The Impact of Pornography on Children
American College of Pediatricians – Updated August 2024
ABSTRACT: The availability and use of pornography has become almost ubiquitous among adults and adolescents. Consumption of pornography is associated with many negative emotional, psychological, sociological, and physical health outcomes. These include increased rates of depression, anxiety, acting out and violent behavior, younger age of sexual debut, sexual promiscuity, increased risk of teen pregnancy, child sex abuse, sexual trafficking, and a distorted view of relationships between men and women. For adults, pornography results in an increased likelihood of divorce which is also harmful to children. The American College of Pediatricians urges healthcare professionals to communicate the risks of pornography use to patients and their families and to offer resources both to protect children from viewing pornography and to treat individuals suffering from its negative effects.
Introduction
Pornography may be defined as “the depiction of erotic behavior (sexual display in pictures or writing) that is intended to cause sexual excitement” in the viewer.[1] Over the past decade there has been a large increase in the pornographic material that is available to both adults and children. Mainstream pornography use has grown common because it is accessible, affordable, and anonymous. It is accessible because it is just a few keystrokes away on the Internet. It is affordable because many online sites offer free pornography to lure viewers to their web sites. It is anonymous because it can be viewed in the privacy of a person’s home. There is no longer a need to visit an adult bookstore or the local XXX theatre. One of the primary uses for pornography is sexual stimulation followed by masturbation. This behavior has been shown to be highly addictive.
In 2008, the Internet and marketing firm Hitwise reported that globally 40,634 web sites distributed pornography.[2] In 2019, the cyber security firm Webroot stated that 35% of all digital downloads were related to pornography.[3] A research survey published in 2023 found that the revenue for the porn industry was $13 billion in the United States and $100 billion globally.[4] Every second $3,075 is spent on Internet pornography according Webroot. The world’s largest pornography site, Pornhub, claims it has 28.5 billion annual visits to its website and it averages 800 searches per second.[5]
Pornography Use and Its Prevalence
A 2014 Barna Group survey revealed the following demographic data regarding pornography use by American adults:[6]
· Among males 18-30 years old, 79% viewed pornography once per month and 63% viewed pornography greater than once per week.
· Among males 31-49 years old, 67% viewed pornography once per month and 38% viewed pornography greater than once per week.
· Among males 50-68 years old, 49% viewed pornography once per month and 25% viewed pornography greater than once per week.
· Among females 18-30 years old, 34% viewed pornography once per month and 19% viewed pornography more than once per week.
· Among females 31-49 years old, 16% viewed pornography once per month and 8% viewed pornography greater than once per week.
· Among females 50-68 years old, 5% viewed pornography once per month and 0% viewed pornography greater than once per week.
Impact on Children
Demographic data are similar among younger age groups. A 2022 survey of Teens and pornography reported that 54% of teens had seen pornography by the time they were 13 years old and 15% prior to 11 years old[7] Thirty-nine percent of boys and 23% of girls have seen scenes of sexual bondage online and 15% of boys and 9% of girls have seen images of child pornography online.[8] A large survey of American young people revealed that 51% of males and 32% of females claimed to have viewed pornography for the first time before they were 13 years old.[9] In a 2012 Australian study of pornography use, men who were frequent pornography users said that their first exposure was between the ages of 11 to 13 years old.[10] Similar findings were recorded in a 2009 study in the Journal of Adolescent Health which found that 85% of adolescent males and 50% of adolescent females had been exposed to pornographic material.[11] Clearly, pornography has become pervasive throughout modern American society. Research, however, is only beginning to delineate its impact upon children, adolescents, and adults.
Grade school children are sometimes exposed to pornography accidentally when they view material on the Internet. They may also encounter a parent’s or close adult’s pornographic material. Sexual predators have purposefully exposed young children to pornography for the purpose of grooming the children for sexual exploitation. Pornography exposure at these young ages often results in anxiety for the child.[12] Children also report feelings of disgust, shock, embarrassment, anger, fear, and sadness after viewing pornography. These children can suffer all the symptoms of anxiety and depression. They may become obsessed with acting out adult sexual acts that they have seen, and this can be very disruptive and disturbing to the child’s peers who witness or are victimized by this behavior. Children under twelve years old who have viewed pornography are statistically more likely to sexually assault their peers.[13] In sum, children exposed to pornographic material are at risk for a broad range of maladaptive behaviors and psychopathology.
Impact on Adolescents
A 2016 a survey of a large Catholic high school in the U.S. revealed that 49% of the boys stated they viewed pornography at least once per week.[14] In 2018, a survey of teens reported that 27% of them had received texts with pornographic material.[15] A Benenson Strategy Group survey of 1,358 teenagers in 2022 revealed how pornography is significantly affecting the lives of current adolescents. It found that the average age of pornography exposure was 12 years old. Fifty-eight percent of the teens reported that they had seen pornography online by accident and 44% said they accessed pornography on a school issued device. One third of the students said they had seen pornography on social media apps. A total of 73% of teens affirmed that they consumed pornography and 67% of the girls said that they intentionally sought out pornography. Fifty-two percent said they had seen violent or aggressive behavior in online pornography. The report revealed that 45% of them claimed that they learned helpful things about sex from pornography.[16] Pornography use is resulting in antisocial behavior for adolescents. Among juvenile criminal offenders, there is a greater self-report of pornography use among the sex offender adolescents than among adolescent criminal offenders who have committed non-sexual crimes.[17] There are increasing reports of sexual assaults involving both perpetrators and victims under 18 years of age. Easy access and frequency of viewing pornography is one of the likely causes of this adolescent-on-adolescent sexual violence.[18]
Impact on Young Adults
The effects of pornography exposure upon older adolescents and young adults were recorded in a series of studies conducted by Dolf Zillman and Jennings Bryant in the 1980’s.[19] There are several factors that make the Zillman/Bryant studies noteworthy. First, they were controlled randomized studies dealing with objective exposure to pornographic material, as opposed to convenience sample surveys about pornography exposure and attitudes. Second, they were conducted before the age of Internet pornography, so the participants would likely have had less exposure to pornography compared to the average young adult today. These studies involved recruiting college students and non-college students from the community. Subjects in the experimental group viewed pornographic material for a period of six weeks, while the control group was exposed to more common movie and television content over the same period. Afterwards, participants were asked a series of questions to evaluate their attitudes regarding relationships and family issues.
The following observations were noted regarding young adults exposed to pornography compared to the control group:
Male subjects demonstrated increased callousness toward women.
Subjects considered the crime of rape less serious.
Subjects were more accepting of non-marital sexual activity and non-coital sexual practices such as oral and anal sex.
Subjects became more interested in more extreme and deviant forms of pornography.
Subjects were more likely to say they were dissatisfied with their sexual partner.
Subjects were more accepting of sexual infidelity in a relationship.
Subjects valued marriage less and were twice as likely to believe marriage may become obsolete.
Men experienced a decreased desire for children, and women experienced a decreased desire to have a daughter.
Subjects showed a greater acceptance of female promiscuity.
In addition to these maladaptive effects on young adults, pornography use can be associated with poor mental health. Americans who watch pornography more often report greater feelings of social isolation and loneliness, lower levels of self-confidence, and less satisfying sex lives.[20] Frequent pornography use is associated with anxiety, stress, and depression in college age adults.[21]
Impact on Women
There is evidence that society’s acceptance of pornography creates unique problems for women. The use of pornography can result in violent and sexually aggressive attitudes towards women. A 2019 study found that participants in the study who reported a higher frequency of viewing rough sex in sexually explicit material were more likely to have a history of engaging in rough sex and to report a higher desire for participating in rough sex.[22] Pornography exposure increases the likelihood of both verbal and physical aggression against the sex partner.[23] Mirror neurons are neurons in the frontal operculum and the parietal lobule that are activated when an observer views an action performed by a second person that is likely to be advantageous to the observer. It is a way to watch an action and learn how to imitate it. These mirror neuron areas are activated and correlate with erections for males viewing pornographic material.[24] It is likely that this mirror neuron activation can cause males viewing pornography to visualize themselves as the male in the video acting out the sexual behavior. It may be one of the reasons that viewers of pornography seem to want to act out the scenes they have experienced and explain why violent and degrading pornography leads to the abuse of women. Men who consume pornography are more likely to adopt rape myth ideology, which is that women cause rape or actually enjoy rape or sexual assault.[25],[26] There is strong evidence that exposure to violent pornography is associated with sexually aggressive behaviors in both adolescent[27] and adult males.[28] It is common for pornographic movies to portray male vs. female verbal and physical aggression as well as sexual acts that are overtly degrading to women.[29] Women who have viewed pornography may develop a poor body image of themselves.[30] For young people, viewing sexually explicit web sites increased the likelihood of having more than one sexual partner in the last three months and for using alcohol and drugs during sexual activity.[31] The phenomenon of teenage sexting (the sending of sexually explicit photos, images, text messages or e-mails using a mobile device) has been linked with pornography exposure.[32] For women, viewing pornography may result in sexual manipulation by a male partner. This is evident by the increased participation in anal sex by women who have viewed pornography despite the data that the majority of women consider anal sex unpleasant.[33]
Impact on Child Abuse and Sex Trafficking
The horrific crime of child pornography robs children of their innocence and can make them perpetual victims for a lifetime. Pornography drives a hyper interest in sex, primarily for men. It also desensitizes these men to the violence and degradation done to women in the pornographic videos. Pornography teaches the viewer that sex is a commodity for which one can pay. As pornography becomes more accepted in society, that society becomes more hypersexualized, and this can increase the demand for sex trafficked women and children. Ultimately, this can lead to the physical exploitation of children. Abusers have abused children and created pornographic abuse material and sold it to third party websites. Pornhub, the most visited pornographic website, has posted videos of minors being sexually assaulted.[34] For the child, child pornography is often the gateway to child sex trafficking and prostitution. Pornographic images of children are often used to groom other children for sexual abuse. Child pornography exists as a crime in perpetuity in that the victims grow up with the knowledge that their images have been spread throughout the Internet and that they have no idea if or when they will be exposed. These children often grow into adults with ongoing psychic trauma.[35] Viewing child pornography can also increase the interest that a sexually deviant viewer has in acting out and sexually abusing a child.[36] It is important to be aware that the creation of “sexting” material is considered the production of child pornography and sending these sexting photos to a third party is considered dissemination of child pornography and is a crime.
Impact on the Brain and Addiction
There is now clear scientific evidence that online pornography is a true addiction, as it fits the definition of addiction as defined by the American Society of Addiction Medicine.[37] The concern over a pornography epidemic has resulted in sixteen U.S. states passing resolutions declaring pornography a public health crisis, which needs education, prevention, research, and policy changes at the community and societal level.[38] Men with acknowledged problematic pornography use display signs of addiction on functional magnetic resonance imaging scans when they are viewing pornography.[39] A primary research article in JAMA Psychiatry shows that pornography consumption is associated with decreased brain volume in the right striatum, decreased left striatum activation, and lower functional connectivity to the prefrontal cortex. The article showed that high pornography consumption is associated with smaller gray matter volume in the viewers and is associated with downregulation of the brain’s response to erotic material. These neural changes in the brains of pornography users are similar to the changes seen in brains of individuals addicted to cocaine, alcohol, and methamphetamines, and this association is one more way regular pornography use mirrors the use of addictive drugs.[40] These changes in the brain indicate pornography’s powerful effects of the dopaminergic reward system of the brain.[41] Exposure to exogenous opioids such as heroin is also a powerful addiction. The human male orgasm causes the release of endogenous opioids that can mimic this powerful drug addiction.[42] The use of pornography to cause orgasm then sets up a powerful addiction to the pornography stimulus. Pornographic images can act as a supranormal stimulus for men making them less interested in natural sexual activity. Erectile dysfunction studies, epidemiologic studies, and detailed clinical case studies provide strong evidence that pornographic viewing is associated with decreased sexual stimulation and desire with natural sexual partners.[43] This may represent tolerance to the addicted material, similar to tolerance to a drug of addiction. These scientific studies are consistent with the observed findings in a 2012 Australian study of pornography showing 20% of regular pornography users preferred the excitement of viewing pornography over being sexually intimate with a real person.[44] Users of pornography often have intentions of stopping use but despite the intention to stop they continue to use pornography.[45] This is another sign of addiction.
Impact on Marriage
Pornography use by adolescents and young adults often leads to a distorted view of sexuality and its role in fostering healthy personal relationships. These distortions include the overestimation of the prevalence of sexual activity in the community, the belief that sexual promiscuity is normal, and the belief that sexual abstinence is unhealthy.[46] These perspectives are likely to make it more difficult for young people to form lasting, meaningful relationships with the opposite sex, which will ultimately result in more anxiety, depression, and overall life dissatisfaction.[47]
Pornography has a negative effect on marriage and long term cohabitating couples, making them more vulnerable to divorce or dissolution, and this in turn has negative health effects for the children involved.[48] The use of pornography in the context of the marriage is largely confined to the husband; the wife being an occasional co-participant, reluctantly accepting the pornography use or being completely unaware of the husband’s personal use of pornography.[49] Women who have husbands or male partners who view pornography feel betrayed, and see pornography use by their husbands as a form of infidelity.[50] Women see pornography as a form of sexual objectification of women. When women view the pornography that their partners are viewing, they can develop a lower self-esteem, feelings of inadequacy, and begin to feel sexually undesirable, and this can impede the women from bonding with their sexual partner.[51] The more a woman perceives her husband or boyfriend using pornography, the more negative the woman rates her relationship in general and the lower she rates her overall sexual satisfaction.[52] This occurs because a significant percentage of male pornography viewers will develop a preference for the fantasy world of pornography over actual sexual activity with their partners.[53] Pornography can reinforce the concept of physical domination of the man over the woman and can increase aggressive and violent behaviors against women.[54],[55] Frequent pornography use by husbands is reported to decrease the quality of marriages over time.[56] In 2002, the American Academy of Matrimonial Lawyers reported that 56% of all divorces involved one party having an obsessive interest in pornographic websites.[57] Men who use pornography and women who accept pornography are more likely to accept marital infidelity and cohabitation[58] which ultimately destabilizes families.
Conclusions
Children suffer many negative effects due to modern society’s exposure to and acceptance of pornography. These negative effects include mental disturbance and unrest for the young school age child, including acting out and violent behavior. Sadly, pornography can contribute to the sexual abuse of children and the sex trafficking of children and women. Pornography is used to groom children for sexual abuse. It also instills the concept of the commodification of human sexuality. This in turn creates the interest and desire for sex trafficking of human beings. Because of its harmfulness to children, pornography must never be used as a tool to teach children human sexuality. For older adolescents and young adults, pornography teaches a false narrative regarding human sexuality and how men and women form healthy sexual relationships. This makes it more difficult for young men and women to form authentic, stable relationships. For parents, pornography is divisive resulting in a decreased quality of marriage and increasing the likelihood of divorce and separation which has been well documented to be harmful to children.
Pediatricians should be equipped to discuss with parents both how and why to prevent pornography exposure for both children and parents. Because the Internet is the primary medium for pornography exposure, home computers should be in public spaces (not in a child’s bedroom) and equipped with Internet filtering and monitoring software to reduce exposure. There are a variety of parental controls and filtering systems available to parents, and some current software vendors offer filtering and monitoring of smart phones which are now the primary technology used by adolescents to access the Internet. Also, there are several software services and programs which offer the ability to create accountability partnerships to increase the success of breaking free from pornography addiction. Pediatricians and pediatric healthcare providers should understand the negative impact that widespread use of pornography is having on today’s children and their parents and how they can help stop this destructive influence on the family.
Primary Author: L. David Perry, MD, FCP
October 2015
Updated August 2024
The American College of Pediatricians is a national medical association of licensed physicians and healthcare professionals who specialize in the care of infants, children, and adolescents. The mission of the College is to enable all children to reach their optimal physical and emotional health and well-being.
Resources
● Internet Filtering Software: Covenant Eyes, Net Nanny, Screen Retriever, and K9 Web protection
● Good Pictures Bad Pictures: Porn Proofing Today’s Young Kids by Kristen Jenson
● Good Pictures Bad Pictures Jr. A Simple Plan to Protect Young Minds by Kristen Jenson
● Defend Young Minds. https://www.defendyoungminds.com/
● Your Brain on Porn. www.yourbrainonporn.com
● The Sex Talk. www.thesextalk.com
● Fight the New Drug. https://fightthenewdrug.org/
● National Center on Sexual Exploitation. https://endsexualexploitation.org/
● NoFap. https://nofap.com/
● Integrity Restored. https://integrityrestored.com/
● Brave Hearts. https://bravehearts.org/
● Strive. https://www.strive21.com/
● Proven Men. https://www.provenmen.org/
REFERENCES
[1] Merriam-Webster Dictionary online. www.merriam-webster.com/dictionary/pornography accessed 6/4/15
[2] Covenant Eyes. Pornography Statistics. https://www.covenanteyes.com/pornstats/ accessed 5/23/23
[3] Jeffrey Hansen. Digital Enslavement Amidst the Search for Intimacy. 2024 pp. 17.
[4] BedBible.com. Porn Industry Revenue – Numbers & Stats. May 2024. https://bedbible.com/porn-industry-revenue-statistics/ accessed 4/19/23
[5] Covenant Eyes. Pornography Statistics. https://covenanteyes.com/pornstats// accessed 5/19/23
[6] Proven Men. www.provenmen.org/2014pornsurvey/about-the-survey/ accessed 6/2/15. Available upon request of the American College of Pediatricians.
[7] Common Sense. Teens and Pornography. 2022. www.commonsensemedia.org/sites/default/files/research/report/2022-teens-and-pornography-final-web.pdf accessed 5/20/23.
[8] Covenant Eyes. Pornography Statistics. https://covenanteyes.com/pornstats// accessed 3/15/24
[9] Leahy, M. Porn University: What College Students Are Really Saying About Sex on Campus (Chicago: Northfield Publishing, 2009).
[10] Szittner K. Study exposes secret world of porn addiction. Sydney.edu. May 10, 2012. http://sydney.edu.au/news/84.html?newsstoryid=9176
[11] Braun-Courville D. and Rojas M. Exposure to Sexually Explicit Web Sites and Adolescent Sexual Attitudes and Behaviors, Journal of Adolescent Health, 45(2009) pp. 156-162.
[12] Flood M. The Harms of Pornography Exposure among Children and Young People. Child Abuse Review. 2009 Vol. 18:384-400.
[13] Manning J. The Impact of Internet Pornography on Marriage and the Family: A Review of the Research. Sexual Addiction and Compulsivity. 2006, 13:131-165.
[14] Zurface A. Survey shows why parents should keep smartphones out of the bedroom. Covenant Eyes. 2023. http://www.covenanteyes.com/blog/parents-keep-smartphones-out-of-bedroom/
[15] Madigan S. Li A, Rash C, et al. Prevalance of multiple forms of sexting behavior among youth: A systematic Review and meta-analysis. JAMA Pediatrics 172:4 (2018). 327-335.
[16] Common Sense. Teens and Pornography. 2022. www.commonsensemedia.org/sites/default/files/research/report/2022-teens-and-pornography-final-web.pdf accessed 5/20/23
[17] Wright P, Tokunaga R and Kraus A. A Meta-Analysis of Pornography Consumption and Actual Acts of Sexual Aggression in General Population Studies. Journal of Communication 66 (2016) 183-205.
[18] The Guardian. ‘Toxic’ online culture fueling rise in sexual assaults on children by other children, police warn | Rape and sexual assault | The Guardian accessed 3/15/2024.
[19] Zillman D, Bryant J. Effects of Prolonged Consumption of Pornography on Family Values. Journal of Family Issues, Vol. 9 No. 4, December 1988, pp. 518-544.
[20] Survey Center of American Life. Politics, Sex, and Sexuality. The Growing Gender Divide. April 2022. https://www.americansurveycenter.org/research/march-2022-aps/ accessed 3/15/2024.
[21] Camilleri C, Perry J and Sammut S. Compulsive Internet Pornography Use and Mental Health: A Cross-Sectional Study in a Sample of University Students in the United States. Frontiers in Psychology, January 2021.
[22] Vogels E. and O’Sullivan L. The Relationship Among Online Sexually Explicit Material Exposure to Desire for and Participation in Rough Sex. Archives of Sexual Behavior. September 2018, Vol. 48, pp. 653-665.
[23] Wright P, Tokunaga R and Kraus A. A Meta-Analysis of Pornography Consumption and Actual Acts of Aggression in General Population Studies. Journal of Communication 66(2016) 183-205.
[24] Mouras H, Stoleru S, Moulier V, Pelegrini-Issac M, Rouxel R, Grandjean B, Glutron D, and Bittoun J. Activation of mirror-neuron system by erotic video clips predicts degree of induced erection: an fMRI study. NeuroImage. September 2008, volume 42, Issue 3, pp. 1142-1150.
[25] Flood M. The Harms of Pornography Exposure Among Children and Young People. Child Abuse Review. 2009 Vol. 18:384-400.
[26] Manning J. The Impact of Internet Pornography on Marriage and the Family: A Review of the Research. Sexual Addiction and Compulsivity 2006, 13:131-165.
[27] Ybarra M, Mitchell K, Hamburger M, Diener-West M, and Leaf P. X-Rated Material and Perpetration of Sexually Aggressive Behavior Among Children and Adolescents: I There a Link? Aggressive Behavior Vol. 37 pp. 1-18 (2011)
[28] Hald G, Malmuth N, and Yuen C. Pornography and Attitudes Supporting Violence Against Women: Revisiting the Relationship on Non-experimental Studies, Aggressive Behavior Vol. 36, 2010, pp. 1065-1086.
[29] Bridges A, Wosnitzer R, Scharrer E, Sun C, and Liberman R. Aggression and Sexual Behavior in Best-Selling Pornography Videos: A Content Analysis Update. Violence Against Women 16(10) 2010, pp. 1065-1086.
[30] Paslakis G, Actis C, and Mestre-Bach G. Associations Between Pornography Exposure, Body Image, and Sexual Body Image: A systematic review. Journal of Health Psychology 2020, pp. 1-18.
[31] Braun-Courville D and Rojas M. Exposure to Sexually Explicit Web Sites and Adolescent Sexual Attitudes and Behaviors, Journal of Adolescent Health, 45(2009) pp. 156-162.
[32] Van Ouytsel J, Ponnett K, and Walrave M. The Associations Between Adolescents’ Consumption of Pornography and Music Videos and Their Sexting Behavior. Cyberpsychology, Behavior, and Social Networking Vol. 17, No. 12, 2014, pp. 772-778.
[33] Tyden T, Olsson S, and Haggstrom-Nordin E. Improved Use of Contraceptives, Attitudes Toward Pornography, and Sexual Harassment Among Female University Students, Women’s Health Issues, Vol. 11, No. 2 March/April 2001, pp.87-94.
[34] BBC News. I Was Raped at 14. Feb 2020. https://www.bbc.com/news/stories-51391981 accessed 3/15/2024.
[35] United States Sentencing Commission. 2012 Report to the Congress: Federal Child Pornography Offenses. https://www.ussc.gov/research/congressional-reports/2012-report-congress-federal-child-pornography-offenses Chapter 5, accessed 4/22/23.
[36] Klein V, Schmidt A, Turner D, and Briken P. Are Sex Drive and Hypersexuality Associated with Pedophilic Interest and Child Sexual Abuse in a Male Community Sample? The Plos One, July 2015. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0129730, accessed 4/22/23
[37] Hilton D Jr, Pornography addiction – a supranormal stimulus considered in the context of neuroplasticity. Brain and Addiction. July 2013.
[38] https://fightthenewdrug.org/states-with-porn-public-health-resolutions/ accessed 3/15/24.
[39] Gola M, Wordecha M, Sescousse M, Lew-Starowicz B, Kossowski M, Wypych S, Makeig M, Potenza M, and Marchewka A. Can Pornography Be Addictive? A fMRI Study of Men Seeking Treatment for Problematic Pornography Use. Neuropsychopharmacology 42, no. 10(2017): 2021-2031. https://www.nature.com/articles/npp201778
[40] Kuhn S, Gallinat, J. Brain Structure and Connectivity Associated with Pornography Consumption, JAMA Psychiatry, May 2014
[41] Love T, Laier C, Brand M, Hatch L, and Hajela R. Neuroscience of Internet Pornography Addiction: A Review and Update. Behavioral Sciences., September 2015 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4600144/pdf/behavsci-05-00388.pdf accessed 5/9/2023
[42] Jern P, Chen J, Tuisku J, Saanijoki T, Hirvonen J, Lukkarinen L, Manninen S, Helin S, Putkinen V, and Nummenmaa L. b
bioRxiv, December 2022. https://www.biorxiv.org/content/10.1101/2022.12.21.521382v1.abstract
[43] Park B., Wilson G., Berger J, Christman M, Reina B, Bishop F, Klam W, and Doan A. Is Internet Pornography Causing Sexual Dysfunctions? A review with clinical reports. Behavioral Science. 2016, 6(3), 17; https://doi.org/10.3390/bs6030017
[44] Katie Szittner, “Study exposes secret world of porn addiction”, Sydney.edu. May 10, 2012. http://sydney.edu.au/news/84.html?newsstoryid=9176 Accessed 6/14/15.
[45] Camilleri C, Perry J, and Sammut S. Compulsive Internet Pornography Use and Mental Health: A Cross-Sectional Study in a Sample of University Students in the United Sates. Frontiers in Psychology, January 2021.
[46] Zillman D, Bryant J. Effects of Prolonged Consumption of Pornography on Family Values. Journal of Family Issues, Vol. 9 No. 4, December 1988, pp. 518-544.
[47] Michael Leahy. Porn University: What College Students Are Really Saying About Sex on Campus (Chicago: Northfield Publishing, 2009).
[48] American College of Pediatricians. The Impact of Family Structure on the Health of Children: Effects of Divorce. https://acpeds.org/position-statements/the-impact-of-family-structure-on-the-health-of-children-effects-of-divorce accessed 3/10/15
[49] Manning Jill. The Impact Internet Pornography on Marriage and the Family: A Review of the Research. Sexual Addiction and Compulsivity 2006, 13:131-165.
[50] http://ifstud ies.org/blog/the-porn-gap-gender-differences-in-pornography-use-in-couples-relationships accessed 4/21/23 Available by request to the American College of Pediatricians
[51] Gewirzt-Meydan A, Mitchell K, Spivak-Levi Z, Kraus S. Attachment insecurities and body image of self-consciousness among women: The mediating role of pornography use. Computers in Human Behavior, 124 (2021).
[52]Stewart DN, Szymanski DM. Young Adult Women’s Reports of Their Male Romantic Partner’s Pornography Use as a Correlate of Their Self-Esteem, Relationship Quality, and Sexual Satisfaction. Sex Roles, May 6, 2012. 67:257-271.
[53] Manning, Jill. The Impact Internet Pornography on Marriage and the Family: A Review of the Research. Sexual Addiction and Compulsivity 2006, 13:131-165.
[54] Zillman D, Bryant J. Effects of Prolonged Consumption of Pornography on Family Values. Journal of Family Issues, Vol. 9 No. 4, December 1988, pp. 518-544.
[55] Manning, Jill. The Impact Internet Pornography on Marriage and the Family: A Review of the Research. Sexual Addiction and Compulsivity 2006, 13:131-165.
[56] Perry S. Does Viewing Pornography Reduce Marital Quality Over Time? Evidence from Longitudinal Data., Archives of Sexual Behavior. July 2016.
[57] Manning, Jill. Testimony of Jill Manning, M.S. Hearing on Pornography’s Impact on Marriage & The Family Subcommittee on the Constitution, Civil Rights, and Property Rights Committee on Judiciary, United States Senate, November 10th, 2005. Page 14
[58] Carroll J, Padilla-Walker L, Olson C, Barry C, Madsen S. Generation XXX Pornography Acceptance and Use Among Emerging Adults. Journal of Adolescent Research. Vol. 23, No. 1. January 2008, pp. 6-30.