This study focused on public and private schools in the town of Parakou, in the north-east of Benin Republic. The study was a cross-sectional, descriptive, analytical study conducted from December 2022 to September 2023, with data collection from May 01 to July 01, 2023. The study population consisted of all students attending general, technical or vocational secondary schools in the city of Parakou for the 2022-2023 academic year. The sampling technique was a non- proportional stratified sampling combined with a simple random draw to include 482 students from secondary schools in the city of Parakou.

1^st level: random selection of establishments

Initially, two strata were created. One was a list of all public schools, and the other was a list of private, technical schools in the commune of Parakou. The name of each school was written on a piece of paper, and a random selection of 5 schools per stratum was made. The list of schools surveyed was then transcribed onto paper.

2^nd stage: class selection and choice of students surveyed

Once in a school, a numbered list of all classes was drawn up by module. A simple random draw was used to select one class per module. The next step was to select around ten students per class.

Data collection was done by a questionnaire collecting information on sociodemographic characteristics, background, biography, social survey, personality and sexual practices and behaviors. The dependent variable was the problematic use of cybersexuality which was assessed using the test proposed by Pawlikowski et al.: the s-IATsex scale. The HAD (Hospital Anxiety and Depression) scale [9] was used to screen for anxiety and depression among the respondents. A subjacent borderline personality was explored with the Borderline Personality Assessment Scale [10] .

· Short Internet sex Addiction Test (s-IATsex) [11]

The short Internet sex Addiction Test (s-IATsex) is a questionnaire designed by Brand, Pawlikowski et al. in 2013, modified and adapted to cybersex from the Internet Addiction Test scale by K. Young (1998), in which the terms “online” or “internet” have been replaced by “online sexual activities” and “internet sex sites”. It is used to assess cybersex addiction. The scale comprises 12 items to be rated on a 5-point Likert scale, ranging from 1 (rarely) to 5 (always), and incorporates the following dimensions: loss of control, time devoted to the activity, craving and social problems linked to the activity. Initially in English, it was translated and validated in French in 2016 by Wéry et al. Scores range from 12 to 60. Psychometric qualities are satisfactory, with an alpha Cronbach = 0.87. The final score is obtained by summing the results on the Likert scale. A score above 30 is suggestive of an addiction to cybersexuality.

· Hospital Anxiety and Depression (HAD) scale [11]

The HAD scale is a screening instrument for anxiety and depressive disorders. It comprises 14 items rated from 0 to 3. Seven questions relate to anxiety (total A) and the other seven to depression (total D), giving two scores (maximum score for each = 21).

To screen for anxiety and depressive symptoms, the following interpretation can be proposed for each of the scores (A and D):

- 7 or less: no symptoms

- 8 to 10: doubtful symptomatology

- 11 and over: definite symptomatology.

· Borderline personality assessment scale [10]

The Personal Borderline Questionnaire (PBQ) is an instrument for assessing borderline personality. Adapted from DSM 5 criteria, it comprises 10 items rated from 1 to 2. The sum of response points gives a score, the interpretation of which has set a threshold score above 12 as being suggestive of Borderline personality.

Data analysis was performed using SPSS version 25 software. To compare the difference between the study's dependent and independent variables, Pearson's Chi² test was used when the numbers were greater than five (05), and Fisher’s exact test when one of the expected numbers was less than or equal to five (05). The association between the variables studied and the dependent variable was determined by the adjusted odds ratio (OR) and its 95% confidence interval (CI95%). The association between two variables was established for a p-value < 0.05 (5% significance level). The logistic regression model was also used to assess the influence of the various independent variables on the dependent variable.

Among the 482 students who took part in the study, the prevalence of problematic use of cybersex in schools in Parakou was 11.4% according to the s-IATsex (Short Internet sex Addiction Test) scale.

The average age of the students was 16.99 ± 2.16, with extremes of 11 and 30. The majority were in secondary school (67.8%), and 405 (84.0%) were financially dependent on their families.

Of the 55 students (11.4%) presenting a problematic use of online sexual practices, males dominated (65.45%). The 16 - 18 age group (56.4%) was more represented (Table 1).

Of the subjects surveyed, 23 of them (41.8%) had a history of sexually transmitted infection. These conditions had various manifestations within the group: hot piss (gonorrhea) in 09 subjects (7.4%), scratching of the external genitalia in 22 subjects (18.0%), discharge from the external genitalia in 14 subjects (11.5%) and lesions of the external genitalia in 06 subjects (4.9%). Among male students, 40 ones (16.3%) suffered from sexual dysfunction or premature ejaculation. Then, the proportions of students regularly consuming alcohol, tobacco and drugs were 56.6%, 26.0% and 3.3% respectively in the study population. The use of any of these psychoactive substances was directly related to sexual activity for 05 (01.0%) respondents. It should be noted that 06 (1.2%) of these surveyed students had already answered in courts for an act related to cybersexuality.

Lastly, 27 (5.6%) of the students surveyed were taking conventional or traditional medical treatment for a problem related to sexuality; thus, the use of certain ointments and medicines (called “bazouka”) as bitter cola and/or ginger was mentioned.

Of those with a cybersex addiction, 49 of them (88.8%) had developed a sexually transmitted infection, while 14 (38.9%) males suffered from sexual dysfunction or premature ejaculation. Consumption of alcohol, tobacco and drugs accounted for 65.5%, 56.3% and 14.5% respectively. In connection with cybersexuality, 01 (1.8%) of the students had legal problems. Finally, 03 students (5.5%) in the same group were taking conventional or traditional medical treatment for their sexuality (Table 2).

Among those with a cybersex addiction, 65.5% had parents with married status. More than seven out of ten (74.5%) had never discussed sexuality with their parents. Almost all of the students (96.4%) had gone through puberty, and 58.2% had sexual partners and experience of sexual intercourse (Table 3).

In the sample, more than one in four (36.7%) regularly or almost always visited web sites producing pornographic videos. The videos were used for sexual stimulation by 13.9% of students, while 13.3% watched them for masturbatory purposes. Similarly, one in ten (10.2%) were subscribers or members of various pornographic social networking groups, and 50.7% said that they had an irresistible urge to view pornographic material to stimulate their libido.

Among students with a cybersex addiction, more than eight out of ten (81.8%) regularly or almost regularly visited web sites producing pornographic videos. While 30.9% used these videos for sexual stimulation, 30.7% of cybersex addicts watched these videos for masturbatory purposes (Figure 1).

The information given by the results of this survey on the different types of videos reveals that those who prefer heterosexual videos (126 subjects or 72%) of young adults (106 subjects or 60.57%) were the most numerous. A subject in this survey is likely to have one or more preferences with regard to these videos (Figure 2).

Active cybersexuality

- Sexting (Figure 3)

Overall, 30.7% of students surveyed have received nude photos from strangers (18.9%), friends (7.9%) and boy/girlfriends (7.5%). At the same time, 8.9% of students sent their nude photos to boyfriends (5.2%) and girlfriends (3.1%). Once they had received the nude photos, only 1.2% of students were able to

discuss the subject with an older person, while 3.8% forwarded them or showed them to close friends. The images sent are often the object of a ruse; 6.6% of sexting students were able to use the photos received to blackmail their owners, respectively because the relationship was over (5.4%), out of jealousy (2.3%) and others to upset the person concerned or under pressure from friends.

Among students who send their intimate photos to others, 4.4% have been victims of blackmail and 2.3% have been victims of sextortion; the intimate content of messages sent has been transferred without their consent to others or published on social networks. 7.4% of these students expressed regret having sent intimate photos online to others. For the rest, it’s a way to live a normal love relationship.

Among students with a problematic use of cybersex, 67.3% have received nude photos or videos and 34.5% have sent them. Of these, 12.7% had blackmailed the photo senders, and 16.4% had been blackmailed because of the photos they had sent.

- Dédipix, skin parties and dating sites

Nearly three out of ten (28.2%) of the students surveyed were aware of dédipix, and 5% of them practiced it. Skin parties, on the other hand, were known from 35.1% of the students surveyed and practiced by 21.2%. They were involved in the camaraderie of drinking establishments (11.2%), various drugs (weed, cocaine) and other substances such as sildenafil. In fact, 30.5% of students were aware of sexual or dating websites. 15.1% had accounts with pseudonyms, and 14.5% had relationships on these sites. It emerges that 4.3% of students had been able to have physical sexual relations with people initially known on a dating site.

In the group of students with an addiction to cybersexuality, 63.6% knew about dedipix, and 16.4% of them practiced it. Similarly, 61.8% of students with a cybersex addiction were aware of skin parties, and 41.8% practiced them regularly. While 70.9% are aware of online dating sites, 38.2% have created accounts on these sites, and 32.7% are involved in online sexual relationships. It should be noted that 23.6% of students with a cybersex addiction have had physical sexual relations with people they have met on dating sites (Table 4).

In the present study, borderline personality was present in 56.4% of people with problematic cybersex use. More than half (55.6%) had difficulty concentrating, and around six out of ten (58.2%) had low self-esteem. Eighteen people (32.7%)

had failed at school, 16 people (29.1%) had anxiety and 6 people (10.9%) had depression (Table 5).

Statistical relationships in bivariate analysis

In bivariate analysis, several factors showed a statistically significant association with problematic use of cybersex use. These included the following variables: gender (p = 0.021), age (p = 0.038), erectile dysfunction or presence of premature ejaculation (p < 0.001), external genital discharge (p < 0.001), history of anxiety (p = 0.001), history of depression (p = 0.010), tobacco use (p = 0.003), use of cannabis and other drugs (p < 0.001), nature of relationship with parents (p < 0.001), parental abandonment (p = 0.027), discussions of sexuality with parents (p = 0.019), puberty (p = 0.010), experience of first sexual intercourse (p < 0.001), the nature of the relationship with the partner (p < 0.001), frequent stimulation of the libido with pornographic images/videos (p < 0.001), consensual sexual intercourse (p < 0.001), access to dating sites (p < 0.001), access to pornographic websites (p < 0.001), exchange of sexual photos or videos (p < 0.001), Borderline personality (p = 0.012), membership of a pornographic publishing group (p < 0.001), sexual violence (p < 0.001), difficulty concentrating (p < 0.001), difficulty having pleasure around oneself (p < 0.001), low self-esteem (p < 0.001), satisfaction with physical sex (p < 0.001), academic failure (p < 0.001), anxiety (p < 0.001) and depression (p < 0.001) (Table 6).

Multivariate analysis of factors associated with addiction to cybersexuality

In multivariate analysis, a significant association was found between addiction to cybersexuality and the following variables: place of residence (OR = 0.164; p = 0.017), external genitalia discharge (OR = 5.37; p = 0.049), having a sexual partner (OR = 2.53; p = 0.010), access to pornographic sites (OR = 7.96; p < 0.001), anxiety (OR = 3.86; p = 0.001) and depression (OR = 2.75; p = 0.018) (Table 7).

Of the 482 targets surveyed, 55 showed problematic use of cybersex. This represents a calculated prevalence of 11.4%.

Several other authors have reported a similar prevalence. These include Vipin K et al. [12] in India in 2022, who found a prevalence of 11% in a population of medical students, R. Ballester et al. [13] (10.8%) in a population of Spanish teenagers in 2015, Giordano et al. [6] who found a prevalence of 10.3% in a population of schoolchildren in the USA in 2017, and V. Cordonnier et al. [14] (10%) in the French population in 2006.

Moreover, the prevalence found in the present study is higher than what has been reported by I. Baati in 2020 in Tunisia (8.7%) [15] . Beutel et al. [16] in Germany in 2017 also reported a lower prevalence than the one in the present study (4.2%). The different types of questionnaires, the study population and the difference in sample size could account for these observed differences. Indeed, the Beutel et al. study was carried out in the general population and involved 2,522 people, a much larger sample size than the present study, which was carried out in schools.

In addition, several other authors have reported higher prevalences. Ross et al. [17] in 2012 among youth groups in Sweden found 18% problematic cybersex users, and Satyanaraya et al. [18] in India in 2021 reported that 22% of local university students had problematic cybersex use.

Age

The average age of the students surveyed in was 16.99 ± 2.16 years. This result is quite close to the one of Rafael Ballester [13] in Spain in 2015 (14.76 ± 0.97) as well as Alexa et al. one [19] in 2019 (15.42 years).

The age extremes of the students surveyed in this study are 11 to 30 years. They were 14 to 97 years old in the study by Manfred E. Beutel et al. [16] in Germany in 2017, and at least 18 years old in India in the study by Satyanaraya et al. in 2021 [18] . This difference can be explained by the absence of an age limit in our study. Under our skies, puberty is becoming increasingly precocious, which only serves to arouse interest in sexuality at an early age, due to its genesis in great curiosity. As the question of sexuality is taboo in our country, the youngest try to talk about it among themselves in small groups, and then rely on the Internet to get to the bottom of it, all the more so as no importance is attached to parental control over connection tools under our skies. As a result, teenagers and young people are the most exposed to the problematic use of cybersexuality, and special attention should be paid to them, especially as we recognize that young people are the driving force behind development, and need to be educated, informed and empowered before any technological adventure.

Gender

In the present study, male gender predominated (65.45%) among students with problematic cybersex use. This result concurs with that of Ballester et al. [13] 2015 in Spain, who also found a male predominance of 48.8%. A. Wéry et al. [7] 2014 in Canada, evoked a predominance of the disorder in two-thirds of men. The same is true with Kumar et al. [12] 2022 in India, who reported a male predominance of 68%. A similarly high prevalence of addiction to cybersexuality was reported by Satyanaraya et al. [18] 2021 in India and by Beutel et al. [16] 2017 in Germany.

Living environment

The present study reported a higher proportion of cybersex addiction in urban than in rural areas (53 (96.36%) of those with cybersex addiction). Similar findings were revealed by Weinstein et al. [20] 2015 in Germany, who found a proportion of 83.5%. Satyanarayana et al. [18] 2021 in India reported that only 10% of the students with addiction in their study lived in rural areas. The study by Cooper et al. [21] 2004 in the United States follows the same dynamic, stating that 64% of people with problematic cybersex use lived in urban areas.

Level of study

Problem use of cybersexuality was observed more at graduate level than at undergraduate level. This could mean that sexual cyberaddiction is more prevalent at higher levels of education. Cordonnier et al. in their study of a general population in France found that more than half of respondents presenting a problematic use of cybersexuality (61%) were in higher education [14] . Without specifying the values, other studies have followed this line of thought; for example, Giordano et al. in the USA (2017) and Ballester et al. [13] in Spain (2015) found after their studies that problematic use of cybersexuality was higher among students with a higher level of schooling. The study carried out by Rousseau et al. in Normandy in 2018 in a population of adolescents aged 15 to 17 found a high level of cybersexuality use among students in advanced classes. Indeed, adolescence is a period of metamorphosis, hormonal cascade and growing curiosity about questions of sexuality. The degree of curiosity seems to evolve with age, maturity and the vagueness that surrounds certain subjects of interest such as sexuality.

Marital status

The results of the present study reported 32 (58.18%) students with a problematic use of cybersexuality, not involved in a romantic relationship. Other authors have reported similar results. Beutel et al. [16] in 2017 in Germany found a proportion of 56.1% of single people addicted to cybersex. Weinstein et al. [20] 2015 found 57.7%. On the other hand, Cooper et al. [21] in 2004 in their study in the USA found that almost 60% of subjects with problematic cybersex use were in a committed romantic relationship, and more than half were married. This difference could be explained by the limited age range imposed by their study, taking into account only adults (18 - 70 years) on the one hand, and on the other, by the targeting of the present study by remaining strictly within the school environment.

Sexuality discussed with parents

The study revealed that 60% of students had never discussed sexuality with their parents. Of these, 74.5% had developed an addiction to cybersexuality. Tchoukou et al. [22] in 2022, in their study of sexual addiction in the general population of Parakou, found that 47.9% of young people did not discuss sexuality with their parents, and 48.6% were sex addicts. This result once again confirms the toxicity of the mysterious meaning reserved for sexuality. If we don’t talk about it, or if we don’t shed light on students’ darker side, they’ll be more likely to explore it themselves on the Internet.

Number of sexual partners

This study shows that targets in a romantic or sexual relationship had an average of 1.79 sexual partners. This is higher than the average of 1.27 sexual partners reported by Satyanara et al. [18] in India. This could be explained by the size of the sample considered. This sample had a strictly superior size of 853 participants.

Consumption of psychoactive substances

The number of students using alcohol in the present study sample was 56.63%. Among problematic cybersex users, 65.45% of students were regular drinkers. Simon Marmet et al. in Switzerland in 2018 dug deeper and reported that 18.6% of respondents in their study had problematic alcohol consumption. This result would suggest that, beyond the simple consumption of alcohol revealed by this study, problematic users of cybersexuality could also be dealing with problematic consumption [23] .

They were respectively 05.18% and 03.31% of targets addicted to cybersexuality to use tobacco and cannabis and other drugs. In the same study in Switzerland in 2018, Marmet et al. found that 11.1% of those with an addiction to cybersexuality had a problematic use of cannabis [23] .

Pires et al. in Portugal in 2019, found in their study conducted in a detoxification center that 78% of psychoactive substance users had a problematic use of cybersexuality [24] . They added that cocaine and other drug users were more addicted to cybersex than alcohol users. In the current study, 50% (8/16) of targets using cannabis or other drugs had a problematic use of cybersexuality.

Factors associated with addiction to cybersexuality in multivariate analysis

Sexual partners

A significant association between having a sexual partner and addiction to cybersexuality was found in this study (p = 0.010). It multiplied the risk of problematic use of cybersexuality by 2.534. The same finding was made by Ballester et al. [13] (p = 0.012) and Beutel et al. [16] (p < 0.001).

Connection to pornographic sites

Connection to pornographic websites is significantly linked to problematic use of cybersexuality, as revealed by this study (p < 0.001). This risk factor has been reported in numerous studies. These include Ross et al. [17] (p = 0.001) and Ballester et al. [13] (p < 0.001). Rousseau et al. [25] found in their study that it was a factor multiplying by 4.19 the risk of problematic use of cybersexuality.

In the present study, external genital discharge (OR = 5.37; p = 0.049), and depression (OR = 2.75; p = 0.018) were significantly associated with addiction to cybersexuality. Several authors did not find the same results.

According to Ballester et al. [13] , male gender, sexual orientation and certain offline sexual relationships are risk factors for addiction to cybersexuality. This explains why the factors vary from one environment to another, depending on the study population.

Anxiety

Anxiety was another factor that this study found to be significantly related to addiction to cybersexuality (OR = 3.863; p < 0.001). Indeed, subjects with anxiety had a high risk of problematic use of cybersexuality. This is a point shared by other authors. Beutel et al. [16] found a similar result in their study. But it’s not possible to state definitively whether this anxiety is either a consequence or a cause of addiction to cybersexuality.

Prevalence of sexting, dédipix, skin parties and dating sites

The practice of sexting in the present study was summarized by a proportion of 08.90% of students having sent their nude photos and/or videos to an interlocutor on the Internet, and by 30.70% having received similar messages. Marion R et al. [25] in France in 2018 also found a higher number of receivers than senders. Above the proportions of the present study, they reported that 62.7% were receivers and 22.1% senders. This difference could be explained by their study’s larger sample size (1208) than the one of the present study. Following the same logic, Kim et al. and Gonzalez et al. found in Canada and Spain respectively: sending 14.4% and receiving 27%, then sending 24% and receiving 58% [19] [26] .

Dedipix, skin parties and dating sites are not discussed very much, but they account for 5%, 21.2% and 15.1% of cybersex practices respectively in this study.