Over the past two decades, the internet has allowed instant access to a wide variety of content, including sexual content that portrays a variety of sexual activities such as masturbation, oral sex, vaginal and anal intercourse, and group sex. During the normal sexual developmental phase (usually between the ages of 9 and 16 years), one of the most common sexual activities is consumption of pornography, either intentional or accidental exposure. In the United Kingdom, 53% of adolescents aged 11 to 16 years have seen online pornography at least once, and the vast majority have viewed pornography before the age of 14.2 In the United States, 20% to 30% of children aged 10 to 12 years have reported some exposure to pornography.3
In most cases, consumption of pornography does not promote the development of mental health disorders and reflects a normal exploration of sexuality.4 However, in 10% to 18% of all adolescents, consumption of pornography reflects compulsive sexual behavior. The disorder is characterized by extensive pornography use and masturbation, use of paid sexual services, risky sexual behaviors, and an intense preoccupation with sex. These behaviors often lead to impaired social or occupational functioning, distress, and negative affect.
How can we identify compulsive sexual behavior among adolescents? And, what are the best practices to treat compulsive sexual behavior?
Human beings are sexual and beginning in childhood are capable of sexual responses.4 Many youngsters report experiencing sexual interest, arousal, and desire before puberty around the age of 10 years, when adrenal glands mature. Adolescence marks the onset of considerable changes in sexual and reproductive maturity that coincide with significant changes in cognitive, emotional, and social functioning.
The progression of sexual events among adolescents follows a fairly consistent sequence: kissing and holding hands, breast and chest fondling, manual genital contact, touching under clothes or without clothes, touching genitals directly, oral sex, and penile-vaginal intercourse. Sometimes these are followed by less common variations, such as anal sex. Although most adolescents show a normal sexual development, some develop compulsive sexual behavior.
Dr Efrati is Founder and Head of the Israeli Center for Healthy Sexuality, and Assistant Professor, Beit-Beri College, Kfar Saba, Israel. He reports no conflicts of interest concerning the subject matter of this article.
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