Pornography Is Not a Public Health Crisis

Since Utah (a state with high religiosity) declared pornography a "public health crisis" in 2016, more than a dozen US states have passed similar resolutions, and the phrase now surfaces in UK debates. The language provokes much fear, and combined with poor sex education, the narrative becomes powerful because when people are afraid, they can become vulnerable to believing misinformation. The language borrows the authority of epidemiology and implies a measurable, population-wide harm on the scale of tobacco, opioids, or obesity. However, the claim does not stand up to the actual standards held by public health itself.

What makes something a public health crisis

Public health crises are defined by evidence: rising mortality or morbidity, plausible causation, and a burden of harm that can be counted across a population. Opioid deaths, the HIV epidemic, and smoking-related cancers meet that bar.

The state resolutions on pornography were not built on new epidemiological data. They were symbolic and non-binding, and largely drafted with advocacy groups (many of which had religious moral imperatives). Nelson and Rothman (2020) argue that porn does not meet the criteria for a public health crisis. Other reports on this topic came to the same conclusion. Pointing the finger at porn risks diverting attention from the real issue: improving comprehensive sex education, including porn literacy.

Indeed, it could be argued that a major lack of sex education is the actual ongoing public health crisis that governments seem to be reluctant to address properly. But it is also documented that some anti-porn campaigns can cause real harm too, making men feel shame for their viewing of pornography, and it is shame, not porn, that can deteriorate people’s mental health to the point of suicidality. While the narrative of “porn is a public health crisis” sound like a virtuous endeavor on the surface, it might actually do more harm than good, and it is not evidence-based.

The causal evidence is weak

Much of the research cited for the public health crisis confuses causation and correlation. There are indeed correlations but no causation. People who watch more pornography have diverse levels of sexual desire, sexual functioning, relationship satisfaction, and those differences are not caused by watching pornography because they can be associated with multiple other factors (correlations).

Research on sexual aggression is mixed, with some studies reporting a small association between pornography and aggressive attitudes, while others show the opposite: People who watch more porn have more egalitarian attitudes towards women. There are even some studies suggesting that there are fewer sexual crimes in countries where porn is more widely available. These are also not claiming causation: It does not mean that pornography reduces the risk of sexual aggression, but it does mean that it is pretty impossible to consider pornography as an epidemic and public health crisis.

"Porn addiction" is not an endorsed diagnosis

The crisis narrative leans heavily on the idea of “pornography addiction.” Yet the DSM-5 does not recognise “porn addiction” as a disorder, due to lack of scientific evidence. The ICD-11 recognises “compulsive sexual behaviour disorder” (CSBD), classifying it as an impulse-control disorder, not an addiction.

ICD-11 also states that distress arising solely from moral disapproval of one's sexual behaviour is not sufficient for diagnosis. That caveat matters. Research repeatedly finds that believing in being “addicted to porn” is predicted more strongly by religiosity and moral incongruence than by how much pornography a person actually watches.

For many people, the distress comes from a conflict between their values and their behaviour. For others, pornography viewing may become compulsive, as it is a coping strategy for emotional regulation. Clinicians can help with that, but it is not evidence of a population-wide pathology.

Erectile dysfunction claims don't hold up

Popular accounts link pornography to a wave of erectile problems in young men. Large studies have not found a consistent relationship between pornography viewing and erectile function, and the popular term PIED (porn-induced erectile dysfunction) has been disproved multiple times. However, the shame induced by sex-negative narratives/society may be a central factor for sexual dysfunction, as well as relationship factors, poor mental health, and medical factors.

The costs of the crisis framing

Calling pornography a public health crisis is not harmless rhetoric. It can induce or amplify shame, which tends to entrench compulsive patterns rather than resolve them. It can lead people to self-diagnose an addiction they do not have and push them towards "recovery" programmes that are not evidence-based, some with hidden religiosity and some that have been documented as iatrogenic.

It also distracts from issues where the evidence is stronger and action is achievable: better inclusive life-long sex education, including porn literacy.

A more useful frame

The narrative and research on pornography are biased because they tend to prioritise the negative aspects of pornography, and they approach the subject as though porn is a monolith. There are multiple types of porn, from problematic misogynistic porn, harmful porn depicting non-consensual acts, to ethical porn which can enhance people’s well-being.

The truth is that not all porn is bad, and sometimes there can even be benefits to watching some types of porn. For example, a study finds that queer people watching queer porn can be a source of meaningful well-being. Another study finds that young people felt pornographies offered a more diverse representation of body types than other media. A study suggests that women who watch pornography solo experience more positive emotions and fewer negative emotions, and partnered watching was associated with lower levels of negative emotions and higher levels of positive emotions.

However, pornography does not come without risks. A lot of media can have risks, in fact, not just porn. Some individuals do struggle with compulsive viewing due to underlying emotional disturbance and shame, and, of course, children should not be exposed to explicit sexual materials.

These real concerns are best met with targeted clinical support and porn literacy education: the same evidence-based methods used for other sexual health issues. Treating pornography as a sexual health topic rather than a public health crisis allows nuance, reduces stigma and keeps the focus on what actually helps.

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