Pornography and problematic pornography use: occurrence, patterns, and associated factors in a national gender-based controlled cross-sectional study

Background A study on pornography is vital due to internet accessibility, widespread pornography usage, and a lack of data, especially in non-western countries. Aim This study estimates the occurrence of pornography use (PU), compares demographic, sexual, and psychological factors between users (PUs) and non-users, and identifies associated factors of PU based on gender. It examines problematic pornography use (PPU), comparing usage patterns between PPUs and non-PPUs, and identifies associated factors of PPU. Methods In 2021, an online cross-sectional nationwide survey was conducted among 1249 Iranians (865 women, 384 men) in all provinces except one, using a convenience sampling method through social media platforms. Outcomes Participants were categorized into PUs and non-users based on their pornography use over the past year. PUs were further divided into PPUs and non-PPUs, using the Problematic Pornography Consumption Scale cutoff (>20). The researcher-made questions assessed patterns of pornography use, demographic characteristics, and sexual information; sexual health variables and psychological factors were evaluated by standard scales. Results PU was reported by 30.1% of participants (n = 376), including 27.5% of women and 35.9% of men. Logistic regression identified being male, shorter marriage duration, earlier age at first sex, lower religiosity, poorer sexual communication, masturbation, substance abuse, and depression as associated factors for PU. Among PUs, 13% (n = 49) were PPUs, including 10% of women and 17.1% of men. Linear regression identified the following risk factors for PPU: being male, longer marriage duration, masturbation, sexual distress, and pornography use. Conversely, having more children was a protective factor. Compared to non-PPUs, PPUs reported higher pornography consumption, the primary motivation being masturbation, greater usage among close friends, prioritizing pornography over sex with their spouse, negative effects on their sex life, and increased use during the COVID-19 pandemic. Clinical Implications Healthcare providers should address modifiable factors related to PU/PPU through early sex education and support. Objective measurements of PPU should be prioritized over subjective perceptions, as many infrequent users feel moral incongruence. Strengths and Limitations The study's applicability may be limited by imbalanced gender participation, recruitment of married individuals, and a small number of PPUs. However, strengths include standardized assessment tools, gender-based data collection, and anonymous sampling to enhance response accuracy in conservative contexts. Conclusion Accurate pornography occurrence measurement requires clear definitions, consideration of dropout rates, and consistent time units. Strong correlations with PPU included frequent masturbation, fewer children, lower education for women, poor sexual communication, and frequent PU for men.