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.
- 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.
- 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.
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.)
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:
- low sexual satisfaction (47.9%)
- low desire (46.2%)
- 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?]
- 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.
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.
But is streaming porn the culprit?
Evidence is growing that it is. See Studies linking porn use or porn/sex addiction to sexual dysfunctions, lower brain activation to sexual stimuli, and lower sexual satisfaction.
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
Studies reporting relationships between porn use and ED, anorgamsia, low sexual desire, delayed ejaculation, & lower brain activation to sexual images.
Already, a growing number 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) 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 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.
2) 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."
3) 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."
4) 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.
5) 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."
6) 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.
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 mentioned to interviewers that they suffered from "orgasmic-erection disorder," while none of the control subjects reported sexual problems.
8) 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."
9) 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.
10) 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.
11) 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.
12) 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.
13) 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."
14) 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.
15) 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.
16) (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.”
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 (beyond those linked to above):
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