Sex & Relationships

Is Porn Bad for You?

Since the advent of the internet, millions of Americans have started visiting porn sites daily. Is there a hidden cost to this newfound access?

"Porn is an easy outlet, a one-way outlet. What a rush! What a release! The Internet puts an endless stream of images at my fingertips. I've conveniently conned myself thinking it's okay, but deep down I know it's wrong. It makes me feel dirty and has hurt my relationship with my wife. I beat myself up afterward, hate myself, and swear that was the last time. But before I know it, I'm back at it again. I'm scared where it's leading. Can you help me?"—Scott, 44 years old.

Scott, a successful lawyer with a wife and two children, showed up at my office for his first session confused and angry about his relationship with pornography. He could see the damage his Internet porn habit was having on his marriage, health, and career, but he couldn't stay away from it. His story is typical of men and women—of all ages, backgrounds, incomes, and lifestyles—who are seeking counseling for serious problems related to pornography.

When I began counseling in the mid-1970s, cases like Scott's were rare and almost inconceivable. Hardcore pornography was difficult to obtain. But in recent decades, new electronic technologies, such as cable television, computers, and iPhones, have transformed it into a product that's available to anyone—anytime, anywhere, and often cheap or free. It's become a substantial part of our economy, boasting annual revenues in excess of $13 billion in the United States and $100 billion worldwide.

The revolution in accessibility has led to record consumption. According to statistics on the Internet Filter Review site, 40 million Americans visit Internet porn sites at least once a month. Some porn users visit sites for only a few minutes at a time. Others, like Scott, visit porn sites daily, spending more than 15 hours per week. One-third of all downloads each month and one-quarter of all online searches each day are for porn. And, according to a 2008 Nielsen Online survey, a record-breaking 25 percent of employees in the United States are accessing porn at work, despite the risks involved.

Not surprisingly, concerns about the effect of porn on individuals and relationships are also on the rise. According to a 2004 survey in Men's Health, more than 70 percent of the men surveyed said they've looked at more porn since the advent of the Internet, and one in two expressed concern about their use of it. The American Academy of Matrimonial Lawyers and the British Nielsen NetRatings organization have identified it as a major cause of divorce and relationship difficulties. An MSNBC study in 2000 revealed that 70 percent of porn users keep their use secret and that from 8 to 15 percent of regular Internet porn users develop compulsive sexual behaviors that significantly impact their lives. In total, up to half of all regular pornography users report some type of negative consequence or concern about their use. No wonder sexual addiction experts, such as Patrick Carnes, have begun calling pornography addiction "our newest and most challenging mental health problem."

Changes in how people access and use pornography have taken the therapeutic community by surprise. The explosion in porn use has happened so fast that many therapists have been caught unprepared; they may not yet comprehend the extent of the problems porn can cause, or how deeply its use can harm individuals and their intimate partners. Despite the increase in the number of people suffering from anxiety, depression, sexual problems, relationship distress, and other serious consequences of habitual porn use, few therapists feel comfortable and confident addressing porn-related concerns.

How We Feel about Porn

Pornography draws strong responses—from the public at large and within the therapeutic community. Many of us have such strong feelings about pornography that we automatically label, condemn, or reject anyone who sees it differently. If we're critical of porn, we might judge people who like it as "excessively permissive," "exploitive," "addicted to sex," or "misogynistic." If we're supportive of porn, we may see those who don't share our view as "sexually uptight," "religiously conservative," "radically feminist," or "against free speech." Unlike other common mental health concerns, such as depression or substance abuse, we have no reasonably coherent and agreed upon clinical perspective for what constitutes a "porn problem" or how to approach it.

Recently, at a professional training, I asked a group of therapists to share their knee-jerk feelings about pornography. The answers came quickly and from all over the emotional map: "disgusted," "excited," "angry," "anxious," "saddened," "afraid," "horny," "repulsed," "ashamed," "shocked," "amused," "curious," and "ambivalent." I wasn't surprised by the range of feelings: I've had all those feelings myself, even though I've been a sex and relationship therapist for 35 years.

In the past, understanding and dealing with our personal reactions to porn may not have been that important to our success as psychotherapists. But today, when clients who develop problems with porn range from 90-year-old men to 9-year-old girls, examining our own attitudes about porn is critical to our success as healers. Without an informed and accurate understanding of porn and its effects, we can easily discount clients' concerns or respond to them in unhelpful, emotionally reactive ways. A study in the January-March 2009 issue of Sexual Addiction and Compulsivity by Michelle Ayres and Shelley Haddock found that therapists' personal attitudes about pornography play the strongest, most significant role of any factor, including training and clinical experience, in influencing their approach to treatment.

The workshop discussion got me thinking about how significantly my attitudes about pornography have changed during the course of my life and counseling career. To a large extent, my personal journey reflects the evolution of pornography from a product that was hard to get to an experience that can be hard to avoid.

A Peephole to Adult Pleasure

It was 1961, and I was 11 years old—the average age of first exposure to pornography—when a neighbor girl showed me some picture cards she'd found in her grandfather's nightstand. They featured pretty women in frilly corsets, posed to reveal breasts spilling out and bottoms exposed. I giggled with my friend, but found them both shocking and stimulating. Several images became locked in my brain, making them easy to recall to this day. Soon after, I discovered a stash of Playboy magazines hidden in a home where I babysat. I enthusiastically perused them from cover to cover, praying that my secret activities would never be discovered. I barely understood the captions, but I liked the colorful cartoons showing shameless, wide-eyed females.

As I grew older, I had only infrequent and experimental contact with pornography, usually when babysitting or at a girlfriend's house when her parents were away. To me, pornography was for adults, definitely a guy thing, not something a "good girl" should pursue. In the East Coast middle-class suburb where I grew up, getting my hands on more pornography would have taken some effort, and even though my parents were more open and communicative about sex than most, I knew they wouldn't approve of my looking at "dirty" magazines or reading steamy novels. Consequently, scarcity, fear, and guilt served as formidable barriers to their use.

Later, in high school, my wrestler boyfriend took me to a party with his teammates where we stood, beers in hand, in a living room and watched grainy black-and-white "stag films" from Europe. This live-action form of pornography was much more exciting than the still shots and written descriptions I'd seen before. Motion pictures made sex real and brought it into the here and now. We stood transfixed by the images, trying to look cool while heating up inside. The images were as disturbing as they were arousing—a young woman slowly stripped and fondled by an older man, and several men being sexual with one woman. It seemed like everything played out in slow motion. Flushed with sexual heat and embarrassment, I looked over at my boyfriend. He seemed uncomfortable and embarrassed, and a little afraid. We left the party early, never discussing what we'd witnessed or felt.

In my early exposures, I saw pornography as a forbidden product, offering a peephole into the off-limits adult world of sexual pleasure. Like smoking cigarettes in back of the schoolyard or taking a shot of alcohol from Dad's liquor cabinet, looking at pornography felt rebellious, but at the same time, a necessary rite of passage. As a way to understand sex, those "dirty" stories, pictures, and films offered a far more compelling view of sexuality than the cryptic and incomplete sex-education materials I was shown in health class. In spite of how the images degraded women and portrayed men in a position of sexual power, pornography gave me a vision of sex that validated sexual passion and pleasure.

Liberating Adult Entertainment

In the early 1970s, I graduated from college and moved to Berkeley, California, to attend social work graduate school and pursue a career as a mental health therapist. The sexual revolution—at least as it was widely portrayed in the media—was in full swing, and had transformed the public perception of sex and its possibilities. Ana•s Nin, David Reuben, Shere Hite, Betty Dodson, Alex Comfort, Judy Chicago, and others were raising my consciousness about the great possibilities inherent in sexual liberation and freedom from ignorance, old hang-ups, and unnecessary taboos. My peers and I thought that almost anybody could become a healthier, happier, more productive human being—and society itself might change for the better—if only people could transcend their parents' puritanical training about sex and overcome unnecessary embarrassments and inhibitions.

It was an exciting time of sexual awakening. Sexual pleasure became a recreational sport and "free love" a spiritual practice. I became involved in a back-to-nature movement that validated the natural beauty of the body. I soaked naked in hot tubs with friends, hiked bare-chested in coastal forests, and skinny-dipped in mountain streams. I volunteered
at the Berkeley Women's Health Collective, helping women perform their own pelvic exams and learn how to recognize common gynecological problems. I delighted in what seemed radically new ideas then—that it's okay to learn about and regain control of our bodies, that nothing is ugly or disgusting about sex (and genitals), and that, like men, women have sexual feelings and needs.

During this period of expanding sexual awareness, hardcore pornography entered the mainstream marketplace. While capitalizing on the changes in social consciousness, this expansion in commercial pornography seemed to reinforce the new spirit of sexual
openness, freedom, and acceptance. Penthouse magazine made Playboy look tame by brazenly revealing the pubic hair of its monthly pets. In 1975, when Playgirl magazine, featuring sexy pictures of men (many with blatant erections), appeared on the market, I wondered whether pornography might be headed in a direction of sexual equality.

Soft and hardcore movies started appearing in adult-only movie theaters in major cities across the country. For the first time, porn titles and stars were showcased on marquees, not hidden away in dark-alley cigar shops. Now the public had easy access to gay porn films (Boys in the Sand and Pink Narcissus), erotic cartoon movies (Fritz the Cat), and full-color features like Deep Throat, The Devil in Miss Jones,and Behind the Green Door.Adult movies emerged as a new and wildly popular form of entertainment. Though Larry, my live-in boyfriend (now my husband), and I were involved in social work, feminist causes, and men's consciousness raising, we'd occasionally slip into a nearby Mitchell Brothers adult movie theater to watch a talked-about release. Any trepidation that these films were inconsistent with our social values was overridden by our curiosity about this exciting new pornography and our desire to feel we were becoming sexually liberated.

A Therapeutic Intervention

My perspective on pornography underwent another shift in the early 1980s, when, as a newly married and practicing clinical social worker, I started specializing in sex therapy. I'd initially worked as a drug-and-alcohol counselor, but switched to sexuality counseling when I noticed a strong connection between people's self-esteem and self-confidence and how good they felt about themselves sexually.

Sex therapy was a new, exciting, and much-needed clinical specialty, providing solid information, advice, and a safe place to discuss and get help for a wide array of sexual-functioning problems and concerns. Leaders in the field—people like William Masters and Virginia Johnson, Lonnie Barbach, Helen Singer Kaplan, Joseph and Leslie LoPiccolo, and Bernie Zilbergeld—were opening doors and providing information that had long been needed.

My training to become a certified sex therapist with the American Association of Sex Educators, Counselors, and Therapists included attending a required Sexual Attitudes Reassessment (SAR) seminar. With my fellow aspiring sex therapists, I watched a wide assortment of sexually explicit movies, some blatantly pornographic, others made and intended specifically for educational and instructional purposes. We watched films on masturbation, heterosexual and homosexual lovemaking, oral and anal sex, sex in the aging and disabled populations, sadomasochism, bondage, and more extreme sexual practices. Then we discussed our reactions in small groups. The seminar enabled us to explore our attitudes, feelings, and beliefs about all kinds of sex, and to gain confidence in helping clients with sexual problems. I found the direct and graphic nature of the SAR helpful for recognizing and challenging harmful myths and stereotypes, such as the mistaken idea that only young and beautiful people can have really good sex.

I began to consider pornography as an intervention that could be used for educational and therapeutic purposes. In sex therapy manuals, trainings, and conferences, it was touted as a product that could help clients reduce inhibitions about sexual practices, avoid boredom, and spice up their sex lives. It was considered "harmless visual stimulation"—an easy way to expand sexual awareness and safely explore sexual fantasies and desires, inside or outside a committed relationship.

To the extent that sex therapists had concern about the dangers of watching pornography, professional discussions were limited to whether porn use could lead to sexual violence. Then, as now, no clear and reliable link emerged. The consensus was that pornography became a problem only when the viewer couldn't distinguish between fantasy sex and real sex (believing, for example, that women enjoy being raped), or was using it in ways that endangered children (leaving it out where it could be seen), or harmed trust in an intimate relationship (pressuring a partner to do something he or she didn't want to do).

In tune with the times, I sometimes assumed that when one person in a relationship was into porn and the other wasn't, the reluctant partner was likely "sexually uptight," "withholding," or "unadventurous." Therapeutic strategies often focused on negotiating the type, use, purchase, and storage of the pornography, rarely on discouraging its use. I might, for instance, help a couple reach a decision that they would only use porn together and would choose movies that they both enjoyed.

Like many of my sex therapy colleagues, I kept a box of classic pornographic novels in my office closet. I'd lend copies of Fanny Hill, The Pearl, and Lady Chatterley's Lover to female clients who were learning to become orgasmic. Hot sexual reading coupled with genital stimulation was and still is promoted in the field as an effective therapeutic intervention for boosting erotic excitement and helping a woman "make it over the hump" to have her first orgasm. I suggested pornography, as I might a heating pad or a vibrator, because of its stimulating effects. Porn, with its repeated descriptions of seduction and sexual activity, offered a way a woman could stay focused on sex and leave distracting thoughts and worries behind. The result of sexual functioning—climaxing—justified whatever means it took to get there.

I did have occasional misgivings, however, about advocating pornography in treatment. As a product, it was usually poorly made and portrayed sex in unrealistic, inaccurate, unsafe, and impersonal ways. For example, even though surveys show that monogamous partners are actually the most satisfied with their sex lives, porn kept featuring extramarital sex, multiple partners, and impulsive sex between strangers as more exciting. It often portrayed women as mere objects and playthings for male sexual enjoyment. It gave little or no consideration to hygiene and protection from pregnancy and disease. It promoted a callous attitude toward sexual exploitation, coercion, and aggression. Recommending pornography to clients began to make me feel, for lack of a better analogy, somewhat like a pimp, introducing clients to a "sleazy" worldview of sex. But I silenced my concerns, reminding myself that an open-minded sex therapist could regard pornography as simply a "tool of the trade."

A Cousin of Sexual Abuse

As time progressed, I became increasingly uncomfortable with pornography. On the few occasions when Larry and I saw pornography together, we now found it disturbing and distracting to the soul-stirring physical love we regularly enjoyed. The dialogue in porn didn't make us blush, but the interactions seemed increasingly humiliating and violent, with behaviors such as a man ejaculating on a woman's face becoming more common. Rather than inspire, pornography appeared to compromise one's private erotic imagination and values, blurring boundaries between fantasy and reality and lowering standards for sexual interaction. I didn't like how porn images would linger in my mind long after we'd turned off a rented videotape, taking my attention away from Larry and fixing it onto images of the porn actors and activities I'd just seen on screen.

At the same time I was experiencing personal concerns, many of my clients began complaining about pornography. They appreciated well-made, instructional, sexual-enrichment books and videos and sexy romantic novels, but their contact with pornography often left them feeling "dirty," sad, disgusted, or angry. They told me they were turned off by its lack of human caring, its racism, and especially the way it depicted women and children as targets for sexual exploitation.

In the mid-1980s, when I began specializing in treating survivors of sexual abuse, I became increasingly aware of the role that porn had in abuse. One client said that when he was a teenager, a 50-year-old next-door-neighbor man had "groomed" him into oral sex by showing him a stash of pornographic magazines. Women told me their perpetrators—often fathers, grandfathers, brothers, and boyfriends—used pornography as a template for the specific type of sexual behavior they coerced them to perform. Some clients recalled being forced by their perpetrator to pose for pornographic pictures during their experiences of abuse.

It was during the 1980s that I researched and wrote two recovery books, Incest and Sexuality and The Sexual Healing Journey, for survivors and their partners wanting to reclaim sexuality as something positive and healthy. When porn came up in the interviews and surveys I conducted for the books, survivors overwhelmingly spoke negatively about pornography, saying, for example, that reading pornographic stories or watching porn on videos and cable television "felt like the abuse all over again."

Added to my pile of concerns about porn, the realization that porn could be used as weapon against vulnerable children and women was the last straw. The clearer I became about conditions necessary for experiencing healthy sexuality—consent, equality, respect, trust, safety—the more doubt I had about advocating pornography as a sexual-enhancement product. How can I support something that portrays sex as a commodity, people as objects, and violence, humiliation, and recklessness as exciting? What am I doing encouraging people to condition their arousal to self-centered, sensually blunted, loveless sex? Do I really want to be advocating a product that's associated with causing sexual harm and relationship problems?

My primary concern about porn wasn't that it was sexually graphic, explicit, or hot: it was that porn conveyed harmful ideas about sex and could lead to hurtful and ultimately unrewarding sexual behaviors. During the 1990s, I switched from recommending porn to suggesting scenes in popular movies, such as the scene in Mississippi Masala in which Denzel Washington makes love to a woman while singing "Happy Birthday" to her. This scene, and others that emphasized mutual caring and readiness, showed highly erotic kissing and full-body, skin-to-skin contact, and celebrated sex as part of a larger relationship, were much more consistent with what I thought could arouse clients without causing them harm. In addition, frustrated with the lack of materials honoring love-based sexuality, I compiled two anthologies of erotic love poetry to recommend to clients and others for inspiration: Passionate Hearts and Intimate Kisses feature classic and contemporary poems in which "heart connection" is at the core of sexual experience.

One day, my concerns about pornography reached a tipping point. I grabbed the box of pornographic novels I'd kept in my office closet, marched outdoors, and tossed it into a trash bin. No regrets! From then on, I felt that personally and therapeutically it was best to avoid pornography. I made a commitment to obtain and clinically recommend only sexually explicit materials that educate and inspire while honoring respectful, responsible, and caring conditions for sexual interaction.

A Possessive Mistress

I may have thought I was done with porn, but it wasn't done with me! In the late 1990s, people began calling my office seeking help for problems they felt had been caused by porn use. One after another, the requests came in, often several per week. Some pleas for help came from porn users themselves, worried about their own dependencies and the possible repercussions—for example, losing interest in their partner, experiencing a compulsive need for sex, and getting into risky and hurtful sexual practices. But many calls came from the intimate partners of porn users, and these callers, primarily women, were in obvious emotional distress. Engagements had been broken, weddings and plans to have children had been called off, and otherwise successful, long-term marriages were teetering on the brink of divorce.

The number of inquiries took me by surprise, so I began to ask my colleagues if they were having similar experiences. Many were, and we began to talk about how porn had changed from a side issue, which arose only occasionally in sessions with clients, to the primary reason many people were now seeking therapy.

Despite my decision to stop using porn personally and professionally, until this point, I still frequently thought of it as a temporary, experimental/supplemental sexual activity, and even a benign adolescent phase in sexual development. But the growing client base experiencing problems with it and the depth of their pain opened my eyes to the fact that, for many, porn was becoming a critical, even essential part of their sexual repertoires. With science-fiction strangeness, porn was competing with real-life partners, and it was even emerging as the most important object of some clients' sexual desires.

Perhaps we should all have seen it coming. Within a short period of time, with the aid of high-tech electronic devices, such as VCRs, cable television, and the Internet, pornography had broken through old barriers of scarcity, expense, and fear of exposure and evolved into a product that was available for pleasure on demand. With 24-hours-a-day availability, media saturation, and unlimited variety, pornographic material was starting to overwhelm people's ability to resist it. As one man shared: "About five years ago, I discovered the Internet, and that's when the shit hit the fan for me. Suddenly it was "Close your eyes and imagine something and go look for it, and with a click of the mouse, there it is!' And best of all, it was free and nobody the wiser."

At this point, porn started looking to me like a compliant mistress, who promised an exciting, personalized, highly charged erotic alternative to the mundane realities and complex challenges of sex with a real partner. Always ready, willing, and reliably sexy, the porn mistress catered to the user's needs. It never got old or tired, required no emotional or sensual attention for "herself," never said no or rejected her "lover," and was always willing to explore any and all sexual acts, or even invent new ones. I was shocked one day when one man disclosed that, even though he loved his wife and experienced satisfying sex with her, when he masturbated to porn, it was "the best sex ever."

The reactions of intimate partners to what was happening was almost identical to that of clients I'd counseled whose partners had been having affairs. Women came to me shocked and traumatized when they'd learned about their partners' relationships with porn. I remember one in particular who clutched her chest as she sobbed, "His betrayal feels like a knife has been thrust in my heart." It didn't matter that her husband's "mistress" was on celluloid and pixels on a screen; he'd still betrayed her by channeling his sexual attention and energy away from her, onto someone else, and then lying about it! She felt angry, hurt, alone, powerless, and unable to compete with the perfect, airbrushed young bodies of the women featured in the videos she'd found her husband masturbating to. Her trust in and respect for him were gone, and she told me she felt as sexually abandoned, insulted, and betrayed as if he'd been with another woman. As with an affair, female partners often spoke of their partner's porn use as absolutely incompatible with their ability to stay in the relationship.

Many of the male porn users in committed relationships were surprised by the intensity of their female partner's reactions. They generally felt entitled to use porn and were ready with rationalizations for their "It's safer than a real affair," "All guys do it," and "It's nothing personal" were among the most common reasons they gave to try to get their partners to understand and accept their actions.

My deeper understanding of the emotional pain that partners of porn users were feeling, coupled with an awareness of the growing number of couples for whom porn use had become a significant relationship issue, changed the way I focused my treatment. Instead of automatically considering porn use as something to be negotiated, I began to address it as I might an extramarital affair. I tried to help both partners understand their relationship crisis, process their feelings, empathize with each other, and rebuild trust, security, and intimacy. With this approach, I reasoned that many porn users would come to see their behavior, and especially their accompanying deceptions, rationalizations, and emotional withdrawal, as inconsistent with their personal goals and the needs of the relationship. I thought that, on their own, they'd decide to give up porn, allowing their partners to process their feelings of betrayal, overcome resentments, and move toward forgiving and trusting again.

Even with my newfound awareness about how porn could assert itself as an easy sexual outlet, I remained na•ve about one vitally important issue. I assumed that once couples could address negative repercussions and get the "real" sexual relationship back on track, the person who had the porn interest would no longer "need" or "desire" it, and could easily give it up. I couldn't have been more wrong! Some clients were able to "ditch-the-mistress," but many weren't. It became apparent that I'd underestimated the power of the new pornography. Something more insidious was going on.

A Drug

Soon after the turn of the new millennium, a new client helped me see what else was at play that made quitting porn so difficult, even for people who wanted to do so. Sam, a shy young man whom I'd been seeing for a few weeks, told me, "Doing porn feels like an incredible rush of life blowing through my veins, and the good part is, I can always go back for more." His description of his porn experience sounded eerily similar to the language used by the patients with drug and alcohol problems I'd worked with through the years. Over time, more of my clients experiencing the impact of porn in their lives began using words and phrases usually associated with hardcore drug addiction. They often referred to using porn as a "high" and a "rush." They started needing a stronger product in higher doses to get the same effect, and when they decided to quit, they frequently complained of continual cravings, preoccupations, and sensations of "withdrawal." "I tried going Ôcold turkey' with porn," one man told me, "but the urges were stronger than when I quit cigarettes and cocaine."

In 2004, concerned about what we were seeing in our practices, Larry and I began working on a recovery book entitled The Porn Trap: The Essential Guide to Overcoming Problems Caused by Pornography (HarperCollins, 2008). Our goal was to create a sex-positive resource for individuals and couples that would help them understand how porn has changed and empower them to address porn problems directly and compassionately with effective strategies for recovery and relationship healing.

What we discovered in researching the book confirmed my feelings that porn use had many of the same properties as drug use. Addiction specialists and neuroscientists, such as Harvey Milkman, Peter Shizgal, Patrick Carnes, T. M. Grundner, and Helen Fisher, were finding that pornography did indeed have a druglike effect on the body and mind. Despite being ingested through the eyes and ears instead of the mouth or bloodstream, porn stimulates the reward and pleasure centers in the brain, instantly and dramatically, increasing the production of dopamine, a neurotransmitter associated with both sexual arousal and drug highs. In addition, using porn for sexual stimulation has been shown to increase production of other "feel-good" chemicals, such as adrenaline, endorphins, testosterone, and serotonin; with sexual climax, it releases powerful hormones related to falling in love and bonding, such as oxytocin and vasopressin.

Research shows that, like compulsive gambling and shopping, porn use can lead to a "process addiction," in which a person becomes addicted to a set of behaviors (e.g. consuming porn) that, in turn, powerfully alter brain chemistry. The Internet and other electronic devices allow porn users to click through a never-ending stream of stimulating material as they look for just the right porn site, the sexual activity of interest, or the ultimate fantasy partner. Like a carefully calibrated slot machine, it rewards only intermittently, compelling the user to stay engaged and not give up. Users can end up looking at porn for longer and longer periods of time, often seeking riskier content to "hit the jackpot" of landing on an extremely stimulating image.

Porn wasn't just operating like a drug—it was operating like a designer drug, able to give the user multiple types of results: novelty, excitement, escape, mastery, and (with orgasm) relaxation. All the new information about porn we were gathering helped explain why people of all ages and from all walks of life could develop such strong attachments to porn that they craved it compulsively, couldn't control their use, and couldn't stop, despite negative consequences.

My newfound knowledge of pornography's druglike effects helped me bring more compassion to the issues porn users faced. Not only were their partners in distress: anyone trying to quit using porn faced his or her own difficult emotional and physiological struggles. I started recommending that clients supplement their individual and couples counseling work with attending 12-step sexual addiction recovery programs, such as Sex Addicts Anonymous, Sexaholics Anonymous, and Recovering Couples Anonymous, or porn recovery groups of their own choosing. I began encouraging intimate partners to attend Codependents of Sex Addicts meetings and to check out supportive websites, such as www.pornaddicthubby.com. With my background in drug and alcohol counseling, I know that support groups can be critical to successful recovery, helping overcome social isolation and shame, building accountability supports, and sharing triumphs.

I began working with clients to develop effective strategies for preventing relapses. Many clients find the "trigger-zone" model and exercises that are described in The Porn Trap beneficial for identifying how close they are to having a possible relapse and knowing just what steps to take to get to safer ground. Given the importance of healthy sexuality to overall recovery and quality of life, advanced work is done to heal troublesome sexual fantasies and develop healthy strategies for self-pleasuring, relaxed sensual touch, and enjoying sexual intimacy with a partner.

Even though my research opened my eyes to porn's potential addictiveness, I know that not everyone gets addicted. Someone can have a problem with porn—for example, broken integrity, relationship difficulties, work problems, or an interest in child porn—and still not have addiction issues. But I began to understand more clearly that, for most of my clients and other porn users and partners with whom I spoke while doing research for the book, porn use almost always carries with it some negative consequences that can't be avoided.

A Threat to Public Health

Since The Porn Trap was published, I've had numerous professional and personal conversations about porn that have sensitized me to the expansion and significance of problems caused by porn. I recently spoke with a woman while we both worked out on treadmills at the YMCA who told me how, after her father had died, she'd found a stash of hardcore porn videos and magazines in his bedroom. "No matter how much I tried not to let it bother me, it changed the way I think about him," she said. A man came up to me after a workshop and asked what he could do to help his 13-year-old son break a habit of masturbating to bondage porn. In my practice, I've seen several soldiers back from the Iraq war suffering from porn addictions they developed there as a way to deal with traumatic stress. And some people told me there were times they've seriously contemplated suicide as a way to escape the isolating nervousness of their obsessions with porn.

I never wanted to be out beating the drum against pornography. In the beginning of my career, if anyone had suggested I'd be here now, I'd have laughed at them. But from my own clients, my research, and my personal experience, I've come to the conclusion that pornography is moving from an individual and couples' problem to a public health problem, capable of deeply harming the emotional, sexual, and relationship well-being of millions of men, women, and children.

As a sex therapist, I'm amazed that what I once saw as a liberating sexual experience and a therapeutic option for improving sex with an intimate partner has evolved into something that can easily hijack and harm people's sexuality. Increasing numbers of clients report that porn has become "the great spoiler" for them sexually by spawning unhealthy interests and reducing their natural responsiveness. One man confided that he could no longer get an erection with a real partner. "I want to go back to how it used to be before I was into porn—when just being near a woman I cared about turned me on. How can I get my old sexuality back?" he asked. Another told me he'd probably remain single all his life: "I've lost all interest in dating. Porn is easier and more convenient than dealing with actual people. And even if I met a nice woman, I doubt she'd really want me, given how twisted my sexual desires have become."

Many female partners of porn users tell me they're turning off to sex with their partner because of the increased pressure they feel to act like porn stars and respond to porn-inspired sexual advances. And women looking for long-term partners are worried about how pornography is shrinking the pool of desirable men. "It's hard to find a guy who isn't into porn and genuinely doesn't like it. But that's who I want as a lifemate and father to my children," one woman explained.

I'm especially troubled by the way contact with porn appears to be harming young people's mental and sexual health. Teens have been identified as one of the largest consumer groups of porn. A 2009 research study of one thousand 13- to 16-year-olds in the United Kingdom by CyberSentinel found that teens are spending an average of one hour and forty minutes a week (87 hours a year) looking at online porn. Studies in the United States report similar exposure rates, with a 2004 study by Columbia University finding that 45 percent of teens admit that they have friends who regularly view and download porn.

Tech-savvy and naturally curious, young people are increasingly turning to Internet porn to learn about sex and as the primary focus of their masturbation. Some teenagers have begun showing signs that exposure to pornography could be undermining their ability to make healthy choices about sexual activity. For example, a 2009 Harris Interactive survey revealed that despite the legal and personal risks involved, 19 percent of teenagers are engaged in sexting—sending and receiving sexually suggestive, nude or nearly nude photos through text messaging or e-mail. And, according to recent data made available in 2009 by the Centers for Disease Control, the age of first sexual involvement has fallen, the teen-pregnancy rate has increased (following nearly 15 years of large decreases), and sexually transmitted disease rates have increased.

Because of cultural shame and silence, children aren't receiving messages informing them that there's a difference between porn fantasies and the real world, where interpersonal dynamics matter and sex has consequences. Without these touchstones, kids may fail to realize how harmful and unfair it is to measure their own sexuality (or anyone else's) against porn standards and how dangerous it can be to try to mimic what they see in porn. A colleague recently told me about a college student who'd inadvertently maimed and almost killed himself trying to act out a sex scene he'd viewed in a porn video.

The only way to prevent the spread of porn-related problems is for people to be informed and to get help early, and for society to be alert to the problems. I'm not in favor of censorship, but with other professionals and health advocates, I support honest, age-appropriate discussions of pornography and its potential repercussions in public forums and health education classes. I believe we need a government body devoted specifically to researching the effects of pornography and developing policies, prevention campaigns, and treatment resources. I see a great need for parents, teachers, employers, clergy, healthcare workers, law enforcers, and therapists to start addressing pornography problems with the same kind of shame-free directness with which we've learned to tackle other public health concerns, such as cigarette smoking, alcohol consumption, domestic violence, and drug abuse.

As therapists, perhaps our most important role is in providing clients a safe place to discuss and examine their concerns. It's best to analyze porn-related situations on a case-by-case basis, taking into consideration a client's personal values, sexual experience, sexual orientation, and relationship status. I often rely on the following questions to help clients increase awareness and begin to evaluate their involvement with porn. Is porn increasing or decreasing your self-esteem and integrity? Is it upsetting or alienating your intimate partner (or harming your future chances of being in a healthy relationship)? Have you become preoccupied, out-of-control, dependent on, or compulsively engaged with porn? How is porn shaping your sexual thoughts, desires, and behaviors? What negative consequences could occur if you continue to use porn? Only when clients determine they want help quitting porn do we proceed in that direction, utilizing the dynamic strategies that exist for achieving sexual recovery and healing. As mental health professionals I believe we're most helpful when we resist our tendencies to automatically condemn or advocate porn. Our effectiveness depends on our ability to join with clients in regularly evaluating porn's impact on their lives. While I remain aware that porn use isn't a problem for everyone, I keep in mind that, given its unprecedented power and accessibility, it can become a problem for anyone.

Wendy Maltz, L.C.S.W., D.S.T., is an internationally recognized psychotherapist, sex therapist, and author of numerous books on sexuality. The Porn Trap: The Essential Guide to Overcoming Problems Caused by Pornography (with Larry Maltz, HarperCollins, 2008) will be available in paperback in January 2010. Wendy and Larry Maltz offer professional training seminars on treating pornography problems. Contact: wendymaltz@healthysex.comThis e-mail address is being protected from spambots. You need JavaScript enabled to view it ; website: www.HealthySex.com.