Link to PDF of the chapter in Introduction to Psychosexual Medicine (2019) – Catherine White MD OBE “Internet Pornography: Addiction or Sexual Dysfunction. Introduction to Psychosexual Medicine?” (2019)
The author’s Wikipedia page (Forensic Physician, Clinical Director St Mary’s Sexual Assault Referral Centre, UN Consultant on Sexual Violence)
Link to the medical textbook: Introduction to Psychosexual Medicine: Third Edition, 3rd Edition, Philipa A. Brough, Margaret Denman
Summary of textbook
This authoritative text for those training in Sexual Medicine now returns in a new edition that builds on what clinicians found most useful in the previous editions – physical and psychological background knowledge and all relevant treatments, combined with psychological therapies, principles, and case examples applied to common problems.
Editor(s) Bio
Dr Philipa A Brough is a Member of the Institute of Psychosexual Medicine (IPM) and Fellow of the FSRH. She graduated from Manchester University and works as a Consultant in Sexual and Reproductive Health in Warrington integrated Sexual Health where she is the Psychosexual lead. She has also worked as an examiner for the MFSRH and co-written the RCOG training tutorial in Psychosexual Medicine. She is an IPM seminar leader, examiner and training committee member.
Dr Margaret Denman is a Member of the IPM. She is a retired GP from Oxford who has also worked in Family Planning, Menopause Clinics, and latterly a Forensic Psychiatry Unit. She has had an interest in Psychosexual Medicine for many years and has seen patients in a variety of settings, both in the hospital and the community. She has edited the IPMJ and is currently an examiner and seminar leader for the IPM.
KEY EXCERPTS:
It is becoming more common in practice to encounter those whose sexual dysfunction has a familiar theme: pornography.
The patient may present in a number of ways:
- Acknowledging a clear connection between pornography and their loss of libido, erectile dysfunction, delayed ejaculation
- With overt concerns about sexual or pornography addiction
- Unaware of any connection at all
Pornography has undergone a huge metamorphosis from early erotic imagery found in pamphlets, books and magazines to professional or homemade films on DVD, to today’s offerings. The latter includes an endless variety of easily accessible, free-streaming, high-definition, often real-time and interactive material. … It would appear to be the transition in the method of presentation of pornographic material that has opened the doors for porn-related sexual dysfunction. Without today’s variety, ease of access and anonymity, there would appear to be little problem.
The activity of using Internet pornography and its power to deliver unending stimulation is thought to constitute ‘supernormal stimuli’. … The more the viewer seeks and masturbates to porn, the more dopamine is produced so that eventually the receptors and signals in the brain fatigue. The viewer is left still wanting, but unable to reach the desired level of satisfaction and so becomes desensitized. For a man this may mean difficulty in maintaining an erection with imagery that would previously have provided reliable stimulation. Even with an erection they may find that ejaculation is delayed and ultimately may be absent as they struggle to reach the previous level of arousal. The viewer may experience their libido diminishing as pornography takes the ‘sex’ out of sex.
Women, like men, may present to us with reduced desire or reduced sensitivity to sexual arousal with their partner … Women are less likely than men to volunteer a preference for using pornography for sexual arousal than for partnered sex and so when enquiring routinely about masturbation in the consultation we should remind ourselves to quantify whether this is satisfactory without pornographic stimulation, rather than assume this is so.
[Those] who have begun their pornography exposure at a time when their brain was highly neuroadaptive may find that they require many months of abstinence before they regain any libido, erectile function or ability to ejaculate.
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