The REAL reason young men suffer from erectile dysfunction, by Anand Patel, MD (2016)

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For some, internet porn has replaced the drive to have sex, reveals Dr Anand Patel (link to article)

By Anand Patel 7 September 2016

Erectile dysfunction sounds like an old man issue, right? Wrong. A recent Italian study found 25% of all new patients with severe erectile problems were under 40.

This reinforces what more and more doctors are seeing: physically healthy men without the usual causes of erectile problems, like low testosterone or early heart disease which occur in older age groups, struggling to get it up. 

So what's going on? While illicit drug use and smoking may be to blame, porn use is also significantly higher in the under 40s.

Porn-induced erectile dysfunction

We are starting to uncover why some men have developed 'porn-induced erectile dysfunction' or PIED. I believe that for this group, porn replaces the drive to have 'real' sex. 

Your brain on porn

A brain chemical called dopamine drives us to seek food and to mate. It's produced during activities that are useful to us and aid survival. During sex, the amount of dopamine released is much higher than other everyday pleasures such as eating food or a nice walk. That's because there should be nothing more rewarding than ensuring the survival of your genes! So whilst eating is important and fun, for your evolutionary brain, nothing beats sex.

Looking at images of naked bodies is certainly pleasurable but it's not usually enough to replace the natural brain circuit that rewards physical sex. But pornographic videos are different; there are new changing images all the time.

The high levels of dopamine that the brain begins to release as you surf a variety of porn tells your primitive brain that this is really rewarding activity and that you should do it again and again.

Misery of addiction

It's why some porn users eventually prefer internet porn to actual sex. And, as with many addictions, you begin to experience less pleasure with actions that were previously enjoyable — so the search begins for something new.

Porn-related masturbation

It's true that the sexual experience of porn-related masturbation is significantly different to the reality of sex with another person. Why?

Well firstly, using your imagination or a single image — for example a naked woman in Playboy — is very unlikely to stimulate enough dopamine release over a long period to override the real-life sexual urge, unlike the response some men develop to online pornography. 

But also, masturbation often uses a different form of grip to penetrative or oral sex and a different part of the penis may be stimulated, and with much greater pressure, and in many without lubrication. It's often why men lose their erections during sex or can't achieve orgasm without masturbating themselves. Their brains have learnt that higher levels of pressure and sensation are required to be aroused and more so to get to orgasm.  So you can have great sex with yourself but fail to maintain an erection with an attractive partner.

For the other partner this can be upsetting — sometimes they feel their mate is having an affair or they themselves are not attractive enough.

Unrealistic expectations

Early exposure to porn reduces the satisfaction rate in teens with their relationships and their partners according to studies (particularly those conducted in the US).

From discussions I've had with younger adults teaching sex ed, there is a greater expectation that women have hairless bodies, men have enormous penises and that anal sex and ejaculating over someone face is a norm, when this is not actually the case. And some doctors say peyronie's disease where microfractures of the penile shaft cause a curvature due to scarring is on the increase, in young men likely due to the vigorous thrusting young people are picking up from porn.

When you then try and have 'real' sex, the dopamine reward is lower. It means there are fewer signals going from the brain down the spinal cord to the penis.

And if there's less nerve triggering of your penis, there's less blood flow so you become brain impotent rather than having a genital problem.

Many men then take medicine to compensate and help their penis work better. But as Viagra only restores genital blood flow in the presence of adequate nerve supply — so your brain needs to be firing — they don't work very well — or for long.

Break the cycle with penile rehab

So how do you solve this vicious cycle and break out of PIED?

Treat PIED same as you would any addiction: stop the stimulus. This means no porn including erotic literature – this embargo includes semi-naked bodies on Instagram for some people who are severely affected. It's tough to do, especially the first few days as the cravings are really strong. But these usually rapidly fade and there's a week or so of return of libido and confidence.

Men usually find that following this they then have a period where they lose their libido significantly, they don't get erections, or even notice their penises are smaller than normal even when not excited. This is because there is no nerve stimulation from the brain via your porn-preferred circuits going down the spinal cord to plump the organ up. 

This period can last a few weeks and is often the time when men return to porn as this worries them so much. BUT it's completely normal. In your brain, the porn-induced circuits are slowly withering due to lack of use and the low dopamine levels mean there is a lack of excitement and pleasure at this stage.

Why does recovery take so long?

This porn-based brain circuit that you've been triggering day after day for months or years has to be dismantled and the old circuits have to start firing again.

And the longer you've been watching porn and especially the younger you started makes a big difference as to how long it takes for recovery.

Gradually, morning erections, desire and erections that even occur spontaneously begin to return. Desire for real sexual partners begins to come back.

Some men recover to 'normal' sexual circuit functioning within several weeks although lots of masturbation will actually slow this recovery down.

Others may take several months — again those that started on internet porn young and have used it a long time are slowest to recover.

Whilst it is difficult to withdraw from pornography, the return of normal sexual excitement and erectile function is totally possible without medication.

This is a key message – some patients are so desperate and have had such significant ED and failure of tablets like Viagra - that they are offered surgical penile implants.

Whilst this may be considered in a small, very select group of patients, perhaps medical professionals are not exploring the real possibility of psychological brain impotence.

It's tough to get out of the cycle of porn surfing and get back to reality but it can be done.

Sites like are brilliant at explaining why PIED happens and how to get out of porn use. Do speak with your doctor - most areas have psychosexual therapists on the NHS that can help with PIED or see