Erectile dysfunction (ED) or impotence – the inability to achieve and maintain an erection – is a common issue for men and people with penises of all ages and sexualities. It's believed to affect a third of people at some point throughout their lives. But in recent years, doctors and therapists have seen a rise in patients and clients with ED. More young men are experiencing erection issues than ever, and experts believe this can be attributed to their relationship with pornography. This is known as porn-induced erectile dysfunction.
Porn-induced erectile dysfunction (PIED)
As PIED is a relatively new phenomenon, medical and psychological experts don’t know for sure whether the one is directly linked to the other, and further research is needed. But according to Daniel Sher, a clinical psychologist and a consultant for the Between Us Clinic, what they do know is 'the proportion of young men battling with PIED has increased exponentially in recent times.' Sher says porn is more easily accessible than ever before, due to the internet. And that advanced brain imaging technology has allowed researchers to hypothesise the process by which porn use can lead to erectile problems.
Watching porn can become a habit that is very difficult to break, and as Dr. Becky Spelman, psychologist and clinical director of Private Therapy Clinic , explains, because having an erection comes to be associated with watching porn, in some cases it becomes impossible to have an erection without it. 'Clearly, this can be a disastrous situation for anyone in a relationship, or anyone who hopes to be in one,' she says.
How common is porn-induced erectile dysfunction?
Recent research conducted by online doctor Zava found 35 per cent of men have experienced ED at some point, with 28 per cent of those aged 20 to 29. Among those who have experienced ED, one in 10 said they believed porn is the cause.
Butt says studies show that up to 40% of men under the age of 40 may experience porn related ED. The numbers of men experiencing ED has gone up drastically over the last 10 years, and the issue in younger men is thought to be porn related rather than health related.
Porn-induced erectile dysfunction causes
The dopamine hypothesis
Dopamine is the chemical in the brain that's responsible for feelings of pleasure and gratification. Sher explains, 'When we watch porn, this causes an explosion of dopamine activity, especially when combined with masturbation. Eventually, the brain gets “overloaded” with dopamine. Greater and greater levels of visual stimulation are needed in order to get the same kick.' And as a result, people tend to watch increasingly hardcore porn in order to achieve the same level of satisfaction.
The way the brain responds to porn is very similar to how it responds to drug addiction, and studies have found that some men then become addicted to porn and are only able to get hard or masturbate and climax whilst watching porn, explains Dr. Aysha Butt, medical director of FromMars. 'They can’t replicate the same with a partner and find that the libido reduces and they start experiencing ED when they are not watching porn. The brain develops a preference for instant gratification, for example, through watching porn, masturbating and climaxing as opposed to delay and reward such as two-person partner intercourse.'
Dr Earim Chaudry, medical director at Manual points to a Journal of the American Medical Association Psychiatry study that found men who engaged with porn found it more difficult to become aroused during actual body-to-body sex. 'The biggest reason for this was down to a higher threshold of sexual arousal required or the fact the porn provided a higher erotic stimulus compared to the "normal" sexual encounter,' Chaudry explains. This essentially numbing of sexual stimulus in real life is one of the forms of ED which has a psychological cause.
Physical and mental health problems caused by PIED
As well as difficulties achieving and maintaining an erection, experts say PIED can have many repercussions on a person's physical and mental health.
Low self-esteem and poor body image
Porn can also perpetuate false representations of body image and healthy sexual relationships, says Dr Simran Deo, an online doctor at Zava UK. This can 'even lead to low self-esteem in men, which again can impact on the ability to maintain an erection when with a partner.'
Chaudry adds, 'The average guy is very rarely depicted in porn, leaving many men feeling appearance-related pressure. What you do see in porn is men that have highly accentuated, stereotypically masculine body parts: the incredibly chiselled jawline, washboard abs and 10-inch penises. These bodies are very rarely found in nature, so most men will feel inadequate in comparison.'
He says that when men start to draw comparisons to these unrealistic expectations and bodies, they can begin to experience mental health issues such as depression and anxiety around body image.
A 2017 survey of 2,000 men and women by International Andrology found a direct correlation between excess porn watching and dissatisfaction with your penis size. 'This can be coupled with an unrealistic expectation of women’s bodies, and also of sexual acts and performance (e.g. multiple orgasms, lengthy sex etc),' Chaudry says.
Decreased sensitivity and sexual disassociation
Men suffering from PIED often have decreased sensitivity to real-life sex, he adds. 'And they can also become dissociated from sex as a physical experience to be shared with a partner.'
PIED and porn addiction
Porn addiction is a hotly debated topic among medical and psychological experts, with many believing there is no such thing as an addiction to porn.
Murray Blackett, psychosexual therapist, College of Sexual and Relationship Therapists (COSRT) specialist on mens' issues, says he struggles with the word addiction and that some therapists prefer the term 'compulsion'.
Cruz believes ED is not a sign of porn addiction unless it is included into a group of other behaviours and symptoms like the persistent need to watch porn, leaving their daily activities and responsibilities aside, and spoiling their relationships because of porn use. With addiction, 'the degree of despair will end up causing them to have more irresponsible sexual behaviours,' he adds. But he agrees with Blackett, saying researchers generally reject the notion of porn addiction.
Getting help for PIED
Remember, watching pornography in moderation can be a positive addition to your sex life. Chaudry says it's only when excessive consumption leads to unrealistic ideals of sex and erection difficulties that it becomes a problem.
See your doctor
Deo says it's worth visiting your doctor to make sure your symptoms are not occurring because of a serious underlying cause. Some medical conditions or medications can cause ED, or make it worse. ED can also be a symptom of other medical conditions such as high blood pressure or high cholesterol.
Stop watching porn
If all investigations come back as normal, it's advised you stop watching porn all together. Some studies have shown that all men with sexual dysfunctions returned to normality after eight months of porn exposure cessation.
'Try making it harder to access by removing material from your phone or computer, or keeping them out of the bedroom. I’d definitely recommend a period of going "cold turkey" on porn to see if things improve,' he says.
For anyone unable to stop using porn and looking to change any behavioural patterns that have become damaging, Spelman recommends seeking out therapy such as cognitive behavioural therapy (CBT). 'Some will find it easier to gradually wean themselves away from excessive porn, while others may find that a “cold turkey” approach works better for them,' she says.
Make lifestyle changes
Some people find they can improve their symptoms by making lifestyle changes like eating a balanced diet that’s high in fibre, stopping smoking and cutting down on alcohol (particularly before sex), says Deo.
'Regular exercise can also help improve the blood flow around your body, as well as help with self-confidence and maintaining a healthy weight. Aim for 30 minutes of exercise, five times a week,' he adds.
Talk to someone
Research by Zava shows that many men don’t talk about their concerns either with their partner, friends, or a medical professional, which could be making things worse. This is why counselling can help, especially if your ED is caused by stress, anxiety or another mental health condition.
A psychosexual therapist will help men experiencing these issues to begin to understand their own arousal, its effect on erections, how to keep their erection and how to worry less and enjoy more. Blackett says, 'The more the performance anxiety can be reduced, then more men can be attuned to their bodies, the more confident they can be in their bodies and the potential for more pleasurable sex exists.' He recommends reading The New Male Sexuality, by Bernie Zilbergeld, and cites it as the best resource for men struggling with PIED.
Deo says depending on the causes of ED, medications called PDE-5 inhibitors can work. The most well known of these are Viagra, Sildenafil or Cialis, but there are other options available. 'Medication isn’t suitable for everyone, so it’s worth speaking to your doctor about your particular circumstances first,' he says.
Last updated: 14-04-2020
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