key: cord-0937878-a0jy1nmj authors: Marchi, Nino Cesar; Fara, Letícia; Gross, Luana; Ornell, Felipe; Diehl, Alessandra; Kessler, Felix Henrique Paim title: Problematic consumption of online pornography during the COVID-19 pandemic: clinical recommendations date: 2021-10-22 journal: Trends Psychiatry Psychother DOI: 10.47626/2237-6089-2020-0090 sha: f94bef978aec0606b586ce4c2e33b59443471670 doc_id: 937878 cord_uid: a0jy1nmj The coronavirus disease (COVID-19) pandemic is one of the greatest contemporary challenges. Feelings of fear and uncertainty triggered by this pandemic have had noxious effects on people’s mental health. This seems to have increased during quarantine and there is evidence of an intensification of reward-directed behavior. Nevertheless, there are few studies dealing with pornography consumption during this period. The aim of this manuscript is to contextualize this phenomenon during the pandemic and suggest some clinical recommendations on the matter. scientific evidence indicate that an increase in online pornography use is expected likewise. [9] [10] [11] With the rise in online pornography consumption, it is likely that there is also an increase in compulsive sexual behaviors and excessive masturbation. 10, 11 Data from Pornhub website show an increase of 11.6% in views in comparison to a random day before COVID-19 pandemic. In Brazil, there has been an even greater increase in views (13.1%). Although, for most people, watching online pornography is adaptive and should not be pathologized, a subgroup of vulnerable individuals is at risk of developing problematic patterns of consumption. 12 Frequent consumption of pornography, especially online, may lead to a range of side effects, such as lower levels of well-being, reduced productivity, and impaired interpersonal relationships, together with increased isolation and narrowing of social repertory, which add to the effects of the pandemic and the "quarantine." 13 In spite of the scarcity of more robust scientific data and the controversy around the subject (sometimes understood as harmless entertainment or benign sexual expression, other times seen as having harmful effects on society), recent studies estimate that pornography may gain new contexts and challenges in some parts of the world during and after the pandemic. 10, 13, 14 In this sense, the aim of this study is to appraise problematic consumption of online pornography during the COVID- 19 pandemic and suggest clinical recommendations on the matter. Several behaviors which potentially affect reward circuits in the human brain may lead to loss of control and may contribute to development of other symptoms of dependence in some individuals. 2, 15 Regarding internet dependence, neuroscientific research supports the assumption that the underlying neural processes are similar to those of addiction to psychoactive substances. 16 The American Psychiatric Disorders, that one of these internet-related behaviors, online gaming, is a potential disorder which leads to dependence and merits further study. 17 On the other hand, other internet-related behaviors, such as online pornography consumption, were not included. Nonetheless, there is little evidence that considers these behaviors as causes of dependence or addiction. 15, 18 In this context, "pornography dependence" is not a formally recognized disorder, mainly because of disagreements among researchers regarding the concept and clinical features and even its existence. 12, 15, 19, 20 However, self-perceived pornography dependence and its perception by health professionals and some researchers, which emerged in the 1970s, has become more relevant since the 1990s as a concept in research as well as in clinical practice. There is an alert on problematic consumption of pornography -its frequency and its possible side effects in legal, psychological (psychological and interrelationship suffering), and health-related aspects of people's lives -since these individuals have been seeking help for dealing with such behaviors. 10, 12 In Excessive consumption of pornography may impact users' financial lives, involving them in legal and occupational problems and leading to interpersonal relationship difficulties. 10, 12 Another impact that can affect pornography users is sexual frustration related to their real-life sex partner. 22 These users frequently criticize their sex partner's body and pressure them to engage in high performance sexual acts, far removed from "real sex" and mostly fanciful. 22, 23 Although some available studies show little association between pornography and erectile dysfunction among young men, 24 other researchers state that the rise in pornography consumption may be the main factor to explain the sharp increase in erectile dysfunction among young people. 25 Another study points out that 60% of men who experienced erectile dysfunction with a real partner did not have the same problem when consuming internet pornography, raising the hypothesis of a complex background linked to the available and easily accessible world of internet sex. 26 Individuals who consume pornography tend to be more susceptible to stress, impairing their ability to meet domestic demands, for example. 27, 28 If these subjects are regular users of online pornography and also parents, the impact may be even greater. Social isolation per se generates relevant negative outcomes in mental health, 4 while young people tend to isolate even further into themselves during quarantine and surf the internet by themselves or with virtual friends, which may become an important source of stress due to the large number of hours that they remain connected. 29 In the context of children One very pertinent concern that has been posited by researchers and also by the authors of this document refers to children and teenagers. Our opinion is that they deserve special attention, mainly because this is the period in which an individual's identity develops and consolidates, as well as because it is the transition to adult life. Next, some very illuminating studies will be mentioned, since they may provide some insights into these concerns, especially with regards to young men. The authors of this study highlight that over the course of the pandemic, children and teenagers seem to be more vulnerable in terms of the availability of Hardcore pornographic content, which is spread around the internet, and some studies seem to corroborate this hypothesis. [30] [31] [32] First exposure to pornographic content at a premature age is a cause of concern for several different sectors of society nowadays. The importance and relevance of these data seem to be confirmed by several scientific studies. A study conducted with young people aged 15 to 29 years reported that mean age of first exposure to online pornography was at 13 for men and 16 for women. 33 Moreover, 84% of those who had watched online pornography in the 12 months prior to the survey were men and 19% were women, but one curious fact was that women consumed pornography on a weekly or daily basis. 34 Another study showed that 64% of young people aged from 13 to 24 actively sought pornography on a weekly basis. 33 Research shows that children and teenagers are more inclined to problematic consumption of online pornography than adults. 35 The most popular pornographic content website A multi-centered study in Europe involving 4,564 teenagers between 14 and 17 years of age suggested that watching pornography on a weekly basis is associated with a higher probability of sending sexual content (sexting) between peers. 38 In another systematic review and meta-analysis of 14 papers reporting cross-sectional studies, sexting behavior among people between 10 and 24 years of age was strongly associated with premature sexual activities, with alcohol use before the sexual act, and with multiple sex partners. 39 Adolescence is a period in which experimentation with sexuality starts. According to specialists, sex education should begin in puberty and adolescence. 40 Studies have already shown the inefficacy of sex education based on fear and guilt. 41 Nonetheless, recently a new way of experimenting with sexuality through sexting, especially among pre-adolescent and adolescent populations, has come to the attention of parents, educators, psychologists, and the general public. 42 Based on studies which suggest that online pornography consumption by young people is related to sexting, it is very likely that this practice will grow exponentially during the pandemic, since many young people and adults will A novel coronavirus from patients with pneumonia in China Prevalence of comorbidities in the novel Wuhan coronavirus (COVID-19) infection: a systematic review and meta-analysis The psychological impact of quarantine and how to reduce it: rapid review of the evidence Preventing problematic internet use during the COVID-19 pandemic: consensus guidance Digital healthcare: the only solution for better healthcare during COVID-19 pandemic? Global preparedness against COVID-19: we must leverage the power of digital health Pandemic fear" and COVID-19: mental health burden and strategies Pornography use in the setting of the COVID-19 pandemic Online porn addiction: what we know and what we don't-a systematic review Pornography addiction in adults: a systematic review of definitions and reported impact The impact of pornography on women: social science findings and clinical observations Hypersexual behavior in a large online sample: individual characteristics and signs of coercive sexual behavior Neuroscience of internet pornography addiction: a review and update Tendencies toward Internet-pornography-use disorder: differences in men and women regarding attentional biases to pornographic stimuli Diagnostic and Statistical Manual of Mental Disorders Can pornography be addictive? An fMRI study of men seeking treatment for problematic pornography use Internet pornography use, perceived addiction, and religious/spiritual struggles Self-reported addiction to pornography in a nationally representative sample: the roles of use habits, religiousness, and moral incongruence Characteristics of 36 subjects reporting compulsive sexual behavior Cyberpornography: time use, perceived addiction, sexual functioning, and sexual satisfaction Sex in America online: an exploration of sex, marital status, and sexual identity in internet sex seeking and its impacts Is pornography use associated with sexual difficulties and dysfunctions among younger heterosexual men? Is internet pornography causing sexual dysfunctions? A review with clinical reports Neural correlates of sexual cue reactivity in individuals with and without compulsive sexual behaviours HPA axis dysregulation in men with hypersexual disorder The role of neuroinflammation in the pathophysiology of hypersexual disorder Psychiatric features of individuals with problematic Internet use Interconnected but underprotected? Parents' methods and motivations for information seeking on digital safety issues Professionals' perceptions of the effect of pornography on Swedish adolescents Safeguarding young people from cyber pornography and cyber sexual predation: a major dilemma of the Internet The porn phenomenon: the impact of pornography in the digital age Young Australians' use of pornography and associations with sexual risk behaviours Motivational systems in adolescence: possible implications for age differences in substance abuse and other risk-taking behaviors Pornhub's 2016 year in review Adolescents and pornography: a review of 20 years of research Low risk associated with most teenage sexting: a study of 617 18-year-olds Is sexual content in new media linked to sexual risk behaviour in young people? A systematic review and meta-analysis The development of adolescent sexual intimacy: implications for counseling Human sexual development Young people's views on sexting education and support needs: Findings and recommendations from a UK-based study Likeness used as bait in Catfishing: how can hidden victims of catfishing reel in relief Top 300 biggest websites: based on both mobile and desktop data for the first time It is time to teach safe sexting NC just prosecuted a teenage couple for making child porn -of themselves. The Washington Post Problematic and non-problematic pornography use and compulsive sexual behaviors among understudied populations: children and adolescents Barriers to female sex addiction treatment in the UK The assessment of problematic internet pornography use: a comparison of three scales with mixed methods Predicting pornography use over time: does self-reported "addiction" matter? Approach bias for erotic stimuli in heterosexual male college students who use pornography Psychometric instruments for problematic pornography use: a systematic review. Eval Health Prof Compulsive sexual behavior and psychopathology among treatment seeking men in São Paulo No conflicts of interest declared concerning the publication of this article.