has been raised about the possible link between the gender stereotypes and unequal relationships between men and women that are enshrined in online pornography images and scripts and the marked increase in young natal women who present with gender dysphoria and want to medically transition (Nadrowski, 2023). Although it is not possible to determine causality, it is nevertheless important to be alert to how exposure to online pornography may be especially detrimental during puberty to some young girls’ elaboration of gender identity.

Online pornography has been found to be more violent than print pornography. Verbal or physical aggression, typically towards a woman, is a common feature of mainstream pornography. There is evidence to indicate that the more one views pornography, and extreme pornography in particular, the more likely it is that the consumer holds more aggressive attitudes and is more likely to objectify women (Hald et al., 2010; Lim et al. 2016). A large meta-analytic study with adult men and women found an association between consumption of online pornography and sexual aggression, but this finding was more robust for verbal rather than physical aggression (Wright et al., 2016a, 2016b).

In a 2019 UK survey (N = 2,002) 38% of women under 40 had experienced strangulation during sex, with 42% of those saying it was unwanted, and that they had felt pressured, coerced, or forced (BBC, 2019).⁵ Strangulation has become normalised amongst the younger generation. In my work with young women under the age of 25, and as young as 14, I have been struck by their acceptance of strangulation as a ‘normal’ request by boys/men, even though they do not enjoy it. It was also clear that none of them understood the risk this involved. It can take more pressure to open a canned drink than to occlude the jugular vein. ‘Breath play’, as it is euphemistically referred to, is potentially lethal. Pornography use is a contributory factor in making such sexual behaviour seem normal and even attractive. A wide range of injuries can be sustained by this activity. Sexual strangulation is the second most common cause of stroke in women under 42 (Bichard et al., 2022). Moreover, because dyspraxia, amnesia, and unconsciousness, which can occur in as little as four seconds, are all potential consequences of strangulation, the consciousness that is needed to withdraw consent is severely compromised.

Alongside the findings that point in the direction of a link between pornography use and sexually violent behaviour, we also find several studies that are inconclusive or contradictory about the association between them (Horvath et al., 2013). Sexual aggression is multi-determined and is likely moderated by individual differences, urging caution against drawing direct causal links (Malamuth et al., 2012). Nevertheless, even though we should exercise caution in this respect, I suggest that we have sufficient evidence to justify explicit interest in our patients’ use of pornography and to be alert to its risks, especially in our work with children, adolescents, and young adults who are nowadays prominent consumers of pornography because it is within easy reach online.

Old book, new cover? How online pornography differs

If the habitual consumption of online pornography is harmful, how might the harms be connected to or result from pornography’s online platform? To date research has focused on the online medium’s effects on habituation and excessive stimulation (Wilson, 2017). The difference between pre-Internet and online pornography is not in any straightforward sense only one of degree. Drawing on a psychoanalytically informed conceptual framework, I have argued elsewhere that the online medium changes, in prudentially significant ways, the consumer’s relationship to sexual material by providing a virtual space within which sexual desire is gratified quickly and non-reflectively, undermining the consumer’s capacity a) to mentalise their sexual desire and that of the other and b) to evaluate the risks associated with the consumption of online pornography (Lemma, 2020, 2021, 2021; Stanley et al., 2018b).

Pre-Internet we inhabited a world that I have characterized as a 3D(esire) world where ‘Desire’ was followed by ‘Delay’ and finally ‘Delivery’ of what we desired (Lemma, 2017). The psychological ‘work of desire’ (i.e., the psychic work consequent to the subjective experience of desire) rested on the development of a capacity to tolerate waiting and the state of frustration that this would give rise to. By contrast, we now live in a 2D(esire) world in which ‘Desire’ results in immediate ‘Delivery’ and bypasses altogether the experience of ‘Delay’. We have immediacy without any mediation. Speed (amplified by cost-free access to online pornography) now reduces the distance between desire and satisfaction: no effort and no waiting. Effectively, ‘the very experience of the cycle of desire has been disintermediated by the online medium’ (Lemma, 2017, p. 66).

‘Delay’ is a psychically important intermediary that encourages the work of representation of experience. The ‘work of desire’ and the anxieties this mobilises, is short-circuited by easy and rapid access to online pornographic images. Developmentally early (often unprocessed) experience fuels the unconscious search for specific sexual scripts and images. The state of mind that the consumer enters when using online pornography is one in which the unbiddable otherness of the other is reduced to a customised version of an ‘other’ felt to be entirely controlled by the self. In the best of circumstances, the otherness of the ‘other’, we might say, imposes a delay of sorts between our desire and its satisfaction. In pornographic virtual space instead, waiting for an actual other who might or might not want us, is replaced by the ‘pornographic other’ who becomes an object that can be manipulated and does not exist outside of our control. This is not an inevitable consequence of online pornography, but virtual space, because of its unique contingencies, lends itself to giving space to more primitive psychic states, such as the omnipotent state of mind I have just sketched out (see also Wood, 2011). All this, of course, is also true of off-line pornography. Recognition of the object of desire as other, that is as separate and with its own volition, is bypassed in both off-line and online pornography. Instead, imaginary possession is enacted through ‘looking’, through autoerotism, and in both media, this entails the negation of the other as a separate subject. However, the way sexual arousal is portrayed in online pornography, and the sheer volume of images that can be rapidly accessed, conspire to produce a potentially highly compelling version of sexual interaction precisely because it is unimpeded by the complexities of different desires and arousal patterns, or the consideration of another person’s needs that, in turn, would require the consumer of pornography to imaginatively identify with the other.

Speed of access and the volume of sexual imagery available online bypass representation through an excess of ‘presentation’. This is of less consequence when we are shopping at an online supermarket and are given the choice of ten different kinds of teas that we could buy. In the online pornography context, however, the choice of whether to consume pornography and what specific kind, is of greater import psychologically (and morally): pursuing ‘vanilla’ pornography is not at all the same for the individual as becoming aroused by watching torture chambers. The ‘choice’ is meaningful and has psychological consequences for how the person relates to her/himself and/or to potential partners, with the attendant risks.

It could be argued that being supplied with images, and not only their absence, can be a positive stimulus to elaborating sexual fantasy. This is indeed correct and reflects a shortcoming of psychoanalytic views that only emphasise the role played by absence of stimuli or frustration. Yet an intoxication of sexual stimuli is also problematic because it leaves no room for the mind to represent what it needs or wants and then to evaluate if this desire is sustaining of well-being or, on the contrary, may be harmful. Instead, it encourages a rapid shift from the possibility of a second-order representation of desire to pure stimulation and sensation undercutting any reflection. This can conspire to quickly escalate potentially harmful (to the self) behaviour online, something that was not possible on the same scale pre-Internet: for example, a magazine or VHS video did not allow any immediate escalation in the material being searched. Now that escalation is possible, we typically observe a predictable pattern. Initial preferences for ‘vanilla’ pornography only ever escalate in the direction of more sexually violent images, not less (Wood, 2013). This is for two reasons. First, pornography exerts a regressive pull towards more infantile modes of sexuality, that is Freud’s (1905) ‘polymorphously perverse’ sexuality that originates in a world of early sensory pleasures that has no limits. Second, online pornography specifically plays on the arousal system’s antipathy to sameness: its use is driven incrementally by the need to achieve or maintain a high level of arousal, and this requires novelty (this contrasts with other potentially addictive behaviours such as alcohol problems where novelty does not play a role). This can lead to a quick escalation of sexual fantasies and takes the consumer where he had not consciously planned to go. This escalation is further amplified by the altered contingencies afforded by virtual space that impact on superego functioning. Because of the anonymity afforded by the Internet, it can invite a ‘disregard for authority’ and, at its worst, becomes a ‘corrupt authority’ (Wood, 2011, p. 136). Speed of presentation thus bears on the capacity to make an autonomous choice about whether and what to view.

Speed and ease of access, coupled with the altered mental state resulting from the specific contingencies of the online environment outlined so far, undermine the capacity to mentalise one’s own sexual desire and that of the other. The importance of mentalisation for healthy human relationships and for mental well-being is widely acknowledged in the psychological literature. In a sexual context, mentalising underpins a person’s ability to imagine, for example, that no matter how strong one’s personal desire for sex, this does not imply that our partner feels the same. Mentalising is what helps to bring perspective to why a partner might not want sex because it allows us to relate to a partner as having a separate mind and volition.

Throughout life the capacity to mentalise can be enhanced or diminished by a range of other environmental influences. I suggest that the online medium for pornography is one such environmental influence that diminishes the capacity to mentalise sexual desire. Mentalising is, of course, a matter of degree and depends on context and relationships, but importantly non-mentalising invariably leads to more non-mentalising: ‘The more we inhabit contexts where mentalising is inhibited or not supported, the more likely we are to neglect aspects of our experience that undermine our mental well-being’ (Lemma, 2021, p. 126). Due to its impact on mentalisation, online pornography has made it harder for the consumer to be intentional or reflective about the use of pornography and how it impacts on them and their relationships.

Clinical implications: ‘ask the question’

In this Brief Report, I have suggested that the consumption of online pornography has introduced risks that were much reduced, or not present, when pornography could only be accessed in print or off-line video formats. These risks are especially significant for the digital generation whose sexual development is now more likely to be shaped by online pornography. The experience of immediacy without mediation, the customization of the object of desire, and the way that the contingencies of virtual space facilitate the loosening, and even corruption, of superego control, are central features of online experience of prudential consequence for the psychological ‘work of desire’. Specifically, I have proposed that habitual use of online pornography un-trains the capacity to mentalise sexual desire and that this is a plausible account of how it can undermine sexual relationships.

To argue that online pornography has negative impacts does not negate that it may also have some ‘good’ outcomes, such as helping those who are marginalised by their sexual preferences to feel that these are normalised through online pornography’s wide reach. Pornography cannot be approached as a monolithic entity. The complex issues it raises do not lend themselves to simple moral assessments, causal accounts, or therapeutic solutions.

However, there is one clear and simple clinical implication of the research findings I have outlined in this report that we can easily routinely implement. We know that even occasional users of pornography rarely admit to using it because of embarrassment or shame. When the use is more problematic, many people struggle to openly share this without prompting. This is why it is important to enquire about pornography use when taking a history of personal relationships. Given the pervasiveness of online pornography and the significant costs to the individual and to their partners when its use becomes problematic, irrespective of the presenting problem, we should routinely ‘ask the question’. This is especially important when working with young people. The expert clinicians and researchers involved in the roundtable discussion as part of the UK Pornography Review were unanimous about the importance of ‘asking the question’.

My own experience of ‘asking the question’ has demonstrated to me the value of earlier identification of problematic use of online pornography and how much more difficult it would most likely have been to get to this problem without directly posing the question. As psychoanalytic practitioners we are careful to not introduce too much structure on the patient’s unfolding narrative by asking questions, preferring instead to prioritise exploration of the internal world. This restraint is important as we are trying to facilitate unconscious communication and the elaboration of the transference. However, some questions are best routinely covered at assessment to ensure early identification of problematic patterns so that the patient can then be helped to explore the inner world dynamics that may be driving a retreat into online pornography.

Patient anonymization statement

Potentially personally identifying information presented in this article that relates directly or indirectly to an individual, or individuals, has been changed to disguise and safeguard the confidentiality, privacy and data protection rights of those concerned, in accordance with the journal’s anonymization policy.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1. https://www.statista.com/statistics/1445661/most-visited-porn-websites

2. Accessed on 13 April 2024: https://www.childrenscommissioner.gov.uk/resource/a-lot-of-it-is-actually-just-abuse-young-people-and-pornography

3. ICD-11 now includes Compulsive Sexual Behaviour Disorder (CSBD), under which compulsive use of pornography can be classified. It is categorized as an impulse control disorder and not as a behavioural addiction.

4. The first site appeared in 1994.

5. British Broadcasting Corporation (2019). Savanta ComRes survey. Table with full results retrieved on 13/04/2024 from:

https://www.comresglobal.com/wp-content/uploads/2019/11/Final-BBC-5-Live-Tables_211119cdh.pdf