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The porn debate: How tube sites rewire arousal and intimacy

A urologist, an addiction psychiatrist, and an ethical porn director clash; how dopamine-driven tube sites reshape arousal, erectile health, and couples.

Steven BartletthostErika LustguestDr. Kay (psychiatrist, addiction specialist)guestGuestguest
Oct 21, 20242h 25mWatch on YouTube ↗

EVERY SPOKEN WORD

  1. 0:00 – 2:31

    Intro

    1. SB

      This has never happened before. Today, we have three experts in their field with three different opinions, debating the subject of porn. This is the first time I've gone on PornHub at work. (laughing)

    2. NA

      (laughing) In one corner, we have Dr. Rena Malik, the sex scientist helping millions of couples enhance their sex lives.

    3. SB

      In the other corner, we have Dr. Kay. The psychiatrist specializing in helping people with addictions to pornography and more.

    4. NA

      Who is up against Erica Lust, who runs a large pornographic production company (bell belling) .

    5. SB

      No one can sit on the fence here. Is porn a benefit to people and society?

    6. EL

      Definitely, and especially for people who haven't really had that right to pleasure, to understand their sexuality.

    7. KS

      But I think what we're clearly seeing is a trend of it being damaging. Let me just share with y'all what I'm afraid of. It is doing way more to the brain than we ever realized. So the first thing that we know is that-

    8. RM

      But, there's data to suggest that couples that use pornography together have better sexual encounters and women who use pornography have better sexual satisfaction rates.

    9. EL

      And remember that women's sexuality has been so much about pleasing others, and you see it with the orgasm gap.

    10. RM

      But my devil's advocate would say that there is a significant number of women interested in looking a certain way that they're often seeing on pornography. That's harmful.

    11. EL

      I'm a bit suspicious about this because honestly, that statement is from 10 years ago.

    12. KS

      There's also unrealistic expectations about performance, that creates shame.

    13. RM

      And small penis anxiety is a real thing, and it's often from watching pornography.

    14. EL

      The real problem is we are not giving sex education to our young people. They are lost.

    15. KS

      But, it doesn't have to be an addiction. It's the way that you relate to it.

    16. RM

      It is something that people can control.

    17. EL

      And parents can learn how to have these conversations with their kids.

    18. KS

      And there are a couple of really nice techniques that you can use. The first is that-

    19. SB

      This has always blown my mind a little bit. 53% of you that listen to this show regularly haven't yet subscribed to this show. So could I ask you for a favor before we start? If you like the show and you like what we do here and you wanna support us, the free simple way that you can do just that is by hitting the subscribe button. And my commitment to you is, if you do that, then I'll do everything in my power, me and my team, to make sure that this show is better for you every single week. We'll listen to your feedback, we'll find the guests that you want me to speak to, and we'll continue to do what we do. Thank you so much.

  2. 2:31 – 3:59

    Dr Rina's Intro

    1. SB

      Let's start with introductions. Dr. Rena, who are you and what do you do?

    2. RM

      So I'm a urologist, which is essentially a medical and surgical doctor of the genitourinary tract. But I see myself more as a digital opinion leader in the space of sexual health and urologic health. So someone who can talk to and speak about complex concepts in addition to sexual health, in a way that people can understand.

    3. SB

      Can you give me sort of, uh, a view of the variety of things that you've worked on in your career, the types of patients you've worked with, and the subject matter broadly that you've addressed and are confronted with in your line of work?

    4. RM

      Absolutely. So, as a urologist, we're trained to treat anything in those areas of the genitourinary tract. So that can be kidney cancer, prostate cancer, bladder cancer, sexual health, erectile dysfunction, female sexual dysfunction, kidney stones, ch- uh, children's issues. But then, when, uh, I did a fellowship in what's called female pelvic medicine and reconstructive surgery, or urogynecology. So I initially trained in dealing with voiding dysfunction, um, and problems with bladder leakage, overactive bladder, prolapse, those sorts of things, and subsequently expanded my practice into sexual medicine. So I take care of patients with issues with erectile dysfunction, arousal, or disorders, ejaculatory dysfunction, um, libido issues, uh, lubrication issues, a whole bunch of different areas of issues that people deal with when it comes to

  3. 3:59 – 4:55

    Dr K's Intro

    1. RM

      sexual health.

    2. SB

      Dr. Kay, same question to you.

    3. KS

      Sure. So I'm a psychiatrist by training, but I had kind of a roundabout way to get there. So, uh, I failed out of college due to video game addiction, and then went to India to find myself, studied, uh, to become a monk for about seven years, and then wound up going to medical school, becoming a psychiatrist, and now the majority of the work that I do is actually, like, focused on the internet. So what I noticed when I was training was that if you look at, like, academic psychiatry or psychiatry, we focus on things like depression or bipolar disorder or anxiety. But I saw that there was a whole lot of evolving mental health problems for the digital generation. Video game addiction, pornography addiction. And I noticed that most of the psychiatrists weren't focused on those, that we kind of had an opioid e- epidemic that's still going on, a lot of problems with alcohol and marijuana, but there are all these digital addictions that are emerging, and those are the people that I work with now.

  4. 4:55 – 6:04

    Erika's Intro

    1. KS

    2. SB

      Erica?

    3. EL

      Yeah.

    4. SB

      Who are you and what do you do?

    5. EL

      I'm... (laughs) Okay. I'm Erica. I'm independent adult filmmaker. I'm an entrepreneur. I made my first short film, explicit short film, 20 years ago, and then I developed a career in this space of indie adult cinema.

    6. SB

      And are you a director-

    7. EL

      Yes.

    8. SB

      ... of adult films?

    9. EL

      Yeah. I direct films, I produce films, I also run the company.

    10. SB

      To set the stage on where we are with pornography, I found some statistics which I thought were quite pertinent to the discussion which is, the first statistic is that 30% of all internet traffic roughly is related to pornography, 35% of all internet downloads are pornographic in nature, 79% of young men view pornography monthly, 64% of young adults actively seek out pornography weekly or more often, one in five mobile searches are for pornographic content.58% of men and 38% of women watch porn at work. And pornography websites receive more traffic than Netflix, Amazon, and Twitter combined.

  5. 6:04 – 10:53

    Does Porn Benefit Society?

    1. SB

      Uh, interestingly, I found another statistic which said that pornography in Poland has increased 310% between 2004, which I guess is when you got into the business, and 2016. Some other sort of potentially adjacent trends which I thought were interesting were that the percentage of men aged 18 to 24 reporting no sexual activity in the past year increased from 18.9% in 2000 to over 30% in 2016, and similar increases in sexual activity are seen in men and women. Um, similar decreases in sexual activity have been seen in men and women. Among high school students, the percentage who have never had sexual intercourse increased from 45% in '91 to 70% in '21. And finally, the average age of first exposure to pornography is now just 11 years old and 64% of young people report t- that they came across pornography by accident. So, I guess my first, um, point of discussion that I wanted to raise is, is pornography a benefit to people and society? And I realize that this question is intentionally short and narrow. But that's the basis of the-

    2. EL

      Mm-hmm.

    3. SB

      ... first conversation and I wanna start with you, Erika.

    4. EL

      Mm-hmm.

    5. SB

      Is porn-

    6. EL

      It-

    7. SB

      ... a benefit to people in society?

    8. EL

      It can be. It can be, definitely. And especially to the others who haven't really had that right to pleasure, to desire, to their sexuality. Remember that women's sexuality especially has been so much about pleasing others. I think that it can help women to find, you know, their own desire, to understand their sexuality, to see others, what they like, what they are doing, and to turn their liberty on, libido on, which is obviously one of the things that so many women are struggling with.

    9. SB

      Let's go anti-clockwise. Dr. K? I'll repeat the statement. Is porn a benefit to people in society?

    10. KS

      The way that porn is being produced and consumed is starting to cause way more harm than good. I mean the, the, the, uh, statistics that you really just machine gunned out, right? Like, it's like one thing after another thing after another thing of things that are, you know, very scary. Like, each statement that both y'all made I could think about a specific person that I've worked with-

    11. EL

      Mm-hmm.

    12. KS

      ... where it's like, yeah, I've seen that problem, I've seen that problem.

    13. EL

      Mm-hmm.

    14. KS

      Um, you know, early exposure. So when you get exposed to pornography before puberty, so everyone thinks that pornography is about, you know, like sexual lust and, and this kind of stuff, and I think in a, in a good way it can be, but what I've seen a lot of-

    15. EL

      For adults.

    16. KS

      For adults.

    17. EL

      Adults.

    18. KS

      Is that children are getting exposed, and I've seen like a very scary correlation between early exposure to pornography, like seven, eight, nine years old, right? So y- I think y- your statistic was the average is 11.

    19. SB

      Yeah.

    20. KS

      That's average, which means that there are people that are higher and people that are lower. And when something, I don't know what exactly, but when we get exposed to pornography very early, it makes some kind of alteration in our brain that makes us way more likely to addictions, not only pornography but other things. So I think that there, you know, sexuality is a healthy part of human existence, um, a lot of the current research suggests that masturbation is also like relatively speaking not unhealthy, it's somewhat healthy, and so pornography can be a part of that. I think especially listening to Erika in how pornography can be used to elevate horizons, increase awareness, um, there can be benefits, but I think what we're clearly seeing is a trend of it being damaging.

    21. RM

      So I would say that I agree with Erika completely. I think there's actually some data to suggest that women who use pornography have better sexual satisfaction rates, have more frequency of sexual encounters because they're learning about their bodies. I mean, we can't know exactly why that is, but we know there is a correlation in that specific way, and so when people are using pornography for sexual curiosity, um, for pleasure, um, they're generally showing good, uh, uh, for, for the most part without any signs of addiction or, or concerns of compulsion in use of pornography, they're using it in, in a good way and they're having better sex because of it. Now in terms of using it as a couple, there's also really strong correlations that couples that use pornography together have better sexual encounters and better sexual satisfaction. So I think there's a lot of ways that pornography is used in a positive way, and not to undermine that there are people who struggle with it, absolutely, but I think yes, there are some benefits. It allows people to experience fantasies, to see different types of sexual cultures as Erika mentioned, and I think that, that, that is an important side of pornography-

    22. EL

      Mm-hmm.

    23. RM

      ... in terms of, um, y- using that to learn what you like and learn what you want to try in your relationship if that's applicable.

    24. SB

      Much of the literature

  6. 10:53 – 12:02

    Are We Desensitized by Porn?

    1. SB

      that I've read about and the studies I've read about show that if you consume pornography, you're somewhat desensitized to the real thing, i.e. sex in your relationships, and when we look at those s- stats on sexlessness, people are having less sex than previous years. People are losing their virginity later and later, and I wonder if that is we've sort of been de- des- desensitized to the real thing because of pornography, Rina?

    2. RM

      Absolutely. So I think that there is certainly people who feel, they use pornography as a way to achieve pleasure and that is the sole way that they achieve pleasure so they are constantly using pornography and, uh, it's sometimes correlated with a certain style of masturbation and those things cannot be replicated with penetrative intercourse of any kind or, you know, manual intercourse with another person and so in those cases then it becomes difficult because your brain habituates to that style of, uh, stimulation and excitement and visual sense- sensations that they're getting from watching pornography and so that does happen to some individuals. I would say it's not the large majority but certainly we're seeing

  7. 12:02 – 13:38

    How Porn Affects the Brain

    1. RM

      more of it.

    2. SB

      What is the impact though on the brain, especially a young brain, that is exposed to pornography?

    3. RM

      Yeah, I mean, there's no, we, there's no studies on kids looking at pornography, so (laughs) I couldn't tell you exactly, but you may be able to talk a lot more about this. (laughs)

    4. KS

      Yeah, I mean, so I like... Uh, first of all, I think this is a fascinating discussion and if I can kind of track back and freestyle for a bit? So I thought it was so interesting 'cause Steven asked this question, right? And he's like, you know, "I- is pornography a problem?" And then I thought it was so interesting that the two women at the table had the more positive answers-

    5. RM

      Mm-hmm.

    6. KS

      ... and the dude is like, "It's bad." (laughs)

    7. SB

      Mm-hmm.

    8. KS

      Right? So I, I think the first thing to understand is that... And it's so, uh, for me, it's eye-opening to hear both of y'all talk. 'Cause I, I think so much of it is like, your experience of it, right? We're talking about pornography as if it's an isolated thing, but the biggest takeaway that I already have is that there is a relationship between the human and the pornography. Uh, Erica was talking about, you know, how the pornography can be used to help the human understand sexuality, become more familiar with pleasure, that we have this org- Connect with your desire. Yeah! And we have this orgasm gap- Mm-hmm. Yeah. And then, and then, you know, she's, uh, and Reena was saying, you know, uh, "We don't s-" Uh, I forgot exactly what you said, but something about, "We don't see it very much." Or you said that the, the, uh, problems of, um, you know, sexuality relating to pornography are, I thought you said, not that common. Which is, uh, which is something that, I'm not saying it's common or uncommon, I think that's just such a interesting selection difference, because I work with people who have pornography and, like, death grip syndrome, because I've never heard-

    9. RM

      Mm-hmm. Mm-hmm.

    10. KS

      ... it discussed, is, like, very common.

  8. 13:38 – 16:58

    What Is Death Grip Syndrome?

    1. KS

    2. SB

      What's death grip- grip syndrome?

    3. KS

      So it's exactly, it's a Twitch chat degenerate way of describing what Dr. Mollick did a great medical job of describing, which is that, so what happens is our body can acclimatize to a certain kind of stimulation. So when, um, oftentimes what happens when... And I- I- I haven't worked with too many women and, and sexual stuff, way more men, um, so that, there's a selection bias there, too. But oftentimes what happens w- is that boys or men will start to masturbate without any kind of lubrication, and so there's a ve- they almost train their bodies physio- physiologically to climax with a certain degree, like, a certain, you know, pounds per square inch of force, and a certain sensation which they get used to, not only at the physiologic level, but also at the neurological level which Dr. Mollick, uh, alluded to, that there's a certain kind of, um, visual stimulation that they almost get used to, the brain acclimatizes to, in order to achieve sexual climax. And then what happens is when these people have a sexual relationship for the first time, the sensations and the f- the, uh, th- uh, from a visual perspective, you know, auditory perspective, because the sounds that we hear in these big, you know, fast food pornography productions are nowhere near the sounds in real life.

    4. RM

      Mm-hmm.

    5. KS

      Um, and, and so the, the inputs of an actual sexual act make it very difficult to have a s- a, a satisfied sexual life. And so I think it, there's a lot of subtlety to, you know, when Dr. Mollick said when couples watch porn together, eh, there are also studies that show that as you increase your pornography consumption, that correlates with relationship dissatisfaction. But that could be a chicken or the egg problem. Am I watching more porn because I'm unhappy with the sexual relationship? Or does watching pornography decrease my satisfaction in the relationship? And so I, I think it's, there's just, like, so much here to explore.

    6. RM

      Yeah. Yeah, and I think y- your point about the couples, usually, yeah, if there's a discrepancy and one partner is watching more porn than the other, then there's that, does this decrease satisfaction, certainly. Um, and I think that your point to saying that you're seeing a lot of it, well, that's, these people come to you for this problem, right?

    7. KS

      Yeah.

    8. RM

      So you're seeing this exclusively.

    9. KS

      Yeah.

    10. RM

      Um, but I think in the general population, um, and maybe they're not coming to the urologist as often, right? Um, but certainly I'm not seeing as much of it, and it's not reported in terms of, like, people complaining about it in studies. And again, these studies are small numbers and they're not generalizable to the entire population, but I would say that it's not as common as I think we let on. But the other important thing to add is that there's a l- because it's so nuanced, there's a big moral component. People have a belief about what pornography is, good or bad, and so when they watch pornography, if they have a moral incongruence, meaning they think it's bad to watch pornography, they are more likely to report having a problem with pornography. So there's a lot of nuance here in terms of how pornography can be beneficial or harmful to a specific individual, and how it affects that specific individual's brains. Whether it's gonna sensi- same pathways, um, you know, as any sort of strong visual stimuli, uh, the way your body sensitizes to those pathways is very individual.

  9. 16:58 – 21:53

    The Dopamine Effect of Porn

    1. RM

    2. SB

      And what about pornography in the brain, then, in terms of its impact on dopamine and how that then will cascade into other areas of our lives?

    3. KS

      Yeah, so I mean, I, I'll launch this one. Um, so I, I think that, uh, the biggest takeaway that I have is it is doing way more than we ever realized. So the first thing is if you get exposed to pornography early on in life, and this accidental exposure... By the way, the most common story that I hear, and this is such a weird, like, anecdotal statistic, is, um, if you're, if you have an older brother and you're a younger brother, I see so many pornography addicts who have older brothers. And the most common story that I hear is, you know, older brother is post-puberty and is watching pornography, which is, like, a little bit more understandable and acceptable. And then your younger brother wants to do whatever you're doing and they get exposed to it at an early age. So the first thing that we know is that early exposure correlates with an increase in potential for addiction. That's probably somewhat neurological and potentially somewhat, um, sociological or family oriented, 'cause if you think about what kind of seven-year-old will get exposure to pornography? Maybe parents aren't in the house as much, so there could be other risk factors. But we, we absolutely know that when you activate...... in an artificial way, the dopaminergic circuitry of the brain. It sensitizes the dopaminergic circuitry and makes it more vulnerable to dopamine later on. This is something called the kindling effect. We see this also, for example, in, like, marijuana as a gateway drug. The reason marijuana is a gateway drug is, is not because it makes you immoral. It's because once we start activating certain circuits in the brain during brain development, it changes the way that they develop. The second thing that we see is that pornography is used as a method of emotional regulation. So if you look at, like, I was trying to figure out what effect does pornography have in the brain, and so I was thinking about, okay, which part of the brain does sex come from? And it turns out that every part of the brain, every neurotransmitter is involved in the sexual act, because the purpose, the evolutionary purpose of a human being is to procreate. So all of our circuitry is designed for this thing. So we, we see that there's absolutely an emotional regulation component, um, because when we get aroused, like, our brain doesn't care about, you know, anything else in our life when it comes to the act of procreation, so we see a lot of emotional regulation, which then becomes an emotional crutch. So I see a lot of this now where, um, people at work will watch pornography, and it's not about masturbation or lust. It's about emotional regulation. I've seen a huge spike in second screen pornography. So we'll be working over here, and I'll just have porn, like, running over here. Like, this is a, a really common story, and it's an emotional regulation fact. Now, the third thing that, that you, uh, you... the question you asked about is dopamine. So here's a really fascinating thing. So it absolutely messes with your dopamine. When it messes with your dopamine, it messes with your motivation, because dopamine is the primary neurotransmitter involved in motivation. So as you watch more pornography, you just stop being as motivated about the other things in your life. And the really crippling thing, the really scary thing from a relationship standpoint, is that if we look at falling in love, falling in love is primarily the function of dopamine. So when we look at a relationship, there's initial attraction, which i- comes from, like, the thalamus and our sensory inputs. "What do I see? What do I hear? Oh, she smells great. Her laugh is beautiful," right? That's all sensory. And then we get into the stage where we're in love, when I can't get enough of this person. "I'm just sitting with this person. We're not talking. We're not doing anything. We're just holding hands, and oh, I'm so in love."

    4. SB

      (laughs)

    5. KS

      So, like, literally what creates that feeling is dopamine. And when we start using pornography on a regular basis, our dopamine stores start to deplete. We start to develop dopamine tolerance, and, like, literally what I'm seeing clinically matches with this because it's harder for people to fall in love. When I talk to p- younger people now who are in their 20s and 30s and struggling to date, you know, you go on a couple of dates, but what's the problem? There's no chemistry. There's no spark. That comes from dopamine. So I think we're seeing all kinds of really scary downstream effects from unregulated pornography use.

    6. EL

      I can't help but feeling that what you're talking about is a very masculine experience-

    7. SB

      Yeah.

    8. EL

      ... somehow, and that when we're talking about porn addiction or compulsory behavior with pornography, it, uh, uh, is very related to men and that we, in our society, tends to see men's experiences as universal experiences. And I think that we lack a perspective of really where wome- women get into this-

    9. KS

      Yeah.

    10. EL

      ... construction of, of addiction, of use of pornography. Is it,

  10. 21:53 – 24:10

    Is Porn Addictive?

    1. EL

      uh-

    2. SB

      Reena, do you see it as an addiction?

    3. RM

      So I...

    4. SB

      (laughs)

    5. RM

      You know, this is what I think. I think that, I, the, there... So it's not been termed an addiction in terms of in medical vernacular. They call it problematic porn use-

    6. EL

      Yes.

    7. RM

      ... because it, there hasn't been a clear definition in terms of addiction, right? Um, but I would say that I think that there are certainly people who have this experience, but there are certainly many, many people who use pornography and don't develop this tolerance. And maybe it's more common in younger people because they're getting access to it sooner and more often, and that has yet to play out, at least I s- tend to see older patients, and so, um, so that has yet to play out in, in older generations. But I would say that I think there's many people who use it fine and don't have an issue, and so I think that while these issues do exist, there's also a whole bunch of other things that are ongoing in society right now that may make it more difficult for people to connect and for people to feel intimacy with people, because it's very difficult currently.

    8. EL

      Mm-hmm.

    9. RM

      More and more people are not getting married. More and more people are choosing to stay single for a variety of reasons. I don't think porn is the only factor there.

    10. EL

      Mm-hmm.

    11. RM

      I do think it is something that people can control, and so they feel like, okay, if you feel like you have a problem with it and you can control pornography, that allows you to feel like you have control in one area of your life that then that control can potentially improve other areas of your life. So I think that there is correlations here, but I think it's very complex, and the way it affects our brains is very complex as well, and, like, dopamine is one way to describe it, but there's, you know, there's different sensitivities in how our brain responds to the same stimuli, right? The way I watch pornography, the way you watch pornography, the way any one of us watches pornography, our brains will respond in a different way, um, because our receptors are l- either more sensitive or less sensitive. And there's no way to really test that on an individual level.

    12. SB

      One of the things I found most interesting when I had the first conversation on this podcast about pornography is my, my team went out and looked at, um, a couple of tools which pull search data. So what are people searching on the subject?

    13. RM

      Mm-hmm.

    14. SB

      And the number one most searched term was, "How do I quit pornography?"

    15. RM

      Mm-hmm.

    16. SB

      And that's quite an interesting thing because there's a certain desperation to that question.

    17. RM

      Mm-hmm.

    18. SB

      You know, going to Google to ask Google how you quit a behavior, that makes me think of it in the context of an addic- an addiction, and in fact, the second most popular search term was also about how, how you

  11. 24:10 – 25:47

    Why People Feel Powerless Over Porn

    1. SB

      quit this thing. And it, and it speaks to a certain powerlessness that a certain percentage of people feel they have with pornography.... um, throwing that out to, to everybody here.

    2. EL

      Mm-hmm. No, but I think this connects also to the stigma, the huge stigma around sex and around porn and this idea that people have somehow that it is bad. I mean people want to watch it, at the same time they n- they have the moral idea that it's bad and that they shouldn't do it, but (sighs) I think we're also talking here... I mean, we end up talking about porn all the time but somehow porn is now very related to technology and how technology kind of has hijacked our lives. It's not only porn we're struggling with in that sense and when, you know, with young people, they are saying they are not having as much sex anymore, you were talking about it before. Uh, kids are not playing as much anymore outside as they used to, so I think we have a correlation there that we need to think about the role of technology and then how much of that space does really this pornography take up. And also, to have in mind that when we're talking about porn, most people see it as a monolithic kinda thing when, when if you go out on the street and you ask people, "What is porn?" They think about the tube sites, that's what th- that's what they have in mind, but actually there's many different kinds of porn existing-

    3. SB

      Do you think there's such a thing as good

  12. 25:47 – 26:45

    Is There Good Porn and Bad Porn?

    1. SB

      porn and bad porn?

    2. EL

      It's a very difficult, uh, kind of a distinction to say bad porn and good porn because if you do that then it's, you classify some type as, as acceptable and other types as non- and you kind of, you know, grow the stigma around it. I think that we need to think about porn that is made with great working conditions, taking care of everybody who's involved in that process, especially the performers, made with, uh, support by intimacy coordinator, talent managers, where the performers have been able to been involved in the process, to give feedback on what is gonna be made, how, how it's working, they'd have, they know all the conditions beforehand, et cetera, they can give feedback afterwards. Uh, I think there are ways of producing pornography that are safer than what we have seen in the past.

    3. SB

      We were

  13. 26:45 – 28:47

    Has Porn Increased Erectile Dysfunction?

    1. SB

      talking a second ago about the impact pornography has on the brain, um, and I know some of your work involves dealing with people who have erectile dysfunction. Some of the stats I read on erectile dysfunction show that there's been quite a significant increase over the last couple of decades in people reporting to have erectile dysfunction. Do you think porn has played a role in increasing erectile dysfunction as it relates to when I'm with my partner in the bedroom and I'm trying to have sex?

    2. RM

      So I think this goes back to the people who are watching pornography and are learning what sex is through pornography and then they go to their sexual encounter with their partner and they don't respond the way that they do on pornography, or their partner doesn't respond the way they do on pornography, and immediately they feel insecure, right? Immediately. And that leads to this psychogenic erectile dysfunction where you are no longer able to perform because you're so stressed about the anxiety of being able to get an erection because maybe things didn't go the way they were supposed to, or maybe you're f- 'cause insecure about your body image, or a whole host of things that come from watching maybe some of the big bucks pornography where we're not really showing real sex, we're showing a produced product that is meant to entertain and, uh, captivate people for a short period of time. And so I think that is one certainly issue that I do see where people start feeling this. The other thing is where people are, um, you know, using, uh, pornography over, quite often and then they, again, are, are unable to get that stimulation through a partner, right? They can't get the same, they're using death grip or they're using, um, you know, the same, this very erotic stimuli, it's very intense visual erotic stimuli that they can't produce with a person, and so then they're like, "Well, why am I not getting aroused and why am I not getting an erection?" And it's because they've now relied on this solely. So I do see that certainly, um, uh, as an issue in some people who are using pornography, but I don't think it's like, pornography use leads to ED, I think it's these other factors on the way to having psychological concerns about your own performance that lead to issues

  14. 28:47 – 33:30

    How Porn Impacts Motivation

    1. RM

      with erections.

    2. SB

      And before we move on, on Dr. K's point about motivation as well, do you believe that there's c- a correlation between the amount that we watch pornography and masturbate and someone's motivation based on what you know about dopamine receptors?

    3. RM

      You know, hard to say. I think, again, it's very individual. Certainly some people will take the eas- like, you know, there is a, uh, availability part when it comes to any sort of addiction-type behavior, so when something is more available to you, and you're using it more often, it can become more problematic and so certainly I think that plays a role in terms of like, if you're using it a lot and it's very available to you and it's an easy way to emotionally regulate, right? If you're having stress in life, you're unhappy with your relationship or you're unhappy with other things, people are often using pornography as a way to avoid those negative emotions and really just participate in something else, like take their mind off of that, and so that is sort of where it becomes this challenge for some people.

    4. KS

      Yeah, I just wanna chime in. So this is fantastic 'cause I, uh, 'cause I, I agree with everything that y'all are saying, a- and I also kinda come to a slightly different conclusion, so the number one search term that we have is, "How do I quit porn?" So when I hear that, and, and I think Dr. Mollick has also done a great job of pointing out, you know, there's a difference between anecdotal clinical experience and what we have randomized clinical trials on. You know, we're not exposing seven-year-olds to pornography and then seeing how their brain develops by doing MRI scans over the course of 10 years. So some of this research is absolutely not there, and we also have the number one search term is, "How do I quit porn?" What that tells me is that there is a l- literally the largest population of what people are looking at-... is to stop using pornography. And I think the reason for that is, is there good porn or is there bad porn? Is it individual? Is it nuance? Completely agree with all those points. It's not a problem for everyone. But I think what I'm seeing very clearly is that it's getting worse, right? So it's not an issue of good or bad. What is the trend that we're seeing? We're trend- the trend that we're seeing is that Erika is saying, "Hey, pornography can be more than the tube sites." So that then begs the question, why does everyone think that pornography is the tube sites?

    5. EL

      Because they hijacked the system.

    6. KS

      Exactly. So I think that word is, is beautiful, hijack. So I think what we're seeing, what I'm seeing is that pornography is getting worse for sure. It's becoming more of a problem. If we look at these tube sites, they're, they're, you know, it's kind of like there's nutrition and then there's calories, and a lot of what I'm hearing y'all talk about, you know, Dr. Mollick is saying if you watch it as part of a relationship, that's nutrition. It can be something healthy. We can learn about ourselves. We can destigmatize various things. Fair enough. But I think we're seeing the same trends that we see with, like, fast food, where now pornography is becoming mass produced, and there are actually studies that show, there's a really fascinating bizarre piece of research, right, which is where the- you have to go with this, where I've gone to find this stuff because we don't have studies, but there was a particular group of biologists who were noticing that a population of beetles was dying out. And they were trying to figure out like, why is this population of beetles dying out? And what they discovered is there's one thing that's responsible for these beetles not mating with each other, which is green beer bottles that were being littered, and the green beer bottle, then what they noticed is that the beetles were trying to go up to the green beer bottle and mate with it, and they were like, "What is going on?" You'd see this, this litter that has a green beer bottle-

    7. EL

      (laughs)

    8. KS

      ... and a bunch of male beetles are clustered around it and, like, they're like, "What is this?"

    9. SB

      (laughs)

    10. KS

      And it turns out that there's this concept of something called a supranormal stimulus. So when a beetle's eyes look at the environment, there are certain signals that indicate this is a fertile female, and a green glass beer bottle activates those parts of the brain. And what we're seeing with these tube sites is things are jigglier. Things are louder. Things are slipperier, right? Uh, we have these 4K high def, like, so we're, we're sort of turning, we're taking what used to be nutritious, and we are turning it into fast food, and that, and what, why all these tube sites, why are they successful? They're in this Darwinian war that's kind of like a race to the bottom. How can I create the pornography that is gonna leech the most traffic away from my competitors? And they're figuring out very rapidly that there are all kinds of weird ways to activate the brain, what our brain looks for and what it gets excited about, and so it feels to me like there's a race to the bottom. We're making pornography for money. We're making it more

  15. 33:30 – 39:29

    How Porn Companies Exploit You

    1. KS

      addictive.

    2. EL

      But, but, but the thing is that these companies behind these tube sites, they are not interested in human sexuality. They're not interested in sex. They're not interested in porn. They're not interested in the conditions of the people-

    3. KS

      Adver-

    4. EL

      ... who are working in front of the camera. I mean, they're selling advertisement, and what do they need for that? They need content that is extreme, that has words that are clickbait-y, that are kind of small clips that are quick to watch. They look at the algorithms to see what works, right?

    5. SB

      Okay. But this, it reminds me of the food industry-

    6. EL

      Yeah, of course.

    7. SB

      ... because yeah, yeah.

    8. EL

      It's the same as big food.

    9. SB

      When you have-

    10. EL

      It's the same as big pharma, big fashion, et cetera. Big porn is the same.

    11. SB

      How, how does an industry succeed if it doesn't engage in that practice though? If, because-

    12. EL

      Yeah.

    13. SB

      ... think about the food industry. The thing that has the most sugar in, and that's the-

    14. EL

      Yeah, yeah.

    15. SB

      ... most available, the cheapest-

    16. EL

      Yeah.

    17. SB

      ... is the thing that's gonna succeed the most. So when, uh, we think about these tube sites-

    18. EL

      Yeah.

    19. SB

      ... some of the stats are crazy. I mean, OnlyFans released their earnings for last year, up 20%. They made 6.6 billion. Um, Pornhub, one of the big tube sites, is the eighth most trafficked website in the world at the moment, doing 5.5 billion monthly visits.

    20. EL

      These are the brands that people recognize.

    21. SB

      And it's, it's extreme. Like, if we think about nutrition, high in sugar.

    22. EL

      Yeah.

    23. SB

      It's extreme. So I get the, the most-

    24. EL

      Yeah.

    25. SB

      ... extreme sort of dopamine stimulation. It's so easy to access.

    26. EL

      Uh-huh.

    27. SB

      I can, one, I don't have to put my shoes on and p- put my aftershave on.

    28. EL

      Uh-huh.

    29. SB

      I can just, I can get on there within 15 seconds.

    30. EL

      Yeah.

  16. 39:29 – 41:25

    Is Sex Education Enough?

    1. EL

    2. SB

      Do you think if people had the sex education, they would still be on OnlyFans talking to what's probably... 'cause there are big agencies now. I- I've seen on social media-

    3. EL

      Yeah.

    4. SB

      ... there are big agencies of men who pretend to be these porn stars on sites like OnlyFans.

    5. EL

      Yes.

    6. SB

      And I see them bragging about their income. It's this big thing on Twitter at the moment.

    7. EL

      Yes.

    8. SB

      "I've made $10,000 this month pretending to be this actress speaking to young men on OnlyFans."

    9. KS

      Yeah. And I think the reason that men do that, part of the reason is because they know what men wanna hear, right? There's a part of us that they know exactly what to say 'cause it won't be an AI bot. It'll be this kind of person. And now what's happening is we're activating the social loneliness aspect and combining it with pornography. So now you actually have a relationship with maybe an AI bot, maybe a dude, right?

    10. EL

      (laughs)

    11. KS

      But there is like some amount of genuine human interaction over the internet. So this is getting worse. And I think sex education is an excellent point. At the same time, I don't know if sex education is gonna be sufficient-

    12. EL

      Mm-hmm.

    13. KS

      ... because I think we can teach people about their bodies, but we're also seeing like a whole scale social skills atrophy-

    14. EL

      Yeah.

    15. KS

      ... where dudes don't know how to talk to girls anymore.

    16. EL

      Yeah. Yeah. And also media. Porn is media. It's important to understand that. It's telling us messages about gender roles, how we interact, about sexuality, how our body functions, et cetera. So when we have all this misinformation going on, on this online huge media of free porn and we see women screaming in fake orgasms after four minutes of hard penetration. And as a woman, you look at her, and you say, "She didn't even use her fingers. What happened?" You know? And you just know that something is wrong here, that this is fake. But then there's lots of men out there thinking, "This is what my girlfriend should be doing. This is how it should work," and then they don't connect in real life.

  17. 41:25 – 44:47

    What Kind of Porn Does Erika Make?

    1. EL

    2. SB

      What kind of porn do you make?

    3. EL

      (laughs)

    4. KS

      (laughs)

    5. SB

      What kind of porn do I make? I make, I make lovely porn. (laughs)

    6. EL

      (laughs)

    7. KS

      I make beautiful porn. I make cinematic porn. I make porn with, you know, with intentions of, of showing (sighs) different, uh, ideas of desire and fantasy where people... I try to work with people who are connecting, who show chemistry together. I ask my performers who they want to work with. I try to team them up. I support them with a system of intimacy coordinator, talent managers, producers in the background that take care of them, that check who they are, what they like, what kind of sexuality do they have.

    8. SB

      But if I was a consumer of your pornography-

    9. EL

      Yes.

    10. SB

      ... what would I notice that I-

    11. EL

      What would you notice? Probably the great cinematography would be the first thing. You would notice kind of narratives, uh, that are erotic driven somehow where people explore their desire and their sexuality. You would notice, um... (sighs) You, you would feel very... I mean, many people tell me, they go, they go like, "Erika, but I watch your films. Is it really porn?" Because they identify porn as something that is kind of tacky, ugly, s- kind of objectifying, et cetera. So suddenly when they see people in my films having sex, coming together, and everything is kind of... you understand why they are desiring each other, and you kind of... I invite them to join this kind of erotic journey of the characters. Then they go, "But this is more like, like in the, in the cinema, in the erotic cinema."

    12. SB

      Can I...Is it fair to assume that because you're, from what I've heard that, that the pornography you produce-

    13. EL

      Yeah.

    14. SB

      ... is, has a slower story arc, which is more reflective of what-

    15. EL

      Sometimes.

    16. SB

      Okay. So- so-

    17. EL

      (laughs)

    18. SB

      ... I'm trying to understand-

    19. EL

      Yeah.

    20. SB

      ... because the things that you, it sounds like you might have-

    21. EL

      Yeah.

    22. SB

      ... removed from the pornography you make-

    23. EL

      Yeah.

    24. SB

      ... versus the pornography I'd find on one of the big tube streaming sites, the most popular videos on those tube streaming sites, it sounds like you might have put yourself at a bit of a competitive disadvantage in many respects, because those streaming sites, if their incentive is purely money-

    25. EL

      Yeah.

    26. SB

      ... the data is gonna determine-

    27. EL

      Uh-huh.

    28. SB

      ... what people see.

    29. EL

      Uh-huh.

    30. SB

      So that's, so it feels-

  18. 44:47 – 46:16

    What’s Better for Relationships: No Porn or Porn?

    1. EL

    2. SB

      What do you think is better for someone's relationship, specifically, uh, sort of men and women, do you think no porn is better for their relationship? Do you think your porn is better for their relationship?

    3. EL

      Yeah.

    4. SB

      Or do you think, and you obviously there's a-

    5. EL

      I think it's individual.

    6. SB

      Okay.

    7. EL

      I think it's a very individual decision what works best.

    8. KS

      Uh, sorry.

    9. EL

      Yeah.

    10. KS

      I, I can answer. I've never seen one of your films.

    11. EL

      Yeah.

    12. KS

      I can tell you it's her porn.

    13. EL

      Oh, thank you.

    14. KS

      Better than no porn.

    15. SB

      (laughs)

    16. KS

      I'm gonna go ahead and go out on a limb in saying that if you're someone who's struggling with pornography, watching an erotic film with a glass of wine with your significant other is a great way to transition from bite-sized fast food, calorie dense-

    17. EL

      Yeah.

    18. KS

      ... jiggly, slippery, loud porn to, like, how do we rewire the brain, right? How do we move one step at a time from this to this?

    19. EL

      Mm-hmm.

    20. KS

      And 'cause like, it, like the word erotic, uh, seems so powerful to me. It's about anticipation.

    21. EL

      Yeah.

    22. KS

      Even when we talk about, you know, differences between male and, and female sexuality, the, the lag time of parasympathetic activation and foreplay is so much more important-

    23. EL

      Yeah.

    24. KS

      ... biologically, and correct me if I'm wrong here-

    25. EL

      Mm-hmm.

    26. KS

      ... um, uh, for women than it is for men. I mean, we're like kinda ready to go-

    27. EL

      Mm-hmm.

    28. KS

      ... and we wanna make it short. And, and so I think like it, it, it's almost like a part of that sexual education is in understanding, okay, how can we teach men-

    29. EL

      Mm-hmm.

    30. KS

      ... to be erotic again?

  19. 46:16 – 50:19

    How to Remove Porn Stigma

    1. KS

    2. SB

      When we talk about watching pornography with your partner-

    3. EL

      Yeah.

    4. SB

      ... I wonder if that is the rule or the exception to the rule. You know? 'Cause I-

    5. KS

      Yeah, I mean, so you're saying what do we do? I think we have an erotic film watch party.

    6. EL

      Yeah.

    7. KS

      Right? We have anime watch parties, we have different kinds of watch parties. Like this thought had never occurred to me before.

    8. SB

      (laughs)

    9. KS

      I'm sure it is a terrible idea.

    10. EL

      (laughs)

    11. KS

      But-

    12. SB

      On that, on that point though, if you reduce the stigma by having these watch parties-

    13. EL

      Mm-hmm.

    14. SB

      ... um, does that then, because you s- cited earlier that it's a tool for emotional regulation, so when people are stressed or depressed or anxious they seek it out, if we remove the stigma, does that increase the addiction?

    15. KS

      So it's a great question. So I think there's, it kind of goes both ways, and what I mean by that is, see, we run into addictions when this substance becomes one, or, or behavior becomes one-to-one correlated with something else. So right now the problem with pornography isn't that it, it, yeah, it, it's, uh, uh, so the problem is if I watch pornography and that's the only method I use to regulate my emotions, that will increase the addiction. Now, the flip side of it is also true. If the only reason I watch pornography is to regulate my emotions, that will strengthen that addictive capability. So I'll give you all just a simple example from like alcohol, right? So if I use alcohol after a hard day's work to get through the day and calm down, and then I stop drinking for fun, whereas alcohol can be used as an emotional coping mechanism or it can be used to celebrate a wedding, right? So th- the substance can be used in different ways and the more that we use it in different ways, in healthier ways, the more it actually chips away at the addiction in some cases. This is also highly individualized. So depending on your genetic predispositions, dispositions and stuff like that, you know, you may not be able to drink at weddings. But we also see the opposite, which is like, you know, a huge number of people are, qualify for an alcohol addiction in college, and then most of those people are able to develop healthy relationships with it. And one of the biggest changes we're seeing in addiction is that there do seem to be healthy relationships that we can develop. I think it's about changing our relationship to the thing. Now, seeing someone naked engaging in a sexual act is not solely about getting off. It's not solely about emotional regulation. It's not solely about dopamine. It can now become a film experience that we can enjoy. So we're diversifying our relationship to the object. I don't know if that makes sense. It's psychoanalytic.

    16. EL

      Yeah. Awareness, mindfulness, understanding of-

    17. KS

      Yeah.

    18. SB

      Yeah.

    19. EL

      ... how to-

    20. SB

      Of how you use that. How you use that.

    21. KS

      And then I, I think this is also great, like just the simple idea that like if dudes are watching this, recognizing that watching an erotic film with your significant other, assuming a heteronormative, a heterosexual relationship, you know, may be a great way for you to enhance your sexual experience. You don't need dick-enhancing pills or, or, you know, whatever else, right? Like 'cause that's, uh, and I'm sure Dr. Mollick knows better than I do, but-

    22. EL

      (laughs)

    23. KS

      ... you know, the majority of the... No, I, I meant more as a urologist.

    24. SB

      (laughs)

    25. EL

      Okay.

    26. KS

      (laughs)

    27. GU

      (laughs) I didn't think that, but okay. (laughs)

    28. KS

      Yeah. (laughs)

    29. EL

      It doesn't work. (laughs)

    30. KS

      No, no. So, so like, you know, my understanding from med school, right?

  20. 50:19 – 51:09

    The Rise of Erotic Audio

    1. KS

    2. GU

      It would be a lot easier. Yeah. (laughs) Pretty quick. Um, but I would say the other thing I've been thinking about while we've been talking about this is we don't talk about erotic audio literature or erotic books-

    3. KS

      Mm-hmm.

    4. GU

      ... which is more commonly used by women. But we don't stigmatize that. Like, women are like, "Oh, I love these books, and I read them all the time," and nobody is sitting here saying, like, it's bad. I don't know. Thoughts on that?

    5. EL

      Because it's not naked bodies. I guess, here, the main problem, again, is back to, to our bodies. We are somehow ashamed of our bodies, of our nakedness, of our sexuality. I mean, women can show nipples online. We know that. Uh, you can't... I, I mean, I'm heavily censored. I can't show anything on my accounts. My, my social media accounts are cut off all the time. It's impossible to grow.

    6. KS

      Do you think

  21. 51:09 – 54:18

    Should Porn Be Banned on Social Media?

    1. KS

      pornography should be banned on social media, Dr. K?

    2. EL

      Should pornography be banned on social media?

    3. GU

      Yes, pornography should be banned.

    4. KS

      Hmm.

    5. GU

      I can answer that. I'm, I'm, I'm making it. I definitely think it should be banned, but I don't th- that, that the explicit images should be banned. But the right to discuss about it, to talk about it, to give, uh, sexual advice, or to, you know, discuss different topics around sexuality, we should be allowed to do that. We should be allowed-

    6. KS

      Well, we're allowed to do that.

    7. EL

      No, I get, I get banned too.

    8. KS

      Really? 'Cause this doesn't get banned.

    9. EL

      Maybe you are allowed to do it.

    10. GU

      YouTube is different.

    11. KS

      Twitter's fine. Instagram's fine. YouTube's fine.

    12. GU

      I get banned a lot. Instagram, Instagram. Meta's tough.

    13. KS

      TikTok's fine.

    14. GU

      I have, I have TED Talks that are censored, so only people-

    15. KS

      Hmm.

    16. GU

      ... who are over 18 and have an account online have access to watch, watch them, and it's me talking.

    17. KS

      Hmm.

    18. GU

      Yeah. No, it def- there is definitely, uh, limitations.

    19. KS

      Yeah, the, the thing that we've noticed is y- your video just doesn't appear in search in the same way, but they still recommend the video. So when we had, for example, Andrew Huberman on a couple weeks ago, and he talked about pornography-

    20. GU

      Mm-hmm.

    21. KS

      ... because porn was in the title and the thumbnail, the video got huge recommendations by the algorithm, but if you typed in Andrew Huberman, it would not come up.

    22. GU

      No.

    23. KS

      Until we changed, took the word porn out, and you type in Andrew Huberman, and it comes up. So that's the only thing we've noticed, but we've been quite surprised actually, by... Yeah, I, I think it's so cool that like, you know, you asked me that question, and she jumped in with an answer.

    24. EL

      (laughs)

    25. KS

      No, no, I think it's good. I, I think it's like... 'Cause you ask, I mean-

    26. EL

      But-

    27. KS

      ... I think that's the value of this, right? 'Cause my, I, I don't feel nearly as passionate. I mean, you asked her the question, you know, is it, which of these is the best? And I jumped in with an answer.

    28. EL

      (laughs)

    29. KS

      I was like, "This is clear to me." And, and I think just a couple of things that I just wanna, uh, touch on. The first is that, um, you know, what Dr. Bolick was saying about, you know, audio lit- literature, like erotic fiction or romance novels, right? So I, I think it's harder to commoditize that, which goes back to Erica's point of, of, you know, like some things are more likely to be turned into fast food. So I think that, uh, uh, erotic literature, it's like harder to do that. Um, I also do think that going back to this earlier point of like, you know, men are epidemiologically more vulnerable to addiction, I think it's more complicated than that, and it just, uh, uh, psychological hurt or problems manifest in men as addiction and look different in, in women when it emerges. Um, so I think it's kinda like, you know, so we're, we're sort of seeing a difference in addictive quality. It's easier to commoditize more sensory organs. Uh, so I, I think that's an important point. And I, I think in terms of, you know, should it be banned or not, like, I don't know. Um, so I work kind of like more at the individual level, and arguably some at scale, but like one of the key things is, you know, I have some ideas about what should be done, but I, I'm not too sure about that. I'm, I'm curious, you know, I, I don't know, like I ne-

    30. EL

      No, but I'm saying it basically because it's open for kids again.

  22. 54:18 – 55:05

    Why Social Media Is Full of Porn

    1. EL

      called Twitter anymore, uh, the X.

    2. GU

      X.

    3. EL

      Go there and it's full of porn.

    4. KS

      It is.

    5. GU

      It is.

    6. KS

      It is full of porn. You can, you- I didn't know that. ... accidentally stumble across porn. I was saying this to my partner a couple weeks ago, I said, "Look at what, how Twitter's changed."

    7. EL

      Yeah.

    8. KS

      And I said, "Watch this." Scroll down my timeline, and I know there's .......................... if I dwell on something more often-

    9. EL

      (laughs)

    10. KS

      ... then it's gonna show me more. But I scroll down. (laughs)

    11. GU

      (laughs)

    12. EL

      (laughs)

    13. KS

      I scroll down and I was like, "Look, porn." And I was like, "Ooh, look, she's taking her clothes off." Scroll, scroll, scroll, scroll, someone being shot.

    14. EL

      I didn't, I didn't realize there was nudity on-

    15. GU

      It didn't happen... I've actually not seen it, but I've had-

    16. KS

      Yeah.

    17. GU

      ... many people who tell me that it comes up on their feed all the time.

    18. KS

      Recent change to the algorithm, which has prioritized again, um, viewership time. So if you wanna, want people to dwell longer, show them video, extreme video, people being shot, someone being hit by a car, fights, pornography. You increase your dwell time, you increase

  23. 55:05 – 1:01:25

    Should We Warn People About Porn?

    1. KS

      your advertising. And this is just how incentives play out. So much of the discussion we've had today, and m- much of my like, m- why I refer to it sometimes as being idealistic, 'cause sometimes it can sound like just give them broccoli.

    2. GU

      Mm-hmm.

    3. KS

      When actually, if you leave them to their own devices, no one's gonna want broccoli. They're gonna take the cookies if the cookies are available. And if you equate this to food, we did put...

    4. SB

      ... labels on food to say, "Look, this has got this m- much calories in it."

    5. EL

      Yes.

    6. SB

      We've put a sugar tax on sugar in the UK.

    7. EL

      Yes.

    8. SB

      We, you know, on cigarettes we say, "If you smoke these cigarettes, this is what's gonna happen-

    9. EL

      Mm-hmm.

    10. SB

      ... to your lungs." And we put explicit images of how your lungs will get, you know, cancers and things like this. Should we be doing something similar with pornography? Because part of me goes just, you know, saying, "We should just give them broccoli," this kind of, like, erotic different porn. They're not gonna, they're not gonna eat it.

    11. EL

      (smacks lips) No, but, but, but also, again, adults, I think they have d- the right to watch pornography, whatever kind of pornography it is, as long as it's legal and a- and, and well done. I wish all pornography would be ethically produced. I know that the industry is working towards more standards, et cetera, because, you know, we have been as a society talking about it. They don't have much of a choice because if they don't go that way...

    12. SB

      Should we, should we tell them about the harms of pornography at the point of consumption like we do with cigarettes?

    13. EL

      It's a bit difficult maybe. I, I think we should. We should talk about what could happen.

    14. SB

      Like gambling.

    15. EL

      What effects like, like gambling, like ... But, but this also happens, we, you, you've been talking about gaming a lot, you know? Uh, there's a way of, of gaming and healthy gaming, right? There's a way of video games that it's too much and not too much. I th- (sighs)

    16. SB

      What do you think, Dr. King?

    17. KS

      Yeah, so I mean-

    18. EL

      Yeah.

    19. KS

      ... I, I think it's, it's a great question, so I've got, like, um, a couple-

    20. EL

      Yeah.

    21. KS

      ... of different things. So I'm gonna, about to contradict myself.

    22. SB

      (laughs)

    23. KS

      So the first is that we know that, you know, putting warning labels on things does move-

    24. EL

      Mm-hmm.

    25. KS

      ... things in the right direction.

    26. EL

      Mm-hmm.

    27. KS

      But I love to just share a story. So when I was a medical student (laughs) , didn't really understand much about medicine or psychiatry or humans. Um, you know, I had a patient who came in and was smoking and so I, I came in and I was like ... You know, he came in and I was, like, a first year medical student so I was like, "I'm gonna be a doctor one day."

    28. EL

      (laughs)

    29. KS

      And so th- this person comes in and I'm like, "Sir, do you know that smoking is dangerous?"

    30. EL

      Mm-hmm.

  24. 1:01:25 – 1:04:17

    Do We Need a Purpose to Quit Porn?

    1. RM

    2. SB

      Interestingly, there's clearly a two-way relationship with purpose, porn, motivation, et cetera, so it... We... Giving them a purpose, one might say, "Well, then we stop porn because then they'll have more motivation to put their shoes on."

    3. KS

      Yeah. So I, I think it, you know, if you look at ... There's one study that showed the two strongest variables with pornography addiction are a sense of meaninglessness in, in life and, uh, I forgot what the other variable is. (laughs) Uh, maybe early age of exposure. Um, but, so I, I, I think it's, it's kind of spot on, right? So when I don't have a life that's worth living, what happens? My body and my brain become squeeze bottles of dopamine because what is the joy of life? So I try to just extract as much dopamine as I can from my b- brain so that I have some joy in the day, some kind of pleasure. And then I watch more of this mass-produced, supernormal stimulus pornography because that squeezes more dopamine out of my neurotransmitters and the more that my life becomes that, now there's a moral component. Now I feel ashamed. Now if ... I remember looking at some statistics on online dating profiles and, like, saying that you're a dude who watches porn is, like, an instant no.

    4. RM

      But if I'm watching pornography, it's gonna sap me of the motivation to pursue my purpose.

    5. KS

      Absolutely. So if I'm extracting all my dopamine through watching pornography, I'm gonna have none left for behavioral reinforcement from other activities. So wa- reading books becomes not as much fun. Going to a park becomes not as much fun. So it's absolutely this vicious cycle where meaninglessness, I have no reason to do anything all day, so I might as well watch some porn.

    6. GU

      Porn?

    7. KS

      Pornographic film. Yeah.

    8. RM

      So we cancel porn then?

    9. GU

      No. (laughs)

    10. RM

      (laughs)

    11. KS

      (laughs)

    12. GU

      No. Please. (laughs)

    13. RM

      (laughs)

    14. KS

      (laughs)

    15. GU

      Let us have it. (laughs)

    16. RM

      Mm-hmm.

    17. KS

      Yeah. I don't, I don't know. I mean, my-

    18. GU

      The monster comes.

    19. RM

      Oh.

    20. KS

      The majority of my income and my brand would collapse-

    21. GU

      Oh.

    22. KS

      ... if you started banning social network. (laughs)

    23. RM

      (laughs)

    24. GU

      (laughs)

    25. RM

      Oh.

    26. GU

      No, I mean, I think there, I think we have to ... I, I mean, I think there's a lot of things we've talked about.

    27. RM

      Yeah.

    28. GU

      But I think sexual education, I think imp- uh, understanding that, you know, uh, explaining to younger kids of what they're watching, right? I think adults have a little bit more, um, their brains are fully developed. They understand what they're watching. They know it's a produced product. They presumably have already gone through the process of finding a job and doing other things that give them purpose. Maybe they have children, maybe they have a family, right? But, but the, yeah, I think it's really in that young generation that they're finding themselves. Maybe they're going out and they're not finding a partner because we know that there's less people coupling, there's higher d- you know, mismatch of expectations. We've talked about that too in terms of dating. And so, you know, it's, it's very easy for those people when they're still trying to figure out what to do with their lives to fall into something like that, and I think if we really focus on that generation, I think ... And that's a generation that probably shouldn't be watching porn anyways, right? Um, and, and I think that would make huge, a huge difference.

    29. RM

      And help parents

  25. 1:04:17 – 1:09:25

    How to Talk to Kids About Porn

    1. RM

      because parents are really, really worried. I- How do you do it?

    2. GU

      I mean, you, you, there, there's many way of kind of, of, of, of starting it, but they, what they need to know really is that you are there for them, you are open. If they have any kind of, of doubts, situations, you are gonna be there for them. This is not a subject that you are gonna, you know, bail out because you feel too ashamed or you can't handle difficult questions.

    3. RM

      Mm-hmm.

    4. GU

      I would tell parents, educate yourself. If you're having kids, you're gonna have to talk to them about sex. So-

    5. RM

      At what age?

    6. GU

      ... if you didn't get education ... What age? You need to start when they're really, really young. You need to start when they're learning language. I mean, young kids today, many of them, they don't know the difference between a vagina and a vulva. Even Billie Eilish in an interview came out saying that she wanted to put her face in, in people's vaginas, no? And you go, "What? What happened?"

    7. RM

      (laughs)

    8. GU

      "You're talking about vulva, girl." You know?

    9. RM

      Yeah. No. I, uh, it has to start from ... I completely agree with everything you're saying. I have kids.

    10. GU

      Yeah.

    11. RM

      I've talked to them about sex. I think you, you have to start early with at least knowing the anatomy, right? Knowing-

    12. GU

      Yes.

    13. RM

      ... what their body parts are and what the body parts, uh, are of the opposite gender, um, so that they know that they're different and, and all that stuff. And then honestly, being open. They're gonna ask you questions. Like, it's ... Kids are curious, and so they'll come home and be like, "What's this? What's that?" And not being like, "Oh, no, no, no, I'm not gonna talk about that." It's just like, "Okay, yeah, let's have a conversation about it and let's talk about it." And realize that it's not gonna be one conversation. It's gonna be, like, throughout their development. As they become older, you're gonna maybe introduce more topics or they may have a question for you, and just never shaming them, and that can come even early, right? Kids are masturbate... Babies are masturbating, like-

    14. GU

      Mm-hmm.

    15. RM

      ... as young ch- that's a soothing behavior, right? And so sometimes you'll see your child doing it. You don't wanna shame them, right? Because that's already setting up that stage of shame. So sort of allow, being like, "Okay, that's, that's fine that you're doing that, but maybe do that in private and that's something that you do in private." Um, but, you know, I think it's really important to have these conversations, and it's uncomfortable. It's gonna be uncomfortable, and know that it's gonna be uncomfortable, but, like, we have a duty 'cause they're not gonna learn it at school in the right way, or enough in school.

    16. KS

      Yeah. So I, I, I, I completely agree with what they said. So it's really interesting 'cause the number one question ... So when we started talk, working with gamers, what happened very quickly is parents started reaching out. And they're like, "Hey, I have a son who's got this problem."

    17. GU

      Mm-hmm.

    18. KS

      Usually a son, sometimes a daughter, 70/30. And, um, "How do I talk to them?" So we actually started doing a study in 2020, 2020 or 2021, where we started developing different kinds of techniques and measuring what worked best. So now we have four years of data. Um, a lot of those findings went into the book about How to Raise a Healthy Gamer, which is actually all about conversational techniques-

    19. GU

      Mm-hmm.

    20. KS

      ... for parents about how to talk to their kids. So for four years, here are the biggest takeaways. Uh, so that book is like, it's conversational techniques about video game addiction, but we find that this works really well for pornography too. So the first is, uh, like Dr. Mollick said, um, multiple conversations. So the first mistake that parents make is that they think that they have to get it all in in one conversation.

    21. RM

      The sex talk, no?

    22. KS

      Right.

    23. RM

      That we all heard about.

    24. KS

      The sex talk.

    25. RM

      It's-

    26. KS

      No, it's, it's lots of them.

    27. RM

      Yeah.

    28. KS

      Second thing, start earlier than you think you need to.

    29. RM

      Yeah.

    30. KS

      So one of the biggest principles that we learn in, in, you know, medicine is that you don't have end of life conversations when someone is dying. You have to have the conversation before it's an issue.So, I think we were talking about, you said, what, 64% of people get exposed to pornography at the age of 11.

  26. 1:09:25 – 1:19:08

    Does Porn Violence Reflect Audience Demand?

    1. GU

      If they're watching that pornography though, the type that's available on those tube streaming sites, do you believe that it will cause, or lead to, a rise in violence between men and women? Because when I look at some of the statistics around this, nearly one in three porn videos contains physical violence and almost 90% of the most famous porn scenes are violent scenes. 18 to 21 year olds, uh, out of 18 to 21 year olds, 79% had seen pornography involving sexual violence when they were children, and almost 50% of young people say girls expect sex to involve physical aggression such as airway restriction, and according to a study in 2000 and, uh, '24, um, of 18 to 35 year olds, they found that 57% of young people aged, um, from 18 to 35 had been strangled themselves during sex, and 51% had been strangled, um, at least once during sex. And my last stat on this is, the BBC revealed that 38% of women under the age of 40 have experienced unwanted slapping, choking and gagging during consensual sex.

    2. RM

      Mm-hmm.

    3. GU

      And 42% of these women said they felt pressured or coerced into doing it.

    4. RM

      Yeah.

    5. GU

      So we can allow people to watch pornography, but is there not a risk that at a very young age, at the age of tw- 11, we're gonna learn that sex is a violent act and that's gonna make us more violent? I'm gonna start with you, Rina.

    6. RM

      Yeah, th- this is a really important discussion and I think, you know, I actually spoke to D- Debbie Herbenick who leads a lot of the studies on strangulation and so basically what they found is that very commonly young people, college age students, are having strangulation or i- during intercourse or during foreplay. And it's become so common that it's almost like kissing, right? Like, this is something that is so common and often consent is not being discussed or it's like, "Hey, can I do this?" "Yeah, it's all right." But it's not like a real discussion and as you guys all know, and especially asphyxiation can lead to loss of oxygen to the brain and, and sort of a whole host of things. And so I think ultimately that is a concern for sure, in terms of, um, you know, we have ratings in movies for a reason, right? Like, we don't show our kids, like, The Boys, for example, on Netflix, right? Because it's very violent. And so similarly, we would like to have ratings on pornography and they shouldn't have access to it but sometimes they see it. Now, uh, yeah, that is a concern. I don't know exactly how to rectify that. Maybe you have some thoughts.

    7. GU

      Is that because we want it though? Earlier on you said that porn is there because we- we want it, so I'm thinking isn't strangulation in porn because that's the type of porn that people want?

    8. RM

      So there is, you know, some people derive pleasure from es- you know, from a temporary occlusion of, uh, of- of breath, right? And that, and so there is some people who enjoy that, uh, erotically, but that doesn't mean that that's universal. And, um, and again, it's fantasy so just because you watch something on pornography doesn't mean that you should be doing it. It's a fantasy, um, it's not real life and that's in a c- hopefully a controlled safe situation where they're producing that pornography.

    9. GU

      Mm-hmm. But I think it's very important when we're starting to talk about sexual violence towards women that we understand that that doesn't come from porn. That existed long before porn. Sexual violence towards women is a systemic problem we have in our society. And we all know that the most dangerous place for a woman is her own home. It's her own husband or her boyfriend or her relatives around her, et cetera. So, the way I see it, porn reflects the values we have in our society. I think I see porn a bit as a mirror of many of the, of- of- of the values in our society, amongst them sexual violence towards women. But then it's also true obviously, that nowadays as porn has become more popular, we're getting into a bigger problem, right? Where their attitudes are also provoked by what they are seeing, so now it's not that easy anymore to say that porn is just a reflection because obviously they also learn from what they see and then they go into their own lives and they try to reproduce what they have learned on- online. And that's- So, so in that case then if I watch- ... violent pornography, when I meet my partner at 15, 16, 18, 21- ... I'm gonna have this expectation that pornography looks, uh, I'm gonna think sex has to be performed in this way where I choke them, I hit them, I spit, or whatever they, whatever, because that's the only sexual education I've had and I got it from Twitter, for example. So that, in that case it will lead to sexual violence, unwanted sexual violence because- No, not necessarily it will lead to that. Uh, it might lead to a curiosity of trying it out- Because 42% of women said that they have been strangled-

    10. SB

      ... uh, felt they were pressured or coerced into s- slapping, choking or being gagged.

    11. EL

      Yeah, and I think many women also feel- feel coerced just to have regular sex, many times in their own marriages.

    12. SB

      What do you think, Dr. K?

    13. KS

      So, so many thoughts.

    14. EL

      (laughs)

    15. KS

      And- and I agree that this is a- a very important discussion. So like, I was kinda curious about this, because I've noticed there's this rise in, like, asphyxiation, so the first question that I asked is like, "Why are people doing this?" So what I found is- there's, once again, not randomized control trials that we're gonna take 100 people, split 'em into two groups and you're gonna, you know... A- and so the first thing is the physiology is actually, like, fascinating. So the- I know this is gonna sound random, we don't really know exactly what's going on, but... So it's really interesting, 'cause if you look at states of meditation, right? So these are states of, like, bliss. So something changes in our brain when we're in a meditative state. Now what the hell does that have to do with asphyxiation? So one of the most common trends of esoteric and deeply spiritual meditation practices are a very low respiratory rate, right? So one practice that I did had a respiratory rate of one breath every eight minutes, so that's like, you know, the re- regular respiratory rate is 13 to 14 times a minute. So what we know is that when the brain runs out of oxygen, as long as we don't damage it, and that's the big problem with as- asphyxiation is that there's no consent, there's no preparation, people feel coerced into it. What we know in meditation is that a high CO2 level and a h- low O2 level cause alterations in the brain that will probably lead to something like a psychedelic experience, a blissful experience, things like that. So when- when we're talking about asphyxiation, something is going on in the brain where we're altering the state of consciousness, we're cutting off airflow to the- the brain. It can be lethal, it can be damaging, permanently damaging, and something can change in the brain that will enhance the experience of sexuality that is experi- that- that- people have. S- so somewhere along the way, people got into this idea. I think the other thing, the other ba- basic trend that we're seeing is that we're getting sexually desensitized. So if you look at, um, the- this is not just sexual, but like if you look at, you know, pornography, what tends to happen is what I find arousing will drift over time, so I need to watch more and more hardcore porn to get the same level of arousal. So there's also something that show- there- there's, uh, you know, studies that show that if you're vulnerable to an addiction, you're also vulnerable to risk-taking behavior. So when you take- when you engage in risk, what happens is like, I don't know if this kinda makes sense, but you know, I had a patient once who was working in a jail, and he was telling me about when he commits a crime. And what he loved... He has really bad ADHD, and what he loves about committing a crime is he is completely dialed in. Because of the risk, he has a survival reason to pay attention to every single detail. He's so focused on the task, and we know that things like flow states involve an intense amount of focus. And so when we're taking a risk, it's activating our dopamine way more. We feel, when I've talked to patients who engage in this kind of behavior, they feel the most alive because of the danger. So there's a lot of stuff that is being activated if it's done in a healthy way. Now there's all kinds of unhealthy stuff going on. Um, I think the statistics kinda speak for themselves. Like my gut check is that while everyone- it doesn't necessarily increase the risk for everyone, I think we're seeing the intersectionality of a couple of things. So the first thing is that men are angry.

Episode duration: 2:25:17

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