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 27 to 33%, while rates for low libido (hypo-sexuality) ranged 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.

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.

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.

GSSAB ED results over time

We'll discuss a number of study results that show the upward trend, but let's start with some of the most irrefutable research. It 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 young Europeans, 18-40, ranged from 14-28%!

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. In 2013, internet penetration rates in Portugal were only 67%, compared with 95% in Norway.

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.

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, 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.

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.

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. 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).

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.

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

1. 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.
2. 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.
3. A 2014 survey of Croatian men 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.

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, in this Israeli case series, researchers asked a man with porn-induced low libido and anorgasmia to stop using porn and take a time-out from masturbation. He had escalated through several genres of porn and experienced little desire for partnered sex. An 8-month reboot (avoiding porn) led to normal libido and enjoyable sexual relations.

In line with anecdotal and experimental evidence

The image to the right 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."

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

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

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

• Rebooting accounts 1
• Rebooting accounts 2
• Short ED recovery stories
• What Experts Tell Guys Suffering From PIED (the good and the bad)
• Are Porn Tube Sites Causing Erectile Dysfunction?

In addition, the following page links to articles and videos by some 60 experts in the field who recognize and treat Porn-Induced ED

• Porn-Induced ED in the Media: Experts who recognize PIED

Already, a handful of studies have correlated use of internet porn with arousal, attraction, and sexual performance problems. [See notes 15-22, below] Results link its use with diminished libido or erectile function, delayed ejaculation, a preference for using porn to achieve and maintain arousal over having sex with a partner, negative effects on partnered sex, decreased enjoyment of sexual intimacy, and lower brain activation to sexual images.

1) The 2014 Cambridge University study reported Porn-Induced ED in 60% of the porn addicts whose brains they scanned. From the 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)."

"[Porn addicts] compared to healthy volunteers had significantly more difficulty with sexual arousal and experienced more erectile difficulties in intimate sexual relationships but not to sexually explicit material.”

2) The 2014 Max Planck Institute study on porn users found that higher hours per week/more years of porn viewing correlated with less activity in users reward centers when exposed to sexual images. From the study:

"This is in line with the hypothesis that intense exposure to pornographic stimuli results in a downregulation of the natural neural response to sexual stimuli."

Lead author Simone Kühn told journalists –

“That could mean that regular consumption of pornography more or less wears out your reward system.”

And 

“That would fit perfectly the hypothesis that their reward systems need growing stimulation.”

3) "Modulation of Late Positive Potentials by Sexual Images in Problem Users and Controls Inconsistent with "Porn Addiction" (2015)" - An EEG study comparing the subjects from an earlier study by the same research lab 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, claims 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. In other words, "porn addicts" appear to be desensitized and to need greater stimulation than non-addicts to become aroused. Three peer-reviewed papers agree with this analysis of the study.

4) "Adolescents and web porn: a new era of sexuality (2015)" - Mentioned above. An Italian study analyzed the effects of Internet porn on high school students, 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).

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.  What sexual dysfunction do 38% of the remaining men have? The study doesn't say, and the authors have publicly dismissed requests for ED rates. The two other primary choices for male 'sexual dysfunction' are ED and low libido.

6) 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.

7) 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 suffered from "orgasmic-erection disorder," while none of the control subjects reported sexual problems.

Dubious studies find no such correlations between ED rates and recent hours/frequency of porn use, and make exaggerated claims that their authors have thus "disproven" the existence of porn-induced sexual dysfunctions. It remains to be seen which aspects of porn use are most predictive of sexual dysfunctions. Frequency of use may not be as predictive as some constellation of years of use, age use started, weekly hours of use over time, percentage of climaxes to internet porn, escalation to novel porn genres, development of porn-induced fetishes, gaps in partnered sex, genetics, etc.

References:

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.

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.

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.

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/ab... (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.