Dr Philippa Kaye, GP with a special interest in women’s and sexual health.
Pornography is everywhere. Thanks to the Internet and the advent of smartphones, pornography is constantly within our reach and almost inescapable.
It’s a far cry from just a few decades ago, when pornography was banished to mainstream newsstand magazines, hastily shoved under the bed, or limited to a copy of The Joy of Sex or a nondescript videotape.
But its new ubiquitous nature is having a real impact on our lives, as people of both sexes are exposed to pornography at increasingly younger ages.
By the age of 18, about 93 percent of boys and 63 percent of girls have viewed pornography, according to the Institute for Family Studies.
But the average age at which porn is first viewed was found to be even younger, just 12 years old.
While there are differences between genders regarding viewing pornography, it is clear that both men and women are frequently exposed to explicit content.
At the end of 2019, around a third (33 per cent) of uses of PornHub, the most used adult content website in the UK, were female.
While many people say they like watching adult content, for others this can become a problem.
A 2019 American study found that 11 percent of men and 3 percent of women reported addiction to pornography.
Unfortunately, there are still many taboos and stigmas in society and in health, and sex remains one of them, particularly female sexual pleasure.
And there are still a lot of feelings of shame and embarrassment around masturbation and porn use, especially in women.
At the end of 2019, around a third (33 per cent) of uses of PornHub, the most used adult content website in the UK, were female.
Take 19-year-old Elise*, who muttered under her breath that “something was wrong down there” and refused to make eye contact.
She was extremely anxious about the appearance of her vulva, the external genitalia, and was requesting a referral to see a plastic surgeon to have her vaginal lips surgically adjusted so that they were the same length and did not protrude.
Her partner had mentioned it and she had gotten into porn because she thought she would be able to see a variety of bodies.
In fact, what he saw was a consistent body type, completely hairless and looking a certain way, without the natural variation that occurs. She thought it was abnormal and this worry had become an intrusive obsession.
The more she worried, the more she searched, which worried her more.
Or Rachel*, 27, who arrived with skin damage from trying to lighten the appearance of her vulva and anus after watching more and more porn.
Aside from body image issues, there is also the risk of pornography addiction, which can have an impact on mental health.
Caryn* had started watching porn when her partner said she was “vanilla” if she didn’t, and the more she watched with her partner, the more she was made to feel like she had to try more and more extreme sexual acts.
She didn’t want to, she didn’t enjoy them, and yet at first she found herself unable to refuse for fear of what her partner might say.
Pornography is now considered mainstream, but the content may not be, and aggressive, violent or degrading acts are presented as the norm.
The women I see in my practice seem to feel, or perhaps are made to feel, that if they do not enjoy these acts then the fault lies with themselves, that something is wrong with them.
Patience, 31, told me that she wanted to feel safe and empowered, that as a sexually liberated woman she could enjoy porn, but in reality it made her feel depressed and anxious about her body and sexual preferences.
Instead of empowering her, it actually made her so eager for sex that she almost stopped having it, and when she did, she didn’t enjoy it, she didn’t get turned on, and it was even painful.
Research conducted in 2021 suggests that 58 percent of women say they have been choked during sex, an increase from 21 percent recorded in a 2020 survey.
Violent acts such as suffocation and strangulation have become normalized despite the very real health risks they entail.
Asphyxiation literally cuts off the flow of blood and therefore oxygen to the brain, causing dizziness with the goal of intensifying pleasure, but it has inherent risks. There is no safe way to perform this act.
Could you be one of 20 Brits caught in the grips of a porn addiction?
Physical risks aside, choking involves a power dynamic, and it has become so normalized that people may not realize that specific consent should be requested.
Even if asked, how many women give consent because they think they should, or because they think their partner will get pleasure from it, rather than because they themselves will get pleasure from it? Is it even true consent?
Much of the porn available is made for the male gaze and focuses on male pleasure.
Anecdotally, I have seen that many heterosexual women prefer to watch female porn, perhaps because it focuses on the pleasure of the women involved.
PornHub has a category titled “popular with women,” which it claims includes “everything from passionate, story-based softcore porn to hardcore gangbangs.”
PornHub’s 2015 data showed that female viewers are 100 times more likely to search for “hard” or “rough” content than men, which seems counterintuitive.
But porn addiction is just like many other addictions, in terms of the brain’s response.
Watching porn affects the reward and pleasure centers in the brain, releasing feel-good chemicals like dopamine.
Over time, it is necessary to watch more and more explicit videos to create the same effect, as if someone with a drug addiction needed higher and higher doses to get high.
This means that viewers may have difficulty becoming aroused and reaching orgasm with a real partner, who responds differently to the image on a screen – after all, porn is not real life. But it can affect real-life relationships.
I have a patient who feels so ashamed about her relationship with pornography that she feels like she can’t form a relationship.
Other signs that you may have a porn addiction include watching increasing amounts of porn, neglecting other activities such as working, eating or sleeping to watch porn, not being able to enjoy sex without porn, and feeling unable to stop even if you are aware of it. the damage it is causing.
We cannot know the true number of women who suffer from pornography addiction, due to stigma and cultural pressures, they may simply not present or present with other mental health problems.
Pornography addiction is a very real and likely growing problem, which can affect mental health and lead to depression, anxiety and body image issues, as well as affecting relationships and even work, perhaps due to concentration difficulties or problems mental health.
Simply replace the word pornography in that sentence with ‘alcohol’, ‘drugs’ or ‘sex’ and it becomes clear that it is an addiction like any other.
Addiction needs treatment and is often not as simple as simply stopping watching porn, which in itself is not simple.
The underlying reasons why the addiction developed, such as anxiety, may need to be addressed, and it is incredibly difficult to stop being exposed to explicit videos when they are easily accessible anywhere and everywhere.
A 2019 American study found that 11 percent of men and 3 percent of women reported addiction to pornography.
In the same way that someone suffering from alcohol addiction can eliminate all sources of alcohol from their home, getting rid of hard copies of pornography, deleting saved tabs or website subscriptions can be helpful, as can installing anti-porn software on your devices (ask someone else to have the password).
Talking therapies can be helpful, as can medications, for example, if there is an underlying mental health condition. Psychosexual counseling can also be used to help treat pornography addiction, although access to it can be difficult and waits can be long.
Society and the Internet have normalized the use of pornography. We now need to normalize talking about the problems it can cause and encourage people to ask for help so they can have a healthy sex life, after all, sex and orgasms are good for your health!
*Patient names have been changed.