Study: Unusual masturbatory practice as an etiological factor in the diagnosis and treatment of sexual dysfunction in young men (2014)

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J.Sexual.MedCOMMENTS: One of the 4 case studies in this paper (reproduced below) reports on a man with porn-induced sexual problems (low libido, fetishes, anorgasmia). The sexual intervention called for a 6-week abstinence from porn and masturbation. After 8 months the man reported increased sexual desire, successful sex and orgasm, and enjoying "good sexual practices."


J Sex Med. 2014 Jul;11(7):1798-806. doi: 10.1111/jsm.12501.

Bronner G1, Ben-Zion IZ.

Abstract

INTRODUCTION:

Masturbation is a common sexual activity among people of all ages throughout life. It has been traditionally prohibited and judged as immoral and sinful by several religions. Although it is no longer perceived as a negative behavior, masturbation is often omitted in the diagnostic inquiry of patients with sexual problems.

AIMS:

The aims of this study are to increase the awareness of clinicians to the importance of including questions regarding masturbatory habits in the process of sexual history taking, to analyze cases of male sexual dysfunction (SD) associated with unusual masturbatory practices, and to propose a practical tool for clinicians to diagnose and manage such problems.

METHODS:

A clinical study of four cases that include a range of unusual masturbatory practices by young males who applied for sex therapy is described. An intervention plan involving specific questions in case history taking was devised. It was based on detailed understanding of each patient's masturbatory practice and its manifestation in his SD.

MAIN OUTCOME MEASURES:

Effects of identifying and altering masturbatory practices on sexual function.

RESULTS:

The four men described unusual and awkward masturbatory practices, each of which was associated with different kinds of SD. The unlearning of the masturbatory practices contributed notably to improvement of their sexual function.

CONCLUSIONS:

The four cases in this study indicate that the detailed questioning of masturbatory habits is crucial for a thorough assessment and adequate treatment of sexual problems in men. We propose specific questions on masturbatory behavior as well as a diagnostic and therapeutic flowchart for physicians and sex therapists to address those problems.

KEYWORDS:

Erectile Dysfunction; Hypoactive Sexual Desire Disorder; Masturbation; Retarded Ejaculation; Sexual Dysfunction; Sexual History Taking; Unusual Masturbatory Practice


 

Case 1: Hypoactive Sexual Desire Disorder

A 35-year-old unmarried healthy man presented for sex therapy with the complaint that although he “met the love of his life” and was attracted to her mentally and sexually, he had no desire to have sex with her. He rarely initiated sexual activity with her and had been rejecting her sexual initiations. She was frustrated and wanted to terminate their relationship. The man admitted that he had been inventing excuses to placate her and had blamed his heavy workload for his fatigue. He reported having daily morning erections and occasional spontaneous erections. He denied abusing any substances and using any medications, and his physical and laboratory examinations (including hormonal profile) were normal. A psychiatric evaluation ruled out mood disorders or anxiety other than his frustration from his sexual problem all of his past relationships with over 20 women followed a similar pattern of passion and enthusiasm in the first weeks, subsiding quickly into loss of interest and low sexual desire, frustration, and termination of the relationship. When asked about masturbatory practices, he reported that in the past he had been masturbating vigorously and rapidly while watching pornography since adolescence.

The pornography originally consisted mainly of zoophilia, and bondage, domination, sadism, and masochism, but he eventually got habituated to these materials and needed more hardcore pornography scenes, including transgender sex, orgies, and violent sex. He used to buy illegal pornographic movies on violent sex acts and rape and visualized those scenes in his imagination to function sexually with women. He gradually lost his desire and his ability to fantasize and decreased his masturbation frequency.

Sexual Diagnosis

In the past, the patient could be diagnosed with compulsive sexual behavior and paraphilia, but when he came for treatment, he presented with hypoactive sexual desire disorder (HSDD).

Sexual Intervention

In conjunction with weekly sessions with a sex therapist, the patient was instructed to avoid any exposure to sexually explicit material, including videos, newspapers, books, and internet pornography. In addition, he was instructed to refrain from masturbation. After 6 weeks of compliance to these restrictions, he noticed signs of increased desire. This was utilized by the therapist to start a relearning process of masturbation while using normal heterosexual fantasies and practicing gentle caressing movements. He was instructed to focus on pleasurable sensations during his arousal, without any attempt to reach orgasm.

Results

After 8 months, the patient reported experiencing successful orgasm and ejaculation. He renewed his relationship with that woman, and they gradually succeeded in enjoying good sexual practices.


 

COMMENTS BY GABE DEEM

Below are excerpts from the case study followed by my comments:

The sexual intervention called for a 6-week abstinence from porn and masturbation. After 8 months the man reported increased sexual desire, successful sex and orgasm, and enjoying "good sexual practices."

Here we have the first ever case study, documenting a healthy young guy with what appears to be porn-induced sexual dysfunction (his penis and drive for porn is fine, just not with his partner.) The treatment was a reboot, a rest from artificial stimulation, in order to "relearn" how to become aroused by his partner and regain his sex drive.

The reboot worked. In a pretty normal timeframe that aligns with what we see from rebooters and what I myself experienced. I took 9 months to regain full sexual function.

detailed questioning of masturbatory habits is crucial for a thorough assessment and adequate treatment of sexual problems in men.

Doctors who see young otherwise healthy guys come in complaining of ED/low sexual desire for their partner, need to be asked about their porn use. If their penis works with porn, and they have a high desire to watch porn but not a high desire for their partner, thats evidence of porn-induced dysfunction. This is where they could ask the men to see if they can easily masturbate (get an erection) and orgasm, without watching or thinking about porn.

Underlined part: They are suggesting that a reboot works for treatment. As in there is now peer reviewed evidence it helps, because simply cutting out porn and masturbation for a period of time increased this mans sex drive and sexual function. This aligns with what many experts on this page have publicly claimed about treating porn-induced sexual dysfunction.

http://yourbrainonporn.com/porn-induced-ed-media

Some pro-porn peeps will claim "there's no evidence that the addiction model works for treatment." Well, Reboot Nation and YBOP suggest recovery based on the "addiction model" and it has worked for thousands, including myself. Addiction is about brain changes and learning (sensitization). This case study, along with thousands of our stories are evidence that the "addiction/neuroplasticity/sexual conditioning" model works for treatment of guys with porn-induced ED.

What's funny, is some of these same people will claim that the rebooting is "harmful." Lol. Yup, advising a guy to go without porn for a period of time to see what happens can be harmful.... Not a chance.

was attracted to her mentally and sexually, he had no desire to have sex with her.

Partners, pay attention to this. He was attracted and in love with his partner, and wanted her mentally and sexually, but couldn't feel anything. This problem is NOT about attraction, it is about brain wiring/learning. Many rebooters will tell you, myself included, that they were with partners they found more attractive then what they watched in porn, yet couldn't feel anything.

He denied abusing any substances and using any medications, and his physical and laboratory examinations (including hormonal profile) were normal.

Some common explanations for young guys with ED are things like drug use, medication use, organic (hormone) issues. These were all ruled out for this guy. He was healthy and hadn't abused drugs.

A psychiatric evaluation ruled out mood disorders or anxiety

Another common explanation for young guys ED is attributed to anxiety/mood disorders. These were ruled out also. Again, he was healthy, and fully functional with porn, just not with his partner.

In the past, the patient could be diagnosed with compulsive sexual behavior and paraphilia, but when he came for treatment, he presented with hypoactive sexual desire disorder

This man had LOW-libido for his partner, but apparently not with porn. Naysayers claim that "compulsive porn users" have "higher-sexual desire" then non-compulsive users. That clearly wasn't the case for this guy. In fact, this isn't the case for many rebooters. If a guy can't masturbate without porn, or has no drive for sex with his partner, but craves porn, this is evidence of sexual conditioning. Furthermore, when guys give up porn they sometimes go into a "flatline" and experience little to no libido for weeks/months. This is clearly not a high-libido issue, but rather evidence of either addiction or sexual conditioning.

I took over a year to be able to masturbate without porn. That clearly isn't a high sex drive, it's porn-induced erectile dysfunction.

the patient was instructed to avoid any exposure to sexually explicit material

He was told to reboot. A reboot is a period of time without any artificial sexual stimulation in order for your brain to regain sensitivity and relearn how to become aroused by a real person. The reboot worked.

This was utilized by the therapist to start a relearning process

Therapist suggested a reboot.

After 8 months, the patient reported experiencing successful orgasm and ejaculation. He renewed his relationship with that woman, and they gradually succeeded in enjoying good sexual practices.

One more time. The reboot worked. He first saw improvement around 6 weeks, and by 8 months could function fully sexually and regained his libido for his partner. The fact that it took him 8 months shoots out the possibility of the "refractory period" as a cause. As crazy as it sounds, this has been suggested by a few naysayers. It is certainly not "normal" for a healthy young man to need months to get another erection.