Case-Based Evidence for Screening Pornography in Marital Therapy

Introduction

The Internet has enhanced the number of opportunities for varied sexual experiences among couples by engaging in pornography use. A dyadic analysis of 430 participants in heterosexual relationships revealed the presence of improved sexual communication, more sexual experimentation, greater sexual knowledge, enhanced sexual closeness, and sexual excitement when the individuals engaged in sharing pornography with their partners.1^,2 However, research in this area also highlights the adverse impact of pornography use amongst couples. In a study of 20,000 married individuals, men who watched an X-rated movie in the last year were, 60% more likely to be divorced, 80% more likely to have had an extramarital affair, 15% less likely to be in a happy marriage, and 20% less likely to be happy with life overall.3 In case of women, the likelihood for each of the above scenarios was lesser except that they were 90% more likely to be involved in an extra marital affair.3

Traditionally, most mental health professionals agreed that pornography use was a harmless activity or even beneficial to marital sexuality. However, with the advent of online pornography, the usage patterns have been found to be more compulsive, coupled with loss of control, and an increased urge to use it much more frequently. This can lead to impairment of functioning and threatening attachment in the marital relationship.4 It has also been observed that an increase in preoccupation with pornography in 1 partner is often associated with deterioration of romantic, family, and work life.5 The solitary, secret use of pornography by keeping it out of knowledge of other partner, results in lack of interest in physical intimacy, makes the other partner insecure about the relationship, and contributes toward emotional coldness and decrease in emotional intimacy.6

The adverse effects of pornography is also known as pornography distress.7 Once woman partner becomes aware of pornography use by their male partner, they believe themselves to be less sexually desirable, unattractive, and experience a negative view of themselves as a wife and a woman.7 In the Indian context, a case report documents the association between indulgence in dating sites and the increased likelihood of developing sexual addiction and comorbid psychological conditions.8 However, there is paucity of literature which documents the role of pornography and its psychosocial correlates in causing marital distress. This study elucidates the case of a client, who approached the tertiary specialty center known as Service for Healthy of Technology (SHUT) Clinic for management of pornography in male partner.

Case Report

A young working couple, who has been married for 1 year, sought consultation at SHUT Clinic for the increased indulgence in and use of pornography by the male partner. This had culminated into increased marital distress for the past 6 months. The husband had been engaging in pornography use for the last 3 years. As reported, use of pornography started as modality to relax as well as to manage his loneliness and boredom. He used to access freely available pornography sites and sometimes also accessed paid sites. He used to engage in pornography use on most days of the week. The wife highlighted that it did not cause any visible dysfunctions in his daily activities or in his professional work. However, the wife reported that she started losing interest in physical intimacy due to type of sexual activities the husband started demanding. It was also revealed that he was drawn toward these sexual activities due to what he had previously viewed through online pornography videos. She often found him preoccupied with simulating the activities as witnessed online, rather than being involved in the present moment while having sex. She observed that he was less interested in engaging in foreplay and was more focused on achieving unrealistic sexual performance from himself and her. All these behaviors caused her to have minimal interest in sex and in sharing physically intimate moments with him. She reported that her inability to fulfil the unrealistic sexual demands also leads to marital and interpersonal difficulties on an everyday basis.

He never allowed her to access his smartphone and laptop. She learned about his habit of pornography use when she found him masturbating to pornography at night. On confrontation, the husband accepted his habit of watching pornography. This acceptance led to few days of abstinence from pornography. However, he gradually relapsed to watching pornography on most days of the week. He attributed this to his inability to resist the use, and more importantly, he enjoyed the novelty of sexual activities available in online pornography. It also helped him to distract from stressors of daily life and disagreements with his wife. In addition, it also helped him cope with the negative emotions experienced in the relationship. The wife insisted that the husband stops engaging in pornography use. She also highlighted the importance of not having unrealistic expectations in relation to performance and pleasure, while engaging in sexual intercourse. This led to lack of communication, increased disagreements, avoidance of physical intimacy, and distress in marital life.

The clinical interview of husband revealed the presence of craving, loss of control, compulsion to engage in pornography use, and poor interpersonal relationship with wife because of the same. This indicated problematic consumption of pornography. The wife was found to be anxious, introverted, and religious in nature. The husband was reported to be extroverted, independent, and a novelty seeker. The inability of the husband to maintain abstinence from pornography consumption often leads to quarrels in the familial context.

The wife secured a score indicating mild severity on Beck Depression Inventory.9 The wife reported decreased interest in engaging in outdoor activities, felt easily tired with tasks at home, experienced decreased appetite, and at times disturbed sleep. The couple also reported witnessing a decline in their productivity at the workplace. The behavioral contract was established to enhance engagement in offline interactive-based activities as well as promotion of abstinence from pornography. Since husband remained on the precontemplation stage to change during sessions. The couple attended few sessions at the SHUT clinic, but later discontinued due to unwillingness on the part of husband.

Discussion and Conclusion

This case report highlights the distress a couple underwent due to pornography consumption in 1 partner. The distress was manifested as a decreased interest in sex, avoidance of sex and physical intimacy, strained communication, poor interpersonal relationship, and marital dissatisfaction. The attitude of wife toward pornography use due to her religious beliefs also contributed toward the distress in the marital relationship. The case findings also corroborate with the observations of a study which included 161 women who were married to pornography users. A positive association was found between learning about secretive pornography use by their marital partner, unfavorable attitude towards pornography, religious salience, and differentiation of self. This often contributed to pornography distress resulting in marital dissatisfaction.10 In case of studies on men, pornography use was associated with lower relationship satisfaction for those who reported low emotional intimacy with a partner.11 The exploration of the dyadic nature of pornography use within 240 romantic couples found that male pornography use was associated with various negative well-being indicators, including less male and female relationship satisfaction, lower female sexual desire, and lower male positive communication. However, both-partner or couple pornography use was associated with higher reported sexual satisfaction for both partners but did not lead to any well-being indicators.12

This case throws light on the need to enhance the understanding of pornography use in marital partners, its consequences, and its impact on the quality of marital relationship and marital satisfaction. This has implications for developing therapeutic treatment modalities to utilize pornography in order to enhance marital satisfaction, as well as to manage decreased desire for sex and marital distress and dissatisfaction.

Ethical Statement

Informed consent of the human subjects had been taken prior to inclusion in the study. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

This study has been approved by the institutional and/or national research ethics committee.