Society and Culture

Why Isn’t Pornography a Public Health Issue?

Elie Cantin-Nantel
October 13, 2023
Pornography is as old as art itself. But unlike previous iterations distributed via painted vases, printing presses, movie theatres or video, the internet offers unlimited hardcore sexual content that is easily accessible, anonymous for viewers and nearly always free. As Elie Cantin-Nantel explains, this dramatic increase in availability creates serious problems for the physical and mental health of users, their families and society at large – with children and young women at greatest risk. And if that sounds like a public health crisis everyone can rally around…you’d be wrong. Cantin-Nantel asks why so many governments, public health organizations and academics are ignoring the porn problem. 
Society and Culture

Why Isn’t Pornography a Public Health Issue?

Elie Cantin-Nantel
October 13, 2023
Pornography is as old as art itself. But unlike previous iterations distributed via painted vases, printing presses, movie theatres or video, the internet offers unlimited hardcore sexual content that is easily accessible, anonymous for viewers and nearly always free. As Elie Cantin-Nantel explains, this dramatic increase in availability creates serious problems for the physical and mental health of users, their families and society at large – with children and young women at greatest risk. And if that sounds like a public health crisis everyone can rally around…you’d be wrong. Cantin-Nantel asks why so many governments, public health organizations and academics are ignoring the porn problem. 
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Almost everything, it seems, is a public health issue these days. Emboldened by their dominant role throughout the Covid-19 pandemic, public health officials now wield a list of things they consider to be within their area of expertise that goes far beyond traditional topics such as community hygiene and inoculations to cover all manner of social ills and economic issues.

The Public Health Ontario web portal can be considered representative of this ever-expanding point of view. Type almost any topic into the search bar and the results provide a long list of documents and websites offering advice, explanation and direction from the public health community. This includes pressing health concerns about influenza, Monkeypox and sexually transmitted infections. Also well-represented are terms such as cannabis, opioids, alcoholism and street drugs. Many topics that might not be immediately associated with public health – such as gambling, climate change, racism, income inequity, hate and misinformation – also yield pages and pages of hits. Even hoarding has apparently become a public health issue.

Yet there is one topic the public health community apparently considers entirely outside its capacious area of concern. Plug the terms “porn” or “pornography” into Ontario’s public health search engine and you get …“no results.” 

Which one isn’t a public health issue? While the Public Health Ontario website offers advice on a long list of issues, ranging from drinking to climate change to hoarding, it has nothing to say about online pornography. (Sources of photos: (top two) Pexels; (bottom left) Unsplash; (bottom right) Shutterstock)

The Modern Ubiquity of Porn

The public health community’s lack of interest in the social, medical and psychiatric effects of porn can’t be due to an absence of supply. Today, pornographic content is available immediately and in immense variety and quantity to anyone with the most basic internet access. Many of the world’s most popular websites are pornographic. Hardcore site XVideos is currently ranked as the internet’s 11th most visited website, putting it one spot ahead of Amazon, the global online retailer. Controversial Canadian site Pornhub is the 13th most visited website with 38 billion visits annually. XNXX is 15th. Both get more daily visitors than more familiar destinations such as Yahoo, Reddit or Netflix. In 2019, the equivalent of 6,650 centuries of pornography was consumed by Pornhub viewers. Quite often this content is entirely free. 

“I call it the never-ending buffet of high-quality gourmet food delivered 24 hours a day free of charge, and you don’t get full,” says Cory Hrushka, an Edmonton-based registered clinical and forensic psychologist and certified sex therapist, in an interview. A feature of our digital era, Hruska observes, is that “we can now watch more [pornography] in an hour than would be typical in a lifetime” during previous generations. 

A never-ending buffet of porn: Edmonton-based registered clinical and forensic psychologist Cory Hrushka observes that it’s now possible to watch more porn in an hour “than would be typical in a lifetime” during previous generations.

Hrushka and other experts agree that while the colossal scale of current porn consumption may be free, it is not costless. There is persuasive evidence of many significant health and relationship consequences arising from this endless digital buffet of sexual images. The victims include not only the many deliberate adult consumers of porn but nearly everyone else caught up in its web – from unwilling subjects of porn videos to families of porn users to innocent children who have the misfortune to stumble upon graphic sex videos in the absence of parental supervision. Given such a wide range of issues affecting the mental and physical health of so many Canadians, it seems legitimate to ask: how can this not be a public health issue? 

The Addiction Effect

Viewing pornography can affect the brain in a manner similar to addictive drugs, stimulating the release of dopamine, a chemical neurotransmitter associated with feeling pleasure. Once a person’s brain gets its first dopamine hit, it typically wants more to keep those good feelings coming. Over time this can create a dependency effect in certain people who seek out ever-greater stimulation to produce the same level of pleasurable feelings. To keep the dopamine flowing, some pornography consumers who once found pleasure in softcore titillation will find themselves turning to harder-edged varieties. 

“Most people are not problematic in their porn use,” observes Hrushka. “They can manage it and it’s not really an issue. But when you start getting that hook, then you start seeing more problematic behaviours.” Estimates vary for how many porn users can become “hooked” in this way, but credible evidence from Australia suggests around 1 percent for women and 4.4 percent for men. And while some researchers use “porn addiction” to describe this process of escalating, habit-forming porn use, Hrushka prefers a strict definition of addiction that is limited to substances capable of directly altering a brain’s chemistry, such as alcohol or drugs. That’s not the case with pornography, video games or other compulsive behaviours. “Technically it’s not an addiction, it’s a disorder,” he notes.

Hard to stop: Hrushka reports that some of his patients will binge-watch porn for “eight to 18 hours” on a weekend; according to Australian research, 1 percent of women and 4.4 percent of men are compulsive porn users. (Source of photo: Shutterstock)

Whatever we call it, the effect can be devastating. Hrushka says he’s had adult patients who “go home on Friday night, and watch eight to 18 hours of porn. I’ve had people binge the whole weekend.” Others will watch porn nine or ten times per day, every day, every week. For the still-developing brains of teenagers, this magnetic habit-forming effect can be even more extreme. “As soon as you give them an iPad, on the count of 10, they’re on the porn sites, and they’re hooked,” says Hrushka.

Reduces Performance

According to the British pornography research hub Your Brain On Porn, an array of academic work links viewing pornography to poor mental and emotional health. This includes loneliness, anxiety, depression and feelings of shame. Porn use has also been associated with other anti-social behaviours such as drug use, drinking and violence. According to an academic study published in the Journal of Adolescence, “Frequent users of the Internet for pornography were found to differ in many social characteristics from the group that used the Internet for information, social communication and entertainment… X-rated material consumers proved to be a distinct sub-group at risk of deviant behaviour.”

Training for the wrong sport: In his widely-viewed 2012 TEDx Talk Gary Wilson, founder of Your Brain on Porn, explains the possible connection between porn watching and erectile dysfunction, and how the effects appear to be reversible after giving up porn. (Source of screenshot: TEDx Talks/Youtube)

Ironically, watching people have sex may also impede actual sexual performance. In his widely-viewed 2012 TEDx Talk “The Great Porn Experiment,” Gary Wilson, the founder of Your Brain on Porn, explains how pornography may be linked to difficulties achieving and maintaining an erection. Such claims are backed by more recent academic work. A survey of nearly 3,500 men aged 18 to 35 in Belgium published in 2021 concludes the “prevalence of erectile dysfunction in young men is alarmingly high, and the results of this study suggest a significant association with problematic pornography consumption.” 

Quips Wilson in an interview with the anti-porn lobby group Fight the New Drug, “Some guys discover they have trained intensely…for the wrong sport. [These young men] had simply conditioned their sexual response to screens, isolation, constant novelty, shock/surprise, fetish porn and watching other people have sex.” Fortunately, Wilson concludes, such problems often resolve themselves when sufferers quit watching porn and shift their focus to real-world partners.

Like drug and alcohol addictions, pornography disorders can also have a devastating effect on relationships and careers. A report by the Wheatley Institute at Brigham Young University in Utah found that couples who consume porn experience a significant decrease in relationship stability and commitment. Marriages in which one of the parties consumes porn are twice as likely to end in divorce as marriages in which neither spouse consumes porn, although the causality is not clear. Similarly, employees who can’t stop watching porn at work are more likely to lose their jobs.  

Children and Porn

Regardless of the risks entailed and the causality, adult viewers of pornography are free to make their own decisions. The same cannot be said for the many, many children whose first contact with sexuality is the cesspool of internet pornography. Writing in  The Atlantic last year, David French noted there are “two kinds of child-pornography problems.” The first “involves the production of child pornography itself – the abuse of children photographed, filmed, and monetized.” The second involves “the remarkably early age at which children are now exposed to pornography, when they start to see the images that shape their minds and hearts.” French’s first problem is properly illegal and widely condemned, though it has proved impossible to eradicate. The second is largely dealt with by a shrug.

How young is too young? According to a Canadian survey of undergraduate students, the average age at which they first encountered porn was 12; one-third said they first saw porn when they were just 10. (Source of photo: Pexels)

According to Canadian research based on a survey of Ontario undergraduate students, the median age of first exposure by children to porn is 12-years-old. Nearly one-third of the respondents said they first saw porn when they were a mere 10-years-old; some were as young as 5. Other research in the U.S. has further found that for a majority of teens, their first brush with porn is accidental rather than deliberate. Porn, in other words, has become so ever-present on the internet that it’s nearly impossible not to find it. 

Unsurprisingly, this tidal wave of pornography consumption by still-developing children and youth has been found to have far-reaching negative effects on their self-esteem, mental health and views about sexuality into adulthood. Young boys who view pornography report feeling sexually inadequate, while young girls say they feel physically inferior. As French observes in The Atlantic, “Women and men are reporting that their relationships are twisted and distorted by early exposure to porn, and that’s contributing to an immense amount of pain, exploitation, and heartbreak.” 

In a powerful essay in the online magazine The Free Press, entitled “I Had a Helicopter Mom. I Found Pornhub Anyway,” teenager Isabel Hogben offers a terrifying testament to the unrestricted access young children have to pornography today. As the now-16-year-old Hogben explains, “The website has no age verification, no ID requirement, not even a prompt asking me if I was over 18. The site is easy to find, impossible to avoid, and has become a frequent rite of passage for kids my age.” Hogben said she was first exposed to porn at age 10. “I saw simulated incest, bestiality, extreme bondage, sex with unconscious women, gangbangs, sadomasochism, and unthinkable physical violence,” she writes. “The porn children view today makes Playboy look like an American Girl doll catalog.”

The Broader Harms

It is not just the consumers of pornography – young and old, deliberate and inadvertent – who may be harmed by the vast supply of sexual images filling the internet. Also suffering are the people who comprise the content of many of these videos. 

Popular pornography websites such as Pornhub typically provide “user-generated content.” This means anyone with a video camera can create their own pornographic videos and upload them for all to see. And while laws require that participants in such videos be of legal age and give their explicit consent to be portrayed, some porn sites are notorious for overlooking these requirements. This has resulted in many disturbing cases of adults and children being filmed naked and/or performing sex acts without their knowledge or consent. 

In 2020, a New York Times article by Nicholas Kristof, “Children of Pornhub,” caused international shockwaves with its portrayal of Serena Fleites. When she was 14, Fleites sent a nude video of herself to a boy she had a crush on. The video was subsequently uploaded to Pornhub – a porn site owned by the Montreal-based company Aylo, formerly known as MindGeek – with devastating personal consequences. Afterwards, she was forced to leave her school, began using drugs, took to harming herself, attempted suicide several times, fought with her family and left home. “A whole life can be changed because of one little mistake,” she told Kristof. At the time of Kristof’s interview, Fleites was 19 and homeless. (She has since improved her life, thanks to donations generated by the Times’ story.)

Nicholas Kristof’s 2020 New York Times investigation into Canadian porn site Pornhub caused global outrage over the case of Serena Fleites (pictured) who, at age 14, spiralled into addiction, self-harm and homelessness after a naked video she sent to a boy she had a crush on was uploaded to Pornhub. (Source of screenshot: New York Times)

Videos depicting actual child sexual abuse have been uploaded to internet porn sites with disturbing frequency. Cases include a mother who found her missing teen in a Pornhub video; the sexual abuser in this situation had posted 58 sex videos of the teenager. Then there’s the infamous and now-defunct porn channel GirlsDoPorn. According to the U.S. Department of Justice, it recruited women for modelling shoots and then forced them to make porn. One of the victims, Kirsty Althaus, a former teen beauty queen, testified she was drugged and then raped on camera. The lead perpetrator of this scheme, Ruben Garcia, received a 20-year sentence in 2020. 

In the wake of Kristof’s New York Times expose and the resulting political furor, Pornhub announced several changes to its content policy. The site now requires “all uploaders to affirm they have obtained and maintain valid consent and proper release documentation for all persons featured in all content uploaded to the platform.” 

“A crime scene”: Laila Mickelwait, founder and CEO of the Justice Defense Fund, asserts that online porn is often the result of sex trafficking. She mistrusts current efforts to make uploaders of porn responsible for verifying the age and consent of performers.

Laila Mickelwait is founder and CEO of the Justice Defense Fund, a U.S. anti-pornography lobby group. In an interview, she says she remains dubious about Pornhub’s newfound commitment to privacy and consent. The system essentially trusts the uploader to comply but, as she points out, the uploaders are often the abusers. And even when victims are successful in getting their videos taken down, quite often they simply pop up on another site. 

“Once a video gets uploaded to Pornhub, it can be viewed by 5 million users per hour who have the opportunity to screen record that crime scene or download it to redistribute it across the internet for the rest of the victim’s life,” Mickelwait says. “The victims call this the ‘immortalization’ of their trauma and they can spend the rest of their life trying to get their abuse videos taken down.” Mickelwait has launched the #Traffickinghub campaign to bring attention to the issue of sex trafficking on Pornhub. “I discovered quickly that Pornhub wasn’t a porn site, it was actually a crime scene,” she says. “And I felt compelled to sound the alarm on what I had discovered.” 

What Can Be Done?

Despite widespread evidence of harm, pornography has been part of humanity’s artistic output since the origin of graven images. This eternal presence, plus the free speech rights of Canadians and the great difficulty in drawing a clear line between eroticism and pornography, means it is not feasible to discuss an outright ban on porn. It is never going away. Even Hrushka, whose psychologist’s practice puts him in regular contact with people suffering from all manner of pornography disorders, opposes a ban. “I don’t have an issue with porn in the general sense,” he says. “I am a proponent for healthy sexuality.” In some cases, he asserts, porn can even have positive health effects.  

Yet the proliferation of modern porn has created many unmistakable and serious health consequences both for its intended users and those caught in its wake. It is worth noting that while current technology has enabled an explosion in access, this followed a lengthy period in Western civilization when pornography was largely suppressed by cultural norms and legal force. Such social pressure lasted well into the 1950s and only gradually relaxed in ensuing decades. And even then, porn remained relatively limited in scope, expensive to buy and hard to come by until our digital age. The issue at hand is thus how modern society can best manage the many negative outcomes arising from the peculiarities of online porn. 

Make it a public health issue: Governments rigorously enforce age limits on alcohol and tobacco. Why not porn? Pictured, a #ProtectChildrenNotPorn demonstration in New York’s Times Square in 2021. (Source of photo: Evan Louey-Dacus, retrieved from Empire State Tribune)

A good place to start would be for Canada to begin treating online porn as a matter of public health. This has been the approach of several U.S. states as well as some European countries. Like other legal substances or activities that bring pleasure but also entail risks for individuals and society, including gambling, alcohol, tobacco and cannabis, adopting a public health stance would recognize that consenting adults have a right to access pornography if they wish. But, by the same token, society has a stake in recognizing the problems it can cause, especially for vulnerable groups.

Canada, for example, strongly enforces smoking, gambling and alcohol age limits. Why should porn be treated any differently? Quite simply, pornography should not be accessible to underaged children. Neither should we tolerate without response other serious concerns such as sex trafficking or grotesque privacy violations that can afflict young women. And we should make sure that anyone suffering from problematic porn use knows how and where to get help. There are solutions to all of these issues.

Out of the Hands of Children

Curtailing online access to porn by children is not impossible, even if it might be technically complicated. Bill S-210, An Act to restrict young persons’ online access to sexually explicit material, was introduced by Quebec senator Julie Miville-Dechêne earlier this year and would make it a crime to allow minors to access porn and mandates that porn sites verify the age of users. It proposes fines of up to $250,000 for the first offence. The bill has passed the Senate and now sits with the House of Commons. 

Protecting the health of Canada’s youth: Quebec senator Julie Miville-Dechêne’s Bill S-210 would, if passed, make anyone allowing minors to access online porn sites liable to a fine of $250,000. (Source of photo: @mivillej/X)

Miville-Dechêne’s bill is similar to laws passed in several U.S. states, including Texas, Virginia, Arkansas, Louisiana, Montana, Mississippi and Utah with apparent success. In Louisiana, for example, Pornhub’s traffic dropped by a reported 80 percent following the requirement of age verification. Pornhub has also pulled out of Utah, Mississippi and Virginia altogether, meaning residents can no longer access its content. Germany, France and the U.K. are also pushing porn sites to do more to verify the age of viewers. 

Critics of these bills often point out that people can use workarounds, such as virtual private networks, to circumvent geographical limits or age verification laws. Overly-strict age verification procedures can also hinder adult access to such sites or result in users handing over their personal information to porn providers. While all this may be the case, the need to limit children’s access to porn remains paramount. That some inventive teens may use fake ID to buy cigarettes or booze doesn’t obviate the need for minimum age laws in those areas – nor negate the benefits of protecting most teens from easy access. 

Adult Issues

Many people are simply not aware of the harms arising from porn. Better public information could help change that. An example is a 2020 Utah law requiring porn sites to post warnings explaining how pornography can harm minors. While the adult film industry complains that such labels are an infringement on rights to free expression under the U.S. Constitution’s First Amendment, smokers have been looking at health warnings on their cigarette packages for decades. From this perspective, labelling should not be particularly controversial. 


You’ve been warned: Utah now requires porn sites to post a warning about the impact online porn can have on minors (top); that doesn’t seem particularly controversial, given that in Ontario online gaming sites (bottom) are required to promote responsible gambling behaviour and warn users of potential problems.

Porn sites could also be required to provide resources designed to help those struggling with compulsive use. This is also not a novel concept. Online sports gambling and casino sites in Ontario, for example, are required to “create initiatives that prevent problem gambling and promote responsible gambling in advertising and marketing.” Similar warnings and links can be found at online cannabis stores and liquor outlet websites such as Wine Rack or Quebec’s SAQ. For Hrushka, porn warnings could become a way to encourage people to seek help. “Many people have benefits [at work],” he notes. “If they need to go to their psychologist, they can get it covered. But a lot of the time, they don’t know that.” 

Fighting porn’s effects on sex trafficking and abuse of privacy are other areas in need of greater attention. The 2021 report Ensuring the Protection of Privacy and Reputation on Platforms such as Pornhub by the House of Commons’ Standing Committee on Access to Information, Privacy and Ethics made 14 recommendations in this area, including making porn sites liable for the material they post and requiring that platforms verify the age and consent of those depicted. 

Conservative MP Arnold Viersen subsequently introduced private member’s bill C-270,  the Stopping Internet Sexual Exploitation Act to give these recommendations the force of law. If passed, the bill would require porn sites to obtain confirmation from porn producers that those in the material are over the age of 18 and that they’ve consented to the publication of the content. It would also ban the distribution of the material if consent has been withdrawn. 

When Viersen introduced an earlier version of his bill, it was endorsed by a wide variety of anti-sex trafficking and women’s groups. Curiously enough, it was also criticized by a trio of feminist academics from the University of Toronto, University of Calgary and Memorial University. They claimed his bill was unnecessary, since sex trafficking is already illegal. Further, the academics argued, it would somehow adversely affect female porn performers. Viersen’s bill, they said, “Fails to recognize the high standards of consent established by porn industry professionals and activists.” Based on the evidence to date, putting such trust in the porn industry seems entirely misplaced. 

The Anti-Public Health Pushback

Despite wide-ranging and convincing evidence of many physical and mental health problems arising from online porn abuse, there remains a strong and puzzling resistance to declaring porn a public health issue, predominantly from feminist academia. Such arguments are typically not based on an absolutist view of free speech, but rather appear to be driven by a political reaction to anything perceived as a conservative perspective, plus relentless advocacy for the paramountcy of sex worker rights above all others.  

The pro-porn perspective: Academics Rebecca Sullivan of the University of Calgary (left) and Valerie Webber of Memorial University (right) argue that efforts to treat online porn as a public health issue are an example of a “moral panic” and will impede the rights of sex workers and the porn industry. (Sources of photos: (left) Justin Quaintance, retrieved from The Quantlet; (right) Fry Family Foundation)

Two of the three academics mentioned above, Rebecca Sullivan, a “feminist media and cultural studies” professor at University of Calgary and Valerie Webber, a postdoctoral fellow at Memorial and former “adult industry” (i.e., porn) worker, also argued against an earlier House of Commons motion put forward by Viersen that brought attention to “the public health effects of online, violent and degrading sexually explicit material of children, women and men.” In their essay “Porn not to blame for public health issues” in The Conversation the pair claim concerns about pornography are evidence of a “moral panic” rather than any real observed harms. To this end, they dismiss nearly all arguments regarding porn’s negative effects as fabricated religious nonsense. As for claims from conservative politicians that imposing age verification requirements on porn sites would protect vulnerable children from accessing the content within, they retort that this is a “simplistic statement to silence criticism” without ever dealing with the actual underlying issue. That impressionable 10-year-olds are stumbling upon hardcore sex acts on their home computer is of no apparent concern.

What is of great concern to Sullivan and Webber and other pro-porn campaigners is that any legal strictures placed upon the production or distribution of pornography could be detrimental to sex workers and the porn industry at large. Efforts that seek to treat, investigate or limit the harms caused by porn, the pair argue, “can have significant consequences for how sexual health is publicly supported, including sexual health curricula, access and privacy rights, research support and professional training.” Further, they claim, it impairs feminist and LGBTQ rights and “sex positivity” in general. Invoking such rights has apparently become a trump card against calls for any restraint in how online porn can be accessed and by whom. In tacitly siding with this argument by studiously ignoring the issue, the public health community is doing a grave disservice to the public they are supposed to serve. 

“Why do some people cling to the notion that porn is a destructive force on the health of the nation?” Sullivan and Webber ask. Perhaps because it is.

Elie Cantin-Nantel is a journalist with True North and an undergraduate student at the University of Ottawa.

Source of main image: Shutterstock.

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