Abstract
Occupational therapy practitioners are increasingly likely to encounter clients who intentionally view sexually explicit media (i.e., pornography). Pornography use may be adaptive, neutral, or maladaptive depending on several variables: whether its use is causing the client distress; whether it is affecting their daily occupations and relationships; its degree of congruence with their values; and environmental constraints, such as client privacy, isolation, and disability. In this column, we argue that all occupational therapy practitioners should be prepared to work with clients who use pornography and to recognize how pornography use as a health management or leisure activity may support or interfere with participation, routines, roles, safety, and client well-being.
In this column, we argue that all occupational therapists should be prepared to work with clients who use pornography and to recognize how pornography use as a health management or leisure activity may support or interfere with participation, routines, roles, safety and client well-being.
Sexually explicit media, also known as pornography, or porn, is now pervasive in society. In the United States, as many as 7% of men and <1% of women view pornography daily (Grubbs et al., 2022 ; Table 1). (In this column, the terms sexually explicit material, sexually explicit media, pornography, and porn are used interchangeably.) Despite laws that are intended to restrict underage access to porn, as many as 71% of youth <18 yr in the United States view it 1×/wk or more (Common Sense Media, 2022). This means that some occupational therapy clients are viewing porn. Some may be struggling with compulsive porn use, and some may even be creating sexually explicit images for personal or commercial use. Despite this, most occupational therapy professionals are undereducated about porn, its potential impact on clients, and how to engage with clients when the topic of sexually explicit media comes up during client interactions. In this column, we argue that all occupational therapy practitioners should be prepared to work with clients who use pornography and to recognize how pornography use as a health management or leisure activity may support or interfere with participation, routines, roles, safety, and client well-being.
Summary of Pornography Use: Related Statistics
What Is Pornography?
As mentioned, the word pornography refers to sexually explicit media—visual, audio, or written—that depicts sexual acts or nudity with the primary intent of sexually arousing the viewer, reader, or listener (McKee et al., 2020). In the United States, some pornography is legal, and other porn is illegal to produce, distribute, or possess. The types of pornography that are illegal to produce include videos of nonconsensual sexual assault or rape (see Crimes and Criminal Procedure, 2009, § 2242), videos that include people younger than age 18 yr (see Crimes and Criminal Procedure, 2009, § 2252), and zoophilic or necrophilic material (Holoyda, 2022; Ricardo, 2021). In addition, as of May 2025, federal law (TAKE IT DOWN Act, 2025; Pub. L. 119-12) criminalized the publication or threatened publication of nonconsensual explicit imagery, including AI-generated deepfake pornography.
How Common Is Pornography Use?
Consuming sexually explicit content is a common occupation for adults, teenagers, and older people. In 2020, as many as 7% of adult U.S. men and <1% of women reported viewing pornography daily (Grubbs et al., 2022), which is consistent with rates found in non-U.S. countries. For example, in Sweden, 17% of men and 1% of women ages 16 to 24 yr report using pornography daily or almost daily (Malki et al., 2021). In Japan, 35% of people ages 20–49 yr report using pornography at least 1×/mo (Ghaznavi et al., 2024), and a survey of more than 15,000 people in Arab nations—including Egypt, Algeria, Jordan, Morocco, and other countries—found that 43% of men and 18% of women report viewing porn 1×/wk or more (Eljawad et al., 2021).
Occupational therapy practitioners who work with the older adult population cannot assume that pornography is irrelevant to their client population. A recent convenience-sample study found that 86% of people older than age 60 yr reported that they had ever searched for pornography online (Ballester-Arnal et al., 2023), and a study of pornography use among Canadian adults age 65 yr and older found that 69% of men and 20% of women had viewed pornography online (Hardy et al., 2022).
Although distributing pornography to minors younger than age 18 yrs is prohibited in all U.S. states, the vast majority of teenagers younger than 18 yr (73% total, 75% cisgender boys and 70% cisgender girls) report that they have consumed pornography, and 54% first saw online pornography when they were age 13 yr or younger (Common Sense Media, 2022). A study of pornography viewing among youth from Greece, Spain, Poland, Romania, the Netherlands, and Iceland found that 19%−27% of youth ages 14 to 17 yr viewed pornography 1×/wk or more (Andrie et al., 2021). Meta-analyses suggest that 15% of youth younger than 18 yr have sent a sexual image, video or message (i.e., sext), and 27% have received one or more (Madigan et al., 2018); in addition, 38% of youth ages 18 to 28 yr have sent a sext, and 42% have received one or more (Mori et al., 2020). The implication is that school-based and pediatric occupational therapy practitioners are likely to encounter youth who are pornography viewers and may be asked to provide clinical expertise in situations that involve youth who are sharing or sending nude digital images, using deepfake or artificial intelligence (AI) pornography websites, or experiencing compulsive pornography use.
Potential Harms of Pornography
Pornography can be harmful to children who are not developmentally ready to see or read about people having sex (Mori et al., 2023), and for this reason multiple U.S. states and nations, including the United Kingdom, France, Germany, Australia, and Canada, have developed laws aimed at preventing children from accidentally encountering it. Occupational therapy practitioners may find it useful to review tips that promote health communication with elementary school–age children who see pornography (see Common Sense Media, 2023b) and teens and preteens who see it (Common Sense Media, 2023a).
Pornography can also be harmful to a subset of adults who develop compulsive behavior or aggressive behavior from using it (Seto et al., 2001). Approximately 11% of men and 3% of women report that they are addicted to—or feel they have lost control of their use of—pornography (Grubbs et al., 2019). Although the percentage of people who are compulsive about pornography use is far lower than what most people may believe given the surfeit of media reports about its potential to be addictive (Duffy et al., 2016), the subset of pornography users who feel their use has gotten out of control experience high levels of psychological distress (Engelhardt et al., 2025).
Pornography use also has been found to predict perceptions of a negative body image for men and women (Paslakis et al., 2022). The fact that the majority of free online pornography presents the viewer with inequities related to gender—for example, women are more likely to be the recipients of aggressive sexual acts, such as spanking, gagging, slapping, hair pulling, and choking (Fritz et al., 2020), whereas men are more likely to be the aggressive partner (Fritz et al., 2020)—coupled with the fact that young adults now report that pornography is their number one source of information about how to have sex (Rothman et al., 2021), raises the possibility that youth may be acquiring erroneous information from pornography that is leading to inequitable sexual behavior in real life (Pathmendra et al., 2023).
It is important to note that some porn is also created through exploitation, force, or coercion (U.S. Department of Justice, 2025) and that not all sexually explicit material is created ethically or depicts ethical sexual behavior. Therefore, it is understandable that occupational therapy practitioners may wonder if there is an ethical issue with any intervention that eases a client’s access to pornography or with helping a client with an occupation that also includes pornography (e.g., masturbation).
Potential Benefits of Pornography Use
Despite the harms that can arise from the use of sexually explicit media, the majority of adults who decide that they would like to view pornography are able to do so without negative consequence to their mental or physical health (Hald & Malamuth, 2008; Willoughby et al., 2016). In these cases, pornography can serve as a source of sexual knowledge; it may help viewers understand their own sexual preferences, orientations, and boundaries (Komlenac & Hochleitner, 2022) or facilitate a better sexual connection with their partners (Kohut et al., 2017). For people who are socially isolated, single, or experiencing loneliness, pornography may offer a low-risk, inexpensive, private, and accessible outlet for sexual expression (Butler et al., 2018) and promote sexual health. Evidence suggests that through masturbation, people may experience reduced stress, an improved mood, or an easier time sleeping (Shan et al., 2025; Wehrli et al., 2024).
A Framework for Occupational Therapy Practitioners to Use to Address Client Pornography Use
For the reasons we have outlined, and in line with the American Occupational Therapy Association’s (AOTA’s; 2025) Code of Ethics, occupational therapy practitioners should not judge clients because of their occupational participation or assume that all pornography use is either completely risk free or inherently detrimental. Modifying our interventions on the basis of our judgment of the perceived risk and benefits of a given occupational participation is not in line with the Code of Ethics; instead, our role is to understand the occupation and help the client work toward their goals.
Pornography use can be considered through occupation-based, functional, and contextual frameworks in occupational therapy that treat activities as factors that may support or interfere with occupational performance, participation, health, and safety depending on their meaning, patterns of use, and environmental context (AOTA, 2020; Kielhofner, 2008; Townsend & Polatajko, 2013). Pornography use may be adaptive, neutral, or maladaptive depending on whether its use is causing the client distress; whether it is affecting the client’s daily occupations and relationships; its congruence with the client’s values; and environmental constraints, such as client privacy, isolation, and disability.
As Twinley (2013) argued in her germinal work on socially and morally questionable occupations, even harmful occupations can serve social or economic functions, and the ethical practice of occupational therapy entails seeking to understand the client’s perspective and, when total abstinence is not a goal, to use the principle of harm reduction to develop safer, more ethical routines with clients.
The following are examples of questions that occupational therapy practitioners could consider exploring when they learn that a client uses pornography: ▪ How is pornography use affecting the client’s occupational balance, roles, routines, and goals (e.g., is the client scrolling porn sites as a time-passing activity or distraction, or do they use pornography every weekend as part of a self-pleasure routine)? ▪ Does the client have goals related to pornography use (e.g., would like to reduce use, would like to find ethically produced material)? ▪ Is pornography use part of a self-pleasure performance pattern (habit, ritual, routine), and does that performance pattern negatively affect the patterns related to partnered sex? ▪ Does the pornography use support stress regulation, sleep, or sexual self-expression? ▪ Are there accessibility issues related to obtaining pornography? ▪ Does it interfere with roles, relationships, or daily functioning? ▪ Are there safety or legal issues relevant to the client’s context (e.g., a 17-yr-old girl who is intellectually or developmentally disabled is sending nudes to her classmates without their consent)? ▪ How does pornography use affect the person’s sense of self, autonomy, and sexual identity, and does it enhance or diminish engagement in meaningful life roles?
Even with a limited understanding of pornography, occupational therapy practitioners can work together with a client to conduct an activity analysis and modify occupation to work toward the client’s sexuality and intimacy goals (Walker et al., 2020).
Discussion
We encourage occupational therapy practitioners to think about pornography use through the lens of daily occupation and habits. Pornography use may be meaningful, especially for people navigating disability, isolation, or limited access to partnered sex, and it may provide individuals with a sense of agency or sexual expression. There is a chance that it can become maladaptive and interfere with relationships, sexual function, sleep, productivity, or mental health—much like other occupations that, when overused or compulsive, create imbalance or harm. However, occupational therapy practitioners should be open to the fact that pornography use, like other occupations, may provide structure, purpose, or meaning to a person’s life and may be something that a client chooses to do as a meaningful occupation that supports physical, emotional, and relational goals.
As they approach pornography use as an occupation, occupational therapy practitioners can consider that it may be habitual and occur at predictable times (e.g., before sleep), or in specific contexts (e.g., when feeling stressed, lonely, or bored), and it may serve a self- regulatory function, such as helping with mood or relaxation. Moreover, pornography use may have performance patterns, such as frequency, duration, or triggers, that shape whether and how it influences daily life (i.e., positively or negatively). In other words, thinking about pornography through the lens of occupation shifts the question from “Is pornography use good or bad?” to “How is pornography use affecting my client’s occupational balance, roles, routines, and goals?” This shift allows for client-centered care.
Occupational therapy practitioners who recognize that they could benefit from more training in topics related to sexual behavior have resources and training options available. These include the Institute for Sex & Occupational Therapy (https://www.sexintimacyot.com/), which recently offered a 90-min webinar on pornography and occupational therapy. They also have the option of contacting other occupational therapy practitioners who specialize in sexuality by looking at the Certified Sexuality Occupational Therapy Practitioner directory (https://www.sexintimacyot.com/csot- directory).
According to the Code of Ethics, occupational therapy professionals must act in the best interests of clients, respecting their right to autonomy while preventing harm from occurring and preventing dangerous situations (AOTA, 2025). As such, occupational therapy practitioners who work with clients on issues pertaining to sexual health or sexual functioning, and those who work with adolescents or young adults in school- or college-based settings in particular, may find they need to seek out additional training related to sexually explicit media and relevant local laws. They may want to form a community of practice to support one another when pornography-related questions arise with clients. Understanding and addressing pornography is not always straightforward, but just as occupational therapy practitioners have grappled with how to address clients’ use of alcohol and other substances, gambling, unsafe driving, or other risky activities that affect daily functioning, they should now prepare to engage with pornography use as an occupation-related issue.
A substantial percentage of the populations occupational therapy practitioners serve are choosing to view sexually explicit material. All occupational therapy practitioners should be prepared to evaluate how clients’ pornography use may support or interfere with participation, routines, roles, safety, and well-being. Pornography use is neither inherently detrimental to all users nor completely risk free for any user. It may be adaptive, neutral, or maladaptive, and it should be considered through the lens of daily occupation and habits. Additional training and resources for occupational therapy practitioners on the topics of pornography, sex, sexuality, and intimate relationships are needed.