Gender differences in pornography use and sexual health outcomes: a systematic review and meta-analysis

BACKGROUND: Pornography consumption is increasingly prevalent worldwide, yet its gender-specific associations with sexual health outcomes remain poorly understood. AIM: This systematic review and meta-analysis aimed to evaluate gender differences in pornography use and its associations with sexual function, sexual satisfaction, masturbation frequency, and psychological parameters among adult men and women. METHODS: Following PRISMA 2020 statement, systematic searches were conducted across PubMed, Scopus, Cochrane Library, and Google Scholar databases up to January 2025. Eligible studies included quantitative observational research comparing male and female pornography users and assessing at least 1 sexual health outcome. Study quality was evaluated using the Newcastle-Ottawa Scale (NOS). Random-effects meta-analyses were performed to calculate pooled standardized mean differences (SMDs), mean differences (MDs), and odds ratios (ORs) with 95% CIs. OUTCOMES: Twenty-one studies involving 138 192 participants were included. Male pornography users demonstrated significantly lower sexual function (MD = -1.54) and sexual satisfaction (MD = -0.63) than female users and reported higher sexual dysfunction rates (MD = 0.88). In contrast, women showed slightly higher psychological distress (MD = 0.67), suggesting greater emotional vulnerability. Significant gender differences were also found in masturbation frequency, with men reporting markedly higher rates (MD = -1.36). RESULTS: The findings reveal a paradox where greater pornography use among men is associated with poorer sexual function and satisfaction, while women exhibit greater psychological strain despite lower engagement. CLINICAL IMPLICATIONS: These results underscore the need for gender-sensitive approaches in sexual health research and clinical practice to address the multifaceted effects of pornography consumption. STRENGTHS AND LIMITATIONS: This study represents the first meta-analytic synthesis of gender-specific pornography-related sexual health outcomes, integrating diverse international data. However, high heterogeneity, reliance on self-reported measures, and limited longitudinal evidence restrict causal inference and generalizability. CONCLUSION: The findings highlight the complexity of pornography's impact on sexual health and emphasize the need for further research to clarify these relationships and address the diverse needs of individuals in clinical settings.