Organic and psychogenic causes of sexual dysfunction in young men (2017)

COMMENTS: A 2017 “Narrative Review” on sexual dysfunction in young men which contains a section on porn-induced delayed ejaculation (reproduced below). Many porn users report that delayed ejaculation (difficulty climaxing during partnered sex) was a precursor to their erectile dysfunction. YBOP FAQ – Any suggestions for healing delayed ejaculation (DE) or anorgasmia?

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PDF OF THE FULL STUDY

Dick, B., A. Reddy, A. T. Gabrielson, and W. J. Hellstrom.

Int J Med Rev 4, no. 4 (2017): 102-111.

Link to abstract

Document Type: Narrative Review

DOI: 10.29252/ijmr-040404

Abstract

Sexual dysfunction, specifically erectile dysfunction (ED), premature ejaculation (PE), and delayed ejaculation (DE), are debilitating diseases, especially in young men. The past decade has seen an increase in the number of young men (under 40 years of age) presenting to their physician with sexual dysfunction. Traditionally, sexual dysfunction in young men was viewed as a strictly psychosomatic problem stemming from underlying psychogenic causes such as anxiety or insecurity. While this is true in some cases, the advent of new diagnostic tools and pharmacotherapy have revealed that the prevalence of organic causes for these diseases is much higher than previously thought. In reality, many patients present with primarily organic sexual dysfunction that then triggers concomitant psychogenic stressors such as anxiety and depression which exacerbate their problem. This review focuses on the common etiologies of sexual dysfunction experienced by young men in order to help educate clinicians so that they may better understand, identify, and serve this growing patient population.

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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

Keywords: Young Men; Erectile Dysfunction; Premature Ejaculation; Delayed Ejaculation; Etiologies