Pornography Use in Adolescents and Its Clinical Implications (2020)

The presence of sexually explicit materials has increased significantly both in mass media and social media [1,2]. Moreover, with the emergence of the Internet, the use of pornography has become widespread throughout the world [3,4]. In the case of adolescents and young adults, recent rates of pornography use have been reported to be around 43% [5]. This increase in consumption patterns may be partly explained by the “Triple A” theory, which highlights easy access to the Internet, the fact that a large part of the population can afford it, and the anonymity that the Internet guarantees to its consumers [6].

Numerous studies have focused on evaluating the use of pornography in this age group and its association with multiple variables. Some authors have tried to define possible profiles of adolescents and young people who consume pornography. For example, Efrati et al. [7] identified that those adolescents who used pornography were usually boys, low on social intimacy, introverted and neurotic, and more overt narcissists, among other factors. In this line, Brown et al. [8] identified three types of pornography users taking into account variables such as age, pornography acceptance, use, motivations for use and religiosity—porn abstainers, auto-erotic porn users and complex porn users.

The Differential Susceptibility to Media Effects Model (DSMM) was designed by Valkenburg and Peter [9] and focuses on microlevel media effects. This model is based on multiple solid theories such as Social Cognitive Theory [10], the Neoassociationist Model [11], the Selective Exposure Theory [12], and the Media Practice Model [13]. The DSMM is structured around four central propositions: (1) Media effects are conditional and depend on dispositional, developmental, and social differential susceptibility variables. (2) Media effects are indirect and cognitive; emotional and excitative media response states mediate the relationship between media use and media effects. (3) The differential susceptibility variables act as predictors of media use and as moderators of the effect of media use on media response states. (4) Media effects are transactional; they influence media use, media response states, and differential susceptibility variables [9].

On the basis of the DSMM framework, Peter and Valkenburg [14] have published a review including studies that have evaluated pornography use in adolescents. In terms of dispositional predictors of pornography use, demographics, personality traits, norm-related variables, sexual interest, and Internet behavior have been explored [14]. It has been suggested that male adolescents are more exposed to pornography than females, although gender differences are smaller the more liberal their country of origin is [15,16,17]. Moreover, rule-breaking and adolescents who use substances may use pornography more frequently [18,19]; the same goes for adolescents with greater sexual interest [20].

Regarding developmental variables, age, pubertal maturation, and sexual experience have been studied in adolescents. There is controversy about whether pornography use increases with age, and existing studies reported conflicting results [15,16,18]. In studying possible trajectories of adolescent pornography use, however, it has been suggested that early puberty may be linked with earlier exposure to pornography and more frequent pornography use later [21]. The same applies to sexual experience, with some authors associating it with more frequent pornography use, while others associated it with a lower frequency [15,20]. Taking social variables into account, poor family functioning, desire for popularity, peer pressure, and victimization online and offline have been related with higher pornography use in adolescents [18,22,23,24]. In this vein, Nieh et al. [21] evaluated the influence of factors such as peer behaviors and parenting style on adolescent pornography use trajectories, finding that parental monitoring protected adolescents from pornography use. Relatedly, Efrati et al. [25] highlighted that the impact of loneliness on the frequency of pornography use may be dependent on individuals’ attachment orientations. In terms of victimization, the possible association between the use of pornography and violence and sexual aggression and coercion, as well as the problematic use of pornography, have been particularly studied [26,27,28,29,30].

Finally, with regard to criterion variables, pornography use has been related to more permissive sexual attitudes [31,32,33]. However, evidence for an association between pornography use and risky sexual behaviors, such as unprotected sex, is mixed [34,35].

Therefore, the existing evidence on how these multiple variables interact with each other is contradictory, and to the best of our knowledge, no study has yet evaluated all the variables proposed by the DSMM. Therefore, there is still a lack of systematic data on how the multiple variables of the DSMM model interact with each other. To this end, the present study aimed to assess in an integrated way the nuclear correlates of the use of pornography in adolescents suggested by the DSMM (dispositional, developmental, social and criterion variables). For this purpose, we tested two of the four DSMM propositions: (1) we explored whether dispositional, developmental, and social variables predict pornography use; (2) we evaluated whether dispositional, developmental, and social variables may not only predict pornography use but also moderate the extent to which pornography use predicts criterion variables. We hypothesized that the explored DSMM proposals will be fulfilled.

The purpose of this research was two-fold: (1) to explore whether dispositional, developmental, and social variables predict pornography use; (2) to evaluate whether these variables not only predict pornography use but also moderate the extent to which pornography use predicts criterion variables.

Regarding dispositional variables, sexual orientation is a relevant multidimensional construct that has been widely evaluated in the adult population [45,46]. However, the prevalence of sexual minority identity has rarely been examined in adolescents [47]. In the present study, 6% of the sample identified as lesbian, gay, or bisexual (LGB) and 3.6% did not define their sexual orientation. These percentages are not far removed from previous studies. For example, Li et al. [48] found that approximately 4% of adolescents self-identified as LGB, while 14% were unsure of their sexual orientation.

When examining norm-related features, also included in the dispositional variables, religiosity seems to be another factor related to adolescent sexuality [49]. In the present study, the percentage of Catholic adolescents was 36.1%, Muslims was 4.9%, and other religions was 5.3%. Other studies that have evaluated religiosity and sexuality in adolescents have found much higher rates of religiosity. For example, 83% of the adolescents in Mexico report being Catholic [50]. The prevalence is closely linked to the history and culture of each country, making it difficult to generalize. In conjunction, substance use reduces social inhibition and is associated with increased risk-taking behaviors, especially in the area of sexuality [51,52]. In adolescent populations, rates of substance use are very heterogeneous and range from 0.4% to 46% [53,54,55,56]. These results coincide with our findings, given that around 20% of our sample reported substance use or abuse.

Finally, sexual interest has also been considered as a dispositional variable in the present study. The percentage of adolescents who reported sexual interest and who used digital media to obtain sexual information was 25.6%. Studies in this field have detected an increase in searching for information on sex among adolescents since the emergence of the Internet [57]. In addition, there seems to be an association between those adolescents who engage in more risky sexual behaviors and the likelihood of seeking this type of information on the Internet [58]. Some of the barriers that adolescents report when doing this type of search are the overabundant content that is difficult to filter out, as well as complaints about unintentional exposure to sexually explicit content during these searches [59].

With respect to developmental variables, the proportion of individuals in the present study with sexual experience was around 33%, a figure similar to the 28.1% reported in previous studies [60]. Moreover, 15–16 years old was the most frequent age of initiation of sexual behavior in our sample. Other studies in this line have reported ages of sexual initiation around 12.8–14 years old [61]. These differences could be due to multiple causes. As some authors suggested, early sexual initiation may be influenced by factors such as alcohol use, the involvement of chat rooms or dating websites, and the use of medication for mental problems [62,63]. However, although the percentages vary, all comprise early sexual initiation (<16 years old) [64].

Regarding social variables, and victimization more specifically, 6.5% of the adolescents reported being victims of sexual abuse. The rate of sexual abuse or assault in other European countries is about 14.6% [65]. Although it is a more common problem among adolescent females, there is a growing recognition that sexual victimization is also a relevant, though invisible, issue among male adolescents [66,67]. In this line, 17.6% of our sample reported being forced to share sexual content through social media. This pressure and the diffusion of sexual content without consent derived from sexting, as well as other online victimization behaviors such as revenge porn, cyberbullying, and online dating violence, are increasingly present in the adolescent population [68,69]. Titchen et al. [70] observed that more than three times as many girls as boys felt pressured to send a sext. They also found an association between sexual abuse and sexting in both sexes, thus suggesting that sexual abuse may lead to early sexualization.

Finally, with regard to media use, 43.6% of adolescents reported the use of pornography, 9.5% reported downloads of sexually explicit materials, and 6.1% engaged in phone sex. The pornography use prevalence was similar to other studies, which reported it to be around 43% [5]. However, these percentages are much lower than those found by other studies in adolescents and young adults, which ranged from 80% to 96% [71,72,73].

As the DSMM suggests [9], dispositional, developmental, and social variables were related to pornography use in our study. More specifically, increases in the odds of pornography use were associated with being male, older, bisexual or with an undefined sexual orientation, substance use, not being Muslim, and higher sexual interest and use of social media to obtain sexual information. These findings are consistent with other studies highlighting that male and female adolescents differ in their patterns of consumption of pornography [74,75]. This could be partially explained by the greater tendency of males to rate sexual stimuli as more pleasant and arousing and to show stronger neural responses derived from exposure to these sexual stimuli [76,77]. However, a slight increase in female pornography use over time has been identified (28% in the 1970s vs. 34% in the 2000s) [78]. Studies exploring the reasons for these sexual differences in pornography use are still very scarce. However, some authors have suggested that some factors may promote female pornography use, such as the rise of feminist porn with less aggressive content, younger age, absence of religiosity, and higher education levels [78,79]. Sexual orientation has also been a factor associated with pornography use. Our findings corroborate previous studies suggesting greater pornography use by bisexual than by heterosexual adolescents [35,80]. However, most studies do not assess sexual orientation or focus only on heterosexual adolescents [14]. Therefore, more research is needed, including with under-represented sexual minorities. A significant association was also found between pornography use and substance use, which is consistent with previous findings [19,81]. Some authors suggest that this correlation may be influenced by factors such as high sensation-seeking levels [81]. Considering the link between religion and pornography use, numerous studies have been based on moral incongruence [82,83]. This addresses the incompatibility between pornography use and an individual’s deeply held values and beliefs about the inappropriateness of that behavior [84]. Pornography use seems to be lower with higher levels of religious attendance, especially among male adolescents, and religious attendance weakens age-based increases in pornography use for both sexes [85].

In addition, we studied whether pornography use predicted criterion variables through SEM, as proposed by the DSMM [9]. We observed a direct association between pornography and the following criterion variables: contraception, unprotected sex, emergency contraception, sex after alcohol and other substances, and infidelity. Pornography is associated with a greater tendency to engage in risky sexual behavior, such as sex under the influence of alcohol and other substances, or the use of emergency contraception. These findings corroborate that exposure to pornography may affect psychosexual development in adolescents. More specifically, pornography could lead to more permissive sexual values and changes in sexual behavior, such as an increase in risky sexual behaviors [31,86]. However, these are controversial findings that should be interpreted with caution. Other studies have failed to find an association between exposure to pornography and risky sexual behaviors such as multiple sexual partners, history of pregnancies, or early sexual initiation [35].

Our findings support the clinical applicability of the theoretical DSMM framework. Therefore, dispositional, developmental, and social variables may predict pornography use and may moderate the extent to which pornography uses predicts criterion variables. However, it must be taken into account that not all the variables included in the study had the same relevance in this association. Furthermore, the literature in this field is extremely controversial. Therefore, more studies and a longitudinal design would be necessary to define the profile of adolescent consumers of pornography. Knowing in depth the impact of pornography on this population would also allow for the design of more effective prevention and regulation proposals.