Anatomy & physiology teacher Gary Wilson explains the physiology of erections, how overstimulation via today's Internet porn can create erectile dysfunction (even in young men), and how others have recovered. For more information see Is my erectile dysfunction (ED) related to my porn use?
DeltaFosB & sensitization articles
Adolescent brain vulnerabilities
Internet porn is different
Reality Check - Regardless of what you may read in some journalistic accounts, multiple studies reveal a link between porn use and sexual performance problems, relationship and sexual dissatisfaction, and reduced brain activation to sexual stimuli.
Let's start with sexual dysfunctions. All studies assessing young male sexuality since 2010 report historic levels of sexual dysfunctions, and startling rates of a new scourge: low libido. Documented in this article.
Erectile dysfunction rates in these recent studies range from 27 to 33%, while rates for low libido (hypo-sexuality) range from 16% to 37%. The lower ranges are taken from studies involving teens and men 25 and under, while the higher ranges are from studies involving men 40 and under.
Prior to the advent of free streaming porn, cross-sectional studies and meta-analysis consistently reported erectile dysfunction rates of 2-5% in men under 40. That's nearly a 1000% increase in youthful ED rates in the last 20 years. What variable has changed in the last 15 years that could account for this astronomical rise?
In addition, this page contains articles and videos by about 70 experts (urology professors, urologists, psychiatrists, psychologists, sexologists, MDs) who have successfully treated porn-induced ED and porn-induced loss of sexual desire
1) 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."
2) 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."
3) 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." 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)."
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 internet 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 ED. Moreover, paper 2 was only a "brief communication" that did not report important data.
4) 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. The most interesting finding is that 16% of those who consume porn more than once a week report abnormally low sexual desire 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, and the remaining, 9.1% report a kind of addiction. In addition, 19% of overall pornography consumers report an abnormal sexual response, while the percentage rose to 25.1% among regular consumers."
5) Patient Characteristics by Type of Hypersexuality Referral: A Quantitative Chart Review of 115 Consecutive Male Cases (2015) - Study on men (average age 41.5) with hypersexuality disorders, such as paraphilias and chronic masturbation or adultery. 27 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% 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 requests for details. Two primary choices for male sexual dysfunction are ED and low libido. The men were not asked about their erectile functioning without porn. If all their sexual activity involved masturbating to porn, and not sex with a partner, they might never realize they had porn-induced ED.
6) 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," while none of the control subjects reported sexual problems.
7) Brain Structure and Functional Connectivity Associated With Pornography Consumption: The Brain on Porn (2014) - A Max Planck 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."
8) 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 addiction. Not so. In line with the Cambridge University brain scan studies, this EEG study reported greater cue-reactivity to porn correlated with less desire for partnered sex. To put another way - individuals with more brain activation and cravings for porn would rather masturbate to porn than have sex with a real person. Study spokesman Nicole Prause claimed that porn users merely had high libido, yet the results of the study say something quite different. Three peer-reviewed papers expose the truth: 1, 2, 3. Also see the extensive YBOP critique.
9) Modulation of Late Positive Potentials by Sexual Images in Problem Users and Controls Inconsistent with "Porn Addiction" (2015) - Another Nicole Prause EEG study. This time comparing the 2013 subjects from the above study to an actual control group. The results: compared to controls, "porn addicts" had less response to one-second exposure to photos of vanilla porn. The lead author, Nicole Prause, claimed these results debunk porn addiction. However, these findings align perfectly with Kühn & Gallinat (2014), which found that more porn use correlated with less brain activation in response to pictures of vanilla porn. Put simply, frequent porn users were desensitized and needed greater stimulation to achieve the same buzz. Four peer-reviewed papers say that Prause findings indicate desensitization, and addiction-related phenomenon: 1, 2, 3, 4 (also see this extensive YBOP critique). By the way, another EEG study found that greater porn use in women correlated with less brain activation to porn.
10) 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, but he eventually got habituated to these materials and needed more hardcore pornography scenes, including transgender sex, orgies, and violent sex. He used to buy illegal pornographic movies on violent sex acts and rape and visualized those scenes in his imagination to function sexually with women. He gradually lost his desire and his ability to fantasize and decreased his masturbation frequency."
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.
11) 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.
12) 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."
13) 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.
14) 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%.
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.
15) (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 -
EXCERPT: The most common phrase is “erectile dysfunction” – which is mentioned more than three times as often as any other phrase – 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.”
Higher frequencies of sexual explicit material (SEM) use were associated with less sexual and relationship satisfaction. The frequency of SEM use and number of SEM types viewed were both associated with higher sexual preferences for the types of sexual practices typically presented in SEM. These findings suggest that SEM use can play a significant role in a variety of aspects of young adults' sexual development processes.
Specifically, higher viewing frequency was associated with less sexual and relationship satisfaction when controlling for gender, religiosity, dating status and the number of SEM types viewed.
Because a substantial proportion of the young adults in this study reported using SEM, the potential implications are especially noteworthy, particularly for young men.
Male and female students and nonstudents were exposed to videotapes featuring common, nonviolent pornography or innocuous content. Exposure was in hourly sessions in six consecutive weeks. In the seventh week, subjects participated in an ostensibly unrelated study on societal institutions and personal gratifications. [Porn use] strongly impacted self-assessment of sexual experience. After consumption of pornography, subjects reported less satisfaction with their intimate partners—specifically, with these partners' affection, physical appearance, sexual curiosity, and sexual performance proper. In addition, subjects assigned increased importance to sex without emotional involvement. These effects were uniform across gender and populations.
Between May 2006 and May 2007, we conducted a three-wave panel survey among 1,052 Dutch adolescents aged 13–20. Structural equation modeling revealed that exposure to SEIM consistently reduced adolescents’ sexual satisfaction. Lower sexual satisfaction (in Wave 2) also increased the use of SEIM (in Wave 3). The effect of exposure to SEIM on sexual satisfaction did not differ among male and female adolescents.
As expected, individuals who did not view SEM (sexually explicit material) at all reported lower negative communication and higher dedication than individuals who viewed SEM alone or both alone and with their partner.
Results revealed that a higher frequency of men's sexual media use related to negative satisfaction in men, while a higher frequency of women's sexual media use related to positive satisfaction in male partners. Reasons for sexual media use differed by gender: Men reported primarily using sexual media for masturbation, while women reported primarily using sexual media as part of lovemaking with their partners.
The purpose of this study was to examine the relationships between men’s pornography use, both frequency and problematic use, on their heterosexual female partner’s psychological and relational well-being among 308 young adult college women. Results revealed women’s reports of their male partner’s frequency of pornography use were negatively associated with their relationship quality. More perceptions of problematic use of pornography was negatively correlated with self-esteem, relationship quality, and sexual satisfaction.
Six-hundred eighty-five heterosexual South Korean male college students participated in an online survey. The majority (84.5%) of respondents had viewed pornography, and for those who were sexually active (470 respondents), we found that higher interest in degrading or extreme pornography was associated with the experience of role-playing sexual scenes from pornography with a partner, and a preference for using pornography to achieve and maintain sexual excitement over having sex with a partner.
We found that higher interest in viewing degrading or extreme pornography ... has a significant positive ... association with sexual concerns.
We argue pornography creates a sexual script that then guides sexual experiences. To test this, we surveyed 487 college men (ages 18-29 years) in the United States to compare their rate of pornography use with sexual preferences and concerns. Results showed the more pornography a man watches, the more likely he was to use it during sex, request particular pornographic sex acts of his partner, deliberately conjure images of pornography during sex to maintain arousal, and have concerns over his own sexual performance and body image. Further, higher pornography use was negatively associated with enjoying sexually intimate behaviors with a partner.
Complete data on 531 Internet users are taken from the General Social Surveys for 2000. Social bonds measures include religious, marital, and political ties. Measures of participation in sexual and drug-related deviant lifestyles, and demographic controls are included. The results of a logistic regression analysis found that among the strongest predictors of use of cyberporn were weak ties to religion and lack of a happy marriage.
Results indicated that the shared variance of pornography acceptance was positively associated with both spouses' pornography use and that spouses' pornography use was negatively associated with their own sexual satisfaction. Wives' pornography use was found to be positively associated with the couple's shared variance of sexual satisfaction, but pornography use did not significantly mediate the relationship between pornography acceptance and sexual satisfaction.
The present study utilized a sample of 1755 adult couples in heterosexual romantic relationships to examine how different patterns of pornography use between romantic partners may be associated with relationship outcomes. While pornography use has been generally associated with some negative and some positive couple outcomes, no study has yet explored how differences between partners may uniquely be associated with relationship well-being. Results suggested that greater discrepancies between partners in pornography use were related to less relationship satisfaction, less stability, less positive communication, and more relational aggression. Mediation analyses suggested that greater pornography use discrepancies were primarily associated with elevated levels of male relational aggression, lower female sexual desire, and less positive communication for both partners which then predicted lower relational satisfaction and stability for both partners.
This study used the Cybersex addiction test, Craving for pornography questionnaire, and a Questionnaire on intimacy among 267 participants (192 males and 75 females) mean age for males 28 and for females 25, who were recruited from special sites that are dedicated to pornography and cybersex on the Internet. Results of regression analysis indicated that pornography, gender, and cybersex significantly predicted difficulties in intimacy and it accounted for 66.1% of the variance of rating on the intimacy questionnaire. Second, regression analysis also indicated that craving for pornography, gender, and difficulties in forming intimate relationships significantly predicted frequency of cybersex use and it accounted for 83.7% of the variance in ratings of cybersex use.
A Love That Doesn’t Last: Pornography Consumption and Weakened Commitment to One’s Romantic Partner (2012) – The study had subjects try to abstain from porn use for 3 weeks. Upon comparing the two groups, those who continued using pornography reported lower levels of commitment than those who tried to abstain. Excerpts:
Study 1 found that higher pornography consumption was related to lower commitment
Study 3 participants were randomly assigned to either refrain from viewing pornography or to a self-control task. Those who continued using pornography reported lower levels of commitment than control participants.
Study 5 found that pornography consumption was positively related to infidelity and this association was mediated by commitment. Overall, a consistent pattern of results was found using a variety of approaches including cross-sectional (Study 1), observational (Study 2), experimental (Study 3), and behavioral (Studies 4 and 5) data.