so in terms of the brain with like masturbation or porn for example people will say uh that you view it it's really easy to access which means there's no barrier to access and therefore it's getting our we're getting this really high release of dopamine from masturbating or watching porn or usually they're talking about porn but obviously those two go together and so that's affecting our thought towards our you know our feelings towards relationships our difficulty maybe pair bonding or or having sexual relationships with our partners what's the truth so I think there's at least two
pieces there one's like the physiological and the psych and so with respect to physiology I am not concerned about these things I wish people could sit in the lab with me sometimes and just see watch someone watching pornography and where all the physiology is going like their brain responses and then the second they put their hand on their genitals like just everything increases 10x I was like do not tell me pornography and I we're showing again low grade low grade porn you know more um easier stuff but they don't usually make that necessarily claim they're
just saying it's porn right well if the claim is porn then we're showing them porn and and high speed I don't know what high speed means either I was like high speed like okay the pixels are a little better on the stuff we show now uh you know I started I always Jo like putting VHS tapes into the thing and trying to hit the start record you know at the same time in the lab when I started at Kinsey Institute we still had the old VH chess approach so it's uh certainly gotten easier to program
but the differences there physiologically are not even close I do not worry about someone watching porn in a way that's going to overwhelm that system because the second your genitals are touched by yourself or someone else the intensity is 100x I don't know I joke with statisticians sometimes because they'll say oh you know that person had a too uh effect size that's ridiculous that's not possible I like come to myp we have huge ofes so the place that kind of thing could come up is uh more with script Theory and things people worry about with
you know if I see this represented in pornography How likely am I to do that and that thing is not accurate or it's a bad practice and so on the the psych end of it there is evidence that people who don't know that pornography is entertainment and that it's not representative of real sex are more likely to adopt those scripts then the other question is well are those scripts accurate and most don't get into the accurate portion of it so for example youth that VI more prnography tend to be more accurate in their General Anatomy
knowledge than youth who don't view it's kind of a nasty finding isn't it you don't know where the clitoris is you're of course not like we are not by any means recommending that you should watch porn let's make that very very clear so if if they come across it I think what's interesting about it and what I'd like to say is it is just a media and it has inaccurate information but it also has accurate information so part of the question is like if you watch this and take something away from it what are you
taking away and why so if there was a study where they showed uh women stimulating their own clitoris and Then followed up with these people I think it was two weeks later something like that the women who viewed the images that had women stimulating themselves became more likely to stimulate their own clitoris that's associated with orgasm consistency that sounds like a great outcome and I would say if your porn shows that and many do that sounds like a potential positive effect of scripts there too and uh just most studies don't look at the positive side
at all they don't even ask they don't look for it so I think most of what we hear about is you know is there violence involved and in violence they include spanking which is often a wanted behavior and something that's portrayed as desirable so it's one of these um sorry I should mention the consent issue as well there like there have been studies of how consent is portrayed in some of these films and how that's understood and it is absolutely the case for example most of these films don't portray verbal consent before the acts began
but when they study non-verbal consent cues are almost always present so that would be things like a woman opening her legs to someone when they're going to have sex with a male um pulling his hips closer into her that would be considered behavioral consent and so it's depending how you look at the nuances of some of these issues they're absolutely concerns to have there but I also think just this cudle of like it's all bad it can only be bad there are only bad things there that's a public perception not a scientific perspect uh so
we're trying to say like slow down a sec and like look at the content and think you know what if I'm an adult viewing this what if I'm an impaired adult viewing this like developmental dislay delayed folks may have more difficulty understanding this is entertainment and that this is not a direct script could also mention trying to think of I'm bouncing around here a uh you know there have also been studies because people were about what extent youth take this as sex education there was a recent nationally representative study where they asked youth who were
like 14 to 17 year olds in the US where they got their sexual information from their education it's still overwhelmingly from their parents and I think people commonly think in the public like oh porn is so bad it's it was like seven to eight% of you said that was their main source of sexual information so you know it's four to five times coming from the parents not porn interesting I I read say that was the opposite it was like 50% was coming from erotic materials a small subset from parents a small subset from school um
I don't know if that I I would have to look back I'll send it to you but um but yeah I saw something very different that that a lot of kids were actually learning education from erotic films they're definitely they're a lot more likely when you say like why are you viewing pornography um in general most people say they use it for masturbation purposes but youth are more likely to say they view it for education also so you still primarily use it for masturbation but they also use it for that purpose but yeah this was
nationally representative just from last year so I don't know if it also have older yeah it could be shifting like there's one big shift in porn findings so you know 20ish years ago it was much more common to see that people who viewed more pornography had lower kind of self-image of their genitals as being negative so they say you know the more I view I feel like my penis isn't big enough my vulva lips are too long you know whatever the uh concerns where nowadays they don't always find that and occasionally they'll find the opposite
where people who view more actually feel more confident it's like what the heck is going on so I'd speculate like you know 20 30 years ago there were just a few production houses they select who goes in the films and they say these kind of breast that kind of vulva this kind of hair that's what's acceptable now we have only fans whatever body type you have someone is attracted to it and you can find representation of someone being attracted to your body type so it may depend now whereas before it's like BN was more monolithic
you know it's like people were more likely to look a particular way now I think there's a lot more representation so if you're looking at things that uh are still in that model is it may be more likely to have a negative effect and then there are people who have trouble with pornography we call it problematic porn use I guess in the literature of course people have called it porn addiction as a Gomen CL nature that's not actually in the medical science or the you know literature but to my review back when I looked at
it last was about 4% is that accurate at least in the research oh man I have no idea so this is the trouble is like every single study is defining it differently and then a few years ago the World Health Organization came up with a whole new diagnosis that had never appeared in any study ever and they said we're going to decide this is the one to try and we're like you could have talk yeah had some consensus yeah so the the international classification of disorders is very different from the diagnostic and statistical manual which
is what we use in the US um so the US like you can't get a diagnosis in unless it's tested if there's some testing and they're not sure yet they may put it in the appendix for further study the ICD doesn't do that they just say try this out and so some people are starting to try and study this new diagnosis me included I have data collection Ono right now for people who meet those particular criteria that yeah like what is problem use we would have to know first to say like well what's the prevalence
of it in the world I've seen 4% too uh you know I think if you just go by distress it's probably higher if you go by the new diagnosis it should be lower like it's supposed to be more selective but I also haven't seen a national representative sample there using the new criteria so I'm really not sure so what are the criteria so for compulsive sex um they have a list of eight and we actually have a standardized interview that we're uh trying right now on some folks who qualify from a questionnaire procedure and so
some of the key ones are a feeling of loss of control so they they don't think they can uh reduce their behavior if they wanted to that they engage in it more than they intend to which is kind of maybe the other side of that another big one is it's not attributable to another disorder or issue that's the primary thing we're studying in this uh particular approach that it's not due to the disapproval essentially um I was like I should get the exact words to be sure representing it well but that you can't attribute it
to the sociocultural arena in which this person is experiencing it so so meaning it's not because other people think it's bad yeah your wife can't diagnose you um your pastor cannot diagnose you those are some of the key features and to me kind of the the main one is a feeling of loss of control has been kind of the constant across all these studies so even before we had this diagnostic proposal it's like that has always I think been the core of all of these as you have to feel like I want Behavior change that
I cannot execute so if somebody falls into that category first question I have is what makes someone more likely to have these issues and are there correlations with certain conditions most of the studies of this are scientists examining who understands themselves to be a pornography addict so it often uses that label even though the diagnosis doesn't some of the uh more common features and things that are under study are things like moral conflict so if you're raised in a more conservative culture whether that's religious country of origin whatever that may be from maybe you believe
that women can't consent to pornography all pornography is abuse well then if you view any porn that's probably highly distressing too so that's a strong predictor in the last year there have been two papers published about the role of narcissism in people who believe they're addicted we think since it's new we think the way that works is uh some FKS say you know I'm having a hard time in life things aren't always going my way but it couldn't be me cuz I'm great and so people must be doing this to me it's the porn industry
who's fighting me you know they want control of me and this is why we're doing some work in conspiracy theories in these groups but also spiritual because I see it's like a Warfare with Satan you know it's like I got to fight my way out so narcissism is a strong predictor of identifying as a porn addict uh interestingly actual porn use is inconsistently related so some studies find viewing more porn is related to feeling you're addicted and some don't which is weird so that it could be a phase question right so maybe people are saying
like well you know I had problems a long time ago I don't know but that addict model is once an addict always an addict and so they're still identifying that way even though they view less like that's a possibility uh it could be that it's a research methods issue like maybe we're not asking about use in the right way it's not a straightforward thing because what is porn use right it's like am I saying have you ever viewed in your lifetime how many times in the week what's a normal hourly consumption rate what if you
view five hours but it's only all at once on Sundays and that's a really long session um but you had time and you weren't working you so it's not totally clear like how empirically to Define it there have been efforts to Define it by total sexual Outlet or TSO which normally is like a count of orgasm uh and I think that's died off there were like some early efforts at that that a bunch of was yeah it's probably not not a good buying to check it out uh but I don't think that survived as a
predictor think of I was going to encapsulate it I was like you may may not be related um but certainly like a conservative values are upbringing narcissism are some of the main predictors okay and in terms of people who find it distressing and have issues with it and you know identifies as porn addicts can they give it up and is that beneficial generally they're are interventions that are geared at porn distress so not porn viewing but like the distress you have around it uh the best supported being acceptance and commitment therapy or act a ton
of therapists are trained in act so the manual is free like they can easily do this so pretty easily accessible as therapy goes and if you target the porn distress in that way it seems to be effective for most folks but interestingly it's not necessarily reducing porn viewing it's reducing kind of your uh feelings about your type of use and bringing the use in line with your values so for example if uh you come home from work and go straight to the study and like masturbate for three hours and don't participate in child care and
you're like I want to be a good father I'm ignoring my responsibilities in my household that's a conflict can you masturbate another time so act is kind of about finding those uh values that are important to you and structuring your porn or masturbation use around those values the abstinence approaches seem to be harmful so we have a few studies now showing that people that say I got to stop entirely it has to be cold turkey uh usually it's in an addiction framework so they say you know zero use is the only acceptable use those folks
have reported having some suicidal ideation in response to what they call a relapse which sometimes even includes masturbation we've even seen folks say you know they have a nocturnal admission so they ejaculate during the evening and say oh you know I've relapsed that's it I'm never going to recover from this I can't do anything about it I was asleep what am I supposed to do and we're like right you're asleep normal it's fine but when people have an absent in school uh it can be very distressing to them surprisingly so you know in our sample
we like what like we we kind of asked thinking most people would endorse this and now I'm so glad we did a lot of people report the prime AR uh emotional experience they have in response to what they feel as a relapse is shame so an abstinence intervention I'd say is a shame based intervention that is you're using shame to try and change Behavior which almost never works so I think if you try an abstinence goal you're very likely to fail you're very likely to have harm from it so I would discourage people from having
that type of approach that doesn't mean I need you to view porn just to be clear it's just the ACT interventions I think are much better studied they have a good rationale and kind of like to work with someone to bring it in line use often does decrease when they do act but not always and that's fine yeah and it seems like it's a a vicious cycle cuz you feel shame when you watch porn you try to abstain from porn something happens and then you feel more shame but then you go back and watch porn
because that's sort of a coping mechanism is that accurate totally could be yeah yeah yeah okay so I think I mean the Tak homes that I would say is that if you're if you feel like you're struggling that's fine but seeking care from somebody who is not specifically saying to abstain entirely because that's probably not realistic and will cause more harm would be a safe bet yeah what she said okay so let's sh and then I do want to clarify um because I've heard you say before it's not all just dopamine so I think let's
clarify you knowe let's let's please clarify this because all I hear all the time is this huge dopamine flood that you get from watching porn let's say porn with master station let's just make it easy that is so above and beyond what you would get with sex and it's so easily obtained because you don't have to seek a partner um that it's causing harm let's just clarify what is really going on with the brain to study dopamine in the brain we use some kind of radio lians that tag dopamine that's active and that helps us
see when and where it's occurring there are some techniques around like timing with that that we don't need to get into but one big dopamine myth I hear all the time is oh when I climax I get an explosion of dopamine dopamine goes down at climax please please stop this it does not explode with climax during arousal it does go up uh the activity absolutely increases there are different types of dopamine it's most common in D2 D3 receptor types so very well replicated that absolutely happens you can do pornography and it will go up the
second you put your hand on your genitals it Expos 10x you know I mean I'm overestimating here please don't hold me to that number but it's manyfold in terms of the dopamine that's experienced when we have people into the lab um we use electrography so that is not dopamine sensitive just to be clear but another measure of like excitation uh absolutely same thing like the second the hand goes on the genitals from a partner the response is much much higher than when we just showed them images of pornography so just no does dopamine go up
when you view porn probably uh there's every reason to think so pretty well replicated but it does not explode with climax uh it's much higher when you touch yourself it's even higher when a partner touches you yeah this dopamine idea I think is related to the addiction claim so I very often see people say anything that that has dopamine is addictive like that's also not true that's a kind of a separate issue but depending who you ask most scientists Define addiction using what we call an incentive salience model um that was published some years ago
it has to meet all these different criteria to be considered an addiction and there are debates as science does about various qualifiers like you know does this qualify for this requirement and does they have to have this and so fair enough you know there's some disagreements but nobody is arguing that dopamine alone Mak something addictive like that is not a scientific perspective if you see that that is disinformation online so I mean but you could I guess one could argue and I'm just playing Devil's Advocate that masturbation is so easy and it releases a similar
amount of dopamine to partnered sex that it could sort of shift your desire to do that rather than do the work to uh find a partner this is again what people claim so that was a common belief with depression interventions in the past too so there are some uh cognitive behavioral therapy manuals that actually have like discouraged the patient from masturbation and I remember seeing that with colleague of mine who studies this with me now but used to do depression treatments he's like what the hell was that and so the part of it that I'm
sympathetic to is like masturbation is solo behavior and if you're someone who's struggling with socializing you don't want to go outside you know you are having depression issues which I think is the case for a lot of these folks it makes sense not to encourage self-isolation however uh this also may be the only source of like physical pleasure a lot of folks have who are struggling with poor mood he and I have both now tried to be Advocates or like stop saying this to people who are depressed like right uh so there is kind of
a funny backlash I think it's not just in this domain of people saying you can't use sex in that way so for example I've seen people saying like uh sex is really good orgasm especially at facilitating sleep so it doesn't affect Sleep Quality so much but the time it takes you to fall asleep is shortened lots of good animal models for this um not as many humans but there's reason to think yeah one could one could imagine so so I sometimes see people say like well you shouldn't use sex in that way though it's like
why not I like wait if it's the prolactin of vasor presson I'm not sure you know it could be either potentially but I don't see any reason why not to use it in that way and so sometimes I hear that like well you make masturbation easy and it's accessible as a way to cope I like but what if it's effective like what if it it helps people in some circumstances at some times so I wouldn't want to be too knee-jerk to say like oh it's use as this is bad it's like well what's the context
if you enjoyed that clip from the Reena malic MD podcast with Dr Nicole pry make sure you check out the full video right here
