← Rena Malik, MD Podcast
Rena Malik, MD Podcast
Moment: Does Porn Affect your Ability to Form Relationships? Explained by a Sex Scientist
00:22:41
In this episode, Dr. Rena Malik hosts Dr. Nicole Prause to tackle subjects around pornography's influence on sexual behavior and mental health. They dispel myths about dopamine's role in addiction and emphasize the complexities of pornography's effects on relationships and individual perceptions. Dr. Prause shares how pornography can improve sexual knowledge while discussing the difficulty in defining problematic porn use.
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- [00:00]
Dr. Rena Malik
So in terms of the brain with like masturbation or porn, for example, people will say 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?
- [00:36]
Dr. Nicole Prowse
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 know we're showing again low grade, low grade porn, you know, more 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 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. You know, I started, I always joy 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 VHS approach. So it's 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 two effect size. That's ridiculous. That's not possible. I was like, come to my lab. We have huge effects. So the place that kind of thing could come up is 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 is 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 view more pornography 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? Yeah. You don't know where the clitoris is. Of course not.
- [02:47]
Dr. Rena Malik
Like, we are not by any means recommending that you should watch porn. Let's make that very, very clear.
- [02:54]
Dr. Nicole Prowse
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 women stimulating their own clitoris and then followed up with these people, it was two weeks later or 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 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. 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 begin, but when they study, nonverbal consent cues are almost always present. So that would be things like a woman opening her legs to someone when they're gonna have sex with a male 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 cudgel 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 perspective. 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 delayed folks may have more difficulty understanding this is entertainment and that this is not a direct script. Could also mention trying to think as I'm bouncing around here a little bit. You know, there have also been studies because people worry 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 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 7 to 8% of youth said that was their main source of sexual information. So you know, it's four to five times coming from the parents, not porn.
- [05:29]
Dr. Rena Malik
So interesting. I, I read a study that was the opposite. It was like 50% was coming from erotic materials, a small subset from parents, a small subset from school. I don't know if that I, I have to look back, I'll send it to you. But, but yeah, I saw something very different, that kids were actually learning education from erotic films.
- [05:49]
Dr. Nicole Prowse
They're definitely, they're a lot more likely when you say like, why are you viewing pornography 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 youth 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.
- [06:09]
Dr. Rena Malik
Mine might have been older.
- [06:10]
Dr. Nicole Prowse
Yeah, 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'd 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 concerns were, nowadays they don't always find that and occasionally they'll find the opposite where people who view more actually feel more confident and 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 breasts, 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 porn 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 are still in that monolith, it may be more likely to have a negative effect.
- [07:19]
Dr. Rena Malik
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 nomenclature 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?
- [07:39]
Dr. Nicole Prowse
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 gonna decide this is the one to try. And we're like, you could have talked.
- [07:57]
Dr. Rena Malik
Yeah.
- [07:58]
Dr. Nicole Prowse
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 U.S. so the U.S. 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. 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 ongoing right now for people who meet those particular criteria. But, 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. 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.
- [08:50]
Dr. Rena Malik
So what are the criteria?
- [08:52]
Dr. Nicole Prowse
So for compulsive sex, they have a list of eight. And we actually have a standardized interview that we're trying right now on some folks who qualify from questionnaire procedure. And so some of the key ones are a feeling of loss of control. So they. They don't think they can reduce their behavior if they wanted to, that they engage in it more than they intend to, which is kind of maybe other side of that, another big one is it's not attributable to disorder or issue. That's the primary thing we're studying in this particular approach. That it's not due to the disapproval. Essentially I was like, I should get the exact words to be sure I'm representing it well, but that you can't attribute it to the socio cultural arena in which this person is experiencing it. So.
- [09:36]
Dr. Rena Malik
So meaning it's not because other people think it's bad.
- [09:39]
Dr. Nicole Prowse
Yeah, your wife can't diagnose you, 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, is you have to feel like I want behavior change that I cannot execute.
- [10:04]
Dr. Rena Malik
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?
- [10:15]
Dr. Nicole Prowse
Most of the studies of this are scientists examining understands themselves to be a pornography addict. So it often uses that label even though the diagnosis doesn't. Some of the more common features and things that are under study are things like moral conflicts. 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 some folks say, you know, I'm having a hard time in life, Things aren't always going my way. But it couldn't be me because 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 they see it's like a warfare with Satan. You know, it's like, I gotta fight my way out. So narcissism is a strong predictor of identifying as a porn addict. Interestingly, actual porn use is inconsistently related. So some studies find doing 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 now. But that addict model is once an addict, always an addict. And so they're still identifying that way even though they view less. That's a possibility. 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 then that's a really long session, but you had time and you weren't working, you know, 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. And I think that's died off. There were like some early efforts at that that a bunch of us. Yeah, it's probably not a good buying to check it out, but I don't know think that survived as a predictor. I think if I was going to encapsulate it, I was like, use may or may not be related, but certainly like a conservative values or upbringing, narcissism are some of the main predictors.
- [12:53]
Samantha Christine
Hey guys, I'm Samantha Christine, host of the Empower podcast right here on the Pursuit Network. If you're into wellness that fits into real life with honest convos, workout tips that actually make sense, nutrition hacks that support your lifestyle, and a lot of encouragement to become your strongest self, you'll feel right at home on my show. Whether you're a busy mom in a season of rebuilding or just trying to stay consistent with the all or nothing mindset, the Empower podcast is for you. New episodes drop every Wednesday wherever you listen to podcasts. So come hang out. I'd love to have you. Okay.
- [13:23]
Dr. Rena Malik
And in terms of people who find it distressing and have issues with it and you know, identify as porn addicts, can they give it up and is that beneficial?
- [13:35]
Dr. Nicole Prowse
Generally there's are interventions that are geared at porn distress, so not porn viewing, but like the distress you have around it. 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 feelings about your type of use and bringing the use in line with your values. So for example, if you come home from work and go straight to the study and like masturbate for three hours and don't participate in childcare 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 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 gotta stop entirely, it has to be cold turkey. 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 emission, 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, it can be very distressing to them. Surprisingly so. You know, in our sample we're 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 primary 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 how to work with someone to bring it in line. Use often does decrease when they do act, but not always. And that's fine.
- [16:05]
Dr. Rena Malik
Yeah. And it seems like it's a Vicious cycle. Because you feel shame when you watch porn. You try to abstain from porn, something happens, 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?
- [16:18]
Dr. Nicole Prowse
Totally could be.
- [16:20]
Dr. Rena Malik
Yeah.
- [16:20]
Dr. Nicole Prowse
Yeah, yeah.
- [16:21]
Dr. Rena Malik
Okay, so I think, I mean, the take 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.
- [16:38]
Dr. Nicole Prowse
Yeah, what she said.
- [16:41]
Dr. Rena Malik
Okay, so let's, and then I do want to clarify because I've heard you say before, it's not all just dopamine.
- [16:48]
Dr. Nicole Prowse
So I think.
- [16:49]
Dr. Rena Malik
Let's clarify. You know, please, 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 masturbation. 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 that is causing harm. Let's just clarify what is really going on with the brain.
- [17:12]
Dr. Nicole Prowse
To study dopamine in the brain, we use some kind of radio ligands 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. Like, it does not explode with climax. During arousal, it does go up. 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 explodes. You know, I mean, I'm overestimating here. Please don't hold me to that number. But it's many fold in terms of the dopamine that's experienced. When we have people into the lab, we use electroencephalography, so that is not dopamine sensitive, just to be clear, but another measure of like excitation. 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. There's every reason to think so, pretty well replicated. But it does not explode with climax. 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 addiction, 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 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 and. But nobody is arguing that dopamine alone makes something addictive. Like that is not a scientific perspective. If you see that, that is disinformation online.
- [19:21]
Dr. Rena Malik
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 find a partner. This is again what people claim.
- [19:40]
Dr. Nicole Prowse
So that was a common belief with depression interventions in past too. So there are some kind of behavioral therapy manuals that actually have like discouraged the patient from masturbation. And I remember seeing that with a colleague of mine who studies this with me now, but used to do depression treatments. He's like, what the hell was this? 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 wanna 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, 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. 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, 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. Not as many in humans, but there's reason to think, yeah, one could, one could imagine. So I sometimes see people say, like, well, you shouldn't use sex in that way. That was like, why not? It's like, wait, if it's the prolactin of the vasopressin, 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 was like, but what if it's effective? 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?
- [21:34]
Dr. Rena Malik
If you enjoyed that clip from The Rena Malik, M.D. podcast with Dr. Nicole Prowse, make sure you check out the full video right here.
- [21:41]
Samantha Christine
Hey, guys, I'm Samantha Christine, host of the Empower Podcast right here on the Pursuit Network. If you're into wellness that fits into real life with honest convos, workout tips that actually make sense, nutrition hacks that support your lifestyle, and a lot of encouragement to become your strongest self, you'll feel right at home on my show. Whether you're a busy mom in a season of rebuilding or just trying to stay consistent with the all or nothing mindset, the Empower Podcast is for you. New episodes drop every Wednesday wherever you listen to podcasts. So come hang out. I'd love to have you.