The Journal of Sex Research

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Religiosity, Perceived Effects of Pornography Use

on Personal Sex Life, and Moral Incongruence:
Insights from the German Health and Sexuality
Survey (GeSiD)

Aleksandar Štulhofer, Christian Wiessner, Goran Koletić, Laura Pietras &

Peer Briken

To cite this article: Aleksandar Štulhofer, Christian Wiessner, Goran Koletić, Laura Pietras & Peer
Briken (2021): Religiosity, Perceived Effects of Pornography Use on Personal Sex Life, and Moral
Incongruence: Insights from the German Health and Sexuality Survey (GeSiD), The Journal of Sex
Research, DOI: 10.1080/00224499.2021.1916422

To link to this article: https://doi.org/10.1080/00224499.2021.1916422

Published online: 04 May 2021.

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THE JOURNAL OF SEX RESEARCH
https://doi.org/10.1080/00224499.2021.1916422

Religiosity, Perceived Effects of Pornography Use on Personal Sex Life, and Moral
Incongruence: Insights from the German Health and Sexuality Survey (GeSiD)
a b a
Aleksandar Štulhofer , Christian Wiessner , Goran Koletić , Laura Pietrasc, and Peer Briken c

a
Department of Sociology, Faculty of Humanities and Social Sciences, University of Zagreb; bInstitute of Medical Biometry and Epidemiology,
University Medical Center Hamburg-Eppendorf; cInstitute for Sex Research, Sexual Medicine and Forensic Psychiatry, Center for Psychosocial
Medicine, University Medical Center Hamburg-Eppendorf

ABSTRACT
Although online pornography use appears to be a mainstream activity, there is little information,
particularly outside of the USA, about how consumers perceive its impact on their sexuality.
Considering increasing concerns about pornography use, this lack of evidence has sociocultural and
clinical ramifications – especially because the recently proposed Moral Incongruence model (MI) suggests
that some individuals may see their pornography use as problematic independently of the frequency of
use. Using data from 4,177 adults from the 2018–2019 national probability-based German Health and
Sexuality Survey, we explored self-perceived impact of pornography use on personal sex life and the role
of MI. Most participants (61.7%) reported no impact of pornography. Women were characterized by
significantly higher odds of reporting positive relative to no impact, while men had higher odds of
reporting mixed/negative compared to no impact. Participants in both the positive and the mixed impact
group reported a significantly higher frequency of pornography use than participants in the no impact
group. In line with the MI model, we observed a significant relationship between participants’ religious
upbringing and self-perceived negative (relative to mixed) impact of pornography use. Social relevance
and clinical implications of the findings are discussed.

Introduction
The prevailing perspective in scholarly literature on pornogra­
phy use is one of concerns, with most studies focusing on
potential harms and adverse outcomes (Fisher et al., 2019;
McKee, 2007). With online use of sexually explicit material
becoming a mainstream behavior among both adults and
young people (Grubbs et al., 2019; Kohut & Štulhofer, 2018;
Owens et al., 2012; Peter & Valkenburg, 2016), a narrative
about a pornography-induced public health crisis emerged,
with a potential to generate distress and self-labeling among
some consumers (Ley, 2018; Vaillancourt-Morel & Bergeron,
2019; Webber & Sullivan, 2018). Given the growing pornogra­
phy addiction treatment industry in the Western world, and
a lack of consensus about diagnosing and treating problematic
pornography use (Briken, 2020; Briken et al., 2007; Kraus et al.,
2016), a rise in the number of self-labeling cases could con­
tribute to a moral panic about pornography use. The current
study aimed to explore how congruent are perceptions about
the impact of pornography use on personal sex life with the
societal concerns.
For the diagnosis of Compulsive Sexual Behavior Disorder
(CSBD), which has been included recently into the 11th edition
of International Classification of Diseases and Related Health
Problems (Briken, 2020; World Health Organization, 2018),
risks for overpathologization of sexual behavior were explicitly
named and attempts were made to systematically exclude
them. Strong sexual interest or a high frequency of sexual
behavior is not sufficient for a diagnosis nor is distress that is
based on sexuality-hostile moral or religious reasons or ego-
dystonic experienced sexual behavior. Central to the diagnosis
is a persistent pattern of failure to control intense and repetitive
sexual impulses or urges, resulting in repetitive sexual behavior
accompanied by distress (Briken, 2020; Kraus et al., 2018).
Although it is commonly assumed that problematic pornogra­
phy use is a risk primarily for individuals characterized by
habitual high-frequency use, it has been recently proposed
that religious individuals may be especially vulnerable to dis­
tress and decreased psychological well-being associated with
personal pornography use (Grubbs, Kraus et al., 2019; Grubbs
et al., 2018; Perry, 2018b). Moral incongruence between inter­
nalized (religion based) beliefs and unacceptable behavior (use
of pornography) has been suggested as a conceptual model to
understand this individual-level vulnerability (Briken, 2020;
Grubbs, Perry et al., 2019).
To provide more insight about self-perceived effects of
pornography use and how they resonate with the narrative
about pornography as a public health hazard, the current
study addressed the prevalence of reported positive, mixed,
negative, and no impacts of pornography use on personal sex
life, as well as characteristics of adult women and men who
report different impact of their pornography use. Further, to
explore the utility of the moral incongruence concept, which
has been tested almost exclusively in North American samples,
we explored its role in reporting different types of self-

CONTACT Goran Koletić gkoletic@hotmail.com Department of Sociology, Faculty of Humanities and Social Sciences, University of Zagreb, I. Lučića, Zagreb
10000, Croatia
© 2021 The Society for the Scientific Study of Sexuality
2 A. ŠTULHOFER ET AL.

evaluated impact of pornography use using the data collected Such a conclusion seems supported by qualitative research,
in a large-scale population-based German sample. It should be particularly by a larger Canadian mixed-methods study that
noted that our study did not address problematic pornography found “no negative impact” to be the most common theme in
use, a clinical construct conceptualized, measured, and diag­ participants’ responses to open-ended survey questions (Kohut
nosed by experts (Bőthe et al., 2019; Kor et al., 2014; Kraus & et al., 2017). However, it should be noted that qualitative
Sweeney, 2019). Instead, we focused on laymen’s perceptions research in this area paints a more complex picture, perhaps
of how, if at all, pornography affects their sexuality. because it is based on developing adolescents’ and emerging
adults’ narratives (Harvey, 2020; Löfgren-Mårtenson &
Månsson, 2010; McCormack & Wignall, 2017).
Self-Perceived Impact of Pornography Use on Personal Sex
Life
Moral Incongruence as an Explanation for Perceiving
In one of the first systematic explorations of the self-perceived Personal Pornography Use as Problematic?
effects of pornography use on personal sex lives, Hald and
In a series of recent papers, Grubbs and colleagues proposed
Malamuth (2008) found little evidence of negative self-
and advanced a conceptual model focusing on a specific psy­
perceived effects in a national probability sample of young
chosocial mechanism, moral incongruence (MI), that underlies
Danes. Overall, they observed moderate positive effects,
self-perceived pornography addiction and problematic porno­
which were more prevalent among male than female
graphy use (Grubbs, Kraus et al., 2020; Grubbs, Lee et al., 2020;
participants.1 Importantly, the authors also noted a significant
Grubbs & Perry, 2018; Grubbs, Perry et al., 2019; Grubbs et al.,
and positive relationship between the frequency of pornogra­
2018). The authors described the mechanism through the
phy use and reported self-perceived positive, but not negative,
following set of propositions: (1) religiosity, which is reflected
effects (Hald & Malamuth, 2008). In discussing the findings,
in the internalization of religious norms and values, leads to (2)
the authors suggested that the gender difference is likely due to
moral disapproval of pornography. When a person uses por­
gender-specific evaluation of and interest in sexually explicit
nography in spite of his/her disapproval, which seems to be
material. They contrasted the finding that frequency of porno­
relatively common (Perry, 2017, 2018a; Perry & Whitehead,
graphy use was positively linked to self-perceived positive
2018), moral incongruence – the experience of incompatibility
effects of using pornography with an expectation, based on
between the person’s behavior and their highly regarded values
the desensitization model (Landripet et al., 2019; Seigfried-
and beliefs about such behavior – leads to self-blame and self-
Spellar & Rogers, 2013), that pornography use will escalate
perceived inability to control the behavior (hence, self-labeling
over time – leading to adverse outcomes. In conclusion, Hald
as “sexual addict”) (Grubbs, Perry et al., 2019). This conceptual
and Malamuth warned against the generalization of their find­
model helps to explain findings that more religious users of
ings across cultures, proposing that Danish culture may be
pornography are likely to report problematic pornography use
characterized by lower risks of sexual aggression compared
and self-proclaimed addictive pornography use at substantially
to, for example, the U.S.A. (Hald & Malamuth, 2008).
lower levels of pornography consumption than less religious
In more than a decade since the publication of the Hald and
participants (Grubbs & Perry, 2018; Grubbs et al., 2018).
Malamuth study, limited additional information about how
Similar dynamics were found for the association between por­
men and women evaluate their pornography use has been
nography use and reporting symptoms of depression (Perry,
made available, despite an increase in the availability of free
2018b).
online pornography and mainstream acceptance of pornogra­
The MI model has been criticized for prioritizing MI over
phy (Lykke & Cohen, 2015). Three studies that used full or
other factors and personal characteristics relevant for either
a brief version of the Pornography Consumption Effects Scale,
dysregulated or just self-stigmatized use of pornography, such
originally developed by Hald, consistently found that self-
as media narratives about pornography addiction, partner’s
percieved positive effects were more prevalent than negative
objections and associated relationship friction, a feminist per­
effects in convenience samples of men who have sex with men
spective on pornography industry and its products, etc. (Fisher
(Hald et al., 2013), heterosexual men (Miller et al., 2018), as
et al., 2019; Vaillancourt-Morel & Bergeron, 2019; Willoughby,
well as Canadian (Hesse & Pedersen, 2017) and Indonesian
2019). In addition, the conceptualization of MI is not comple­
university students (Wijaya Mulya & Hald, 2014). In another
tely clear on the distinction between subjective (i.e., the experi­
earlier study that was carried out in a large-scale non-
ence of MI) and objective factors (i.e., high frequency of
probability-based sample of Australians to explore self-
pornography use) (Grubbs, Kraus et al., 2019). While in an
perceived effects on pornography use on personal attitudes
earlier paper the authors seemed to believe that the frequency
toward sexuality, 35% of participants reported no impact,
of use was of secondary importance to MI (Grubbs & Perry,
59% of participants reported positive impact and only 7%
2018), in a later paper they seem to have adopted a less hier­
negative impact of pornography use (Mckee, 2007).
archical viewpoint, in which MI and highly frequent use of
In conclusion, the literature suggests that self-perceived
pornography are conceptualized as independent predictors of
impact of pornography use on personal sex life, when any is
problematic pornography use (Grubbs, Perry et al., 2019).
reported, is more often perceived as positive than negative.
However, meta-analytic findings reported in the later study
1 indicated that the association between MI and problematic use
It should be noted that the authors explored levels of positive relative to
negative impact. They did not assess the absolute prevalence of reporting (rz = .66) was substantially greater than the association between
positive, negative, and no impact of pornography use. the frequency of pornography use and problematic outcomes

(rz = .28), strengthening the theoretical emphasis on the role of
MI (Grubbs, Perry et al., 2019).
It should be stressed that most of the evidence in support of
the MI model has been collected in North American, primarily
U.S., samples (Grubbs & Perry, 2018; Grubbs, Perry et al., 2019).
This prompts a question about the extent to which the model
may be culture-specific (see Vaillancourt-Morel & Bergeron,
2019) or substantially more relevant for a society characterized
by high religiosity (including more fundamental branches of
Christianity) and rising moral panic related to pornography
use, not only among young people, as mirrored in an increasing
number of U.S. states declaring pornography a public health
crisis (Ley, 2018; McKay et al., 2021; Webber & Sullivan, 2018).
The scant evidence from other countries, mostly European, is
largely indirect – with the exception of a recent Polish study
(Lewczuk et al., 2020). More precisely, two earlier studies, also
based on a large-scale convenience sample as the Polish one,
reported significant associations between religiosity indicators,
on the one hand, and problematic sexual use of Internet (Ross
et al., 2012) and hypersexuality (Štulhofer et al., 2016), on the
other hand. Unlike the Lewczuk et al. study, the two studies (one
sampling Swedish and another Croatian adults) did not include
an indicator of moral disapproval of pornography. The Polish
study (Lewczuk et al., 2020), which directly explored the MI
model, found that moral disapproval of pornography and reli­
giosity predicted self-perceived addiction and problematic por­
nography use, respectively. In contrast to small effect sizes of
these links, the authors reported strong associations between the
frequency of pornography use and the two indicators of proble­
matic pornography use – reiterating the dilemma about the
contribution of high levels of pornography use to self-
perceived problematic pornography use independently of MI
(Bőthe et al., 2020; Štulhofer et al., 2016). Considering that
Poland is one of the most religious European societies (Luijkx
et al., 2016), systematic exploration of the MI model in less
religious societies is notably missing.
Study Aims
There were two main rationales for this study. First, considering
the scant literature on self-perceived impact of pornography use,
we wanted to provide information about how perceptions about
the self-perceived impact of pornography use on personal sex life
resonate with the emerging narrative on pornography as a public
health crisis risk. Second, the current study aimed to empirically
assess the validity of the MI conceptual model in a less religious
society compared to the U.S.A.,2 where most of the evidence in
support of the model has been collected (Grubbs, Perry et al.,
2019). This seems important, because it provides insights about
the model’s utility in different cultural settings – which has
scientific, but also clinical implications. Are faith-based moral
beliefs and values linked to self-perceived negative impact of
pornography use on person’s sexuality in a similar fashion, and
independently of the frequency of pornography use, in more
religious and less religious societies?
2
According to the World Values Survey data (see http://www.worldvaluessurvey.
org/WVSOnline.jsp).
THE JOURNAL OF SEX RESEARCH 3
Using a large-scale national probability-based sample of
German adults, we explored differences in self-perceived
impact of pornography use on personal sex life focusing on
the following two research questions:
RQ1 – Which characteristics differentiate participants who
reported positive and those who reported mixed or negative
self-perceived impact of pornography use on their sex life from
peers who reported no effects?
RQ2 – Does MI, as suggested by the recent literature, account
for some of these differences in the German context?
We believe that the phenomenon of self-perceived impact of
pornography use and the role of MI have both clinical and
social relevance (Grubbs, Perry, et al., 2019). Self-perceived
harm is distressing and, apart from reduction in psychological
well-being, may lead to adverse health outcomes – particularly
in an environment in which the narrative about harms of
pornography use is gaining mainstream traction. In such socio­
cultural climate, self-stigmatization among pornography users
may contribute to a more negative public view of sexuality and/
or a moral panic regarding pornography use. In exploring the
role of MI, the current study also has direct ramifications for
clinical management of individuals who report problematic use
of sexually explicit material (Briken, 2020; Grubbs et al., 2017;
Kraus et al., 2018).
Method
Participants and Data Collection
To test the research questions, we used data from the first
German national sex survey (GeSiD: German Health and
Sexuality Survey). The analytical sample for the current
study included 4,177 participants who reported any lifetime
pornography use (44.2% were women; 648 individuals
answered that they never used pornography). All partici­
pants were German-speaking residents, aged between 18
and 75 years (M = 45.6, SD = 15.2). The study used a two-
stage stratified register-based sampling, with 178 municipa­
lities (200 sampling points) selected in the first stage, and
a random proportional to size sample of residents per
sampling point selected in the second stage. Young adults
aged 18 to 35 years, the part of the population that is most
sexually active and most vulnerable to sexually transmitted
infections, were oversampled to enable more detailed
insights into sexual risk taking and the associated repro­
ductive and sexual health outcomes. The dataset was
weighted for age, gender, education, nationality, and region
to be broadly representative of the adult German popula­
tion (for a detailed description of the GeSiD study metho­
dology, see Matthiesen et al., 2018). Calculated according to
the 2016 guidelines of the American Association for Public
Opinion Research (AAPOR) adapted for use in the context
of German public opinion surveys (Stadtmüller et al., 2019),
the study response rate was 30.2%.
Fieldwork was carried out between October 2018 and
September 2019 by 257 trained interviewers employed by the
4 A. ŠTULHOFER ET AL.
Kantar GmbH social research institute. Prior to an inter­
viewer’s visit (interviewer’s biological sex was matched with
participant’s), all selected participants received a personal letter
with brief study information, an endorsement letter from the
German Federal Center for Health Education, and the research
team’s contact information. Written informed consent was
obtained from all participants; 30 EUR (about 34 USD) was
offered as a token of appreciation.
The questionnaire, which was extensively pretested in 2016/
2017 using a sample of 1,555 individuals (Matthiesen et al.,
2018), was a combination of computer assisted personal inter­
viewing (CAPI) and, for more sensitive questions (including
a module about pornography use), computer assisted self-
interviewing (CASI). During the CASI phase, the interviewer
stayed in the same room with the participant, but was
instructed to position themselves so that they could not see
what the participant was typing. The interviewers’ role was to
provide support, if needed. The questionnaire consisted of 260
questions, which were divided into 18 modules that focused on
different aspects of sexual health. On average, the interview
took about 51 minutes (median completion time was 48 min­
utes). All GeSiD study procedures were approved by the Ethical
Board of the State Psychotherapy Chamber in Hamburg.
Measures
Pornography Use
In the questionnaire, pornography was defined as: “When we
refer to ‘watching pornography’ (in this section) we refer to all
media depicting primarily erotic and sexual acts (texts, draw­
ings, photos, films, clips, streams, and online material); porno­
graphic images are used for sexual arousal.” Frequency of
pornography use in the past 12 months was measured on
a 5-point scale ranging from 1 = never to 5 = daily. Self-
perceived impact of pornography use was assessed by the
following question: “Did your consumption of pornography
have an impact on your sex life? Four choices were offered:
1 = no impact, 2 = a positive impact, 3 = both a positive and
negative impact, and 4 = a negative impact.
Sociodemographic Characteristics
Apart from age and gender, we also asked about education
(no completed school, primary, secondary, and tertiary edu­
cation), monthly household income (ranging from 1 = up to
200 EUR (≈ US$ 237) to 10 = 6,000 EUR (≈ US$ 7,101) or
more), urban vs. rural place of residence (living in
a settlement of up to 5,000 inhabitants), and current relation­
ship status (dichotomized into single and married or in
a relationship). In addition, the following question was used
to address sexual identity: “Please select the answer which
describes best how you see yourself at present?” Answers were
anchored on a 7-point scale. The first five points ranged from
1 = exclusively heterosexual to 5 = exclusively homosexual/gay,
while the final two points denoted asexual and other identi­
ties. Due to a small number of participants in all but the
exclusively heterosexual category, the indicator was dichoto­
mized into 0 = exclusively heterosexual identity and 1 = a
sexual minority identity.
Attitudes toward Sexuality
Liberal vs. non-liberal attitudes about sexuality were measured
with a single-item indicator (“Many people use terms ‘liberal’
and ‘conservative’ to describe their attitude toward sexuality
(. . .) to which group do you belong?”). A 7-point scale, ranging
from 1 = liberal (open-minded) to 7 = conservative (traditional),
was used to record responses.
Moral Issues with Pornography
Only participants who reported either mixed or negative self-
perceived impact on pornography use on their sex life were
asked a question about possible negative consequences of their
pornography use (“Has your pornography consumption ever
resulted in: (a) Relationship problems; (b) termination of
a relationship; (c) lack of sexual desire for your partner; (d)
problems at work or at school; (e) bad consciousness of a moral
or religious practice; and (f) none of the above?”) to which
participants were to respond with yes or no. Checking the item
“A bad consciousness of a moral or religious nature” indicated
a dissonance or moral incongruence between personal beliefs
or values and practice.
Religiosity Indicators
Apart from the standard public opinion measure of religiosity
(“How often do you practice your faith (visit service, pray,
comply with religious rules)?”), with four response categories
ranging from 1 = never to 4 = often,3 the survey also asked
about being raised religiously. The latter indicator was formu­
lated as: “I experience a strictly religious upbringing in my
childhood and youth”, with a corresponding scale ranging
from 1 = does not apply to me at all to 5 = totally applies to me.
Analytical Strategy
To explore the two research questions, multinomial logistic
regression was used to identify predictors and correlates of self-
perceived impact of pornography use, with the no impact
group serving as reference category. Taking into account the
complex sampling design used in the GESID study, the multi­
variate regression analysis was carried out with Stata’s 15 svy
command to adjust for stratification and clustering of the data,
as well as for post-hoc weighting (by sex, age, education,
nationality, and region) based on the 2016 census data. The
analysis was carried out sequentially. Sociodemographic char­
acteristics were included in the first step (model A), the fre­
quency of pornography use was added in the second step
(model B), and attitudes toward sexuality and religiosity indi­
cators were added in the final step (model C). Model fit indices
(log-likelihood, AIC, and BIC) were estimated using raw data
(i.e., without adjustment for data nestedness and weighting).
To assess possible differences between the mixed impact
and the negative impact group, we employed binomial logistic
regression analysis, with the larger group (mixed impact) ser­
ving as reference. Due to the negative impact group’s small size
(n = 87), the number of independent variables in this logistic
regression model was limited to seven. In addition to basic
3
Participants who had previously reported that they were not religious were
assigned “never” as their frequency of practicing faith.
 THE JOURNAL OF SEX RESEARCH 5

sociodemographic characteristics (gender, age, education, and Table 1. Sociodemographic characteristics of the sample (Only participants who
reported lifetime pornography use; n = 4,177).
sexual orientation), only the indicators that were consistently
associated with the outcome in the multinomial testing (fre­ % (unweighted n; weighted
n)
quency of pornography use and religious upbringing) were Age
included in this final analysis. To further explore the MI con­ 18–25 12.0 (652; 496)
ceptual model, the indicator of moral disapproval of porno­ 26–35 18.2 (966; 750)
36–45 17.3 (716; 713)
graphy use – for which only participants who reported negative 46–55 22.8 (752; 940)
or mixed impact of pornography use provided information – 56–65 18.1 (698; 746)
was also added to the analysis. 66–75 11.5 (393; 473)
Gender
Less than 6% of participants who reported any lifetime Male 55.8 (2,174; 2,296)
pornography use did not answer the question about the self- Female 44.2 (2,003; 1,822)
perceived impact of pornography use on their sex life. There In a relationship/married
Yes 76.4 (3,206; 3,146)
was less than two percent of missing information about the No 23.6 (971; 973)
frequency of pornography use in the past 12 months and <0.5% Residence
of missing responses to the question about religious upbring­ Rural (up to 5,000 inhabitants) 14.2 (582; 586)
Urban 85.8 (3,595; 3,532)
ing. Similarly rare was missing information regarding the fre­ Education
quency of attending religious ceremonies (<1.5%). No completed formal education 1.5 (40; 63)
Primary education 27.8 (727; 1,137)
Secondary education 50.9 (2,372; 2,082)
Results Tertiary education 19.7 (1,005; 806)
Income
Basic sociodemographic characteristics, including the frequency Less than 1,299 EUR (≈ US$ 1,542) 13.1 (477; 505)
1,300 to 2,599 EUR (≈ US$ 1,543–3,084) 33.3 (1,208; 1,278)
of pornography use in the past 12 months, of the current study’s 2,600 to 4,499 EUR (≈ US$ 3,086–5,339) 35.9 (1,460; 1,377)
sample are presented in Table 1. A great majority of participants 4,500 EUR or more (≈ US$ 5,341) 17.7 (749; 681)
reported no impact of pornography use on their sex life (61.7%). Sexual identity
Exclusively heterosexual 88.1 (3,528; 3,534)
Of the rest, most noted a positive impact of using pornography Sexual minority 11.9 (562; 478)
(24.9%). Mixed impact was reported by 11.1% and a negative Religious practice
impact by 2.5% of participants (n = 87). In the negative impact Never 46.8 (1,962; 1,910)
Seldom 24.0 (1,007; 980)
group, 57.5% of individuals were men (n = 50). Sometimes 16.1 (671; 658)
Often 13.0 (502; 530)
Religious upbringing
RQ1 – Differences between Participants Who Reported No 1 (Does not apply to me at all) 45.3 (1,974; 1,864)
2 14.7 (645; 604)
Impact and Those Who Reported Positive and Mixed/ 3 18.1 (737; 746)
Negative Impact of Pornography Use, Respectively 4 11.4 (438; 469)
5 (Completely applies to me) 10.4 (377; 429)
The findings of sequential multinomial logistic regression ana­ Frequency of pornography use (past
lysis are shown in Table 2. With only sociodemographic indi­ 12 months)
Never 38.7 (1,476; 1,556)
cators included (see Model A), the odds of reporting a positive Up to several times a year 31.6 (1,315; 1,271)
impact compared to reporting no impact were increased by Up to several times in a month 17.8 (766; 716)
a sexual minority identity (AOR = 1.77, p < .001) and decreased Several times a week 10.4 (467; 419)
Daily 1.5 (70; 59)
by age (AOR = 0.99, p < .001). In the case of mixed/negative
Note. Numbers do not always add up due to missing information. Percentages are
impact, the odds of belonging to this group were also increased based on weighted analyses.
by reporting a sexual minority identity (AOR = 2.73, p < .001)
and decreased by age (AOR = 0.96, p < .001), female gender
(AOR = 0.29, p < .001), and being married or in a relationship pornography use was controlled for, suggesting gender-
(AOR = 0.63, p = .006). The odds of reporting mixed/negative specific perceptions of the impact among individuals with
impact of pornography use on personal sex life, compared to more frequent pornography use. This interaction effect (fre­
reporting no effects, were over 70% lower among female than quency of pornography use was mean centered before building
male participants. We also observed a role of education, with the interaction term) was confirmed in the case of positive
completed tertiary education – when compared to completed (AOR = 1.63, p < .001), but not negative impact of pornography
secondary education – increasing the odds of reporting mixed/ use (AOR = 0.82, p = .277) (not shown in tables). An inspection
negative impact (AOR = 1.69, p = 001). of the non-parametric interaction effect indicated that the odds
Adding the frequency of pornography use (Model B) some­ of reporting positive, relative to neutral, impact of pornogra­
what affected the previously reported findings. After this inclu­ phy use on personal sex life were substantially higher among
sion, age and sexual identity ceased to significantly predict more frequent female pornography users than among more
reporting positive and mixed/negative impact of pornography frequent male pornography users. We observed no differences
use, respectively. In addition, female participants were charac­ in the odds between male and female participants characterized
terized by significantly higher odds of belonging to the positive by less frequent pornography use.
impact group than male participants (AOR = 1.62, p < .001). With practically identical effect size, frequency of pornogra­
The difference became significant once the frequency of phy use increased the odds of reporting both positive
6 A. ŠTULHOFER ET AL.

Table 2. Predictors and correlates of self-perceived impact of pornography use on personal sexual life (Reference category = no impact).
Positive impact Mixed or negative impact
Model A AOR 95% CI AOR 95% CI
Age 0.99*** 0.98–0.99 0.96*** 0.96–0.97
Female gender 0.84 0.70–1.01 0.29*** 0.22–0.38
In a relationship/married 1.19 0.92–1.53 0.63** 0.46–0.87
Sexual minority 1.77*** 1.36–2.31 2.73*** 2.07–3.59
Education (reference = secondary education)
No completed school 1.09 0.43–2.80 0.20 0.03–1.38
Primary education 0.84 0.65–1.09 0.64* 0.42–0.98
Tertiary education 1.05 0.83–1.32 1.69** 1.24–2.30
Income 1.02 0.97–1.07 0.99 0.94–1.05
Urban place of residence 0.93 0.73–1.20 1.39 0.88–2.19
Observations = 3,565; Log likelihood = −3086.78, AIC = 6213.55, BIC = 6337.13; pseudo R2 = .056
Model B AOR 95% CI AOR 95% CI
Age 1.00 0.99–1.00 0.98*** 0.97–0.98
Female gender 1.62*** 1.28–2.06 0.57*** 0.43–0.76
In a relationship/married 1.36* 1.06–1.76 0.75 0.53–1.06
Sexual minority 1.48** 1.11–1.97 2.27*** 1.68–3.08
Education (reference = secondary education)
No completed school 1.48 0.46–4.81 0.29 0.04–2.07
Primary education 0.99 0.75–1.30 0.76 0.50–1.16
Tertiary education 1.04 0.82–1.32 1.65** 1.19–2.28
Income 1.01 0.96–1.05 0.99 0.93–1.05
Urban place of residence 0.92 0.73–1.16 1.46 0.97–2.31
Frequency of pornography use 1.92*** 1.69–2.17 1.94*** 1.69–2.23
Observations = 3,505; Log likelihood = −2912.32, AIC = 5868.65, BIC = 6004.26; pseudo R2 = .096
Model C AOR 95% CI AOR 95% CI
Age 1.00 0.99–1.00 0.98*** 0.97–0.98
Female gender 1.58*** 1.25–2.00 0.58*** 0.44–0.78
In a relationship/married 1.40* 1.08–1.81 0.73 0.52–1.03
Sexual minority 1.41* 1.05–1.89 2.36*** 1.74–3.20
Education (reference = secondary education)
No completed school 1.69 0.52–5.46 0.27 0.04–1.90
Primary education 1.01 0.77–1.34 0.74 0.48–1.13
Tertiary education 1.03 0.80–1.32 1.65** 1.18–2.30
Income 1.01 0.96–1.06 0.99 0.93–1.06
Urban place of residence 0.96 0.77–1.21 1.44 0.93–2.24
Frequency of pornography use 1.86*** 1.64–2.11 1.96*** 1.69–2.28
Liberal/conservative sex attitudes 0.93 0.87–1.00 1.05 0.97–1.14
Religious upbringing 0.96 0.89–1.03 1.15** 1.05–1.25
Religious practice (reference = never)
Rarely 1.01 0.79–1.29 0.73* 0.54–0.99
Sometimes 0.97 0.73–1.30 0.79 0.57–1.09
Often 1.00 0.69–1.44 0.66 0.42–1.03
Observations = 3,461; Log likelihood = −2862.35, AIC = 5788.69, BIC = 5985.47; pseudo R2 = .100
Note. CI = confidence interval around adjusted odds ratio (AOR); * p < .05, ** p < .01, *** p < .001.

(AOR = 1.92, p < .001) and mixed/negative impact effects. As presented in Table 3, the odds of belonging to the
(AOR = 1.94, p < .001) in comparison to no effects. The latter group were substantially increased by both religious
addition of sex attitudes and religiosity indicators (Model C) upbringing (AOR = 1.30, p = .031) and moral issues with
did not change the pattern of observed predictors and corre­ pornography (AOR = 2.11, p = .025). It should also be noted
lates. Religious upbringing significantly increased the odds that the frequency of pornography use significantly decreased
(AOR = 1.15, p = .003) of belonging to the mixed/negative the odds (AOR = 0.48, p < .001) of reporting negative, in
group. Fit indices associated with the three multinomial regres­
sion analyses indicated a continuous improvement in model fit,
pointing to the explanatory importance of the frequency of Table 3. Predictors and correlates of self-perceived negative impact of pornogra­
pornography use and religious upbringing. phy use on personal sexual life (Reference category = mixed impact; n = 507).
AOR 95% CI
Age 1.01 0.99–1.04
RQ2 – the Role of MI Female gender 0.88 0.42–1.87
Sexual minority 1.28 0.60–2.70
The significant role of religious upbringing in explaining dif­ College/university education 0.57 0.30–1.07
ferences in reporting the impact of pornography use on perso­ Frequency of pornography use 0.48*** 0.36-.65
Moral issues with pornography 2.11* 1.17–3.83
nal life provided some support for the MI. Additional evidence Religious upbringing 1.30* 1.03–1.64
was observed in the analysis that directly compared partici­ Note. CI = confidence interval around adjusted odds ratio (AOR); * p < .05, **
pants who reported mixed and those who reported negative p < .01, *** p < .001.

contrast to mixed impact of pornography use on personal sex
life.
Discussion
The current study aimed to address the issue of self-perceived
impact of pornography use on personal sex life in a large-scale
national study of health and sexuality in Germany. Attempting
to understand characteristics underlying different evaluations,
we focused on the theoretical model of MI that links religious
values and beliefs to a negative evaluation of personal porno­
graphy use. Considering that this association has predomi­
nantly been explored in studies carried out in the U.S.A.
(Grubbs & Perry, 2018; Grubbs, Perry et al., 2019), we revisited
the relation using data from an overall less religious and more
sexually permissive European society. The findings of our
multivariable regression analyses can be summarized in the
following points. First, we found consistent evidence of the
role of MI in reporting negative impact of pornography use on
personal sex life. Second, compared to participants who
reported no impact of pornography use on personal sex life,
women were characterized by substantially higher odds of
reporting positive impact, while men had higher odds of
reporting mixed and negative impact. Third, sexual minority
identity was substantially linked to both positive and mixed/
negative impact. Fourth, the frequency of pornography use
distinguished those who reported positive impact from the no
impact group in the same way that it distinguished between
participants characterized by mixed/negative impact and those
who reported no impact. Fifth, we observed a robust and
negative role of college/university education in reporting
mixed/negative impact. Finally, lower (not higher) frequency
of pornography use, moral issues with pornography, and reli­
gious upbringing were linked to perceiving pornography hav­
ing a negative effect on personal sex life, compared to mixed
impact of pornography use. This central finding, which we later
discuss in more detail, may appear counter-intuitive: indivi­
duals who linked their pornography use to adverse sexual out­
comes reported substantially less frequent use than participants
who reported a positive role of pornography. However, the
finding is in line with the findings that the majority of users
do not find their pornography use harmful (Hald & Malamuth,
2008) and that in some cases it may contribute to higher
personal (Štulhofer et al., 2010) and dyadic sexual satisfaction
(Vaillancourt-Morel et al., 2019), as well as with the recently
proposed MI model (Grubbs, Perry et al., 2019).
Similarly to what was reported in a number of studies
carried out in the North American context (Grubbs et al.,
2014; Grubbs & Perry, 2018; Grubbs, Perry et al., 2019;
Grubbs et al., 2018), MI also had a significant role in our
national sample from Germany – a country characterized by
relatively low religiosity levels. Although we did not directly
assess MI (i.e., the GeSiD questionnaire did not include an
operationalization of this psychosocial mechanism), the cur­
rent study suggests a novel analytical contribution to the con­
ceptual model, which will require further assessment to
confirm (or refute). Our findings confirm the notion that
religiosity, broadly speaking, increases the risk of reporting
(self-perceived) negative effects of pornography use on
THE JOURNAL OF SEX RESEARCH 7
personal sex life (Grubbs & Perry, 2018; Grubbs, Perry et al.,
2019). However, they distinguish between current religiosity
levels, as indicated by the frequency of attending religious
ceremonies, and religious upbringing or growing up sur­
rounded by faith- and religion-based values and beliefs. We
would argue that the latter is likely to affect a person’s moral
perspective considerably stronger than reasons underlying the
person’s current religious attendance – which may reflect social
conformism, the importance of maintaining personal network
ties, and/or the need for social support. Acknowledging that
the evidence we obtained is only suggestive of the proposed
primacy of the exposure to religious moral notions and beliefs
during childhood and, likely, early adolescence, as well as
potentially culture-specific, we nonetheless find the insight
important for working with individuals experiencing poten­
tially negative effects of pornography use on their sexual life. It
is our hope that this proposition will be further tested in the
future.
The substantial gender difference found in the current
study – compared to male participants, women were charac­
terized by substantially higher odds of reporting positive and
lower odds of reporting mixed/negative impact, relative to no
impact – is at odds with the results of the 2008 Danish study.
Hald and Malamuth (2008) found reports of positive self-
perceived effects of pornography use on personal sex life
more prevalent among male, compared to female, participants.
In contrast, in the Indonesian study, female students reported
a larger difference between positive and negative self-perceived
effects than their male peers (Wijaya Mulya & Hald, 2014).
Taking into account that the gender difference in the current
study was observed with the frequency of pornography use
controlled for, one possible explanation would be the media
accounts about addiction to pornography and pornography-
induced sexual dysfunctions, which have been almost invari­
ably focused on men. It has been suggested that such dramatic
narratives can influence some men to self-label as pornography
addicts (Cantor et al., 2013; Ley et al., 2014), as well as influence
the views of mental health professionals (Klein et al., 2019).
We also observed that a sexual minority identity, in
comparison to exclusively heterosexual identity, was linked
to both positive and mixed/negative impact, relative to no
impact of pornography use on personal sex life. In the
present study, larger effect sizes were associated with report­
ing mixed/negative impact, which is at odds with the Hald
et al. (2013) findings that only 3% of MSM in a large-scale
North American survey reported any negative effects. Self-
perceived positive effects are likely linked to the educational
and identity-supporting role of pornography, as indicated in
recent qualitative studies (Harvey, 2020; Nelson et al., 2014).
The reporting of mixed and negative impact points to
a diversity of experiences with pornography among sexual
minority individuals, with some of them likely affected by
unrealistic expectations promoted by pornographic material
(Harvey, 2020) or by genital and body appearance compar­
isons with actors (Whitfield et al., 2018) that generally seem
to affect men more than women (Cranney, 2015).
In line with previous findings (Hald & Malamuth, 2008;
Kvalem et al., 2014), the frequency of pornography use was
higher in participants who reported positive impact than those
8 A. ŠTULHOFER ET AL.
who reported no impact of their pornography use.
Interestingly, the same was observed for those who reported
a mixed/negative impact, relative to no impact. The novel
insight provided by the current study is that the frequency of
pornography use was higher among men and women who
reported mixed (i.e., both positive and negative) impact than
in participants who reported negative impact. Considering that
it does not align with what should be expected based on the
pornography as a public health hazard thesis, the observation
has policy ramifications (Nelson & Rothman, 2020). However,
potential implications of the finding need to be weighed against
the fact that we did not assess specific content of pornographic
material used, which may constitute an additional difference
between some of the groups explored in the current study.
Finally, we should also note that tertiary education was
consistently related to increased odds of reporting mixed/nega­
tive impact of pornography use on personal sex life, relative to
no impact. Considering that the current study did not include
any indicators that can assist in pinpointing a mechanism
underlying this relationship, at this point we can only speculate
that the association reflects a higher likelihood of encountering
narratives about problematic use of pornography, pornography
addiction, and sexual health problems allegedly related to the
consumption of sexually explicit material. It may also be that
more educated people are more easily disturbed, compared to
their less educated peers, by sexually explicit material depicting
sexual acts they find aggressive or degrading – regardless of
whether they encountered it unintentionally or were searching
for it. Future studies, particularly qualitative ones, should
address these plausible mechanisms.
Overall, what can be concluded about self-perceived effects
of pornography use on sex life and as the role of MI as the basis
of existing cross-cultural evidence? Across post-industrial
Western societies, there is consistent quantitative and qualita­
tive evidence that most people perceive their pornography use
as having no negative effects on personal sex life (Hald &
Malamuth, 2008; Miller et al., 2018; Löfgren-Mårtenson &
Månsson, 2010; McKee, 2007). What is less clear is whether
they believe that their pornography use has no effect or
a positive effect. In contrast, the finding that only a small
minority of participants report negative effects of pornography
is consistent in the literature. A similar finding was reported in
a non-Western country, but the study included only college
students, who are likely the least conservative segment of the
national population (Wijaya Mulya & Hald, 2014). The intent
to which such findings, as noted by Hald and Malamuth
(2008), may be biased by an ingrained optimism or the ten­
dency to describe personal happenings in more positive terms
than (objectively) deserved, remains unknown. Taking into
account that the majority of participants in the current study
reported no impact, this bias appears to be of limited concern
here.
In the case of MI, the evidence collected in the U.S.A.,
Poland, and Germany supports the conceptual model in
which personal faith and religiosity contribute to self-
perceived negative effects of pornography use independently
from or even contrary to frequent use of sexually explicit
material. Although a direct comparison of effect sizes is not
feasible due to differences in sampling strategy, basic
participant characteristics, the key indicators, and analytical
approaches, all three studies observed the effect of MI4 –
regardless of the fact that the U.S.A. and Poland are highly
religious countries, unlike Germany. A task for future studies is
to enable comparative assessments of the links between MI, on
the one hand, and faith and religiosity intensity levels, different
types of faith- and religion-based beliefs, and specific religious
denominations, on the other hand. Such evidence might be of
substantial use in clinical settings.
Clinical Implications
The results of our study also indicate that MI is an important
concept both for clinical assessment, as well as for counseling
and therapy. Keeping in mind that we did not address proble­
matic, compulsive, or dysregulated pornography use, possible
distress linked to self-evaluation of pornography use and its
perceived impact on personal sex life should be clinically
approached in a differentiated way. If the experience of distress
is mainly caused by an anti-sexual or, more specifically, an
anti-pornography moral attitude, compulsive sexual behavior
disorder should not be diagnosed. In such cases, sex-positive
counseling with the aim of reducing MI should be offered.
What is interesting and new about our study is that MI appears
to be better predicted by religious upbringing and deeply
rooted religious attitudes and beliefs (which may or may not
be very explicit) than by current religious practice. Thus, it may
make sense to focus on such attitudes in psychotherapy, but
not in the context of sexual addiction or dysregulated sexuality
interventions. It should also be noted that some therapeutic
approaches, either individual- or couple-focused, might even
increase MI by reinforcing moralistic, sex-negative attitudes.
Instead, a sex-positive approach focused on resolving interna­
lized sociocultural conflicts (Coleman et al., 2018), which uti­
lizes techniques that bring balance between sexual inhibition
and excitation and assists in improving the client’s understand­
ing of his/her sexuality, is more promising (Briken, 2020).
Study Limitations and Strengths
Although pornography use can affect both personal and rela­
tional (dyadic) sex life, the current study focused exclusively on
a particular aspect of the former phenomenon. In addition to
standard limitations related to the use of self-reported mea­
sures, which is unavoidable in research on sensitive topics such
as sexual behavior, our outcome was operationalized as
a single-item indicator. This precluded an analysis of its metric
characteristics. However, the indicator, which was also used in
a recent Norwegian sexuality and health national study
(Koletić, et al., 2021), appears to have solid face validity.
Although Hald proposed a more complex operationalization
of self-perceived effects of personal pornography use (i.e., the
Pornography Consumption Effects Scale; Miller et al., 2019;
Hald & Malamuth, 2008; Hald et al., 2013), their approach is
not feasible for large-scale national sex studies, which require
relatively brief measures to enable the assessment of a wide
range of topics of interest. Similarly, following Grubbs, Kraus
4
The term “effect” does not refer to any causal relationship.

et al. (2019), we used a single-item indicator of the use of
pornography being morally reprehensible to the user. To
reduce this limitation, we also assessed MI indirectly by explor­
ing links between a single-item religiosity measure (i.e., the
frequency of attending religious ceremonies) and a single-item
measure of religious family socialization, on the one hand, and
self-perceived problems associated with one’s pornography
use, on the other hand. To the best of our knowledge, no
validated multi-item measure of MI has been introduced in
the literature – which should be prioritized in future research
in this area. Finally, the fact that we did not assess preferred
pornographic content (i.e, “genre”; (Hald et al., 2018),
a possible confounder of identified differences between mixed
and negative impact groups, is a limitation to be avoided in
future studies.
Among the current study’s strengths, such as probability-
based sampling, design-adjusted statistical analysis, and statis­
tical power, we should also underscore the use of multiple
indicators of religiosity. Each of these indicators tapped into
a different facet (upbringing, current practice, and moral eva­
luation) of the construct.
Conclusions
In this large-scale national probability-based sample of adult
Germans we addressed self-perceived impact of pornography
use on personal sex life and the role of MI – the concept that
was recently proposed to explain why some individuals, mostly
men, report problematic pornography use and adverse mental
health outcomes despite relatively moderate levels of pornogra­
phy use. Two key findings, which may be specific to the more
sexually permissive and less religious European context, were
obtained. First, the majority of surveyed participants reported
that pornography did not impact their sex life. Second, we
observed a significant relationship between religious upbringing
and self-perceived negative impact of pornography use, as pre­
dicted by the MI conceptual model. Both findings are relevant
for sexuality and relationship therapy.
Funding
The study was funded by the German Federal Centre for Health Education
[Grant numbers: Z2/25.5.2.1/18; Z2/25.5.2.1/20].
ORCID
Aleksandar Štulhofer http://orcid.org/0000-0001-5138-3644
Christian Wiessner http://orcid.org/0000-0001-7943-9881
Goran Koletić http://orcid.org/0000-0003-0976-1685
Peer Briken http://orcid.org/0000-0002-1360-014X
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