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

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 consensus 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 dysfunction (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-perceived 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 interpretation 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.

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-presenting 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 Diversity 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 temporary problems with sexual dysfunction, both of which may contribute 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 sexual dysfunction specific scales.

What Is Internet Pornography (IP) Addiction?

Despite lack of formal recognition in the DSM-5,⁸ early empirical research reported on the existence of IP addiction as: compulsive 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 compulsive 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’ conceptualizations 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 propensity 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 interference with everyday life), and emotional distress (guilt, shame, and regret).^18,30 In the absence of consensus on a standardized definition 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 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 problems compared to frequent IP users.

IP Addiction and Sexual Dysfunction

On review of the last 20 years of literature, qualitative researchers found IP viewing was associated with both positive^32–36 and negative sexual outcomes.^35,37–40 Recently, clinicians focused on increased incidence of young men presenting with ED and postulated modern IP consumption as the cause.² Despite academic debate on whether prevalence of ED actually increased,⁴¹ consumer evidence for the association of IP and sexual problems is formidable. 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 experience 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 consumers suggesting a link between sexual dysfunction and IP addiction 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 association 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 demonstrated 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 dysfunction assessment scales.

Aims

To summarize, there appears to be a distinction between men with self-perceived IP addiction and recreational or frequent IP users in current research, with men with self-perceived IP addiction demonstrating 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 definition of IP use to include both the frequency (how often), and duration (how long one watches IP per session) to address qualitative 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 outcomes and extend research by moving from global screening measures of sexual response to using specific sexual dysfunction measures of ED and EE and SS. Third, we aim to assess whether self-perceived IP addiction predicts ED, EE, or individual and partner-specific 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 sexual content accessed via smartphone, tablet or computer.

Participants and Procedure

The key task was to find a non-clinical group of high frequency 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 representative 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 eliminated 14 men who were aged above 44 years to avoid skewing the data. When using Reddit websites to obtain a broad range of 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 pornography 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 individually 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 Cronbach α = 0.88; subscale range α = 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 indicating 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 α ranges from 0.73 and above, and test-retest ranges from r = 0.68–0.84.^53,54 In the present study, it was demonstrated that the IIEF-5 had good internal consistency (Cronbach α 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 instruments, 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 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 α = 0.64–0.86).⁵⁷ The internal consistency for our study was α = 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 strongest 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) Partner SS (SS-Partner) assesses: give and take, emotional exchange, partners initiation, orgasm, pleasure, creativity, availability, variety, 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-clinical populations.⁶² The NSSS was shown to have good internal consistency (SS-Self α = 0.91–0.93; SS-Partner α = 0.90–0.94.)⁶² The internal consistency for our study for both SS-Self and SS-Part was Cronbach α = 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 internal consistency (Depression α = 0.82–0.94; Anxiety α = 0.87–0.90; Stress α = 0.9–0.93).⁶⁷ Good internal consistency was demonstrated in our study with Cronbach ranges: Depression α = 0.92; Anxiety α = 0.78: Stress α = 0.85.

Frequency and Duration of IP Use: Operationalization of IP use in previous research is varied. However, frequency was usually 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’ frequency items to assess average viewing time per sitting.²³ Participants 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

RESULTS

Underlying Assumptions

We used SPSS (24) package. Following preliminary analysis using T test, Bivariate scatter plots, Histograms, Q–Q plots, variable skew and kurtosis all values were normally validated. Hierarchical Multiple Regression was performed with and without logarithm transformations, and there were no statistical differences between raw scores versus transformed scores: Raw data was used for statistical assumption compliance. The IIEF-5; CHEES and DASS-21-Anxiety scores were leptokurtic and negatively skewed in keeping with low rates of ED, EE and anxiety in the general population.^50,58,64 Heteroscedasity was questioned in the ED and EE variables so we performed Bootstrapping to ensure validity. There was no difference between Listwise and Pairwise results: Thus, Listwise analyses were reported. Homoscedasity was assessed by visual inspection of a plot of studentized residuals versus unstandardized predicted values. Due to the small numbers of men who met diagnostic cut off scores for ED and EE, we analyzed outcomes scores as continuous variables.

Preliminary Analysis

Independent T-test and One-Way ANOVA, using robust measures (Welch and Games Howell with P < .05) were performed to test whether a difference existed in outcome measures between men who were in relationships vs men who were single. Pearson’s correlations at 95% CI were used to examine associations between variables. Bonferroni correction was applied to an analysis to correct for number of correlations. Hierarchical multiple regression analysis was run with CPUI-9 subscales and total scores; both total score and subscales were significant, thus only total scores were reported. Standardized residuals were inspected and met acceptable parameters. There was no multi-collinearity within the data or in the model with VIF and tolerance rating with normal limits and variance proportions distributed across different dimensions. Independence of residuals was achieved with all Durbin Watson scores close to 2. Results were analyzed for outliers and no individual participant had undue influence as all leverage values <0.2, Cooks distance and DFBETAS <1.

Descriptive Statistics

Details on demographics and sex related variables are found in Table 1. and confirm our sample as high frequency IP viewers with majority (67.8%) viewing IP ≥4/wk. One way ANOVA found that that men in a monogamous relationship had twice the amount of partner sexual activity compared to those who were single (M = 4.33, SD 1.42 vs M = 2.88, SD = 1.41, P < .001), whilst men who had secret affairs accessed IP more frequently than those in monogamous relationships (M = 6.20, SD = 1.32, P = .008). There was no difference in relationship status for duration of IP use or masturbation.

Our sample was largely not concerned by their IP use with the majority of men (82.3%) reporting low scores on self-perceived IP addiction (see Table 2 for outcome variables). One way ANOVA found no difference in relationship status and self-perceived IP addiction, except for men who were in open/poly-amorous relationships who had less self-perceived IP addiction than all other men (M = 15.93, SD 7.23 vs single M = 19.56, SD 10, P = .02; monogamous M = 18.93, SD = 9.79, P = .03; secret affairs M = 20.44, SD 9.08, P = .04). ED: Using the recommended cut off score of ≤21,⁵⁵ the majority of men (72%) had no erection problems, however similar to other studies a total of 27.4% indicated mild ED or worse.^41,47,50 One way ANOVA demonstrated that men who were single had reduced erectile function to men who were in a monogamous relationship or open/poly-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 that corresponded to a low probability of EE, while 3.3% had scores indicative of EE. There was no difference between EE scores in men with different relationship status. SS: Most men reported moderate or higher individual SS (77.5%) and partner SS (64.2%). One-way ANOVA found men who were single demonstrated reduced individual satisfaction compared to men in monogamous and open/poly-amorous relationships (single M = 34.81, SD 7.96 vs monogamous M = 38.44, SD 7.3, P < .001; open/poly M = 39.56, SD 5.6, P < .001) and greater partner satisfaction in men in acknowledged open/poly-amorous relationships (M = 38.3, SD 9.34, vs single 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 analysis were performed to test for the unique contribution of self-perceived IP addiction on ED, EE, SS-Self and SS-Part. Variables identified in prior research were entered first. Accordingly, frequency and duration of IP use were added, then ED, EE, SS-Self, SS-Part, followed by DASS-21 subscales, and finally perceived 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 addiction 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, 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-perceived 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 demonstrated that individual sexual dissatisfaction was predicted by decreased satisfaction with one’s partner, increased erection problems, 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 expectations, there was no evidence of self-perceived IP addiction predicting 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 association between IP use and self-perceived IP addiction and sexual function, distinguishing between IP use (both frequency and duration), and self-perceived IP addiction. Our study provided further empirical evidence that simply watching “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 addiction can develop sexual problems regardless of their amount of IP use. In our study we found that increased ED was predicted 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 sexually 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 compared 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 sexual 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 feelings 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 addiction may create unfavourable comparisons with real life sexual 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 predicted 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 frustration about EE along with individual and partner dissatisfaction. 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-perception of inadequate ejaculatory latency/control and individual 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 preoccupation 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 frustration, 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 research into self-perceived IP addiction and EE, our interpretation 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 literature.⁷⁸ The unique predictor of self-perceived IP addiction and individual sexual dissatisfaction confirms extensive research associating 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. Certainly, 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 findings that single men have higher levels of ED and sexual dissatisfaction 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 providing 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 However, we believe that distress (shame, guilt, regret) may not just reflect moral disapproval, but may represent the fact that IP content can escalate to extreme deviations from real life sexual experience. 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 addiction, 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 limitation by assessing years of IP use, to see if self-perceived IP addiction 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. 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 sexual function. At this stage of empirical development this distinction 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 dysfunction in clinical samples. Finally, we believe the use of forced response was a limitation of our study as it was likely to have contributed 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 predicted 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 clinicians to screen for self-perceived IP addiction in young men presenting for treatment of sexual dysfunction.

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.

Funding

None.

REFERENCES

Author notes