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

This study investigates problematic pornography use (PPU) within the framework of the newly established Compulsive Sexual Behavior Disorder in the ICD-11, aiming to fill gaps in understanding PPU beyond Western contexts and among women, gender-diverse, and sexually diverse individuals by validating the Problematic Pornography Consumption Scale (PPCS and PPCS-6) and Brief Pornography Screen (BPS), and assessing PPU risk across diverse groups. Utilizing data from the International Sex Survey (n = 82,243; mean age = 32.4 years, SD = 12.5) spanning 42 countries across five continents, the research confirms the robust psychometric properties of these tools—demonstrated by a confirmatory factor analysis (e.g., CFI = 0.985, TLI = 0.981, RMSEA = 0.060, 90% CI = 0.059-0.060) and strong inter-factor correlations (rs = 0.72-0.96)—and their associations with correlates like treatment-seeking. Results show 3.2% of participants are at risk of PPU based on PPCS, with men exhibiting the highest rates, significant country- and gender-based variations, but no differences by sexual orientation; notably, only 4-10% of those at risk sought treatment, while 21-37% desired it but faced barriers like cost. The study validates these measures across 26 languages, estimating PPU risk at 3.2-16.6% globally, varying by group and tool, highlighting the need for broader cultural and demographic consideration.