Sousa, A. D. (2019).
Journal of Psychosexual Health, 1(3–4), 275–276. https://doi.org/10.1177/2631831819890766
Abstract
Compulsive pornography use is on the rise and is a common compulsive sexual behavior being seen in the younger age groups between 18 and 30 years of age. The treatment of the same involves a combination of medical and behavioral management. We present herewith a case of a 69-year-old male who developed compulsive pornography usage for the first time and that responded well to psychotherapy and medication.
Keywords Compulsive pornography use, late life, pornography
Introduction
“Compulsive pornography use” or “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.1 This falls under the categories of “sexual addiction” or “compulsive sexual behaviors” and is a subtype of “internet addiction behaviour.”2 There is a debate on whether compulsive pornography use is actually an addiction and if it must be categorized as a sexual compulsivity or rather a subset of hypersexual behaviour.3 Scientific literature is divided on the diagnostic criteria for the disorder while it remains a fact that clinicians are seeing more patients with this problem over the past few years.4 We present herewith a case report of compulsive pornography use starting for the first time in a 69-year-old male and responding well to medication and behavior management.
Case Report
A 69-year-old married retired accountant was accompanied by his wife to the outpatient clinic with chief complaints of watching pornography videos and images for 4 to 6 hours-a-day and enjoying the same and even watching the same sometimes in the middle of the night between 3 am to 6 am. The wife mentioned that this behavior started around 4 months prior to presentation and his wife noticed the same a week prior to coming to us. One night the wife got up at 4 am and did not find the husband in bed and when she quietly went to the hall where he was sitting, she found him seeing pornography videos on his mobile phone. The wife confronted her husband who admitted doing the same for some time every night where he would get up at 2 am and see sexual videos and images for 3 to 4 hours in the night. He would do the same 1 to 2 hours in the day when he was alone or in the bathroom. There was no compulsive masturbatory behavior with the same though the patient claimed that he would indulge in masturbation on and off while seeing these videos. The patient told his wife that he enjoyed seeing these videos and he would feel younger and excited on doing so.
The patient on interview replicated all that the wife had mentioned. He also mentioned that he accidently stumbled on a porn site while surfing the internet and this had awoken his curiosity to see these videos. He claimed seeing only heterosexual pornography videos with no interest in viewing videos which showed sexual deviations. He and his wife were last involved sexually around 10 years ago and there had been no physical sexual contact between the two since. The man claimed that the videos bought some sexual excitement to him. He also mentioned that his wife had no sexual interest and refused to be involved sexually with him. When questioned there was no deviance or abnormality in the personal sexual history of the patient or his wife. He also denied any homosexual impulses or feelings. The couple was questioned independently and no history of any psychopathology in the patient’s life till the present situation was elicited. This was the first time ever in the patient’s life that this sort of behavior prevailed. The patient accepted that he sexually enjoyed the videos and that he felt no harm if he was happy with the same. He in fact never knew or thought of this as an abnormality and even tried to argue that it is normal and that he did not trouble anyone by his behavior. There was no history suggestive of child sexual abuse, abnormal sexual feelings, sexual deviations, homosexual tendencies, and bisexuality. There was also never a feeling of wanting to show these videos to others and his wife or share the same online. The patient had gone for a complete health checkup prior to presentation and all reports were normal with no medical complications. The patient was advised a magnetic resonance imaging study of the brain from our side which was normal and did not show signs of any organic brain damage except mild cerebral atrophy which was age related. His Mini-Mental State Examination score was 29/30 and normal. This was done to rule out any dementia that could have contributed to this behavior.
The patient was counseled and psychoeducated about the problem, and he accepted that it was an abnormality with reluctance and said that he would stop doing the same. He was also psychoeducated with his wife about how an active sexual life could be maintained post-60 years of age and they were advised on the same. The patient however continued his behavior as reported on 2 weekly follow-ups and he was started taking Fluoxetine (Mumbai, India) 20 mg/day for the same. This was increased to 40 mg/day in a week. The patient also underwent on eclectic behavior management focusing on how to divert himself and reduce pornography use. We did not follow up after a month but were telephonically informed by the patient’s wife that the behavior had stopped and that he was maintaining the dose of Fluoxetine.
Discussion
There have been many reports on compulsive pornography use or addiction.5 There has been to the best of our knowledge no report of this behavior having an onset after the age of 65 years. Treatment guidelines and management issues are not well defined due to lack of a consensus or approaches.6 It is a disorder that is increasing now with the availability of and easy access to digital media and the internet.7 The patient in our study had symptoms for 4 months and accepted, though with reluctance, that his behavior was abnormal. The acceptance led to a resolution of symptoms along with the help of medications and behavioral management. The acceptance of abnormality of the behavior holds the key to successful treatment. This being rare, makes treatment difficult. This case report aims to make clinicians aware of the rare yet possible chance of compulsive pornography use for the first time in late life.
Declaration of Conflicting Interests
The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author received no financial support for the research, authorship, and/or publication of this article.
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