Debunking Kris Taylor’s “A Few Hard Truths about Porn and Erectile Dysfunction”

Introduction

I was surprised and somewhat baffled by grad student Kris Taylor’s recent VICE article on porn use and sexual dysfunctions. In his article Taylor not only misrepresented the content of a 2016 review of literature I co-authored with 7 US navy doctors, he chose to omit over 40 studies linking porn use to sexual problems and lower sexual arousal. Before I address specific sections of Kris Taylor’s article here are the studies and articles he was given, yet chose to neglect in his article:

Over 40 studies linking porn use or porn addiction to sexual dysfunctions & lower arousal. The first 7 studies in the list demonstrate causation, as participants eliminated porn use and healed chronic sexual dysfunctions.
Over 80 studies linking porn use to less sexual and relationship satisfaction.
Articles, interviews and videos citing over 150 experts (urology professors, urologists, psychiatrists, psychologists, sexologists, MDs) who acknowledge and have successfully treated porn-induced ED and porn-induced loss of sexual desire.
Over 60 studies reporting findings consistent with escalation of porn use (tolerance), habituation to porn, and even withdrawal symptoms.
All the neurological studies published on porn users/sex addicts: 55 neuroscience studies (MRI, fMRI, EEG, neurospychological, hormonal) provide strong support for the addiction model.
31 reviews of the literature & commentaries by some of the top neuroscientists in the world. All lend support to the porn addiction model.
Approximately 3,000 first-person stories of recovery from porn-induced sexual problems (Rebooting accounts 1, Rebooting accounts 2, Rebooting accounts 3, Short PIED recovery stories).

The rest of this piece will consist of excerpts from Kris Taylor’s article followed by YBOP comments, and excerpts from the 2016 review of literature I co-authored with 7 US navy doctors.

The truth behind current and historical sexual dysfunction rates in young men.

KRIS TAYLOR: “Hooked on porn: Prepare for a tsunami of damaged people,” warned the Herald last year. They quote Brisbane based sexologist Liz Walker, saying “before the internet appeared, erectile dysfunction in males under 40 was reported as being about 2-5 per cent, now that figure has jumped to between 27 and 33 per cent.“

The percentages given by Liz Walker were accurate and they are documented both in this lay article (Research confirms sharp rise in youthful sexual dysfunctions) and in this extensive review of the literature involving 7 US Navy doctors and myself: Is Internet Pornography Causing Sexual Dysfunctions? A Review with Clinical Reports (2016). Among the eight authors were seven physicians with the following expertise: two urologists, a neuroscientist, and two psychiatrists, and a general medical physician.” One author, Dr. Klam, is Director of Mental Health at the Naval Medical Center – San Diego. These seven doctors have spent much of their careers treating (primarily) young men.

KRIS TAYLOR: “But when you try to find the research she’s citing, thing get murkier. Her source is this paper, which in turn gives numbers sourced from two papers – neither of which reference pornography as causative. Not to mention that the second author of the paper is Gary Wilson, a well-known fervent anti-pornography campaigner.”

Taylor cites the US Navy paper and proceeds to blatantly misrepresent its content (perhaps hoping no one would click on the link). Taylor “suggests” that our paper cited only 2 isolated studies to support the claim that ED rates in men under 40 have skyrocketed since the advent of streaming tube sites (2006). In reality, we examined every PubMed listed study previously published that provided sexual dysfunction rates for men under 40.

We also examined all PubMed sourced meta-studies and meta-analyses examining ED rates in both men over and under 40. A meta-analysis is a study that reviews all previous studies on a particular subject, and lists the pertinent data. (Taylor may not yet know what a meta-analysis is as he linked to one of meta-analysis we cited.)

What did our paper cite in the 2^nd paragraph to support the claim that historical ED rates for men under have been between 2-5%? (The following citation numbers and their original links are provided.)

[2] – (2000) Meta-analysis that reviewed 93 studies from across the globe.
[3] – (1992) Largest US survey.
[5] – (2001) ED rates from 29 developed countries (13,000 subjects).
Not cited: 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.

Taylor failed to provide a single study to refute our claim that ED rates for men under 40 have been consistently reported as between 2-5%. Instead, he attempted to mislead the reader with a single 2013 study, implying that high rates of erectile dysfunction in young men were always normal. However, the paper also supports our claims. He said:

KRIS TAYLOR: “By some estimates erectile ‘dysfunction’ may occur for about half of all men, and 1 in 4 men seeking treatment for erectile dysfunction will be under 40.”

However, the paper’s authors were clearly surprised to find that 25% of men who visited doctors for erectile dysfunction were under 40. The name of the study says it all: One Patient Out of Four with Newly Diagnosed Erectile Dysfunction Is a Young Man—Worrisome Picture from the Everyday Clinical Practice. (The study did not assess ED rates in the general population.)

Further, what did our paper cite in the 3^rd paragraph to support the claim that recent studies report much higher rates of sexual dysfunction for men under 40?

[9] – (2013). The above study. The rates of severe ED nearly 10% higher than in men over 40.
[6] – (2015). Europeans, 18–40, ED rates ranged from 14%–28%. Low libido as high as 37%.
[8] – (2012). ED rates of 30% in a cross-section of Swiss men aged 18–24.
[10] – (2014). Males aged 16-21: ED (27%), low sexual desire (24%), problems with orgasm (11%).
[11] – (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 (47.9%), low desire (46.2%), problems in erectile function (45.3%).
[12] – (2014). New diagnoses of ED in active duty servicemen reported that rates had more than doubled between 2004 and 2013.
[13] – (2014). Cross-sectional study of active duty male military personnel aged 21–40 found an overall ED rate of 33.2%.
[16] – (2010). Brazilian study of men 18-40 reported ED rates of 35%.

The takeaway: The claims that historical rates of youthful ED have ranged from 1-5 percent, and that studies since 2010 have reported a tremendous increase in ED rates is supported by the peer-reviewed literature. All the above evidence (and more) was presented in the first 3 paragraphs of the US Navy paper. This fact indicates that Kris Taylor purposely misled VICE and its readers.

Over 40 studies link porn use/porn addiction to sexual problems & lower arousal (all omitted by Taylor)

KRIS TAYLOR: “While searching in vain for research that supported the position that pornography causes erectile dysfunction, I found a variety of the most common causes of erectile dysfunction. Pornography is not among them. These included depression, anxiety, nervousness, taking certain medications, smoking, alcohol and illicit drug use, as well as other health factors like diabetes and heart disease. Even riding a bike for too long can cause temporary erectile dysfunction if the bike seat compresses nerves in the perineum.”

First we will address Kris Taylor “searching in vain for research that supported the position that pornography causes erectile dysfunction.” This claim is rather hard to swallow as Taylor was earlier given this YBOP page by Liz Walker. It contains over 40 studies linking porn use or porn addiction to sexual dysfunctions and lower arousal. The first 7 studies in the list demonstrate causation, as participants eliminated porn use and healed chronic sexual dysfunctions (one of the three being the US Navy paper, which included case reports). Sixteen of these studies made it into the 2016 US Navy paper, and they were introduced with this paragraph:

While such intervention studies would be the most illuminating, our review of the literature finds a number of studies that have correlated pornography use with arousal, attraction, and sexual performance problems [27, 31, 35, 36, 37, 38, 39, 40, 41, 42, 43], including difficulty orgasming, diminished libido or erectile function [27, 30, 31, 35, 43, 44], negative effects on partnered sex [37], decreased enjoyment of sexual intimacy [37, 41, 45], less sexual and relationship satisfaction [38, 39, 40, 43, 44, 45, 46, 47], a preference for using Internet pornography to achieve and maintain arousal over having sex with a partner [42], and greater brain activation in response to pornography in those reporting less desire for sex with partners [48].

The following very convincing study was published after the US Navy paper appeared: Male masturbation habits and sexual dysfunctions, 2016. Like our paper, it too demonstrated causation as 35 men who developed erectile dysfunction and/or anorgasmia attempted to quit porn and cut back on masturbation. The study reported that 19 men experienced significant improvement by the time the author wrote up the paper. The author is a French psychiatrist who is the current president of the European Federation of Sexology. He is hardly a “fervent anti-pornography campaigner,” yet he noted that many of the men he assessed were addicted to porn.

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.

The takeaway: Kris Taylor was given numerous studies linking porn use to sexual problems and lower arousal, along with over 80 studies linking porn use to lower sexual and relationship satisfaction. Once again, Taylor deliberately mislead VICE and its readers.

A 500% or so increase in youthful ED in the last 10 years cannot be explained away by the usual factors

Kris Taylor claims that the recent tremendous rise in youthful ED must be caused by the variables usually correlated with ED in men over 40.

KRIS TAYLOR: While searching in vain for research that supported the position that pornography causes erectile dysfunction, I found a variety of the most common causes of erectile dysfunction. Pornography is not among them. These included depression, anxiety, nervousness, taking certain medications, smoking, alcohol and illicit drug use, as well as other health factors like diabetes and heart disease. Even riding a bike for too long can cause temporary erectile dysfunction if the bike seat compresses nerves in the perineum.

As explained in our paper, smoking, diabetes and heart disease rarely cause ED in men under 40 (citation 16). It takes years of smoking or uncontrolled diabetes to manifest neuro-vascular damage severe enough to cause chronic ED. From our paper:

Traditionally, ED has been seen as an age-dependent problem [2],and studies investigating ED risk factors in men under 40 have often failed to identify the factors commonly associated with ED in older men, such as smoking, alcoholism, obesity, sedentary life, diabetes, hypertension, cardiovascular disease, and hyperlipidemia [16].

As for “taking certain medications, smoking, alcohol and illicit drug use,” none of rates of these correlative factors have increased over the last 15 years (smoking has actually decreased). From the US Navy paper:

However, none of the familiar correlative factors suggested for psychogenic ED seem adequate to account for a rapid many-fold increase in youthful sexual difficulties. For example, some researchers hypothesize that rising youthful sexual problems must be the result of unhealthy lifestyles, such as obesity, substance abuse and smoking (factors historically correlated with organic ED). Yet these lifestyle risks have not changed proportionately, or have decreased, in the last 20 years: Obesity rates in U.S. men aged 20–40 increased only 4% between 1999 and 2008 [19]; rates of illicit drug use among US citizens aged 12 or older have been relatively stable over the last 15 years [20]; and smoking rates for US adults declined from 25% in 1993 to 19% in 2011 [21].

As for “depression, anxiety, nervousness,” none of these cause erectile dysfunction, they are simply weakly correlative to ED. In fact, some studies report that depressed and anxious patients have higher sexual desire. Other studies suggest the obvious: depression doesn’t cause ED; having ED increases scores on depression tests. From the US Navy paper:

Other authors propose psychological factors. Yet, how likely is it that anxiety and depression account for the sharp rise in youthful sexual difficulties given the complex relationship between sexual desire and depression and anxiety? Some depressed and anxious patients report less desire for sex while others report increased sexual desire [22, 23, 24, 25]. Not only is the relationship between depression and ED likely bidirectional and co-occurring, it may also be the consequence of sexual dysfunction, particularly in young men [26].

As we said in our paper’s conclusion:

Traditional factors that once explained sexual difficulties in men appear insufficient to account for the sharp rise in sexual dysfunctions and low sexual desire in men under 40.

This 2018 study on urology patients under the age of 40 found that patients with ED did not differ from men without ED, thus debunking Kris Taylor’s assertions (Factors For Erectile Dysfunction Among Young Men–Findings of a Real-Life Cross-Sectional Study):

Overall, 229 (75%) and 78 (25%) patients had normal and impaired Erectile Function (EF); among patients with ED, 90 (29%) had an IIEF-EF score suggestive for severe ED. Patients with and without ED did not differ significantly in terms of median age, BMI, prevalence of hypertension, general health status, smoking history), alcohol use, and median IPSS score. Similarly, no differences were reported in terms of serum sex hormones and lipid profile between the two groups.
These findings showed that young men with ED do not differ in terms of baseline clinical characteristics from a comparable-age group with normal EF, but depicted lower sexual desire scores, clinically suggesting a more probable psychogenic cause of ED.

For some reason those with ED had low sexual desire (should’ve asked about porn!) To repeat, Kris Taylor, like other porn-induced ED deniers, argue that young men’s ED is caused by the exact same risk factors that are related to ED in men over 40. These claims do not match the peer-reviewed literature.

Finally, Taylor’s claim that bike-riding is associated with ED has recently been debunked. An excerpt from the article:

“As cycling gains in popularity, as both a hobby and a professional sport, it is important for the public to know that it has no credible link to urologic disease or sexual dysfunction,” said Dr. Kevin McVary, a spokesman for the American Urological Association.

Addressing the two papers Kris Taylor cited (both were extensively discussed in the US Navy review)

Ignoring the 7 papers demonstrating cessation of internet porn use reversing sexual dysfunctions, and 35 other studies that link internet porn use to sexual dysfunctions and low arousal, Taylor cited 2 papers as the “best available research”:

But the best research we have so far simply doesn’t support the claims. For example, a 2015 cross-sectional online study of 3,948 Croatian, Norwegian, and Portuguese men published in the Journal of Sexual Medicine indicated that “contrary to raising public concerns, pornography does not seem to be a significant risk factor for younger men’s desire, erectile, or orgasmic difficulties.” Another 2015 study, this time of 208 non-treatment seeking American men indicated that viewing pornography was “unlikely to negatively impact sexual functioning, given that responses actually were stronger in those who viewed more [pornography]”.

Neither paper was an actual study, and both have been formally criticized in the peer-reviewed literature. Both papers were discussed at length in the US Navy review of the literature – which I will excerpt below. I have a lot to say about both papers, so I have created separate sections for each. I will start with the second paper mentioned by Taylor, because we addressed it first in our review of the literature.

PAPER 2: Prause & Pfaus, 2015.

KRIS TAYLOR EXCERPT: Another 2015 study, this time of 208 non-treatment seeking American men indicated that viewing pornography was “unlikely to negatively impact sexual functioning, given that responses actually were stronger in those who viewed more [pornography]”.

I provide the formal critique by Richard Isenberg, MD and a very extensive lay critique, followed by my comments and excerpts from the US Navy paper:

In the same journal as the paper: Letter to the editor by Richard A. Isenberg MD (2015)
Very extensive lay critique: Nothing Adds Up in Dubious Study: Youthful Subjects’ ED Left Unexplained (2015)

The claim: Contrary to Taylor’s claim (and Prause & Pfaus claim), the men who watched more porn did not have “stronger responses.” None of the 4 studies underlying underlying the paper’s claims assessed genital or sexual responses in the lab. What Prause & Pfaus claimed in their paper was that men who watched more porn rated their excitement slightly higher while watching porn. The key phrase is while watching porn – not while having sex with an actual person. Arousal ratings while viewing porn tell us nothing about one’s arousal or erections when not viewing porn. It tells us nothing about porn-induced ED, which is the inability to become sufficiently aroused without using porn. That said, details from Prause & Pfaus, 2015 reveal that they could not have accurately assessed their subjects’ arousal ratings (much more below).

For argument’s sake let’s suppose that men viewing more porn rated their arousal a bit higher than men who viewed less. Another, more legitimate, way to interpret this arousal difference between the two porn-use groups is that men who watched the most porn experienced slightly greater cravings to use porn. This is quite possibly evidence of sensitization, which is greater reward circuit (brain) activation and craving when exposed to (porn) cues. Sensitization (cue-reactivity and cravings) is a primary addiction-related brain change.

Several recent Cambridge University brain studies demonstrated sensitization in compulsive porn users. Participants’ brains were hyper-aroused in response to porn video clips, even though they didn’t “like” some of the sexual stimuli more than control participants. In a dramatic example of how sensitization can affect sexual performance, 60% of the Cambridge subjects reported arousal/erectile problems with partners but not with porn. From the Cambridge study:

“[Porn addicts] 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).”

Put simply, a heavy porn user can report higher subjective arousal (cravings) yet also experience erection problems with a partner. Certainly, his arousal in response to porn is not evidence of his “sexual responsiveness” or erectile functioning with a partner. Studies reporting sensitization/cravings or cue-reactivity in porn users/sex addicts: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21 , 22, 23, 24.

The reality behind Prause & Pfaus 2015: This wasn’t a study on men with ED. It wasn’t a study at all. Instead, Prause claimed to have gathered data from four of her earlier studies, none of which addressed erectile dysfunction. It’s disturbing that this paper by Nicole Prause and Jim Pfaus passed peer-review as none of the data in their paper matched the data in the underlying four studies on which the paper claimed to be based. The discrepancies are not minor gaps, but gaping holes that cannot be plugged. In addition, the paper made several claims that were patently false or not supported by the data.

We begin with false claims made by both Nicole Prause & Jim Pfaus. Many journalists’ articles about this study claimed that porn use led to better erections, yet that’s not what the paper found. In recorded interviews, both Nicole Prause and Jim Pfaus falsely claimed that they had measured erections in the lab, and that the men who used porn had better erections. In the Jim Pfaus TV interview Pfaus states:

“We looked at the correlation of their ability to get an erection in the lab.”
“We found a liner correlation with the amount of porn they viewed at home, and the latencies which for example they get an erection is faster.”

In this radio interview Nicole Prause claimed that erections were measured in the lab. The exact quote from the show:

“The more people watch erotica at home they have stronger erectile responses in the lab, not reduced.”

Yet this paper did not assess erection quality in the lab or “speed of erections.” The paper only claimed to have asked guys to rate their “arousal” after briefly viewing porn (and it’s not clear from the underlying papers that this simple self-report was asked of all subjects). In any case, an excerpt from the paper itself admitted that:

“No physiological genital response data were included to support men’s self-reported experience.”

In a second unsupported claim, lead author Nicole Prause tweeted several times about the study, letting the world know that 280 subjects were involved, and that they had “no problems at home.” However, the four underlying studies contained only 234 male subjects, so “280” is way off.

A third unsupported claim: Author of the critical Letter to the Editor linked to above, Dr. Isenberg, wondered how it could be possible for Prause & Pfaus 2015 to have compared different subjects’ arousal levels when three different types of sexual stimuli were used in the 4 underlying studies. Two studies used a 3-minute film, one study used a 20-second film, and one study used still images. It’s well established that films are far more arousing than photos, so no legitimate research team would group these subjects together to make claims about their responses. What’s shocking is that in their paper Prause & Pfaus unaccountably claim that all 4 studies used sexual films:

“The VSS presented in the studies were all films.”

This statement is false, as clearly revealed in Prause’s own underlying studies. This the first reason why Prause & Pfaus cannot claim that their paper assessed “arousal.” You must use the same stimulus for each person to compare all the subjects.

A fourth unsupported claim: Dr. Isenberg also asked how Prause & Pfaus 2015 could compare different subjects’ arousal levels when only 1 of the 4 underlying studies used a 1 to 9 scale. One used a 0 to 7 scale, one used a 1 to 7 scale, and one study did not report sexual arousal ratings. Once again Prause & Pfaus inexplicably claim that:

“Men were asked to indicate their level of “sexual arousal” ranging from 1 “not at all” to 9 “extremely.”

This too is false as the underlying papers show. This is the second reason why Prause & Pfaus cannot claim that their paper assessed “arousal” ratings in men. A study must use the exact same rating scale for each person to compare the subjects’ results. In summary, all the Prause-generated headlines about porn use improving erections or arousal, or anything else, are unwarranted.

Prause & Pfaus 2015 also claimed they found no relationship between erectile functioning scores and the amount of porn viewed in the last month. As Dr. Isenberg pointed out:

“Even more disturbing is the total omission of statistical findings for the erectile function outcome measure. No statistical results whatsoever are provided. Instead the authors ask the reader to simply believe their unsubstantiated statement that there was no association between hours of pornography viewed and erectile function. Given the authors’ conflicting assertion that erectile function with a partner may actually be improved by viewing pornography the absence of statistical analysis is most egregious.”

In the Prause & Pfaus response to the Dr. Isenberg critique, they once again failed to provide any data to support their “unsubstantiated statement.” As this analysis documents, the Prause & Pfaus response not only evades Dr. Isenberg’s legitimate concerns, it contains several new misrepresentations and several transparently false statements. Finally, our review of the literature commented on Prause & Pfaus 2015:

“Our review also included two 2015 papers claiming that Internet pornography use is unrelated to rising sexual difficulties in young men. However, such claims appear to be premature on closer examination of these papers and related formal criticism. The first paper contains useful insights about the potential role of sexual conditioning in youthful ED [50]. However, this publication has come under criticism for various discrepancies, omissions and methodological flaws. For example, it provides no statistical results for the erectile function outcome measure in relation to Internet pornography use. Further, as a research physician pointed out in a formal critique of the paper, the papers’ authors, “have not provided the reader with sufficient information about the population studied or the statistical analyses to justify their conclusion” [51]. Additionally, the researchers investigated only hours of Internet pornography use in the last month. Yet studies on Internet pornography addiction have found that the variable of hours of Internet pornography use alone is widely unrelated to “problems in daily life”, scores on the SAST-R (Sexual Addiction Screening Test), and scores on the IATsex (an instrument that assesses addiction to online sexual activity) [52, 53, 54, 55, 56]. A better predictor is subjective sexual arousal ratings while watching Internet pornography (cue reactivity), an established correlate of addictive behavior in all addictions [52, 53, 54]. There is also increasing evidence that the amount of time spent on Internet video-gaming does not predict addictive behavior. “Addiction can only be assessed properly if motives, consequences and contextual characteristics of the behavior are also part of the assessment” [57]. Three other research teams, using various criteria for “hypersexuality” (other than hours of use), have strongly correlated it with sexual difficulties [15, 30, 31]. Taken together, this research suggests that rather than simply “hours of use”, multiple variables are highly relevant in assessment of pornography addiction/hypersexuality, and likely also highly relevant in assessing pornography-related sexual dysfunctions.”

The US Navy paper highlighted the weakness in correlating only “current hours of use” to predict porn-induced sexual dysfunctions. The amount of porn currently viewed is just one of many variables involved in the development of porn-induced ED. These may include:

Ratio of masturbation to porn versus masturbation without porn
Ratio of sexual activity with a person versus masturbation to porn
Gaps in partnered sex (where one relies only on porn)
Virgin or not
Total hours of use
Years of use
Age started using porn
Escalation to new genres
Development of porn-induced fetishes (from escalating to new genres of porn)
Level of novelty per session (i.e. compilation videos, multiple tabs)
Addiction-related brain changes or not
Presence of hypersexuality/porn addiction

The better way to research this phenomenon, is to remove the variable of internet porn use and observe the outcome, which was done in the Navy paper and in two other studies. Such research reveals causation instead of fuzzy correlations open to varying interpretation. My site has documented a few thousand men who removed porn and recovered from chronic sexual dysfunctions.

Finally, co-author Nicole Prause is obsessed with debunking PIED, having waged a 3-year war against this academic paper, while simultaneously harassing and libeling young men who have recovered from porn-induced sexual dysfunctions. See documentation: Gabe Deem #1, Gabe Deem #2, Alexander Rhodes #1, Alexander Rhodes #2, Alexander Rhodes #3, Noah Church, Alexander Rhodes #4, Alexander Rhodes #5, Alexander Rhodes #6, Alexander Rhodes #7, Alexander Rhodes #8, Alexander Rhodes #9, Alexander Rhodes#10, Alex Rhodes#11, Gabe Deem & Alex Rhodes together#12, Alexander Rhodes#13, Alexander Rhodes #14, Gabe Deem#4, Alexander Rhodes #15.

PAPER 1: Landripet & Stulhofer, 2015.

KRIS TAYLOR EXCERPT: For example, a 2015 cross-sectional online study of 3,948 Croatian, Norwegian, and Portuguese men published in the Journal of Sexual Medicine indicated that “contrary to raising public concerns, pornography does not seem to be a significant risk factor for younger men’s desire, erectile, or orgasmic difficulties.”

Landripet & Stulhofer, 2015 was designated as a “brief communication” by the Journal, and the two authors selected certain data to share, while omitting other pertinent data (more later). As with Prause & Pfaus the Journal published a critique of Landripet & Sulhofer: Comment on: Is Pornography Use Associated with Sexual Difficulties and Dysfunctions among Younger Heterosexual Men? by Gert Martin Hald, PhD

As for the claim that Landripet & Štulhofer, 2015 found no relationships between porn use and sexual problems. This is not true, as documented in both this YBOP critique and the US Navy review of the literature. Furthermore, Landripet & Stulhofer’s paper omitted three significant correlations they presented to a European conference (more below). Let’s start with the first of three paragraphs from our paper that addressed Landripet & Štulhofer, 2015:

A second paper reported little correlation between frequency of Internet pornography use in the last year and ED rates in sexually active men from Norway, Portugal and Croatia [6]. These authors, unlike those of the previous paper, acknowledge the high prevalence of ED in men 40 and under, and indeed found ED and low sexual desire rates as high as 31% and 37%, respectively. In contrast, pre-streaming Internet pornography research done in 2004 by one of the paper’s authors reported ED rates of only 5.8% in men 35–39 [58]. Yet, based on a statistical comparison, the authors conclude that Internet pornography use does not seem to be a significant risk factor for youthful ED. That seems overly definitive, given that the Portuguese men they surveyed reported the lowest rates of sexual dysfunction compared with Norwegians and Croatians, and only 40% of Portuguese reported using Internet pornography “from several times a week to daily”, as compared with the Norwegians, 57%, and Croatians, 59%. This paper has been formally criticized for failing to employ comprehensive models able to encompass both direct and indirect relationships between variables known or hypothesized to be at work [59]. Incidentally, in a related paper on problematic low sexual desire involving many of the same survey participants from Portugal, Croatia and Norway, the men were asked which of numerous factors they believed contributed to their problematic lack of sexual interest. Among other factors, approximately 11%–22% chose “I use too much pornography” and 16%–26% chose “I masturbate too often” [60]

As I and the Navy doctors described, this paper found a pretty important correlation: Only 40% of the Portuguese men used porn “frequently,” while the 60% of the Norwegians used porn “frequently.” The Portuguese men had far less sexual dysfunction than the Norwegians. With respect to the Croats, Landripet & Štulhofer, 2015 acknowledge a statistically significant association between more frequent porn use and ED, but claim the effect size was small. However, this claim may be misleading according to an MD who is a skilled statistician and has authored many studies:

Analyzed a different way (Chi Squared), … moderate use (vs. infrequent use) increased the odds (the likelihood) of having ED by about 50% in this Croatian population. That sounds meaningful to me, although it is curious that the finding was only identified among Croats.

In addition, Landripet & Stulhofer 2015 omitted three significant correlations, which one of the authors presented to a European conference. He reported a significant correlation between erectile dysfunction and “preference for certain pornographic genres”:

“Reporting a preference for specific pornographic genres were significantly associated with erectile (but not ejaculatory or desire-related) male sexual dysfunction.”

It’s telling that Landripet & Stulhofer chose to omit this significant correlation between erectile dysfunction and preferences for specific genres of porn from their paper. It’s quite common for porn users to escalate into genres that do not match their original sexual tastes, and to experience ED when these conditioned porn preferences do not match real sexual encounters. As we pointed out above, it’s very important to assess the multiple variables associated with porn use – not just hours in the last month or frequency in the last year.

The second significant finding omitted by Landripet & Stulhofer 2015 involved female participants:

“Increased pornography use was slightly but significantly associated with decreased interest for partnered sex and more prevalent sexual dysfunction among women.”

A significant correlation between greater porn use and decreased libido and more sexual dysfunction seems pretty important. Why didn’t Landripet & Stulhofer 2015 report that they found significant correlations between porn use and sexual dysfunction in women, as well as a few in men? And why hasn’t this finding been reported in any of Stulhofer’s many studies arising from these same data sets? His teams seem very quick to publish data they claim debunks porn-induced ED, yet very slow to inform women about the negative sexual ramifications of porn use.

Finally, Danish porn researcher Gert Martin Hald’s formal critical comments echoed the need to assess more variables (mediators, moderators) than just frequency per week in the last 12 months:

“The study does not address possible moderators or mediators of the relationships studied nor is it able to determine causality. Increasingly, in research on pornography, attention is given to factors that may influence the magnitude or direction of the relationships studied (i.e., moderators) as well as the pathways through which such influence may come about (i.e., mediators). Future studies on pornography consumption and sexual difficulties may also benefit from an inclusion of such focuses.

Bottom line: All complex medical conditions involve multiple factors, which must be teased apart before far reaching pronouncements are appropriate. Landripet & Stulhofer’s statement that, “Pornography does not seem to be a significant risk factor for younger men’s desire, erectile, or orgasmic difficulties” goes too far, since it ignores all the other possible variables related to porn use that might be causing sexual performance problems in users – including escalation to specific genres, which they found, but omitted in the “Brief Communication.” Paragraphs 2 & 3 in our discussion of Landripet & Stulhofer, 2015:

Again, intervention studies would be the most instructive. However, with respect to correlation studies, it is likely that a complex set of variables needs to be investigated in order to elucidate the risk factors at work in unprecedented youthful sexual difficulties. First, it may be that low sexual desire, difficulty orgasming with a partner and erectile problems are part of the same spectrum of Internet pornography-related effects, and that all of these difficulties should be combined when investigating potentially illuminating correlations with Internet pornography use.
Second, although it is unclear exactly which combination of factors may best account for such difficulties, promising variables to investigate in combination with frequency of Internet pornography use might include (1) years of pornography-assisted versus pornography-free masturbation; (2) ratio of ejaculations with a partner to ejaculations with Internet pornography; (3) the presence of Internet pornography addiction/hypersexuality; (4) the number of years of streaming Internet pornography use; (5) at what age regular use of Internet pornography began and whether it began prior to puberty; (6) trend of increasing Internet pornography use; (7) escalation to more extreme genres of Internet pornography, and so forth.

Before confidently claiming that we have nothing to worry about from internet porn, researchers still need to account for the very recent, sharp rise in youthful ED and low sexual desire, and the many studies linking porn use to sexual problems.

Kris Taylor resorts to ad hominem and misrepresentation. I respond.

KRIS TAYLOR: Her source is this paper, which in turn gives numbers sourced from two papers – neither of which reference pornography as causative. Not to mention that the second author of the paper is Gary Wilson, a well-known fervent anti-pornography campaigner.

I was going to ignore Taylor’s ad hominem attack, but the above two sentences expose his tactics and bias. The first sentence misrepresents the content of our review of the literature, while the second attempts to dismiss it by mislabeling me “a fervent anti-pornography campaigner.”

As described earlier my co-authors included 7 US Navy doctors, among them 2 psychiatrists, 2 urologists, and an MD with a PhD in neuroscience from John Hopkins. My co-authors have spent much of their careers treating (primarily) young men. The paper provided 3 clinical case reports of servicemen, who had developed porn-induced sexual dysfunctions. Has Taylor ever seen patients for sexual dysfunctions? Has he ever performed a medical examination? It’s clear that Taylor’s goal was to encourage his reader to ignore the paper, the medical doctors who authored it, and just take his word for the paper’s content and merit.

As for Taylor’s branding me “a fervent anti-porn campaigner,” I have explained in multiple interviews my history and how I ended up creating www.yourbrainonporn in 2011. (For more see this 2016 interview of me by Noah B. Church.) As stated on the site’s “About” page, I am an atheist (as were my parents and grandparents), and my politics are far-left liberal. I had no opinion on porn.

Details: Through a fluke in search engine categorization, around 2007 (shortly after the advent of streaming tube porn), men complaining of porn-induced erectile dysfunction and low libido for real partners began posting on my wife’s rather obscure forum created for discussions around sexual relationships. Over the next few years many otherwise healthy men on that forum healed their sexual dysfunctions by giving up porn. Eventually we blogged about this phenomenon, because so many men found reading their peers’ experiences helpful. Soon my wife’s forum was overflowing with relatively young men seeking to heal the unexpected effects of their internet porn use. During this period, we cannot count how many times we asked academic sexologists to look into this phenomenon. They refused.

Sadly, many of the men suffering from porn-induced sexual dysfunctions had been suicidal when they arrived, fearing that they were broken for life. In the face of continued stonewalling by the experts who should have been investigating the sufferers’ circumstances, we felt a need make a cyberspace available that presented the relevant science and the stories of the men who recovered from a range of porn-induced sexual dysfunctions (chiefly delayed ejaculation, loss of attraction for real partners, and fleeting or unreliable erections). Www.yourbrainonporn.com was born. If it campaigns for anything, it would be sexual health.

Would Taylor’s professors approve of his tactics? If they would, he has spent too much on his tuition.