Sarno emerged from the proto-pornographic sexploitation film genre of the 1950s & 1960s; he had written and directed approximately 75 theatrically released feature films in the sexploitation, softcore and hardcore genres as well as a number of shot-on-video features for the 1980s hardcore video market.
Sarno, a pioneer of the sexploitation film genre, completed his first adult-oriented feature, Nude in Charcoal, in 1961. Among his best-known films in the genre are Sin in the Suburbs (1964, which was about wife swapping), Flesh and Lace, The Swap and How They Made It (1966, in which his wife appeared), and Moonlighting Wives (1966). Sarno's work of the sexploitation period was typified by stark chiaroscuro lighting, long takes, and rigorous staging. He was also well known for scenarios centering on issues of psycho-sexual anxiety and sexual identity development.
During his sexploitation period, Sarno worked with such actors as Uta Erickson, Dyanne Thorne (star of the Ilsa series), Audrey Campbell (Olga's House of Shame series), Michael Alaimo, Patricia McNair, Tod Moore, and his cousin, Joe Santos, who would become a regular on television's The Rockford Files.
Beginning in 1968, Sarno's work became somewhat more explicit, predicting the emergence of soft-core. His breakthrough feature Inga (1968) was one of the first X-rated films released in the United States. Other noteworthy soft-core features include Vibrations (1968), Passion in Hot Hollows (1969), Daddy, Darling (1970), Young Playthings (1972), Confessions of a Young American Housewife (1974, which was about foursomes), and Misty (1975). Sarno was also the director of Deep Throat Part 2 (1974), the R-rated sequel to the hardcore classic Deep Throat.
After 1968, Sarno's soft-core work was divided between films produced in the United States and films produced in Europe, principally Sweden, Germany, and Denmark. Many of Sarno's European features were made with American backing. In Europe, he was known for having worked with actresses Marie Liljedahl, Christina Lindberg, Helli Louise, and Marie Forså.
Sarno's first hardcore feature was Sleepyhead (1973) featuring Georgina Spelvin and Tina Russell. Reluctant to be associated with the hardcore genre, Sarno began directing explicit films under various pseudonyms, like "Karl Andersson" in Touch of Genie (1974). He acknowledges being the uncredited director of such adult features as Inside Jennifer Welles (1977) starring Jennifer Welles and Deep Inside Annie Sprinkle (1981) starring Annie Sprinkle. Over the course of his hardcore career, Sarno worked with such adult film stars as Harry Reems, Eric Edwards, Jamie Gillis, Marc Stevens, Marlene Willoughby, Gloria Leonard, Sonny Landham, Seka, and Ron Jeremy.
Personal life and death
Sarno married Peggy Steffans, who was younger than him and was a non-sex performing actress and costumer in some of his films, and they had a son.
Singled out for praise by critic Andrew Sarris during the 1970s, Sarno's work has been acknowledged in recent years by tributes at the New York Underground Film Festival, the Torino Film Festival in Turin, Italy, the Cinémathèque Française in Paris, and The Andy Warhol Museum.