Introduction
Since the end of the 20th century, there has been a tremendous increase in the use of internet, social media, and smartphones, resulting in the permanent online presence of the pornography industry. On the web, there is the availability of pornographic material with free access, which makes it even easy for those under 18s. Online pornography use is increasing and can cause addiction considering the “triple A” influence, including accessibility, affordability, and anonymity.
Because of the cultural stigma of moral status, it is difficult for researchers to define pornography, and they utilize euphemism phrases such as uncensored media or materials, aphrodisiacal, or online sexual activity to refer to pornography.– The average age of pornography consumers declined in current years, which enlightens that people at an early age are being exposed to such media or materials and may influence the understanding of young adults regarding sexual behavior. They get confused to find normal, acceptable, and rewarding sexual attitudes.
The topic of pornography use is controversial. There is a different opinion regarding pornography use in various sources in which some claim that it is having negative impacts, positive results, or likely to possess mixed consequences. There is an increase in discussion regarding the influence of pornography on sexual health and behavior, which revealed that young people are using pornography as a form of sexual education.
In contrast, pornography can be scrutinized positively, as if it offers an approach to explore one’s sexuality., Even before the marriage, couples are exposed to watching pornography during their counseling, and sometimes psychologists recommend watching pornography together for the couples who were having problems in their marital life.
There is an increase in discussion regarding the influence of pornography on sexual health and behavior which revealed that young people are utilizing pornography as a source of sexual education and implementing the practices viewed into their genuine experience. In addition, several literature express its impact on mental health, such as the pressure experienced by women to engage in anal intercourse, which is shown in 15% to 32% of pornographic scenes. It is easy to get articles regarding how pornography is affecting lives but challenging to conclude whether pornography is good for sexual heath.
The purpose of this systematic review is to learn more about how young people use pornography and if it has negative consequences for their health and well-being. Furthermore, the review will aid in addressing or exploring the argument over whether pornography addiction is good for sexual health or not.
Design and Methodology
Study Design
This systematic review included observational and experimental studies, following qualitative and quantitative methods.
Search Strategy
To justify the need for this systematic review, a search was conducted in the Cochrane database of systematic reviews to see if any existing or ongoing systematic reviews on the topic were available, and then a review of existing literatures was conducted on PubMed, JSTOR, Ovid Medline, Ovid Embase, EBSCO, CINAHL plus, and Biomed Central, which revealed that several studies had been conducted regarding how pornography is viewed. Despite this, no systematic review (SR) addressed whether pornography is beneficial to sexual health.
PubMed, Embase, CINAHL plus, Cochrane databases, and Google Scholar were used to conduct a comprehensive search using the MeSH terms “pornography” and “sexual health,” connected using the Boolean operators “AND” and “OR.” The literature search was not restricted to a single nation; however, it was limited from the years 2000 to 2010. Because of their applicability, SPIDER search strategy techniques (sample, phenomena of interest, design, assessment, and study type) were utilized to conduct the SR (Table 1). The database search resulted in 144, 314, 120, and 32 articles from CINAHL plus, PubMed, Google Scholar, and Cochrane library, respectively, which is shown in Figure 1.
Study Selection
Inclusion and exclusion criteria (IC/EC) are listed in Table 2.
Before implementing the IC and EC, manual screening was done to 610 articles to avoid duplication bias. After removing 126 duplicate articles, the literature search resulted in 484 papers. After screening those papers with the designed IC and EC, 20 were taken for assessing eligibility, and final 13 articles were selected for the critical appraisal. In contrast, others were not peer-reviewed, which may affect the quality of research and cause bias.
Inclusion Criteria and Exclusion Criteria Implementation
Initially, the discovered publications were checked for research type (R) based on the title, which resulted in the exclusion of numerous studies based on IC/EC. The second step, which was confined to data acquired through interviews, focus groups, questionnaires, and surveys, including qualitative and quantitative research, evaluated the abstract for sample (S) and design (D). In several studies, the particular goal of determining whether or not pornography addiction is beneficial to sexual health and its impact on sexual health was not stated in the abstract. At the third screening step, IC/EC for the phenomena of interest (PI) and evaluation (E) was adopted. A total of 20 publications were scanned for full-text evaluation and categorized as “E” or “D.” Articles with insufficient or misdirected information regarding the impact of pornography on sexual health were eliminated. After adopting IC/EC, a final of 14 publications were listed in the SR for critical assessment (Figure 1 and Table 2).
PRISMA Flow Chart
Critical Appraisal
The methodological strengths and weaknesses of 13 studies and the study’s validity, the results’ dependability, and the existence of biases were examined using the critical assessment (refer to Table 3). The studies were also examined to see if they were well-designed, conducted, and published, as well as if they addressed the systematic review question. The studies were evaluated using a variety of methodologies, with the critical appraisal skills program (CASP) being used to grade the qualitative research’s quality. The cross-sectional study appraisal instrument (AXIS) was designed particularly for cross-sectional research assessment.
Ethical Statement
The School Research Ethics Panel (SREP) allied health at Anglia Ruskin University received an application for ethical approval and determined that no ethical consent was required for this study because the systematic review only required retrieving and synthesizing data from previously published articles.
The Outcome of the Critical Appraisal and Ethical Appraisal
After a thorough and ethical examination, 11 papers were chosen for the review. Because of a lack of information on participant permission and obtaining ethical approval, and low internal validity of the study, which affects the dependability of the results, 2 studies were excluded from this systematic review.
Data Abstraction
Microsoft Excel was used to extract the data. The data retrieved included the article’s in-text reference, research design, study context, sample size, and if the study’s major goal was connected to pornography and sexual health, was pornography beneficial or bad for sexual health? The study limitations and conclusion are also included.
Analysis
After organizing and analyzing the data taken from the final articles using Microsoft Excel, a textual narrative synthesis was performed, as though it had data from both qualitative and quantitative research, and meta-analysis could not be completed for such method studies.
Results
Characteristics of the Included Studies
3 of the studies were conducted in the United States; the others were conducted in Malaysia, Ethiopia, Hungary, Nigeria, Indonesia, and Brazil, and one study was conducted in both the United States and Hungary. All the researchers analyzed the influence of pornography on sexual health, but 2 of them (Ali et al and Mesquita et al) explored the fantasy and discourse around online pornography usage.
The Designs of the Included Studies
There was one qualitative study that collected data via in-depth interviews through interpretative and exploratory approach, and 10 cross-sectional studies–community-based, school-based, college-based, and household surveys were included in the SR, in which the data were collected via self-administered questionnaires, computer-assisted interviews, probability-based web panel.
Source of Information Regarding the Effects of Pornography Addiction on Sexual Health
Except for Bőthe et al, who used a previously published research on the news site, the data retrieved from the studies were self-reported by the participants. Each study reported their own experiences with pornographic exposures based on internet access and technical abilities, and each study included varied samples varying in age groups (adults and adolescents) and educational levels. Table 5 shows the characteristics, designs, sources of information, and summaries of the findings.
After the analysis, 6 major themes were identified from the reviewed articles which included the following themes.
Risky Sexual Behavior Because of Pornographic Exposure
The frequency of pornographic exposure is often related to sexual dissatisfaction, a higher preference for sexual intercourse, and the increased frequency of masturbation. Later sexual aggressiveness, liberal sexual norms and gender role views, earlier sexual behavior, poorer levels of sexual pleasure, more desires for certain body types, unfavorable attitudes toward monogamy, group sex involvement, and larger numbers of sexual partners, associate with an increased number of hook up partners, oral sex and sexual intercourse during a hookup, sexual permissiveness, anal intercourse, number of sexual partners, engaging in extramarital sex, and in paying for sex.
Sexual Functioning Problems and PPU/FPU
Frequency of pornography use (FPU) is caused by increased sexual desire, which encourages sexual thoughts, resulting in faster sexual reactions and higher levels of sexual comfort and self-acceptance and lower levels of sexual anxiety, shame, and guilt. People who view too much pornography are more likely to have a refractory period while trying to engage in sexual activities with their partner, leading to problems with sexual functioning. Sexual anxiety was shown to be positively connected with problematic pornography use (PPU) severity, whereas sexual satisfaction was found to be adversely associated. When comparing PPU and FPU, FPU showed a slight unfavorable connection with sexual functioning difficulties.
Compulsive Pornography Uses and Mental Health
According to Camilleri et al, there is a potential link between pornography use and decreased mental well-being and lower psychosocial functioning in those who reported higher levels of internet pornography addiction behaviors. Like the clinical expression of anxiety (American Psychiatric Association, 2013), feelings of restlessness/frustration/irritation when unable to access pornography websites significantly predicted both anxiety and stress. It is represented by preoccupation, behaviors such as rushing work to access pornography websites, and dependence, challenging to stop using pornography websites, reflecting a level of dependence-related anxiety.
Adolescent Dating Abuse Because of Pornography Use
Adolescent dating abuse (ADA) is now considered one of the country’s most significant public health concerns. Pornography use in the company of others, being asked to perform a sexual act first seen in pornography, and watching pornography while or after marijuana use have all been connected to ADA victimization.
Effects of Pornography Use on Sexual Response During Masturbation
Consumption of pornography may lead to male porn consumers masturbating more frequently than they would otherwise. Frequent masturbation (because of regular pornography use) could undermine male porn users’ sexual performance, arousability, or partnered sexual interest by keeping these porn users in a near-continual state of relative postejaculatory refractory time (PERT), in which their arousal is suppressed.
Fantasy and Discourse in Consumption of Online Pornography
The consumption of pornography reflects and refracts socially established features established as beautiful and adequate in terms of body shape. It is also possible to state that the female and male “standards” disseminated by the pornographic industry cause a few expectations, create complexes, and intensify the low self-esteem of both women and men because some women understand that to please their partners, they must look exactly like the porno actresses. Men believe that they must have the same sexual organs as those presented in porno videos and movies to prove their masculinity and satisfy their partners.
Discussion
The consequences of pornography use continue to be a source of controversy as the literature indicates reports of both positive and negative effects of pornography use on the consumer. Among individuals who view pornography use as acceptable, such use opens the door to sexual empowerment and autonomy. According to McNabney et al, a higher frequency of pornography use predicted greater sexual functioning across all outcome variables during masturbation yet had no deleterious effects on sexual outcomes during partnered activity in females. In contrast, the same study reveals that frequent masturbation (because of frequent pornography use) could undermine male porn users’ sexual performance, arousability, or partnered sexual interest by keeping these porn users in a near-continual state of relative PERT, in which their arousal is suppressed. Pornographic exposure is frequently linked to sexual dissatisfaction, a higher preference for sexual intercourses, and increased masturbation, leading to subsequent sexual aggression, permissive sexual norms and gender role attitudes, earlier sexual behavior, lower levels of sexual satisfaction, higher preferences for specific body types, negative attitudes toward monogamy, participation in group sex, and higher numbers of sexualists.
When both PPU and FPU were included, FPU demonstrated a modest negative connection with community sexual functioning difficulties. Furthermore, it has a major negative influence on mental health, resulting in severe or extremely severe sadness, anxiety, and stress. Compulsive pornography users prefer accessing pornography over spending time with others, neglecting daily obligations because of selecting to access pornography, and rushing through work to access the websites. When it came to self-perception, young individuals were the most likely to say that pornography was the most useful source of knowledge about having sex. Because they regard this period to be intimate and utilized to achieve happiness and self-knowledge, they consume web content mostly through smartphones and computers in the absence of their spouses.
Strength and Limitations
This SR is the first to debate whether pornography is favorable for sexual health, which summarized the prevalence of pornography viewing and explained the elements that influence its frequency. At the same time, because of a dearth of studies specifically concentrating on the influence of pornography on sexual health, gaining a meaningful answer to the research question proved challenging. So, additional study into the concerns of whether porn attracts more individuals with sexually aggressive tendencies, those in unhappy relationships, those with weaker reward systems in their brains, and those with sexual addiction—or whether it triggers these things—should be undertaken.
Conclusion
The topic of pornography use is controversial. Watching pornography may be a healthy phenomenon if it is occasional, not impairing the personal and social life; however, it can become pathological if watched excessively and impairs the individual functioning.
Declaration of Conflicting Interests The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding The authors received no financial support for the research, authorship, and/or publication of this article.
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