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Yes. Thank you, Angela. Good. Now, do you want me to start again? Or could you hear me? We could hear you to start where I was trying to you. Yes. So I was just talking about depictions of sexual images and how you know, depictions have gone through. You know, most societies, you know, both modern on ancient on diet think particularly of interest to me. I don't know whether any of you have read the Kamasutra, but if you read the Carbon Sutra, I think most people think of the conversation has just been about sexual positions. But actually, that is one chapter in one book. It's actually seven books. A whole of the common sutra on Do That was talking about all different sorts of sexual practices. It even mentions men who come to quickly on how that's an issue. It also mentions about how men can make their Penis is bigger. So anxiety is an issues related to sex and sexual function have been around since sentient times. Um, Pompeii, which is a depiction in the middle. I think what's interesting about that, in particular, is the Victorians went in to excavate Pompeii in the 18 hundreds on day was so shocked about what they found because of depictions of erotic images that actually they destroyed quite a bit of the artifacts because they didn't want to disturb. Um particularly, I think, they mentioned disturb the sensibilities of women. Children on day also mentioned the working classes. So a lot of these depictions and books that were written, you know, historically were only ever really in the hands of a few, those few people that really upper echelons of society me in the car. Miss Future, for instance, was actually written for a lifestyle manual for the man about town, because the man it, you know, those men that could have concubines that could have many wives were a very small starter of society. The vast majority of people in in a lot these cultures really would have been very well, you know, working very hard just to survive. But it's just really to put it into context. It these sorts of explicit images have been around for thousands of years now. What changed in the history of erotic images rather than you know, being drawings on cave walls or sculptures or drawing, say, with Prince on with moving images. Of course, the dissemination of those images would reach a wider population. And I remember going back to at the bottle of for two conferences I ever went to about 20 years ago was the European society off? It wasn't sexual medicine of sexology on. There was a guy there actually selling 19 forties French porn on in that. And at that time 20 years ago, of course, that was on a video. Former, um on. I decided to buy one and I watched it. And it was really interesting, because if you look at these images on the right of the screen, basically these were very similar to those 19 sort of forties early films of pornographic images on the only really difference in terms of any of the sexual practices that you saw, what we're basically they were heterosexual couples, Um, all groups on also a women at a huge amount of pubic hair, which, of course, is something that you don't see now and and that's a vast difference. And actually, the term pornography in was only only really came in to use in the Victorian era on was really about public health concern on public high June, mainly related to prostitutes and prostitution. So, really, what's changed is not necessarily, although, of course it it would be mainly heterosexual images. Historically, although I'm I'm sure there's some evidence of depictions of same sex couples, as in that that first cave drawing or one of those drawings that was found inside of some historic building. But in the main they would pretend to be men and women. But there was a really range of different sexual practices depicted as you can see. You know, if you look at the one in the middle. I mean, really, that's me, you know, be ds Mbai. All but another name. So lots of things were explored on Drawn, but I think the difference is now is the medium in which they're shown on the AC accessibility. Um, and I think, you know, we've gone from those historic ways of portraying sexual images, too, Of course, videos. What's available on on adult channels on the TV to know it's all of a global the mobile phone. So the difference isn't necessarily what's displayed. It's the accessibility on the difficulty in controlling content, particularly for anyone that has a mobile phone, regardless of the age of the owner of that mobile phone on, I think that's what's made a really difference. Um, it's accessible, It's affordable. And of course, you know it's on your own mobile phone. It's anonymous on for young people, you know you don't necessarily even after of your your own phone. You just need a friend with the phone on. You know what young people in Children like they share things that they find on that they see online on. Do you know that that to me? How schools as caused issues? But it's not just about pornography, of course. Pornography. That's what it is. It's explicit images. I think it's what's contained in pornography. Um, that is is off concern, which will talk. I'll talk about a little bit more in a minute, and you've got life streaming mean in particular. You know, child abuse in in other countries is sometimes paid for by people overseas. On that abuses livestreamed onto their computer on Google searches, for example, I put naked woman on her just on my Google search on there were hundreds of depictions of splayed Volver XYZ women having anal sex women have been or all sex, and that's just three putting naked women in in a Google search. APS. So I see. Sometimes I see people who don't necessarily have a problem with watching pornography. But they have a problem with constantly searching on their APS for images on Maybe, um uh, text what? Such with people? That they find it on various websites and that might include things like Instagram. It might snap. Church is another one Tic tac. There's an awful lot of sexual contact content on things like tic Tac, Um, And then, of course, you've got the dating sites like tinder and grinder. You know, which is part of that hook up culture, which, you know for some people, is what they're looking for. But also, you know, it's very don't know whether you've ever seen anybody you know where they try and ask your age. I mean, often it will just say, Are you 18 and you just click Yes, and you have access to the site. There's often no more. So are restrictions in that this chat rooms and this podcast. So it's all just one click away. There's no I mean when I first after both started working with people. I mean, these were more adults, you know, over 18. This is many years ago about issues where people have developed maybe compulsive you ing of pornography or other websites. You know, that was a time when maybe everybody just had one computer in the home. And so controlling that behavior from a habit point of your habitual point of view. You know, often men you just, you know, move in that computer in a public space in the home. Well, with the access on mobile phones, you know you can't do that anymore. It's very difficult to control what people are able to view. And I think this is what's, you know. I don't know whether, you know, but the average age of exposure to pornography. And this is born out a swell by the NSP. See, See, the average age is about 10 or 11 years old, and I suppose what we don't know is what that exposure, um, to it, you know, a young still developing mind what impact? That might have long term on that young person. And a bit later on, I got some sort of short case not not in debt case. That is but some little snapshots of the sorts of problems we see in clinic where maybe social media or pump pornography is mentioned. Onda. Um, you know, but it's a four out of 5. 16 year old boys and girls regularly access porn on the Internet, you know. So this is this is a really common a common problem. Um, and certainly it's reflected in what we see. And the other issue, of course, is issues related to job corn on prophy and I, I think on the not maybe not this like I'll go but the other one in a minute, if you see there in 2000 and four, there were nearly half a million files downloaded of child sex abuse 2000 and eight in there were 45 million files downloaded of sexual abuse and on that is just shocking statistics. And if you talk to anybody that works for the police in this particular area, I mean, the last person I spoke to, he just told me that they've got warehouses and warehouses of illegal images waiting to be processed. Um, for people who have been caught download in and view in child pornography. And if I just get back to this one in terms of the most popular searches on, I don't know whether any of you have looked upon recently, but that a lot of the regular porn that's available on things like, you know, porn Hope or Red Tube. Um, these are most common searches, as you can see. And I think what? The last time I looked at anything, I think what really shocked me know early was the violence. Um, but also the focus on incest poor, where you've got young people pretending to be brother and sister or you've got analogy. A woman all over a 18 or over dressed up like a child in a child's bedroom. Um, supposedly having a having sexual intercourse or sexual play with someone who's pretending to be a stepfather. So, you know, I think once once you start having or exposing people to certain, um, images, then I think the boundaries tend to escalate because people are looking for other content. Um, that's certainly and in terms of when I first started working in the clinic, if I ever saw anybody in the clinic which wasn't that often, but certainly did see people who've been accused of being a pedophile or maybe even process prosecuted. Didn't they would have attended the clinic, not necessarily for that, but that was part of the history. Historically, what you would find is PDF files, for example, um would tend to be fairly isolated individuals, Um, no viewing. And it's in a line because, you know, the access to the Internet wasn't, you know, things weren't readily available on what you do find now, which is different is anybody that's got any sexual interest, can find a group or a forum or a chat room and share their desires or fantasies with other like minded people. On one of the issues with that, particularly when it comes to child abuse, is for those individuals. It can often normalize what they're viewing because they're meeting and sharing their desires with other people who feel the same on. I think that's one of the biggest difference is I've certainly seen many people who not the same charge abuse, but they've had a particular sexual interest that you know, might not have harmed anyone until they went online and found other people that should share their interests. And then there's a certain sort of encouragement to go further. I remember seeing one man who had a bit of a fresh a fetish in terms of voyeurism on, um, you know, view and women from afar. And, you know, it didn't really develop that interest until he found a group that shared his interests online on. Then he started getting involved in upskirting um, Andi. It was only when I think he got caught in somewhere like Tesco's, using his phone to put under the skin of a teenage girl when he got arrested on. Of course, the first thing is wife food. Recently had the baby knew about it was when you and the police were knocking at the door to sees his computers, and he ended up with a suspended sentence. This is before the law changed, but he also was often then on the sex offenders register. So for some people, they're become be an escalation in behavior because what's available So in terms of young people, this was a survey in 2019. It was a massive surveys, any about 1000 young people, but they talked about you know their views on porn on about 62% of these young people that watch porn in the last month, half of them felt that felt that the sex important isn't depicted as loving and consensual. And that certainly might experience of viewing what's are available online. 51%. I'm surprised that it's not morphine. Porn focuses on male pleasure on a lot of certainly a lot of porn is focused on penetration of any orifice, usually with the very limited, limited, limited arousal and build up on. Certainly if I see particularly young women in clinic or young people in clinic, um, for example, experience in problems with painful penetration, I always now ask about arousal and build up. You know, Is there any kissing? Is there any touching before penetration occurs? You know, because, really, for some of the young people and you're on women, that their experience of arousal is really been if they're in a, um, with a male partner, has been led by perhaps that male partners view of what's normal based on pornography. And I think you know, we did delay where well, I've got a disservice to the young people that we see, um, on, you know, 40% 5% of people in this survey said that their sex education, they said that was one of the main sources on that can lead to all sorts of issues. It's a bit like if you learn about what's what's sex is from porn. It's like learning to drive in a Ferrari. You know, there's none of this slow developing what you like, what you might like touching. It's a combination of, you know, pornography hook up culture, and I'm sure you know, some people enjoy that, but there's a new, awful lot of other people that can cause problems on. Also, 71% say that port has given them ideas about what to try out in the bedroom. And certainly one of the things that occurs fairly frequently in some of the young people's clinics, not necessarily in our service but within sexual health is, you know, the amount of, um, women who are saying you say that they are young people who say that they're being choked and gags because that is no become, you know, for some groups of young people are a fairly common occurrence, and in fact? Well, actually, it was a colleague of mine who had, uh, hook up in London and, um, with somebody and they'd never been sexually intimate before on one of that. Now, that is very passionate until he put his hands around the throat and he couldn't understand why she didn't think that was pleasurable. So I think there's a new, awful lot of going on in terms of correct now. Expectations of what we should be doing. The natural survey, which is a much larger survey. I mean, this was 15,000 people, but of course, the age range is from 60 to 74 you know, um, but again, I mean, this is slightly different. It just suggests that lessons in school might have a part to play. But of course, I don't know necessarily the age break breakdown of these statistics, but certainly friends are a big influence. Um, peer pressure on. Do you know what your friends tell you is normal and wanted to be part of a group? You know, all those things are incredibly important when you're a teenager. I mean, the, uh, there was a survey by the BBC called porn laid bare with just about 1000 people online. Young people about their relationship to pornography on 55% of men of men, said porn have been the main source of education on certainly in our sexual dysfunction clinic. Abduct. Certainly one of the questions I always ask is, you know, do you watch? For what age did you start watching porn on? Of course, men with sexual dysfunction like, for example, erectile dysfunction, inhibited ejaculation are certainly a swell. Want to know how many times they masturbate? Because, you know, that could have an impact on their sexual function. So I mean, there there is some sort of strive towards creating a broader sex education curriculum. Um, I think this was put back a bit with Cove it, but trying to, you know, allow you on people opportunities for discussion about the Internet or what they see and how it impacts on their perspectives of sex. Um, but I still sent there are most subjects, and certainly they are comparing a campaigning for things like female orgasm to be included, because what I think Well, you know, I think we all know that how, when a man's aroused his Penis goes from stool to erect. I think what what some young women don't realize is also there the Giants on. We'll also lengthen and widen in order to get ready for any form of penetration on that, in fact, with good arousal the top of the vagina balloons. And of course, that makes sex a lot more comfortable, whether they're being penetrated with a vibrator or with the Penis or with fingers. And so I think there's a new, awful lot more that particularly young with women or young people needs to learn about their own body's, particularly in terms of, you know, anybody that has a vagina. You know, it's hidden away, and sometimes we don't necessarily think about what the vagina needs to do in terms of experience. Full arousal. So, really, what you've got is hard call, high speed porn. You know, meat in the adolescent brain on D. I don't think necessarily in my experience in the work that I do, that it's no, always a healthy relationship. So there's all sorts of things that pornography and explicit images conduce, you know, in terms of the sexual violence, which is certainly heavily depicted. I mean, it just strikes me as we have such a a strange culture at the moment. On the one hand, you've got a lot of talk about, you know, consent on respect and only, uh, the hand. You know, people are viewing content on a regular basis that includes coercion on violence on I just you know, the two seems so sort of contradictory to me, you know, but and it's certainly, you know, create social scripts and discourses about, you know, sex and people and what is normal. And it can also lead to online risk with bullying and certainly people being black male, particularly if they've, you know, shared images of themselves. Which of course, is really common. I mean, sex thing is sending explicit photographs of yourself on your phone, Um, on, you know, this is very common. I mean, my friend of money is 11 year old son a few years ago, now sent a picture of his erection and his friends sent a picture of there erect Penis is to a girl in their class, another 11 year old girl in the class. Now, neither of those boys had had a sexual relationship. So where have they learned that sending those images was normal certainly wasn't from their parents. I'm assuming it was discussion with their peers and what they've seen online, you know, And as a result of that, you know, it meant that social services got involved. The police will call because the gold girl told her parents, You know, it could leave young people very in a very vulnerable position. So why why do young people sex? Well, there's peer pressure that can be partner pressure where you're told your your boring or you know as good as someone else or you're not doing what somebody else did. And if you want to please your partner and you're meddling in love with them, you might end up doing something that, actually, naturally you wouldn't have thought about. And, you know, people will say everyone does it, but and also, I thought, do it too. You know, it's not uncommon on things like tinder and grinder to send pictures of your genitals. You know, it's fairly common practice on. Do you know I've known it happened to me and I've got a friend is an interior designer in a very posh town in North Yorkshire, on one of her delivery man after you delivered carpets, then sent you a picture of his erect Penis. I'm just why he thought that appropriate. I've got no idea. So you know, if adults are doing it And if adults are struggling with the boundaries of of what they should be doing with other people, then of course, teenagers, you know they haven't even got their pre fund frontal cortex still hasn't developed, you know? So they are going to be more prone to risk taking on a lack of impulse control. And if adults don't have that, how can we expect young people to have that ability and, of course, the consequences of send in, you know, images. You know, a scarlet letter refers to a book that was written where you know somebody's reputation regarding sexual activity, then followed them around forever on, and that's really what that means. It could lead to isolation, bullying, taunting, abuse, because your you know, your partner, who you love at the moment you sent these images to might not love you or you might not love them in a few months' time, and they could share those images with people on. That, of course, could lead to exclusion. Onda. Also, you can end up even a zone under 18 on the sex offenders register. So if you get a caution for a sexual offenses, even if you're under 18, you can spend a year on the sexual offenders register. And if you're 18 and over, that can be two years, so it can have real big consequences. And I don't know whether any of you saw this that came out in 2020 about off stead about girls being asked for news by up to 11 boys at night on it, you know, the sexual harassment have become normalized among school those Children on. That's part of that reason why they set up the hashtag me to a school movement to try and highlight the issues that are happening in schools. On the sorts of things that we talked about, where you know, sex, his name, calling rumors about sexual activity on wanted or inappropriate comments of these these air you know, boys and girls under the young people feeling pressure to do sexual things, they didn't want to do unwanted touching. And so, you know this is an issue, I think for all young people, and I think we need to be doing more personally, not sure what we do, but we definitely need to be doing more. So I think, as a parent or a caregiver role regard in it. You know, it is about being aware of the type of inappropriate content that your child males child may see on the platforms and absent they use on. You know, it's a challenge to keep them safe, and certainly if any of you are worried and want to find out more. Certainly the child exploitation and online protection website is really, really helpful. If you're worried about online sexual abuse or the way someone has been communicating with you online, because in terms of grooming, what can happen is is a lot of forums and APS We're adults or predatory adults can contact young people, Um, pretending that there somewhere someone of a similar age on what tends to happen is they try and encourage at some point that young person to send an image of a naked image off them on. Then they might use black male in terms of encouraging that young person to go further in terms of maybe meeting up etcetera. I mean, most of the explicit, um, a lot of external, a lot A lot of expensive images of Children available online or put on online by the Children themselves. So APS No, To be honest, I've not heard of half of these, so but certainly the top up snatcher I've definitely heard off on what they're saying is is a most popular act at the sexting. Sex could be saved even though they're supposed to disappear. This kit messenger where predators contact your child by a kit on concerned unsolicited. Honestly, cities sex. Um, I think the data naps. I think there was a big issue recently with tender the Historically there was no age verification on If your child went on tinder, it could. It could be much. They could be much with the Nadal on. But there's been breaches of security that is exposed to use is data and location. So there's a whole difference in a whole range of Ask APs where adults concoct tacked young people if they're you know, if they're interested in meeting somebody under age on D and courage in sexual contact. So I mean, I think, these ideas about digital literacy and encouraging parents and caregivers and guardians to educate themselves. And I certainly think that's really important because, you know, when I've talked to groups about anything to do with, you know what's available online, a lot of people have fairly shocked and surprised on. I think that, you know, that means they have no idea about what's what's available on what risk there, Charles, your Children might be at. Okay, um, you know, parental controls their operation Shal controls. But, you know, really, it's about trying to teach your child strategies about how to deal with offensive material. That's incredibly difficult, because that depends on the relationship you might have with your child. It might depend on, you know how able to you are to have those conversations. You know, that is not going to be something that's doable for everybody. You know, it depends very much, you know. I see people come from very sometimes very dysfunctional family backgrounds. You know, these sorts of conversations they're not gonna be able to be had in those environment. And if you've got a child that's, you know, emotionally or psychologically vulnerable, you know they're much more likely to be a risk. But at the end of the day, anybody can be a risk from what's available. But I think it's important that we have open conversations. I think schools have a really important role, but I think families, too. But I have a problem. I used to teach many, many years ago, sex education in schools, and it was very limited because it also depends on who's doing the sex education. If you've got somebody that's really uncomfortable, and they have been designated to do that as part of their role, it's very difficult to have open conversations. But I think it's really important that they do, you know, in critical thinking, and that's okay. But again that relies on the intelligence of the child on their ability to question what they viewing on. To be honest, you know, if you're young, you're Norman's a racing around some of what you see, even if you think you know it's maybe awful or discussing, you might still feel sexually aroused by it. You know, sexual arousal can occur even when we don't necessarily from a rational point of you think this is something I remember years ago my There's There was a a book called My Secret Garden by Nancy Friday, and I think that's the first time I dread anything really explicit. And I probably would have been in my early twenties and it was a friend's house on. I remember picking the book up. I'm flicking through it and just thinking, Oh, that's disgusting. Oh my God, that's terrible! Then I put it down. Well, the next minute, I picked it back up again because not only did I think it was, you know, terrible on disgusting. I also found it a rising. So you with arousal, you can have a really confluently between what you think is acceptable but also what you find a rising. You can also find that with people who have been sexually abused. Um, Andi, sometimes they have been around. I'm during that abuse because it's like their body is over rising. Um, other parts of the brain, and sometimes when you're working with people have been sexually abused. Doctor. They struggled to make sense of why, when something was abused, it abusive. Did they also feel sexually aroused and you know you can spend in therapy for quite some time, sort of exploring that to try and help the person understand that that's quite normal. Your body is doing what your body is designed to do when you feel something you feel or see something that's arousing, even if that context is totally inappropriate and abuse it. So there's also other sorts of absolute you know, can be used with young people. Not that is not porn pornography abscess such, but they can. You know that's where you can put messages about other people. You can write their attractiveness. You know you can create fake profiles. That is all sorts of ways in which young people can bully each other. Um, on this can have a, you know, name core falling and bullying. As I would understand, it is very different today because a north, a lot of it goes, goes on online, you know, so you don't even have to be. It could be the bullying could be happening in your own home in your own bedroom because it's happening online. It's also about, you know, how important was it when you were in school to be invited to a party or belong to a certain group and if you weren't invited, But you see everybody else wasp because it's all over Facebook. Facebook. You know, that could make you and feel insecure and left out on Wonder why people don't like you. And sometimes you know, when we're doing an assessment in psych sexual therapy issues at school, in stones of bowling can have a lifelong impact on, you know, someone self esteem and their and their confidence. So, you know, there are There are avenues online that if you're worried about what your child might be seeing and particularly I would again recommend the child exploitation on online protection as well as the end end especies see, So the ways that exposure can impact on sexual and mental health. Well, it can impact in terms off trauma. So a young person viewing something that may be emotionally they're not ready to see what they see it. You can't undersea. It, um, can lead to me really post traumatic stress in some cases so it can cause trauma. Um, it can cause problems with sexual function on. We see this very often with, um I mean, what what? What I've seen in clinic over 20 years, for example. We've always Well, I suppose, are the age group of the people we see now is much younger. So historically, 20 years ago, the vast majority of men with problems with, um, ejaculated disorders, erectile dysfunction. We're more likely to be older man with cardiovascular disease, diabetes, spinal cord injury. But that is not the case Now, the majority off men that referred into our clinic problems with sexual function are under 35 on. We see a lot of eight because we're a university town in Nottingham. We see an awful lot of university students. What we don't see in clinic, which might be worth pointing out with, are very few, um, Trans identified young people or people with different gender identities. Um, I don't know why that is. I don't know whether it's because those young people would have to go to a GP first to get a referral into our clinic. Um, but also in nothing him. We have, ah, large service for transgender health. Um, on they also have a psychosexual therapist based s. Oh, I suppose I've never really had that discussion about about, you know, what sort of referrals they see. Um but I'm not sure where those young people are going. Um, it can lead to unrealistically expectations about body images about body image, about size, of breast size, of genital size, of testicles, size of Penis is you know how pretty you are. You know how attractive you seem, how you compare to an instagram model, how your girlfriend compares to integrate and instagram model all those ideas about unrealistic expectations. And I do some private work for a clinic in London on, But it does offer, uh, penal, uh, lengthening on girth and Huntsman, Um, I tend to see those generally young men know always, um, who are worried about Penis size. And historically, if young men were worried about Penis size historically before the Internet, it would be related to um, um been in the changing rooms. You know where you compared to yourself to other boys that you saw naked. And it was mainly about frosted signs. Whereas now there's a lot more comparison to the image image is that people see on on social media and also important ah, graffiti so it can lead to body image issues, relationship distress. If you find your partner, you know, looking at images that can cause issues on for some people, exposure to online activity can lead to sexual compulsion or sexual addiction, whether that's in terms of, you know, sexualized chatting or whether it's the viewing of a sexual ized images. So tradition. Sorry. Think we're course about airports two now, So there's lots of questions coming in on spinach. Just in question, I say, Wait, get to them in about five minutes. That'd be great. Yeah, that's fine. So, as I've just said, traditional factors that once explained male sexual difficulties a pay insufficient to to account for the sharp rise in erectile dysfunction, delayed ejaculation degrees, decreased sexual satisfaction on diminished libido on. That's certainly what we've seen in clinic. So these are just a few examples before I finish. So the first one is 17 year old girl wanted the Labia plus D after boyfriend shared a photo her genitals to a friend, and they made derogatory comments. One example. 32 year old woman with vaginal muscle was a virgin on Dwyer. Husband decided that they would try and help her and encourage her to be sexually active, would to show her out hard call. Pornography on that resulted in post traumatic stress. And she had flashbacks any time he approached this sexually. The 20 year old man who wanted the Penis enlargement, as he felt in adequate for much important a 19 year old woman who have recently been seen you was traumatized after seeing porno, porno, pornographic images at the age of 12, Um, and also a 20 year old woman with avoidance of relationships after being get agday showed during her first sexual encounter age. 16 years, you know, and some of these people are going to be coming into your clinics, and I think it's just having awareness of what's available. And there was a 20 year old man I saw you was in a heterosexual relationship, but he really wanted to try fisting, um, plan to meet men on grinder. So their issues there, you know, not with what you wanted to try, but going online and meeting somebody that you don't know and that you don't necessarily trust could put you in a very vulnerable position. So a 21 year old man who never all doesn't or ejaculated with the sexual partner, but no issues with masturbation. It's a fairly common presentation on one of the first questions I would be asking. Would it be? Would be about pornography, use and frequency of masturbation? Because what can happen is you can get desensitized those psychologically and physically because of the masturbation habit. And therefore it's def difficult to replicate the same level of arousal with a partner. So a 23 year old man had only had three sexual partners, but he'd been able to orgasm and ejaculation due to conflict between the messages on the lessons about consent. You've had it school on the fact that all three women wanted him to show them during sexual activity, and he didn't find that arousing a tall in fact, it you know, it really was really put off by that, and therefore he struggled to maintain his arousal. And another man here can't stop using a viewing pornography and pictures of Instagram models, you know, and that could end up in the sexual compulsion. If somebody can't stop and find it difficult, somebody is only around by naked pictures of naked women rather than women in really life. Um, there's all sorts of to say and the what? The last one here was a 24 year old man who experienced erectile dysfunction with a partner on the partner, then announced it on Facebook. So for that young man, that was really humiliating on a really struggled then for him to perform because all the time in his head when he met somebody was what had happened before. On both course, we know the anxiety and stress elevate the sympathetic nervous system, which constricts the smooth muscle of the penile tissue on can lead to, um resulting in erectile dysfunction. So certainly with a lot of issues with psychogenic erectile dysfunction, it's about managing anxiety and stress due to the impact of adrenaline. So Internet pornography can maintain high levels of sexual arousal on elevated dopamine on because of the unlimited novel, content is available and in terms of dopamine on anybody's. For any experience working with Parkinson's, patients who were prescribed open mean antagonist also experience on cast characteristic compulsive pornography. Use on great in your activity to sex to accuse related to those dopamine antagonists so that constant sexual arousal and novelty produces, You know, high level of dopamine, and it's very difficult that that level of dopamine is, you know, is very compulsive in terms of you want to keep experiencing it so you might go for more and more maybe explicit, illegal or novel contact to experience that same level of high. So are there any benefits? Well, for some people, there is, um, ethical porn available. You have to pay for it. But there is somebody. I'm not sure what the name is now, but there you can look up ethical porn and that ethical in terms of consent between the actors and also in terms of you know what, they're being paid for that activity. You could be others online. And, you know, and some people who work with older people who might struggle with sexual arousal might suggest that pornography can help. But yeah, I'm a bit skeptical, as you can probably tell. And so the final slide. These are some of the resources if you're interested in sexual behavior. Certainly the natural survey is really interesting. Think you know again, is that online activity in young people? A c e o p of mentioned child line. Your brain on porn is about the impact of porn and its impact on sexual function, particularly related to men on the no fat website. Fact is, in American word from masturbation on, that's all about explaining how masturbation and poor canon impact on sexual function and you can get, you know, fat up for your phone, and they suggest 90 days abstinence. If you want to try and condition your body to normal responses for men that have, ah, a psychogenic erectile dysfunction, there is a website mojo dot so on for any and a range of different sexual problems, The Sexual Advice Association is a really, really useful website. The most common download on that website is for painful sex for women. So there's a lot of information on that you might find useful. Thank you. I really appreciate that, Amy. Okay, Yeah, I kind of just get up, breaks up a little bit that so come up. We have absolutely the factors that play. So you saw. Really? It's my I'm struggling to hear you. Really? Um, class. Yeah. Um, so I think we'll just be a few of the questions is there are loads. Um, let me just have a look through. So a couple of people commented about. Do you think they're any benefits? The pornography, for example, Opening up the question, Um, opiate more from the information of people about sex education on dosing positives. A told him no graffiti, Angela. And you're clear? Well, I'm sure, but I think you need to. I mean, I think you have to look for pornography that so you might get for example, um, you might look, if if you're a woman, you might look for pornography that's that's been produced by other women. You know, you might have to be a bit not just looking on porn, huh? Or Red Tube. You have to. You might have to be more specific in what you're looking for. So you know, it's looking for resources where you know it's a rousing. But at the same time, it's know, including things that you might find offensive them. Allowance of the question. Thank you Know in this presentation I can't see any positives. I'm afraid. I'm sure there are ethical porn. That's the way to go. Okay, thank you. A new all has got interesting question. So she said, Well, they said there's data that lots of young people find their sex education overwhelmingly negative and focused on risk. How do we have discussions with young people about Colon without adding today? Well, I think what I sent the conversations personally rather than saying port is bad too, you know, because I mean that doesn't that's nuts not going to be helpful because they're going to view it, and they might not think it's. But maybe the discussion is more about, you know, arousal. You know that there are, you know, there are different ways of arousal and talking about, you know, whole body around salon. And you know what happens to the body and making it more positive, because I really I mean, I would say when I talk sex education, we were quite positive. I think, really, I think it's about balance. I think if you come in young people and so this is a little bad, don't watch it. I wouldn't rush to watch it. I have to say so I completely agree. I think it's I think it's including things like they're trying to campaign for about female orgasm about how the body works, how you can get different forms of pleasure, not just focusing on the genitals, you know, because that's what we do. If we're working with people like with spinal cord injury, were looking at all the other ways you can gain pleasure from your body. So maybe it should be much more than it should be. More educated on pleasure and the importance of, you know, arousal. Yeah, absolutely not. Just S t i z and yeah, because honestly, as a young person, I would have gone to find it. I think that's a really good point, if you can hear me out of No, that was much better. Know that a lot of you know, kind of lost porn can be really focused on penetrative sex as the kind of, like, main thing that we're missing the, um, kind of other parts of sex. Just that you're saying that arousal and the pleasure around and actually those are the positives that we would be great if we could be. We could talk about that more, um, on it and it's not, and it's it's about not pretending. Young people haven't seen what's out there as well. Yeah, we did have some and other questions I just wanted to cover. If that was Okay, So, uh, Charlotte asked, do you find there any other major drivers behind escalating behavior other than being driven by the community they have found online? This was when you were talking about the man who got caught for upskirt in. Well, I think I think dopamine has a part to play because there's something about if you're watching something that you find really around saying and then you watch that same thing over and over again at some point, it won't be a surrounds that. And then you looking for something else to try and recreate that same level of of arousal so it can end up spiraling because you're becoming desensitized for what you're watching and when you and when you get sexually aroused, it produces dopamine on so you can't just met. You know, a lot of that production is to do with novel content on. That's why it's a lot about flicking with different images. If you look at all the a lot of the porn on things like red tube and pulling up the SureClicks. So you go from one to short clip toe, another short click to look for something that actually triggers that heightened arousal. And then Joe's asked the question, saying, It's interesting how small the percentage of people learning about sexual practices from health professionals are. What barriers do you think there are in place? They're stopping health professionals from discussing house and safe sexual practices on sexual health with their patients. I just don't think my very comfortable at it, and I don't think they're very good at it. I mean, I I've been, I hate to say, banging on about asking the masturbation question for nearly about 10 years. Do I know any urologists that's know incorporated it in their assessment? No, you know, And I remember going to a conference, and it was all suited and booted urologist. Now these of urologists that dealing with, you know, male body parts day in, day out on, I asked them to put their hands up if they thought sex was important. Well, they all looked at their shoes. I've never seen such a group of such embarrassed men in all my life. You know when Children say, if you can't, if I can't see you, you can't see me. You know what Children do when they're That's exactly what they did on that educated, intelligent professionals that couldn't even answer a question as to whether they thought sex was important on what was really that interest in his one eminent consultant and put his hand up. And then they all joined in. Then they all wanted to be part of the group that really thought sex was important. I just said, We're not very good, that's it. And we know, you know, I tend to when I'm doing an assessment. Of course I would, you know, taking into account, you know what might be working with the motion, But one of the first things in assessment I want to know about behavior. You know, if I'm seeing a woman who is complaining of painful penetration, I want to know what she does, you know? I want to know, you know, actually ever had anything inside of a joint? I want to know what she does with a partner. I want to know how long if she has sexual intercourse or if a partner uses a vibrate your dildo. I want to know how long that lasts. I want to know. Does she know whether she's aroused or no, you know I want to know about that behavior. And and that's a bit I think we don't We don't talk about and I don't see me feel very comfortable at it. Suddenly, Yeah, I think it can be something that's very different, you know? Health. Professional sign. Difficult to talk about. Even a basic sexual history could be difficult for professionals that aren't used to it. Yeah, and you need to look someone in the I mean, I got asked in Guy named many after a hysterectomy many years ago. I got asked by the gynecologist was you know, whether any problems sexually, but they never looked away from a computer screen. Well, even the father an issue I wouldn't have talked mean, you know, you need to couldn't connect with the person who's sitting in front of you. Yeah, well, I can say is it gets easier than more. You do it. I mean, to me, it's like asking about, you know, your testicles shopping this on. Then I Sorry. I know it was we could talk for ages on all of these points there. So, so many good questions that have come through. I think it just want to ask one more if that was okay. So your l e n l e has said just to play the devil's advocate. Are there any benefits to increase exposure to pour naion the general population, such as increased openness about discussing sex, increased openness, open mindedness about fetishes, a basic form of sex education for people who otherwise maybe denied information and acceptance of sex workers and industry? So, you know, obviously you had a question similar to this at the beginning, but but more detailed, kind of. With a few specific points, I wondered if you have any thoughts on those. Well, I think this just generally on social media think there's much more except except, you know, with Is it only funds? You know, this is a lot more people putting themselves out. There is, you know, doing things online sexually and get paid good money for it. And, you know, maybe that d stigmatizes it among, you know, among that peers. I'm a bit old in the tooth, really. But I'm sure all that online, you know, saying that you're selling sex and you're making good money from it must normalize that as a profession. I can't see it. It it would be any other way. So I suppose it does normalize some things. I think I think the only thing that I've seen with a couple of young people it all seems much more complicated, you know? And when people are saying that I have in polyamorous relationships Andi, they've got safe words on I mean, severe illnesses Sounds exhausting. But, you know, maybe for those young people it isn't. Maybe that's just my age. And I'm really so far, you know, that I don't I think I think the best thing with things like that is to us young people themselves, cause really, they're the ones that going to know whether they found it, a benefit or no and that you've been obviously doing this for quite a long time before. I imagine that was kind of, um as much eso Shal media on back Sesto kind of instant Internet. What? What? How do you think it's changed kind of in the last 10 15 years? Because, you know, obviously lot of people are asking about benefits of a lot of things like that. Have you seen have you go south? Seen an increase in, um, like sexual dysfunction in younger people have had a what happened? You think a massive increase in young people. Massive. You know, I can only say from my perspective, which is seeing people with sexual problems. I don't know how many people out there or having a really good and enjoyable sex life without any problems. I only see, you know, out or the majority of people in our clinic are under 35 with a huge proportion in their twenties. And that's on what the other thing I've seen is a huge increase in anxiety. Generalized anxiety, health anxiety, body image, anxiety. See, uh, yeah. So that's what I've seen. But then I'm in a You know, I'm in a specific context. Yeah, I But you think that either change in the last massive change massive change in aged, a massive change and anxiety. Yeah. Okay. It's really interesting. I mean, the whole talk was really interesting. Thank you. Angela. Um, we really appreciate you giving up your evening to come and talk to us tonight. Um, so, uh, we'll end the session there. We will be. We have got feedback form. We would like people to complete, if that is okay. On on. Do anybody who is a stash local representative. If you have time commute, it's down the cool. And we will just have to meet and greet We had discussed. So thanks again. And really, really, really. Actually, you take care. You, too. Thank you Were gonna say nice to meet you all, but I can't see anybody. Bye bye, Ellie. Um, are you that you know about would be post the feet that form in the chat? Or does it gets sent to everybody to event, right? Typically, we go in there, chats. I don't think it's gone up. So I make sure that it goes up to everyone by email because I can't. I'm trying to pull it off. This country is like having that, but no, no. Real eyes. That's okay. Um, yeah. I'll make sure that we concern that out by a day of of That's pretty anything. Um, all right. I can put on the trip Twitter a swell, and it's like Thanks for coming. Or is it is it like, too stiff? But it's not specific. It's more. Yeah. So at least you're using good. Anybody who's still here who's not a wrap them. Don't see that there's the kind of linked to be back form. Yeah, yeah, okay. We'll just give everyone else a few moments and then we will get started. Let's the recording early.