Sexual Medicine Open Access has just published a paper coauthored by Nicole Prause and Jim Pfaus entitled “Viewing Sexual Stimuli Associated with Greater Sexual Responsiveness, Not Erectile Dysfunction.”[i] This was not a study on porn users complaining of unexplained erectile dysfunction (ED), and, despite the study’s title, no penile responses or erections were measured in the laboratory.[ii] Rather, the authors pulled data from four earlier studies, none of which investigated ED as a function of weekly porn use, and then they “reanalyzed” those data to make claims about ED as a function of porn use.
Essentially, the authors of this misguided work “binned” test subjects from four separate studies into three groups: men who were not using porn at all, men who were using porn .01 to 2 hours per week, and men who were using porn 2.01 or more hours per week. Then they compared those bins with answers to various (differing) questionnaires that were gathered in the earlier studies. In short, the subjects in the underlying studies were not investigated using a common protocol. In fact, three different arousal measurement scales were used, as were three different visual sexual stimuli (three minute videos, twenty second videos, and still photos). And only a small minority (n=47) of the men completed a questionnaire about erectile functioning. (Ironically, their erectile-function scores indicated that these few men, average age 23, actually did have mild ED.) Given the many inconsistencies, neither a correlation nor a lack of correlation, as claimed by Prause and Pfaus, could shed much light on a very real problem: sexual dysfunction reported by porn users.
In actuality, there are several much better pieces of research looking at erectile dysfunction among porn users – particularly heavy porn users (including sex/porn addicts). In one recent UK survey of 350 self-identified sex addicts, 26.7% reported issues with sexual dysfunction.[iii] Another study, looking at 24 male sex addicts, found that 1 in 6 (16.7%) reported erectile dysfunction.[iv] Yet another study, this one looking at 19 male porn addicts, found that 11 (58%) reported they had trouble with arousal/erections with real-world partners but not with porn.[v] This last bit, the fact that ED often occurs with real-world partners but not with porn, coincides with what we see when treating porn addicts in our psychotherapeutic practices. This factor is not taken into account at all by Prause and Pfaus.
Furthermore, the Prause and Pfaus paper did not report erection levels in response to porn viewing. Instead, it reported arousal to porn viewed, apparently not fully understanding that arousal is not the same thing as erection responsiveness. For instance, in the study looking at 19 porn addicts, brain scans showed that porn-addicted subjects had more arousal (brain activation) to porn than the control group.[vi] However, sexual performance with a partner was clearly another matter. As such, press headlines claiming the study by Prause and Pfaus proves that porn will improve sexual performance are unduly optimistic.
In any case, German researchers have found that porn-related problems do not correlate with hours spent using porn, but rather with number of images/videos opened during a viewing session.[vii] In other words, a need for novelty, new genres, and constantly changing stimulation is apparently more telling than weekly hours of use. The authors of this study state:
Erections may become conditioned to aspects of VSS [porn] that do not transition easily to real-life partner situations. Sexual arousal may be conditioned to novel stimuli, including particular sexual images, specific sexual films or even non-sexual images. It is conceivable that experiencing the majority of sexual arousal within the context of VSS may result in a diminished erectile response during partnered sexual interactions. Similarly, young men who view VSS expect that partnered sex will occur with themes similar to what they view in VSS. Accordingly, when high stimulation expectations are not met, partnered sexual stimulation [may not produce an erection].[viii]
We agree. It’s likely that if researchers want to investigate the phenomenon of porn-related sexual dysfunction, they will have to focus not on hours of use but on the following factors:
- Years of use
- How early use starts
- Degree of escalation to new genres
- Percentage of masturbation sessions with and without porn
- Partnered sexual activity
It’s also worth noting that this paper claimed such a large percentage of college-aged men used either zero or less than 2 hours of porn per week. These numbers are very different from existing research. For instance, when conducting research for his book, Porn University, Michael Leahy sampled over 100 college campuses, looking for trends in porn usage, and he found that only 51% of college males viewed less than 5 hours of porn per week.[ix] Meanwhile, Prause and Pfaus claim that 60% of their test subjects (81 of 136) look at porn less than 2 hours per week. This is a significant deviation, and it causes us to doubt the generalizability of the test population in the data that they examined.
To their credit, Prause and Pfaus do acknowledge that their work has limitations, writing that “these data did not include hypersexual patients. Results are probably best interpreted as limited to men with normal, regular VSS use [porn use].”[x] However, this did not stop them from touting porn use as being associated with greater sexual responsiveness rather than sexual dysfunction. Remember, the title of their study is “Viewing Sexual Stimuli Associated with Greater Sexual Responsiveness, Not Erectile Dysfunction.” If that’s not the message they’re pushing, then why not choose a different title?
There is no doubt that solid research on men complaining of porn-related sexual dysfunction is much needed. Growing numbers of physically healthy men, including men in their sexual prime, are suffering from ED directly related to their use of online pornography. And this issue is not caused entirely by frequency of masturbation and orgasm (i.e., the need for a sexual refractory period). In reality, the problem is increasingly related to the fact that when a man spends 70, 80, or even 90% of his sexual life masturbating to online porn – endless images of sexy, exciting, constantly changing partners and experiences – he is, over time, likely to find a real world partner less sexually stimulating than the visuals parading through his mind.
Until this research arrives, we need to take care not to misinform people making decisions about how much porn to consume. After all, there was a point in our history when alcohol and tobacco did not have warning labels. We as clinicians and researchers should likely be spreading a more cautionary, or at least a more accurate, message to the public.
*By Robert Weiss LCSW, CSAT-S and Stefanie Carnes, PhD, CSAT-S
Robert Weiss LCSW, CSAT-S is Senior Vice President of Clinical Development with Elements Behavioral Health. He has developed clinical programs for The Ranch outside Nashville, Tennessee, Promises Treatment Centers in Malibu, and The Sexual Recovery Institute in Los Angeles. He is the author of numerous books, including the recently published Always Turned On: Sex Addiction in the Digital Age coauthored with Dr. Jennifer Schneider. For more information, you can visit his website, www.robertweissmsw.com/.
Stefanie Carnes, PhD, CSAT-S became president of the International Institute of Trauma and Addiction Professionals in November, 2010. She is a licensed marriage and family therapist and an AAMFT approved supervisor. She speaks regularly at national conferences. Her area of expertise is working with patients and families struggling with multiple addictions, such as sexual addiction, eating disorders and chemical dependency. She is the author of several books, including Mending a Shattered Heart: A Guide for Partners of Sex Addicts.
[i] Prause, N., & Pfaus, J. (2015). “Viewing sexual stimuli associated with greater sexual responsiveness, not erectile dysfunction.” Sexual Medicine Open Access.
[ii] “No physiological genital response data were included to support men’s self-reported experience.” (p. 7 of Prause and Pfaus, 2015).
[iii] Hall, P. (2012). Understanding and treating sex addiction: A comprehensive guide for people who struggle with sex addiction and those who want to help them. Routledge.
[iv] Raymond, N. C., Coleman, E., & Miner, M. H. (2003). Psychiatric comorbidity and compulsive/impulsive traits in compulsive sexual behavior. Comprehensive Psychiatry, 44(5), 370-380.
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