Problematic pornography use across countries, genders, and sexual orientations: Insights from the International Sex Survey and comparison of different assessment tools

Background and aims Problematic pornography use (PPU) is a common manifestation of the newly introduced Compulsive Sexual Behavior Disorder diagnosis in the 11th edition of the International Statistical Classification of Diseases and Related Health Problems. Although cultural, gender- and sexual orientation-related differences in sexual behaviors are well documented, there is a relative absence of data on PPU outside Western countries and among women as well as gender- and sexually-diverse individuals. We addressed these gaps by (a) validating the long and short versions of the Problematic Pornography Consumption Scale (PPCS and PPCS-6, respectively) and the Brief Pornography Screen (BPS) and (b) measuring PPU risk across diverse populations. Methods Using data from the pre-registered International Sex Survey [n = 82 243; mean age (Mage) = 32.4 years, standard deviation = 12.5], a study across 42 countries from five continents, we evaluated the psychometric properties (i.e. factor structure, measurement invariance, and reliability) of the PPCS, PPCS-6, and BPS and examined their associations with relevant correlates (e.g. treatment-seeking). We also compared PPU risk among diverse groups (e.g. three genders). Results The PPCS, PPCS-6, and BPS demonstrated excellent psychometric properties [for example, comparative fit index = 0.985, Tucker–Lewis Index = 0.981, root mean square error of approximation = 0.060 (90% confidence interval = 0.059–0.060)] in the confirmatory factor analysis, with all PPCS’ inter-factor correlations positive and strong (rs = 0.72–0.96). A total of 3.2% of participants were at risk of experiencing PPU (PPU+) based on the PPCS, with significant country- and gender-based differences (e.g. men reported the highest levels of PPU). No sexual orientation-based differences were observed. Only 4–10% of individuals in the PPU+ group had ever sought treatment for PPU, while an additional 21–37% wanted to, but did not do so for specific reasons (e.g. unaffordability). Conclusions This study validated three measures to assess the severity of problematic pornography use across languages, countries, genders, and sexual orientations in 26 languages: the Problematic Pornography Consumption Scale (PPCS, and PPCS-6, respectively), and the Brief Pornography Screen (BPS). The problematic pornography use risk is estimated to be 3.2–16.6% of the population of 42 countries, and varies among different groups (e.g. genders) and based on the measure used.