The big issue: Rude awakenings
Therapy Today, November 2025

Irfan’s* first experiences with sex were steeped in stress: struggles to put on a condom, plus fears that he and his girlfriend would be overheard by family elsewhere in the house, meant he lost his erection. A selfperpetuating cycle of performance anxiety and erectile dysfunction (ED) arose. ‘Attempting to have sex felt like a humiliation ritual,’ he recalls. ‘In contrast, watching pornography felt safe and fun, because there was no one watching me. I stopped dating because masturbating alone was less pressured.’

Gradually Irfan, 21, began to recede from socialising with friends too. He moved from watching ‘standard, mainstream stuff’ to ‘brutal videos of men in various acts of submission being hurt. It would grip me while I was turned on, but afterwards I’d feel revolted by my own behaviour.’ Pornography went from being Irfan’s refuge to facilitating reclusion to making him feel repulsed by himself.

Pornography is currently the subject of new legislation as politicians attempt to troubleshoot the elements deemed to be having the most insidious impacts. As part of the new Online Safety Act, as of 25 July 2025, all sites and apps operating in the UK that allow pornography must verify viewers’ ages as 18-plus, following research showing that 8% of children aged eight to 14 had visited a digital pornography service in a month.¹ An independent review of the challenges of regulating pornography led by Conservative peer Gabby Bertin published in February² outlined 32 recommendations, the first of which became Government policy this June, when it was announced that depictions of non-fatal strangulation (NFS) in pornography would be outlawed.³ This brought what is disallowed on screens in line with what was already barred in person: NFS was criminalised by the Domestic Abuse Act 2021, but the normalisation of ‘sexual choking’ via pornography was posited to be a key reason why 38% of women aged 18 to 39 reported being strangled in bed.⁴ Moves to eliminate or restrict ‘deepfake’ and ‘nudification’ image generators – AI tools used to create phony yet convincing explicit depictions of people, overwhelmingly female and almost exclusively non-consensually⁵ – look to be next on the cards.⁶ Fifty-five per cent of teenagers opined that they’d find the distribution of deepfakes of themselves to be a potentially greater violation than the spread of genuine nude photos, due to the total lack of control they’d have over fabricated images’ existence.⁵ 

But how much of this is entering our therapy spaces and are we seeing rising numbers of clients presenting with grey areas around their experiences with pornography? 

Ofcom research found that 13.8 million UK adults (29%) accessed pornographic content services in May 2024.⁷ Many of those consumers would assess their personal relationships with such material to be largely healthy and non-concerning. But significant numbers of others, like Irfan, perceive themselves to have problematic pornography use (PPU), characterised by feeling ‘out of control’, causing distress and having negative consequences. Precise figures are hard to obtain: studies estimate PPU prevalence to be between three and 38% of men, and one and 23% of women who view online pornography within their lifetimes.⁸ 

Anecdotally, therapists are noting an uptick in the numbers of clients presenting with concerns related to sexually explicit image material (SEIM). ‘Over the past three to four years, it used to be that I would get maybe two or three queries a month specifically about PPU; now it’s usually three or four queries a week, particularly from teens and young adults,’ says BACP psychotherapist Joe Martin. And agony aunt Sally Land, who took over The Sun’s famous ‘Dear Deidre’ column half a decade ago, says ‘PPU has been the single biggest issue in my inbox since starting the job.’ 

The current legal changes and political debates present new challenges for therapists navigating this area. And news coverage of horrifying stories like the Gisèle Pelicot case – the French woman covertly drugged by her husband and raped by scores of men, who plotted via a chat room entitled ‘Without her knowledge’ hosted on a now-shuttered pornography site – raises additional questions, not just around the prevalence of PPU in therapy but how it’s showing up: is it limited to forensic or specialist spaces, or emerging in everyday counselling rooms? 

Whether you’re ready or not, the likelihood appears to be that pornography is about to star in your therapy space. 

Presentation

How can problems with pornography present? ‘Rule 34’ is an internet meme which holds that ‘Anything you can think of, there will be pornography about.’ Issues related to pornography are similarly multitudinous and don’t always involve uncontrolled or extreme consumption nor particularly shocking or deviant themes. 

'Our users variously divulge that pornography can detract from their sexual wellbeing by limiting their beliefs about how “good sex” should look: from body image to the intensity of pleasure and the assumption that if your partner’s not screaming in constant ecstasy then you’re a below-par lover to presuming that the visually dramatic acts seen on camera, like gargantuan ejaculations onto faces, are what everyone desires in reality,’ says Grace Willatt, Science Lead at sex and relationship therapy app Mojo. Others confess shame about watching pornography that conflicts with their values, and lying or being secretive about their habits. For some, the headache is that watching pornography has become their go-to, inflexible self-soothing strategy – which isn’t ideal if they’re seeking solace immediately after a catastrophic morning meeting in their busy office, say, or to calm a fear of flying.

38% of women aged 18 to 39 reported being strangled in bed⁴

Ryan Campinho Valadas, an HCPC and COSRT registered psychosexual and relationships therapist and clinical tutor at the Contemporary Institute of Clinical Sexology, specialises in supporting queer men. ‘Lots of gay clients initially turn to pornography for education in the absence of other resources,’ he says. ‘But later some feel pornography starts to hinder their sexual imagination.’ They perceive that repeated viewing of the same narrative structures or overreliance on pornography to provoke and stoke arousal has stunted their ability to think outside the box when it comes to stimulating what’s inside their boxers. There are also emotional impacts. ‘Many have been criticised and demonised for their queer identity; as a result internalised homophobia and emotions like grief and anger can crop up while watching gay sex scenes too,’ he states. 

Psychotherapist Adam Wick is a navy veteran who sees lots of clients from the forces. ‘One member of the military who served on the front lines in several recent conflicts told me he’d pull up pornography clips on his mobile phone while he was actively in combat,’ he recalls. ‘He wasn’t the only one.’ Wick suggests that this could have been an attempt to escape or dissociate from the horrors of war. Alternatively it may be a bid to reframe ‘unacceptable, unmasculine’ adrenalised sensations of terror as a more ‘acceptable, masculine’ rush of arousal, transforming battle into a ‘sexy game’ as a strategy for coping and cloaking fear. Whatever the motivations, the veteran felt deep disquietude about his use of pornographic content once he returned home. 

Wick also reports copious clients asserting that they have ‘pornographyinduced erectile dysfunction’ (PIED). This term originated within online forums and self-help communities. It’s not a formally recognised medical condition, but it’s a popular concept which holds that (over) consumption of pornography can condition some men’s sexual arousal to respond only to the potent, on-demand stream of novel, often hardcore footage found on sites like Pornhub, XVideos and XHamster. Sufferers report that the threshold for getting turned on becomes so warped that partnered sex is no longer sufficiently exciting, or the reality of another person – their smell, their sounds, their agency – is too far removed from pornographic movies to induce an erection. There may well be more complex factors at play in any individual’s personal circumstances than this summary of PIED outlines, yet some studies do suggest a significant link between ED and PPU.⁹ 

The ED sufferer is not the only person affected: their partner may feel rejected, lonely, unattractive, unsatisfied or resentful too. Serena,* 34, was especially aggrieved that her ex-husband attributed his impotence to his habit of buying customised clips from a creator on OnlyFans. ‘I felt I’d been cheated on,’ she says. ‘He wasn’t just looking at random videos of all sorts of women having sex; he was paying just one woman for personalised recordings. I think he developed feelings for her and saw himself as some valiant white knight funding her bills.’ For Serena, her ex ‘using the joint account to buy a sex worker’s time while I cried over his PIED’ takes the cake. 

BACP registered and COSRT accredited psychosexual and relationship therapist Lucy Frank has noticed ‘more couples coming to therapy together to discuss conflict or tension arising from pornography use, rather than just individuals seeking help’. However, she cautions that this trend may not wholly indicate an increase in PPU or pornography-related difficulties testing partnerships; growing social acceptance of couples counselling, greater openness towards conversations about sex and more honest acknowledgment of ‘pornography playing some part in the majority of relationships’ may additionally be nudging the needle. 

Frank is seeing plenty of PPU though – and one variant specifically. ‘Sadly a common motif in my particular therapy room is for individuals who have experienced sexual abuse or trauma to hunt out pornography that is rough, violent or degrading, allowing them to re-experience aspects of that trauma in a controlled environment,’ she explains. Such survivors may attempt to reprocess their experiences via pornography: by giving themselves the power to press play – and stop – choose the script and perhaps ‘orgasm quickly without emotional connection’, they seek to regain autonomy and distance themselves from pain. But what begins as an attempted ‘fix’ can morph into a complication of its own, says Frank: ‘In my experience, using pornography to move helplessness into control can become highly addictive.’ 

Joe Martin, psychotherapist 

Addiction or compulsion? 

For Jas,* 37, a pustule on her genitals represented undeniable evidence that she was in more than a spot of bother with pornography. ‘I used a powerful vibrator to masturbate over explicit animated videos for so long that I bruised my labia, which led to an excruciating cyst,’ she says. Weeks earlier she’d discovered her girlfriend was cheating and kicked her out of their shared flat. ‘I’d always enjoyed pornography, but now my self-esteem was in the gutter I turned to it more frequently to help me feel sexy again,’ Jas reasons. Suddenly solely responsible for paying the rent, the freelance graphic designer took on more jobs – but ended up procrastinating with pornography every time she opened her laptop to work. ‘I downloaded hours of alien hentai [X-rated Japanese anime]; the hyper-surreal fantasies helped me block out the world, but the mess was still there when I resurfaced… and getting messier,’ she sighs. Two months down the line, ‘evasive, excessive’ pornography use had contributed to Jas being in debt, in agony and feeling in trouble. Some people would describe this scenario as Jas being ‘addicted’ to porn.

29%: 13.8 million UK adults accessed pornographic content services in May 2024⁷ 

That term – ‘addicted’ – is the subject of debate among therapists specialising in PPU. In broad brushstrokes, viewpoints are binarised between psycho-sexological therapy outlooks, which fervently declare that ‘pornography and sex are not addictive’, and addiction therapies that counter, ‘yes, they are’. 

Both agree that clients present with behaviours pertaining to pornography that they feel are ‘beyond their control’ and that may involve harmful dependencies or obsessions. They disagree on whether these behaviours should be categorised as ‘compulsive’ – fundamentally driven by a need to relieve feelings of distress – or ‘addictive’ – driven by changes in brain chemistry relating to pleasure pathways – and, consequently, how they should be treated. 

‘The main difference is that addiction is a disease that takes hold at neurological level, whereas compulsion does not, as it is always dependent on the distress it’s trying to soothe,’ explains Silva Neves, author of Compulsive Sexual Behaviours: a psycho-sexual treatment guide for clinicians,¹⁰ and who is firmly in the ‘compulsive’ camp. ‘So, if an alcoholic initially drinks vodka to soothe something, the addiction to alcohol remains even if the issue they were trying to soothe disappears. In contrast, compulsion stops as soon as the distressing thing is resolved. Oftentimes, addiction treatments are based on abstinence, because true addictions can kill, whereas with compulsion, treatments work with underlying issues without necessarily needing a behavioural approach.’ 

Arguably, the view that it is ‘compulsive’ appears to be the dominant one – the World Health Organization (WHO) determined that data were insufficient to prescribe a ‘pornography/sex addiction’ diagnosis in the International Classification of Diseases, 11th Revision (ICD-11). Furthermore, it lists diagnostic criteria for compulsive sexual behaviour disorder (CSBD) in the ‘Impulse control disorders’ category, rather than under ‘Disorders due to addictive behaviours’. ‘Pornography addiction’ is not a recognised diagnosis in the most up-to-date edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) either. 

Neves says that even diagnoses of pure CSBD are rare. ‘If you’re diligent with the criteria, they’re very hard to meet,’ he elaborates. ‘Firstly, because a person with CSBD is not supposed to derive any pleasure from their actions, but most sexual behaviours – even unwanted ones – do produce some pleasure. Secondly, the ICD-11 specifies that “distress that is entirely related to moral judgments and disapproval about sexual impulses, urges, or behaviours is not sufficient to meet the requirement [for CSBD]”; in my experience, most people presenting to clinic feel intense shame about their behaviours due to external judgments.’ So he considers that a lot of PPU relates to compulsive behaviours but not to a more serious, persistent and involuntary disorder.  

Julie Sale, Founding Director and Principal of the Contemporary Institute of Clinical Sexology (theinstituteofsexology.org), says ‘The conceptualisation of sex and pornography as addictive often tends to shame and pathologise kinky and LGBTQIA+ people, whose sexualities don’t conform to mainstream, heteronormative limits.’ Some fear that pornography addiction therapy approaches that prescribe abstinence or have (sometimes undisclosed or unobvious) religious underpinnings, like 12-step programmes, can be tantamount to sexual orientation conversion efforts. 

Moreover, Sale considers it vital to distinguish between people experiencing perceived problematic usage of legal pornography and those looking at illegal materials depicting crimes like child abuse. ‘These are two distinct populations with different treatment paths, but they’re frequently conflated in discussions,’ she warns. ‘Page 4 of the Sex Addicts Anonymous [SAA] core Green Book groups unlawful practices like bestiality, sexual assault and molestation together with a host of other behaviours, including fear or avoidance of sex, compulsive crossdressing, anonymous sex, promiscuity… and compulsive internet pornography viewing, all as examples of addicts “acting out”.’ 

Ted,* 67, had been married for 34 years when he gave his wife’s friend a massage. As a bodywork practitioner it wasn’t extraordinary for him to touch other people, but this particular woman was deemed ‘too close to home, the session too intimate and outside what the marriage allowed’. He was also watching ‘pornography showing people enjoying fun, healthy, erotic adventures’ around four times a week ‘at peak’. A couples counsellor told Ted he was an addict and sent him to SAA meetings. ‘I found myself in a room with folks in recovery describing masturbating for days on end, to off-the charts wild stuff… I thought, “That’s not me”. It was bad advice to go,’ he recalls.

BACP accredited and COSRT senior accredited therapist Dr Paula Hall is founder of the Laurel Centre – ‘the UK’s largest provider of sex and pornography addiction services’ – and Pivotal Recovery CIC – a not-for-profit service offering courses to help ‘people struggling with pornography addiction, sex addiction and compulsive sexual behaviours’. She’s in the ‘addiction’ camp but thinks many people have outdated, pejorative views of what more modern addiction models and treatments look like, and that experiences like Ted’s are absolutely nothing like what she aims for. ‘Problematic pornography use truly is on a spectrum, so I work flexibly, incorporating sexology training,’ she states. Similarly, the Association for the Treatment of Sex Addiction and Compulsivity (ATSAC) was founded by COSRT sex and relationship therapists with a view to making pornography addiction approaches more integrative and avoiding pathologising or punishing clients with diverse sexualities. 

Hall emphasises that through an addiction lens, out-of-control pornography use ‘is viewed as a behavioural addiction, like gambling or gaming, not a chemical addiction like drugs or alcohol’. While the two may share certain neurobiological, phenomenological, genetic and clinical parallels, they’re not measured by the same criteria, like the presence of withdrawal symptoms due to physical dependency. And indeed, gambling disorder was reclassified from the ‘Impulse control disorders’ label to the ‘Disorders due to addictive behaviours’ group in the ICD in 2019, so where matters of sex ‘officially’ sit in the books may not be set in stone either. 

‘It’s difficult to have any hard-and-fast ideas in this realm,’ Hall says. Certainly this ongoing debate around PPU points to both the complexity and the ever-evolving nature of this landscape. 

Silva Neves, psychosexual and relationship therapist 

Slippery slope 

Another hot topic is the notion of whether online pornography can act as a ‘slippery slope’, compelling certain users to slide towards seeking ever more hardcore, heavy material, until some end up breaking the law, becoming engrossed in child sexual abuse material (CSAM), or illegal ‘extreme pornography’ depicting themes such as necrophilia or interference with animals. 

‘For every 100 clients I see about CSAM, I’d estimate this would be the story for 99 of them,’ says BACP therapist Gavin Conn, a forensic clinical supervisor and trustee at the Specialist Treatment Organisation for Perpetrators and Survivors of Sexual Offending (StopSO). ‘I don’t think they’re all sex monsters. I think lots of them start viewing pornography in an unhappy place, or a stressed place, and that ends up driving them to a monstrous place.’ 

Child protection agency Lucy Faithfull Foundation agrees, stating, ‘Our experience running groups for viewers of CSAM is that all of them “graduated” to CSAM by way of conventional, legal pornographic sites.’ 

It’s not certain whether online pornography creates a new interest in illegal material for some people, or awakens or enables an existing deviant schema. Forensic therapist John Goss, who works with and around sexual offending as well as compulsive sexual behaviour (CSB) is trained to assess under the AIM3 Harmful Sexual Behaviour framework. He believes that even if a latent attraction towards children were present in the offenders he works with (from the point of arrest right through court hearings), many of them would not have pursued their interest and committed crimes were it not for the ‘perfect storm’ of algorithms steering them in all-too-accessible dark directions, and encouragement from other criminals via platforms like chat rooms, Dropbox and Snapchat. 

Of course, the majority of online pornography users who accidentally encounter illegal material are appalled by it. Even repeated exposure to CSAM does not magically make a paedophile. Julie Sale observes that content moderation taskforce employees at the Internet Watch Foundation – as detailed in the podcast Pixels From A Crime Scene – comb through CSAM daily without becoming ‘hooked’. 

Zuzanna,* 45, learned her ex-partner had been viewing footage of minors under the age of six being abused when police knocked on her door one morning with a warrant to seize his laptop. ‘He claimed he’d found the first file totally in error while downloading software for his 3D printer, and that it escalated from there,’ she says. ‘I’m sceptical about how hapless and helpless it all was, though, because he was full of excuses, from calling pictures “art house” to claiming “There was no violence” to making out he was acting in a type of trance state.’ 

Paula Hall, sexual and relationship psychotherapist 

Drawing the line 

In the face of manifold ferociously fought arguments, unresolved unknowns and confronting case studies, are non-specialised therapists suited to support clients who present with pornography problems? 

John Goss cautions that without specialist training therapists can quickly get out of their depth. He recommends that if a criminal offence concerning explicit material is divulged or suspected you should pass the client on to a forensic expert. ‘You might think you can manage a client in possession of five CSAM images, but what do you do once the trust builds and after several sessions they admit it’s actually 5,000? Will you know what to write in a letter to the courts?’ Gavin Conn suggests doing StopSO’s training as a first step towards greater understanding. 

47% fall in visits to the UK’s most frequented pornographic website, Pornhub, 13 days after legislation came into place¹¹ 

To prepare for non-forensic situations, Silva Neves advocates undertaking a Sexual Attitude Reassessment (SAR). ‘It’s the best method to gain exposure to various erotic content and self-reflect on your reactions, including contempt and disgust. If therapists are not tuned into their own erotic outlooks and opinions, they’re more likely to be caught unawares when something “unusual” is shared. Just a flickering facial expression is enough to convey judgment and shame your client.’ 

It’s an issue that may also come up for those working with children and young people. BACP’s Safeguarding Lead, Jo Holmes, says: ‘A child divulging perceived PPU wouldn’t necessarily be an immediate safeguarding referral. Stay curious and non-judgmental and employ the Lucy Faithfull Traffic Light System to help determine if a young person’s sexual behaviour is expected (green), inappropriate (amber) or abusive (red). Safeguarding should be dynamic, so keep checking in regularly in case of changes.’ Stay vigilant for signs that a young person’s comments and attitude towards porn might reflect abuse, whether current or historic: ‘Viewing SEIM may unlock a memory of past abuse or exploitation,’ Holmes warns. Pay attention to where the material is coming from – has someone else deliberately shown your young client pornography? – as well as what it contains and how the child is reacting to it. 

Cultural difference 

Cultural awareness is also crucial. Ryan Campinho Valadas encounters ‘gay clients who’ve felt criticised or pathologised by therapists who didn’t know about elements of queer culture’, while Joe Martin cautions against ‘inadvertently promoting Western views’. 

Kim Loliya, Director of Black Psychotherapy, says: ‘Discussions about pornography with clients of colour must be situated within an intersectional understanding of how influences like the white gaze, fetishisation and early sexualisation of Black and Brown bodies can create cognitive dissonances and painful tensions. Be transparent about the religious roots of some PPU treatment models: if a trans client has been shunned by their faith, then is asked to work with a 12-step model, for example, it can inflame wounds. Supervision is useful – don’t automatically pass clients off like hot potatoes! In fact, conducted antioppressively, there is space for therapy to be reparative.’ 

Kim Loliya, Director of Black Psychotherapy

Emerging realities 

As it stands, new age verification laws are already having an impact. According to data analytics firm Similarweb, daily visits to the UK’s most frequented pornographic website, Pornhub, fell 47% from 3.6 million on 24 July 2025 – the day before agegating was enforced – to an average of 1.9 million on 8 August.¹¹ Similarly, traffic to OnlyFans decreased by 10%. This suggests that to a degree the ruling is successfully acting as intended. 

On the other hand, demand for virtual private network (VPN) services – tools that use remote servers to disguise your location online and conceal your IP address, allowing adults and tech-savvy children to use the internet as though they’re in another country, circumventing UK age blocks – has also soared in response to SEIM legislation, potentially skewing the figures: half of the top 10 free apps in Apple’s UK download charts appeared to be for VPNs the Monday after age-gates were activated.¹² 

Grace Willatt fears VPNs may spell trouble for clients: ‘The use of workarounds to “cheat” identification software – including by curious minors – may well enhance feelings of secrecy, guilt and shame and make it feel harder to talk openly about pornography use and associated questions or concerns,’ she warns. Critics additionally suggest that an unintended side effect of age verification may be normalising the idea of using technology to bypass filters and dodge or break the law to view pornography… or to gain sexual gratification more widely. Others posit that it could drive users to seek stimulation in unpoliced places, like the dark web, where they might be more likely to be exposed to extreme, illegal and dangerous content. 

Certainly the public are dubious that age verification will work to protect children.¹³ ‘We’d be foolish to think the protection will be comprehensive,’ agrees Jo Holmes. Fit-for-purpose sex education, teaching pornography literacy and psychoeducation, and welcoming dialogue are vital. 

The true impact will remain to be seen – and thankfully researchers are watching. ‘In 2020, an extensive review by Josh Grubbs and colleagues identified key gaps in our understanding of PPU, and concluded that there was almost no empirical basis for the treatment of compulsive sexual behaviours,’¹⁴ says Beáta Bőthe, Assistant Psychology Professor at the University of Montreal, and Director of the Sexuality, Technology and Addictions Research Laboratory (STAR Lab). ‘Right now we know precious little about perceived problematic interactions with pornography for women and gender-diverse individuals, because most work has focused on men.’ STAR Lab has just launched a fresh initiative to set research priorities for CSBs over the next decade, emphasising interdisciplinary co-operations, gold standard methods to test various therapeutic models, long-term follow-ups to assess efficacy of PPU treatments over time, and more diverse samples. Holmes highlights that BACP and the Nuffield Foundation have also teamed up on a project running until October 2027, which will explore how a thorough understanding of the risks, harms and benefits of digital life can be integrated into therapy for children and adolescents with mental health challenges.¹⁵ 

Ultimately the effects of online pornography are too widely spread and swiftly growing for any therapist to bury their head in the sand about it. With the ever-changing landscape of the online world and the rapid development of AI, it’s likely that – even with legislation – access to pornographic material will increase. It’s an issue that affects every therapist. Ask yourself, if a client six months into the work revealed their use of pornography was impacting their life, would you know how to react and work with the issue ethically and effectively? If X-rated discussions disarm you then X marks the spot of where to concentrate your professional development. 

*Names have been changed. 

John Goss, forensic therapist