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Furthermore, the psychological toll on performers in this genre is a significant ethical concern. Unlike mainstream cinema, where intimacy coordinators and strict protocols are becoming standard to protect actors, the sets of extreme pornography have historically lacked such safeguards. The aftermath for performers can include long-term physical injury and profound psychological distress. The narrative that "they chose to do it" often ignores the complex reality of post-traumatic stress and the stigma that prevents performers from seeking help. When the product being sold is indistinguishable from actual violence, the claim that it is merely a "fantasy" becomes difficult to sustain.
