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An Erectile Dysfunction Myth

Pornography is not the problem.

According to many popular dialogues online and in the media today, watching too much pornography can cause erectile dysfunction. In response to my writing, I regularly receive criticism from folks who believe that porn addiction has affected the quality of their sex lives and the ability to get erections.

Below are a few examples of such comments, edited for length and profanity. Please note that I did not “cherry-pick” these comments. Instead, I merely chose the three most recent ED-related comments received :

  • "Porn is one of the most addicting drugs out there. they cause so many problems in ones life including ED. so shut the f*** up and sit the f***down, your a f****** fraud. stop trying to get attention, gary wilson is better than u will ever be. are you mad that you didn't discover this and your trying to cover it up? f*** yourself. just look at all the porn addiction websites u f****** fraud."
  • "A number of guys, including myself, have said in other forums that we started masturbated with limp d*** to porn. Porn was strong enough to arouse me mentally that I could orgasm with a 30-50% erect penis. I masturbated like this for at least a year or more…Work wise, I am a neuroscience graduate student at UCSF. A little more background, I attempted to sleep with 9 or 10 women in 2012 and dated 4 of them for 2 months or longer and was never able to get erect or sustain erections. I also smoke probably once a week (socially)and drink 2 times a week (never hard), but never have been addicted to anything…"
  • "It's mind boggling that people still question whether or not there is such thing as porn addiction. …To the author, I challenge you to explain the RAPIDLY growing number of teenagers and 20 something's males with erectile dysfunction. There is a DIRECT CONNECTION to the availability of high speed internet porn, and over stimulation of their brains to why they can't perform with real women. The writing is on the wall. I don't need to read that in a scientific journal to take it as fact. I have lived it and known MANY others in the same boat.It doesn't really matter if you believe it's real or not because there are enough men coming out about their issues with porn that to deny it is madness, and soon enough the medical industry is going to have to address it…Sites like yourbrainonporn,nofap and yourbrainrebalanced don't exist for s***s and giggles. These are men who are brave enough to take the first step in admitting they have a problem."

There is scientific value to anecdotes, as such claims can often give rise to scientific theories and hypotheses, and guide future research. An apple falling on Newton’s head is a good example of an anecdote that drove the development of a testable theory. It is reasonable to examine whether there is medical or scientific evidence that might support the above anecdotes and to encourage future research.

A review of Pubmed, the largest online database of medical literature, reveals that there is not a single published study linking pornography and erectile dysfunction. A search for the terms “erectile dysfunction pornography” yields 52 publications. Of these, the bulk are studies that use pornography, or “visual sexual stimuli” (VSS) to test erectile dysfunction. In fact, urologists and researchers have found that pornography viewing is an effective, noninvasive and reliable test for psychogenic erectile dysfunction. One fascinating study identified that the brain activities of men watching pornography are not significantly different in men with and without erectile dysfunction.

Two compelling recent studies discuss high rates of erectile dysfunction, among young men. A 2013 study by Capogrosso, et al., found that 25% of men seeking treatment for first-onset ED were under age 40, and characterized these high rates as “worrisome.” A 2012 study by Mialon, et al., identified that 30% of young Swiss men reported a history of erectile dysfunction (though the majority of these reports were classified as “mild” ED). This study is remarkable, in that it represents a valid snapshot of the population of all young Swiss men, given that the research involved over 9,000 men, reporting for nationally-required universal medical screening to determine military capacity.

Both of these studies identify that there is very little existing research that examines the rates of erectile dysfunction in young men. Historically, this has been studied and treated predominantly in older men. However, society has undergone a dramatic shift in the past years, as medications for erectile dysfunction have become more widely available. Since 1999, when Bob Dole appeared in commercials for Viagra, there appears to have been a decrease in the stigma associated with disclosing erectile dysfunctions. The high numbers of disclosure of erectile dysfunction in young men may reflect this change, and not an increase in the rates actually experienced.

On what do Miallon and Capogrosso blame these high rates of erectile dysfunction in young men? The answer is not pornography. In fact, pornography use doesn’t come up in either of these studies, nor in any of the reports of these young men. Mialon, et al., found that young men’s erectile dysfunction was linked to use of medication without a prescription, to a low level of sexual experience, and to both mental and physical health. Tobacco use, alcohol use, and drug use were also significant predictors. Capogrosso, et al, found similar results, where young men presenting for treatment of ED reported much higher rates of cigarette smoking and alcohol use when compared to their older counterparts.

It is frankly surprising to many of us that one-quarter to one-third of young men may experience erectile dysfunction. But I think that the surprise about these rates is likely tied to the fact that throughout history, this wasn’t something that was researched, or disclosed by young men. Any report of ED in young men is surprising, because we have long believed that this just doesn’t happen to young men.

When men, whether old or young, report erectile dysfunction, I think it is an opportunity rather than a tragedy. In my clinical practice, I invite such men to explore the idea that one’s genitalia plays only a small role in sexual activity. Failing to get an erection may direct men to attend to other aspects of the interaction, and may also sometimes be a cue to attend to psychological or relational issues; Herb Goldberg, Ph.D., called this “The Wisdom of the Penis.” I sympathize with the fear and anger expressed by the men in the above comments, who are struggling with something they don't understand and can't control. But I’m saddened by the degree to which this vibrant dialogue has accepted that a man’s sexual value is determined solely by the hardness of his erection.

A similar problem has occurred when women are accused of becoming "addicted" to vibrators, with the fear that using them inhibited a woman's ability to have orgasms during so-called "normal" sex. Like the arguments about male porn use and erectile dysfunction, this argument is tainted by gender bias and a lack of understanding of sexuality.

These perspectives remind me of other documents also available on the Pubmed site, treatises from the 1800s on the dangers of masturbation and “self-pollution.” These arguments were introduced to medicine in the 1700s by Samuel Tissot, but also occur in many religious and spiritual traditions, such as Eastern religions that discuss "Chi" and the tantric offshoot called Karezza. All of these theories are based on the nonscientific concept that orgasm or ejaculation somehow deplete a person's energy, just like athletic coaches commonly tell athletes to refrain from sex prior to competition.

I’m glad the reddit no-fap site, and the yourbrainonporn sites are inviting and encouraging young men to share their stories and discuss sexuality, and they may be helping these young men to educate themselves. Those are all good things, though I worry that these sites are great examples of the dangerous power of social psychology. Peer pressure, conformity theory, expectancy theory, and sample bias can all lead to the impression that these anecdotes are more representative than they truly are.

The porn use reported by these individuals is not "a single variable" but involves masturbation and significant time on the Internet, affecting their daily schedule, physical health, relationships, etc. Any or all of these variables may also affect erectile function and are not discussed in a simplistic "blame-porn" approach.

As a clinician, I’m ethically concerned when groups actively recommend things that are not supported by science or clinical practice. At this point, there’s no scientific evidence to suggest that the ED reported by these young men cannot be explained by known causes. To ethically assert otherwise would require research or studies that weeded through individuals making these reports, and used good methodology and thorough assessments that ruled out the above causes, to identify if there is truly a group of men with ED that cannot be explained by factors other than porn use. But, at this time, it appears most clinically and scientifically appropriate to work under the assumption that porn use and erectile dysfunction are not causally linked.

UPDATE (3-27-15): Two recent studies have been published by researchers who examined whether there truly is a potential epidemic of porn-related erectile dysfunction. Prause and Pfaus published this study in Sexual Medicine, finding that porn use did not predict sexual dysfunction, but instead, predicted higher levels of sexual responsiveness.

Landripet and Stulhofer studied European men from Croatia, Norway, and Portugal, and they found that there was no reliable connection between porn use and sexual dysfunction. Indeed, there was no statistical relationship between men who use higher rates of pornography and reports of sexual dysfunction. There were inconsistent but weak associations with moderate use of pornography. However, such inconsistent associations most likely suggest that porn use may only be related to sexual dysfunction as an indirect variable. In other words, porn use is not a valuable marker to use or address, and rates of sexual dysfunction in young men are still best explained by the issues described above.

These two studies actually address the frequent complaints by those who cry out that there's no evidence that porn causes ED simply because there's been no study of erectile dysfunction, which considers the high levels of Internet porn use among young men today. Now, there are two studies, both conducted independently, by respected researchers. And neither find any evidence to support this myth. Alas, I'm sure that rather than accept these findings, true believers will find ways to discount this evidence, and remain committed to the belief that porn "broke their penises."

You can follow David Ley on Twitter, @DrDavidLey.

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