Let’s Talk About Porn

By Heleen Woest, MA, LPC
Life Solutions Counseling

Well, this is a topic people have opinions about. Say “porn” and you may get an enthusiastic defense, a firm objection, or a very awkward silence.

But what if you are the person who cannot seem to stop? Or the partner who has just discovered something they knew nothing about? Maybe you are worried about what your child saw online. Or you feel okay about your own use but wonder whether you should feel guilty.

Those are different concerns, and I would not treat them all the same way. I want to look at what the research can tell us, including the findings that might challenge what we already believe.

Porn is easy to find, and people can watch it privately. Some people experience serious problems with it; others do not. Before deciding that someone needs to stop, or that their concern is nothing to worry about, I would ask: Can you control your use? Is it affecting your life? Does it conflict with your values or an agreement with your partner? Is anyone being pressured or harmed?

“Porn addiction” is a common phrase. For some people, it describes wanting to stop, trying repeatedly, and still returning to a behavior that is causing problems. For others, it feels like a label that turns sexual shame or high desire into a disease.

Clinicians disagree in part because the diagnostic systems do not use the same framework. The DSM-5-TR does not include a stand-alone diagnosis called pornography addiction, sex addiction, or compulsive sexual behavior disorder. The ICD-11 does recognize Compulsive Sexual Behaviour Disorder, or CSBD, but places it among impulse-control disorders, not substance-related or addictive disorders. Kraus and colleagues’ ICD-11 clinical guidance describes a persistent pattern, generally six months or longer, of difficulty controlling intense, repetitive sexual urges or behaviors that leads to marked distress or meaningful impairment.

That is a much higher bar than “I watch more than I want to” or “my partner is upset.” A high level of sexual interest is not CSBD when a person has control and is not experiencing significant impairment. The World Health Organization guidance also says that distress entirely caused by moral disapproval is not enough for the diagnosis.

That does not mean we can ignore the word entirely. A person can be deeply distressed because a behavior conflicts with faith or personal values. A person can also have a genuine, persistent loss-of-control pattern. Sometimes both are happening. A careful assessment does not use faith, frequency, a screen-time total, or a partner’s anger as a shortcut to diagnosis.

The American Association of Sexuality Educators, Counselors and Therapists, or AASECT, takes a different position on the addiction label. It says there is not sufficient empirical evidence to classify sex or pornography addiction as mental-health disorders, while also recognizing that sexual urges and behaviors can have serious physical, psychological, spiritual, and sexual-health consequences. Disagreeing about the diagnosis is not a reason to dismiss someone who is struggling.

You have probably seen the claims about dopamine and porn changing the brain. Some are based on research. Others go quite a bit further than the studies do.

Sexual arousal, attention, learning, and motivation involve reward-related brain systems. That does not establish that online pornography “floods the brain with dopamine,” damages dopamine receptors, or creates inevitable desensitization. Functional MRI, or fMRI, measures an indirect blood-oxygenation signal. It does not directly measure dopamine or diagnose addiction.

Some small studies of selected people seeking help for problematic use find differences in response to sexual cues. For example, Gola and colleagues’ fMRI study of 28 heterosexual men seeking treatment for problematic pornography use and 24 comparison participants found greater ventral-striatal response to cues predicting erotic images in the treatment-seeking group. That cue response was associated with several reported problem measures. The researchers said the findings could be consistent with an addiction-like model.

That finding supports a possible explanation, but it does not prove it. The study was small, male-only, cross-sectional, and conducted with a selected treatment-seeking sample. It cannot tell us whether the observed difference came before the problem, followed it, reflected another factor, or applies to women, queer people, non-treatment-seekers, or casual users.

Other studies have not found some of the brain differences described in popular accounts. A small PET and MRI study by Stormezand and colleagues found no group differences in striatal D2/3 receptor availability or cerebral blood flow among men with and without compulsive pornography use. That does not prove that no relevant brain difference could ever exist. It does directly challenge claims that a characteristic receptor deficit or brain injury has already been established.

Psychologist Nicole Prause and colleagues have also challenged a straightforward addiction explanation. Their 2015 EEG study found patterns they interpreted as inconsistent with a particular addiction prediction. Gola’s published response argued that the same finding could fit some addiction models. This is an important disagreement about how to interpret a laboratory task, not a test that can settle whether an individual person needs help.

For now, there is no brain scan that diagnoses PPU or CSBD. Studies can help explain how attention, motivation, and learned cues may be involved. They have not established that ordinary viewing causes brain damage or that one mechanism explains everyone’s experience.

What about “tolerance,” “withdrawal,” and escalation? Some people who report problematic use also report more time spent, rapid switching, novelty-seeking, or withdrawal-like symptoms. In a preregistered Polish survey, Lewczuk and colleagues found that self-reported tolerance and withdrawal were associated with higher PPU and CSBD severity. Because it was cross-sectional and self-report based, it cannot establish cause or a universal biological withdrawal syndrome.

A seven-day randomized abstinence study of regular student users by Fernandez and colleagues found no confirmatory overall withdrawal effect. A narrower exploratory finding appeared only among participants with both very high prior use and higher PPU scores. People’s symptoms still need attention, but this study does not support telling every viewer to expect withdrawal, escalation, or permanent harm.

Digital design can make novelty and rapid switching easier. Recommendation systems, autoplay, and endless feeds can shape what people encounter and how long they stay online. Research has not established that pornography recommendation algorithms cause a particular person’s escalation or dyscontrol. If keeping your phone out of the bedroom helps you sleep or stick to a decision, you can try it. You do not need evidence of brain damage to change a habit that is bothering you.

People often ask whether so-called “ethical pornography” solves the problem. What would make it ethical, and how would a viewer know?

Anti-exploitation feminist writers including Gail Dines and Robert Jensen ask how commercial sexual media may reinforce objectification, gender inequality, racism, or ideas about who is entitled to power. Their books, Pornland and Getting Off, put industry practices and cultural messages at the center of the discussion. These concerns deserve attention even when an individual viewer does not report a clinical problem. Their arguments should also be distinguished from studies testing a particular outcome in a particular population.

Performer-led and sex-positive voices ask us to listen to adult workers themselves. The essays and interviews in The Feminist Porn Book, coedited by Tristan Taormino, bring together scholarship and industry voices about consent, labor, representation, and creative control. Meaningful choice and fair working conditions matter. So does recognizing that performers do not all have the same experiences or opinions.

Listening to performers does not require ignoring exploitation. Taking exploitation seriously does not mean assuming every adult performer has been coerced. We still need to ask about consent, working conditions, pay, representation, and how use fits with a viewer’s values and relationship agreements.

A frequently cited 2010 content analysis by Bridges and colleagues found that 88.2% of 304 scenes in 50 top-selling and top-rented DVDs from 2004 to 2005 contained at least one researcher-defined physical aggressive act. That statistic is often repeated inaccurately as “88% of today’s most-viewed online videos.” It was not that. It tells us something important about the scripts in one commercially successful DVD sample from a particular era. It cannot tell us whether performers consented to a scene off camera, whether production conditions were safe, or what any viewer will imitate.

A later systematic review of content analyses by Carrotte and colleagues found major differences in media sampled, definitions used, and whether consent was considered. That is a reminder to be cautious with headline percentages.

We cannot reliably judge consent from the finished scene. Intense activity does not necessarily mean abuse, and someone smiling on camera does not establish that they freely agreed to what happened. In real life, Dunkley and Brotto’s clinical review describes consent as freely given, informed, specific, ongoing, and reversible. Pressure, incapacity, ignored boundaries, or an inability to stop are not made okay by calling something a preference or a kink.

A small 2023 international Delphi panel led by McKee, Dawson, and Kang proposed features that might help adults ages 18 to 25 think more critically about sexually explicit media: diversity of bodies and identities, communication of consent, attention to known production conditions, mutual pleasure, safer-sex depictions, and a range of sexual scripts. This was expert consensus, not a safety certification, production audit, or study showing benefits for viewers. It did not include young adults on the panel, and its authors documented other meaningful limits. The proposed criteria may help people ask questions, but they do not verify that a production was safe or beneficial.

Industry codes and screening programs deserve the same restraint. Some organizations publish ethics pledges or health-screening protocols. Those efforts may reduce particular risks. They are not government oversight, and they cannot let a viewer verify consent, age, fair pay, freedom from coercion, or safety in a specific production. A viewer cannot take the word “ethical” as a guarantee.

Private sexual behavior is not automatically betrayal. Couples define privacy, fidelity, sexual media, and disclosure differently. If two people have an explicit agreement and one person breaks it, the injured partner may reasonably experience that as a serious trust rupture. If the couple never discussed it, the work may begin with a hard but useful conversation about assumptions rather than a universal accusation.

In a 35-day diary study with 217 Canadian couples, Vaillancourt-Morel and colleagues found that unknown solitary use was associated with lower same-day user satisfaction and intimacy. It did not predict change in satisfaction or intimacy over a year. Known solitary use had mixed long-term intimacy associations for users and partners. In other words, concealment and unspoken use can be clinically important, but the study cannot show that secrecy alone caused lasting relationship damage.

Sometimes what hurts most is discovering a broken agreement or realizing that your partner has not been honest with you. I would want to understand that hurt rather than decide it does not matter because other couples feel differently about porn.

Some couples who view sexual media together report greater intimacy or easier sexual conversation. In four dyadic datasets, Kohut and colleagues found that shared viewing and similarity in solitary-use patterns were associated with higher satisfaction in those samples. The researchers were clear that their observational design cannot show that shared viewing caused the satisfaction. Couples who already have more openness, compatible desire, or comfort talking about sex may be more likely to choose it.

A 35-day daily-diary study that included mixed-sex and same-sex couples found no overall same-day association with relationship satisfaction, while associations with desire and partnered activity differed by the user’s and partner’s sex. Vaillancourt-Morel and colleagues offer a useful reminder that no one pattern describes everybody.

None of this means a couple should watch together to improve their relationship. Both people need to want it, and either person must be free to say no without pressure or punishment.

If you are worried about your use or arguing with a partner about theirs, these are some of the questions I would start with.

Consider these:

• Control: Can I choose when to use, reduce, pause, or stop when I decide to? Have I tried repeatedly and found that I cannot follow through?
• Impact: Is this interfering with sleep, work, finances, parenting, health, concentration, or relationships?
• Function: What tends to happen just before I use or want to use? Stress, boredom, loneliness, anxiety, conflict, habit, sexual interest, difficulty sleeping, or something else?
• Values: Does this fit my freely held beliefs about sexuality, faith, integrity, privacy, and the kind of life I want?
• Relationship agreements: What has actually been discussed? What has been assumed? Has an explicit agreement been broken?
• Safety: Is anyone feeling pressured, fearful, coerced, monitored, or unable to say no? Is there violence, intimidation, image-based abuse, or a concern involving minors?
• The broader clinical picture: Could depression, anxiety, OCD symptoms, trauma symptoms, mania or hypomania, medications, substances, sleep problems, or a medical concern be relevant?

A clinician should never diagnose CSBD from a quiz. They should also not dismiss a person who says, “I do not feel in control.” The goal is to understand the actual pattern and decide what support fits.

It is reasonable to ask a therapist how they approach pornography concerns before committing to treatment. Do they assess control and consequences, or assume that any use is addiction? Can they respect religious commitments without imposing their own? Can they take a partner’s distress seriously without making that partner responsible for someone else’s behavior?

You can also ask, “What would progress look like, and how would we measure it?” More sleep, fewer unwanted episodes, reduced shame, better communication, keeping a chosen agreement, or ending use altogether may all be relevant. The therapist should be able to explain the plan, its evidence, and its limits in ordinary language. You are allowed to ask questions and seek a different fit.

Therapy can help when porn use feels out of control, interferes with daily life, conflicts with your values, or has hurt a relationship. It can also help you work through sexual shame without asking you to give up beliefs that matter to you.

Several therapies have been studied, but the evidence does not yet identify one approach that works best for everyone. A 2025 meta-analysis by López-Pinar, Esparza-Reig, and Bőthe included 20 psychotherapy studies and 2,021 participants at baseline. Only 25% were randomized trials, 84% of participants were men, no gender-diverse participants were included, and outcomes were largely self-reported. The pooled controlled estimate for PPU symptoms drew on only three studies and 98 analyzed participants, although it was encouraging.

A 2024 systematic review by Roza and colleagues included 28 studies with 500 participants, many of them case reports or quasi-experimental studies, and rated all interventions low or very low certainty. A therapist can use the available research to plan treatment, but should explain how much uncertainty remains.

Mindfulness may help you pause and notice an urge, a feeling, or something on the screen that catches your attention before you act automatically. The PPU-specific research is early and small. A 13-person uncontrolled CSBD pilot by Holas and colleagues reported some encouraging changes after mindfulness-based relapse prevention, but it had no control group or follow-up. That is too small a study to establish how well it works or for whom.

Trauma may be relevant for some people, but we should not assume it explains everyone’s use. A person may use sexual media in relation to stress, anxiety, loneliness, habit, boredom, sleep disruption, shame, depression, or relationship pain. Another person may have trauma symptoms that need their own careful assessment and treatment. A systematic review of biopsychosocial PPU factors found substantial differences across the studies and cannot establish that childhood trauma causes PPU.

EMDR has guideline support for PTSD. If a person has separately assessed trauma symptoms, EMDR may be considered for the trauma with a qualified clinician. That is different from saying EMDR has been proven to treat problematic pornography use itself. The PPU reviews do not identify controlled PPU outcome trials showing that EMDR is superior to CBT or ACT. Training in an approach is not the same thing as research demonstrating that it works for this specific problem.

Some people appreciate Internal Family Systems, or IFS, introduced by Richard Schwartz in No Bad Parts, because it can make room for curiosity and self-compassion: “What is this urge trying to do for me right now?” A 2025 IFS scoping review found emerging general evidence, much of it case studies and small studies, not an established PPU treatment base. Some people find that way of asking questions helpful. It does not establish that their use comes from trauma or that IFS is a proven PPU treatment.

What do you want to change, and why? That is where I would start.

Some people want to stop entirely because use feels out of control, they do not like who they are becoming around it, it conflicts with deeply held faith, it has caused meaningful harm, or it violates an agreement they freely chose. Those can be valid reasons to choose abstinence.

Some people want to reduce a behavior that has become automatic, restore sleep, stop using it to avoid difficult feelings, or set a clearer boundary around devices. Some want help sorting out shame, desire discrepancy, or a partner conflict. Some adults do not want to stop using sexual media at all but want to use it more consciously, honestly, and in a way that fits their values and agreements.

The research does not show that abstinence is universally superior. Briken and colleagues’ sexual-medicine review recommends goals that build self-control, reduce harm and distress, and support sexual health rather than treating the renunciation of sexuality itself as the goal. A clinician can help you work out your goal without choosing it for you.

Discovering hidden use can bring shock, anger, grief, intrusive thoughts, sleep disruption, and self-doubt. Those symptoms deserve attention, whether or not you meet the criteria for PTSD. “Betrayal-related distress,” “relationship injury,” or “trust rupture” can name the experience without claiming a diagnosis before a qualified assessment.

Barbara Steffens and Marsha Means, in Your Sexually Addicted Spouse, write from a partner-trauma perspective and challenge the idea that the partner caused or enabled the behavior. That can be reassuring after a painful discovery. A trauma-informed therapist can validate distress, help with boundaries, and assess symptoms without automatically diagnosing PTSD. Whether the person wants to repair the relationship, leave it, or take time to decide should remain their choice.

The person who used porn also needs help that goes beyond feeling bad about themselves. If they want to repair the relationship, they need to acknowledge what happened, take responsibility for their choices, and listen without demanding quick forgiveness. Their partner does not have to stay, forgive, resume intimacy, or take charge of their recovery.

Couples work can be one option if both people want it and it is safe. Before starting joint sessions, a clinician should speak with each person separately and privately to assess intimate partner violence, coercive control, fear of retaliation, and whether both people can speak freely. The American Psychological Association cautions that conjoint therapy is not appropriate for all couples affected by violence. If there is abuse or violence, please read Life Solutions Counseling’s guidance on when to avoid couples counseling.

Some couples choose a planned, clinician-supported conversation about what happened because surprises and partial answers have become destabilizing. That can be helpful for some people. It is not a universal requirement, and it may be inappropriate in situations involving violence, coercion, severe instability, dissociation, self-harm risk, or unresolved trauma. If a structured conversation is used, it should be voluntary, paced, and focused on meaningful honesty without unnecessary detail. The person who was hurt does not lose their voice or their right to ask questions. Either person can pause.

Rebuilding trust does not give someone permission to monitor or control their partner. Some adults freely agree to limited, time-bounded transparency while rebuilding trust. That is different from compelled passwords, location tracking, device searches, spyware, or constant monitoring. Research on technology-facilitated abuse shows how easily digital tools can become coercive control. Both people should freely agree to it. It should be proportionate to the concern, safe to decline, and open to change.

What about a polygraph? It is not a reliable way to settle whether someone is telling the truth. It measures physiological arousal, not truth, and the American Psychological Association warns that the evidence does not support its use as a reliable and valid deception detector. A person’s physical reaction can reflect fear, shame, or anger rather than dishonesty.

For some couples who both want it and feel safe, a qualified sex therapist may offer gentle, non-goal-oriented exercises to rebuild comfort and connection at the couple’s own pace. No one should be pressured to resume physical intimacy. Either person can decline or stop without being pressured.

• AASECT. 2016, current statement. AASECT Position on Sex Addiction.
• Bőthe, B., Tóth-Király, I., Demetrovics, Z., and Orosz, G. 2020. High-Frequency Pornography Use May Not Always Be Problematic.
• Briken, P., Bőthe, B., Carvalho, J., et al. 2024. Assessment and treatment of compulsive sexual behavior disorder: a sexual medicine perspective.
• Chew, P. K. H., Yow, Y. J., and Tan, C. S. Y. 2025. Prevalence of problematic pornography use: a meta-analysis.
• Fernandez, D. P., et al. 2023. Effects of a 7-Day Pornography Abstinence Period on Withdrawal-Related Symptoms.
• Gola, M., and colleagues. 2017. Can Pornography be Addictive? An fMRI Study of Men Seeking Treatment for Problematic Pornography Use.
• Gola, M., et al. 2022. What should be included in the criteria for compulsive sexual behavior disorder?
• Grubbs, J. B., Kraus, S. W., and Perry, S. L. 2019. Self-reported addiction to pornography in a nationally representative sample: The roles of use habits, religiousness, and moral incongruence.
• Grubbs, J. B., Perry, S. L., Wilt, J. A., and Reid, R. C. 2019. Pornography Problems Due to Moral Incongruence: An Integrative Model with a Systematic Review and Meta-Analysis.
• Grubbs, J. B., et al. 2018. Moral disapproval and perceived addiction to internet pornography: A longitudinal examination.
• Grubbs, J. B., Kraus, S. W., Perry, S. L., Lewczuk, K., and Gola, M. 2020. Moral incongruence and compulsive sexual behavior: Results from cross-sectional and longitudinal analyses.
• Kraus, S. W., Krueger, R. B., Briken, P., et al. 2018. Compulsive sexual behaviour disorder in the ICD-11.
• Lewczuk, K., et al. 2022. Withdrawal and tolerance as related to compulsive sexual behavior disorder and problematic pornography use.
• Fernandez, D. P., and Griffiths, M. D. 2020. Psychometric Instruments for Problematic Pornography Use: A Systematic Review.
• Prause, N., et al. 2015. Modulation of late positive potentials by sexual images in problem users and controls inconsistent with porn addiction.
• Gola, M. 2016. Decreased LPP for sexual images in problematic pornography users may be consistent with addiction models. Everything depends on the model.
• Stormezand, G. N., et al. 2021. No evidence for decreased D2/3 receptor availability and frontal hypoperfusion in subjects with compulsive pornography use.

• Abdi, K., et al. 2025. Effect of pornography use on sexual satisfaction: a systematic review and meta-analysis.
• American Urological Association. 2018. Erectile Dysfunction: AUA Guideline.
• Kohut, T., et al. 2021. But What’s Your Partner Up to? Associations Between Relationship Quality and Pornography Use Depend on Contextual Patterns of Use Within the Couple.
• Perry, S. L., and Schleifer, C. 2018. Till Porn Do Us Part? A Longitudinal Examination of Pornography Use and Divorce.
• Grubbs, J. B., and Gola, M. 2019. Is Pornography Use Related to Erectile Functioning? Results From Cross-Sectional and Latent Growth Curve Analyses.
• Rowland, D. L., and Cooper, E. B. 2024. Pornography and Sexual Dysfunction: Is There Any Relationship?
• Vaillancourt-Morel, M.-P., Rosen, N. O., Willoughby, B. J., Leonhardt, N. D., and Bergeron, S. 2020. Pornography use and romantic relationships: A dyadic daily diary study.
• Vaillancourt-Morel, M.-P., Rosen, N. O., Bőthe, B., and Bergeron, S. 2024. Partner Knowledge of Solitary Pornography Use: Daily and Longitudinal Associations with Relationship Quality.
• Wright, P. J., Tokunaga, R. S., Kraus, A., and Klann, E. 2017. Pornography Consumption and Satisfaction: A Meta-Analysis.