Women and men are different. In the striving for equal opportunity and treatment there is often confusion about equal and same, which can lead to neutering or muting constructive dialogue.
Pornography is not hard to discern—as Supreme Court Justice Potter Stewart said in 1964, “...I know it when I see it”1,2—but it can be challenging to define. From Greek words porne (prostitute) and graphein (write) pornography first appeared in the English language in 1842.3,4 It is more erotic than aesthetic in nature and can be thought of as printed, audio, or visual material containing the explicit description or display of sexual organs or activity that stimulates excitement or intense reaction, usually sexual.
The inside of a vessel matters. When we want to clean a cup, we clean the inside. If we want to know the contents of a cup we look inside or observe what is being poured into it.
What goes into the mind affects thoughts, attitudes, and behaviors. Why else would companies pay $5 million for a 30-second commercial during the 2018 Super Bowl?5 Television viewing habits are correlated with health-affecting behavior and attitudes. Adolescents 12-17 years of age who consume more sexual content on television are more likely to have an earlier sexual debut.6 In young men, higher past pornography viewing is associated with less egalitarian attitudes toward women and higher levels of hostile sexism.7
In 2013, 30% of all internet data transfer was pornography, and porn sites had more unique visitors than Netflix, Amazon, and Twitter combined.8 In 2015, PornHub, a pornography website, had 21.2 billion visits and streamed 75GB of data each second, enough to fill approximately 175 million 16GB iPhones.9 That is a lot of content being poured into a lot of cups. About 70%-80% of internet pornography viewers are male.8,9 Men and women watch different pornography. Preference for same-sex over heterosexual pornography is higher among women (21.3% of women vs 1.8% of men), and watching things they wouldn’t (or couldn’t?) do in real life is more common among men (14% of women vs 70% of men).10
Pornography promotes, exaggerates, or validates concepts such as: women are sexual objects; everyone is always ready for and wanting sex; women are valued for what they do or are willing to have done to them sexually; women are for sex; and women are trophies. Much pornography presents men expressing their physical dominance and nearly unedited or uncontrolled fantasies as always beneficial or desired without input from or regard for their female partners.
In January 2018, Dr Lawrence G. Nassar was sentenced to 40-175 years in jail for molesting girls as young as 6 years of age all under the pretense of providing medical examinations or treatments.11 Although he plead guilty to sexually abusing seven girls, more than 160 have come forward to recount their tales of horror.11 This sentencing was in addition to the 60 years he had already received in November 2017 for child pornography.11
For much of the past year, there has been a series of allegations of sexual misconduct by men against women. Sexual misconduct, ranging from words to unwanted touching to forcible rape, is nothing new. Our social and sexual histories discussions with patients have taught us that. How did something so long standing and well known become such hot news? Incidents that affect the rich and powerful get more attention. The initial person accused was a prominent, wealthy Hollywood movie producer and career maker who supported the “right” causes and people, and said the “right” things. While the scope of his deplorable behavior and sexual misconduct were prolific and ugly, that amongst his victims were many rich, prominent, white women provided necessary substrate and energy to foment a sustained negative public response and backlash.12,13
Sex-specific rates and directionality of pornography viewing and sexual misconduct, abuse, and assault are reminders: men and women may be equal, but we surely are not the same. Two dissimilar things, however, can be equally esteemed, treated, and valued. People with more than one child experience this daily: each has different strengths, weaknesses, needs, gifts, ways of bringing sorrow and joy; but all are loved and valued equally.
The realities of this present, ephemeral, sullied world have potential implications in medicine for the health of our workplace and patients. For the health of our workplace, so long as the standard is the standard, and opportunities for attaining it are equal, how one gets to it or manifests it can vary greatly. Too often people misconstrue following the path to success as meaning following in the same footsteps and trajectory. Some stride longer; some have bigger feet; some have a larger backpack; some start further above or below on the path.
That path has enough challenges; sex and gender should not be additional. Be kind, be wise, and listen. Would you want or accept your mother or daughter being treated “that” way? Would you say or do “those things” with your parents or progeny present? If a female colleague comes with a concern or negative experience, listen without interruption, judgement, or blame.
For the health of our patients, including questions about pornography in the social or sexual history can yield useful contextualizing biopsychosocial information. Perhaps physicians should ask about pornography more often, especially as part of adolescent care, mood disorders, and erectile dysfunction.
Is pornography a type of public health issue? It is more pervasive than tobacco, alcohol, drugs, and firearms, all things that have regulatory parameters on them in order to promote or protect public health and safety. One regulatory example would be to require pornography websites to be “.xxx” to make it easier for parents or anyone so inclined to erect cyberbarriers. Another would be to increase resources for research on the effects of pornography on mood and behavior and for (re)education of those whose main teacher about sex and sexuality has been pornography.
Pornography affects how young people think about sex, and how men think about and approach women.14 Most people drink alcohol without becoming alcoholics. Most people who smoke cigarettes do not get lung cancer, but the vast majority of people who get lung cancer smoked cigarettes. Regardless, in efforts to be our brother’s keeper, we take action to help prevent and treat the results of suboptimal, even self-injurious decision making in these and other areas of behavior that affect health. Just because pornography might not be not creating an army of sexual assaulters does not mean it is not negatively impacting the mind, which governs thoughts, which governs attitudes, which governs the acceptability of actions. Be it for size, rate of pour, or rate of fill, some cups are more likely to overflow their content than others. We can do more to be our brother’s and sister’s keeper.