Watching online pornography continued to be a popular pursuit among men and women in 2017. According to PornHub\u2019s latest report, about 28.5 billion people visited the site, or an average of 81 million people per day. More than 4 million videos were uploaded and 120 million video votes were posted on Pornhub, of which nearly 80% were positive. That\u2019s a million votes more than people cast in the last U.S. Presidential election. Studies estimate 86-96% of men and slightly fewer women view pornography, although older adults have far lower rates of porn consumption. It is clear viewing online porn is a leisure activity enjoyed by millions of Americans. Research exploring the negative effects of pornography have primarily analyzed the association between exposure to pornography and a range of sexual activities deemed risky (e.g., anal sex or sex with multiple partners). A study on adolescents framed pornography as an ordinary and unproblematic component of their lives, with the only issue being an objection from parents when they found out. In this context, pornography was perceived as a leisure activity performed during free time. Participants also used pornography to explore their sexual desires, emerging sexual identities and develop new sexual techniques. For many individuals, viewing pornography may be a healthy sexual activity to facilitate solitary masturbation or enhance sexual activity. The Secondary Effects of Pornography Behavioral addictions, such as long-term, excessive reliance on pornography, can lead to neurochemical changes in the brain. The three-stage model describes addiction as a neuro-biochemically based shift from impulsive action learned through positive reinforcement to compulsive actions learned through negative reinforcement. In this model, the addictive cycle includes binge\/intoxication, withdrawal\/negative affect and preoccupation\/anticipation. When an individual compulsively views pornography online, the continued release of dopamine into the reward system stimulates changes in the brain that reinforce the experience. Although pornography addiction is not associated with the same harms of substance use disorders, it can inflict significant damage and get progressively worse. Detrimental Effects of Pornography While the precise statistics are unknown, some individuals view pornography excessively and experience difficulty controlling its use. A 2002 Kinsey Institute survey found 9% of porn viewers tried unsuccessfully to stop. Some individuals report intense urges or cravings, social-occupational impairments or relying on pornography to cope with anxiety or dysphoric moods, all of which fit within the realm of addiction. A 2015 study analyzed men with an average age of 41.5, seeking treatment for hypersexuality, who masturbated (\u201ctypically with very frequent pornography use\u201d) seven or more hours a week. An estimated 71% experienced sexual dysfunction and 33% reporting difficulty having an orgasm. Many of these men preferred online pornography for achieving and maintaining arousal to having sex with partners. In individuals reporting less desire for sex with partners, greater brain activation was seen in response to pornography. Studies have confirmed the dopamine increase resulting from watching porn potentially results in users needing an escalating degree of stimulation from real sex in order to match easily accessible porn. When one partner uses porn at a high frequency (typically men in heterosexual couples), the tendency is to withdraw emotionally from the relationship. These men report increased secrecy, less intimacy and more depression. Excessive pornography use results in increased relationship dissatisfaction among coupled men and women. Pornography may be used to feel pleasure and escape feelings of low self-esteem, anxiety, boredom and frustration. It can also lead to feelings of emptiness, despair, shame, low self-esteem and deep loneliness for both partners. Additional research is needed to better understand the psychological effects of pornography use. Many people feel ashamed and hide this until it negatively disrupts their work, romantic or social relationships. Eliminating shame and exploring underlying issues are key components of successful porn addiction treatment.