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. Prevalence estimates for PPU vary across populations. Although cultural, gender-, and sexual-orientationrelated 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 in the literature by validating the long and short versions of the Problematic Pornography Consumption Scale (PPCS and PPCS-6, respectively) and the Brief Pornography Screen (BPS) and examining PPU across diverse populations. Methods: Using data from the preregistered International Sex Survey (N = 82,243; M age = 32.4 years, SD = 12.5), we evaluated the psychometric properties of the PPCS, PPCS-6, and BPS, and examined their associations with relevant correlates (e.g., treatment-seeking). We also compared PPU across diverse groups (e.g., three genders). Results: The PPCS, PPCS-6, and BPS demonstrated excellent validity and reliability. 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% to 10% of individuals in the PPU+ group had ever sought treatment for PPU, while an additional 21% to 37% wanted to, but did not do so for specific reasons (e.g., unaffordability). Conclusions: This study is an important step towards validating PPU assessments across a range of populations and providing free, valid, and reliable measures of PPU in 26 languages. The findings and the state-of-the-art, standardized measurement tools contribute to an improved understanding of PPU in underrepresented and underserved populations and should promote future high-quality research on PPU