Dec 02, 2019
By Janet Zacharias , Lynn Scruby

Addressing Pornography, Part 1: Harms on individuals, families and society

Take away messages:

  • It is increasingly evident that there is a critical connection between technology, pornography and wellbeing.
  • Nurses can gain important insights into the health and social impact of pornography based on current research.
  • Pornography is considered by many to be a serious public health issue.

Access, anonymity, and availability of free online pornographic material have been identified as the most significant factors in increased consumption of pornography, and negative health impacts on the individual, families, and society have been strongly associated with pornography use. The decision by the state of Utah to declare pornography a public health crisis in April 2016 (the first US state to do so) provided our impetus to review the current literature pertaining to pornography harms. In Canada, the Standing Committee on Health in Ottawa conducted a study on the health impacts of violent and degrading pornography in 2017 and made four recommendations based on study findings (Government of Canada, 2017).

In part 1 of this article, we present findings from a literature review on the harms of pornography pertaining to health and well-being to inform Canadian nurses about this issue. In part 2, we present recommendations to address this issue from a public health perspective.

A hypersexualized culture and today’s pornography

Pornographic activities often include explicit and graphic views of genitals and acts, such as masturbation, as well as vaginal, oral, and anal sex, intended to elicit sexual arousal (Peter & Valkenburg, 2016).

Content has drastically changed over the past decades, and today’s Internet pornography commonly includes violence, perversion, and a perceived sense of pleasure from inflicted pain (Riemersma & Sytsma, 2013). Sexual behaviour has increasingly become depersonalized and dehumanized; what was once considered unacceptable sexual behaviour has now become acceptable online. Currently, 88% of downloaded pornography includes violence against women (e.g., spanking, gagging, slapping); 48.7% includes verbal aggression (e.g., name-calling) (Bridges, Wosnitzer, Scharrer, Sun, & Liberman, 2010).

The rise of the Internet has been identified as a key factor responsible for increased access to pornography (Bulot, Leurent, & Collier, 2015), which is often free and highly variable in content. Thus, pornography is primarily a 21st-century phenomenon of the technological era.

How big is the problem?

Worldwide, pornography is a multibillion-dollar industry. Nearly all men and 80% of university-aged women have been exposed to pornography as adolescents (Bulot et al., 2015), and 84% of young men and 19% of young women watch pornography weekly or daily (Lim, Agius, Carrotte, Vella, & Hellard, 2017). While reported statistics on first exposure vary, the increase in pornography use has been consistent, with first exposure occurring at younger ages (Lim, Carrote, & Hellard, 2016).

Its addictive nature

A large body of research indicates a strong correlation between problematic sexual behaviour, such as pornography use, and addiction (Lim et al., 2016). Magnetic resonance imaging (MRI) studies reveal that viewing pornography activates the same brain regions as does substance addiction, including nicotine, cocaine, and alcohol addiction (Voon et al., 2014).

Historically, those at highest risk of forming addictive patterns relating to problematic sexual behaviour, such as pornography addiction, typically tend to suffer from unresolved or concurrent psychological problems that often stem from childhood (Riemersma & Sytsma, 2013). A concerning finding, however, points to a new type of addictive pattern, where no underlying psychological problem is evident in affected individuals. This type affects particularly the younger generation and puts everyone at risk wherever access exists.

Erectile dysfunction (ED)

Erectile dysfunction has become increasingly common in men younger than 40 (Park et al., 2016; Voon et al., 2014). Studies identify a strong link between pornography use and ED (Voon et al., 2014); clinical reports yield similar findings, adding that abstaining from pornography use can be effective in treating ED, a finding that suggests the condition is not solely a physiological one but has a significant psychological and/or behavioural component (Park et al., 2016).

Adolescent health and high-risk behaviours

Increased pornography use is linked to earlier sexual activity, a higher number of partners, and engaging in casual sex (Bulot et al., 2015). In adolescents, increased pornography use is associated with high-risk sexual behaviours, including anal sex, unsafe sex, and alcohol or drug use. However, the impacts of pornography use among adolescents are much broader, including lower self-esteem, social immaturity, higher social isolation, behavioural issues, depression, and reduced healthy emotional attachments with family (Owens, Behun, Manning, & Reid, 2012).

The internet has fostered an increased exposure to pornography. (Drawing used and modified with permission by Faye Hall, Winnipeg Artist)

Pornography affects sexual health within relationships

A strong negative correlation exists between pornography use and marital well-being (Doran & Price, 2014; Maddox, Rhoades, & Markman, 2011). Pornography use is linked to poor self-image, unrealistic expectations regarding partners (Goldsmith, Dunkley, Dang, & Gorzalka, 2017), and lower sexual satisfaction and relationship contentment (Doran & Price, 2014). It is also associated with increasing acceptance of teenage, premarital, and extramarital sex (Wright, 2013). Long-term implications include increased loneliness in a relationship, relational isolation, and relational deterioration (Butler, Pereyra, Draper, Leonhardt, & Skinner, 2018). Pornography is also a significant factor in divorce (Doran & Price, 2014).

Attitude and behavioural changes

Adolescents often use pornography as a source of sexual education, which contributes to their forming expectations around a type of sexuality that is demanding (Mattebo, Larsson, Tydén, & Häggström-Nordin, 2013). Given that pornography is based on fantasy, youths’ reliance on pornography for sex education can skew their views of healthy sexuality (Bulot et al., 2015; Lim et al., 2016; Owens et al., 2012).

Gender issues: Violence and exploitation of women

Recurrent pornography use has been linked to increased violence toward women (Lim et al., 2016). In pornography, most verbal and physical violence (95%) is directed toward women (Bridges et al., 2010), who often perform degrading, painful, and violent sexual acts, thereby normalizing behaviours that the majority of women do not find pleasant (Harrison & Ollis, 2015). Male and female expectations relating to sexual relations differ; about half of women in a committed relationship do not approve of pornography use, and one-third view its use as infidelity (Carroll, Busby, Willoughby, & Brown, 2017). Pornography use also tends to be the starting point for other sexual behaviours, such as prostitution (McIntyre, Clark, Lewis, & Reynolds, 2015).

So what?

Because pornography has been identified as a social and public health issue, it calls for action from a health care perspective. In part 2, we offer four main recommendations to combat this issue from a public health perspective.

Authors’ note

We reviewed the academic literature, focusing on the last five years, using search engines including CINAHL, Scopus, and PubMed. Study types included previous literature reviews, meta-analyses, longitudinal designs, and clinical, experimental, and observational studies. The extent of Canadian studies was limited, with most research originating from the US, followed by Europe. Key studies reviewed are referenced herein.


Bridges, A. J., Wosnitzer, R., Scharrer, E., Sun, C., & Liberman, R. (2010). Aggression and sexual behavior in best-selling pornography videos: A content analysis update. Violence Against Women, 16(10), 1065–1085. doi:10.1177/1077801210382866

Bulot, C., Leurent, B., & Collier, F. (2015). Pornography, sexual behavior and risk behavior at university. Sexologies, 24(4), 187–193. doi:10.1016/j.sexol.2015.09.006

Butler, M. H., Pereyra, S. A., Draper, T. W., Leonhardt, N. D., & Skinner, K. B. (2018). Pornography use and loneliness: A bidirectional recursive model and pilot investigation. Journal of Sex and Marital Therapy, 44(2), 127–137. doi:10.1080/0092623X.2017.1321601

Carroll, J. S., Busby, D. M., Willoughby, B. J., & Brown, C. C. (2017). The porn gap: Differences in men’s and women’s pornography patterns in couple relationships. Journal of Couple & Relationship Therapy, 16(2), 146–163. doi:10.1080/15332691.2016.1238796

Doran, K., & Price, J. (2014). Pornography and marriage. Journal of Family and Economic Issues, 35(4), 489–498. doi:10.1007/s10834-014-9391-6

Goldsmith, K., Dunkley, C. R., Dang, S. S., & Gorzalka, B. B. (2017). Pornography consumption and its association with sexual concerns and expectations among young men and women. Canadian Journal of Human Sexuality, 26(2), 151–162. doi:10.3138/cjhs.262-a2

Government of Canada, Minister of Health. (2017). Response from minister of health.

Harrison, L., & Ollis, D. (2015). Young people, pleasure, and the normalization of pornography: Sexual health and well-being in a time of proliferation? In J. Wyn & H. Cahill (Eds.), Handbook of children and youth studies (pp. 155–167). New York: Springer. doi:10.1007/978-981-4451-15-4_13

Lim, M. S. C., Carrote, E. R., & Hellard, M. E. (2016). The impact of pornography on gender-based violence, sexual health and well-being: What do we know? Journal of Epidemiology and Community Health, 70(1), 3–5. doi:10.1136/jech-2015-205453

Lim, M. S. C., Agius, P. A., Carrotte, E. R., Vella, A. M., & Hellard, M. E. (2017). Young Australians’ use of pornography and associations with sexual risk behaviors. Australia and New Zealand Journal of Public Health, 41(4), 438–443. doi:10.1111/1753-6405.12678

Maddox, A. M., Rhoades, G. K., & Markman, H. J. (2011). Viewing sexually-explicit materials alone or together: Associations with relationship quality. Archives of Sexual Behavior, 42(2), 441–448. doi:10.1007/s10508-009-9585-4

Mattebo, M., Larsson, M., Tydén, T., & Häggström-Nordin, E. (2013). Professionals’ perceptions of the effect of pornography on Swedish adolescents. Public Health Nursing, 31(3), 196–205. doi:10.1111/phn.12058

McIntyre, S., Clark, D., Lewis, N., & Reynolds, T. (2015). The role of technology in human trafficking. A white paper prepared for Microsoft.

Owens, E. W., Behun, R. J., Manning, J. C., & Reid, R. C. (2012). The impact of Internet pornography on adolescents: A review of the research. Sexual Addiction & Compulsivity, 19(1–2), 99–122. doi:10.1080/10720162.2012.660431

Park, B. Y., Wilson, G., Berger, J., Christman, M., Reina, B., … Doan, A. P. (2016). Is Internet pornography causing sexual dysfunctions? A review with clinical reports. Behavioral Sciences, 6(3), E17. doi:10.3390/bs6030017

Peter, J., & Valkenburg, P. M. (2016). Adolescents and pornography: A review of 20 years of research. Journal of Sex Research, 53(4–5), 509–531. doi:10.1080/00224499.2016.1143441

Riemersma, J., & Sytsma, M. (2013). A new generation of sexual addiction. Sexual Addiction & Compulsivity, 20(4), 306–322. doi:10.1080/10720162.2013.843067

Voon, V., Mole, T. B., Banca, P., Porter, L., Morris, L., … Irvine, M. (2014). Neural correlates of sexual cue reactivity in individuals with and without compulsive sexual behaviors. PLOS One, 9(7), 1–9. doi:10.1371/journal.pone.0102419

Wright, P. J. (2013). U.S. males and pornography, 1973–2010: Consumption, predictors, correlates. Journal of Sex Research, 50(1), 60–71. doi:10.1080/00224499.2011.628132

Janet Zacharias, RN, BN is a Clinical Instructor at Red River College in Winnipeg, Manitoba. Email:

Lynn Scruby, RN, PhD is an Assistant Professor at the College of Nursing, Rady Faculty of Health Sciences, University of Manitoba.
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