Can watching too much pornography possibly cause problems with men’s sexual performance, such as erectile dysfunction (ED)? Evidence increasingly suggests that this may be one of the side effects of men's fascination with porn, and it also may be turning into a more common problem of men's sexual health.
One survey of 28,000 Italian men found that "excessive consumption" of porn, starting at age 14, and daily consumption in their early to mid-20s, desensitized men to even the most violent images. According to the head of the Italian Society of Andrology and Sexual Medicine, this can cause male sexual dysfunction by lowering libido and eventually leading to an inability to get an erection.
“Due to the pornography available on the Internet, we are finding out that this type of sex dysfunction is a real entity,” said David B. Samadi, MD, chairman of the urology department and chief of robotic surgery at Lenox Hill Hospital in New York City. “It is a problem in the brain, not the penis."
To some extent, porn-related ED can affect anyone, but Dr. Samadi said he sees it mainly in younger men who are in their teens and early 20s.
Benchmark research from the Johns Hopkins Bloomberg School of Public Health in Baltimore found that about 18 million American men have ED, meaning they're unable to achieve or maintain an erection sufficient for sexual intercourse. The problem can be physical, relating to blocked blood flow to the penis; psychological; or a combination.
“Most of the time, chronic disease, such as heart disease or diabetes, contributes to erectile dysfunction, but in my particular practice, I will say 15 to 20 percent of the erectile dysfunction I see is related to porn consumption,” said Muhammed Mirza, MD, an internist based in Jersey City, N.J., and the founder of ErectileDoctor.com
Are You at Risk for Porn-Related ED?
It’s not necessarily how much porn a person watches. The type can also play a role, Samadi said. Unlike the soft-core porn images seen in such magazines as Playboy or Penthouse, online pornography is generally more graphic and often depicts kinky, deviant, or even violent behavior. It's also available 24/7.
Porn can lead to unrealistic expectations that increase a person’s tolerance for sex. Samadi likened the phenomenon to what occurs when someone consistently drinks more and more alcohol. Eventually, that person has a harder time feeling inebriated. The same happens with porn and sexual performance.
“You need more and more stimulation as you build up this tolerance, and then comes your reality with a wife or partner, and you may not be able to perform,” he said. Too much porn can desensitize a man to sex, and, eventually, he can be unable to get excited by ordinary sexual encounters, Samadi explained.
Chronic porn consumption can cause a shift in brain chemicals that may contribute to organic erectile dysfunction, said Dr. Mirza. “Your expectations become much higher than normal,” he said. "If you look at any porn video image, they are magnified. This is not what the normal anatomy looks like.”
Samadi agreed. “Many of the images seen in porn are unrealistic and magnified," he said. "No one can go on for hours.”
"'Reel' life is very different than real life," said Nicole Sachs, LCSW, a social worker in Rehoboth, Del., and the author of "The Meaning of Truth." The unrealistic imagery seen in some pornography can make men or women feel self-conscious, which could lead to problems with sexual function or intimacy, she said.
“What seems so easy when watching porn takes work in real life,” she said. “Sex in pornography or even with prostitutes is quick, easy, and impersonal,” she said. “Intimacy is hard and can be embarrassing.” Queuing up the porn may seem like the easy way out, but this can lead to a vicious cycle. “Impotence begets impotence, and interest in porn can grow from there,” she explained.
What Is the Treatment for Porn-Related ED?
Porn-related ED is not treated with drugs designed to help men achieve an erection, said Samadi. “Medications are not the treatment for this because the problem is not the penis, it’s the brain,” he said. “There is a mismatch between the brain and penis, so you may get the erection with these medications, but not the satisfaction.”
Samadi first takes a history to find out what may be responsible for the ED. “Shame and guilt may play a role if someone is watching lot of pornography, so I always talk to the individuals separately,” he said.
Treatment is similar to a 12-step recovery program, he said. It starts with a 4- to 6-week plan to desensitize certain receptors in the brain. Talk therapy also helps address some of the underlying issues. “We also encourage men spend more time with a partner," he said. "We try to have [partners] touch one another, reconnect, and slowly build the relationship back up.”
It’s not a simple fix, Sachs added. “Sex is half in your head and half in your body, and it takes work to treat the psychological component," she said. "There is no pill to treat these issues.”
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