Internet pornography and adolescent health

There has been an explosion in the use of the internet in the past decade, particularly among young people.1 In 2009, 96% of 12–14-year-olds in Australia went online, with 60% doing so via a mobile device.1 The massive volume of sexually explicit material, now easily accessible on the internet, has led to mounting concern about young adolescents easily engaging with pornography. Some of this concern undoubtedly has a moral overtone, but there are also genuine questions about the potential for exposure to pornography at a young age to bring forward the onset of sexual activity. Early sexual activity heightens the risk for sexually transmissible infections and unwanted pregnancy,2 which are in turn linked to poor mental health.3,4

There is abundant international evidence that adolescents are exposed to sexually explicit material on the internet, both by choice and inadvertently. The most comprehensive Australian survey shows that 28% of 9–16-year-olds had seen sexual material on line.5 A substantial proportion had seen genitals (17%) or images of sexual acts (16%) online, with the likelihood increasing sharply with age.5 Overseas studies, mainly from the United States, have explored adolescent internet exposure to sexually explicit material in more detail. For example, a survey of adolescents up to 18 years found that boys were exposed to sexually explicit images online at an earlier age, had more frequent exposure and saw more violent images, while girls reported more involuntary exposure. Boys were much more likely to report sexual excitement than girls, who more frequently reported embarrassment.6

Cross-sectional studies have demonstrated a strong relationship between internet exposure to sexually explicit material, endorsement of earlier and more diverse sexual practice, and sexual behaviour that predisposes to adverse sexual and mental health outcomes.7-9 Young people who reported having visited sexually explicit websites were more likely to have higher numbers of sexual partners, engage in a wider diversity of sexual practices, and use alcohol or drugs in association with sexual encounters.7-9 All these factors have been associated with a higher risk of sexually transmitted infections and unwanted pregnancy.

There is also a strong body of evidence (mostly from studies of adults) establishing a link between exposure to sexually explicit material and engagement in aggressive or violent sexual practices.10,11 Other potential consequences of exposure to internet pornography that have been observed in adult women, but not yet investigated in adolescents, include reporting a more negative body image, and increased pressure to engage in acts seen in pornography.12

There have been few relevant longitudinal studies, largely because of the difficulty of recruiting adolescents old enough to respond to questions on sensitive matters of sexual attitudes and behaviour, but young enough to have had limited actual sexual experience. One study of Dutch adolescents found that exposure to sexually explicit material on the internet did not predict subsequent sexual behaviour.13 However, in the US, studies found that adolescents with greater exposure were more likely to have engaged in sexual intercourse14 or aggressive or violent sexual practices.15

A major difficulty with interpreting most research in this field is that adolescents predisposed to earlier and more varied sexual engagement may be the ones who will seek exposure to sexual content through the media. The relationship may even be a circular one, with those predisposed being further stimulated by the material they find online.16 The problem of determining causal sequence is heightened by the wide range of interrelated factors that are associated with earlier engagement in sex. Intent to have sex is a consistent predictor of earlier sexual activity in adolescents and it is an important factor to study. Any factor heightening intent, or providing opportunities for sexual engagement in those with intent, will increase the likelihood of having sex. Assessment of intent is only possible in longitudinal studies, but those published to date did not report having incorporated questions in this area.

We are therefore faced with strong hypotheses and evolving evidence, but a substantial degree of uncertainty on the role of internet exposure to pornography in adolescent health, and what, if anything, needs to be done about it. The recognition that acute, overt harms arise through cyberbullying (whether via the internet or text messaging) and online solicitation17,18 has led to development of school policies and parental guidance in these areas. For the more general question of internet exposures, it is also clear that sex education, and open discussion of sexual matters within schools and families, assists young people in decision making, and does not increase the likelihood of earlier engagement in sex.19 Therefore, a continuing emphasis on these prevention strategies should serve as a counter to new pressures that internet exposure may be exerting on young people’s decision making.

A proper understanding of the role of the internet and social networking media in adolescent health and development will require a new generation of cohort studies that have the scope to enquire about socially sensitive issues, and yet ensure the trust and security of participants. There will also be a need for new measurement methods and new collaborations across disciplines. The pay-offs in making the right policy choices to safeguard young people during a vulnerable life phase will go well beyond the immediate questions about internet pornography.