Introduction <p>The easy and affordable access to the Internet and digital gadgets has revolutionised how young individuals spend their leisure time. One such revolution is the easy access to pornographic material on the Internet. This study looks at how pornography use affects psychological distress after pornography use among Malaysian university students, focusing on the role of perceived pornography addiction and sexual self-esteem.</p> Methods <p>Using a purposive sampling method, an online survey was conducted in 2021 among 418 self-identified pornography users and heterosexual students aged between 18 and 28 from diverse backgrounds. Data was collected in 2021. Participants answered a single question to report their pornography use and perceived pornography addiction, as well as the sexual esteem subscale of the Multidimensional Sexual Self-Concept Questionnaire (MSSCQ) for sexual self-esteem and the Kessler Psychological Distress Scale (K10) for psychological distress after pornography use.</p> Results <p>The findings found that only perceived pornography addiction significantly mediates the link between pornography use and psychological distress after pornography use, while perceived pornography addiction and then sexual self-esteem (i.e., double mediators) and sexual self-esteem do not. This implied that students with higher pornography use tend to report higher perceived pornography addiction and thus experience higher psychological distress after pornography use.</p> Policy implications and conclusion <p>These findings concluded that perceived pornography addiction is an important underlying mechanism in explaining the impact of pornography use on psychological distress after pornography use. The results fill in our understanding of the psychological experience of pornography use among Malaysian university students. It also provides additional knowledge to sexual health educators and practitioners for designing and implementing intervention programs, which we hope will be valuable to their work.</p>