Pornography use has been associated with negative effects on male sexual function, resulting in decreased sexual function. In addition, there is evidence that frequent pornography use may influence sexual risk behaviors, including having multiple partners and not using condoms. Given that the college phase is characterized by intense discovery and experimentation, understanding the relationship between pornography craving, sexual risk behaviors, and overall sexual satisfaction is essential for developing effective interventions to promote sexual health in this population.

To investigate the mediating role of sexual risk behaviors in the relationship between pornography craving and overall sexual satisfaction among university men.

This is a cross-sectional and online study conducted from September to November 2023 with university men in Brazil. We included cisgender and university men from Brazil and excluded women and men who reported no sexual activity in the past four weeks. Total scores on the International Index of Erectile Function (IIEF), Pornography Craving Questionnaire (PCQ), and Sexual Risk Behaviors Scale (SRBS) were used to assess overall sexual satisfaction, pornography craving, and sexual risk behaviors, respectively. The IIEF was validated in Brazilian men to assess sexual function. PCQ and SRBS are undergoing validation by our group. Mediation (model 4) analysis was conducted in IBM SPSS® v26.0 using the PROCESS macro v4.2 with pornography craving as the independent variable, overall sexual satisfaction as the dependent variable, and sexual risk behaviors as the mediator.

Seven hundred and one university men participated in the study. However, 174 (24.8%) men who had no sexual activity in the past four weeks were excluded. Thus, data from 527 university men (33.2 ± 11 years) were analyzed. Most participants lived in southern Brazil (n = 185, 35.1%), identified as heterosexual (n = 312, 59.2%), had a partner (n = 392, 74.4%), did not have a medical diagnosis of anxiety (n = 411, 78%) and depression (n = 476, 90.3%), were non-smokers (n = 422, 80.1%), and drank alcoholic beverages less than once a week (n = 230, 43.6%). There was a significant mediating effect (ß?=?0.008, 95% BCa CI 0.001; 0.028) of the sexual risk behaviors in the relationship between pornography craving and overall sexual satisfaction among university men. A direct effect of pornography craving on overall sexual satisfaction was also observed (ß = -0.152). The mediated proportion (%) of the model was 62%.

Sexual risk behaviors partially mediate the relationship between pornography craving and overall sexual satisfaction among university men. Higher pornography craving may lead to increased sexual risk behaviors, negatively affecting satisfaction. Future studies should use longitudinal designs to establish causality and explore additional mediators, such as emotional well-being and relationship quality.

These findings highlight the need for interventions promoting sexual health in university settings. Physiotherapists and other health professionals can integrate these insights into educational programs addressing pornography use and its impact on sexual behaviors. Public health policies should consider strategies to reduce risk behaviors and enhance sexual well-being through awareness campaigns and targeted interventions.