Malki K, Rahm C, Öberg KG, et al. Frequency of Pornography Use and Sexual Health Outcomes in Sweden: Analysis of a National Probability Survey. J Sex Med 2021;XX:XXX–XXX. Sep 12 2021. https://doi.org/10.1016/j.jsxm.2021.08.003
Abstract
Background: Little is known about pornography use and its relationship with sexual health outcomes in the general population.
Aim: To assess frequency of pornography use and the association of sexual health outcomes with frequent pornography use in Sweden.
Methods: Cross-sectional analysis of 14,135 participants (6,169 men and 7,966 women) aged 16–84 years in a Swedish nationally representative survey from 2017. We used logistic regression to assess the association of sexual health outcomes with use of pornography ≥3 times/wk.
Outcomes: Frequency of pornography use (never; less than once/mo to 3 times/mo; 1–2 times/wk; 3–5 times/wk; and daily or almost daily) and sexual health outcomes (eg, sexual satisfaction and sexual health problems).
Results: In total, 68.7% of men and 27.0% of women used pornography. Among men aged 16–24 years, 17.2% used pornography daily or almost daily, 24.7% used pornography 3–5 d/wk and 23.7% used pornography 1–2 d/wk. Among women aged 16–24 years, the proportions were 1.2% for daily or almost daily, 3.1% for 3–5 times/wk, and 8.6% for 1–2 times/wk. Frequency of pornography use decreased with age among both men and women. While 22.6% of all men and 15.4% of all women reported that their or a sex partner's pornography use predominantly had positive effects on their sex life, 4.7% of men and 4.0% of women reported that the effects were predominantly negative. Variables indicating sexual dissatisfaction and sexual health problems were associated with use of pornography ≥3 times/wk: for example, dissatisfaction with sex life (age-adjusted odds ratio [aOR]: men 2.90 [95% CI 2.40–3.51]; women 1.85 [95% CI 1.09–3.16]), not having sex in the preferred way (aOR: men 2.48 [95% CI 1.92–3.20]; women 3.59 [95% CI 2.00–6.42]) and erection problems (aOR: men 2.18 [95% CI 1.73–2.76]).
Clinical Implications: While frequent pornography use is common, potential effects on sexual health outcomes are likely to differ between individuals.
Strength & Limitations: We used a large and recent nationally representative survey with detailed information regarding frequency of pornography use. The temporality of associations of sexual health variables with frequency of pornography use could not be assessed.
Conclusion: In this analysis of a nationally representative survey in Sweden, we found that frequent pornography use was common among young men; that reporting predominantly positive effects of pornography use on the sex life was more common than reporting predominantly negative effects; and that sexual dissatisfaction and sexual health problems were associated with using pornography ≥3 times/wk.
Key Words: PornographyNational Probability SurveySexual Health OutcomesSexual SatisfactionSexual Dysfunction
We assessed the frequency of pornography use and its association with sexual health outcomes using a large and nationally representative survey from 2017 in Sweden. In line with data presented in the survey report,33 around 70% of men and 30% of women aged 16–84 years used pornography; the frequency was higher in younger age groups and decreased with age. Among men aged 16–24 years, approximately 40% used pornography at least 3 times per week (of which around half used pornography daily or almost daily), and over 20% used pornography 1–2 times/wk. Among women in the same age group approximately 4% used pornography at least 3 times per week and 9% used pornography 1-2 times/wk. While less than 5% of men and women reported that their or a sex partner's pornography use had predominantly negative effects on the sex life, over 20% of men and 15% of women reported predominantly positive effects. Dissatisfaction with the quality and quantity of sexual activity and (especially among men) sexual health problems were associated with using pornography 3 times per week or more.
Data on frequent pornography use have been scarce as most studies have used small online surveys or self-selected samples and published data from population-based surveys have not included fine grained information about the frequency of pornography use.26,28,31,32 Data on weekly or monthly pornography use have been presented for 2 US nationally representative surveys from the past decade, although these surveys have not focused on sexual health outcomes. In the Relationship in America survey from 2014, 40% of men and 19% of women aged 18-23 years had used pornography in the past week.30 In the New Family Structures Study from 2011 to 2012, 47% of men and 21% of women aged 18–23 years reported using pornography once a month or more.30 While more detailed data were not presented for these US surveys, weekly pornography use in our Swedish study vs the Relationship in America survey was more common among young men and less common among young women. While it is possible that pornography use differs between the populations, there may be differences between the surveys in the type of individuals who participated and in how they reported their pornography use. Moreover, our study used more recent data (from 2017) and use of smartphone devices and the availability of online entertainment have increased rapidly in the past years.
In accordance with previous research,10,26,38 we found that a minority of individuals reported that their or a sex partner's pornography use had predominantly negative effects on their sex life and reporting of predominantly positive effects was substantially more common. Importantly, frequent pornography use has been subject to much societal concern due to suggested effects on sexual wellbeing and sexual health problems although the evidence regarding such claims is conflicting.2,10, 11, 12, 13, 14, 15,27 We found associations of frequent pornography use with dissatisfaction with the quantity and quality of sexual activity and among men, with lack of arousal when having sex and erection problems. Moreover, we observed an association between frequent pornography use and not having had sex in the last year among men (which was in contrast with previous studies26,39), but not women. Further, while frequent pornography use was associated with reporting predominantly positive effects on the sex life among both men and women, an association with reporting predominantly negative effects was only observed for men; this is in line with previous observations indicating that self-reported problematic use of pornography is more common among men.
Use of pornography has been associated with changes in behaviors during sexual activity29,40 and it has been hypothesized that frequent pornography use introduces dissatisfaction by affecting expectations on sexual activity.41,42 Moreover, pornography use has been suggested to decrease partnered sexual activity and long-term sexual relationships by providing a more easily available substitute.43 However, it is reasonable to hypothesize that sexual dissatisfaction or not being able to find sex partners might increase pornography use.44 Similarly, while frequent pornography use could be hypothesized to increase the risk of sexual health problems, individuals who experience such problems may also use more pornography. The associations could also be explained by other factors (such as stress and boredom45) associated with frequent pornography use and with sexual dissatisfaction, not having partnered sex (among men) and sexual health problems. In fact, erection problems and some variables indicating sexual dissatisfaction were associated with both reporting of predominantly positive and predominantly negative effects of pornography on the sex life, indicating no consistent directionality in the associations of pornography use, as experienced by the respondents, with such outcomes. While the experience of pornography use, its potential effects on sexual health outcomes and the underlying mechanisms for such possible links are likely to differ greatly between individuals, specific sexual interests and type of pornography consumed,21,27 causal effects of pornography use on the group level can only be established in interventional studies. The findings from this study should be considered as hypothesis generating.
Limitations
We used survey data, which are subject to response and reporting bias,30,46 although such biases might have been mitigated by the use of self-administered questionnaires47, 48, 49 and the weighting of the sample to be representative of the Swedish population with respect to the distribution of gender, age, region, country of birth and educational level. The survey did not define pornography, nor was information available about the type of pornography used and the duration and context of use. The questions used in the survey had not been validated and their interpretation may have differed between participants. Because the data were cross-sectional, we could not assess temporality of the associations of sociodemographic and sexual health variables with the frequency and self-reported effects of pornography use.
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