With the inclusion of “Gambling Disorder” in the “Substance Use and Addictive Disorders” chapter of the DSM-5 [1], the APA publicly acknowledged the phenomenon of behavioral addiction. Furthermore, “Internet Gaming Disorder” was placed in Section 3—conditions for further study.

This represents the ongoing paradigm shift in the field of addictions that relates to addictive behavior, and paves the way for new research in the light of cultural changes caused by the new technologies.

There is apparently an existing common neurobiological [2] and environmental [3] ground between the varying addictive disorders, including both substance abuse and addictive behavior; this can manifest as an overlapping of both entities [4].

Phenomenologically, behaviorally addicted individuals frequently exhibit a problematic consumption model: impaired control (e.g., craving, unsuccessful attempts to reduce the behavior), impairment (e.g., narrowing of interests, neglect of other areas of life), and risky use (persisting intake despite awareness of damaging psychological effects). Whether these behaviors also meet physiological criteria relating to addiction (tolerance, withdrawal) is more debatable [4,5,6].

Hypersexual disorder is sometimes considered one of those behavioral addictions. It is used as an umbrella construct that encompasses various problematic behaviors (excessive masturbation, cybersex, pornography use, telephone sex, sexual behavior with consenting adults, strip club visitations, etc.) [7]. Its prevalence rates range from 3% to 6%, though it is difficult to determine since there is not a formal definition of the disorder [8,9].

The lack of robust scientific data makes its research, conceptualization, and assessment difficult, leading to a variety of proposals to explain it, but is usually associated with significant distress, feelings of shame and psychosocial dysfunction [8], as well as other addictive behaviors [10] and it warrants direct examination.

Concurrently, the rise of the new technologies has also opened up a pool of problematic addictive behavior, mainly Internet Addiction. This addiction may focus on a specific application on the internet (gaming, shopping, betting, cybersex…) [11] with potential for risk-addictive behavior; in this case, it would act as a channel for concrete manifestations of said behavior [4,12]. This means inevitable escalation, providing new outlets for established addicts as well as tempting people (due to increased privacy, or opportunity) who would not have previously engaged in these behaviors.

Online pornography use, also known as Internet pornography use or cybersex, may be one of those Internet-specific behaviors with a risk for addiction. It corresponds to the use of Internet to engage in various gratifying sexual activities [13], among which stands the use of pornography [13,14] which is the most popular activity [15,16,17] with an infinite number of sexual scenarios accessible [13,18,19,20]. Continued use in this fashion sometimes derives in financial, legal, occupational, and relationship trouble [6,21] or personal problems, with diverse negative consequences. Feelings of loss of control and persistent use despite these adverse results constitute “online sexual compulsivity” [22] or Problematic Online Pornography Use (POPU). This problematic consumption model benefits from the “Triple A” factors [23].

Due to this model, pornography-related masturbation may be more frequent nowadays, but this is not necessarily a sign of pathology [21]. We know that a considerable proportion of young male population access Internet for pornography consumption [24,25]; in fact, it is one of their key sources for sexual health [26]. Some have expressed concern about this, addressing the time gap between when porn material is consumed for the first time ever, and an actual first sexual experience; specifically, how the former can have an impact on sexual development [27] like abnormally low sexual desire when consuming online pornography [28] and erectile dysfunction, which has spiked dramatically among young men in the past few years when compared to a couple decades ago [29,30,31,32,33].

We systematically reviewed the existing literature on the subject of POPU to try and summarize the various recent advances made in terms of epidemiology, clinical manifestations, neurobiological evidence that supports this model of problematic use, its diagnostic conceptualization in relation to hypersexual disorder, its proposed assessment instruments and treatment strategies.