YBOP response to Jim Pfaus’s “Trust a Scientist: Sex Addiction Is a Myth” (January, 2016)

How about trusting addiction neuroscientists and peer-reviewed papers?

Before I address many of the claims within the Pfaus article (link to the Pfaus article), it must be noted that Jim Pfaus omitted the 52 neuroscience-based studies (and 27 reviews of the literature and commentaries) on porn users published in the last few years. So far, the results of every “brain study” (MRI, fMRI, EEG, neuropsychological, neuro-hormonal) offer support for the concept of porn addiction. In addition to reporting the same fundamental brain changes as seen in substance addicts, a few studies also reported greater porn use is associated with erectile dysfunction, delayed ejaculation, decreased libido, and reduced neural response to images of vanilla porn.

The 52 neuroscience-based studies on porn users also align with over 370 internet addiction “brain studies” (PET, MRI, fMRI, EEG) published in the last few years. Without exception, these studies reported the same addiction-related brain changes as seen in substance addicts. Internet porn addiction is, in fact, a subtype of internet addiction, as this recent review of the neuroscience literature pointed out – “Neuroscience of Internet Pornography Addiction: A Review and Update (2015)“.

Update (2019): The world’s most widely used medical diagnostic manual, The International Classification of Diseases (ICD-11), contains a new diagnosis suitable for porn or sex addiction: “Compulsive Sexual Behavior Disorder.”

Update (2019): News reports paint Jim Pfaus as having spent years engaging in inappropriate sexual behaviors with young female students. Pfaus was placed on administrative leave, then mysteriously departed the university. There’s a certain irony in Pfaus chronically railing against the existence of porn and sex addiction (and personally attacking those who say porn-induced ED exits), while being unable to control his own sexual behavior.

Let’s examine the claims and distortions in this piece by Jim Pfaus:

JIM PFAUS: “They’re not included in the Diagnostic and Statistical Manual of Mental Disorders (DSM), and by definition, they don’t constitute what most researchers understand to be addiction.”

RESPONSE: The claim about “most researchers” is unsupported. Some of the top addiction researchers in the world recognize Internet porn addiction. Valerie Voon of Cambridge University, Marc Potenza of Yale University, Simone Kuhn of the Max Planck Institute, and many others have published studies the results of which support the porn addiction model. See this list.

Moreover, it appears that DSM sexuality work group member Richard Krueger MD told a Canadian journalist that he had no doubt internet porn addiction is real, and that he expected that the DSM would eventually include internet porn addiction when adequate research became available.

As for addiction experts, the American Society of Addiction Medicine (ASAM) published its new definition of addiction and stated that all addiction is one condition and that “sexual behavior addictions” not only exist but involve the same fundamental mechanisms and brain changes as do drug addictions. ASAM’s 3000 medical doctors are many of the addiction researchers that provide the hard data, such head of NIDA, Nora Volkow, MD. PhD, and Eric Nestler MD, PhD.

QUOTE FROM ASAM FAQS –

5. QUESTION: “This new definition of addiction refers to addiction involving gambling, food, and sexual behaviors. Does ASAM really believe that food and sex are addicting?

ANSWER: “Addiction to gambling has been well described in the scientific literature for several decades. In fact, the latest edition of the DSM (DSM-V) will list gambling disorder in the same section with substance use disorders. The new ASAM definition makes a departure from equating addiction with just substance dependence, by describing how addiction is also related to behaviors that are rewarding. This is the first time that ASAM has taken an official position that addiction is not solely “substance dependence.” This definition says that addiction is about functioning and brain circuitry and how the structure and function of the brains of persons with addiction differ from the structure and function of the brains of persons who do not have addiction. It talks about reward circuitry in the brain and related circuitry, but the emphasis is not on the external rewards that act on the reward system. Food and sexual behaviors and gambling behaviors can be associated with the pathological pursuit of rewards described in this new definition of addiction.“

As for the highly controversial and politicized DSM, it must be remembered that this same organization classified homosexuality as a mental disorder. The DSM doesn’t determine reality, nor is reality up for a vote. It’s quite telling that the head of The National Institute of Mental Health (NIMH), Tom Insel stated that the newly published DSM-5 “lacked validity“. Insel stated that “patients deserve better” and that the NIMH would no longer fund research based on the DSM diagnostic categories. Insel was very clear we he stated,

“it is critical to realize that we cannot succeed if we use DSM categories as the “gold standard.”

But the big news is that The World Health Organization appears poised to set right the APA’s excessive caution. The next edition of the ICD is due out in 2018. The beta draft of the new ICD-11 includes a diagnosis for “Compulsive sexual behavior disorder” – which is an umbrella term for “sex addiction”, “porn addiction”, “cybersex addiction”, hypersexuality, “out of control sexual behaviors”, and the like. The debate about porn addiction is over, Jim.

JIM PFAUS: “Here’s why: addicts withdraw……The same goes for a guy obsessed with watching porn. He might prefer to endlessly watch porn, but when he’s unable to, no withdrawal indicative of addiction occurs. He’ll never be physically addicted.”

RESPONSE: Pfaus spends considerable text suggesting that “withdrawal symptoms” equal “addiction”. First, it is well established in the addiction field that neither the presence nor absence of withdrawal symptoms determines the existence of an addiction. That said, porn addicts consistently report withdrawal symptoms that mirror drug withdrawal. Please see multiple reports on these pages:

• What does withdrawal from porn addiction look like?
• PDF of self-reported withdrawal symptoms

Pfaus may claim these are only anecdotes, yet there are now 10 studies reporting withdrawal symptoms in porn users. In addition, Swansea and Milan universities reported that internet addicts, most of whom had been accessing porn or gambling, suffered a form of cold turkey when they stopped using the web, just like people coming off drugs.

In saying that “physical symptoms” must be present for an addiction to exist, Pfaus is confusing addiction with physical dependence. For example, millions of individuals take chronically high levels of pharmaceuticals such as opioids for chronic pain, or prednisone for autoimmune conditions. Their brains and tissues have become dependent on them, and immediate cessation of use could cause severe withdrawals symptoms. However they are not necessarily addicted. Addiction involves multiple well-indentified brain changes that lead to what we know as the “addiction phenotype”. If the distinction is unclear, I recommend this simple explanation by NIDA.

Pfaus’s “withdrawal = addiction” argument falls apart when we consider that nicotine is often listed as the most addictive substance, and yet causes relatively mild withdrawal symptoms. Finally, the DSM-5 has added pathological gambling into the newly created behavioral addiction category, ending the argument that only drugs can cause and addiction, and with it the claim that “dependence” equals addiction. See this DSM-5 publication.

JIM PFAUS: “As such, the anti-fapper narrative is usually the only point discussed: Guys stop masturbating after they stop downloading porn, and after a few days, they say they’re able to get normal erections again.”

RESPONSE: Pfaus falsely claims it takes a “few days” for men with porn-induced ED to regain normal erectile functioning. Instead, it generally takes months, and up to two years, in some cases, for young men to achieve normal erections again. Pfaus has often spun the nonsensical story that porn-induced ED is cause by a refractory period. I’ve never heard of a 9-month refractory period for a 23-year old. Readers might find interesting this peer-reviewed paper describing porn-induced anorgasmia/loss of libido in a 35-year-old healthy man. It took 8-months of no porn for him to regain normal sexual functioning.

JIM PFAUS: “This coincides with the somewhat popular idea that watching porn leads to erectile dysfunction, a position that porn-addiction advocates such as Marnia Robinson and Gary Wilson state emphatically.”

RESPONSE: First, my book Your Brain on Porn: Internet Pornography and the Emerging Science of Addiction, which came out last year (updated December, 2017), addresses porn-related sexual dysfunctions such as difficulty orgasming and sustaining erections. It has been endorsed by various experts. And I recommend it to anyone who wants to understand what is going on on recovery forums, as well as the relevant science (more of which has come out since, and all of which aligns with what I wrote).

Second, it’s not just Gary Wilson. On this page readers can see articles, podcasts and videos by over 130 experts (urology professors, urologists, psychiatrists, psychologists, sexologists, MDs) who have successfully treated porn-induced ED and porn-induced loss of sexual desire.

Third, almost 40 studies linking porn use or porn addiction to sexual problems and lower arousal in response to sexual stimuli or partnered sex (the first 7 studies in this list demonstrate causation).

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 7 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. Two of the three men healed their sexual dysfunctions by eliminating porn use. The third man experienced little improvement as he was unable to abstain from porn use. Excerpt:

Traditional factors that once explained men’s sexual difficulties appear insufficient to account for the sharp rise in erectile dysfunction, delayed ejaculation, decreased sexual satisfaction, and diminished libido during partnered sex in men under 40. This review (1) considers data from multiple domains, e.g., clinical, biological (addiction/urology), psychological (sexual conditioning), sociological; and (2) presents a series of clinical reports, all with the aim of proposing a possible direction for future research of this phenomenon. Alterations to the brain’s motivational system are explored as a possible etiology underlying pornography-related sexual dysfunctions. This review also considers evidence that Internet pornography’s unique properties (limitless novelty, potential for easy escalation to more extreme material, video format, etc.) may be potent enough to condition sexual arousal to aspects of Internet pornography use that do not readily transition to real-life partners, such that sex with desired partners may not register as meeting expectations and arousal declines. Clinical reports suggest that terminating Internet pornography use is sometimes sufficient to reverse negative effects, underscoring the need for extensive investigation using methodologies that have subjects remove the variable of Internet pornography use.

2) Male masturbation habits and sexual dysfunctions (2016) – It’s by a French psychiatrist who is the current president of the European Federation of Sexology. While the abstract shifts back and forth between Internet pornography use and masturbation, it’s clear that he’s mostly referring to porn-induced sexual dysfunctions (erectile dysfunction and anorgasmia). The paper revolves around his clinical experience with 35 men who developed erectile dysfunction and/or anorgasmia, and his therapeutic approaches to help them. The author states that most of his patients used porn, with several being addicted to porn. The abstract points to internet porn as the primary cause of the problems (keep in mind that masturbation does not cause chronic ED, and it is never given as a cause of ED). 19 of the 35 men saw significant improvements in sexual functioning. The other men either dropped out of treatment or are still trying to recover. Excerpts:

Intro: Harmless and even helpful in his usual form widely practiced, masturbation in its excessive and pre-eminent form, generally associated today to pornographic addiction, is too often overlooked in the clinical assessment of sexual dysfunction it can induce.

Results: Initial results for these patients, after treatment to “unlearn” their masturbatory habits and their often associated addiction to pornography, are encouraging and promising. A reduction in symptoms was obtained in 19 patients out of 35. The dysfunctions regressed and these patients were able to enjoy satisfactory sexual activity.

Conclusion: Addictive masturbation, often accompanied by a dependency on cyber-pornography, has been seen to play a role in the etiology of certain types of erectile dysfunction or coital anejaculation. It is important to systematically identify the presence of these habits rather than conduct a diagnosis by elimination, in order to include habit-breaking deconditioning techniques in managing these dysfunctions.

3) 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.

4) How difficult is it to treat delayed ejaculation within a short-term psychosexual model? A case study comparison (2017) – A report on two “composite cases” illustrating the causes and treatments for delayed ejaculation (anorgasmia). “Patient B” represented several young men treated by the therapist. Interestingly, the paper states that Patient B’s “porn use had escalated into harder material”, “as is often the case”. The paper says that porn-related delayed ejaculation is not uncommon, and on the rise. The author calls for more research on porn’s effects of sexual functioning. Patient B’s delayed ejaculation was healed after 10 weeks of no porn. Excerpts:

The cases are composite cases taken from my work within the National Health Service in Croydon University Hospital, London. With the latter case (Patient B), it is important to note that the presentation reflects a number of young males who have been referred by their GPs with a similar diagnosis. Patient B is a 19-year-old who presented because he was unable to ejaculate via penetration. When he was 13, he was regularly accessing pornography sites either on his own through internet searches or via links that his friends sent him. He began masturbating every night while searching his phone for image…If he did not masturbate he was unable to sleep. The pornography he was using had escalated, as is often the case (see Hudson-Allez, 2010), into harder material (nothing illegal)…

Patient B was exposed to sexual imagery via pornography from the age of 12 and the pornography he was using had escalated to bondage and dominance by the age of 15.

We agreed that he would no longer use pornography to masturbate. This meant leaving his phone in a different room at night. We agreed that he would masturbate in a different way….

Patient B was able to achieve orgasm via penetration by the fifth session; the sessions are offered fortnightly in Croydon University Hospital so session five equates to approximately 10 weeks from consultation. He was happy and greatly relieved. In a three-month follow-up with Patient B, things were still going well.

Patient B is not an isolated case within the National Health Service (NHS) and in fact young men in general accessing psychosexual therapy, without their partners, speaks in itself to the stirrings of change.

This article therefore supports previous research that has linked masturbation style to sexual dysfunction and pornography to masturbation style. The article concludes by suggesting that the successes of psychosexual therapists in working with DE are rarely recorded in the academic literature, which has allowed the view of DE as a difficult disorder to treat remain largely unchallenged. The article calls for research into pornography usage and its effect on masturbation and genital desensitisation.

5) Situational Psychogenic Anejaculation: A Case Study (2014) – The details reveal a case of porn-induced anejaculation. The husband’s only sexual experience prior to marriage was frequent masturbation to pornography – where he was able to ejaculate. He also reported sexual intercourse as less arousing than masturbation to porn. The key piece of information is that “re-training” and psychotherapy failed to heal his anejaculation. When those interventions failed, therapists suggested a complete ban on masturbation to porn. Eventually this ban resulted in successful sexual intercourse and ejaculation with a partner for the first time in his life. A few excerpts:

A is a 33-year-old married male with heterosexual orientation, a professional from a middle socio-economic urban background. He has had no premarital sexual contacts. He watched pornography and masturbated frequently. His knowledge about sex and sexuality was adequate. Following his marriage, Mr. A described his libido as initially normal, but later reduced secondary to his ejaculatory difficulties. Despite thrusting movements for 30-45 minutes, he had never been able to ejaculate or achieve orgasm during penetrative sex with his wife.

What didn’t work:

Mr. A’s medications were rationalized; clomipramine and bupropion were discontinued, and sertraline was maintained at a dose of 150 mg per day. Therapy sessions with the couple were held weekly for the initial few months, following which they were spaced to fortnightly and later monthly. Specific suggestions including focusing on sexual sensations and concentrating on the sexual experience rather than ejaculation were used to help reduce performance anxiety and spectatoring. Since problems persisted despite these interventions, intensive sex therapy was considered.

Eventually they instituted a complete ban on masturbation (which means he continued to masturbate to porn during the above failed interventions):

A ban on any form of sexual activity was suggested. Progressive sensate focus exercises (initially non-genital and later genital) were initiated. Mr. A described an inability to experience the same degree of stimulation during penetrative sex as compared to that which he experienced during masturbation. Once the ban on masturbation was enforced, he reported an increased desire for sexual activity with his partner.

After an unspecified amount of time, the ban on masturbation to porn lead to success:

Meanwhile, Mr. A and his wife decided to go ahead with Assisted Reproductive Techniques (ART) and underwent two cycles of intrauterine insemination. During a practice session, Mr. A ejaculated for the first time, following which he has been able to ejaculate satisfactorily during a majority of the couple’s sexual interactions.

6) Pornography Induced Erectile Dysfunction Among Young Men (2019) – Abstract:

This paper explores the phenomenon of pornography induced erectile dysfunction (PIED), meaning sexual potency problems in men due to Internet pornography consumption. Empirical data from men who suffer from this condition have been collected. A combination of topical life history method (with qualitative asynchronous online narrative interviews) and personal online diaries has been employed. The data have been analyzed using theoretical interpretative analysis (according to McLuhan’s media theory), based on analytic induction. The empirical investigation indicates that there is a correlation between pornography consumption and erectile dysfunction that suggests causation. The findings are based on 11 interviews along with two video diaries and three text diaries. The men are between the ages of 16 and 52; they report that an early introduction to pornography (usually during adolescence) is followed by daily consumption until a point is reached where extreme content (involving, for example, elements of violence) is needed to maintain arousal. A critical stage is reached when sexual arousal is exclusively associated with extreme and fast-paced pornography, rendering physical intercourse bland and uninteresting. This results in an inability to maintain an erection with a real-life partner, at which point the men embark on a “re-boot” process, giving up pornography. This has helped some of the men to regain their ability to achieve and sustain an erection.

Introduction to the results section:

Having processed the data, I have noticed certain patterns and recurring themes, following a chronological narrative in all of the interviews. These are: Introduction. One is first introduced to pornography, usually before puberty. Building a habit. One begins to consume pornography regularly. Escalation. One turns to more “extreme” forms of pornography, content-wise, in order to achieve the same effects previously achieved through less “extreme” forms of pornography. Realization. One notices sexual potency problems believed to be caused by pornography use. “Re-boot” process. One tries to regulate pornography use or eliminate it completely in order to regain one’s sexual potency. The data from the interviews are presented based on the above outline.

7) Hidden in Shame: Heterosexual Men’s Experiences of Self-Perceived Problematic Pornography Use (2019) – Interviews of 15 male porn users. Several of the men reported porn addiction, escalation of use, and porn-induced sexual problems. Excerpts relevant to porn-induced sexual dysfunctions, including Michael – who significantly improve his erectile function during sexual encounters by severely limiting his porn use:

Some men talked about seeking professional help to address their problematic pornography use. Such attempts at help-seeking had not been productive for the men, and at times even exacerbated feelings of shame. Michael, a university student who used pornography primarily as a coping mechanism for study-related stress, was having issues with erectile dysfunction during sexual encounters with women and sought help from his General Practitioner Doctor (GP):

Michael: When I went to the doctor at 19 [. . .], he prescribed Viagra and said [my issue] was just performance anxiety. Sometimes it worked, and sometimes it didn’t. It was personal research and reading that showed me the issue was porn [. . .] If I go to the doctor as a young kid and he prescribes me the blue pill, then I feel like no one is really talking about it. He should be asking about my porn use, not giving me Viagra. (23, Middle-Eastern, Student)

As a result of his experience, Michael never went back to that GP and started doing his own research online. He eventually found an article discussing a man approximately his age describing a similar type of sexual dysfunction, which caused him to consider pornography as a potential contributor. After making a concerted effort to lower his pornography use, his erectile dysfunction issues began to improve. He reported that even though his total frequency of masturbation did not reduce, he only watched pornography for about half of those instances. By halving the amount of times he combined masturbation with pornography, Michael said he was able to significantly improve his erectile function during sexual encounters with women.

Phillip, like Michael, sought help for another sexual issue related to his pornography use. In his case, the problem was a noticeably reduced sex drive. When he approached his GP about his issue and its links to his pornography use, the GP reportedly had nothing to offer and instead referred him to a male fertility specialist:

Phillip: I went to a GP and he referred me to specialist who I didn’t believe was particularly helpful. They didn’t really offer me a solution and weren’t really taking me seriously. I ended up paying him for six weeks of testosterone shots, and it was $100 a shot, and it really didn’t do anything. That was their way to treat my sexual dysfunction. I just do not feel the dialogue or situation was adequate. (29, Asian, Student)

Interviewer: [To clarify a previous point you mentioned, is this the experience] that prevented you from seeking help thereafter?

Phillip: Yup.

The GPs and specialists sought by the participants seemed to offer only biomedical solutions, an approach that has been criticized within literature (Tiefer, 1996). Hence, the service and treatment these men were able to receive from their GPs was not only deemed inadequate, but also alienated them from further accessing professional help. Although biomedical responses seem to be the most popular answer for doctors (Potts, Grace, Gavey, & Vares, 2004), a more holistic and client-centered approach is needed, as the issues highlighted by men are likely psychological and possibly created by pornography use.

Lastly, men reported the impacts pornography had had on their sexual function, something that has only recently been examined within the literature. For example, Park and colleagues (2016) found that Internet pornography viewing might be associated with erectile dysfunction, decreased sexual satisfaction, and diminished sexual libido. Participants in our study reported similar sexual dysfunctions, which they attributed to pornography use. Daniel reflected on his past relationships in which he was not able to get and keep an erection. He associated his erectile dysfunction with his girlfriends’ bodies not comparing to what he had become attracted to when watching pornography:

Daniel: My previous two girlfriends, I stopped finding them arousing in a way that wouldn’t have happened to someone who was not watching porn. I had seen so many naked female bodies, that I knew the particular things that I liked and you just start forming a very clear ideal about what you want in a woman, and real women aren’t like that. And my girlfriends didn’t have perfect bodies and I think that’s fine, but I think that got in the way of finding them arousing. And that caused problems in the relationships. There are times I couldn’t sexually perform because I was not aroused. (27, Pasifika, Student)

The remaining studies are listed by date of publication:

8) 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.”

9) Clinical encounters with internet pornography (2008) – Comprehensive paper, with four clinical cases, written by a psychiatrist who became aware of the negative effects internet porn was having on some of his male patients. The excerpt below describes a 31 year old man who escalated into extreme porn and developed porn-induced sexual tastes and sexual problems. This is one of the first peer-reviewed papers to depict porn use leading to tolerance, escalation, and sexual dysfunctions:

A 31-year-old male in analytic psychotherapy for mixed anxiety problems reported that he was experiencing difficulty becoming sexually aroused by his current partner. After much discussion about the woman, their relationship, possible latent conflicts or repressed emotional content (without arriving at a satisfactory explanation for his complaint), he provided the detail that he was relying on a particular fantasy to become aroused. Somewhat chagrined, he described a “scene” of an orgy involving several men and women that he had found on an Internet pornography site that had caught his fancy and become one of his favorites. Over the course of several sessions, he elaborated upon his use of Internet pornography, an activity in which he had engaged sporadically since his mid-20s. Relevant details about his use and the effects over time included clear descriptions of an increasing reliance on viewing and then recalling pornographic images in order to become sexually aroused. He also described the development of a “tolerance” to the arousing effects of any particular material after a period of time, which was followed by a search for new material with which he could achieve the prior, desired level of sexual arousal.

As we reviewed his use of pornography, it became evident that the arousal problems with his current partner coincided with use of pornography, whereas his “tolerance” to the stimulating effects of particular material occurred whether or not he was involved with a partner at the time or was simply using pornography for masturbation. His anxiety about sexual performance contributed to his reliance on viewing pornography. Unaware that the use itself had become problematic, he had interpreted his waning sexual interest in a partner to mean that she was not right for him, and had not had a relationship of greater than two months’ duration in over seven years, exchanging one partner for another just as he might change websites.

He also noted that he now could be aroused by pornographic material that he once had no interest in using. For example, he noted that five years ago he had little interest in viewing images of anal intercourse but now found such material stimulating. Similarly, material that he described as “edgier,” by which he meant “almost violent or coercive,” was something that now elicited a sexual response from him, whereas such material had been of no interest and was even off-putting. With some of these new subjects, he found himself anxious and uncomfortable even as he would become aroused.

10) Exploring the Relationship Between Erotic Disruption During the Latency Period and the Use of Sexually Explicit Material, Online Sexual Behaviors, and Sexual Dysfunctions in Young Adulthood (2009) – Study examined correlations between current porn use (sexually explicit material – SEM) and sexual dysfunctions, and porn use during “latency period” (ages 6-12) and sexual dysfunctions. The average age of participants was 22. While current porn use correlated with sexual dysfunctions, porn use during latency (ages 6-12) had an even stronger correlation with sexual dysfunctions. A few excerpts:

Findings suggested that latency erotic disruption by way of sexually explicit material (SEM) and/or child sexual abuse may be associated to adult online sexual behaviors.

Furthermore, results demonstrated that latency SEM exposure was a significant predictor of adult sexual dysfunctions.

We hypothesized that exposure to latency SEM exposure would predict adult use of SEM. Study findings supported our hypothesis, and demonstrated that latency SEM exposure was a statistically significant predictor of adult SEM use. This suggested that individuals who were exposed to SEM during latency, may continue this behavior into adulthood. Study findings also indicated that latency SEM exposure was a significant predictor of adult online sexual behaviors.

11) 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.

12) Cyber-porn dependence: voices of distress in an Italian internet self-help community (2009) – This study reports on a narrative analysis of two thousand messages written by 302 members of an Italian self-help group for cyberdependents (noallapornodipendenza). It sampled 400 messages from each year (2003–2007). Excerpts relevant to porn-induced sexual dysfunctions:

For many their condition is reminiscent of an addicted escalation with new levels of tolerance. Many of them in fact search for increasingly more explicit, bizarre and violent images, bestiality included….

Many members complain about increased impotence and lack of ejaculation, feeling in their real life like “a dead man walking” (“vivalavita” #5014). The following example concretizes their perceptions (“sul” #4411)….

Many participants stated that they usually spend hours looking at and collecting pictures and movies holding their erect penis in their hand, unable to ejaculate, waiting for the ultimate, extreme image to release the tension. For many the final ejaculation puts an end to their torture (supplizio) (“incercadiliberta” #5026)…

Problems in heterosexual relations are more than frequent. People complain they have erection problems, lack of sexual relations with their spouses, lack of interest in sexual intercourse, feeling like a person who has eaten hot, spicy food, and consequently cannot eat ordinary food. In many cases, as also reported by spouses of cyber dependents, there are indications of male orgasmic disorder with the inability to ejaculate during intercourse. This sense of desensitization in sexual relationships is well expressed in the following passage (“vivaleiene” #6019):

Last week I had an intimate relation with my girlfriend; nothing bad at all, despite the fact after the first kiss I didn’t feel any sensation. We didn’t finish the copulation because I didn’t want to.

Many participants expressed their real interest in “chatting on line” or “telematic contact” instead of physical touch, and a pervasive and unpleasant presence of pornographic flashbacks in their mind, during sleep and during sexual intercourse.

As stressed, the claim of a real sexual dysfunction is echoed by many testimonials from female partners. But also forms of collusion and contamination appear in these narratives. Here are a few of the most striking comments of these female partners…

Most of the messages sent to the Italian self help group do indicate the presence of pathology by those participants, according to the model of salience (in real life), mood modification, tolerance, withdrawal symptoms and interpersonal conflict, a diagnostic model developed by Griffiths (2004)….

13) 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/sex addiction. Not so. Steele et al. 2013 actually lends support to the existence of both porn addiction and porn use down-regulating sexual desire. How so? The study reported higher EEG readings (relative to neutral pictures) when subjects were briefly exposed to pornographic photos. Studies consistently show that an elevated P300 occurs when addicts are exposed to cues (such as images) related to their addiction.

In line with the Cambridge University brain scan studies, this EEG study also reported greater cue-reactivity to porn correlating with less desire for partnered sex. To put it another way – individuals with greater brain activation to porn would rather masturbate to porn than have sex with a real person. Shockingly, study spokesperson Nicole Prause claimed that porn users merely had “high libido,” yet the results of the study say the exact opposite (subjects’ desire for partnered sex was dropping in relation to their porn use).

Together these two Steele et al. findings indicate greater brain activity to cues (porn images), yet less reactivity to natural rewards (sex with a person). That”s sensitization & desensitization, which are hallmarks of an addiction. Eight peer-reviewed papers explain the truth: Also see this extensive YBOP critique.

14) 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.”

15) 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.”

16) Modulation of Late Positive Potentials by Sexual Images in Problem Users and Controls Inconsistent with “Porn Addiction” (2015) – A second EEG study from Nicole Prause’s team. This study compared the 2013 subjects from Steele et al., 2013 to an actual control group (yet it suffered from the same methodological flaws named above). The results: Compared to controls “individuals experiencing problems regulating their porn viewing” had lower brain responses to one-second exposure to photos of vanilla porn. The lead author claims these results “debunk porn addiction.” What legitimate scientist would claim that their lone anomalous study has debunked a well established field of study?

In reality, the findings of Prause et al. 2015 align perfectly with Kühn & Gallinat (2014), which found that more porn use correlated with less brain activation in response to pictures of vanilla porn. Prause et al. findings also align with Banca et al. 2015. Moreover, another EEG study found that greater porn use in women correlated with less brain activation to porn. Lower EEG readings mean that subjects are paying less attention to the pictures. Put simply, frequent porn users were desensitized to static images of vanilla porn. They were bored (habituated or desensitized). See this extensive YBOP critique. Nine peer-reviewed papers agree that this study actually found desensitization/habituation in frequent porn users (consistent with addiction): Peer-reviewed critiques of Prause et al., 2015

17) 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.”

18) Patient Characteristics by Type of Hypersexuality Referral: A Quantitative Chart Review of 115 Consecutive Male Cases (2015) – A study on men (average age 41.5) with hypersexuality disorders, such as paraphilias, chronic masturbation or adultery. 27 of the men 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% of the men who chronically masturbated to porn 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 repeated requests for details. Two primary choices for male sexual dysfunction are erectile dysfunction and low libido. It should be noted that the men were not asked about their erectile functioning without porn. This, if all their sexual activity involved masturbating to porn, and not sex with a partner, they might never realize they had porn-induced ED. (For reasons known only to her, Prause cites this paper as debunking the existence of porn-induced sexual dysfunctions.)

19) Men’s Sexual Life and Repeated Exposure to Pornography. A New Issue? (2015) – Excerpts:

Mental health specialists should take in consideration the possible effects of pornography consumption on men sexual behaviors, men sexual difficulties and other attitudes related to sexuality. In the long term pornography seems to create sexual dysfunctions, especially the individual’s inability to reach an orgasm with his partner. Someone who spends most of his sexual life masturbating while watching porn engages his brain in rewiring its natural sexual sets (Doidge, 2007) so that it will soon need visual stimulation to achieve an orgasm.

Many different symptoms of porn consumption, such as the need to involve a partner in watching porn, the difficulty in reaching orgasm, the need for porn images in order to ejaculate turn into sexual problems. These sexual behaviors may go on for months or years and it may be mentally and bodily associated with the erectile dysfunction, although it is not an organic dysfunction. Because of this confusion, which generates embarrassment, shame and denial, lots of men refuse to encounter a specialist

Pornography offers a very simple alternative to obtain pleasure without implying other factors that were involved in human’s sexuality along the history of mankind. The brain develops an alternative path for sexuality which excludes “the other real person” from the equation. Furthermore, pornography consumption in a long term makes men more prone to difficulties in obtaining an erection in a presence of their partners.

20) 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.

21) 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.

22) An Online Assessment of Personality, Psychological, and Sexuality Trait Variables Associated with Self-Reported Hypersexual Behavior (2015) – Survey reported a common theme found in several other studies listed here: Porn/sex addicts report greater arousabilty (cravings related to their addiction) combined with poorer sexual function (fear of experiencing erectile dysfunction).

Hypersexual” behavior represents a perceived inability to control one’s sexual behavior. To investigate hypersexual behavior, an international sample of 510 self-identified heterosexual, bisexual, and homosexual men and women completed an anonymous online self-report questionnaire battery.

Thus, the data indicated that hypersexual behavior is more common for males, and those who report being younger in age, more easily sexually excited, more sexually inhibited due to the threat of performance failure, less sexually inhibited due to the threat of performance consequences, and more impulsive, anxious, and depressed

23) 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.” (See studies reporting habituation/desensitization to porn and escalation of porn use) 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 problematic 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 sexual dysfunction. Moreover, paper 2 was only a “brief communication” that did not report important data which the authors reported at a sexology conference.

24) The effects of sexually explicit material use on romantic relationship dynamics (2016) – As with many other studies, solitary porn users report poorer relationship and sexual satisfaction. An excerpt:

More specifically, couples, where no one used, reported more relationship satisfaction than those couples that had individual users. This is consistent with the previous research (Cooper et al., 1999; Manning, 2006), demonstrating that the solitary use of SEM results in negative consequences.

Employing the Pornography Consumption Effect Scale (PCES), the study found that higher porn use was related to poorer sexual function, more sexual problems, and a “worse sex life”. An excerpt describing the correlation between the PCES “Negative Effects” on “Sex Life” questions and frequency of porn use:

There were no significant differences for the Negative Effect Dimension PCES across the frequency of sexually explicit material use; however, there were significant differences on the Sex Life subscale where High Frequency Porn Users reported greater negative effects than Low Frequency Porn Users.

25) 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.

26) Associative pathways between pornography consumption and reduced sexual satisfaction (2017) – This study is found in both lists. While it links porn use to lower sexual satisfaction, it also reported that frequency of porn use was related to a preference (or need?) for porn over people to achieve sexual arousal. An excerpt:

Finally, we found that frequency of pornography consumption was also directly related to a relative preference for pornographic rather than partnered sexual excitement. Participants in the present study primarily consumed pornography for masturbation. Thus, this finding could be indicative of a masturbatory conditioning effect (Cline, 1994; Malamuth, 1981; Wright, 2011). The more frequently pornography is used as an arousal tool for masturbation, the more an individual may become conditioned to pornographic as opposed to other sources of sexual arousal.

27) “I think it has been a negative influence in many ways but at the same time I can’t stop using it”: Self-identified problematic pornography use among a sample of young Australians (2017) – Online survey of Australians, aged 15-29. Those who had ever viewed pornography (n=856) were asked in an open-ended question: ‘How has pornography influenced your life?’.

Among participants who responded to the open-ended question (n=718), problematic usage was self-identified by 88 respondents. Male participants who reported problematic usage of pornography highlighted effects in three areas: on sexual function, arousal and relationships. Responses included “I think it has been a negative influence in many ways but at the same time I can’t stop using it” (Male, Aged 18–19). Some female participants also reported problematic usage, with many of these reporting negative feelings like guilt and shame, impact on sexual desire and compulsions relating to their use of pornography. For example as one female participant suggested; “It makes me feel guilty, and I’m trying to stop. I don’t like how I feel that I need it to get myself going, it’s not healthy.” (Female, Aged 18–19)

28) Organic and psychogenic causes of sexual dysfunction in young men (2017) – A narrative review, with a section called “Role of Pornography in Delayed Ejaculation (DE)”. An excerpt from this section:

Role of Pornography in DE

Over the last decade, a large increase in the prevalence and accessibility of Internet pornography has provided increased causes of DE associated with Althof’s second and third theory. Reports from 2008 found on average 14.4% of boys were exposed to pornography before the age of 13 and 5.2% of people viewed pornography at least daily.76 A 2016 study revealed that these values had both increased to 48.7% and 13.2%, respectively.76 An earlier age of first pornographic exposure contributes to DE through its relationship with patients exhibiting CSB. Voon et al. found that young men with CSB had viewed sexually explicit material at an earlier age than their age-controlled healthy peers.75 As previously mentioned, young men with CSB can fall victim to Althof’s third theory of DE and preferentially choose masturbation over partnered sex due to a lack of arousal in relationships. An increased number of men watching pornographic material daily also contributes to DE through Althof’s third theory. In a study of 487 male college students, Sun et al. found associations between the use of pornography and a decreased self-reported enjoyment of sexually intimate behaviors with real-life partners.76 These individuals are at an elevated risk of preferentially choosing masturbation over sexual encounters, as demonstrated in a case report by Park et al. A 20-year-old enlisted male presented with difficulty achieving orgasm with his fiancée for the previous six months. A detailed sexual history revealed that the patient relied on Internet pornography and use of a sex toy described as a “fake vagina” to masturbate while deployed. Over time, he required content of an increasingly graphic or fetish nature to orgasm. He admitted that he found his fiancée attractive but preferred the feeling of his toy because he found it more stimulating that real intercourse.77 An increase in the accessibility of Internet pornography places younger men at risk of developing DE through Althof’s second theory, as demonstrated in the following case report: Bronner et al. interviewed a 35-year-old healthy man presenting with complaints of no desire to have sex with his girlfriend despite being mentally and sexually attracted to her. A detailed sexual history revealed that this scenario had happened with the past 20 women he tried to date. He reported extensive use of pornography since adolescence that initially consisted of zoophilia, bondage, sadism, and masochism, but eventually progressed to transgender sex, orgies, and violent sex. He would visualize the pornographic scenes in his imagination to function sexually with women, but that gradually stopped working.74 The gap between the patient’s pornographic fantasies and real life became too large, causing a loss of desire. According to Althof, this will present as DE in some patients.73 This recurring theme of requiring pornographic content of an increasingly graphic or fetish nature to orgasm is defined by Park et al. as hyperactivity. As a man sensitizes his sexual arousal to pornography, sex in real life no longer activates the proper neurological pathways to ejaculate (or produce sustained erections in the case of ED).77

29) Pornography increasingly damaging health and relationships says Brno’s University Hospital study (2018) – It’s in Czech. This YBOP page contains a short press release in English and a choppy Google translation of the longer press release from the hospital website. A few excerpts from the press release:

Increased use of and exposure to pornography are increasingly damaging normal relations and even the health of young men, according to a study released Monday by Brno’s University Hospital.

It said many young men were simply not prepared for normal relationships because of the myths created by the pornography they were watching. Many men turned on by pornography could not physically get stimulated in a relationship, the study added. Psychological and even medical treatment was required, the report said.

In the Sexological department of the Faculty Hospital in Brno, we also record more and more frequent cases of young men who are not able to have a normal sex life as a result of pornography, or to establish a relationship.

The fact that pornography is not merely a “diversification” of sex life but often has a negative impact on the quality of partner sexuality is evidenced by the increasing number of patients in the Sexual Section of Brno University Hospital who, due to excessive monitoring of inappropriate sexual content, are getting into health and relationship problems.

In middle age, male partners are replacing partner sex with pornography (masturbation is available anytime, faster, without psychological, physical or material investment). At the same time, sensitivity to normal (real) sexual stimuli accompanied by the risk of having sex-related dysfunctions associated only with a partner is significantly reduced by the monitoring of pornography. This is a risk of intimacy and proximity in the relationship, ie the psychological separation of partners, the need for masturbation on the Internet is gradually increasing – the risk of addiction increases and, last but not least, sexuality can change in its intensity but also in the quality of normal pornography is not enough, and these people resort to perversion (eg, sado-masochistic or zoophilous).

As a result, excessive monitoring of pornography may result in addiction, which is manifested by sexual dysfunction, disorder of relationships leading to social isolation, disrupted concentration, or neglect of work responsibilities, where only sex plays a dominant role in life.

30) Sexual Dysfunctions in the Internet Era (2018) – Excerpts:

Low sexual desire, reduced satisfaction in sexual intercourse, and erectile dysfunction (ED) are increasingly common in young population. In an Italian study from 2013, up to 25% of subjects suffering from ED were under the age of 40 [1], and in a similar study published in 2014, more than half of Canadian sexually experienced men between the age of 16 and 21 suffered from some kind of sexual disorder [2]. At the same time, prevalence of unhealthy lifestyles associated with organic ED has not changed significantly or has decreased in the last decades, suggesting that psychogenic ED is on the rise [3]. The DSM-IV-TR defines some behaviors with hedonic qualities, such as gambling, shopping, sexual behaviors, Internet use, and video game use, as “impulse control disorders not elsewhere classified”—although these are often described as behavioral addictions [4]. Recent investigation has suggested the role of behavioral addiction in sexual dysfunctions: alterations in neurobiological pathways involved in sexual response might be a consequence of repeated, supernormal stimuli of various origins.

Among behavioral addictions, problematic Internet use and online pornography consumption are often cited as possible risk factors for sexual dysfunction, often with no definite boundary between the two phenomena. Online users are attracted to Internet pornography because of its anonymity, affordability, and accessibility, and in many cases its usage could lead users through a cybersex addiction: in these cases, users are more likely to forget the “evolutionary” role of sex, finding more excitement in self-selected sexually explicit material than in intercourse.

In literature, researchers are discordant about positive and negative function of online pornography. From the negative perspective, it represents the principal cause of compulsive masturbatory behavior, cybersex addiction, and even erectile dysfunction.

31) Is Pornography Use Related to Erectile Functioning? Results From Cross-Sectional and Latent Growth Curve Analyses” (2019) – The researcher who saddled humankind with “perceived pornography addiction” and claimed it somehow “functions very differently from other addictions,” has now turned his dexterity to porn-induced ED. Even though this Joshua Grubbs-penned study found correlations between poorer sexual functioning and both porn addiction and porn use (while excluding sexually inactive men and thus many men with ED), the paper reads as if it has completely debunked porn-induced ED (PIED). This maneuver comes as no surprise to those who have followed the earlier dubious claims of Dr. Grubbs in relation to his “perceived pornography addiction” campaign. See this extensive analysis for the facts.

While the Grubbs paper consistently downplays the correlations between higher pornography use and poorer erections, correlations were reported in all 3 groups – especially for sample 3, which was the most relevant sample as it was the largest sample and averaged higher levels of porn use. Most importantly, this sample’s age range is the most likely to report PIED. Not surprisingly, sample 3 had the strongest correlation between higher levels of porn use and poorer erectile functioning (–0.37). Below are the 3 groups, with their average daily minutes of porn viewing and the correlations between erectile functioning amount of use (a negative sign means poorer erections linked to greater porn use):

1. Sample 1 (147 men): average age 19.8 – Averaged 22 minutes of porn/day. (–0.18)
2. Sample 2 (297 men): average age 46.5 – Averaged 13 minutes of porn/day. (–0.05)
3. Sample 3 (433 men): average age 33.5 – Averaged 45 minutes of porn/day. (–0.37)

Fairly straightforward results: the sample that used the most porn (#3) had the strongest correlation between greater porn use and poorer erections, while the group that use the least (#2) had the weakest correlation between greater porn use and poorer erections. Why didn’t Grubbs emphasize this pattern in his write-up, instead of using statistical manipulations to try to make it disappear? To summarize:

• Sample #1: Average age 19.8 – Note that 19-year old porn users rarely report chronic porn-induced (especially when only using 22 minutes a day). The vast majority of porn-induced ED recovery stories YBOP has gathered are by men aged 20-40. It generally takes time to develop PIED.
• Sample #2: Average age 46.5 – They averaged only 13 minutes per day! With a standard deviation of 15.3 years, some portion of these men were fifty-something. These older men did not start out using internet porn during adolescence (making them less vulnerable to conditioning their sexual arousal solely to internet porn). Indeed, just as Grubbs found, the sexual health of slightly older men has always been better and more resilient over all, than users who began using digital porn during adolescence (such as those with an average age of 33 in sample 3).
• Sample #3: Average age 33.5 – As already mentioned, sample 3 was the largest sample and averaged higher levels of porn use. Most importantly, this age range is the most likely to report PIED. Not surprisingly, sample 3 had the strongest correlation between higher levels of porn use and poorer erectile functioning (–0.37).

Grubbs also correlated porn addiction scores with erectile functioning. The results reveal that even in subjects with relatively healthy erectile functioning, porn addiction was significantly related to poorer erections (–0.20 to –0.33). As before, the strongest correlation between porn addiction and poorer erections (–0.33) occurred in Grubbs’s largest sample, and the sample of an average age most likely to report porn-induced ED: sample 3, average age: 33.5 (433 subjects).

Wait a minute you ask, how dare I say significantly related? Doesn’t the Grubbs study confidently declare that the relationship was only “small to moderate,” meaning it’s no big deal? As we explored in the critique, Grubbs’s use of descriptors varies remarkably, depending upon which Grubbs study you read. If the Grubbs study is about porn use causing ED, then the above numbers represent a meager correlation, tossed aside in his spin-laden write-up.

However, if it’s Grubbs’s most famous study (“Transgression as Addiction: Religiosity and Moral Disapproval as Predictors of Perceived Addiction to Pornography“), where he proclaimed that being religious was the real cause of “porn addiction,” then numbers smaller than these constitute a “robust relationship.” In fact, Grubbs’s “robust” correlation between religiosity and “perceived pornography addiction” was only 0.30! Yet he audaciously used it to usher in a completely new, and questionable, model of porn addiction. The tables, correlations and details referred to here are found in this section of a longer YBOP analysis.

32) Survey of Sexual Function and Pornography (2019) – In this study, researchers looked for a link between ED and indices of pornography addiction using a “craving” questionnaire. While no such link turned up (perhaps because users don’t accurately assess their degree of “craving” until they attempt to quit using), some other interesting correlations appeared in their results. Excerpts:

Rates of erectile dysfunction were lowest in those [men] preferring partnered sex without pornography (22.3%) and increased significantly when pornography was preferred over partnered sex (78%).

…Pornography and sexual dysfunction are common among young people.

…Those [men] who used on an almost daily basis or more had ED rates of 44% (12/27) compared to 22% (47/213) for those more “casual” users (≤5x/week), reaching significance on univariate analysis (p=0.017). It may be that volume does play a role to some extent.

…The proposed pathophysiology of PIED seems plausible and is based on a variety of researchers work and not a small collection of researchers that might be swayed by an ethical bias. Also supporting the “causation” side of the argument are reports of men regaining normal sexual function after discontinuation of excessive pornography use.

…Only prospective studies will be able to definitively solve the question of causation or association, including interventional studies evaluating the success of abstention in treating ED in heavy pornography users. Additional populations that warrant special consideration include adolescents. There has been concern raised that early exposure to graphic sexual material may affect normal development. The rate of teenagers being exposed to pornography before the age of 13 has gone up three fold over the last decade, and now hovers around 50%.

The above study was presented at the American Urological Association’s 2017 meeting. A few excerpts from this article about it – Study sees link between porn and sexual dysfunction (2017):

Young men who prefer pornography to real-world sexual encounters might find themselves caught in a trap, unable to perform sexually with other people when the opportunity presents itself, a new study reports. Porn-addicted men are more likely to suffer from erectile dysfunction and are less likely to be satisfied with sexual intercourse, according to survey findings presented Friday at the American Urological Association’s annual meeting, in Boston.

“The rates of organic causes of erectile dysfunction in this age cohort are extremely low, so the increase in erectile dysfunction that we have seen over time for this group needs to be explained,” Christman said. “We believe that pornography use may be one piece to that puzzle”.

33) Sexual Dysfunction in the New Father: Sexual Intimacy Issues (2018) – This chapter from a new medical textbook entitled Paternal Postnatal Psychiatric Illnesses addresses porn’s impact on the sexual function of a new father, citing a paper co-authored by this website’s host, “Is Internet Pornography Causing Sexual Dysfunctions? A Review with Clinical Reports.” This page contains screenshots of relevant excerpts from the chapter.

34) Prevalence, Patterns and Self-Perceived Effects of Pornography Consumption in Polish University Students: A Cross-Sectional Study (2019) Large study (n = 6463) on male & female college students (median age 22) reports relatively high levels of porn addiction (15%), escalation of porn use (tolerance), withdrawal symptoms, and porn-related sexual & relationship problems. Relevant excerpts:

The most common self-perceived adverse​ effects of pornography use included: the need for longer stimulation (12.0%) and more sexual stimuli​ (17.6%) to reach orgasm, and a decrease in sexual satisfaction (24.5%)…

The present study also suggests that earlier exposure may be associated with potential desensitization to sexual stimuli as indicated by a need for longer stimulation and more sexual stimuli required to reach orgasm when consuming explicit material, and overall decrease in sexual satisfaction…

Various changes of pattern of pornography use occurring in the course of the exposure period were reported: switching to a novel genre of explicit material (46.0%), use of materials that do not​ match sexual orientation (60.9%) and need to use more extreme (violent) material (32.0%)…

35) Sexual and reproductive health and rights in Sweden 2017 (2019) – A 2017 survey by The Swedish Public Health Authority contains a section discussing their findings on pornography. relevant here, greater pornography use was related to poorer sexual health and decreased sexual dissatisfaction. Excerpts:

Forty-one percent of men aged 16 to 29 are frequent users of pornography, i.e. they consume pornography on a daily basis or almost on a daily basis. The corresponding percent among women is 3 percent. Our results also show an association between frequent pornography consumption and poorer sexual health, and an association with transactional sex, too high expectations of one’s sexual performance, and dissatisfaction with one’s sex life. Almost half of the population state that their pornography consumption does not affect their sex life, while a third do not know if it affects it or not. A small percentage of both women and men say their pornography use has a negative effect on their sex life. It was more common among men with higher education to regularly use pornography compared to men with lower education.

There is a need for more knowledge on the link between pornography consumption and health. An important preventive piece is to discuss the negative consequences of pornography with boys and young men, and school is a natural place to do this.

36) Internet Pornography: Addiction or Sexual Dysfunction? (2019) – Link to PDF of the chapter in Introduction to Psychosexual Medicine (2019) – White, Catherine. “Internet Pornography: Addiction or Sexual Dysfunction. Introduction to Psychosexual Medicine?” (2019)

37) Abstinence or Acceptance? A Case Series of Men’s Experiences With an Intervention Addressing Self-Perceived Problematic Pornography Use (2019) – The paper reports on six cases of men with porn addiction as they underwent a mindfulness-based intervention program (meditation, daily logs & weekly check-ins). All 6 subjects seemed to benefit from meditation. Relevant to this list of studies, 2 of 6 reported porn-induced ED. A few report escalation of use (habituation). One describes withdrawal symptoms. Excerpts from the cases reporting PIED:

Pedro (age 35):

Pedro self-reported as being a virgin. Pedro talked about the feelings of shame he experienced with his past attempts at sexual intimacy with women. His most recent potential sexual encounter ended when his fear and anxiety prevented him from getting an erection. He attributed his sexual dysfunction to pornography use…

Pedro reported a significant decrease in pornography viewing by the end of the study and an overall improvement in mood and mental health symptoms. Despite increasing the dosage of one of his anti-anxiety medications during the study due work stress, he said he would continue meditating because of the self-reported benefits of calmness, focus, and relaxation he experienced after each session.

Pablo (age 29):

Pablo felt he had little to no control over his pornography use. Pablo spent several hours each day ruminating on pornography, either while actively engaged in watching pornographic content or by thinking about watching pornography at the next possible opportunity when he was busy doing something else. Pablo went to a doctor with concerns about sexual dysfunctions he was experiencing, and though he disclosed concerns about his pornography use to his doctor, Pablo was instead referred to a male fertility specialist where he was given shots of testosterone. Pablo reported the testosterone intervention as having no benefit or usefulness to his sexual dysfunction, and the negative experience prevented him from reaching out for any further help with regards to his pornography use. The pre-study interview was the first time Pablo was able to converse openly with anybody regarding his pornography use…

39) Can time to ejaculation be affected by pornography? (2020) – Large study reporting a robust correlation between greater porn use and “delayed ejaculation” (difficulty orgasming with a partner). Excerpts  & table from the study:

42) 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. It was “Sexuality media and new forms of sexual pathology sample 125 young males, 19-25 years” Its Italian name is “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.

43) MedHelp article (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 –

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.”

Article about the latest spin campaign: Sexologists Deny Porn-induced ED by Claiming Masturbation Is the Problem (2016)

JIM PFAUS: “These types of advocates are wedded to the idea that porn is an uncontrolled stimulus the brain gets addicted to because of the dopamine release it causes. According to their thinking, anything that causes dopamine release is addictive“

RESPONSE: A false statement by Pfaus. Of course, I never said that “anything that causes dopamine release is addictive“. I’m guessing that Pfaus, of all researchers, realizes that sexual activity is a unique natural reward. Sexual activity induces the highest levels of nucleus accumbens dopamine naturally available. The same goes for endogenous opioids. In fact, Pfaus has published studies showing that sexual activity leads to conditioned place preference (CPP). CPP is used to assess the addictiveness of substances. Studies on rats have demonstrated that sex is a unique stimulus in that it activates the same reward system neurons as addictive drugs such as meth. By comparison, other natural rewards (food, water) may only overlap 10-20% with the sex/addictive drug neurons.

I suggest the following study, which compared the neurobiology of sexual activity with the neurobiology of sensitization to addictive drugs. (By the way sensitization is the core brain change involved in addiction, as proposed by the incentive motivation theory of addiction.) “Natural and Drug Rewards Act on Common Neural Plasticity Mechanisms with ΔFosB as a Key Mediator (2013)“. An excerpt from conclusion:

“Thus, natural and drug rewards not only converge on the same neural pathway, they converge on tphe same molecular mediators, and likely in the same neurons in the nucleus to influence the incentive salience and the “wanting” of both types of rewards.”

This means that addictive drugs and sex activity induce the same brain changes on the same neurons that lead to craving and wanting for IT, whether that IT is drugs or sex.

JIM PFAUS: “For instance, according to proponents of the sex addiction industry, the more porn someone watches, the more they’ll experience erectile dysfunction.”

RESPONSE: No so. It’s already established in studies on both internet porn addiction (1, 2, 3) and internet video-gaming addiction, that symptoms do not correlate with “hours of use.” Instead of just current hours of use, a combination of variables appear to correlate best with porn-induced ED. These may include:

1. Ratio of masturbation to porn versus masturbation without porn
2. Ratio of sexual activity with a person versus masturbation to porn
3. Gaps in partnered sex (where one relies only on porn)
4. Virgin or not
5. Total hours of use
6. Years of use
7. Age started using porn
8. Escalation to new genres
9. Development of porn-induced fetishes (from escalating to new genres of porn)
10. Level of novelty per session (i.e. compilation videos, multiple tabs)
11. Addiction-related brain changes or not
12. Presence of hypersexuality/porn addiction

The better way to research this phenomenon, is to remove the variable of internet porn use and observe the outcome. Such research reveals causation instead of correlations open to interpretation. My site has documented a few thousand men who removed porn and recovered from chronic sexual dysfunctions.

JIM PFAUS: “However, my recent study with Nicole Prause, a psychophysiologist and neuroscientist at UCLA, showed that’s absurd. While advocates of sex and porn addiction are quick to correlate the amount of porn a guy looks at to how desensitized his penis is, our study showed that watching immense amounts of porn made men more sensitive to less explicit stimuli. Simply put, men who regularly watched porn at home were more aroused while watching porn in the lab than the men in the control group. They were able to get erections quicker and had no trouble maintaining them, even when the porn being watched was “vanilla” (i.e., free of hardcore sex acts like bondage).”

RESPONSE: Prause & Pfaus did not support its claims: I provide the formal critique by Richard Isenberg, MD and a very extensive lay critique, followed by my comments and excerpts from Dr. Isenberg’s critique:

• In the same journal as the paper: Letter to the editor by Richard A. Isenberg MD (2015)
• Very extensive lay critique: Nothing Adds Up in Dubious Study: Youthful Subjects’ ED Left Unexplained (2015)

Prause & Pfaus 2015 wasn’t a study on men with ED. It wasn’t a study at all. Instead, Prause claimed to have gathered data from four of her earlier studies, none of which addressed erectile dysfunction. It’s disturbing that this paper by Nicole Prause and Jim Pfaus passed peer-review as the data in their paper did not match the data in the underlying four studies on which the paper claimed to be based. The discrepancies are not minor gaps, but gaping holes that cannot be plugged. In addition, the paper made several claims that were false or not supported by their data.

We begin with false claims made by both Nicole Prause and Jim Pfaus. Many journalists’ articles about this study claimed that porn use led to better erections, yet that’s not what the paper found. In recorded interviews, both Nicole Prause and Jim Pfaus falsely claimed that they had measured erections in the lab, and that the men who used porn had better erections. In the Jim Pfaus TV interview Pfaus states:

We looked at the correlation of their ability to get an erection in the lab.

We found a liner correlation with the amount of porn they viewed at home, and the latencies which for example they get an erection is faster.

In this radio interview Nicole Prause claimed that erections were measured in the lab. The exact quote from the show:

The more people watch erotica at home they have stronger erectile responses in the lab, not reduced.

Yet this paper did not assess erection quality in the lab or “speed of erections.” The paper only claimed to have asked guys to rate their “arousal” after briefly viewing porn (and it’s not clear from the underlying papers that this simple self-report was even asked of all subjects). In any case, an excerpt from the paper itself admitted that:

No physiological genital response data were included to support men’s self-reported experience”

In other words, no actual erections were tested or measured in the lab, which means that no such data or conclusions were peer-reviewed!

In a second unsupported claim, lead author Nicole Prause tweeted several times about the study, letting the world know that 280 subjects were involved, and that they had “no problems at home.” However, the four underlying studies contained only 234 male subjects, so “280” is way off.

A third unsupported claim: Dr. Isenberg’s Letter to the Editor (linked to above), which raised multiple substantive concerns highlighting the flaws in Prause & Pfaus , wondered how it could be possible for Prause & Pfaus to have compared different subjects’ arousal levels when three different types of sexual stimuli were used in the 4 underlying studies. Two studies used a 3-minute film, one study used a 20-second film, and one study used still images. It’s well established that films are far more arousing than photos, so no legitimate research team would group these subjects together to make claims about their responses. What’s shocking is that in their paper authors Prause and Pfaus unaccountably claim that all 4 studies used sexual films:

“The VSS presented in the studies were all films.”

This statement is false, as clearly revealed in Prause’s own underlying studies. This is the first reason why Prause and Pfaus cannot claim that their paper assessed “arousal.” You must use the same stimulus for each subject to compare all subjects.

A fourth unsupported claim: Dr. Isenberg also asked how Prause & Pfaus 2015 could compare different subjects’ arousal levels when only 1 of the 4 underlying studies used a 1 to 9 scale. One used a 0 to 7 scale, one used a 1 to 7 scale, and one study did not report sexual arousal ratings. Once again Prause and Pfaus inexplicably claim that:

“Men were asked to indicate their level of “sexual arousal” ranging from 1 “not at all” to 9 “extremely.”

This statement, too, is false, as the underlying papers show. This is the second reason why Prause and Pfaus cannot claim that their paper assessed “arousal” ratings in men. A study must use the same rating scale for each subject to compare the subjects’ results. In summary, all the Prause-generated headlines and claims about porn use improving erections or arousal, or anything else, are unsupported by her research.

Authors Prause and Pfaus also claimed they found no relationship between erectile functioning scores and the amount of porn viewed in the last month. As Dr. Isenberg pointed out:

Even more disturbing is the total omission of statistical findings for the erectile function outcome measure. No statistical results whatsoever are provided. Instead the authors ask the reader to simply believe their unsubstantiated statement that there was no association between hours of pornography viewed and erectile function. Given the authors’ conflicting assertion that erectile function with a partner may actually be improved by viewing pornography the absence of statistical analysis is most egregious.

As is customary when a letter critical of a study is published, the study’s authors were given a chance to respond. Prause’s pretentious response entitled “Red Herring: Hook, Line, and Stinker” not only evades Isenberg’s points (and Gabe Deem’s), it contains several new misrepresentations and several transparently false statements. In fact, Prause’s reply is little more than smoke, mirrors, groundless insults, and falsehoods. This extensive critique by Gabe Deem exposes the Prause and Pfaus response for what it is: A critique of the Prause & Pfaus response to Richard Isenberg’s letter.

Summary: The 2 core claims made by Klein/Kohut/Prause remain unsupported:

1. Prause & Pfaus failed to provide data for its core claim that porn use was not related to scores on an erection questionnaire (IIEF).
2. Prause & Pfaus failed to explain how its authors could reliably assess “arousal” when the 4 underlying studies used different stimuli (still images vs. films), and use no scale or very different number scales (1-7, 1-9, 0-7, no scale).

If Prause and Pfaus had answers to the above concerns, they would have put them in their response to Dr. Isenberg. They didn’t.

Finally, Jim Pfaus is on the editorial board of The Journal of Sexual Medicine and spends considerable effort attacking the concept of porn-induced sexual dysfunctions. Co-author Nicole Prause is obsessed with debunking PIED, having waged a 3-year war against this academic paper, while simultaneously harassing and libeling young men who have recovered from porn-induced sexual dysfunctions. See: Gabe Deem #1, Gabe Deem #2, Alexander Rhodes #1, Alexander Rhodes #2, Alexander Rhodes #3, Noah Church, Alexander Rhodes #4, Alexander Rhodes #5, Alexander Rhodes #6, Alexander Rhodes #7, Alexander Rhodes #8, Alexander Rhodes #9.

Again, to understand the effects of internet pornography, trust addiction neuroscientists and their peer-reviewed papers.

It must be noted that Prause (and occasionally Pfaus) engage in targeted harassment, defamation and cyber-stalking. See this page that was created to counter the ongoing harassment and false claims made by former UCLA researcher Nicole Prause as part of an ongoing “astroturf” campaign to persuade people that anyone who disagrees with her conclusions deserves to be reviled.

Comments under the Pfaus article:

by Charles Samenow, MD, MPH, editor of Sexual Addiction and Compulsivity: The Journal of Treatment and Prevention:

It’s a shame that you destroy any credibility by citing things that are factually inaccurate. As the editor of Sexual Addiction and Compulsivity (note the title includes a broad approach to this disorder… and we continue to publish articles based on differing models including hypersexuality, problematic sexual behaviors, etc…) I can safely say that #1) we use external reviewers all the time and 2) our low impact factor has largely been due to the fact that for years we received almost no submissions due to the dearth of research in the area leading us to a very low rejection and circulation rate. Impact factor is not just related to number of citations. Finally, David Delmonico who was instrumental in the journal previously, actually has stepped down from the associate editor position due to inactivity over several years. So your insinuations that he is self-promoting are not only incorrect but quite frankly unprofessional. Quite ironic that you as an author who bases his whole critique on following research/science (or lack thereof) did not do his due diligence in reaching out to me or others to check his facts first. Any one of us on the editorial board or in SASH are always willing to dialogue, share, and keep an open mind. Are you?

Written by Frederick Toates:

The following comments were written by a retired UK professor (Frederick Toates) who is the author of the recent book “How Sexual Desire Works: The Enigmatic Urge.” It is a comprehensive review of the relevant research in this field. These comments are posted with his permission:

Right at the outset, the author switches vocabulary from addiction, writing “…in fact, hypersexuality and porn obsessions are not addictions at all”. Of course, hypersexuality is not synonymous with addiction unless other criteria are also met but rephrasing addiction as obsession seems to me to be confusing. In a clinical context, obsession is a very different phenomenon from addiction, though sharing some features. I would invite anyone who feels that using ‘obsession’ in some way mitigates the impact to observe the bleeding hands of an OCD hand-washer and compare this with a kid told to put his smartphone away.

 We are told that the guy denied his porn shows no sign of physical addiction. But what other kind of addiction is there that he might or might not show? This suggests a Cartesian split between body and mind, which modern neuroscience rejects. If Jim Pfaus means signs outside the brain/mind, then neither do many cocaine addicts show this.

My reading of their books does not suggest to me that Wilson/Robinson do claim that “anything that causes dopamine release is addictive”. Dopamine is released all the time in all of us and I can’t believe that they are unaware of this. Surely their point is that under certain conditions dopamine release can be such as to increase incentive salience to the point of addiction.

Jim Pfaus writes: “But there’s a difference between compulsion and addiction. Addiction can’t be stopped without major consequence, including new brain activity. Compulsive behavior can be stopped; it’s just difficult to do so”. The experience of US soldiers being offered discharge from Vietnam was that a change of circumstances could quickly undermine even heroin addiction (Robins). Doubtless there was new brain activity accompanying their discharge but so is there in a compulsive checker or hand-washer who heals (see Jeff Schwartz, UCLA). It is true that withdrawal from alcohol can be extremely dangerous without medical supervision but that does not mean that from a psychological perspective alcohol addiction should be put in a class all of its own. The idea that compulsive behaviour is simply “difficult” to stop is something of an understatement to put it mildly.

Jim writes “Plenty of compulsive and ritualistic sexual behaviors aren’t addictions; they’re symptomatic of other issues”. But most if not all addictions can be symptomatic of other issues. See the brilliant work of Bruce Alexander and Gabor Mate on the triggering role of alienation and despair in drug addicts.

Take the extreme case of a young man who masturbates until he has damaged his penis and who seeks help. I find it hard to see how it would enlighten him to be told that he is compelled but not addicted.

Let me hasten to add that I am not writing from a religious perspective and neither do I stand to make a single cent from sexual addiction. I wrote what I thought was a balanced account of sexual addiction in a recent book and indeed it earned a very high praise from no less a dignitary than Jim Pfaus! (Please see link — http://www.amazon.com/How-Sexual-Desire-Works-Enigmatic/dp/1107688043/ref=sr_1_1?s=books&ie=UTF8&qid=1453918582&sr=1-1