|Year : 2021 | Volume
| Issue : 3 | Page : 122-127
A multicenter study on problematic pornography consumption: prevalence and correlates among undergraduate medical students
Bhavin Naranbhai Kadavala1, Disha Alkeshbhai Vasavada1, Parveen Kumar1, Renish Bhupenderabhai Bhatt1, Vishal Kanaiyalal Patel2, Deepak Sachidanand Tiwari1
1 Department of Psychiatry, M.P. Shah Medical College, Jamnagar, Gujarat, India
2 Department of Psychiatry, Dr. M.K. Shah Medical College and Research Center, Ahmadabad, Gujarat, India
|Date of Submission||08-Apr-2021|
|Date of Decision||15-Jun-2021|
|Date of Acceptance||03-Jul-2021|
|Date of Web Publication||26-Jul-2021|
2nd Floor, Department of Psychiatry, Trauma Building, M.P. Shah Medical College, Jamnagar, Gujarat
Source of Support: None, Conflict of Interest: None
Introduction: Internet pornography use is a sexual behavior, and it comprises a variety of online sexual activities, including watching pornography, online pornography exchange, and engaging in sex chats. Due to rise in Internet access and technologies, online pornography and other type of repetitive behaviors have increased. The current study was aimed to estimate the prevalence of problematic pornography consumption among undergraduate medical students. Methods: A multicenter, cross-sectional study was carried out at seven different centers of Gujarat from October 2020 to December 2020. Online structured questionnaire in two different parts: (1) Demographic details and usage pattern of pornography among students, (2) Problematic Pornography Consumption Scale was prepared and shared with all undergraduate students through designated faculty. Logistic regression analysis was used for problematic pornography consumption (as dependent variable) and other categorical variables as independent variables. Results: A total of 1926 participants completed the study. The prevalence of problematic pornography consumption among participants was 14.6% (95% confidence interval 12.4–16.1). Male participants and participants who are in a romantic relationship have higher problematic pornography consumption. Participants' gender (odds ratio OR = 3.562), relationship status (OR = 1.636), weekly (OR = 1.749), and daily (OR = 1.733) pornography consumption emerged as statistically significant with the problematic pornography consumption from the logistic regression analysis. Conclusion: Problematic pornography consumption is more prevalent among male under graduate medical students than females. It is important to educate the students about the potential harmful adverse effects of pornography and to develop a positive attitude toward sex.
Keywords: Correlates, medical students, pornography, undergraduate
|How to cite this article:|
Kadavala BN, Vasavada DA, Kumar P, Bhatt RB, Patel VK, Tiwari DS. A multicenter study on problematic pornography consumption: prevalence and correlates among undergraduate medical students. Asian J Soc Health Behav 2021;4:122-7
|How to cite this URL:|
Kadavala BN, Vasavada DA, Kumar P, Bhatt RB, Patel VK, Tiwari DS. A multicenter study on problematic pornography consumption: prevalence and correlates among undergraduate medical students. Asian J Soc Health Behav [serial online] 2021 [cited 2021 Sep 21];4:122-7. Available from: http://www.healthandbehavior.com/text.asp?2021/4/3/122/322291
| Introduction|| |
The word “Pornography” is derived from the Greek word pornographos, meaning literally the writing of harlots. Originally, the word was used to describe the life and times of a prostitute. The evolution from the earliest caveman drawings to the present day virtual content has been long and with controversy. Previously, pornography was considered a taboo in the society but not anymore. This is because it is frequently spoken about and debated publicly in many places and media as simple as through mobile phone conversations. Internet pornography use is a sexual behavior. It comprises a variety of online sexual activities, including watching pornography, online pornography exchange, engaging in sex chats, using sex webcams, searching for sexual partners, or engaging in sexual role playing, among which stands watching pornography, which is the most popular activity. At present, in India, watching porn in private is not a criminal offense; however, storing or publishing images of child sexual abuse is punishable.
Due to rise in Internet access and technologies, the possibilities of conduit for sexual interactions, online pornography, and other type of repetitive behaviors have increased. Kumar et al. reported that more than 25% college students have problematic internet use. Excessive or problematic pornography comes under the term of “Pornography addiction.” “Pornography addiction” is a recent diagnostic label which is used to define patients with a propensity and tendency to view pornography images and videos frequently and regularly and also experiencing distress when not allowed to do so. This falls under the broader rubric of “sex addiction” or as a subtype of “Internet Addiction Behavior.” The recent revision of the Diagnostic and Statistical Manual in its fifth edition did not include pornography addiction. However, there are mixed views on categorizing pornography as addiction or as a sexual compulsivity or a subset of hypersexual behavior. Impulsivity and compulsivity were found to be associated with those having problematic Internet pornography usage than those who did not use pornography with the same severity.
Different studies reported a negative effect of exposure to pornographic imagery on the Internet. Manning reported that marital relationships are experiencing negative consequences as a result of Internet pornography, such as increased aggression and undervaluing of monogamy. Overall, pornography consumption has increased over this past decade among males, particularly in the young age group and decreased with increasing age of participants. Pornography addiction ranged from 4.5% in the Swedish population to 12.5% in India.,
The current Indian literature is lacking about the prevalence of problematic pornography consumption. To fill this gap, the current study was aimed to estimate the prevalence of problematic pornography consumption among undergraduate medical students.
| Methods|| |
Study design and participants
A multicenter, cross-sectional and anonymous study was carried out to assess the prevalence of problematic pornography consumption from October 2020 to December 2020 among undergraduate medical students. Seven medical college of Gujarat (M. P. Shah Medical College Jamnagar, Government Medical College Bhavnagar, GMERS Medical College, Patan, GMERS Medical College Sola, C. U. Shah Medical College, GMERS, Gandhinagar, Surat Municipal Institute of Medical Education and Research) participated in the study. At each center, one designated faculty member was designated for the collection of sample.
Online Google form was made and shared with all undergraduate students through their E-mail address and WhatsApp group. Google form was sent to 3000 students. Students using pornography were asked to fill form. Three reminders at a gap of 3 days were sent to participants. The Google document contained structured questionnaire in two different parts: (1) Demographic details and usage pattern of pornography among students and (2) Problematic Pornography Consumption Scale (PPCS). Online written consent was obtained from each participant. Those who gave consent were included in the study, whereas those who denied for participation were excluded from the study.
Demographic details and usage pattern
Demographic details such as age group, gender, residential area, and relationship status were included. The usage pattern variable for pornography use such as weekly pornography consumption, daily pornography consumption, and age of first contact with pornography was used.
Problematic Pornography Consumption Scale
PPCS was used to measure problematic internet pornography consumption. It consists of 18 items that assesses the six core components of addiction: salience, mood modification, conflict, tolerance, relapse, and withdrawal. Each component is measured by the three items of the scale. Participants' responses were recorded on the following 7-point linear scale from 1 (never) to 7 (all the time). A cutoff score of 76 was used to ascertain normal and problematic use; a score of 76 or higher indicates possible problematic pornography consumption. The Cronbach's alpha of the original PPCS was 0.96, and 0.95 in the Indian sample. For the current study, PPCS demonstrated satisfactory internal consistency using Cronbach's alpha (0.94).
Data entries and analysis were done using Microsoft Excel and Statistical Package for the Social Sciences version, International business machines, Armonk, New York, United States. Problematic pornography consumption among the categorical data such as gender, relationship status, age groups, age of first exposure to pornography, weekly, and daily consumption of pornography were assessed using the Chi-square test. Logistic regression analysis was used to predict problematic pornography consumption by using as dependent variable, whereas categorical variables such as age groups, gender, relationship status of participants, age of first exposure to pornography, weekly pornography consumption, and daily pornography consumption as the independent variable. P < 0.05 was considered statistically significant.
This study was approved by the Institutional Ethics Committee (Shri M. P. Shah Government Medical College, Jamnagar) with reference number IEC/Certi/147/05/2020 obtained on October 16, 2020.
| Results|| |
A total of 1926 participants completed the study. Majority of participants (92.5%) belonged to the Hindu religion, followed by Muslim (4.5%) and (3%) others. The prevalence of problematic pornography consumption among participants was 14.6% (95% confidence interval 12.4–16.1). The prevalence of problematic pornography consumption among males was estimated to be 19% and 3.3% among females.
[Table 1] shows that male participants have statistically significant higher prevalence of problematic pornography consumption (χ2 = 75.938, P < 0.001). Participants of 24–26 years' age group have significantly higher prevalence of problematic pornography consumption (χ2 = 10.054, P = 0.007). Participants who are in a romantic relationship have significantly higher prevalence of problematic pornography consumption (χ2 = 14.864, P < 0.001). No statistically significant difference was observed as per domiciliary area of participants [Table 1].
|Table 1: Demographic characteristics of the participants and relation of problematic pornography consumption|
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Table 2 shows that participants with pornography consumption nearly every day per week have significantly higher prevalence of problematic pornography consumption (χ2 = 148.781, P < 0.001). Participants using pornography daily for more than 20 min have significantly higher prevalence of problematic pornography consumption (χ2 = 123.543, P < 0.001). Participants with the first exposure to pornography before the age of 10 years have significantly higher prevalence of problematic pornography consumption (χ2 = 70.623, P < 0.001) [Table 2].
Logistic regression analysis was run to predict problematic pornography consumption from the different categorical data such as gender, relationship status of participants, weekly pornography consumption, and daily pornography consumption. Participants' gender (odds ratio [OR] = 3.562), relationship status (OR = 1.636), weekly (OR = 1.749), and daily (OR = 1.733) pornography consumption emerged as statistically significant with the problematic pornography consumption, as shown in [Table 3].
|Table 3: Logistic regression analysis of different variables with problematic pornography consumption|
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| Discussion|| |
The current study found 14.6% prevalence of problematic pornography consumption among participants. The prevalence was estimated to be 19% among males and 3.3% among females. Ross et al. in Sweden reported that 2% of women and 5% of men have serious Internet sexual problems. Ybarra and Mitchell reported that 90% youth of age group 12–18 years have access to pornography. The addiction to pornography was observed to be 4% in males and 1% in females among the Australian population by Rissel et al. Cooper et al. reported 10% of participants have online sexual addiction. The prevalence of pornography addiction reported to be 7.1% by Mennig et al., while 12.2% by Dwulit and Rzymski. The easy accessibility and greater availability of such material with increasing access to the Internet could be the reason for increased prevalence of problematic pornography consumption. Furthermore, the anonymous nature of online study has the advantage of providing higher rates for acceptance of such behaviors.
The current study found that male participants have higher prevalence of problematic pornography consumption than female participants. A study by Chowdhury et al. from Bangladesh and Willoughby et al. among the US college students reported higher consumption of pornography among males., in consistent with current study results Kvalem et al. at Scandinavia reported higher consumption of pornography material by males. Cooper et al. (2002) observed that men are more likely to use the Internet pornography in general for light recreation and to deal with stress. These gender differences are the results of an evolutionary perspective that men are more aggressive and this translates to more pornography usage than women. Emmers-Sommer et al. revealed that it is difficult to pinpoint whether gender differences are due to biological or social influence or it is influenced by cultural constraints placed on gender. Certain sexual neuroimaging studies also observed gender differences in the brain activity of ventromedial prefrontal cortex and found that females have weaker response to visually erotic stimuli.
The current study found a higher prevalence of problematic pornography consumption among participants spending more time on pornography daily and per week. It was observed that excess viewing of pornography has been associated with brain changes similar to other addictions. While consistent use of pornography may facilitate information processing and craving due to certain metacognition changes similar to addictive behaviors.
The current study found a higher prevalence of problematic pornography consumption among participants in any relationship (such as romantic relation). These results are consistent with Dwulit and Rzymski findings; participants engaged in a romantic relationship had a higher frequency of pornography use as compared to singles. Brand et al. observed a positive relationship between subjective sexual arousal when watching Internet pornographic pictures. Young also found that participants' key motive for cybersex is the expectation of finding sexual arousal and gratification. Wallmyr anf Welin also described pornography as arousing, exciting, or stimulating. These could also be the possible reason for the higher prevalence of problematic pornography consumption among participants in the relationship as compared to singles.
The current study found a higher prevalence of problematic pornography consumption among participants exposed to pornography at younger age. The findings of the current study are consistent with previous studies, which reported that the age of first exposure to pornography was significantly associated with higher self-perceived addiction in both males and females. The premature age of exposure to pornography is also associated with higher sexual activity. Sex is unique among natural rewards as it causes persistent change in synaptic plasticity which manifest as an increase in the N methyl D aspartate- alpha amino hydroxyl methyl isoxazolepropionic acid (NMDA-AMPA) receptor ratio, similar to what occurs with other substance use. Through the brain's mirror system, young people resonate with the motivational state of individuals depicted in these films.
There are several negative effects of pornography on young people such as unhealthy interference with normal sexual development, stimulation of premature sexual activity, development of misleading and potentially harmful attitude toward sex, emotional side effects includes; nightmares, residual feelings of shame, guilt and confusion, and poor quality of life, depressive, and anxiety symptoms.,
In light of these findings and adverse effects, sex education should include issues that are important to young people such as emotions and relationships, rather than simply focusing on reproduction, public health, and other interests of the state. Furthermore, it is important to provide education to students about the adverse effects of pornography.
| Limitation|| |
This study was conducted over multiple centers and over large sample. However, cross-sectional, online, and anonymous nature of the study could be biased in the direction of both over-reporting and underreporting. Furthermore, structured psychiatric interview and diagnostic criteria were not included. The factors such as accessibility of pornography, sex education, peer influence, and parental supervision were also not included in this study. Further cognitive or personality correlates of Internet activities in general, online/computer were primarily not included in the sample.
| Conclusion|| |
Problematic pornography consumption is highly prevalent among the undergraduate medical students. Higher prevalence was observed among males, those who were spending more time on pornography weekly and daily and had an early age exposure to pornography. Participants' gender, relationship status, weekly, and daily pornography consumption correlates are highly associated with problematic pornography consumption. Therefore, it is important to educate students about the potential harmful adverse effects of pornography and to develop a positive attitude toward sex.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Habidin N, Abdullah MY, Salleh MA. Online pornography on smartphones amongst the teenage juvenile. Humanit Soc Sci Rev 2016;6:355-66.
Wéry A, Billieux J. Problematic cybersex: Conceptualization, assessment, and treatment. Addict Behav 2017;64:238-46.
Alexandraki K, Stavropoulos V, Burleigh TL, King DL, Griffiths MD. Internet pornography viewing preference as a risk factor for adolescent Internet addiction: The moderating role of classroom personality factors. J Behav Addict 2018;7:423-32.
Kumar S, Singh S, Singh K, Rajkumar S, Balhara YPS. Prevalence and pattern of problematic internet use among engineering students from different colleges in India. Indian J Psychiatry 2019;61:578-83.
] [Full text]
Ley D, Prause N, Finn P. The emperor has no clothes: A review of the 'pornography addiction' model. Curr Sex Health Rep 2014;6:94-105.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th
ed. Arlington: American Psychiatric Publishing; 2013.
Bancroft J, Vukadinovic Z. Sexual addiction, sexual compulsivity, sexual impulsivity, or what? Toward a theoretical model. J Sex Res 2004;41:225-34.
Wetterneck CT, Burgess AJ, Short MB, Smith AH, Cervantes ME. The role of sexual compulsivity, impulsivity, and experiential avoidance in internet pornography use. Psychol Rec 2012;62:3-17.
Manning JC. The impact of internet pornography on marriage and the family: A review of the research. Sex Addict Compulsivity 2006;13:131-65.
Price J, Patterson R, Regnerus M, Walley J. How much more Xxx is generation X consuming? Evidence of changing attitudes and behaviors related to pornography since 1973. J Sex Res 2016;53:12-20.
Ross MW, Månsson SA, Daneback K. Prevalence, severity, and correlates of problematic sexual Internet use in Swedish men and women. Arch Sex Behav 2012;41:459-66.
Kumar P, Patel VK, Bhatt RB, Vasavada DA, Sangma RD, Tiwari DS. Prevalence of problematic pornography use and attitude toward pornography among the undergraduate medical students. J Psychosex Health 2021;3:29-36.
Bőthe B, Tóth-Király I, Zsila Á, Griffiths MD, Demetrovics Z, Orosz G. The development of the problematic pornography consumption scale (PPCS). J Sex Res 2018;55:395-406.
Ybarra ML, Mitchell KJ. Exposure to internet pornography among children and adolescents: A national survey. Cyberpsychol Behav 2005;8:473-86.
Rissel C, Richters J, de Visser RO, McKee A, Yeung A, Caruana T. A profile of pornography users in Australia: Findings from the second Australian study of health and relationships. J Sex Res 2017;54:227-40.
Cooper A, Morahan-Martin J, Mathy RM, Maheu M. Toward an increased understanding of user demographics in online sexual activities. J Sex Marital Ther 2002;28:105-29.
Mennig M, Tennie S, Barke A. A psychometric approach to assessments of problematic use of online pornography and social networking sites based on the conceptualizations of internet gaming disorder. BMC Psychiatry 2020;20:318.
Dwulit AD, Rzymski P. Prevalence, patterns and self-perceived effects of pornography consumption in polish university students: A cross-sectional study. Int J Environ Res Public Health 2019;16:1861.
Chowdhury MR, Chowdhury MR, Kabir R, Perera NK, Kader M. Does the addiction in online pornography affect the behavioral pattern of undergrad private university students in Bangladesh? Int J Health Sci (Qassim) 2018;12:67-74.
Willoughby BJ, Carroll JS, Nelson LJ, Padilla-Walker LM. Associations between relational sexual behaviour, pornography use, and pornography acceptance among US college students. Cult Health Sex 2014;16:1052-69.
Kvalem IL, Træen B, Lewin B, Štulhofer A. Self-perceived effects of internet pornography use, genital appearance satisfaction, and sexual self-esteem among young Scandinavian adults. Cyberpsychology 2014;8:5-22.
Emmers-Sommer T, Hertlein K, Kennedy A. Pornography use and attitudes: An examination of relational and sexual openness variables between and within gender. Marriage Fam Rev 2013;49:349-65.
Lindelöv M, Thorbjörnsson CB. Women's Health at Work. Facts and Prejudices: Psychological Differences between Women and Men. Solna, Stockholm: National Institute for Working Life (Arbetslivsinstitutet); 1998. p. 61-95.
George M, Maheshwari S, Chandran S, Rao TS. Psychosocial aspects of pornography. J Psychosex Health 2019;1:44-7.
Allen A, Kannis-Dymand L, Katsikitis M. Problematic internet pornography use: The role of craving, desire thinking, and metacognition. Addict Behav 2017;70:65-71.
Brand M, Laier C, Pawlikowski M, Schächtle U, Schöler T, Altstötter-Gleich C. Watching pornographic pictures on the Internet: Role of sexual arousal ratings and psychological-psychiatric symptoms for using Internet sex sites excessively. Cyberpsychol Behav Soc Netw 2011;14:371-7.
Young KS. Tangled in the Web: Understanding Cybersex from Fantasy to Addiction. Bloomington, IN: Authorhouse; 2001.
Wallmyr G, Welin C. Young people, pornography, and sexuality: Sources and attitudes. J Sch Nurs 2006;22:290-5.
Bulot C, Leurent B, Collier F. Pornography sexual behaviour and risk behaviour at university. Sexologies 2015;24:e78-83.
Pitchers KK, Schmid S, Di Sebastiano AR, Wang X, Laviolette SR, Lehman MN, et al.
Natural reward experience alters AMPA and NMDA receptor distribution and function in the nucleus accumbens. PLoS One 2012;7:e34700.
Mouras H, Stoléru S, Moulier V, Pélégrini-Issac M, Rouxel R, Grandjean B, et al.
Activation of mirror-neuron system by erotic video clips predicts degree of induced erection: An fMRI study. Neuroimage 2008;42:1142-50.
Benedek EP, Brown CF. No excuses: Televised pornography harms children. Harv Rev Psychiatry 1999;7:236-40.
Morrison TG, Ellis SR, Morrison MA, Bearden A, Harriman RL. Exposure to sexually explicit material and variations in body esteem, genital attitudes, and sexual esteem among a sample of Canadian men. J Mens Stud 2007;14:209-22.
[Table 1], [Table 2], [Table 3]