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COMMENTARY
Positive Porn: Educational, Medical,
and Clinical Uses

MARY ANN WATSON, PhD and RANDYL D. SMITH, PhD

Metropolitan State University of Denver, Denver, CO, USA
Downloaded by [McGill University Library] at 06:38 12 December 2012

Despite its widespread use, pornography has been vilified as a symp-

tom of personal and cultural depravity and as a cause of rape,
aggression, devaluation of women, and marital dissolution. Yet in
some cases there may be personal, relational, and social value to
the use of sexually explicit material. In this paper, we briefly review
the literature, summarizing both negative and neutral-to-positive
findings, then describe specific uses of sexually explicit material in
educational, clinical, and medical settings.

KEYWORDS sexually explicit material, pornography, e-porn,

erotica

Use and enjoyment of sexually explicit materials are widespread, but so are
condemnation and attempts at regulation. As a culture, America seems to
be deeply conflicted regarding graphic depictions of sex. Pornography is a
thriving multibillion dollar per year business. At the same time, censorship
efforts continue to target not just profoundly explicit materials but also erotic
literary works, racy music videos, Victoria’s Secret commercials, and even
mainstream publications that are seen as too sexually provocative, such as
The New Our Bodies, Ourselves women’s health book and the annual Sports
Illustrated swimsuit issue (Stern & Handel, 2001; Strong, Yarber, Sayad, &
DeVault, 2008).
Perhaps reflective of the cultural ambivalence is an apparent inability
to clearly define what constitutes pornography. More than 45 years ago, a
United States Supreme Court justice famously opined that he could never
succeed in intelligibly defining pornography, but “I know it when I see
it” ( Jacobellis v. Ohio, 1964). Since then, the meaning of pornography has

Address correspondence to Mary Ann Watson, Metropolitan State University of Denver,

P.O. Box 173362, Denver, CO 80217. E-mail: watsonm@mscd.edu

122
 Positive Porn 123

only gotten murkier as more and more forms of adult entertainment have
hit the market. Porn films and centerfold-type magazines have been joined
by pay-per-view shows, Internet Web sites, “reality porn” shows such as
Bang Bus, hotel-room movies, cable porn networks, and free mobile porn
for smartphones to create an industry larger than twice the size of the
Hollywood film industry (Rich, 2001). Into that mix, some would add the
growing sex-toy business, sexually explicit home videos, and even erot-
ically charged or sexually stimulating literature, paintings, sculpture, and
photography.
For the purposes of this paper, we will consider pornography as a
subtype of sexually explicit material (SEM). Pornography involves explicit
erotic stimuli designed to produce sexual arousal and may be subdivided
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into such categories as erotica (nonviolent, nondegrading consensual sexual

behavior), violent porn, and degrading porn (Fisher & Barak, 1991). Not
all SEM, however, aims to deliver sexual arousal. For example, some might
consider informational materials designed to educate people about the facts
associated with reproduction to be “sexually explicit,” and the Motion Pic-
ture Association of America uses a rating system which includes justification
phrases such as “graphic sexuality” in describing theatrically released, PG-
13-rated movies which are presumably not intended to arouse the audience
(Potts & Belden, 2009). We are concerned in this paper with SEM which
does affect users’ sexual behavior and sexual pleasure. To that end, we often
interchange the terms “pornography” (designed expressly for sexual arousal
and satisfaction, usually in a very immediate way) and other “sexually ex-
plicit material” which may be less sensational and commercial, but which,
like pornography, may be used to enhance sexual pleasure and fulfillment.
It is important to note that this paper addresses only adult use of—and adult
involvement in—sexually explicit material.
Not surprisingly, the sheer scope and variety of pornographic materials
have led to heightened concern about the damaging effects of pornogra-
phy on society. Negative sentiments abound: From some thoughtful, well-
intentioned feminist groups who believe that pornography is a violation of
a woman’s civil rights, to the religious right who tend to portray the use
and enjoyment of sexually explicit material as anti-woman and anti-family,
to those who purport that all erotic material is pathological, the belief of
many is that there are no positive usages for such material. Unfortunately,
this anti-porn narrative may create a hostile climate that undermines the
value SEM may have in certain settings. In this paper we review some of
the research on the harms that pornography may cause and address poten-
tial social benefits, including therapeutic and educational uses, of sexually
explicit materials. Clinicians, physicians, educators, and students add their
voices. Quotations are taken from written surveys and interviews of students,
clinicians, educators, and medical staff (Table 1).
 124 M. A. Watson and R. D. Smith

TABLE 1 Interviewees for survey

Category Number/response

College/university students 267 positive; 2 negative

College/university faculty/sex educators 8
Clinicians/psychologists 7
Medical staff/patient 7

NEGATIVE IMPACT

There is little empirical evidence to support such broad claims that pornog-
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raphy causes or contributes to violence, sexual deviance, degradation of

women, destruction of relationships, public health concerns, and moral de-
cay. Granted, pornography consumption and its consequences are hard to
study experimentally; assigning people to viewing and nonviewing condi-
tions raises both ethical concerns and validity issues, since forced use of
pornographic materials undoubtedly results in different reactions than view-
ing by choice. Hence, the literature that does exist is largely based on survey
methodology and correlational analyses and often results in complex and
even contradictory conclusions. For example, while there is evidence that
long-term exposure to violent pornography increases acceptance of coer-
cion and aggression in sexual relationships (Malamuth, Addison, & Koss,
2000; Perrin et al., 2008), the studies on uses of nonviolent pornography by
normal, noncriminal populations produce equivocal findings with regard to
increases in coercion and aggression (Kingston, Federoff, Firestone, Curry,
& Bradford, 2008).
Just as the type of pornography (violent versus nonviolent) is a signif-
icant variable when considering associations with aggression, so too is the
type of viewer. Consistent associations have been found between frequent
pornography use and aggression among viewers who are already prone to
acts of criminal behavior, sexual violence, and general aggression. Criminals
are more likely than noncriminals to “act out” sexually—including mastur-
bation, consensual sex, or coercive sex—after viewing pornography (Allen,
Emmers, Gebhardt, & Giery, 1995). Even among noncriminal men, those with
antisocial tendencies showed a preference for violent porn (Bogaret, 2001)
and were at increased risk for sexual aggression when pornography was
viewed frequently (Malamuth et al., 2000). But does pornography directly
contribute to aggression against women, or, on the other hand, do sexually
aggressive men gravitate toward pornography? In other words, is pornogra-
phy a cause or a symptom? These questions are not answered definitively,
but it does appear that pornography, for men already predisposed to ag-
gression, may not be a benign source of entertainment but rather a poten-
tially hazardous ingredient in a complex mix of influences. Still, there is no
 Positive Porn 125

evidence that the overall availability of sexually explicit materials in a society

increases rates of sex-related crimes (Diamond, 2009).
Beyond the question of pornography’s relationship to aggression, much
of the recent literature on pornography focuses on Internet porn, or e-porn,
use among the general population. It is estimated that 31% of the total online
population has visited sex Web sites (Leone & Bielsmith, 1999), and numbers
of online users are increasing because of the accessibility, affordability, and
anonymity of online sites. Roughly one-quarter of all online searches involve
porn (Perrin et al., 2008), and experts put the percentage of persons with
problematic sexually compulsive behavior in reference to viewing sexually
explicit material at approximately 8–17% of the population of users (Cooper,
Delmonico, & Burg, 2000; Cooper, Scherer, Boies, & Gordon, 1999). This
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group of users exhibits behavioral indicators of sexual compulsivity (e.g.,

spending 11 or more hours per week in online sexual pursuits) and reports
personal distress and impairment of functioning (e.g., declining performance
at work) as a result of Internet pornography consumption (Cooper, Putnam,
Planchon, & Boies, 1999).
Even among those who do not develop compulsivity or so-called addic-
tion, there may be negative implications of pornography consumption. More
frequent consumers of Internet pornography appear to be lonelier than non-
consumers or infrequent consumers (Yoder, Virden, and Amin, 2005). While
that association is only correlational, it is probably safe to say that frequent
use of pornography does not promote genuine social interactions that might
mitigate loneliness. Another concern expressed in the literature relates to
sexual esteem and sexual dysfunctions. Morrison, Ellis, Morrison, Bearden,
and Harriman (2006) surveyed 188 college men with varying levels of real
life sexual experience. When using sexually explicit material, those with the
least sexual experience tended to compare their sexual, genital, and body
esteem with the perceived sexual, genital, and body esteem of the actors. As
might be expected, those with the least experience had negative correlations
with body esteem, genital esteem, and sexual esteem. These researchers
found that individuals who reported more real-life sexual experience evi-
denced more favorable perceptions of their genitals and had higher levels
of sexual esteem and lower levels of sexual anxiety compared with those
men who reported no experience with sexual intercourse. Similar conclu-
sions were drawn by Peter and Valkenburg (2009) based on their research
with Dutch participants: Exposure to sexually explicit materials negatively
affected sexual satisfaction, especially among participants who had limited
real-life sexual experience.
When considering the potentially negative impacts of sexually explicit
material, it is important to extend the discussion beyond the effects on the
consumer, to the effects on the consumer’s partner. Most studies seem to
focus on heterosexual couples and have found that some women with
boyfriends and husbands who are heavy users of pornography experience
 126 M. A. Watson and R. D. Smith

profound personal distress, negative views of the relationship, and dimin-

ished self-worth (Bergner & Bridges, 2002; Bridges, Bergner, & Hesson-
McInnis, 2003). While the majority of women may attach neutral to slightly
positive meaning to their partners’ use of pornography, a substantial minor-
ity of women was distressed by it (Bridges et al., 2003). A recent study by
Twohig, Crosby, and Cox (2009) also suggests an association between men’s
pornography consumption and negative behavioral outcomes such as dam-
age to important relationships, although it was evident that the problematic
outcomes occurred only for some viewers.
Clearly, pornography can sometimes cause harm to some of its users.
Interestingly, though, many people seem to overestimate the harm it may
cause, as a result of the “third person effect.” Research has verified that
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individuals, when considering the impact of pornography, tend to ascribe

greater negative effect to others than to themselves (Hald & Malamuth, 2008).
This third person effect might be particularly evident among women who,
when viewing sexually explicit material, believe that the material would have
an adverse effect on other viewers, even though they believe they are not
negatively affected (e.g., Rogala & Tydén, 2003). Lo and Paddon (2000) found
that perceived harm to others was a predictor of support for restrictions on
access to pornography. Likewise, one’s own exposure—or lack thereof—is
another predictor of support for restrictions. Lottes and Weinberg (1998)
developed an Attitudes Toward Erotica Questionnaire that was administered
to 663 college students. Respondents who were more religious, less sexually
active, and who viewed erotica less often evaluated all types of sexually
explicit material as more harmful and having fewer positive effects. These
persons also supported more restrictions on availability than did students
who were less religious and more sexually active.

NEUTRAL-TO-POSITIVE IMPACT

While pornography may produce emotional, behavioral, and/or self-esteem-

related concerns for some of its consumers, there also may be benefits to its
use. Proponents of sexually explicit material have long held that greater ac-
cess to information about sexuality/sexual health may diminish anxieties, and
encouragement of sexual expression may enhance individual enjoyment and
relational connection. Others cite the sheer entertainment value of pornog-
raphy, and some have even suggested that access to sexually explicit media
allows for safe satisfaction of sexual curiosities and proclivities that other-
wise might be deemed deviant or dangerous (Newman, 1997; Thompson,
Chaffee, & Oshagan, 1990). We will describe briefly some historical notes on
sexually explicit gendered publications and the concept of goodness-of-fit
between sexual fantasy and arousal and availability of visual images. We will
confine our arguments to those supported by the scientific literature.
 Positive Porn 127

As cited previously, 8–17% of Internet pornography users experience

compulsive or so-called addictive use, some of which may be associated
with an individual’s recent access, since there seems to be a characteristic
trajectory of intense early involvement followed by a natural decline in Inter-
net pornography consumption (Leiblum, 1997). Noncompulsive, recreational
users constitute the remaining (83–92%) e-porn consumers. In one survey
of 9,177 subjects conducted on MSNBC, the majority of users indicated that
they used Internet sex sites less than ten hours per week, with 43% of these
persons accessing these sites less than one hour per week (Cooper, Scherer
et al., 1999). Cooper, Scherer, and colleagues (1999) concluded that “the
vast majority of on-line users generally seem to use Internet sexual venues
in casual ways that may not be problematic” (p. 160). Most respondents
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(68.2%) said that their online behavior did not interfere with, nor did it jeop-
ardize (78.8%), any area of their lives. Other studies have shown that online
viewing of pornography may allow for the formation of virtual communities
where isolated, socially or sexually anxious, or disenfranchised individuals
can communicate, find romantic partners, or practice some sexual behav-
ior in a safe setting (Cooper et al., 2000; Leiblum, 1997). McKenna, Green,
and Smith (2001) surveyed 62 females and 42 males and found that their
main reasons for turning to the Internet for sexual expression were safety
concerns, desire for frequent and convenient sexual outlets, and to expand
sexual knowledge and repertoire.
Regardless of the reason for accessing sexually explicit material online,
the behavior’s widespread acceptance is becoming more and more evident.
In a study of college students’ attitudes toward and usage of pornography
by O’Reilly, Knox, and Zusman (2007), 94% of men and 86% of women
responded that pornography use was “OK” (versus “completely against it”).
A study with a more nuanced measure of attitudes revealed that 66% of the
men and 48% of the women surveyed viewed Internet pornography con-
sumption as a normal or somewhat normal activity (Beaver & Paul, 2011).
Likewise, when participants in yet another study were asked about their
emotional responses when viewing sexually explicit material online, two-
thirds of the sample reported no worries about being judged if others found
out about their behavior, and approximately 70% said they never felt anx-
ious, guilty, or embarrassed about being caught looking at Internet porn
(Goodson, McCormick, & Evans, 2000).
The Internet is only the latest means of access in the long history of
sexually explicit material. Drawings from ancient times depict persons en-
gaged in sexual activity (Calvert & Richards, 2007; Diamond, 2009). Viva,
a 1970s women’s publication geared toward male nudity, had a five-year
publishing history beginning in 1973 (Beggan & Allison, 2009). Low sales
led to the cessation of this publication in 1979. Nevertheless, from a study of
the letters to the editor section of this magazine, many women indicated an
interest in viewing male nudity and said they were not adversely impacted
 128 M. A. Watson and R. D. Smith

by this material. Some women interpreted their own interest in this material
as leading not to their victimization but rather to their own empowerment.
This Viva study lends support to the goodness-of-fit concept, as male and
female respondents report more arousal to film clips selected by their own,
rather than the opposite, gender. A study of 395 male and female undergrad-
uates (195 female) at a U.S. university found that while male students were
sexually responsive to both male and female scripts, women reported more
sexual arousal, more positive and less negative effect, more absorption in
the sexually explicit material, and more frequent intercourse after viewing
the videos designed for women (Mosher & MacIan, 1994). These authors
concluded that psychosexual responsiveness to pornography is a function
of goodness-of-fit between sexual scenes and sexual script, a finding that
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has been supported more recently by Paul (2009). Emotional absorption in,
rather than clinical observation of, the material has been correlated with
favorable response to SEM (Sheen & Koukounas, 2009). (Note the list of
sexually explicit material [Table 2] frequently incorporated into classroom
and clinical practice by the educators and clinicians surveyed for this study.)
International studies of uses of sexually explicit material and, in partic-
ular, female uses of sexually explicit material, add another layer of meaning
to the oft-heard debate on feminism and pornography. Understanding U.S.
feminist debate as the feminist debate obscures the simple fact that the
terms of the U.S. debate are not internationally applicable (Paasonen, 2009;
Lerum & Dworkin, 2009; Vanwesenbeeck, 2009). In Finland, for example,
feminist porn debates have been less passionate; conservative Christian per-
spectives remain rather subdued; and institutional sex discourses advocate
active sexuality over sexual abstinence. One Swedish survey of cybersex
users (1,835 respondents) found that women ages 35–49 had significantly
more experience with cybersex than men of the same age. Men’s interest in
cybersex seemed to decrease with age while women’s interest stayed almost
the same, even undergoing a slight increase with age when focusing on
the three age groups between 18 and 49 years. Cybersex may be an activ-
ity in which women feel most comfortable expressing their sexuality, freed
of their concerns and of the restrictions and attitudes of the larger society
(Leiblum & Doring, 2002). Another Swedish study (Rogala & Tydén, 2003)
examining women’s use of pornography found that 65% of the women par-
ticipants reported outcomes that were “positive” or “excited” as a result of
their pornography consumption compared to 27% who endorsed “negative”
outcomes and 8% who stated pornography had “neither positive nor neg-
ative” effects. Among the explanations offered by these women regarding
how their sexual behavior was influenced by pornography were comments
such as “a tip on new positions,” “new ideas—it makes me feel more sexy,”
and “it can wake the lust.”
In another international study, Hald and Malamuth (2008) administered
a newly developed Pornography Consumption Effect Scale (PCES) to a large
 Positive Porn 129

TABLE 2 Sexually explicit resources

The professional educators, clinicians, and medical practitioners who participated in this
survey use the following sexually explicit materials in their work:
Adult sex education/Videos
Becoming me: The gender within. (2009). Hamilton, NJ: Films for the Humanities &
Sciences.
Becoming orgasmic. (1993). Chapel Hill, NC: Sinclair Intimacy Institute.
Body loving. (1980). Evergreen, CO: Gladys Strahl Productions.
Erotic massage: The touch of love. (2003). Tucson, AZ: Secret Garden Publishing.
Films by Candida Royale. New York, NY: Femme Productions.
(Sex)abled: Disability uncensored. (2009). Pasadena, CA: SexSmart Films.
Sex therapy video series: A gay male couples’ guide to sexual pleasure. (2006). Lake Worth,
FL: HSAB.org.
Sex therapy video series: A heterosexual couples’ guide to sexual pleasure. (2006). Lake
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Worth, FL: HSAB.org.

Sex therapy video series: A lesbian couples’ guide to sexual pleasure. (2006). Lake Worth,
FL: HSAB.org.
Sexuality reborn. (1993). West Orange, NJ: Kessler Institute for Rehabilitation.
Talking about sexual issues and SCI . (1992). Vancouver, BC, Canada: G.F. Strong
Rehabilitation Centre.
The better sex video series: Better sexual techniques, Vol. 1. (1991). Chapel Hill, NC: Sinclair
Intimacy Institute.
The price of pleasure: Pornography, sexuality, and relationships. (2008). Northampton,
MA: Media Education Foundation.
The tantric secrets of sacred sex. (2006). Los Angeles, CA: Lightworks Audio and Video.
Adult sex education/Books and pamphlets
Anand, M. (2000). Sexual ecstasy: The art of orgasm. New York, NY: Tarcher/Putnam
Books.
Baer, R. W. (2003). Is Fred dead? Pittsburgh, PA: Dorrance Publishing Company.
Barbach, L. (1995). Erotic interludes: Tales told by women. New York, NY: Penguin Group.
Barbach, L. (2001). For each other. New York, NY: Signet Publishers.
Cameron, L. (1996). Body alchemy: Transsexual portraits. San Francisco, CA: Cleis Press.
Chester, L. (1993). The unmade bed: Sensual writing on married love. New York, NY:
Perennial Press.
Comfort, A. (1991). The new joy of sex. New York, NY: Pocket Books.
Djerassi, C. (2008). Sex in an age of technological reproduction: ICSI and taboos. Madison,
WI: University of Wisconsin Press.
Ducharme, S. H., & Gill, K. M. (1997). Sexuality after SCI . Baltimore, MD: Paul H. Brookes
Publishing Company.
Gabriel, B. (1996). The fine art of erotic talk: How to entice, excite, and enchant your lover
with words. New York, NY: Bantam.
Hall, P. (2005). The good sex guide. New York, NY: Barnes & Noble.
Hebert, L. A. (1987). Sex and back pain. Greenville, ME: IMPACC, USA.
Joannides, P. (2009). The guide to getting it on (6th ed.). Waldport, OR: Goofy Foot Press.
Love, P., & Robinson, J. (1995). Hot monogamy. New York, NY: Plume Publishing.
Maltz, W. (1996). Passionate hearts: The poetry of sexual love. Novato, CA: New World
Library.
Mooney, T. O., Cole, T. M., & Chilgren, R. A. (1975). Sexual options for paraplegics and
quadriplegics. Boston, MA: Little, Brown and Co.
Naphtali, K., MacHattie, E., & Elliott, S. L. (2009). PleasureABLE: Sexual device manual for
persons with disabilities. Vancouver, BC, Canada: University of British Columbia.
Pitt-Kethley, F. (1994). The literary companion to sex. New York, NY: Random House.
Stubbs, K. R. (2000). The essential tantra: A modern guide to sacred sexuality. New York,
NY: Tarcher Publishing.
 130 M. A. Watson and R. D. Smith

TABLE 2 Sexually explicit resources (Continued)

Thornton, L., Sturtevant, J., & Sumrall, A.C. (Eds.). (1990). Touching fire: Erotic writings by
women. New York, NY: Carroll and Graf Publishing.
Tisdale, S. (1995). Talk dirty to me. Norwell, MA: Anchor.
Tuana, N. (2004). Coming to understand orgasm and the epistemology of ignorance.
Hypatia, 19(1), 194–232.
Watson, M. A. (2008). My sexuality workbook (5th ed.). Dubuque, IA: Kendall-Hunt.
Yarber, W. L., Sayad, B. W., & Strong, B. (2010). Human sexuality: Diversity in
contemporary America (7th ed.). New York, NY: McGraw Hill.
Web sites for adult sex education
www.AASECT.org. AASECT is a national organization for sex educators, counselors, and
therapists.
www.cialis.com. This is an online resource on the subject of erectile dysfunction.
www.levitra.com. This is an online resource on the subject of erectile dysfunction.
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www.mobilewomen.org. This is an online magazine for women in wheelchairs.

www.scisexualhealth.com. This Web site discusses sexual health and fertility after brain
and spinal cord injury.
www.sexsmartfilms.com. SexSmart Films is an online archive of films and videos on
human sexuality and sexual health from the past 60 years.
www.sexualhealth.com. The Sexual Health Network is dedicated to providing easy access
to sexuality information, education, support, and other resources.
www.SIECUS.org. This is the Web site for the U.S. Sexuality Information and Education
Council.
www.viagra.com. This is an online resource for the subject of erectile dysfunction.
Fertility clinics
Films for “collection” rooms:
Hustler films. Beverly Hills, CA: Larry Flynt Publications.
Playboy films. Chicago, IL: Playboy Enterprises, Inc.
Penthouse films. Hightstown, NJ: Effex Media LLC.
Magazines for “collection” rooms:
Hustler. Beverly Hills, CA: Larry Flynt Publications.
Playboy. Chicago, IL: Playboy Enterprises, Inc.
Penthouse. Palm Coast, FL: Penthouse Magazine.
Sex perpetrators treatment facility
Monarch 21 PPG (2010). Salt Lake City, UT: Behavioral Technology Inc.

representative sample of 688 Danish 18–30-year-olds. This study of self-

perceived effects of hardcore pornography consumption found that both
men and women reported small to moderate positive effects and little, if any,
negative effects of such consumption. (The participants in this study were all
from a very liberal cultural background where pornography is widely avail-
able and where attitudes toward pornography traditionally have not been
negative.) A separate study of 584 (382 female, 202 male) Canadian college
students that tested the relationship between sexual anxiety and exposure
to pornography showed that both male and female participants’ levels of
sexual anxiety were inversely correlated with their self-reported exposure
to sexually explicit material (Morrison et al., 2004). For both the males and
females in the Morrison study, sexual self-esteem positively correlated with
their self-reported exposure to sexually explicit material; for the females
 Positive Porn 131

only, sexual self-esteem positively correlated with their estimated number of

sexual partners. Of those women who had been exposed to sexually explicit
material such as Playboy and other “top-shelf” magazines (84.4% of the 382
women students), two-thirds (65%) believed that it had positively affected
their sexual behavior, for example, “an inspiration to try new things” and “it
makes me feel sexy.” From these data, Morrison and his colleagues (2004)
concluded that there is compelling evidence to suggest that an association
between exposure to sexually explicit material and viewers’ attitudes and
behaviors may be far more complicated than the male as victimizer/female
as victim ethos of a harms-based perspective.
In a review article in the International Journal of Law and Psychiatry,
Diamond (2009) concluded that sexual erotica is viewed not only with
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widespread personal acceptance and use but with general tolerance for
its availability to adults. This attitude is seen by both men and women not
only in urban communities but also in conservative and rural communities
as well. Further, this finding holds nationally in the United States as well
as internationally. The general finding is that, for adults, sexually explicit
material should not be restricted. There is consistent agreement that sexually
explicit material be restricted from children’s involvement and use. In some
studies, it has been shown that few adults have any interest in viewing
sexually explicit material that includes children or is violent in nature
(Fisher & Barak, 2001). Sexually explicit material seems entertaining and
pleasurable to large segments of every society investigated, and while critics
invoke charges of dishonoring women, others see sexually explicit material
as liberating and empowering. It appears that, without evidence of social
harm from its availability, there is no reason to believe that pornography
should not be legally available.

METHODOLOGY

This literature review is expanded to include qualitative, author-conducted

phone surveys (Table 3) and student questionnaire responses (Table 4).
Phone interviews were conducted by the authors over a three-month period
with college/university sex educators, clinicians/sex therapists, and medical
services staff/patients. Student responses to questions concerning use of
sexually explicit material in the college/university classroom were collected
over a two-semester, one-year period by the first author.
All student respondents answered the questions anonymously after com-
pleting a college-level sexuality course, Psychology of Human Sexuality. Col-
lege/university faculty respondents were the instructors of record for all of
the sexuality courses taught at the college/university level in the Denver
metropolitan area. All fertility clinic coordinators in the Denver, Colorado,
metropolitan area were contacted and constitute the majority of the medical
 132 M. A. Watson and R. D. Smith

TABLE 3 Phone protocol for clinicians/university faculty/medical staff

1. Do you incorporate any sexually explicit material (visual/written/auditory) in your

work/practice/teaching?
2. How do you introduce these materials? Any screening processes?
3. How do you use this (these) material(s)?
4. What feedback, if any, have you received concerning the use of sexually explicit material
in your work/practice/teaching? Negative? Positive? Neutral?
5. What specific materials do you use? (We are composing a resource list for professionals.)

staff responses. All clinicians listed in the Colorado Psychological Associ-

ation referral list as having a specialty in sex therapy comprise the clini-
cians/psychologist sample. All survey respondents signed a confidentiality
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form.

EDUCATIONAL USE

Educational material should provide sex information and the dispelling of

commonly believed myths. A review by Brewster and Wylie (2008) chronicles
the development and use of explicit materials in sexual education within
secondary schools, universities, medical schools, and clinics in the United
Kingdom. Sexually explicit material is used in very limited fashion with
children but more frequently with adolescent and adult populations. More
recently, publications by the U.K. Family Planning Association (FPA) aimed at
children 12 years and older explored feelings about sexuality, body image,
and relationships; a publication for age 16 years and above explored all
aspects of sexuality and relationships. Sexually explicit illustrations given
are all line drawn. This school sex education covers a wide range of topics
including anatomy, puberty, childbirth, contraception, masturbation, STDs,
sexual orientation, and sexual attitudes and behaviors. For many, this material
is the sole source of detailed, explicit information about sexuality and about
the male and female bodies.
In the United States, the Unitarian Universalist Association (UUA), along
with the United Church of Christ Justice and Witness Ministries, have pub-
lished a comprehensive sexuality curricula for children, teenagers, young
adults, and adults entitled Our Own Lives (OWL). Each age group has a sep-
arate curriculum and length and number of sessions increase with the ages of
the participants. This program gives information, including age-appropriate
explicit material (films depicting anatomy and sexual behavior) on subjects
ranging from birth, babies, bodies, puberty, sexual orientation, sexual health,
and responsible sexual decision making. Parent orientation sessions are a
central portion of this program. This educational program strives to prepare
children and adults to make informed, healthier decisions based on complete,
 Positive Porn 133

rather than incomplete, information. Although developed by two religious

organizations, OWL contains no religious references or doctrine. It is esti-
mated that, in the 40+ years of this sex education curriculum, more than
7,000 facilitators have been trained and more than 200,000 persons have
participated. For young adults and adults, the curriculum would include
additional, more conceptually advanced material related to understanding
differences in fantasy and arousal (Robb, 2009).
Another U.S. program, Sexual Attitude Restructuring (SAR) (Stayton,
1998), originally was developed in the 1960s by the San Francisco-based
National Sex Forum. This implosion model of training, including the use
of explicit films, small group discussions, and informational lectures, is sug-
gested as an acceptable and reliable way of helping educational, medical, and
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clinical professionals reassess their own attitudes about various aspects of

sexuality, lower their anxieties about sexual activities, and become comfort-
able with the subjects that comprise the field of human sexuality. Follow-up
studies (Barratt, 2008) indicate that of 7,400 adults who had participated in
a SAR, 96% believed that the SAR was beneficial. Fewer than 2% believed
that the SAR experience might have been personally harmful, although 6%
believed the experience might have been harmful to others (i.e., the “third
person effect”). Ninety-three percent rated the sexually explicit material com-
ponent of a SAR as helpful; 6% said no effect; 1% rated this component
negatively (Rosser et al., 1995).
According to Schoen (2010), producer of sexually explicit sexual ed-
ucation materials, sexuality educators have a responsibility to create more
effective learning tools. In the sexuality field, Alfred Kinsey, William Masters,
Ted McIlvenna, John Money, and Deryck Calderwood all were proponents
of film as a powerful tool for learning. Dr. Schoen has been the producer
of many explicit films used in a variety of educational settings. In a recent
phone interview, Dr. Schoen quoted one of his film viewers: “I have wanted
to write to you to let you know how much we enjoy your videos. We have
watched all of your films and have learned so much. We enjoy them together
which serves to open lines of communication and share thoughts and ideas
in the various techniques presented by the couples.”
To further investigate the impact of sexually explicit material in edu-
cational settings, eight phone interviews were conducted with university/
college faculty and other community-based adult sex educators following
the phone interview protocol (Table 3). These eight educators incorporate
sexually explicit material in their professional educational work. This explicit
material (Table 2) is used to teach college and university students in a variety
of psychology, women’s studies, and biology courses; to teach medical stu-
dents in their psychiatry rotation; and to teach in the community in a variety
of adult-centered human sexuality courses. Each of these eight educators
incorporates visual material in written and film format. A composite of their
 134 M. A. Watson and R. D. Smith

interview responses yielded recommendations for using sexually explicit ma-

terial in an educational setting. The recommended steps, with quotes from
these educators, follow:

Preview the Material

Each of the eight educators screens the films/books to be used in the class-
room setting prior to their use. In most cases, students are told during the
previous class session and at the beginning of the class session with the
explicit material that they will be watching sexually explicit scenes. The stu-
dents are asked not to bring friends or relatives to these sessions. (Note
that these educators do not use “live” demonstrations. Film provides a more
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predictable and controllable environment for education.)

College faculty member: I indicate to my college students in the very first

class that I would be irresponsible and negligent not to include sexually
explicit material in this Psychology of Sexuality course.

Introduce the Film Prior to Showing It

Medical school faculty member: I prefer to introduce this material early

within the curriculum. I give the class a choice: If anyone is very un-
comfortable with the material, they can leave or close their eyes and
no judgment will be made. The purpose of the showing of sexually ex-
plicit material in the classroom is not to change attitudes but to increase
awareness of attitudes.

College faculty member: “I certainly indicate, in announcing the plan to

show sexually explicit material, that they may choose not to attend. I
do strongly urge them to attend. I request that they watch the material,
not immersing themselves in the arousal components of the material,
but in watching educationally and clinically, to see what they can learn
for themselves or others in order to enrich their sensual and sexual
lives—what might or might not work for them.

College faculty member: I do tell the students in advance what they can
expect from the films. I want to maintain a safe space in the classroom.
They can choose to not come or to leave for this portion of the class
presentation. Virtually no one chooses not to come.

Follow Up the Film with Discussion

College faculty member: In my 30 years of teaching human sexuality I’ve

had only two comments that were negative. Initially, the students are
 Positive Porn 135

TABLE 4 Questions to college/university students

Describe your rationale for the inclusion or exclusion of sexually explicit visual material in
the college or university classroom.
The following three films were shown in class that included sexually explicit material. Please
indicate what, if anything, you learned from each of these three films:
1. Better Sex Basics, Vol. 1, Sex Therapy Video Series
2. Sexuality Reborn
3. Becoming Me: The Gender Within

shocked by the explicit nature of the films I use; after a few minutes they
get into it and are fine.
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Community sex educator for a Black adult audience: By and large my par-
ticipants have made positive comments: “I enjoyed this,” “It’s interesting
even though I’ve never spent much time thinking about these topics.”

College faculty member: After each of the explicit segments, I have the
students take a few minutes to list the positive and negative components
of each of the interactions they have just witnessed. We talk as a class
about couple communication, sexual positions for different sensations,
orgasmic response, and other issues raised by the films. I take time
to debrief with the students about their individual/class comforts and
discomforts in watching the material.

Student response to the use of sexually explicit material in the classroom

was overwhelmingly positive. Of 269 student respondents to this survey
(Table 4), only two gave negative responses. Examples of positive student
responses to the explicit homosexual and heterosexual video segments are
as follows:

Female student: College is a place where teachers should push you to

step outside of your comfort level. Several of the videos we watched put
me far outside of my comfort level, however, they were a very effective
tool to use to help me gain knowledge of the material. I don’t believe
material that helps a person learn should be excluded from a classroom
just because it is sexually explicit.

Female student: Coming from a very conservative family, I was taught to

see sex as wrong and dirty. I honestly did not see it as a normal act in
relationships. These videos allowed me to get a glimpse of life outside
of my conservative home. These videos jolt the students into reality and
push their boundaries to open their minds and encourage them to learn
more.

Female student: I think it is important that sexually explicit material be

used in the college or university classroom. I feel this way because sex
 136 M. A. Watson and R. D. Smith

is such a taboo subject in our society and I think people should be

more willing to talk about it with their peers, teachers, parents, children,
relatives, etc. It is sad to say that this is the first decent sexual education
that I have had and I am 23 years old.

Female student: It really opened my eyes to how tender sex can be for
all couples, not just heterosexuals. The homosexual clips were very eye-
opening because you always think about their sexual relationships but
never know.

Female student: After watching the touching of the body and how you
can learn about your partner’s body, I actually tried it. I now know more
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about my partner and where he enjoys being touched and kissed. It

makes for better sex!

Female student: Being a newlywed and a virgin up to my wedding, my

knowledge of foreplay and sensate focus were small. My husband and I
were stuck in one position and I wasn’t having orgasms as often as he
was. I shared my notes with my husband and now we take our time and
enjoy each other’s company and each other’s bodies!!!

Examples of student responses to an explicit film with disabled couples are

as follows:

Male student: In the past I had some similar injuries from a military
accident and I was told that I would need to abstain. Now I know that I
could, in fact, have considered a relationship.

Male student: Couples with spinal cord injury are just as kinky and sexual
as couples without any disability. Actually, I would have to say that
couples with disabilities are least likely to have communication issues
with intimacy.

Female student: My brother had disabilities and I never knew if he had

a sex drive. Because I was able to watch this, I learned otherwise.

Female student: As hard as this was to watch, it changed my perspective

on the willingness of disabled persons to have intercourse despite com-
plications with their physical impairment. I also found it very interesting
that their erogenous zones were altered after injury.

Female student: I was really intrigued by this movie to see couples with
disabilities either interacting sensually or sexually or making love. I had
never thought that a person who cannot control bowel movements or
their bladder could successfully participate in a sexual experience without
 Positive Porn 137

grossing their partner, but disabilities don’t change sexual desire and this
film shows how people get around that.

Examples of student responses to explicit transsexual surgical scenes:

Female student: On the Discovery Channel they take out or blur the
explicit parts. This was great!

Male student: One of my best friends currently is trans, and I ask a lot
of questions to get educated. This movie really helped me to understand
the world he lives in.
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Though the results of our student and educator surveys were overwhelming
positive, there were those who objected to educational uses of sexually ex-
plicit material. Even with the careful preplanning and thoughtful discussion
recommended by the strategies, educators who show sexually explicit mate-
rial may risk offending or even outraging an occasional student. One college
faculty member reported that “a student brought a formal complaint against
me, saying that, in showing films that included some same-sex interactions,
I was promoting homosexuality . . . ” Similarly, a college student responded
that “I personally think unless it’s a class on sex therapy and how to help
possible future patients, there isn’t any need for it in an academic setting. In
my view it is pornography, and that should never mix with academics.”

Developing New Teaching Tools

Another avenue for sex education using explicit material calls for the de-
velopment of an Internet-based, theoretically driven, innovative approach to
instruction in sex and sexuality. An Internet sex education Web site would
access text, sound, still pictures, videos, and animation to engage human
beings’ multisense capabilities. Multimedia is particularly important in the
area of sexual education in order to address information, motivation, and
behavioral skills deficits in this critical area (Barak & Fisher, 2001).

MEDICAL USE

Physicians are typically the first line of intervention when patients have
concerns or needs related to their sexual functioning. All too often, though,
sexual health is overlooked or ignored by the health care system (Tepper,
1992). Patients may be hesitant to ask questions of their providers related to
sexuality. Providers are often anxious and underprepared to provide accurate
information to their patients. Several educational models have been used in
 138 M. A. Watson and R. D. Smith

the medical school classroom to train developing clinicians around areas of

sexual health.
The Sexual Attitude Restructuring (SAR) model described above has
been used in the training of medical students. Research conducted at the
University of Pennsylvania School of Medicine revealed that medical stu-
dents who participated in the implosion model (explicit films incorporated
into the medical school curriculum) were significantly more comfortable in
confronting sexual issues with their patients than those who saw no films
(Stayton, 1998). SARs include films on adult solo and mutual masturbation;
oral, vaginal, and anal sex; lesbian and gay sexual interactions; sex between
older couples; and disabled persons having sex. The major goals of this
component of medical school training are to make students more tolerant
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of the wide spectrum of normal human sexual responses, to force students

to think about controversial sexual issues, to condition medical students not
to overreact to sexual stimuli, and to increase sensitivity and a humanitarian
perspective. Sexuality training is not a new phenomenon in medical educa-
tion. In 1970, John Money, professor and researcher at The Johns Hopkins
Medical School, presented a six-session audiovisual program to freshman
students at the medical school. These students were exposed to erotic ma-
terial in the form of readings, slides, and movies. He believed that this was
a necessary and useful tool in medical school education (Schoen, 2010).
Our review takes into consideration the value of sexuality education
incorporated into medical practice. Six staff members and one patient of
medical facilities were interviewed using the phone format described in
Table 3. Three of the interviewees were laboratory managers of fertility
clinics; one was a fertility clinic patient; others were medical representatives
of cardiology, orthopedic, and spinal cord injury hospitals or clinics. Each of
these clinics incorporates sexually explicit material into its treatment regimen
in a variety of ways, including education, physical therapy, arousal, and
posttreatment sexual health.

Spinal Cord Injury

Body image is an important adjustment issue for men and women with
spinal cord injury because their feelings can influence their desire to engage
in sexual activity. It is natural for women and men who are newly injured to
take time to be comfortable with their bodies. Women and men will need to
learn that:
(1) they are still desirable;
(2) they can have the opportunity to meet people, fall in love, and marry;
(3) they are sexual beings;
(4) they have sexual desires;
(5) they have the ability to give and receive pleasure;
 Positive Porn 139

(6) they can have active sex lives; and

(7) they can become pregnant, or create a pregnancy, and have children.

However, it is important for women and men to learn about how spinal cord
injury can impact their minds and bodies. When potential problems are pre-
vented or managed, they can feel comfortable in exploring, expressing, and
enjoying all aspects of sexuality no matter the level of impairment (Lindsey
& Rivera, 2004).

Director of Patient/Family Education, spinal cord injury hospital: I say to

each of the patients, “Sex is spoken here.” I use sexually explicit videos
to teach and to help these patients learn about their own route to sexual
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health. We give brochures that include sexually explicit images to educate

on sexual positions, erogenous zones, changes in body functioning, etc.

Orthopedics

Practice manager, orthopedic clinic: Everyone with back pain is curious

about their ability to continue to have a comfortable sex life with their
pain. We give out a booklet including drawings of sexual positions to
each of our patients.

Office manager, orthopedic clinic: Most of the patients are really pleased
that we give them a brochure that has the sexually explicit drawings. It’s
one less thing that is worrying them.

Cardiology

Practice manager, cardiology clinic: Everyone is open to learning about

their own bodies—what they can do or not do after cardiac surgery. We
give out brochures with sexually explicit drawings that patients can take
with them.

Nurse, cardiology clinic: Older guys are so glad that I bring up the issue
of sexuality after surgery or other cardiac conditions. Their wives are
happy that I bring up the subject and are happy that they leave with
visual material.

Fertility
Unlike the above medical specialties, where sexually explicit material is used
to assist patients in maintaining or renewing their sexual health, fertility clin-
ics rely on SEM for laboratory purposes. Because reproductive treatment
often involves semen analysis, most fertility clinics have incorporated sexu-
ally explicit material to assist men in generating ejaculate samples.
 140 M. A. Watson and R. D. Smith

Embryologist in fertility clinic: We use a wide variety of sexually explicit

visual material for the “collection” rooms. We have magazines and DVDs
in each of the rooms with a TV for individual use.

Laboratory manager in a fertility clinic: I say nothing to each man. I take

them to the individual “collection” room. Nothing is forced on them.
The use of the sexually explicit material is totally up to them. The goal,
obviously, is to provide stimuli, if desired, for ejaculate samples.

Laboratory manager, fertility clinic: When I take them to the “collection

room,” I do not ask about morals, etc. I simply point out the TV and the
available materials that are in the room. No one in my many years of
work here, with 2,500 patients per year, has ever said they were shocked
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by the presence of the explicit material. One man said, “I’m glad you
have this. I’m not allowed to watch this at home.”

Embryologist, fertility clinic: We’ve had hundreds of collections here per

year. I’ve only had one man who asked that I remove all DVDs from
the room prior to his entering. He said he wanted to make sure that his
“collection” was a medical process, not an arousal process.

Embryologist, fertility clinic: One man recently said, “What you guys have
here [referring to the explicit material] is boring.” “I’d never heard that
before,” I said, “If you want to bring in your own, you can.”

Male patient sent to a hospital for fertility tests: I had heard from friends
who had gone to fertility clinics that they had a collection of adult materi-
als to make the process as easy as possible. I assumed this would be the
case in the hospital where I went for fertility testing, but it wasn’t. They
just gave me a sample cup and told me to go to the bathroom – a sterile
bathroom right outside the doctor’s coffee lounge with fluorescent lights
and an industrial toilet. It was one of the worst masturbation experiences
of my life. Pornography would have been a God-send, believe me!

CLINICAL USE

Sex education is the guiding theme of the use of sexually explicit material in
a clinical practice. According to Kaplan (1979), it is important that a therapist
never assume that a patient is knowledgeable about human sexuality. In her
clinic, life-sized models of the male and female genitalia in various stages
of arousal were used. In 1999, in Hong Kong, at the World Association
of Sexology meeting, the collected professionals adopted a Declaration of
Sexual Rights. This Declaration included the right to sexual freedom, sexual
pleasure, sexual information, and sexual health care (Tiefer, 2001).
Lenore Tiefer, in her book Sex Is Not A Natural Act (1995), concluded
that women are in more danger from the repression of sexually explicit
 Positive Porn 141

material than from their free expression. She elaborated upon her belief
that the fundamental context of women’s sexuality in our time is ignorance
and shame, yet there is no tradition of sexual coaching of intercourse or
masturbation training or honest feedback to get questions answered. Another
harm to suppressing sexually explicit material is that it deprives people of
learning more about the human imagination. Tiefer (1995) concluded her
powerful essay “Some Harms to Women of Restrictions on Sexually Related
Expression” with the comment: “What always amazes me is people who
want to have exciting and gratifying sex but who think it comes ‘naturally’
without practice or knowledge.”
Because sex does not always come naturally, individuals and couples
may bring sexual concerns and dissatisfaction to psychotherapy. For a couple
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with discrepant desires, the suggestion of viewing online sites to increase un-
derstanding and normalcy of the behavior could also be beneficial (Newman,
1997). Clinically, therapists may encourage patients to explore their sexuality
in creative efforts (e.g., writing, painting, photography), which can then be
combined with Internet usage (Leiblum & Doring, 2002).
Seven clinicians (psychologists/sex therapists/sex offender treatment
counselors) were interviewed using the interview protocol in Table 3. These
seven clinicians use auditory and visual sexually explicit material in their
work. Each of the clinicians prescreened all of the material being used in
order to match the specific material to the needs of the individual or couple.
Some of the sex therapists indicate that they look for erotic/sexually explicit
material that shows respect and mutuality for all persons involved.

Psychologist/sex therapist: I use sexually explicit material to jump-start

arousal. For couples or singles, gay or straight, this is a useful method to
decrease shyness and increase arousal and desire. Certain erotic material
is very helpful to decrease shame.

Psychologist: I use sexually explicit films to help some persons develop

sexual fantasies. I’ve found this helpful with women who have been
particularly conservative or rigidly religious; those who have been anor-
gasmic.

Psychologist/sex therapist: Particularly in situations where one of the

partners is addicted, I try to help them find visual material that fits the
overlap between their two fantasy lives. When alone, they could use their
solitary fantasy material but, if using visual material together, they need
to find material that is exciting for both.

Psychologist/sex therapist: For women who have been sexually abused,

watching more loving, healthy explicit material gives them some models
of behavior that are achievable. This is helpful for their partners as well.
 142 M. A. Watson and R. D. Smith

Psychologist/sex therapist: I’ve never had any negative reactions to any

of these suggestions of the use of sexually explicit material. Many say
they have learned a great deal. Even though a few have been initially
taken aback at the suggestion of watching explicit material together, they
realize how helpful this material has been for them.

Clinical director of a sex offender program: We don’t tell them in advance

what they are going to be seeing. Our main goal is to teach tools to
decrease arousal to problematic stimuli and to increase healthy arousal
to appropriate stimuli. We teach them to write their own scenes—both
auditory and visual—that increase healthy arousal options.
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CONCLUSIONS AND FURTHER PROSPECTS

Well-intentioned anti-porn crusaders have lamented that pornography cor-

rupts its users, exploits and degrades women, and corrodes moral and reli-
gious standards. However, as is evident both from our review of the empiri-
cal literature and from the qualitative data provided by medical, educational,
and psychological professionals, sexually explicit material has many positive
uses. We would certainly not argue that all pornography is beneficial or even
harmless, but we would argue against those who conclude that all pornog-
raphy is patently dangerous, devoid of purpose, and destructive to society.
Because the impact of pornography on its users is complex—depending on
a host of variables which include the type of pornography, the amount of
exposure, and the characteristics of the viewer—future research should focus
on how these same variables affect outcomes related to the educational and
therapeutic uses of sexually explicit materials.

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