What about "sexual exhaustion" as a cause of PIED?

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UPDATE: Peer-reviewed paper by US Navy doctors - Is Internet Pornography Causing Sexual Dysfunctions? A Review with Clinical Reports (2016) - It’s an extensive review of the literature on porn-induced sexual problems. The review provides the latest data revealing a tremendous rise in youthful sexual problems. The paper also examines the neurological studies related to porn addiction and sexual conditioning. The doctors provide 3 clinical reports of men who developed porn-induced sexual dysfunctions.


The concept of "sexual exhaustion" comes from Traditional Chinese Medicine and the Ayurvedic tradition. Even where those traditions have validity, things can turn sour when their practitioners start to justify their traditions in terms of Western science. For example, the explanation offered here via a site member sounds sciency, but a lot of it is conjecture without scientific basis, or simply wrong (that is, not supported by Western-style research). Many of the biochemical pathways described in it do not occur. The author mixes factual physiology with manufactured physiology.

A more accurate version of how erections are controlled is here: Review. Central control of penile erection: A re-visitation of the role of oxytocin and its interaction with dopamine and glutamic acid in male rats (2011), or view a more simplified explanation, with diagrams, here.

Meanwhile, here are a few of the inaccuracies in the explanation the site visitor linked to:

The hypothalamus releases the neurohormone dopamine which results in sexual arousal.

The dopamine nerve cells of the reward circuit (nucleus accumbens) send impulses into the hypothalamus, which in turn activates oxytocin-producing neurons which, in turn, activate nerves in the spinal cord, which in turn activate nerves traveling to the penis. So it is the reward circuit dopamine that controls most types of erections.

When you feel sexually aroused, the brain releases the neurotransmitter acetylcholine into the bloodstream in the sex organs

False. The actual pathway is described above. Acetylcholine is released from parasympathetic nerve endings connecting to penile tissues, not into the blood. Although acetylcholine is involved, the primary neurotransmitter for the penile erections is NO (nitric oxide), which is released from a unique group of "non-adrenergic, non-cholinergic (NANC)" nerves.

Excessive sexual activity and over-ejaculation lead to overproduction of androgen hormones,

False. All reports from men who have had blood tests, and all experimental evidence, prove this to be false.

Since dopamine is the precursor to the stress hormone epinephrine (adrenaline), excess dopamine results in the adrenal glands overproducing epinephrine and putting the body in a prolonged state of fight-or-flight stress.

Half right, but all wrong. Dopamine may be a precursor to norepinephrine, but the dopamine produced in the reward circuit stays in the reward circuit and does not travel to the adrenals.

At the same time, norepinephrine is synthesized from dopamine and released from the adrenal medulla into the blood as a hormone, along with the stress hormone cortisol.

False, brain dopamine stays in the brain, and is not sent to the adrenals. Also, cortisol is not controlled by dopamine in the blood; it is controlled by ACTH released into the blood, which in turn is controlled by brain CRF.

Yes, dopamine is one likely factor involved with porn-induced ED - but it's not too much, it's too little. It's called desensitization and described here. The problem is an addiction process, not a matter of "sexual exhaustion."

What he's trying to describe is adrenal exhaustion. This can happen, but not via the biochemical pathways he describes. The symptoms of true adrenal exhaustion (low cortisol, a stress hormone) are many and varied, with ED being way down on the list. Incidentally, most MD's do not recognize 'adrenal exhaustion,' but low levels of other hormones show up in patients, so it's likely low stress hormones are also possible. Here's a good list of the types of symptoms that may be related to low stress hormones: http://www.stopthethyroidmadness.com/adrenal-info/symptoms-low-cortisol/

Semen leakage article

This article is basically a knock-off of the main thesis of the Herballove article discussed above. As explained, in terms of Western medicine, much of the article is simply incorrect. Other parts are not known, such as what happens to the spinal nerves that go to the penis. None of the claims are backed up by any research studies.

Here are my comments on aspects of the semen leakage article:

Semen leakage is a sign of sexual exhaustion.

Western medicine doesn't recognize 'sexual exhaustion.' The term sexual exhaustion is used for a temporary state observed in many mammalian species, and extensively studied in rats. See: Men: Does Frequent Ejaculation Cause A Hangover?

Semen leakage is caused due to weakening of parasympathetic nerve. Parasympathetic nerves are responsible for keeping the ejaculation valve shut and holding the erection. It is difficult to hold the erection with weak nerves and hence the problem of semen leakage arises.

No evidence either way for this claim.

Masturbation, if practiced regularly, stimulates the acetylcholine/parasympathetic nervous functions.

So what? Nerves don't wear out. What about the parasympathetic nerves that release acetylcholine onto the heart, continuously, from months before your birth until the moment of your death?

Stimulation when taken to a greater level can cause over production of sex hormones and neuro-transmitters like acetylcholine, dopamine and serotonin. A larger secretion of these hormones and neurotransmitters, causes the brain and adrenal glands to perform excessive dopamine-norepinephrine-epinephrine conversion.

Complete nonsense. No evidence whatsoever for the overproduction of sex hormones due to masturbation or sex. The 3 neurotransmitters listed do NOT leave the brain and enter circulation, so they cannot directly affect the adrenal glands, although their imbalance may indirectly do so. There is no "excess conversion of dopamine to norepinephrine." All this is fabricated information, and cannot occur in the manner described.

So where are we? Maybe something does happen to the parasympathetic nerves, but the nerves responsible for erections are far more than just parasympathetic. Maybe the problem and its resolution still come down to a decline in dopamine signalling in the brain, which affects the tone of the nerves innervating the penis.

This study from a few months ago confirmed that "psychogenic ED" arises from loss of gray matter in the reward center and hypothalamus. Macrostructural alterations of subcortical grey matter in psychogenic erectile dysfunction (2012) This correlates with the low-dopamine hypothesis. This is exactly what I theorized in my Porn & ED video from 2 years ago. Not blowing my own horn on this - it's just simple logic that the brains erection centers would have to be altered to explain chronic ED in otherwise healthy young men.

There's lots still to learn about male sexuality. Meanwhile, see this FAQ and the 3 major links - Any connection between orgasm, masturbation, and testosterone levels?


A few reasons porn-induced sexual dysfunctions are not due to sexual exhaustion:

1) Medicine doesn't recognize sexual exhaustion. There are no known physiological correlates for it. This isn't reason enough to pooh-pooh it, but there's no science to back the concept.

2) Young guys recover much slower than old guys in their 50s. This alone disproves it.

3) Many young guys who have recovered from PIED masturbate at low frequencies. Once a day or less. (PS - what is too much masturbation??)

4) There are a few reports of PIED by guys who only ejaculated once a week (bodybuilding sites). Others recovered from PIED - but went back to ONLY porn - and again developed ED.

5) Almost every guy with PIED who had blood tests had no abnormalities.

6) Why wouldn't sexual exhaustion occur with men who have a lot of sex, or don't use porn to masturbate? In other words, where are the young healthy guys who have unexplained ED who DID NOT USE PORN?

7) If it's sexual exhaustion, why has no one healed from it while still using porn?

Why does this matter?

You may be thinking, "Why does it matter whether the cause is sexual exhaustion or addiction-related brain changes?"

Here's why: Many guys with porn-induced sexual dysfunction may wrongly believe that they can continue viewing porn, or edging to porn without ejaculating and still recover, because they believe "excess ejaculation" is the cause of their sexual problems. For many, this will not work because it is the extreme novelty of Internet porn which is overstimulating their brains, and causing dopamine dysregulation (an addiction process).

Hundreds of websites link to YBOP, so I have seen many guys who simply cut out ejaculation to treat their "sexual exhaustion." It didn't work for them when cutting out porn did. This suggests the problem is in their brains not their penises, and that their brains need a rest.

What's more important is the millions of young men who have yet to develop problems or have yet to use internet porn. If we accept the sexual exhaustion model of ED/DE, then the next logical step is  to believe that internet porn causes no problems. That is the current meme and we know it is false. Not only does it cause ED & delayed ejaculation, it also can cause morphing sexual tastes, loss of attraction to real partners, and for a few others increased social anxiety, brain fog, low motivation, etc.

Accepting "over masturbation" as the cause of PIED is not neutral - it completely eliminates Internet porn as a cause of any of the many problems its use generates - including sexually conditioning an entire generation.

A comment from this thread on yourbrainrebalnced, discussing "sexual exhaustion":

This guy Gibson is so full of it, for anyone who's on the fence with this. I'm twenty six, I masturbated (without porn) twice a day nearly every day through high school, started getting laid and dating in college, STILL masturbated on top of that, dated women where we would smash 3 or more times a day, every day. I have ejaculated buckets, had tons of sex, had tons of self sex and I was always rock hard even on round 3 or 4. At twenty four I took some 8 months of alone time started getting into porn tube sites a little before, became kind of reclusive and over the 8 months escalated into a full blown multiple tab, multiple times a day habit.  Bam! next girl I date I have horrid Ed, spend the next year trying anything to fix it, only thing that helped my erections? Quitting porn.

For anyone who thinks sexual exhaustion is the cause of your ED, I am walking proof, when the brain is properly balanced, and there's a girl in front of you naked, it'll find a way to give you an erection even if you shoot dust when you cum. I know, I've seen the other side. Porn novelty has broken the brain in a way that masturbation and sex just can't.

To further make my point, I'd note that my it's only been about two weeks since O. I have been masturbating and having sex throughout my reboot with zero tolerance for looking at porn, and while its been slow going my erections, and sensitivity have improved dramatically where supplements, diet, doctors and other life style changes have failed.

The problem is porn. Sexual exhaustion is a lie designed to sell you worthless supplements that cost a fraction at the drug store than what SE websites try to sell them to you for.

So, seriously, Gibson, how dare you try and capitalize on the misery of these broken desperate people?

You claim you're trying to help, but the fact is that when our response is 'no that's not the problem I have, it's more like this.' You just ignore it, and relink to some shitty site where they make up 'science' and then sell you over priced vitamins.


Im starting to believe that what you are saying is that excessive masturbation has no consequences at all. Couldn't excessive masturbation be an addiction too? Or be so harmful as PMO?

I am saying that masturbation is not the cause of what guys report as porn-induced ED. I am saying that if one believes that ejaculation causes chronic ED in healthy young men, then you must also believe that sex causes chronic ED in healthy young men. I've never seen any evidence of sex causing chronic ED.

When I say chronic ED, I am talking about the type that takes months to regained normal functioning. 

I am also saying that the physiology presented by websites such as Herbalove or others is fabricated nonsense. It's not only not proved, most of it goes against accepted mechanisms.

Masturbation has effects that can last for days and week, and I suspect that overriding normal satiation mechanism could have effects. Have you read this - Men: Does Frequent Ejaculation Cause A Hangover?

Couldn't excessive masturbation be an addiction too?

Yes it could.

Or be so harmful as PMO?

It certainly could be harmful. However, it wouldn't wire sexual response to all the properties that porn exhibits, such as novelty, fetishes, searching, seeking, etc. That's one difference.