Critique of “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

YBOP COMMENTS: A new study by a team of sexologists in Australia purportedly investigated porn’s impact on sexual function. The study claims to have found porn use isn’t associated with sexual dysfunctions, but rather “believing” you’re addicted to porn is associated with sexual dysfunction. However, this “study” used an invalid assessment (CPUI-9), and is based on a false premise (that duration of porn use is what leads to problems).

Problem #1 – Invalid Assessment: Cyber Pornography Use Inventory-9

A study (Fernandez et al., 2017) tested the validity of the CPUI-9, a purported “perceived pornography addiction” questionnaire developed by Joshua Grubbs, and found that it couldn’t accurately assess “perceived porn addiction”, and that individuals who say the feel “addicted” to porn, or feel they have compulsive use, actually struggle with compulsive use when they try to abstain. Put simply, a study tested the CPUI-9 and found that individuals who think they’re addicted to porn most likely are. (Do Cyber Pornography Use Inventory-9 Scores Reflect Actual Compulsivity in Internet Pornography Use? Exploring the Role of Abstinence Effort).

Quote from Fernandez et al., 2017:

Our findings suggest that if an individual perceives compulsivity in their own IP use, it is likely that these perceptions might be indeed reflective of reality.

The researchers in this new study, in the very last citation in the limitations section, eventually acknowledge Fernandez et al., 2017, but they egregiously ignore the main reason the CPUI-9 is invalid: it doesn’t measure “perceived addiction.” 

In an attempt to address the problems Fernandez et al., 2017 pointed out about the CPUI-9, this is what the sexologists on this new study said:

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).

While the above statement is true, the CPUI-9 is invalid because it inflates scores related to one’s moral disapproval, the main reason the CPUI-9 is an invalid assessment of so-called “perceived addiction”, is that it doesn’t accurately measure perceived addiction. Furthermore, it isn’t only that scores among those with moral opinions about porn are inflated, it is that those who have actual compulsive use are deflated, and are unrelated to “emotional distress scores.”

From Fernandez et al., 2017:

More importantly, actual compulsivity as conceptualized in the present study (failed abstinence attempts x abstinence effort) had no relationship with Emotional Distress scores. This suggests that individuals who experience actual compulsivity in their pornography use do not necessarily experience emotional distress associated with their pornography use.

Examining the CPUI-9 reveals three glaring truths exposed by the authors of Fernandez et al., 2017 (and in the YBOP critique):

  • The CPUI-9 cannot differentiate between an actual porn addiction and a mere belief in porn addiction (“perceived addiction”).
  • The first two sections (questions 1-6) assess the signs and symptoms of an actual pornography addiction (not “perceived pornography addiction”).
  • The “Emotional Distress” questions (7-9) assess levels of shame and guilt, and are not found in any other type of addiction assessment (i.e., they don’t belong).

Bottom line: The results of Fernandez et al., 2017 place all assertions based on CPUI-9 results, and all of the resulting headlines, in serious doubt.

Problem #2 – Duration of use does not predict problems, novelty does.

The sexologists said:

Our study provided further empirical evidence that simply watching “a lot of porn” or “watching porn for long durations” was not associated with ED.

The false assumption the sexologists make is that “duration of use” is what leads to problems, when past research showed that “sex applications used” (novelty) was a better predictor of problems than duration of use.

Results indicate that self-reported problems in daily life linked to online sexual activities were predicted by…the number of sex applications used when being on Internet sex sites in daily life, while the time spent on Internet sex sites (minutes per day) did not significantly contribute to explanation of variance in IATsex score.

Since its inception, YBOP has argued that it is the novelty that internet porn provides that is driving increasing rates of sexual dysfunction among young men, not simply time spent “watching” porn. Consider this, who experiences more stimulation: a guy who watches a 2-hour porn movie with 3 “sex” scenes, or a guy who has multiple tabs open with several different compilation videos showing clips of the most intense parts of extreme porn scenes? Of course, the second scenario is far more stimulating to the brains reward circuit.

Take famous musician John Mayor as an example, who in his famous Playboy interview said “There have probably been days when I saw 300 vaginas before I got out of bed.” Indeed, what sets internet porn apart from porn of the past isn’t mere nudity, but rather unending novelty.

Problem #3 – Startling high rates of erectile dysfunction among subjects left unexplained.

First, the authors acknowledge that their method of gathering subjects could be seen as “biased” because, well, it absolutely was.  They intentionally sought porn-enthusiastic subjects who did not feel “addicted” to porn.  

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.

They sought their subjects on the social media site Reddit.com:

an anonymous on-line survey that was advertised to Reddit social media groups whose sole function was to share [internet porn]

This same social media site also has communities where over a million people are trying to recover from porn addiction and porn-induced sexual dysfunctions. This is akin to going to a casino and asking gamblers who haven’t yet lost it all, how gambling has affected them and how they feel about their use in order to show gambling doesn’t cause problems, while a gambling addiction recovery clinic is next door. If you want to say smoking doesn’t lead to cancer, stay out of the ward.

Second, the study still found 27.4% of the subjects had erectile dysfunction! Even in non-clinical porn-loving sample.

From study:

the majority of men (72%) had no erection problems, however similar to other studies a total of 27.4% indicated mild ED or worse.

Yup, you read that right. This is yet another study on young men that found startling high rates of erectile dysfunction in young men (age 18-44 in this one). 

Based on the above problems, alternative results from this study could read like this: “Study finds almost 30% of porn users have erectile dysfunction, and those with a porn addiction are even more likely to experience sexual problems!”

It is a shame that the authors of this new study came so close to reality discussing the severe limitations of their study:
 
“a further criticism of our research may be that men in our sample are IP addicted, but are yet to realize.”
 
According to Fernandez et al,. 2017 and several other peer-reviewed critiques of “perceived addiction”, this is most likely true. These sexologists apparently are yet to realize it.
 
 

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. Whelan G, Brown J. Pornography Addiction: An Exploration of the Association Between Perceived Addiction, Erectile Dysfunction, Premature (Early) Ejaculation, and Sexual Satisfaction in Males Aged 18-44 Years. J Sex Med 2021;XX:XXX–XXX.