Alvin Cooper and Coralie R. Scherer Sylvain C.

Boies
San Jose Marital and Sexuality Centre Stanford University

Barry L. Gordon
Petaluma, CA

A growing number of clients are presenting in therapy with problems related to their on-line sexual
habits. Adults who had used the Internet for sexual pursuits at least once (N = 9,177) completed a
59-item on-line survey. Men and women generally behaved differently, and most (92%) indicated their
on-line sexual behaviors were not problematic. Heavy users (8%) reported significant problems typically
associated with compulsive disorders. Problems were highly correlated with time spent on-line for sex.
Results are discussed in terms of their research and practice implications, including diagnosis and
treatment. Recommendations are made for outreach prevention programs and future policies.

Use of the Internet and the amount of time people are spending problem? Do you know enough about sexual behavior on the
on-line for work, school, and recreation is exploding. As people Internet—where people go, what they typically do, and how they
devote increasing amounts of time to this "cyber-dimension," do it?
professional psychologists and other social scientists are question- There is an almost unlimited amount of information available to
ing how this technology affects interpersonal communication and be accessed on the Internet, and a sizable chunk of it is related to
behavior (Kandell, 1998; Turkic, 1995). More important, for us as sexuality. In fact, sex is the number one searched topic on the
clinicians, it seeks to answer the question of how this technology Internet (Cooper, 1998; Freeman-Longo & Blanchard, 1998).
affects us and our clients. With an estimated 9 million people From the Internet's earliest days, sites for sexually explicit mate-
logging on daily and a 25% increase in growth every 3 months rial quickly took root and flourished. This situation led to questions
(Cooper, 1998; Fernandez, 1997), you probably have noticed In- of regulation and controversy, including attention from the U.S.
ternet references cropping up with your clients—or you will soon. government. Nevertheless, people continue to use on-line services
If a husband were to drag his wife into your office because he to pursue their sexual interests and to make contact with others for
was upset she spends their "together time" corresponding with her a multitude of sexual agendas. For example, it was recently esti-
pals in sexually oriented chat rooms instead of paying attention to mated that during the month of April 1998, the five most fre-
him, what would you think? Would you be able to distinguish quently accessed sexually oriented adult Web sites had roughly 9
"normal sexual exploration" from a deeper "sexual acting-out" million visitors, which represents 15% of the 57 million Americans
in the universe of World Wide Web (WWW) users (Goldberg,
1998a).
ALVIN COOPER received his PhD from Texas Tech University. He is the
clinical director of the San Jose Marital and Sexuality Centre, Santa Clara,
CA, as well as Coordinator of Training in the Department of Counseling Diverging Views of Internet Sexuality
and Psychological Services, Stanford University. His research interests
include sexuality and the Internet and sexual compulsivity. Two major positions appear to have developed among scholars
CORALIE R. SCHERER received her PhD from the University of Florida. She and laypeople on Internet sexuality. The first position to emerge
is a staff psychologist at the San Jose Marital and Sexuality Centre, Santa was that Internet sexuality is pathological. This perspective is
Clara, CA. Her research interests include sexuality and the Internet and consistent with a medical model and tends to focus on addiction
women's issues. and compulsivity (Bingham & Piotrowski, 1996; Durkin & Bryant,
SYLVAIN C. BOIES is a postdoctoral fellow in the Department of Counseling 1995; Van Gelder, 1985; Young, 1997). The second position
and Psychological Services, Stanford University. His research interests regards on-line sexuality as more adaptive, emphasizing sexual
include sexuality and the Internet and issues of sexual diversity.
exploration and relatedness (Cooper, 1998; Cooper & Sportolari,
BARRY L. GORDON received his PhD from the University of California at
1997; Leiblum, 1997).
Riverside. He is a clinical and consulting psychologist who practices in
Petaluma, CA. His research interests include sexuality on the Internet and
compulsive Internet use. The Pathological Perspective on Internet Sexuality
CORRESPONDENCE CONCERNING THIS ARTICLE should be addressed to Alvin
Cooper, San Jose Marital and Sexuality Centre, 100 North Winchester The first studies of Internet sexuality, or "cybersex," empha-
Boulevard, Suite 330, Santa Clara, California 95050. sized the pathological aspects of sexual behavior. Durkin and
154
 SEXUALITY ON THE INTERNET 155

Bryant (1995) focused on the use of the Internet for criminal and exercised in generalizing these traits to all users of on-line sexual
deviant behavior. They distinguished various motivations for sites. The researchers studied very few individuals and they dealt
erotic computer communication, from mild flirtations to seeking with very specific issues, from obsessive bondage fantasies to
and sharing information about sexual services to frank discussions developing on-line love affairs. Nevertheless, this cluster of qual-
of specific deviant sexual behavior. They posited that cybersex ities offers intriguing possibilities.
allows a person to operationalize sexual fantasies that would Mental health professionals continue to debate whether the
otherwise have self-extinguished if it were not for the reinforce- concept of addiction can be appropriately applied to the realm of
ment of immediate feedback provided by on-line interactions. In a sexuality. Carnes, a prominent figure in the treatment of sexual
similar way, Van Gelder (1985) pointed out the dangers of Internet addiction, estimated that between 3 and 6% of the general popu-
communication being used to obtain child pornography, to contact lation might be deemed to be sexual addicts (Carnes, 1991; E.
youngsters, or to misrepresent one's sexual identity (with either Coleman, personal communication, 1998; Schneider, 1991). Le-
harmless or malevolent intent). vine and Troiden (1988) and Coleman (1991), supporters of the
As the Internet gained popularity and cases of excessive use concept of sexual compulsion, were cautious. They wanted to limit
were reported, researchers became interested in studying the ad- the application of the concept to behavior that is in conformity
dictive (including sexually addictive) potential for its use (Young, with current social mores and customs in order avoid stigmatiza-
1996, 1997; Young & Rogers, 1998). Internet addiction, as it is tion of patients. Their caution seems warranted in light of research
often called, usually implies a psychological dependence on the that indicates that therapists' initial assessment of sexual addiction
Internet that is characterized by an increasing investment of re- may be influenced by a number of variables, including their
sources in related activities, unpleasant feelings when off-line, values, religiosity, and gender (Hecker, Treppe, Wetchler, & Fon-
increasing tolerance to the effect of being on-line, and denial of the taine, 1995).
problematic behavior (Kandell, 1998). Depression was found to be Addiction and compulsion remain two leading models in sexual
a significant factor in the development of pathological Internet use behavior research. A measure of sexual compulsivity (Kalichman
(Young & Rogers, 1998), and it was suggested that excessive use & Rompa, 1995) was found to be positively associated with
may be related to psychological difficulties stemming from social loneliness, low self-esteem, and lack of sexual self-control. These
isolation (Leiblum, 1997). descriptors are consistent with clinical and theoretical portrayals of
Young (1996) studied Internet addiction over a 3-year period. persons with sexual addictions (Carnes, 1991). Recognizing the
She modified the Diagnostic and Statistical Manual of Mental value of this relevant body of research, in this study we collected
Disorders, fourth edition (DSM-IV; American Psychiatric Asso- data on factors reflecting some of the assumptions associated with
ciation, 1994) criteria for pathological gambling and in so doing these findings that are also reflective of the addiction and com-
was able to identify 396 "addicts." She found that the addicts in her pulsion models.
sample used the Internet an average of 38 hr per week for nonac-
ademic and nonprofessional purposes. This use, in turn, caused An Adaptive Perspective: Sexual Expression
detrimental effects in their performance in academic and profes-
sional spheres. "Nonaddicts" were found to use the Internet an A few authors recently presented more adaptive views of the use
average of 8 hr a week without reporting significant consequences. of the Internet for sexual purposes. Newman (1997) argued that the
Young (1997) identified three psychological reinforcements un- creation of the "information superhighway" offers new ways to
derlying computer mediated communication: social support, sex- candidly discuss sexuality. He gave as an example a situation in
ual fulfillment, and creating a persona. She found that dependent which one partner in a couple wants to take part in a sexual activity
individuals predominantly used the highly interactive features of that is met with reluctance by the other partner. He suggested that
the Internet to meet, socialize, and exchange ideas with new the information available to both partners on the Internet can
people. In contrast, nondependent individuals primarily used the normalize sexual desire and inform their ongoing discussions.
Internet to gather information and to maintain preexisting relation- Framing sexual interactions within the context of relatedness,
ships through electronic mail. These findings suggest that the use Cooper and Sportolari (1997) examined the notion of romance in
of particular types of media may be associated with pathology. cyberspace. They coined the term "computer mediated relating"
The attitudes individuals hold about computer use for sexual and (CMR) to describe the interactions taking place through the use of
romantic purposes appear to parallel closely those they hold to- electronic mail (E-mail). They identified a number of positive
ward sexuality in general. Cyberspace sexuality seems to be re- aspects to this type of relating, including, most notably, a reduction
garded by both mental health professionals and laypersons with a in the role that physical attributes play in the initial decision to
measure of trepidation—that too much of a good thing might be pursue a relationship. Cooper and Sportolari argued that these
detrimental. This wariness seems to extend to commonly accepted exchanges can promote and support focus on common interests,
concepts that are used in research on sexuality. values, and emotional intimacy over the more typical focus on
Bingham and Piotrowski (1996) first applied the notion of physical attractiveness.
addiction to users of sexual Internet sites. They included 6 indi- Leiblum (1997) viewed cybersex as a type of sexual expression
viduals diagnosed as "addicted to cybersex" in an outpatient that ranges along a continuum from simple curiosity to obsessive
community-based treatment for sex offenders. The researchers involvement. For the people or their partners who seek therapy for
identified four common characteristics in these 6 individuals: sexual concerns, on-line sexual pursuits are often part of a con-
inadequate social skills, engagement in sexually explicit fantasies, stellation of issues linked to social isolation and having an unsat-
communication with a figment of their imagination, and an inabil- isfactory life. She distinguished three composite clinical profiles of
ity to control the urge to engage in cybersex. Caution should be persons who experience problems with cybersex. The first profiled
156 COOPER, SCHERER, BOIES, AND GORDON

group she called "loners," which comprises persons for whom and use adult-only resources (Morahan-Martin & Schumacher, in
cybersex represents an accommodation to problematic or impov- press). In a similar way, multiple user domains (MUDs; compet-
erished life situations of either short or long duration. The second itive, aggressive, and action-oriented games) were found to be
category she called "partners" because the involved persons are primarily used by males. Morahan-Martin (1998) offered that the
part of a couple. One partner's involvement with cybersex causes proportion of male-to-female users (Nua, 1998) has changed in the
relational or sexual difficulties. The third group she called "para- last 4 years. In 1994, men outnumbered women 20:1. The gap has
philics" because they are dependent on cybersex to supply them been reduced to a ratio of 2:1. Morahan-Martin argued that this
with a source of stimulation and satisfaction for their unconven- difference is due in part to the fact that the on-line culture is
tional sexual predilections and behaviors. masculine and that attitudes toward technology are transferred to
It appears that Internet users access sexual sites for many the use of the Internet.
different reasons and purposes. The above theoretical arguments
and clinical observations remain to be investigated and supported The MSNBC On-Line Sexuality Survey
empirically. There is an important gap in knowledge about Internet
users who access sexual sites, which could be partially filled by Measures
collecting, describing, and examining data on these individuals.
Assuming that all individuals who access sexual sites are dealing Our study attempted to expand significantly our knowledge base
with pathological issues would be an error. A more open, sex- of who goes on-line for sexual pursuits, where they go, and
positive stance that considers on-line sexual behavior as ranging whether it seems to be causing problems in their lives. It is an
along a continuum from "normal" to "problematic" expression attempt to understand and predict possible implications of choices
increases the likelihood of capturing a greater understanding of they may make. A 59-item questionnaire was designed to survey
this new twist in age-old human behavior. users of sexual Internet sites about their on-line preferences and
motivations, including age, gender, occupational status, sexual
orientation, current relational status, on-line sexual pursuit behav-
Computer-Mediated Survey Research
ior, frequency of specific sexual pursuit behaviors, preoccupation
The use of the Internet for sexuality survey research is a new with being on-line, feelings experienced while on-line, the degree
idea. It raises at least two important questions: Are the data to which they present themselves differently from the way they
gathered reliable? How will the measurement of the WWW audi- actually are, and measures of propensity to engage in novel or
ence affect research conclusions? With the exception of one study risky sexual behaviors.
(Yates, Wagner, & Surprenant, 1997), which found that college
students reported significantly more sexually risky behaviors when Recruitment and Programmed Safeguards
reporting on paper questionnaires than on a simple computer
network, studies support the use of this modern technology. Other Announcements of the survey were made on the front page of
studies using computer-mediated technology to assess psychopa- the MSNBC Web site, the on-line presence (or "gateway") of a
thology or measure risky sexual behavior have found that adoles- major U.S. news organization. Media interest in the survey re-
cents and adults respond as or more truthfully using a computer sulted in interviews and stories on NBC, MSNBC, and ABC
than they do either face-to-face (Hasley, 1995; Kobak et al., 1997a; television networks as well as several major newspapers, which
Locke et al., 1992; Millstein & Irwin, 1983), over the telephone then resulted in a serendipitous secondary recruitment. Individuals
(Kobak et al., 1997b), or on paper-and-pencil questionnaires who visited the MSNBC Web site were invited to participate in
(Locke et al., 1992; Millstein & Irwin, 1983; Turner, Ku, Lind- this study by accessing the survey located at a specific Internet
berg, Pleck, & Sonenstein, 1998). Thus, it seemed the next logical address. Those who chose to do so had electronic access to an
step was to inquire about on-line behavior by conducting a study interactive Web page containing informed consent and the 59-item
on-line. questionnaire. Participants were instructed to answer each item and
to submit their completed questionnaires electronically. Program-
Profiling: An Inclusive Approach for Studying ming precautions were taken to prevent multiple submissions of
Internet Sexuality the survey by each respondent. The MSNBC server initially as-
signed a globally unique identifier (GUID) number to each partic-
Very little empirical data exists on the characteristics or moti- ipant that was stored as a cookie in his or her Web browser
vation of individuals who access sexually explicit sites. There is program for the duration of the survey. GUIDs were included in all
some sense that Internet users are likely not to constitute a unitary submissions and were subsequently used to identify multiple sub-
group but rather to form diverse subgroups. There is clear evidence missions of the survey by individual respondents. A hidden source
that gender constitutes a variable that distinguishes users of sex- code was used to block multiple submissions and also to load a
ually explicit Internet sites. Males have been found to make up Web page reading "Sorry you can only vote once"; however, a
two thirds of users and account for 77% of on-line time (Com- determined user would have been able to submit more than one
merceNet/Nielsen Media, 1998). They go on-line on a daily basis survey from different computers (e.g., both work and home).
more frequently than females (Graphics, Vizualization and Usabil- All respondents were volunteers and remained anonymous. Re-
ity Center, 1997) and feel more competent and comfortable using sponse sets were stored in an appended database linked to the
the Internet than women (Atwood, 1996). Men use the Internet for MSNBC server. The final data were electronically transferred in
a wider variety of reasons and are more likely to use the Internet text delimited format using a file transfer protocol (FTP) client and
for recreational purposes; that is, to gamble, unwind, play games, imported into a Microsoft Access 7.0 database. Statistical analyses
 SEXUALITY ON THE INTERNET 157

were completed using SPSS 8.0 software running under Win- Although a much larger percentage of respondents were males
dows 95 on a Pentium 233 MMX platform. (86%), they had demographic data similar to those of men who
visited the MSNBC.com Web site. Table 1 shows that the age
distribution of male respondents did not significantly differ, ^(1)
Validity and Reliability
= 5.66, p < .06, ns from Goldberg's (1998b) estimates of adult
Because all participants were completely anonymous, a rigorous male visitors to the MSNBC.com Web site. Female respondents
screening protocol was designed to increase the validity and reli- were younger than women in the estimated population, and nearly
ability of the results. Data were collected over a 7-week period twice as many (59% vs. 34%) fell into the 18-to-34-years-old age
during March and April 1998, and a total of 13,529 surveys were range (Goldberg, 1998b). Demographic profiles of visitors to the
returned. All questionnaires were verified to help ensure their adult-oriented websites (Goldberg, 1998a) were also very similar
authenticity and appropriateness. Approximately 8% (n = 1,152) to the respondent data, including the percentage of men (88%) and
were initially eliminated because they were (a) determined to be frequency of 18-to-34-year-old women (53%). Although the nature
multiple submissions (n = 354); (b) submitted by respondents of self-selected surveys limits generalizing results to the entire
reportedly under 18 (n = 555) or over 90 years of age (n = 12); population of Internet users, the above data increase confidence in
(c) found to have inconsistent responses between critical items our overall findings and demonstrate that on the Internet—as well
(n = 82); or (d) submitted with all items left blank (n = 149). as elsewhere in our society—men are the largest consumers of
Again, to be conservative, the decision was made to analyze sexually explicit material.
data only from submissions that were complete. Thus, an addi-
tional 3,200 (24%) questionnaires were eliminated because they Effects of Large Sample Size
had 1 to 46 blank items. The final sample consisted of 9,177
individuals with complete responses. A frequency analysis re- Because the final sample of respondents to the survey was still
vealed that 87% (n = 2,779) of the discarded surveys had 1 to 5 very large (N = 9,177), attention was paid to the possibility that
blank items. These were compared with the final sample to ensure trivial differences could possibly reach statistical significance
that it was representative of all participants in the survey. Overall, when analyzed. Despite the large size of the sample, many vari-
both groups were similar or identical across a variety of important ables had extremely small variances. ANOVAs and conservative
demographic and behavioral variables. The discarded group had post hoc analyses (Scheffe, Bonferroni) were used whenever pos-
slightly fewer males (84%) than the selected group (86%), which sible to control for sample size effects.
was probably significant, A^(l) = 10.87, p < .01, due to effects of
large sample sizes. Two-way analyses of variance (ANOVAs; A First Look at the Results
Gender X Selection) and Bonferroni post hoc analyses revealed no
significant age differences between females (p < .09) and only As previously discussed, male respondents (86%) outnumbered
a 2.5-year age difference between males (p < .01). There were female respondents (14%) by a ratio of 6:1. The average overall
also no significant differences between samples in measures of age of the sample was 34.96 years, SD = 11.62 years. Men were
sexual orientation, ;^(2), = 4.52, p < .10, ns, professional occu- slightly older (35.34 years, SD = 11.79) than women (32.60 years,
pational status, ^(1) = 2.96, p < .10, ns, or Internet access SD = 10.24). Most participants (87%) identified themselves as
location ^(3) = 4.17, p < .24, ns. There was a small difference heterosexual, 7% identified themselves as gay or lesbian, and 7%
in current relational status, ,^(3) = 7.73, p < .05, due to slightly labeled themselves as bisexual. Most individuals (64%) were ei-
more males (4%) being married in the discarded group. ther married (47%) or in a committed relationship (17%). Of the
single individuals (36%), half were dating (18%), and half were
not dating (18%).
Self-Selection and Sample Bias A majority of respondents (59%) worked in professional occu-
pations that include the computer field (24%), educator (2%),
Because this study was based entirely on voluntary responses health care provider (3%), management (10%), and professional
from self-selected visitors to the MSNBC.com Web site, we con- (20%). Thirteen percent of respondents were students, and 2%
sidered possible sample bias. For example, individuals who chose were unemployed. The remaining 27% were distributed similarly
to participate might have been heavier users of the Internet in among various occupations, including clerical, industrial, trades,
general or have had greater interest in the sexual aspects of the
Internet. This would not make their responses inherently unreli-
able, but it could skew the final sample and possibly diminish the
responses' usefulness as indicators of widespread Internet user Table 1
behavior. To further assess the possibility of self-selection bias, Gender and Age Ranges in Goldberg and Survey Samples
demographic data of the 9,177 respondents in the final sample During April 1998
were compared with a parallel random sample of 3.8 million
estimated visitors to the MSNBC.com Web site during April 1998 Goldberg sample Online survey sample
(Goldberg, 1998b). Respondents were also compared with a par- Age range Males Females Males Females
allel sample of 9.6 million estimated visitors to the five most
frequently accessed sexually oriented adult Web sites during the Ages 18-34 43.0% 34.1% 45.6% 58.8%
identical time period (Goldberg, 1998a). They were found to be Ages 35^9 38.0% 43.3% 36.5% 35.5%
Ages 50+ 19.0% 22.6% 17.9% 5.7%
similar in a number of important measures.
158 COOPER, SCHERER, BOIES, AND GORDON

and sales. A much higher ratio of males had professional or overwhelming majority (92%) spends under 11 hr per week in
managerial positions (40%) or were in the computer field (2:1). on-line sexual pursuits. Of those, almost half (47%) report spend-
Most individuals reported that they go on-line for sexual pur- ing less than 1 hour a week on-line for sexually related activities.
suits by using a computer at home (78.8%); 5.8% admitted using Less than 8% of the sample spends 11 or more hr per week
an office computer, and 12.7% said they do so both at home and engaging in on-line sexual activities. Thus, on the dimension of
at the office. Less than 3% indicated going on-line for sexual time on-line, most people appear to be very capable of limiting
pursuits in other settings. Women are more likely (84%) than men their on-line time in sexual pursuits to reasonable levels.
(78%) to sign on at home, ^(1) = 24.07, p < .0001. More men Most people (61%) admitted pretending occasionally (48%) or
(6%) than women (5%) go on-line at work, ^(1) = 5.06, p < .05, often (20%) to be a different age than they are. Despite the popular
or both at home and at work (men = 14%, women = 7%), ^(l) conception that "gender bending" is a pervasive activity, it was
= 40.31, p < .0001. More women (4%) than men (3%) indicated found to be a fairly unusual event. Only 5% of the sample indi-
signing on in settings other than at home or at the office, )f(l) cated pretending to be a different gender, and most of them (4%)
= 15.04, p < .001. The finding that 1 out of 5 individuals sign said that they do so only occasionally. Less than half of the
onto sexually related sites through their office computer does not respondents (38%) said they present themselves as a race different
necessarily indicate excessive use. For some individuals, their than their own on occasion (27%) or more often (11%). A small
office computer may be their only connection to the Internet. yet considerable proportion of respondents (14%) reported mis-
Strong gender differences for preferred on-line media were representing themselves on other unidentified factors.
evident, with men most preferring Web sites featuring visual Almost 3 out of 4 respondents (70%) indicated keeping secret
erotica (50% men to 23% women), ^(l) = 331.33, p < .0001, and from others how much time they spend on-line for sexual pursuits.
women favoring chat rooms (49% women to 23% men), ;^(1) = Significantly more men (72%) than women (62%) reported keep-
377.42, p < .0001. It is significant that 51% of women reported ing their time involvement secret, ^(l) = 46.64, p < .0001.
they never download sexual material. Women, on-line as else- People appear to use sexual material on the Internet in much the
where, prefer more interaction and the development of relation- same ways they generally use sexual stimuli in our society—as a
ships and seem to be less interested in visual stimuli (Web sites) source of entertainment more than for sexual release (analogous to
alone. This is consistent with the position expressed by Bailey, reading a Playboy issue or viewing Baywatch). Most participants
Gaulin, Agyei, and Gladue (1994) that differences exist between reported their on-line sexual experiences to be satisfying but not
genders on relevant aspects of human mating psychology, namely, particularly arousing. Whereas 88% of the sample experienced
response to visual cues. some form of excitement when pursing sexual interests on-line,
Individuals were asked to report the total number of hours they few of them (20%) felt both excited and aroused. Only 16% were
spend on-line per week for various purposes. The most frequent never satisfied with their experience, and most (87%) reported
response was between 1 and 10 hr a week (30%). Less than 3% never feeling guilty or ashamed about it. Significantly more men
reported going on-line for less than 60 min per week. This was not (84%) than women (80%) reported being satisfied to some degree
surprising considering that the survey was conducted on-line. with their on-line sexual pursuits, ^(l) = 13.53, p < .001.
Almost one third (27%) said they spend between 11 and 20 hr a As previously reported by Gaither, Franklin, Hegstad, and Plaud
week on-line, and 20% reported being on-line for 21 to 30 hr a (1997), significant differences were found between men and
week. Approximately 5% (5%) spend between 41 and 50 hr women on the three variables reflecting risk-taking characteristics.
on-line. Only 3% spend between 51 and 60 hr on-line, and 5% Men (M = 29.12, SD = 6.24) had significantly higher sexual
indicated they sign on for more than 60 hr a week. The distribution risk-taking (SSS) scores than women (M = 27.43, SD = 6.45),
of frequencies between genders was similar. Thus, 3 out of 4 F(l, 9175) = 83.37, p < .0001. In a similar vein, men (M = 24.43,
people spend between 1 and 30 hr a week on-line for work-related SD = 6.62) had significantly higher nonsexual risk-taking (NES)
and recreational activities. scores than women (M = 22.38, SD = 6.78), F(l, 9175) = 105.12,
Despite previous research and speculation, our data clearly p < .0001. Men also had significantly higher sexual compulsivity
found that going on-line for sexual pursuits did not lead to heavy (SCS) scores (M = 17.79, SD = 6.11) than women (M = 16.59,
use for the vast majority of people. Table 2 reveals that an SD = 6.32), F(l, 9175) = 42.25, p < .0001. The SSS and SCS

Table 2
Time Spent On-Line for Sexual Pursuits by Males and Females

Hours per week spent on-line for sexual pursuits

Gender <1 1-10 11-20 21-30 31-40 41-50 51-60 61-70 71-80+

Male
N 3,581 3,668 446 115 27 15 8 6 31
Percent 45.3 46.4 5.6 1.5 0.3 0.2 0.1 0.1 0.4
Female
N 696 467 70 13 15 10 2 2 4
Percent 54.5 36.5 5.5 1.0 1.2 0.8 0.2 0.2 0.3
Total 4,278 4,135 516 128 42 25 10 8 35
Percent 46.6 45.1 5.6 1.4 0.5 0.3 0.1 0.1 0.4
 SEXUALITY ON THE INTERNET 159

scores in this study were about 20% higher and the NES scores Table 4
were about 10% lower than Gaither reported with his college-aged Risk and Distress Scores as a Function of Time Spent On-Line
sample. This probably reflects higher sexual seeking behavior for Sexual Pursuits (TOS)
(SSS and SCS) and age (35 compared with 19 years old for the
average ages) among the on-line users. Low Moderate Heavy
users users users

Score M SD M SD M SD
A Second Look at the Data
SSSS 27.3 6.3 29.9 5.9 32.2 6.3
The sample was divided into three groups representing their NSSS 23.7 6.7 24.4 6.5 25.3 6.9
time spent on-line for sexual pursuits (TOS). Low users (LU) spent SCS 16.4 5.6 18.3 6.0 21.1 7.5
less than 1 hr/week TOS, moderate users (MU) spent 1-10 hr/week Distress 4.0 1.8 4.5 2.0 5.4 2.7
TOS, and heavy users (HU) spent 11-80+ hr/week TOS. Ninety-
Note. SSSS = Sexual Sensation Seeking Scale; NSSS = Nonsexual
two percent of respondents were classified either as LU (46.6%) or Sensation Seeking Scale; SCS = Sexual Compulsivity Scale.
MU (45.1); only 8.3 were classified as HU.
Table 3 summarizes group differences on demographic vari-
ables. Gender ratios and ages did not differ between groups, F(2, the MU group reported more, and the HU group reported the most
9171) = 1.43, p < .24, ns, although men were slightly older than distress.
women, F(2, 9171) = 5.60, p < .004. LU groups reported having Most respondents (68.2%) said that their on-line behavior does
the most marriages and committed relationships, MU groups had not interfere with, nor does it jeopardize (78.8%), any areas of their
fewer, and HU groups reported having significantly fewer mar- lives. Table 5 illustrates that the use of computers both at work and
riages and committed relationships, x*(2) = 15.85, p < .0004. A at home to access the Internet also increased with TOS. In other
similar pattern was revealed with reported levels of interference, words, heavy users were more likely to go on-line for sexual
X*(5) = 38.02, p < .0001, and jeopardy, ^(5) = 24.09, p < .0002, pursuits using computers at home and at work compared with
in the lives of respondents, such that the LU group reported aspects moderate and low users. The use of chat rooms and news groups
of their lives were least interfered with and least jeopardized, the also increased with TOS use, reflecting that heavy users are more
MU group reported more so, and the HU group reported the most likely to choose these media than the two other groups. It should
as TOS increased. Table 4 shows that SSS, NES, and SCS also be noted that sexually oriented USENET newsgroups are fre-
increased with TOS. Two-way ANOVAs (TOS X Gender) and quently used to both post and download visual erotica.
Schefee post hoc analyses revealed significant differences between Factor analysis was performed on 16 items relating to re-
groups (p < .001) for all three measures of risk taking behavior spondents' experiences both on-line and off-line. Principal-
(LU < MU < HU). components analysis and varimax rotation revealed four factors
When asked directly, most people who accessed sexual Internet that had eigenvalues greater than 1.00 and accounted for 57.3%
sites did not report being distressed by their on-line behavior. Only of the total variance. These factors are shown in Table 6 and
12% of the sample indicated perceiving themselves as download-
ing sexual material too often.
Multiple regression of several items in the SCS scale indicated 8.00
that they were strong predictors of TOS, R = .23, F(3, 9173) =
166.19, p < .0001. A distress score was computed by summing the
responses to the three items and is shown in Table 4. Linear
regression of distress scores as a function of TOS was highly
significant, F(l, 9175) = 428.77, p < .0001, as shown in Figure 1. 7.00-
Two-way ANOVAs (TOS X Gender) and Scheffe post hoc anal-
ra
yses of distress scores revealed significant differences among the o
three groups, which is consistent with the three Kalichman scales
discussed earlier such that the LU group reported the least distress, J! 6.00
5
10
0>
Table 3
Demographic Data as a Function of Time Spent On-Line 5.00
for Sexual Pursuits (TOS)

Category Low users Moderate users Heavy users

N 4,278 4,135 764

4.00
Males (%) 83.7 88.7 84.8
Age (years) 35.4 34.5 35.1 <1 1-10 11-20 21-30 31-40 41-50 51-60 61-70 71-80 80+
Married-committed (%) 65.8 63.4 58.6 Time Online for Sexual Pursuits (hrs/wk)
Not interfered (%) 77.4 62.2 49.0
Not jeopardized (%) 84.0 76.0 65.1
Figure I. Distress score as a function of time on-line for sexual pursuits.
160 COOPER, SCHERER, BOIES, AND GORDON

Table 5 Persons who spend large amounts of time on-line report more
Log-On Location and Preferred On-Line Medium as a Function perceived problems. A significant correlation was found between
of Time Spent On-Line for Sexual Pursuits (TOS) time spent on-line for sexual pursuits and negative effects on one's
life. The HU group preferred chat rooms to Web sites and reported
Low Moderate Heavy higher frequencies on items that "most interfered" with and "most
Variable users (%) users (%) users (%)
jeopardized" important aspects of their lives. This finding has also
Log-on location been reported in recent studies, suggesting that for both men and
Home 81.2 77.4 72.4 women the most powerful and potentially problematic types of
Work 7.0 5.2 2.2 interactions take place in chat rooms with other Internet users.
Home and work 7.3 16.0 24.5 The finding that heavy users from both genders use chat rooms
Other 4.4 1.3 0.9
On-line medium more than average users suggests that high use is associated with
WWW 47.4 47.1 33.6 greater interaction with other Internet users. The relationship be-
Chat rooms 23.4 27.6 37.0 tween these two variables seems to corroborate an association of
Newsgroups 9.5 14.4 15.7 sexually compulsive or addictive behavior with social isolation
E-mail 10.9 6.5 6.7
Other 8.8 4.4 7.0 (Leiblum, 1997). It presupposes that individuals are motivated by
a need for greater social contact, which is consistent with Young's
Note. WWW = Worldwide Web. (1997) position that social support and sexual fulfillment serve as
psychological reinforcements underlying computer-mediated
communication.
were named to reflect the items clustered within them. Factors The association between high use and interaction appears to be
include Reflection (eigenvalue = 4.47, 27.9% of variance), less strong for women, however. HU women were found to use
Action (eigenvalue = 2.00, 12.5% of variance), Arousal (eig- Web sites twice as much as MU women. Thus, it seems that other
envalue = 1.58, 9.9% of variance), and Excitement (eigen- variables mitigate this relationship in women. One possibility is
value = 1.12, 7.0% of variance). The factors are discussed in that women who visit Web sites are more responsive to visual
detail in the Implications and Applications sections following. cues, a quality often attributed to men's sexuality. This is of
In general, people appear to have different experiences or be particular interest when one considers that younger women repre-
involved in various psychic operations while pursuing sex on sented a significant proportion of our sample. It suggests that
the Internet. younger women may feel freer to explore that aspect of their
sexuality.
These findings lead to a number of important conclusions. The
Implications
vast majority of on-line users generally seem to use Internet sexual
Internet communication might be reflective of the demands of venues in casual ways that may not be problematic. However, the
an increased pace and intensity that individuals in our society strong correlation between time spent on-line for sexual pursuits
experience. Computers, the Internet, and E-mail allow for easy and measures of distress, of sexual compulsivity, and of sensation
access to vast stores of information as well as the ability to have seeking (sexual and nonsexual) suggest that these variables can
rapid and brief contacts with interested others. For most individ- serve as indicators in identifying individuals at risk for developing
uals, the availability of this type of communication and means of psychological difficulties. The finding that a significant minority
accessing information may increase their productivity and enhance of people who spend more than 11 hr a week on-line for sex had
their lives; however, the nature of this type of communication higher scores on these four measures than the rest of the sample
might also create problems for those individuals who are more reinforces the association between TOS and the manifestation of
susceptible to intense sexualized interactions. problematic behaviors.

Table 6
Factor Loadings of Items Relating to Respondents' Experiences On-Line and Off-Line

Factor Item relating to respondents' experiences Loading

Reflection When I am online for sexual pursuits I sign onto sexually oriented news groups. .74
When I am online for sexual pursuits I go to other sexually oriented sites. .74
When I am NOT online I spend a lot of time re-living past online experience. .81
When I am NOT online I spend a lot of time thinking of new ways to go online. .73
Action When I am online for sexual pursuits I download sexually explicit materials. .68
When I am online for sexual pursuits I enter sexually oriented chatrooms. .78
When I am NOT online I spend a lot of time planning my next online experience. .77
Arousal When online for sexual pursuits I often feel excited and aroused. .71
When online for sexual pursuits I often feel guilty or ashamed. .78
When online for sexual pursuits I have presented myself as being a different gender. .71
When online for sexual pursuits I have presented myself as being a different [other], .68
Excitement When online for sexual pursuits I often feel excited. .73
When online for sexual pursuits I often feel satisfied. .75
 SEXUALITY ON THE INTERNET 161

The number of individuals for whom Internet sex can be prob- Applications
lematic appears consistent with estimates made of this problem in
the population at large. E. Coleman (personal communication, The Internet as a medium shares with its older print, radio, film,
May 1998) estimated that 5% of the general population deals with and TV siblings a fascination with things sexual. This study
issues of sexual compulsivity. The slightly higher percentage provides an important first step in understanding this very common
(8.5%) found in our study can be explained by the sample being use of the Internet. By helping clinicians get a better sense of the
entirely made up of individuals who go on-line for sexual pursuits. demographics and usage patterns of those who use the Internet for
The results of this study support previous findings (Young, sexual pursuits, we hope that mental health professionals can
1997) and the view of many clinicians that, for a vulnerable but develop guidelines for preventing, diagnosing, intervening in
significant minority of heavy Internet users, on-line sexual behav- (early) and treating (later) sexual compulsivity and related disor-
ior can be detrimental. Although on-line sexuality appears to be a ders. We also hope that these findings can serve as a platform from
form of sexual exploration or recreation without negative conse- which to form policies and develop sexually oriented outreach
quences for most people, those who spend 11 hr or more time programs with an eye toward having beneficial effects on sexual
on-line in sexual pursuits show signs of psychological distress and issues into the 21st century.
admit that their behavior interferes with some area(s) of their lives. In the media's portrayal—and therefore the public's percep-
Consistent with Leiblum's (1997) position, it is likely that sexual tion—the sexual dimension of the Internet is likened to the sirens
of mythology, an irresistible and corrupting force which lures
problems can be best understood and treated when considered
"netizens" to the rocks. These are compelling images, but alas, like
within a global understanding of a person's psychological func-
the sirens themselves, they are more fantasy than reality. Instead,
tioning. These data are to be interpreted with caution, however.
this study found, and clinicians need to be aware, that most persons
They are correlations and do not ascribe directionality or causality.
(92%) who go on-line for sexual pursuits do not spend excessive
At present, these findings suggest only an association and do not
amounts of time at it and report very little interference in their
explain whether these problems were caused by the availability of
lives.
sexual outlets on-line or whether already existing issues were just
being played out in a new forum. The good and bad news is that
only about an 8% minority could be characterized as compulsive What to Look for
users. This makes on-line sexual compulsivity a relatively rare
First, how do persons come in for treatment, and what are some
condition among the on-line community. Hearing clients talk about
presenting complaints? We found that some users reported prob-
sexual "surfing" on the Internet should raise our interest but not
lems in their relationships as a result of Internet use. As therapists,
necessarily our alarm. We have much to learn about the wide
we know that partners often fight with, withdraw from, and even
variety of sexual offerings available on the Internet, both positive
end their relationships with one another. It should not be surprising
and negative, and may have to hold our assumptions in check until
that they sometimes do so by retreating to their keyboards. The
we understand what meaning it has in our clients' lives. This
therapist needs to determine whether Internet usage issues, like
research might point to certain criteria that help provide concrete
money, parenting, or housekeeping issues, are yet another way in
markers, such as a minimum amount of time on-line. However,
which couples play out their ongoing relationship struggles. These
clinicians need to be cautious about jumping to a diagnosis of an
issues create distress but do not necessarily constitute a compul-
on-line sexual compulsion or addiction. sion. However, the access, affordability, and anonymity provided
On the other hand, if the 8% of respondents in the study that by the Internet (or "Triple A"; Cooper, 1998) can transform
were found to have sexually compulsive features were to gener- simpler, more common relational difficulties into more complex
alize to the 57 million people who log on daily, a whop- and serious troubles. Imagine a scenario in which an angry spouse
ping 4,560,000 persons could be at risk. Thus, we should neither gets up in the middle of the night, unable to sleep. She wants
minimize nor ignore the signs if we suspect our clients have comfort and maybe some retaliation for a perceived hurt from her
probtems where sex and the Internet intersect. We need to explore partner. Without even leaving the house she gets involved in an
with clients whether their on-line usage is excessive and whether on-line sexual tryst. Although the on-line spouse might argue that
it is creating or resulting from problems that already exist in their she has not actually cheated, she has certainly been involved in a
lives. type of sexual interaction. A boundary has been crossed, which
The identification of four factors related to the on-line experi- makes it a little easier to act out in this way again—and perhaps
ence of users (Reflection, Action, Arousal, and Excitement) sug- again. The continued lowering of the acting-out threshold could
gests that people can have different experiences or be involved in ultimately lead to a much higher incidence of computer mediated
various psychic operations while pursuing sex on the Internet. This "incidents" and long-term consequences to the involved parties.
finding is particularly useful for one to consider when trying to Rarely do persons with sexually compulsive tendencies present
determine where a problem lies for someone who experiences for therapy with that as their chief complaint. Sexually compulsive
distress from their on-line behavior. It could provide a way to behaviors are usually ego-syntonic, gratifying (at least momentar-
understand the needs and motivations underlying on-line experi- ily), and not often consciously linked with other life difficulties.
ence. This model remains to be tested by gathering additional The person is more often "dragged" or "pushed" into therapy
information about respondents' experiences and their psychologi- because of an unhappy partner, threat of or actual job loss, or a
cal functioning. Therapeutic interventions that focus on the iden- scrape with the law (including sexual harassment charges).
tified specific psychological processes could help foster awareness Relationship issues are not the sole means for coming to treat-
and change in clients. ment. Clients present with depression, loneliness, substance abuse
162 COOPER, SCHERER, BOIES, AND GORDON

or other forms of compulsive behavior (e.g., shopping, gambling, off-line commitments and responsibilities to family, friends, work,
food). Their on-line activities may be a desperate attempt to salve or school?
these painful wounds. An Internet problem may even surface as a Next, inquire about the Excitement dimension. Are the persons
complaint about a sleep disorder. In actuality, these clients cannot titillated by their on-line sexual pursuits? Most participants in the
stop downloading images or do not want to log off sexually study reported feeling excited and satisfied but not particularly
oriented chat rooms. Thus, therapists who suspect sexually acting- aroused or guilty about their on-line sexual activities. Be mindful
out issues are at play, particularly among their younger, college that even noncompulsive persons report that they prefer to keep
educated professional clients who have access to computers, might their on-line (and off-line) sexual enterprises secret. Therefore, the
well consider whether an Internet component underlies the clinician is very likely to encounter resistance to this line of
problem. questioning. It is not unusual to encounter secrecy about one's
sexual pursuits, on- or off-line, but when it is deeply entrenched
and associated with shame and guilt the clinician should be
Evaluation concerned.
The fourth line of inquiry, Arousal, is often the most difficult for
Once it is decided that an assessment of the individual or
both the therapist and the patient. It can be difficult for the
couple's on-line activities is warranted, detailed information about therapist to ask about, and embarrassing for the client to admit, the
their meanings and effects should be gathered along four dimen-
type and nature of one's sexual preferences and fantasies. Still, for
sions: (a) Action, the level of direct activity (downloading, com-
the fullest picture to emerge the therapist should ask about whether
municating, etc.); (b) Reflection, the cognitive involvement that
his or her clients are Moused by their on-line activities, whether
can have an obsessive quality; (c) Excitement, the reported level of
they masturbate while on-line or later, and whether these images
excitement (without arousal) and satisfaction with on-line activi-
become incorporated into their ongoing sexual fantasies. Another
ties; and (d) Arousal, the experience of excitement and arousal
line of questioning would be to explore whether patients misrep-
(often accompanied by guilt associated with on-line activities).
resent themselves on-line. The study findings revealed that creat-
A diagnostic interview along the Action dimension should in-
ing an on-line persona who is a different age, height, gender, and
clude questions about the number of hours spent on-line total as
so on was a piece of the Arousal factor. Finally, the therapist needs
well as for sexual pursuits. The clinician should be aware of the
to inquire about guilt and shame associated with on-line sexual
finding that the number of hours spent on-line in these activities
activities. If arousal, misrepresentation, and guilt are not present,
was highly correlated with the degree to which life problems were
proceed with therapy as usual. If this trio is present and seen in
reported. However, as important as whether a person spends more
conjunction with frequent on-line usage for large amounts of time
or less than 11 hr on-line for sexual purposes is whether and to
and disruption in social, occupational, and recreational arenas, then
what degree their lives are being disrupted. Has there been a
the possibility of an on-line sexual compulsion becomes more
drop-off in interest in or frequency of partner sex, emotional
salient.
withdrawal from family or friends, preoccupation with the Inter-
net, and concomitant difficulties with concentration or commit-
ment to work, and so forth? Finding the answers to such questions Treatment
may necessitate interviewing a partner, employer, or other signif-
icant persons as part of the evaluation process. Clinicians need not There is a need for specifically tailored treatment strategies for
be shy about asking which and how many Internet media are being those having difficulties with Internet sexuality. Treatment models
accessed (Web sites, chat rooms, E-mail, newsgroups, etc.), what are already being developed, such as the computer addiction pro-
they do, and what the draw is for each. (Be alert here to the concept grams at Maclean Hospital (Belmont, MA) and at Del Amo Hos-
of the triple A engine. Many persons still have off-line sexual pital (Torrance, CA). Special interventions are being designed to
pursuits; however, they have found that going on-line is less assist their sexually acting-out patients with Internet usage prob-
expensive [affordability]. They are less embarrassed because they lems (Shaw, 1997). Inpatient treatment is indicated only for per-
are able to log on whenever and to whatever medium they wish sons with entrenched, dangerous, or severely disruptive manifes-
[accessibility] without the fear of recognition [anonymity]). Bear tations of sexual compulsivity. The majority of patients will be
in mind that in general, men prefer sexually explicit Web sites and treated in outpatient settings. Most of us will rely on interventions
women prefer chat rooms. Remember also that sexual compulsiv- that can be used in our offices.
ity and distress were found to be associated with high numbers of Treatment for on-line sexual acting out needs to be centered on
hours spent on-line and the use of chat rooms. Try to discover how breaking the denial and isolation. Group (psychotherapy or 12-step
extensive or limited a person's social support networks are; social programs), couples, and individual psychotherapy is the optimal
isolation and difficulty with social and intimate relationships are treatment combination. Groups can provide exposure to differing
often key indicators of persons vulnerable to psychological sexual values and norms, opportunities to challenge cognitive
difficulties. distortions and denial, and the social support needed to make
Inquire into the cognitive effect (Reflection) of on-line sexual lasting changes. Couples therapy can be a forum for assessing
pursuits. Are these clients preoccupied with reliving past experi- reasons the clients' current interpersonal involvements are lacking
ences? Are they obsessively thinking about their latest experience or being withdrawn from. Individual therapy can help patients
or planning for their next? Are they making promises to them- examine the deeper intrapsychic roots of their behavior as well as
selves or to others to quit going on-line and then breaking those the current life circumstances that maintain it. Also valuable are
promises? Are they having difficulty with concentration or with support groups for the partners of on-line sexual compulsives.
 SEXUALITY ON THE INTERNET 163

Outreach: Prevention, Programs, Policy or off-line support groups or to moderated chats that are (or could
be offered in the future) as a service of organizations, such as
As on-line communication rapidly gains importance in the lives church groups, mental health associations, managed care organi-
of increasing numbers of Americans, there is a need for mental zations, and so forth.
health professionals to be involved in these early stages of its 2. Programs be developed to educate individuals about the poten-
development in order to minimize potential problems and adverse tial positive effects the Internet can have (a) for helping individuals
effects. In addition, there are tremendous opportunities to help develop healthy sexual self-esteem and behaviors, (b) for clarify-
shape, direct, and maximize the positive ways that sexuality in our ing questions and correcting misinformation about sexuality, (c)
society can be affected. for developing virtual communities for minority and disenfran-
The Internet is already being used to address a host of sexual chised populations, and (d) for first-line interventions for persons
issues in our society. Disenfranchised minorities (e.g., the dis- who struggle with issues they are not yet ready to acknowledge
abled, survivors of sexual trauma, transsexuals) are meeting, form- off-line (e.g., sexual orientation, being a survivor of sexual assault)
ing virtual communities, and exploring sexuality and relationships but who might tremendously benefit from "lurking" for a while
on-line. Teens are taking their sexual questions from the locker and seeing how others deal with similar issues.
room to their terminals. Lonely people are bringing their romantic 3. Internet service providers (ISPs) and major providers of on-line
hopes to on-line matchmaking services. Each group has unique adult entertainment post criteria (e.g., spending more than 10 hr
questions, anxieties, and fears. Sending simplistic messages that per week in on-line sexual activities) and warnings about the
on-line sexuality is not for them (especially to teens) only height- potential negative impact on one's life of going on-line for sexual
ens curiosity and intensifies shame. It causes them to go under- pursuits. In addition, it is recommended that they provide links and
ground with their sexual concerns, perhaps compounding their an invitation to visit other Web sites (such as the American
difficulties. If this happens, we have little hope of intervening and Psychological Association's Web Site) where on-line sexual acting
facilitating positive outcomes. Psychologists and other mental out and related issues might be addressed in more detail. The
health professionals can be instrumental in both disseminating alternative sites might contain self-assessment instruments on sex-
information and ensuring that it is accurate, accessible, specifically ual acting out, criteria for when to seek therapy or some other
tailored to the intended sexual community, and ethically rendered. intervention, and information on how to link up with treatment
We can keep creating specially designed single-issue Web sites, programs, organizations, or networks of qualified providers. It is
which deal with anything from STDs to paraphilias. These might recommended that the costs of these on-line clearinghouses would
include detailed and comprehensive interactive behavioral treat- be borne by interested parties, including the adult entertainment
ment modules for common sexual problems (e.g., premature ejac- industry, managed care organizations, and the recipients of these
ulation) as well as frequently asked questions (FAQs). We can potential referrals (e.g., affiliated treatment programs).
become expert moderators for scheduled interactive on-line chats. To date, the adult entertainment industry has been very respon-
We can create on-line movies and animations that address the sive to public opinion and pressure. It has incorporated a number
many sexual questions of the Internet populations. We can be a of suggestions (e.g., offering Web site monitors, such as Cyber-
presence on the Internet as a critical adjunct and first-line inter- Nanny, and requiring that credit card numbers be presented so that
vention for sexual concerns in the rapidly evolving telehealth field, minors are denied access) to enhance its image as a responsible
which promises to be increasingly important in the 21st century. and legitimate member of the on-line community.
Considering the increasing use of computers by young adults in
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Cotton, D. J., Finkelstein, D. M., Page, P. L., & Slack, W. V. (1992). Revision received November 9, 1998
Computer-based interview for screening blood donors for risk of HIV Accepted November 10, 1998