Research confirms sharp rise in youthful sexual dysfunctions

Research confirms sharp rise in youthful sexual dysfunctions. Young men today appear to be experiencing a sharp increase in ED (and other sexual dysfunctions) since the advent of streaming internet. All studies assessing young male sexuality since 2010 report historic levels of erectile dysfunction, and startling rates of a new scourge: low libido.

Erectile dysfunction rates ranged from 14 to 37%, while rates for low libido (hypo-sexuality) ranged from 16% to 37%. One of the most dramatic examples of how younger men are suffering higher rates of ED is from a research survey of male adult film actors published in 2018: 37% of male porn stars, ages 20-29, had moderate to severe erectile dysfunction (the IIEF is the standard urology test for erectile function). Compare the younger porn actors to the older porn actors:

youthful sexual dysfunctions Male adult entertainers characteristics table

ED rates before the Internet

These high rates are a recent phenomenon, but comparing ED rates in men over time can be challenging. Traditionally, ED rates have been negligible in young men, and did not begin to rise sharply until after age 40. For example, here’s a graph from a Dutch study comparing data from prior to 2004.

youthful sexual dysfunctions

The next challenge is to understand the extent to which ED rates have risen. This is thorny because ED rates have been measured using various different instruments in the last 25 years. Some researchers asked a single (yes/no) question and requested those with ED to rate its severity. Others use a 5- or 6-question version of a more recent instrument that employs Likert scales. It’s called the IIEF (The International Index of Erectile Function), and is used widely today.

Still other researchers used different questionnaires. In 2019, the BBC did its own survey of over 1000 people 18-25. Twenty percent of porn watchers 18-25 think it has affected their ability to have sex.

Historical ED rates

What about other historical rates of ED in peer-reviewed literature using various instruments? First, here are results from the 2 major cross-sectional studies on ED in sexually active American men. Both predated heavy internet penetration.

  1. In the 1940s, the Kinsey report concluded that the prevalence of ED was less than 1% in men younger than 30 years, less than 3% in those 30–45.
  2. A 1999 cross-sectional study (based on data gathered in 1992) published by the Journal of the American Medical Association reported erectile dysfunction rates of only 5%, and low sexual desire in 5%. In that study, the ages of the men surveyed ranged from 18 to 59, so a third of them were over 40, which means the rates for sexually active men under 40 were lower.

In 2002 Dutch researchers did a meta-analysis of 6 high-quality ED studies. All of the studies reviewed from Europe (5) reported ED rates for men under 40 of approximately 2%. The sixth was the one reported immediately above.

Fewer sexually active men have ED

Note: Keep in mind that ED rates for all men in every age group are higher than rates for sexually active men. For example, in the 1992 data for sexually active men 18-59, the average ED rate was only 5%. However, the rates for men (both sexually active and not) were 7% in men 18-29. It was 9% in men 30-39, 11% in men 40-49, and 18% in men 50-59. In order to compare “apples to apples,” we, like most researchers, focus on rates for sexually active men. This unfortunately fails to count ED problems in young men who avoid sex due to porn-induced sexual dysfunctions.

Before we turn back to recent studies, it’s important to understand a bit more about the pathology of erectile dysfunction. ED is usually classified as either psychogenic or organic. Traditionally, psychogenic ED is associated with psychological factors (e.g., depression, stress, or anxiety) while organic ED is attributed to physical conditions (e.g., neurological, hormonal, or anatomical.) The most common diagnosis for guys under 40 is psychogenic ED.

Men under 40

Studies investigating ED risk factors in men under 40 typically fail to find the causes commonly associated with ED in older men, such as smoking, alcoholism, obesity, sedentary life, diabetes, hypertension, cardiovascular disease, and hyperlipidemia. Be very skeptical if you read that the preceding causes of organic ED in older men are also the cause of a sharp rise in youthful ED. It takes years for various lifestyle factors to manifest as vasculogenic or neurogenic ED. Indeed, a 2018 paper that looked at ED risk factors in young men found no differences in the usual ED risk factors between those with ED and those with no problems (average age 32). The only difference was that those with ED had low sexual desire. The researchers didn’t ask about porn use.

Recent studies on young men

Now, we turn to other recent studies on young men (~40 and under). Using the IIEF-5, a 2012 cross-sectional study of Swiss men aged 18-24 found ED rates of 30%, and a 2010 Brazilian study of men 18-40 reported ED rates of 35%. A 2013 Italian study reported one in four patients seeking help for new onset ED were younger than 40. Astonishingly, the rate of severe ED was nearly 10% higher in younger men than in men over 40.

The University of Florence urology clinic reported that first time ED patients under 40 comprised about 5% of the total patient population. By 2014-2015 men under 40 seeking help for ED comprised 15% of first time patients. Also, a 2015 paper about 4,211 Italians who sought outpatient help for sexual dysfunction found that compulsive masturbators were younger than the other men and had higher rates of ED (and were likely masturbating to internet porn).

Rising rate

A 2014 study of new diagnoses of ED in active duty servicemen reported that rates had more than doubled between 2004 and 2013. Rates of psychogenic ED increased more than organic ED, and rates of unclassified ED remained relatively stable. A 2014 cross-sectional study of active duty, relatively healthy, male military personnel aged 21-40 found an overall ED rate of 33.2%, using the IIEF-5. About half of them also had PTSD (a known risk factor for ED). In a further military study published in 2015, the researchers found that ED was associated with sexual anxiety and genital self-image, both of which could easily be tied to heavy internet porn use.

Erectile dysfunction has implications for safe condom use. A 2015 study on problematic condom use, which sampled 479 men (mean age 20.43), reported unexplained erection difficulties during condom use in a total of 62% of the young men:13.8% during condom application, 15.7% during penetrative sex, and 32.2% during both. (This was not a cross-sectional study; researchers noted that they over-sampled those with problems.)

Low sexual desire

The next studies reveal that abnormally low sexual desire is also cropping up in young men.

  • A 2014 study on Canadian adolescents reported that 53.5% of males aged 16-21 have symptoms indicative of a sexual problem. Erectile dysfunction was the most common (27%), followed by low sexual desire (24%), and problems with orgasm (11%). The authors were baffled why rates were so high, and were surprised that sexual dysfunction rates for males surpassed females, unlike in earlier published literature.
  • The same Canadian researchers published a 2-year longitudinal study in 2016, in which they found that, over several checkpoints during the 2 years, the following percentages of 16-21 year old males reported:
    1. low sexual satisfaction (47.9%)
    2. low desire (46.2%)
    3. problems in erectile function (45.3%)

While females’ sexual problems improved over time the males’ sexual problems did not. “Unlike for male adolescents, we found a clearer picture of improvement over time for female adolescents, suggesting that learning and experience played a role in improving their sexual lives.” And, “The only factor that emerged as a strong predictor was relationship status. Adolescents who were not in a sexual relationship were approximately three times more likely to report a problem in sexual functioning compared to those who were in a sexual relationship.” [All subjects were sexually active, but who would be using the most porn?]

ED and low sexual desire
  • A 2015 study on Italian high school seniors (18-19) found that 16% of those who use porn more than once per week  reported abnormally low sexual desire. Non-porn users reported 0% low sexual desire.
  • A 2014 survey of Croatian men under 40 and under reported ED rates of 31% and low sexual desire rates of 37%.

A 2015 study, which asked Canadian men using porn 7 or more hours per week about their sexual functioning, found that 71% had sexual dysfunctions, with 33% reporting difficulty orgasming. Average age 41.5.

This 2018 article about UK a study reported that one in two men in their 30s struggle getting and maintaining an erection!

Together, these studies suggest a recent increase in ED in men ~40 and under, as well as startling rates of anorgasmia and low sexual desire, starting quite young (as does internet porn use).

None of these studies had young men remove porn use to investigate internet porn’s effects on their sexual performance, despite the fact that its use represents a drastic change in men’s sexual environment in the digital age. However, the peer-reviewed evidence supporting internet porn as the culprit in youthful sexual dysfunction continues to accumulate. See this list of 39 studies linking porn use or porn addiction to sexual dysfunctions and lower arousal to sexual stimuli. The first 7 studies in this list demonstrate causation as participants eliminated porn use and healed chronic sexual dysfunctions.

Two studies using the exact same questionnaire: 2001 vs. 2011 (GSSAB)

It would be well to look at some of the most irrefutable research that demonstrates a radical rise in ED rates over a decade using very large samples (which increase reliability). All the men were assessed using the same (yes/no) question about ED, as part of the Global Study of Sexual Attitudes and Behavior (GSSAB), administered to 13,618 sexually active men in 29 countries. That occurred in 2001-2002.

A decade later, in 2011, the same “sexual difficulties” (yes/no) question from the GSSAB was administered to 2,737 sexually active men in Croatia, Norway and Portugal. The first group, in 2001-2002, were aged 40-80. The second group, in 2011, were 40 and under.

Based on the findings of prior studies one would predict the older men would have far higher ED scores than the younger men, whose scores should have been negligible. Not so. In just a decade, things had changed radically. The 2001-2002 ED rates for men 40-80 were about 13% in Europe. By 2011, ED rates in Europeans, ages 18-40, ranged from 14-28%!

youthful sexual dysfunctions ED rates in Europe

What changed in men’s sexual environment during this time? Well, major changes were internet penetration and access to porn videos (followed by access to streaming porn in 2006, and then smartphones on which to view it). In the 2011 study on Croatians, Norwegians and Portuguese, the Portuguese had the lowest rates of ED and the Norwegians had the highest. During 2013, internet penetration rates in Portugal were only 67%, compared with 95% in Norway.

In line with clinical, anecdotal, and experimental evidence

The image below appeared in an analysis of ED posts from MedHelp forums. “Nearly 60% of men posting on the forums were under 24 years old. This was a surprising finding for researchers, as erectile dysfunction is generally considered a condition that strikes older men.”

Participants in ED Forum, by age

An Irish Times poll asked thousands of readers about ED, and the number of men 24-34 with issues was 28%:

Have you experienced erectile dysfunction?

Click on graphics from 2015 Irish Times poll to see ED rates, which show higher rates in young men than in men 35-49!

Documented recovery stories

About 3,000 self-reports of recovery from ED and other sexual dysfunctions after quitting internet porn can be found on these pages:


Quick summary of recent peer-reviewed studies assessing young male sexuality

Erectile dysfunction and correlated factors in Brazilian men aged 18-40 years (2010)

  • Prevalence of ED in 1,947 men was 35.0% (73.7% mild, 26.3% moderate/complete). Used the IIEF-5.

Sexual dysfunctions among young men: prevalence and associated factors (2012)

  • Ages 18-24. Swiss military (mandatory for all Swiss national males). Used the IIEF-5. ED rates of 30%

One patient out of four with newly diagnosed erectile dysfunction is a young man–worrisome picture from the everyday clinical practice (2013)

  • New onset ED as the primary disorder was found in 114 (26%) men ≤ 40 years. Almost half of the young men suffered from severe ED, with comparable rates in older patients.

Erectile dysfunction among male active component service members, U.S. Armed Forces, 2004-2013 (2014).

  • New diagnoses of ED in active duty servicemen reported that rates had more than doubled between 2004 and 2013.

Prevalence and characteristics of sexual functioning among sexually experienced middle to late adolescents (2014)

  • Ages 16-21. Erectile Dysfunction – 27%; Low sexual desire – 24%; Problems with orgasm – 11%. Used the IIEF-5.

Sexual Functioning in Military Personnel: Preliminary Estimates and Predictors (2014)

  • Ages 21-40. Used the IIEF-5. ED rates of 33%

Genital Image, Sexual Anxiety, and Erectile Dysfunction Among Young Male Military Personnel (2015)

  • Age 40 and under. ED rates of 33%. Used the IIEF-5.

Is Pornography Use Associated with Sexual Difficulties and Dysfunctions among Younger Heterosexual Men? (2015)

  • Europeans, 18–40. A yes/no question from the GSSAB (2011). ED rates ranged from 14%–28%. Low libido rates as high as 37%.

A Longitudinal Study of Problems in Sexual Functioning and Related Sexual Distress Among Middle to Late Adolescents (2016)

  • 2-year longitudinal study in which they found that, over several checkpoints during the 2 years, the following percentages of 16-21 year old males: low sexual satisfaction (48%), low desire (46%), problems in erectile function (45%). Used the IIEF-5.

Erectile Dysfunction Among Male Adult Entertainers: A Survey (2018)

  • 37% of male porn stars, ages 20-29, had moderate to severe erectile dysfunction. Used the IIEF-5.

Sexual Dysfunction Among Young Men: Overview of Dietary Components Associated With Erectile Dysfunction (2018)

  • 24.6% of men ages 18-40 categorized as having ED. Used the IIEF-5.

Is online pornography consumption linked to offline sexual dysfunction in young men? A multivariate analysis based on an international web-based survey

  • 21.5% of 2067 sexually active men ages 18-45 had ED. Used the IIEF-5.

Studies linking porn use or porn/sex addiction to sexual problems & lower arousal

In addition to the studies below, this page contains articles and videos by over 140 experts (urology professors, urologists, psychiatrists, psychologists, sexologists, MDs) who acknowledge and have successfully treated porn-induced ED and porn-induced loss of sexual desire. The first 7 studies demonstrate causation as participants eliminated porn use and healed chronic sexual dysfunctions:

1) Is Internet Pornography Causing Sexual Dysfunctions? A Review with Clinical Reports (2016)

An extensive review of the literature related to porn-induced sexual problems. Involving 7 US Navy doctors, the review provides the latest data revealing a tremendous rise in youthful sexual problems. It also reviews the neurological studies related to porn addiction and sexual conditioning via Internet porn. The doctors provide 3 clinical reports of men who developed porn-induced sexual dysfunctions. Two of the three men healed their sexual dysfunctions by eliminating porn use. The third man experienced little improvement as he was unable to abstain from porn use.

Excerpt:

Traditional factors that once explained men’s sexual difficulties appear insufficient to account for the sharp rise in erectile dysfunction, delayed ejaculation, decreased sexual satisfaction, and diminished libido during partnered sex in men under 40. This review (1) considers data from multiple domains, e.g., clinical, biological (addiction/urology), psychological (sexual conditioning), sociological; and (2) presents a series of clinical reports, all with the aim of proposing a possible direction for future research of this phenomenon. Alterations to the brain’s motivational system are explored as a possible etiology underlying pornography-related sexual dysfunctions.

This review also considers evidence that Internet pornography’s unique properties (limitless novelty, potential for easy escalation to more extreme material, video format, etc.) may be potent enough to condition sexual arousal to aspects of Internet pornography use that do not readily transition to real-life partners, such that sex with desired partners may not register as meeting expectations and arousal declines. Clinical reports suggest that terminating Internet pornography use is sometimes sufficient to reverse negative effects, underscoring the need for extensive investigation using methodologies that have subjects remove the variable of Internet pornography use.

2) Male masturbation habits and sexual dysfunctions (2016)

It’s by a French psychiatrist who is the current president of the European Federation of Sexology. While the abstract shifts back and forth between Internet pornography use and masturbation, it’s clear that he’s mostly referring to porn-induced sexual dysfunctions (erectile dysfunction and anorgasmia). The paper revolves around his clinical experience with 35 men who developed erectile dysfunction and/or anorgasmia, and his therapeutic approaches to help them. The author states that most of his patients used porn, with several being addicted to porn. The abstract points to internet porn as the primary cause of the problems (keep in mind that masturbation does not cause chronic ED, and it is never given as a cause of ED). 19 of the 35 men saw significant improvements in sexual functioning. The other men either dropped out of treatment or are still trying to recover.

Excerpts:

Intro: Harmless and even helpful in his usual form widely practiced, masturbation in its excessive and pre-eminent form, generally associated today to pornographic addiction, is too often overlooked in the clinical assessment of sexual dysfunction it can induce.

Results: Initial results for these patients, after treatment to “unlearn” their masturbatory habits and their often associated addiction to pornography, are encouraging and promising. A reduction in symptoms was obtained in 19 patients out of 35. The dysfunctions regressed and these patients were able to enjoy satisfactory sexual activity.

Conclusion: Addictive masturbation, often accompanied by a dependency on cyber-pornography, has been seen to play a role in the etiology of certain types of erectile dysfunction or coital anejaculation. It is important to systematically identify the presence of these habits rather than conduct a diagnosis by elimination, in order to include habit-breaking deconditioning techniques in managing these dysfunctions.

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

One of the 4 case studies in this paper 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. This is the first peer-reviewed chronicling of a recovery from porn-induced sexual dysfunctions.

Excerpts from the paper:

“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. He eventually got habituated to these materials and needed more hardcore pornography scenes. These included transgender sex, orgies, and violent sex. He used to buy illegal pornographic movies on violent sex acts and rape. Then he 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.”

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.

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.

4) How difficult is it to treat delayed ejaculation within a short-term psychosexual model? A case study comparison (2017)

A report on two “composite cases” illustrating the causes and treatments for delayed ejaculation (anorgasmia). “Patient B” represented several young men treated by the therapist. Interestingly, the paper states that Patient B’s “porn use had escalated into harder material”, “as is often the case”. The paper says that porn-related delayed ejaculation is not uncommon, and on the rise. The author calls for more research on porn’s effects of sexual functioning. Patient B’s delayed ejaculation was healed after 10 weeks of no porn.

Excerpts:

The cases are composite cases taken from my work within the National Health Service in Croydon University Hospital, London. With the latter case (Patient B), it is important to note that the presentation reflects a number of young males who have been referred by their GPs with a similar diagnosis. Patient B is a 19-year-old who presented because he was unable to ejaculate via penetration. When he was 13, he was regularly accessing pornography sites either on his own through internet searches or via links that his friends sent him. He began masturbating every night while searching his phone for image…If he did not masturbate he was unable to sleep. The pornography he was using had escalated, as is often the case (see Hudson-Allez, 2010), into harder material (nothing illegal)…

Patient B was exposed to sexual imagery via pornography from the age of 12 and the pornography he was using had escalated to bondage and dominance by the age of 15.

We agreed that he would no longer use pornography to masturbate. This meant leaving his phone in a different room at night. We agreed that he would masturbate in a different way….

Patient B was able to achieve orgasm via penetration by the fifth session; the sessions are offered fortnightly in Croydon University Hospital so session five equates to approximately 10 weeks from consultation. He was happy and greatly relieved. In a three-month follow-up with Patient B, things were still going well.

Psychosexual Therapy

Patient B is not an isolated case within the National Health Service (NHS) and in fact young men in general accessing psychosexual therapy, without their partners, speaks in itself to the stirrings of change.

This article therefore supports previous research that has linked masturbation style to sexual dysfunction and pornography to masturbation style. The article concludes by suggesting that the successes of psychosexual therapists in working with DE are rarely recorded in the academic literature. This has allowed the view of DE as a difficult disorder to treat remain largely unchallenged. The article calls for research into pornography usage and its effect on masturbation and genital desensitisation.

5) Situational Psychogenic Anejaculation: A Case Study (2014)

The details reveal a case of porn-induced anejaculation. The husband’s only sexual experience prior to marriage was frequent masturbation to pornography – where he was able to ejaculate. He also reported sexual intercourse as less arousing than masturbation to porn. The key piece of information is that “re-training” and psychotherapy failed to heal his anejaculation. When those interventions failed, therapists suggested a complete ban on masturbation to porn. Eventually this ban resulted in successful sexual intercourse and ejaculation with a partner for the first time in his life.

A few excerpts:

A is a 33-year-old married male with heterosexual orientation, a professional from a middle socio-economic urban background. He has had no premarital sexual contacts. He watched pornography and masturbated frequently. His knowledge about sex and sexuality was adequate. Following his marriage, Mr. A described his libido as initially normal, but later reduced secondary to his ejaculatory difficulties. Despite thrusting movements for 30-45 minutes, he had never been able to ejaculate or achieve orgasm during penetrative sex with his wife.

What didn’t work:

Mr. A’s medications were rationalized; clomipramine and bupropion were discontinued, and sertraline was maintained at a dose of 150 mg per day. Therapy sessions with the couple were held weekly for the initial few months, following which they were spaced to fortnightly and later monthly. Specific suggestions including focusing on sexual sensations and concentrating on the sexual experience rather than ejaculation were used to help reduce performance anxiety and spectatoring. Since problems persisted despite these interventions, intensive sex therapy was considered.

Stopped masturbation

Eventually they instituted a complete ban on masturbation (which means he continued to masturbate to porn during the above failed interventions):

A ban on any form of sexual activity was suggested. Progressive sensate focus exercises (initially non-genital and later genital) were initiated. Mr. A described an inability to experience the same degree of stimulation during penetrative sex as compared to that which he experienced during masturbation. Once the ban on masturbation was enforced, he reported an increased desire for sexual activity with his partner.

After an unspecified amount of time, the ban on masturbation to porn lead to success:

Meanwhile, Mr. A and his wife decided to go ahead with Assisted Reproductive Techniques (ART) and underwent two cycles of intrauterine insemination. During a practice session, Mr. A ejaculated for the first time, following which he has been able to ejaculate satisfactorily during a majority of the couple’s sexual interactions.

6) Pornography Induced Erectile Dysfunction Among Young Men (2019) – Abstract:

This paper explores the phenomenon of pornography induced erectile dysfunction (PIED), meaning sexual potency problems in men due to Internet pornography consumption. Empirical data from men who suffer from this condition have been collected. A combination of topical life history method (with qualitative asynchronous online narrative interviews) and personal online diaries has been employed. The data have been analyzed using theoretical interpretative analysis (according to McLuhan’s media theory), based on analytic induction. The empirical investigation indicates that there is a correlation between pornography consumption and erectile dysfunction that suggests causation.

The findings are based on 11 interviews along with two video diaries and three text diaries. The men are between the ages of 16 and 52; they report that an early introduction to pornography (usually during adolescence) is followed by daily consumption until a point is reached where extreme content (involving, for example, elements of violence) is needed to maintain arousal. A critical stage is reached when sexual arousal is exclusively associated with extreme and fast-paced pornography, rendering physical intercourse bland and uninteresting. This results in an inability to maintain an erection with a real-life partner, at which point the men embark on a “re-boot” process, giving up pornography. This has helped some of the men to regain their ability to achieve and sustain an erection.

Introduction to the results section:

Having processed the data, I have noticed certain patterns and recurring themes, following a chronological narrative in all of the interviews. These are: Introduction. One is first introduced to pornography, usually before puberty. Building a habit. One begins to consume pornography regularly. Escalation. One turns to more “extreme” forms of pornography, content-wise, in order to achieve the same effects previously achieved through less “extreme” forms of pornography. Realization. One notices sexual potency problems believed to be caused by pornography use. “Re-boot” process. One tries to regulate pornography use or eliminate it completely in order to regain one’s sexual potency. The data from the interviews are presented based on the above outline.

7) Hidden in Shame: Heterosexual Men’s Experiences of Self-Perceived Problematic Pornography Use (2019)

Interviews of 15 male porn users. Several of the men reported porn addiction, escalation of use, and porn-induced sexual problems. Excerpts relevant to porn-induced sexual dysfunctions, including Michael – who significantly improve his erectile function during sexual encounters by severely limiting his porn use:

Some men talked about seeking professional help to address their problematic pornography use. Such attempts at help-seeking had not been productive for the men, and at times even exacerbated feelings of shame. Michael, a university student who used pornography primarily as a coping mechanism for study-related stress, was having issues with erectile dysfunction during sexual encounters with women and sought help from his General Practitioner Doctor (GP):

Michael

When I went to the doctor at 19 [. . .], he prescribed Viagra and said [my issue] was just performance anxiety. Sometimes it worked, and sometimes it didn’t. It was personal research and reading that showed me the issue was porn [. . .] If I go to the doctor as a young kid and he prescribes me the blue pill, then I feel like no one is really talking about it. He should be asking about my porn use, not giving me Viagra. (23, Middle-Eastern, Student)

As a result of his experience, Michael never went back to that GP and started doing his own research online. He eventually found an article discussing a man approximately his age describing a similar type of sexual dysfunction. This caused him to consider pornography as a potential contributor. After making a concerted effort to lower his pornography use, his erectile dysfunction issues began to improve. He reported that even though his total frequency of masturbation did not reduce, he only watched pornography for about half of those instances. By halving the amount of times he combined masturbation with pornography, Michael said he was able to significantly improve his erectile function during sexual encounters with women.

Phillip

Phillip, like Michael, sought help for another sexual issue related to his pornography use. In his case, the problem was a noticeably reduced sex drive. When he approached his GP about his issue and its links to his pornography use, the GP reportedly had nothing to offer and instead referred him to a male fertility specialist:

Phillip: I went to a GP and he referred me to specialist who I didn’t believe was particularly helpful. They didn’t really offer me a solution and weren’t really taking me seriously. I ended up paying him for six weeks of testosterone shots, and it was $100 a shot, and it really didn’t do anything. That was their way to treat my sexual dysfunction. I just do not feel the dialogue or situation was adequate. (29, Asian, Student)

Interviewer: [To clarify a previous point you mentioned, is this the experience] that prevented you from seeking help thereafter?

Phillip: Yup.

The GPs and specialists sought by the participants seemed to offer only biomedical solutions. This is an approach that has been criticized within literature (Tiefer, 1996). Hence, the service and treatment these men were able to receive from their GPs was not only deemed inadequate, but also alienated them from further accessing professional help. Although biomedical responses seem to be the most popular answer for doctors (Potts, Grace, Gavey, & Vares, 2004), a more holistic and client-centered approach is needed. The issues highlighted by men are likely psychological and possibly created by pornography use.

Impact on sexual function

Lastly, men reported the impacts pornography had had on their sexual function. This is something that has only recently been examined within the literature.

For example, Park and colleagues (2016) found that Internet pornography viewing might be associated with erectile dysfunction, decreased sexual satisfaction, and diminished sexual libido. Participants in our study reported similar sexual dysfunctions, which they attributed to pornography use. Daniel reflected on his past relationships in which he was not able to get and keep an erection. He associated his erectile dysfunction with his girlfriends’ bodies not comparing to what he had become attracted to when watching pornography:

Daniel: My previous two girlfriends, I stopped finding them arousing in a way that wouldn’t have happened to someone who was not watching porn. I had seen so many naked female bodies, that I knew the particular things that I liked and you just start forming a very clear ideal about what you want in a woman, and real women aren’t like that. And my girlfriends didn’t have perfect bodies and I think that’s fine, but I think that got in the way of finding them arousing. And that caused problems in the relationships. There are times I couldn’t sexually perform because I was not aroused. (27, Pasifika, Student)

The remaining studies are listed by date of publication:

8) The Dual Control Model – The Role Of Sexual Inhibition & Excitation In Sexual Arousal And Behavior (2007)

Newly rediscovered and very convincing. In an experiment employing video porn, 50% of the young men couldn’t become aroused or achieve erections with porn (average age was 29). The shocked researchers discovered that the men’s erectile dysfunction was,

related to high levels of exposure to and experience with sexually explicit materials.

The men experiencing erectile dysfunction had spent a considerable amount of time in bars and bathhouses where porn was “omnipresent,” and “continuously playing“. The researchers stated:

“Conversations with the subjects reinforced our idea that in some of them a high exposure to erotica seemed to have resulted in a lower responsivity to “vanilla sex” erotica and an increased need for novelty and variation, in some cases combined with a need for very specific types of stimuli in order to get aroused.”

9) Clinical encounters with internet pornography (2008)

Comprehensive paper, with four clinical cases, written by a psychiatrist. He became aware of the negative effects internet porn was having on some of his male patients. The excerpt below describes a 31 year old man who escalated into extreme porn. He developed porn-induced sexual tastes and sexual problems. This is one of the first peer-reviewed papers to depict porn use leading to tolerance, escalation, and sexual dysfunctions:

A 31-year-old male in analytic psychotherapy for mixed anxiety problems reported that he was experiencing difficulty becoming sexually aroused by his current partner. After much discussion about the woman, their relationship, possible latent conflicts or repressed emotional content (without arriving at a satisfactory explanation for his complaint), he provided the detail that he was relying on a particular fantasy to become aroused. Somewhat chagrined, he described a “scene” of an orgy involving several men and women that he had found on an Internet pornography site that had caught his fancy and become one of his favorites.

Recalling pornographic images

Over the course of several sessions, he elaborated upon his use of Internet pornography. It was an activity in which he had engaged sporadically since his mid-20s. Relevant details about his use and the effects over time included clear descriptions of an increasing reliance on viewing and then recalling pornographic images in order to become sexually aroused. He also described the development of a “tolerance” to the arousing effects of any particular material after a period of time. This was followed by a search for new material with which he could achieve the prior, desired level of sexual arousal.

As we reviewed his use of pornography, it became evident that the arousal problems with his current partner coincided with use of pornography, whereas his “tolerance” to the stimulating effects of particular material occurred whether or not he was involved with a partner at the time or was simply using pornography for masturbation. His anxiety about sexual performance contributed to his reliance on viewing pornography. Unaware that the use itself had become problematic, he had interpreted his waning sexual interest in a partner to mean that she was not right for him, and had not had a relationship of greater than two months’ duration in over seven years, exchanging one partner for another just as he might change websites.

Need for stronger images

He also noted that he now could be aroused by pornographic material that he once had no interest in using. For example, he noted that five years ago he had little interest in viewing images of anal intercourse. But he now found such material stimulating. Similarly, material that he described as “edgier,” by which he meant “almost violent or coercive,” was something that now elicited a sexual response from him, whereas such material had been of no interest and was even off-putting. With some of these new subjects, he found himself anxious and uncomfortable even as he would become aroused.

10) Exploring the Relationship Between Erotic Disruption During the Latency Period and the Use of Sexually Explicit Material, Online Sexual Behaviors, and Sexual Dysfunctions in Young Adulthood (2009)

Study examined correlations between current porn use (sexually explicit material – SEM) and sexual dysfunctions, and porn use during “latency period” (ages 6-12) and sexual dysfunctions. The average age of participants was 22. While current porn use correlated with sexual dysfunctions, porn use during latency (ages 6-12) had an even stronger correlation with sexual dysfunctions. A few excerpts:

Findings suggested that latency erotic disruption by way of sexually explicit material (SEM) and/or child sexual abuse may be associated to adult online sexual behaviors.

Furthermore, results demonstrated that latency SEM exposure was a significant predictor of adult sexual dysfunctions.

We hypothesized that exposure to latency SEM exposure would predict adult use of SEM. Study findings supported our hypothesis, and demonstrated that latency SEM exposure was a statistically significant predictor of adult SEM use. This suggested that individuals who were exposed to SEM during latency, may continue this behavior into adulthood. Study findings also indicated that latency SEM exposure was a significant predictor of adult online sexual behaviors.

11) Use of pornography in a random sample of Norwegian heterosexual couples (2009)

Porn use was correlated with more sexual dysfunctions in the man and negative self perception in the female. The couples who did not use porn had no sexual dysfunctions. A few excerpts from the study:

In couples where only one partner used pornography, we found more problems related to arousal (male) and negative (female) self-perception.

In those couples where one partner used pornography there was a permissive erotic climate. At the same time, these couples seemed to have more dysfunctions.

The couples who did not use pornography... may be considered more traditional in relation to the theory of sexual scripts. At the same time, they did not seem to have any dysfunctions.

Couples who both reported pornography use grouped to the positive pole on the ‘‘Erotic climate’’ function and somewhat to the negative pole on the ‘‘Dysfunctions’’ function.

12) Cyber-porn dependence: voices of distress in an Italian internet self-help community (2009)

This study reports on a narrative analysis of two thousand messages written by 302 members of an Italian self-help group for cyberdependents (noallapornodipendenza). It sampled 400 messages from each year (2003–2007). Excerpts relevant to porn-induced sexual dysfunctions:

For many their condition is reminiscent of an addicted escalation with new levels of tolerance. Many of them in fact search for increasingly more explicit, bizarre and violent images, bestiality included….

Many members complain about increased impotence and lack of ejaculation, feeling in their real life like “a dead man walking” (“vivalavita” #5014). The following example concretizes their perceptions (“sul” #4411)….

Many participants stated that they usually spend hours looking at and collecting pictures and movies holding their erect penis in their hand, unable to ejaculate, waiting for the ultimate, extreme image to release the tension. For many the final ejaculation puts an end to their torture (supplizio) (“incercadiliberta” #5026)…

Many problems

Problems in heterosexual relations are more than frequent. People complain they have erection problems, lack of sexual relations with their spouses, lack of interest in sexual intercourse, feeling like a person who has eaten hot, spicy food, and consequently cannot eat ordinary food. In many cases, as also reported by spouses of cyber dependents, there are indications of male orgasmic disorder with the inability to ejaculate during intercourse. This sense of desensitization in sexual relationships is well expressed in the following passage (“vivaleiene” #6019):

Last week I had an intimate relation with my girlfriend; nothing bad at all, despite the fact after the first kiss I didn’t feel any sensation. We didn’t finish the copulation because I didn’t want to.

Many participants expressed their real interest in “chatting on line” or “telematic contact” instead of physical touch, and a pervasive and unpleasant presence of pornographic flashbacks in their mind, during sleep and during sexual intercourse.

As stressed, the claim of a real sexual dysfunction is echoed by many testimonials from female partners. But also forms of collusion and contamination appear in these narratives. Here are a few of the most striking comments of these female partners…

Most of the messages sent to the Italian self help group do indicate the presence of pathology by those participants, according to the model of salience (in real life), mood modification, tolerance, withdrawal symptoms and interpersonal conflict, a diagnostic model developed by Griffiths (2004)….

13) Sexual Desire, not Hypersexuality, is Related to Neurophysiological Responses Elicited by Sexual Images (2013)

This EEG study was touted in the media as evidence against the existence of porn/sex addiction. Not so. Steele et al. 2013 actually lends support to the existence of both porn addiction and porn use down-regulating sexual desire. How so? The study reported higher EEG readings (relative to neutral pictures) when subjects were briefly exposed to pornographic photos. Studies consistently show that an elevated P300 occurs when addicts are exposed to cues (such as images) related to their addiction.

In line with the Cambridge University brain scan studies, this EEG study also reported greater cue-reactivity to porn correlating with less desire for partnered sex. To put it another way.  Individuals with greater brain activation to porn would rather masturbate to porn than have sex with a real person. Shockingly, study spokesperson Nicole Prause claimed that porn users merely had “high libido,” yet the results of the study say the exact opposite (subjects’ desire for partnered sex was dropping in relation to their porn use).

Together these two Steele et al. findings indicate greater brain activity to cues (porn images), yet less reactivity to natural rewards (sex with a person). That”s sensitization & desensitization, which are hallmarks of an addiction. Eight peer-reviewed papers explain the truth: Also see this extensive YBOP critique.

14) Brain Structure and Functional Connectivity Associated With Pornography Consumption: The Brain on Porn (2014)

A Max Planck Institute study which found 3 significant addiction-related brain changes correlating with the amount of porn consumed. It also found that the more porn consumed the less reward circuit activity in response to brief exposure (.530 second) to vanilla porn. In a 2014 article lead author Simone Kühn said:

We assume that subjects with a high porn consumption need increasing stimulation to receive the same amount of reward. That could mean that regular consumption of pornography more or less wears out your reward system. That would fit perfectly the hypothesis that their reward systems need growing stimulation.”

A more technical description of this study from a review of the literature by Kuhn & Gallinat – Neurobiological Basis of Hypersexuality (2016).

“The more hours participants reported consuming pornography, the smaller the BOLD response in left putamen in response to sexual images. Moreover, we found that more hours spent watching pornography was associated with smaller gray matter volume in the striatum, more precisely in the right caudate reaching into the ventral putamen. We speculate that the brain structural volume deficit may reflect the results of tolerance after desensitization to sexual stimuli.”

15) Neural Correlates of Sexual Cue Reactivity in Individuals with and without Compulsive Sexual Behaviours (2014)

This fMRI study by Cambridge University found sensitization in porn addicts which mirrored sensitization in drug addicts. It also found that porn addicts fit the accepted addiction model of wanting “it” more, but not liking “it” more. The researchers also reported that 60% of subjects (average age: 25) had difficulty achieving erections/arousal with real partners as a result of using porn, yet could achieve erections with porn. From the study (“CSB” is compulsive sexual behaviours):

“CSB subjects reported that as a result of excessive use of sexually explicit materials…..[they] experienced diminished libido or erectile function specifically in physical relationships with women (although not in relationship to the sexually explicit material)”

“Compared to healthy volunteers, CSB subjects had greater subjective sexual desire or wanting to explicit cues and had greater liking scores to erotic cues, thus demonstrating a dissociation between wanting and liking. CSB subjects also had greater impairments of sexual arousal and erectile difficulties in intimate relationships but not with sexually explicit materials highlighting that the enhanced desire scores were specific to the explicit cues and not generalized heightened sexual desire.”

16) Modulation of Late Positive Potentials by Sexual Images in Problem Users and Controls Inconsistent with “Porn Addiction” (2015)

A second EEG study from Nicole Prause’s team. This study compared the 2013 subjects from Steele et al., 2013 to an actual control group (yet it suffered from the same methodological flaws named above). The results: Compared to controls “individuals experiencing problems regulating their porn viewing” had lower brain responses to one-second exposure to photos of vanilla porn. The lead author claims these results “debunk porn addiction.” What legitimate scientist would claim that their lone anomalous study has debunked a well established field of study?

In reality, the findings of Prause et al. 2015 align perfectly with Kühn & Gallinat (2014), which found that more porn use correlated with less brain activation in response to pictures of vanilla porn. Prause et al. findings also align with Banca et al. 2015. Moreover, another EEG study found that greater porn use in women correlated with less brain activation to porn. Lower EEG readings mean that subjects are paying less attention to the pictures. Put simply, frequent porn users were desensitized to static images of vanilla porn. They were bored (habituated or desensitized). See this extensive YBOP critique. Nine peer-reviewed papers agree that this study actually found desensitization/habituation in frequent porn users (consistent with addiction): Peer-reviewed critiques of Prause et al., 2015

17) Adolescents and web porn: a new era of sexuality (2015)

This Italian study analyzed the effects of Internet porn on high school seniors, co-authored by urology professor Carlo Foresta, president of the Italian Society of Reproductive Pathophysiology. Most interesting is the 16% of those who consume porn more than once a week report abnormally low sexual desire. This compared with 0% in non-consumers (and 6% for those who consume less than once a week). From the study:

“21.9% define it as habitual. 10% report that it reduces sexual interest towards potential real-life partners.  [The] remaining, 9.1% report a kind of addiction. In addition, 19% of overall pornography consumers report an abnormal sexual response. […This] percentage rose to 25.1% among regular consumers.

18) Patient Characteristics by Type of Hypersexuality Referral: A Quantitative Chart Review of 115 Consecutive Male Cases (2015)

A study on men (average age 41.5) with hypersexuality disorders, such as paraphilias, chronic masturbation or adultery. 27 of the men were classified as “avoidant masturbators,” meaning they masturbated (typically with porn use) one or more hours per day, or more than 7 hours per week. 71% of the men who chronically masturbated to porn reported sexual functioning problems, with 33% reporting delayed ejaculation (a precursor to porn-induced ED).

What sexual dysfunction do 38% of the remaining men have? The study doesn’t say, and the authors have ignored repeated requests for details. Two primary choices for male sexual dysfunction are erectile dysfunction and low libido. It should be noted that the men were not asked about their erectile functioning without porn. This, if all their sexual activity involved masturbating to porn, and not sex with a partner, they might never realize they had porn-induced ED. (For reasons known only to her, Prause cites this paper as debunking the existence of porn-induced sexual dysfunctions.)

19) Men’s Sexual Life and Repeated Exposure to Pornography. A New Issue? (2015)

Excerpts:

Mental health specialists should take in consideration the possible effects of pornography consumption on men sexual behaviors. [This also applies to men’s] sexual difficulties and other attitudes related to sexuality. In the long term pornography seems to create sexual dysfunctions, especially the individual’s inability to reach an orgasm with his partner. Someone who spends most of his sexual life masturbating while watching porn engages his brain in rewiring its natural sexual sets.  [He] will soon need visual stimulation to achieve an orgasm (Doidge, 2007).

Many different symptoms of porn consumption, such as the need to involve a partner in watching porn, the difficulty in reaching orgasm, the need for porn images in order to ejaculate turn into sexual problems. These sexual behaviors may go on for months or years. It may be mentally and bodily associated with the erectile dysfunction, although it is not an organic dysfunction. Because of this confusion, which generates embarrassment, shame and denial, lots of men refuse to encounter a specialist

Pornography offers a very simple alternative to obtain pleasure without implying other factors that were involved in human’s sexuality along the history of mankind. The brain develops an alternative path for sexuality which excludes “the other real person” from the equation. Furthermore, pornography consumption in a long term makes men more prone to difficulties in obtaining an erection in a presence of their partners.

20) Masturbation and Pornography Use Among Coupled Heterosexual Men With Decreased Sexual Desire: How Many Roles of Masturbation? (2015)

Masturbating to porn was related with decreased sexual desire and low relationship intimacy. Excerpts:

Among men who masturbated frequently, 70% used pornography at least once a week. A multivariate assessment showed that sexual boredom, frequent pornography use, and low relationship intimacy significantly increased the odds of reporting frequent masturbation among coupled men with decreased sexual desire.

Among men [with decreased sexual desire] who used pornography at least once a week [in 2011], 26.1% reported that they were unable to control their pornography use. In addition, 26.7% of men reported that their use of pornography negatively affected their partnered sex and 21.1% claimed to have attempted to stop using pornography.

21) Erectile Dysfunction, Boredom, and Hypersexuality among Coupled Men from Two European Countries (2015)

Survey reported a strong correlation between erectile dysfunction and measures of hypersexuality. The study omitted correlation data between erectile functioning and pornography use, but noted a significant correlation. An excerpt:

Among Croatian and German men, hypersexuality was significantly correlated with proneness to sexual boredom and more problems with erectile function.

22) An Online Assessment of Personality, Psychological, and Sexuality Trait Variables Associated with Self-Reported Hypersexual Behavior (2015)

Survey reported a common theme found in several other studies listed here: Porn/sex addicts report greater arousabilty (cravings related to their addiction) combined with poorer sexual function (fear of experiencing erectile dysfunction).

Hypersexual” behavior represents a perceived inability to control one’s sexual behavior. To investigate hypersexual behavior, an international sample of 510 self-identified heterosexual, bisexual, and homosexual men and women completed an anonymous online self-report questionnaire battery.

Thus, the data indicated that hypersexual behavior is more common for males, and those who report being younger in age, more easily sexually excited, more sexually inhibited due to the threat of performance failure, less sexually inhibited due to the threat of performance consequences, and more impulsive, anxious, and depressed

23) Online sexual activities: An exploratory study of problematic and non-problematic usage patterns in a sample of men (2016)

This Belgian study from a leading research university found problematic Internet porn use was associated with reduced erectile function and reduced overall sexual satisfaction. Yet problematic porn users experienced greater cravings. The study appears to report escalation, as 49% of the men viewed porn that “was not previously interesting to them or that they considered disgusting.” (See studies reporting habituation/desensitization to porn and escalation of porn use) Excerpts:

This study is the first to directly investigate the relationships between sexual dysfunctions and problematic involvement in OSAs. Results indicated that higher sexual desire, lower overall sexual satisfaction, and lower erectile function were associated with problematic OSAs (online sexual activities). These results can be linked to those of previous studies reporting a high level of arousability in association with sexual addiction symptoms (Bancroft & Vukadinovic, 2004; Laier et al., 2013; Muise et al., 2013).”

Escalation

In addition, we finally have a study that asks porn users about possible escalation to new or disturbing porn genres. Guess what it found?

Forty-nine percent mentioned at least sometimes searching for sexual content or being involved in OSAs that were not previously interesting to them or that they considered disgusting, and 61.7% reported that at least sometimes OSAs were associated with shame or guilty feelings.”

Note – This is the first study to directly investigate the relationships between sexual dysfunctions and problematic porn use. Two other studies claiming to have investigated correlations between porn use and erectile functioning cobbled together data from earlier studies in an unsuccessful attempt to debunk porn-induced ED. Both were criticized in the peer-reviewed literature: paper #1 was not an authentic study, and has been thoroughly discredited; paper #2 actually found correlations that support porn-induced sexual dysfunction. Moreover, paper 2 was only a “brief communication” that did not report important data which the authors reported at a sexology conference.

24) The effects of sexually explicit material use on romantic relationship dynamics (2016)

As with many other studies, solitary porn users report poorer relationship and sexual satisfaction. An excerpt:

More specifically, couples, where no one used, reported more relationship satisfaction than those couples that had individual users. This is consistent with the previous research (; ), demonstrating that the solitary use of SEM results in negative consequences.

Employing the Pornography Consumption Effect Scale (PCES), the study found that higher porn use was related to poorer sexual function, more sexual problems, and a “worse sex life”. An excerpt describing the correlation between the PCES “Negative Effects” on “Sex Life” questions and frequency of porn use:

There were no significant differences for the Negative Effect Dimension PCES across the frequency of sexually explicit material use. However, there were significant differences on the Sex Life subscale. [Here] High Frequency Porn Users reported greater negative effects than Low Frequency Porn Users.

25) Altered Appetitive Conditioning and Neural Connectivity in Subjects With Compulsive Sexual Behavior (2016)

“Compulsive Sexual Behaviors” (CSB) means the men were porn addicts, because CSB subjects averaged nearly 20 hours of porn use per week. The controls averaged 29 minutes per week. Interestingly, 3 of the 20 CSB subjects mentioned to interviewers that they suffered from “orgasmic-erection disorder” None of the control subjects reported sexual problems.

26) Associative pathways between pornography consumption and reduced sexual satisfaction (2017)

This study is found in both lists. While it links porn use to lower sexual satisfaction, it also reported that frequency of porn use was related to a preference (or need?) for porn over people to achieve sexual arousal. An excerpt:

Finally, we found that frequency of pornography consumption was also directly related to a relative preference for pornographic rather than partnered sexual excitement. Participants in the present study primarily consumed pornography for masturbation. Thus, this finding could be indicative of a masturbatory conditioning effect (Cline, 1994; Malamuth, 1981; Wright, 2011). The more frequently pornography is used as an arousal tool for masturbation, the more an individual may become conditioned to pornographic as opposed to other sources of sexual arousal.

27) “I think it has been a negative influence in many ways but at the same time I can’t stop using it”: Self-identified problematic pornography use among a sample of young Australians (2017)

Online survey of Australians, aged 15-29. Those who had ever viewed pornography (n=856) were asked in an open-ended question: ‘How has pornography influenced your life?’.

Among participants who responded to the open-ended question (n=718), problematic usage was self-identified by 88 respondents. Male participants who reported problematic usage of pornography highlighted effects in three areas: on sexual function, arousal and relationships. Responses included “I think it has been a negative influence in many ways but at the same time I can’t stop using it” (Male, Aged 18–19). Some female participants also reported problematic usage. Many of these reported negative feelings like guilt and shame. There was an impact on sexual desire and compulsions relating to their use of pornography. For example as one female participant suggested; “It makes me feel guilty, and I’m trying to stop. I don’t like how I feel that I need it to get myself going, it’s not healthy.” (Female, Aged 18–19)

28) Organic and psychogenic causes of sexual dysfunction in young men (2017)

A narrative review, with a section called “Role of Pornography in Delayed Ejaculation (DE)”. An excerpt from this section:

Role of Pornography in DE

Over the last decade, a large increase in the prevalence and accessibility of Internet pornography has provided increased causes of DE. This is associated with Althof’s second and third theory. Reports from 2008 found on average 14.4% of boys were exposed to pornography before the age of 13. They also showed 5.2% of people viewed pornography at least daily. A 2016 study revealed that these values had both increased to 48.7% and 13.2%, respectively. An earlier age of first pornographic exposure contributes to DE through its relationship with patients exhibiting CSB.

Voon et al. found that young men with CSB had viewed sexually explicit material at an earlier age than their age-controlled healthy peers. As previously mentioned, young men with CSB can fall victim to Althof’s third theory of DE. this means they preferentially choose masturbation over partnered sex due to a lack of arousal in relationships. An increased number of men watching pornographic material daily also contributes to DE through Althof’s third theory. In a study of 487 male college students, Sun et al. found associations between the use of pornography and a decreased self-reported enjoyment of sexually intimate behaviors with real-life partners.

Preferring masturbation to real partners

These individuals are at an elevated risk of preferentially choosing masturbation over sexual encounters. This was demonstrated in a case report by Park et al. A 20-year-old enlisted male presented with difficulty achieving orgasm with his fiancée for the previous six months. A detailed sexual history revealed that the patient relied on Internet pornography. He also made use of a sex toy described as a “fake vagina” to masturbate while deployed. Over time, he required content of an increasingly graphic or fetish nature to orgasm. He admitted that he found his fiancée attractive but preferred the feeling of his toy. He found it more stimulating that real intercourse.

An increase in the accessibility of Internet pornography places younger men at risk of developing DE through Althof’s second theory. This is  demonstrated in the following case report. Bronner et al. interviewed a 35-year-old healthy man presenting with complaints of no desire to have sex with his girlfriend. This was despite being mentally and sexually attracted to her. A detailed sexual history revealed that this scenario had happened with the past 20 women he tried to date. He reported extensive use of pornography since adolescence that initially consisted of zoophilia, bondage, sadism, and masochism. Eventually he progressed to transgender sex, orgies, and violent sex. He would visualize the pornographic scenes in his imagination to function sexually with women, but that gradually stopped working.

Loss of desire

The gap between the patient’s pornographic fantasies and real life became too large, causing a loss of desire. According to Althof, this will present as DE in some patients.73 This recurring theme of requiring pornographic content of an increasingly graphic or fetish nature to orgasm is defined by Park et al. as hyperactivity. As a man sensitizes his sexual arousal to pornography, sex in real life no longer activates the proper neurological pathways to ejaculate (or produce sustained erections in the case of ED).

29) Pornography increasingly damaging health and relationships says Brno’s University Hospital study (2018)

It’s in Czech. This YBOP page contains a short press release in English. It is a choppy Google translation of the longer press release from the hospital website. A few excerpts from the press release:

Increased use of and exposure to pornography are increasingly damaging normal relations and even the health of young men, according to a study released Monday by Brno’s University Hospital.

Many young men were simply not prepared for normal relationships because of the myths created by the pornography they were watching. Many men turned on by pornography could not physically get stimulated in a relationship. Psychological and even medical treatment was required, the report said.

In the Sexological department of the Faculty Hospital in Brno, we also record more and more frequent cases of young men who are not able to have a normal sex life as a result of pornography, or to establish a relationship.

Growing problem

The fact that pornography is not merely a “diversification” of sex life but often has a negative impact on the quality of partner sexuality is evidenced by the increasing number of patients in the Sexual Section of Brno University Hospital who, due to excessive monitoring of inappropriate sexual content, are getting into health and relationship problems.

In middle age, male partners are replacing partner sex with pornography. Masturbation is available anytime, faster, without psychological, physical or material investment). At the same time, sensitivity to normal (real) sexual stimuli accompanied by the risk of having sex-related dysfunctions associated only with a partner is significantly reduced by the monitoring of pornography. This is a risk of intimacy and proximity in the relationship, ie the psychological separation of partners, the need for masturbation on the Internet is gradually increasing – the risk of addiction increases and, last but not least, sexuality can change in its intensity but also in the quality of normal pornography is not enough, and these people resort to perversion (eg, sado-masochistic or zoophilous).

As a result, excessive monitoring of pornography may result in addiction, which is manifested by sexual dysfunction, disorder of relationships leading to social isolation, disrupted concentration, or neglect of work responsibilities, where only sex plays a dominant role in life.

30) Sexual Dysfunctions in the Internet Era (2018)

Excerpts:

Low sexual desire, reduced satisfaction in sexual intercourse, and erectile dysfunction (ED) are increasingly common in young population. In an Italian study from 2013, up to 25% of subjects suffering from ED were under the age of 40 [1], and in a similar study published in 2014, more than half of Canadian sexually experienced men between the age of 16 and 21 suffered from some kind of sexual disorder [2]. At the same time, prevalence of unhealthy lifestyles associated with organic ED has not changed significantly or has decreased in the last decades, suggesting that psychogenic ED is on the rise [3].

The DSM-IV-TR defines some behaviors with hedonic qualities, such as gambling, shopping, sexual behaviors, Internet use, and video game use, as “impulse control disorders not elsewhere classified”—although these are often described as behavioral addictions [4]. Recent investigation has suggested the role of behavioral addiction in sexual dysfunctions. Alterations in neurobiological pathways involved in sexual response might be a consequence of repeated, supernormal stimuli of various origins.

Risk factors

Among behavioral addictions, problematic Internet use and online pornography consumption are often cited as possible risk factors for sexual dysfunction, often with no definite boundary between the two phenomena. Online users are attracted to Internet pornography because of its anonymity, affordability, and accessibility, and in many cases its usage could lead users through a cybersex addiction: in these cases, users are more likely to forget the “evolutionary” role of sex, finding more excitement in self-selected sexually explicit material than in intercourse.

In literature, researchers are discordant about positive and negative function of online pornography. From the negative perspective, it represents the principal cause of compulsive masturbatory behavior, cybersex addiction, and even erectile dysfunction.

31) Is Pornography Use Related to Erectile Functioning? Results From Cross-Sectional and Latent Growth Curve Analyses” (2019)

The researcher who saddled humankind with “perceived pornography addiction” and claimed it somehow “functions very differently from other addictions,” has now turned his dexterity to porn-induced ED. Even though this Joshua Grubbs-penned study found correlations between poorer sexual functioning and both porn addiction and porn use (while excluding sexually inactive men and thus many men with ED), the paper reads as if it has completely debunked porn-induced ED (PIED). This maneuver comes as no surprise to those who have followed the earlier dubious claims of Dr. Grubbs in relation to his “perceived pornography addiction” campaign. See this extensive analysis for the facts.

While the Grubbs paper consistently downplays the correlations between higher pornography use and poorer erections, correlations were reported in all 3 groups – especially for sample 3, which was the most relevant sample as it was the largest sample and averaged higher levels of porn use. Most importantly, this sample’s age range is the most likely to report PIED. Not surprisingly, sample 3 had the strongest correlation between higher levels of porn use and poorer erectile functioning (–0.37). Below are the 3 groups, with their average daily minutes of porn viewing. It also shows the correlations between erectile functioning and amount of use. A negative sign means poorer erections linked to greater porn use.

Results
  1. Sample 1 (147 men): average age 19.8 – Averaged 22 minutes of porn/day. (–0.18)
  2. Sample 2 (297 men): average age 46.5 – Averaged 13 minutes of porn/day. (–0.05)
  3. Sample 3 (433 men): average age 33.5 – Averaged 45 minutes of porn/day. (–0.37)

These were fairly straightforward results. The sample that used the most porn (#3) had the strongest correlation between greater porn use and poorer erections. The group that use the least (#2) had the weakest correlation between greater porn use and poorer erections. Why didn’t Grubbs emphasize this pattern in his write-up, instead of using statistical manipulations to try to make it disappear?

To summarize:
  • Sample #1: Average age 19.8. Note that 19-year old porn users rarely report chronic porn-induced (especially when only using 22 minutes a day). The vast majority of porn-induced ED recovery stories YBOP has gathered are by men aged 20-40. It generally takes time to develop PIED.
  • Sample #2: Average age 46.5. They averaged only 13 minutes per day! With a standard deviation of 15.3 years, some portion of these men were fifty-something. These older men did not start out using internet porn during adolescence. This made them less vulnerable to conditioning their sexual arousal solely to internet porn. Indeed, just as Grubbs found, the sexual health of slightly older men has always been better and more resilient. It is better  than users who began using digital porn during adolescence. For example, those with an average age of 33 in sample 3).
  • Sample #3: Average age 33.5. As already mentioned, sample 3 was the largest sample and averaged higher levels of porn use. Most importantly, this age range is the most likely to report PIED. Not surprisingly, sample 3 had the strongest correlation between higher levels of porn use and poorer erectile functioning (–0.37).
Correlations

Grubbs also correlated porn addiction scores with erectile functioning. The results reveal that even in subjects with relatively healthy erectile functioning, porn addiction was significantly related to poorer erections (–0.20 to –0.33). As before, the strongest correlation between porn addiction and poorer erections (–0.33) occurred in Grubbs’s largest sample. And this was the sample of an average age most likely to report porn-induced ED: sample 3, average age: 33.5 (433 subjects).

Wait a minute you ask, how dare I say significantly related? Doesn’t the Grubbs study confidently declare that the relationship was only “small to moderate,” meaning it’s no big deal? As we explored in the critique, Grubbs’s use of descriptors varies remarkably, depending upon which Grubbs study you read. If the Grubbs study is about porn use causing ED, then the above numbers represent a meager correlation, tossed aside in his spin-laden write-up.

However, if it’s Grubbs’s most famous study (“Transgression as Addiction: Religiosity and Moral Disapproval as Predictors of Perceived Addiction to Pornography“), where he proclaimed that being religious was the real cause of “porn addiction,” then numbers smaller than these constitute a “robust relationship.” In fact, Grubbs’s “robust” correlation between religiosity and “perceived pornography addiction” was only 0.30! Yet he audaciously used it to usher in a completely new, and questionable, model of porn addiction. The tables, correlations and details referred to here are found in this section of a longer YBOP analysis.

32) Survey of Sexual Function and Pornography (2019)

In this study, researchers looked for a link between ED and indices of pornography addiction using a “craving” questionnaire. No such link turned up. Perhaps this is because users don’t accurately assess their degree of “craving” until they attempt to quit using.  However, some other interesting correlations appeared in their results. Excerpts:

Rates of erectile dysfunction were lowest in those [men] preferring partnered sex without pornography (22.3%) and increased significantly when pornography was preferred over partnered sex (78%).

…Pornography and sexual dysfunction are common among young people.

…Those [men] who used on an almost daily basis or more had ED rates of 44% (12/27). This compared to 22% (47/213) for those more “casual” users (≤5x/week), reaching significance on univariate analysis (p=0.017). It may be that volume does play a role to some extent.

…The proposed pathophysiology of PIED seems plausible and is based on a variety of researchers work. This is not a small collection of researchers that might be swayed by an ethical bias. Also supporting the “causation” side of the argument are reports of men regaining normal sexual function after discontinuation of excessive pornography use.

Causation?

…Only prospective studies will be able to definitively solve the question of causation or association. [These should] including interventional studies evaluating the success of abstention in treating ED in heavy pornography users. Additional populations that warrant special consideration include adolescents. There has been concern raised that early exposure to graphic sexual material may affect normal development. The rate of teenagers being exposed to pornography before the age of 13 has gone up three-fold over the last decade. It now hovers around 50%.

The above study was presented at the American Urological Association’s 2017 meeting. A few excerpts from this article about it – Study sees link between porn and sexual dysfunction (2017):

Young men who prefer pornography to real-world sexual encounters might find themselves caught in a trap, unable to perform sexually with other people when the opportunity presents itself, a new study reports. Porn-addicted men are more likely to suffer from erectile dysfunction and are less likely to be satisfied with sexual intercourse. This was according to survey findings presented Friday at the American Urological Association’s annual meeting, in Boston.

The rates of organic causes of erectile dysfunction in this age cohort are extremely low. So the increase in erectile dysfunction that we have seen over time for this group needs to be explained,” Christman said. “We believe that pornography use may be one piece to that puzzle”.

33) Sexual Dysfunction in the New Father: Sexual Intimacy Issues (2018)

This chapter from a new medical textbook entitled Paternal Postnatal Psychiatric Illnesses addresses porn’s impact on the sexual function of a new father, citing a paper co-authored by this website’s host, “Is Internet Pornography Causing Sexual Dysfunctions? A Review with Clinical Reports.” This page contains screenshots of relevant excerpts from the chapter.

34) Prevalence, Patterns and Self-Perceived Effects of Pornography Consumption in Polish University Students: A Cross-Sectional Study (2019)

Large study (n = 6463) on male & female college students (median age 22) reports relatively high levels of porn addiction (15%), escalation of porn use (tolerance), withdrawal symptoms, and porn-related sexual & relationship problems. Relevant excerpts:

The most common self-perceived adverse​ effects of pornography use included the need for longer stimulation (12.0%). It also included more sexual stimuli​ (17.6%) to reach orgasm, and a decrease in sexual satisfaction (24.5%)…

The present study also suggests that earlier exposure may be associated with potential desensitization to sexual stimuli. This was indicated by a need for longer stimulation. Additionally, more sexual stimuli were required to reach orgasm when consuming explicit material, and overall decrease in sexual satisfaction

Various changes of pattern of pornography use occurring in the course of the exposure period were reported. One was switching to a novel genre of explicit material (46.0%). There was use of materials that do not​ match sexual orientation (60.9%). Some reported the need to use more extreme (violent) material (32.0%)…

35) Sexual and reproductive health and rights in Sweden 2017 (2019)

A 2017 survey by The Swedish Public Health Authority contains a section discussing their findings on pornography. relevant here, greater pornography use was related to poorer sexual health and decreased sexual dissatisfaction. Excerpts:

Forty-one percent of men aged 16 to 29 are frequent users of pornography. They consume pornography on a daily basis or almost on a daily basis. The corresponding percent among women is 3 percent. Our results also show an association between frequent pornography consumption and poorer sexual health. They also show an association with transactional sex. [There were links to] too high expectations of one’s sexual performance, and dissatisfaction with one’s sex life. Almost half of the population state that their pornography consumption does not affect their sex life. By comparison, a third do not know if it affects it or not. A small percentage of both women and men say their pornography use has a negative effect on their sex life. It was more common among men with higher education to regularly use pornography compared to men with lower education.

There is a need for more knowledge on the link between pornography consumption and health. An important preventive piece is to discuss the negative consequences of pornography with boys and young men. School is a natural place to do this.

36) Internet Pornography: Addiction or Sexual Dysfunction? (2019)

Link to PDF of the chapter in Introduction to Psychosexual Medicine (2019) – White, Catherine. “Internet Pornography: Addiction or Sexual Dysfunction. Introduction to Psychosexual Medicine?” (2019)

37) Abstinence or Acceptance? A Case Series of Men’s Experiences With an Intervention Addressing Self-Perceived Problematic Pornography Use (2019)

The paper reports on six cases of men with porn addiction as they underwent a mindfulness-based intervention program (meditation, daily logs & weekly check-ins). All 6 subjects seemed to benefit from meditation. Relevant to this list of studies, 2 of 6 reported porn-induced ED. A few report escalation of use (habituation). One describes withdrawal symptoms. Excerpts from the cases reporting PIED:

Pedro (age 35):

Pedro self-reported as being a virgin. He talked about the feelings of shame he experienced with his past attempts at sexual intimacy with women. His most recent potential sexual encounter ended when his fear and anxiety prevented him from getting an erection. He attributed his sexual dysfunction to pornography use…

Pedro reported a significant decrease in pornography viewing by the end of the study and an overall improvement in mood and mental health symptoms. Despite increasing the dosage of one of his anti-anxiety medications during the study due work stress, he said he would continue meditating because of the self-reported benefits of calmness, focus, and relaxation he experienced after each session.

Pablo (age 29):

Pablo felt he had little to no control over his pornography use. He spent several hours each day ruminating on pornography, either while actively engaged in watching pornographic content or by thinking about watching pornography at the next possible opportunity when he was busy doing something else. He went to a doctor with concerns about sexual dysfunctions he was experiencing, and though he disclosed concerns about his pornography use to his doctor, Pablo was instead referred to a male fertility specialist where he was given shots of testosterone. Pablo reported the testosterone intervention as having no benefit or usefulness to his sexual dysfunction, and the negative experience prevented him from reaching out for any further help with regards to his pornography use. The pre-study interview was the first time Pablo was able to converse openly with anybody regarding his pornography use…

38) Lecture describing upcoming studies – by Urology professor Carlo Foresta, president of the Italian Society of Reproductive Pathophysiology

The lecture contains the results of longitudinal and cross-sectional studies. One study involved a survey of high school teens (pages 52-53). The study reported that sexual dysfunction doubled between 2005 and 2013, with low sexual desire increasing 600%.

  • The percentage of teens that experienced alterations of their sexuality: 2004/05: 7.2%, 2012/13: 14.5%
  • The percentage of teens with low sexual desire: 2004/05: 1.7%, 2012/13: 10.3% (that’s a 600% increase in 8 years)

Foresta also describes his upcoming study, “Sexuality media and new forms of sexual pathology sample 125 young males, 19-25 years” (Italian name – “Sessualità mediatica e nuove forme di patologia sessuale Campione 125 giovani maschi“). The results from the study (pages 77-78), which used the International Index of Erectile Function Questionnaire, found that regular porn users scored 50% lower on sexual desire domain and 30% lower of the erectile functioning domain.

39) MedHelp comments and questions (not peer-reviewed)

Here’s an article about an extensive analysis of comments and questions posted on MedHelp concerning erectile dysfunction. What’s shocking is that 58% of the men asking for help were 24 or younger. Many suspected that internet porn could be involved as described in the results from the study

The most common phrase is “erectile dysfunction”. It is mentioned more than three times as often as any other phrase. It is followed by “internet porn,” “performance anxiety,” and “watching porn.”

Clearly, porn is a frequently discussed subject. “I have been viewing internet pornography frequently (4 to 5 times a week) for the past 6 years,” one man writes. “I am in my mid-20s and have had a problem getting and maintaining an erection with sexual partners since my late teens when I first started looking at internet porn.”

Article about the latest spin campaign: Sexologists Deny Porn-induced ED by Claiming Masturbation Is the Problem (2016)


References (beyond those linked to above):

1.         Papagiannopoulos D, Khare N, Nehra A. “Evaluation of young men with organic erectile dysfunction.” Asian journal of andrology. 2015;17(1):11-6. Epub 2014/11/06. doi: 10.4103/1008-682x.139253. PubMed PMID: 25370205; PubMed Central PMCID: PMCPmc4291852.

2.         Martins FG, Abdo CH. “Erectile dysfunction and correlated factors in Brazilian men aged 18-40 years.” The journal of sexual medicine. 2010;7(6):2166-73. Epub 2009/11/06. doi: 10.1111/j.1743-6109.2009.01542.x. PubMed PMID: 19889149.

3.         “Erectile dysfunction among male active component service members, U.S. Armed Forces, 2004-2013.” Msmr. 2014;21(9):13-6. Epub 2014/10/01. PubMed PMID: 25267600.

4.         Wilcox SL, Redmond S, Hassan AM. “Sexual functioning in military personnel: preliminary estimates and predictors.” The journal of sexual medicine. 2014;11(10):2537-45. Epub 2014/07/22. doi: 10.1111/jsm.12643. PubMed PMID: 25042933.

5.         Laumann EO, Paik A, Rosen RC. “Sexual dysfunction in the United States: prevalence and predictors.” JAMA : the journal of the American Medical Association. 1999;281(6):537-44. Epub 1999/02/18. PubMed PMID: 10022110.

6.         Prins, J., M. H. Blanker, A. M. Bohnen, S. Thomas, and J. L. H. R. Bosch. “Prevalence of Erectile Dysfunction: A Systematic Review of Population-Based Studies.” International Journal of Impotence Research 14, no. 6 (December 2002): 422–32. doi:10.1038/sj.ijir.3900905.

7.         de Boer, B. J., M. L. Bots, A. A. B. Lycklama a Nijeholt, J. P. C. Moors, H. M. Pieters, and Th J. M. Verheij. “Erectile Dysfunction in Primary Care: Prevalence and Patient Characteristics. The ENIGMA Study.” International Journal of Impotence Research 16, no. 4 (February 12, 2004): 358–64. doi:10.1038/sj.ijir.3901155.

Articles from 2012 onwards

8.         Mialon A, Berchtold A, Michaud PA, Gmel G, Suris JC. “Sexual dysfunctions among young men: prevalence and associated factors.” The Journal of adolescent health : official publication of the Society for Adolescent Medicine. 2012;51(1):25-31. Epub 2012/06/26. doi: 10.1016/j.jadohealth.2012.01.008. PubMed PMID: 22727073.

9.         Capogrosso P, Colicchia M, Ventimiglia E, Castagna G, Clementi MC, Suardi N, et al. “One patient out of four with newly diagnosed erectile dysfunction is a young man–worrisome picture from the everyday clinical practice.” The journal of sexual medicine. 2013;10(7):1833-41. Epub 2013/05/09. doi: 10.1111/jsm.12179. PubMed PMID: 23651423.

10.         O’Sullivan LF, Brotto LA, Byers ES, Majerovich JA, Wuest JA. “Prevalence and characteristics of sexual functioning among sexually experienced middle to late adolescents.” The journal of sexual medicine. 2014;11(3):630-41. Epub 2014/01/15. doi: 10.1111/jsm.12419. PubMed PMID: 24418498.

11.         Ivan Landripet, PhD and Aleksandar Štulhofer, PhD. “Is Pornography Use Associated with Sexual Difficulties and Dysfunctions among Younger Heterosexual Men?” (Brief Communication) The journal of sexual medicine, Epub 2015/03/26. doi: 10.1111/jsm.12853

12.         Wilcox SL1, Redmond S, Davis TL., “Genital Image, Sexual Anxiety, and Erectile Dysfunction Among Young Male Military Personnel.” J Sex Med. 2015 Apr 30. doi: 10.1111/jsm.12880.

13.       Sutton, Katherine S., Natalie Stratton, Jennifer Pytyck, Nathan J. Kolla, and James M. Cantor. “Patient Characteristics by Type of Hypersexuality Referral: A Quantitative Chart Review of 115 Consecutive Male Cases.” Journal of Sex & Marital Therapy 41, no. 6 (December 2015): 563–80. doi:10.1080/0092623X.2014.935539.

Valerie Voon’s team at the University of Cambridge

14.       Voon V, Mole TB, Banca P, Porter L, Morris L, Mitchell S, et al. “Neural correlates of sexual cue reactivity in individuals with and without compulsive sexual behaviours.” PloS one. 2014;9(7):e102419. Epub 2014/07/12. doi: 10.1371/journal.pone.0102419. PubMed PMID: 25013940; PubMed Central PMCID: PMCPmc4094516.

15.       Carvalheira A, Traeen B, Stulhofer A. “Masturbation and Pornography Use Among Coupled Heterosexual Men With Decreased Sexual Desire: How Many Roles of Masturbation?” Journal of sex & marital therapy. 2014:1-10. Epub 2014/09/06. doi: 10.1080/0092623x.2014.958790. PubMed PMID: 25189834.

16.       Sun C, Bridges A, Johnason J, Ezzell M. “Pornography and the Male Sexual Script: An Analysis of Consumption and Sexual Relations.” Archives of sexual behavior. 2014. Epub 2014/12/04. doi: 10.1007/s10508-014-0391-2. PubMed PMID: 25466233.

17.       Morgan, E. M. Associations between young adults’ use of sexually explicit materials and their sexual preferences, behaviors, and satisfaction. J. Sex Res. 2011, 48, 520–530.

18.       Maddox, A. M.; Rhoades, G. K.; Markman, H. J. Viewing Sexually-Explicit Materials Alone or Together: Associations with Relationship Quality. Arch. Sex. Behav. 2011, 40, 441–448.

19.       Bridges, A. J.; Morokoff, P. J. Sexual media use and relational satisfaction in heterosexual couples. Pers. Relatsh. 2011, 18, 562–585.

20.       Stewart, D. N.; Szymanski, D. M. Young Adult Women’s Reports of Their Male Romantic Partner’s Pornography Use as a Correlate of Their Self-Esteem, Relationship Quality, and Sexual Satisfaction. Sex Roles 2012, 67, 257–271.

Korea study showing men preferring violent porn to real women

21.       Sun, C.; Miezan, E.; Lee, N.-Y.; Shim, J. W. Korean Men’s Pornography use, Their Interest in Extreme Pornography, and Dyadic Sexual Relationships. Int. J. Sex. Health 2015, 27, 16–35.

22.       Pornography’s Impact on Sexual Satisfaction – Zillmann – 2006 – Journal of Applied Social Psychology – Wiley Online Library http://onlinelibrary.wiley.com/doi/10.1111/j.1559-1816.1988.tb00027.x/abstract (accessed Jul 4, 2015).

23.        Giovanni Castellini, Giovanni Corona, Egidia Fanni, Elisa Maseroli, Valdo Ricca and Mario Maggi, “Does compulsive sexual behavior really exist? Psychological, relational, and biological correlates of compulsive masturbation in a clinical setting.”

24.        Voon V, Mole TB, Banca P, Porter L, Morris L, Mitchell S, et al. Neural correlates of sexual cue reactivity in individuals with and without compulsive sexual behaviours. PloS one. 2014;9(7):e102419. Epub 2014/07/12. doi: 10.1371/journal.pone.0102419. PubMed PMID: 25013940; PubMed Central PMCID: PMCPmc4094516.

25.        Kuhn S, Gallinat J. Brain structure and functional connectivity associated with pornography consumption: the brain on porn. JAMA psychiatry. 2014;71(7):827-34. Epub 2014/05/30. doi: 10.1001/jamapsychiatry.2014.93. PubMed PMID: 24871202.

34 thoughts on “Research confirms sharp rise in youthful sexual dysfunctions

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