Porn induced Erectile Dysfunction (PIED)

Porn induced erectile dysfunction is commonly referred to as the inability to get or maintain an erection during sexual activity because of a high exposure to pornography.

A debate exists about pornography’s availability and Erectile Dysfunction. Certainly, masturbation, with or without pornography, diminishes a man’s capacity to have sex for some period after reaching orgasm. This is called a refractory period. If a man through compulsive behavior masturbates frequently to pornography, it does not seem unreasonable that he might have difficulty having sex with a partner soon thereafter. Exhausting one’s sexual capacity and drive, with or without the stimulation visual images provides, will reduce a man’s desire to engage in the discourse needed to create the bond that could lead to sex.

Yet, that neither means that pornography was the cause of the diminished capacities described nor that the compulsive retreat to images of sexual activity falls into the category of an addiction. However, leaving aside the terms used to describe what some are calling an epidemic of porn related ED, what evidence is there that pornography is the cause of the ED being identified in ever younger men?

The reality is that some men note that their diminished capacity to engage in sexual activity with a partner is problematic, even while getting an erection and reaching orgasm with masturbation with pornography is unaffected. They can abstain for days and still are unable to engage in sex with a partner.

It would seem that there is a cause and effect. However, some researchers cast doubt that such a relationship exists. An Italian study published in 2013 by Capogrosso, et al., (J Sex Med. 2013 Jul;10(7):1833-41) noted that of 439 men who presented with erectile dysfunction, 114 (26%) were under 40 (mean age 32). Worse, nearly half of them had severe ED. What is fascinating is that what distinguished these men from older individuals were lifestyle issues known to affect erections: smoking, illicit drug use, and alcohol consumption. The young men were less likely to have other illnesses, to have leaner body masses, and to have higher testosterone levels but the weight placed on them by poor lifestyle choices may be the reason for their ED, not the use of pornography.

Indeed, in a Swiss study (J Adolesc Health. 2012 Jul;51(1):25-31), approximately 30% of young men experienced erectile Dysfunction (ED). They noted that “ED was directly linked with medication without a prescription, length of sexual life, and physical health.” They concluded, “Multiple health-compromising factors are associated with these dysfunctions (ED and PE–Premature Ejaculation). These should act as red flags for health professionals to encourage them to take any opportunity to talk about sexuality with their young male patients.”

In the 90’s, the release of Viagra gave men the opportunity to identify their problem, to seek medical care, and to be counted. It may be that the higher than expected rates of ED in young men is not a result of the increased availability of pornography but in the increased inclusion of those who would have suffered silently were a treatment not available.

Men may resort to pornography because the immediate availability of stimulation allows access when the capacity to achieve an erection and reach orgasm is best for them. The ability to provide self-stimulation that is immediately responsive to what the individual finds pleasurable, with precisely modulated degrees of pressure and positioning, may make reaching orgasm easier than with a partner. A partner might not be able to provide such a fine application of pleasurable sexual stimulation. Masturbation can be healthy and normal but if it is a means of avoiding contact with women it may reveal issues to be resolved in how someone sees the role of another person in a relationship.

Some men may have the issues of compulsive/impulsive behavior. Others may be isolated and use masturbation with pornography as a compensation for loneliness, or as a means to manage stress. The reasons run from positive and affirming to unhealthy and psychologically damaging.

For many people (men and women), masturbation is an exploration of the breadth of human sexuality that can be a very enriching process. The key is that it never become a substitute for the intimacy that can be so important a means of bonding, nor so consuming that it interferes with the normal activities that make us fully-integrated, societal beings.

Pornography may be a mere tool for men and women and, as with any tool, it can be misused. For those who experience ED and who also masturbate with compulsion to pornography, the spectrum of psychological and physical reasons are all worthy of evaluation.