How's Your Marriage, Doctor?

This month I want to talk about a subjectthat is increasingly becoming aproblem for medical couples: Internetpornography. Although it's almost exclusivelya male pastime, it's invariablyupsetting to women. Sometimes it causesmarital tension, conflict, and disconnection.Sometimes it's the byproductof marital unhappiness and distance.Whether it's the cause or the effect,Internet porn is a lonely and solitaryactivity that creates a huge barrier tomarital openness, honesty, and emotionaland sexual intimacy.

In my work with medical couples facingthis problem, I've heard many stories.The following are 2 disguisedexcerpts from recent sessions:

• Dr. A: "I'm horribly ashamed ofmyself—I'm spending more time visitingporn sites than I used to."
• Mrs. A: "I was using the computerto help my daughter with a school projectand suddenly a whole list of pornographicsites appeared on the browserhistory. I was shocked and rather disgusted.I asked my husband about it,but he denied responsibility. I knowit's not spam. He spends a lot of timeon the net late in the evening."

A COMMON DILEMMA

Playboy

Penthouse

There are a number of reasons whymen look at Internet porn. For somemen, it is rare and simply novel.They're intrigued and curious. They doit once and never return. For some, itis infrequent and only mildly arousingor exciting—similar to browsing furtivelythrough popular magazines like or . For others, it issituational. These are men who visitpornographic sites only when they'reaway from their wives and feelinglonely and bored.

For some men, Internet pornbecomes increasingly compelling andtime-consuming. It takes on a compulsivequality and cuts into other leisureactivities, like reading, watching TV, orpursuing hobbies. For other men, ithas a fetishistic quality—called a paraphilia—as the man seeks out forms ofsexual activity that are bizarre, unusual,idiosyncratic, and certainly notsomething that he enjoys with hiswife. This behavior requires assessmentand treatment by a mentalhealth professional.

WHEN IT'S A PROBLEM

Then there are the men who actuallybecome addicted to Internet porn,which is no different than becomingaddicted to alcohol or other drugs.They can't stop on their own. Thesemen need professional help. For them,pornographic browsing is no longer alate-night activity to pursue whentheir wife's asleep; it's a serious neurophysiologicaldisorder.

I strongly urge physicians who arespending increasing time viewingporn to talk to their primary carephysician about it. The truth is, youcould be depressed. The time youspend viewing porn on your computermay be a symptom of despondency,anguish, alienation from loved ones,or diminished self-worth. In addition,you could be developing an obsessive-compulsivedisorder or be in the earlystages of addiction.

Michael F. Myers, a clinicalprofessor in the Departmentof Psychiatry atthe University of BritishColumbia in Vancouver,Canada, is the author ofDoctors' Marriages: A Lookat the Problems and Their Solutions (Plenum;212-620-8000) and How's Your Marriage?:A Book for Men and Women (AmericanPsychiatric Press; 800-368-5777). The immediatepast president of the CanadianPsychiatric Association, he welcomes questionsor comments at [email protected].