Problematic Pornography Use (PPU); Understanding the Impact, Symptoms and Pathway to Recovery

Joe's first experience of pornography happened when he was 10 years old. He remembers the shock, confusion and excitement of seeing something "taboo". What started as curiosity quickly escalated into consuming more explicit and degrading content. This early exposure distorted his understanding of sex, relationships, intimacy and even his sense of self. Like many young people, he had no developmental capacity to process what he was seeing. Pornography had begun to shape his arousal system before he had the emotional or relational maturity to make sense of it.

As Joe grew older, this foundation had devastating consequences. He struggled with relationships, avoided intimacy, and developed pornography-induced erectile dysfunction (PIED). Real live sexual experiences triggered anxiety, dread and feeling of humiliation. Porn became the only place he felt "safe", where performance didn't matter and no one could reject him. Over time, this coping mechanism became a painful cycle of shame, self-loathing and isolation.

Joe's story mirrors the experiences of many people seeking help for problematic pornography use (PPU) -a growing issue among Gen Z where 1 in 2 students at University watch pornography with 77% stating they struggle with it. As government try to regulate the online landscape, the Online Safety Act (2025) now requires all UK pornography sites to verify users as 18 +, acknowledging research showing that 8% of children aged 8-14 years access pornography monthly. Policy changes reflect increasing concerns about harmful porn trends, including depictions of non-fatal strangulation and deepfakes-content known to normalise violence, distort sexual expectation and violate personal autonomy.

While millions of adults can watch pornography without reporting problems, studies suggest that between 23-38% may struggle with some level of compulsion or harmful use. In my clinical practice referrals for PPU continue rising, often linked to erectile dysfunction, relationship breakdown, low self-esteem, anxiety and profound loneliness.

How Problematic Pornography Use Presents in Therapy

PPU does not always involve extreme or shocking material. It can develop gradually, influencing someone's self-image, expectations of sex and emotional wellbeing. Many people begin therapy after noticing they struggle to stop and say stopped, it has become a secret and compulsive behaviour contravenes their values. The double life of a "public self" and "private self" becomes exhausting.

A partner's discovery if often a common trigger for seeking help. Partners often sense that "something is off"- changes in behaviour, secrecy or emotional distancing, not wanting to engage sexually. When challenged, attempts to explain away these behaviours may include gaslighting or minimising, causing deep relational damage. For many couples, the crisis is not only the pornography use but the secrecy, deceit and betrayal surrounding it.

Young men frequently present with pornography-induced erectile dysfunction. Although not a formal medical diagnosis, PIED is widely discussed in research and online communities. Excessive consumption of high-intensity, novelty-driven porn may condition arousal patterns so strongly that real-life intimacy feels fat, slow or "not enough". Studies increasingly suggest connections between PPU and ED (erectile dysfunction), particularly when novelty escalation leads to more extreme content.

The effects extend to Partners, who feel rejected, unattractive, insecure or betrayed. Discovering paid content-such as personalised videos on subscription platforms-can intensify the rupture and destabilise relationship safety.

For some individuals, PPU is linked with trauma. People with histories of domestic abuse, early childhood adversity or sexual trauma may use pornography to re-enact themes of power, control or degradation in a way that feels a safer then real-life intimacy. Porn becomes a maladaptive coping strategy, a way to regulate overwhelming emotions or recreate situations in which they can "press play and press stop".

Addiction, Compulsion or Both? Clinical Perspectives.

Debate continues about whether pornography use can be classified as an addiction. To provide clarity I use the ICD-11 definition of Compulsive Sexual Behaviour Disorder (CSBD), which includes:

1. Persistent, repetitive behaviour that feels out of control
2. Continued us despite harmful consequences
3. Multiple unsuccessful attempts to reduce or stop
4. A pattern that lasts at least 6 months

This framework emphasises impaired control and functional impact rather than moral judgements about sexuality.

In practice, many people experience pornography along a spectrum-from addiction-like craving to anxiety-driven compulsion. Through the addiction lens, out of control pornography use is viewed like a behaviour addiction, like gambling or gaming, not a chemical addiction like drugs or alcohol.

Therapeutic Approaches for PPU and the Path to Recovery

Effective therapy for problematic pornography use focuses on:

1. Identifying emotional and environmental triggers
2. Understanding the patterns of compulsion or craving
3. Regulating difficult emotions
4. Rebuilding sexual confidence and healthy intimacy
5. Strengthen behaviours aligned with personal values
6. Addressing trauma and or attachment issues were relevant

Recovery does not require perfection. It requires commitment, insight, awareness, understanding support and capacity for change. Whether someone labels their addiction as PPU, addiction or compulsive sexual behaviour, the goal is the same: regaining control, rebuilding confidence and restoring wellbeing.