Threads relating to this issue are springing up all over the Web on bodybuilding, medical help, and pick-up artist forums, in at least twenty countries. Notice from one such forum:

Due to the overwhelming emails and requests we have received concerning pornography addiction and erectile dysfunction, we decided to create an entirely different thread. ED due to porn is becoming rapidly common, especially for young men.

Desperate young men from various cultures, with different levels of education, religiosity, attitudes, values, diets, marijuana use, and personalities are seeking help. They have only two things in common: heavy use of today's Internet porn and increasing need for more extreme material.

Many have previously been to doctors, undergone various tests, and been declared "just fine" physically. Neither they nor their health care providers considered excessive porn use as a potential cause of their continued performance problems. Most were assured that "masturbation cannot cause erectile dysfunction." (Probably true, but unfortunately Internet porn use can.) The final diagnosis was generally "performance anxiety." Desperate, many also looked online. See this 900-post thread and this 300-post one.

Is anxiety really the cause? Here's a simple test: Try to masturbate (alone) using no porn and no fantasy—only sensual touch. Use the same speed and pressure as you would during intercourse. How erect is your penis without porn? If your penis is not fully erect, or it takes effort to become erect, then the chances are that anxiety is not the source of your problems. Persistent performance problems can certainly lead to anxiety, however. As one man said after he recovered following three months without masturbation or porn,

It's hard to tell where addiction ends and anxiety begins. I think a combination of the two is involved in a lot of situations.

Not long ago, Italian urologists confirmed an erectile dysfunction-porn use connection via a large survey. When interviewed about the survey, urologist Carlo Foresta (head of the Italian Society of Andrology and Sexual Medicine and professor at the University of Padua) mentioned that 70 percent of the young men his clinic treated for sexual performance problems had been using Internet pornography heavily.

For them, recovery appears to take 6-12 weeks, and rests primarily on one factor: avoiding the extreme stimulation of Internet erotica. (Many also avoid masturbation for a time, either because at first they cannot masturbate without porn fantasy, or because climax triggers binging.)

Among those who recover, progression is surprisingly similar. Men typically report that after a few days of intense sexual cravings, their libido plummets and their penis seems "lifeless," "shrunken," or "cold." These "flatline" symptoms typically continue for up to six weeks on average, dependent upon age and intensity of porn use.

Gradually, morning erections return, followed by libido and, perhaps, occasional spontaneous erections. Finally, there is complete recovery of erectile health, sexual desire for real partners, sex becomes extremely pleasurable, and condom use is no longer problematic.

• I am a 25-year old male, masturbating a lot from 13 and using porn from 14. Gradually, it took more to turn me on: bigger fantasies or harder porn, and I stopped getting hard without touching. During sex I would struggle to get an erection or keep it, especially for intercourse. Over the past 7 years I haven't held down a relationship, and the main reason for me has been this problem. Now the good news: When I realized the cause, I immediately gave up porn. Over the last 6 weeks I held off masturbating as much as I possibly could. (My best record was 9 days!) It all paid off. I just went away with a girl for the weekend and it was the best ever. I don't think I'm out of the woods yet. I still get pretty anxious from all the bad experiences over the years. But I just wanted to tell you all it can work, and it's well worth it!
• Week 12, age 36 - I'm actually totally impressed how HUGE I get. It has been kinda hard to ignore. I mean, my erections are ROCK HARD and ENORMOUS. I remember asking other guys who went before me about when they noticed the return of their full erections. Well, I think I got mine back.

How can porn cause sexual performance trouble?

The cause appears to be physiological, not psychological, given that such diverse men change only one variable (porn use), yet report a similar recovery pattern. For these men, anxiety is secondary.

Recent behavioral addiction research suggests that the loss of libido and performance occur because heavy users are numbing their brain's normal response to pleasure. Years of overriding the natural limits of libido with intense stimulation desensitize the user's response to a neurochemical called dopamine.

Dopamine is behind motivation, "wanting" and all addictions. It drives the search for rewards. We get little spurts of it every time we bump into anything potentially rewarding, novel, surprising, or even anxiety-producing.

Animal models have established that both sexual desire and erections arise from dopamine signals. Normally, dopamine-producing nerve cells in the reward circuitry activate the sexual (libido) centers of the hypothalamus, which in turn activate the erection centers in the spinal cord, which send nerve impulses to the genitalia. A steady stream of nerve impulses, which release nitric oxide into the penis and its blood vessels, maintain an erection.

Nitric oxide in turn stimulates the blood vessel dilator cGMP, the on/off switch for engorgement and erection. The more cGMP is available the more durable the erection. So, the pathway from the brain to an erection is:

Reward circuitry (dopamine) > hypothalamus > spinal cord > nerves > penis

Erections start with dopamine and end with cGMP. Sexual enhancement drugs work by inhibiting the breakdown of cGMP, thus allowing it to accumulate in the penis. Yet if the patient's brain isn't producing enough signals in the first place, ED drugs will not increase libido or pleasure even if they (sometimes) produce an erection.

My ED is definitely porn-related because even erection pills do little but sometimes help enough to penetrate or get an erection. But, NEVER is the feeling good...because I still don't feel anything. I've lost most, if not all my sensitivity.

In the case of age-related erectile dysfunction, cardiovascular conditions or diabetes, the primary weak link tends to be the nerves, blood vessels, and penis. However, for men with porn-induced erectile dysfunction, the weak link is not the penis, but rather the desensitized dopamine system in the brain.

The relevance of recent addiction brain science