Pornography: A Public Health Problem?

Arthur L. Caplan, PhD


May 30, 2017

Hi. I am Art Caplan. I am at the New York University (NYU) School of Medicine, where I direct the program on medical ethics.

I read an article the other day in which flight attendants said they could not believe the number of people who watch pornography on airplanes. People watch pornography on their phones or computers right out among kids and other customers. It becomes a source of complaints and a problem that airline personnel do not want to deal with.

Porn is big business in the United States. It is [one of] the most common reasons for people to be online. Companies that make it are making fortunes. [Online pornography] basically set back the videotape industry once it could come into the home. All kinds of people can access it, whether they be minors, adults, or people with psychological problems. Some people say, "We have a big public health problem in this country. We ought to treat pornography as a public health difficulty." I am not as opposed to that idea as others might be who see it as a free-speech thing or something that you can choose to access online to entertain yourself.

There are people who get into trouble with pornography. They lose relationships, like marriages, because they are constantly watching it online. They cannot seem to find a way to break the addiction. That does require, partly, a healthcare response. You also worry that what is seen in porn may lead to behaviors that partners or spouses do not really want to engage in. Pornography tries to get to the fringes of sexuality because that is where the viewership is. If it was just straight missionary sex, I do not think people would be watching it in the same way. There may be public health issues there about what is acceptable and respectful. Dealing with the desire for sex or child porn deserves a response too.

Part of the problem is, I am not sure what to do about pornography. It is not always bad. It can be entertaining and fun to watch. It can be an adjunct to people's sexual lives. I understand all of that. We do not necessarily have the research. We do not necessarily have the expertise to know how to [assess when] pornography is a part of somebody's sexual life as opposed to overtaking it, dominating it, or encouraging behaviors that are not healthy or good for others.

I do not think [the general concept of pornography] is wrong, but it starts to become a public health issue along with drug addiction, opioid abuse, and even, to some extent, the very controversial issue of guns. We can do a lot of things with a public health model of harm or risk reduction, or an addiction model used to help break people of bad habits, whether it's obesity or irresponsible sexuality. Those are things that medicine and healthcare can play a role in.

Are they the only places to do it? No. Should we be censoring what pops up on the Internet when it comes to sex? I do not think so. There is more to do, and there are people who are vulnerable to the lure of the pornography industry. Medicine does have a role to play.

I am Art Caplan at the NYU School of Medicine. Thanks for watching.

Talking Points: Is Online Pornography a Health Crisis?

Issues to consider:

  • Utah, South Dakota, and Arkansas have passed resolutions deeming pornography a public health crisis of epidemic proportions.

  • Some healthcare professionals worry that pornography promotes abuse of women and children by depicting rape and abuse as acceptable acts.

  • Some people are concerned that pornography can also ruin marriages and lead to sexual addiction or other unhealthy behaviors, and that it can affect a person's work, leading to significant distress and feelings of shame.

  • Pornography defenders say that erotica can enhance sex lives, provide a safe recreational outlet, and perhaps even reduce the incidence of sexual assault.

  • Pornography triggers brain activity in people with compulsive sexual behavior, similar to that triggered by drugs in the brains of drug addicts. However, this does not necessarily mean that pornography itself is addictive.[1]

  • Some research suggests that pornography addiction does not exist. People who said they had trouble controlling their consumption of pornography did not show a typical addiction response to sexual images. With addiction, increased brain activity is expected in response to relevant stimuli—heroin in the case of a drug addict, for example. But the porn study's participants showed decreased brain activity in response to pornography.[2]

  • After pornography was legalized in Denmark in 1969, researchers reported a corresponding decline in sexual aggression.[3]

  • Various international studies have put porn consumption rates at 50%-99% among men and 30%-86% among women.[3]

  • Perceived addiction to Internet pornography, but not pornography use itself, is uniquely related to the experience of psychological distress.[4]

  • As many as 1 in 25 adults are affected by compulsive sexual behavior, an obsession with sexual thoughts, feelings, or behavior which they are unable to control.[1]


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