Debunking “Should you be worried about porn-induced erectile dysfunction?” – by The Daily Dot’s Claire Downs. (2018)

Introduction

Here we have yet another propaganda piece, this one attempting to deny the existence of widespread porn-induced sexual problems. This one is by The Daily Dot’s Claire Downs whose expertise is described asA third-generation worker in the Chicago futures industry, she specializes in cryptocurrencies and altcoins.” Interestingly, none of the recent hit pieces attempting to debunk porn-induced ED are by science journalists, let alone academics or health professionals.

Like other such articles, Downs cites the same two studies (which did not, in fact, find what Downs asserts they did) while ignoring the preponderance of empirical and clinical evidence in the field.

Before I address specific sections of The Daily Dot article, here are studies that Claire Downs chose to neglect. (I say ‘chose’ because most of the following studies were cited in this 2016 review of literature, which Downs mentioned in her piece, yet disregarded because she wished to disparage one of its 8 authors):

In her intro Downs claims that “we spoke to doctors and sexual health experts about this research“, but the article only quotes two so-called experts. Neither is a heath professional who sees males suffering from sexual problems:

  1. Dr. Nicole Prause, a non-academic who’s extensive history of actively campaigning against porn-induced ED and porn addiction is well documented.
  2. Dr. Heather Berg, who is described as a teacher of gender studies at USC working on a book about the adult film industry.” The book? “Porn Work: Adult Film at the Point of Production, investigates porn performance, precarity, and worker organizing

The article relies on two porn-friendly PhD’s, without a medical professional in sight, let alone an actual urologist. Perhaps Claire Downs should have perused this page containing articles and videos by over 110 experts (urology professors, urologists, psychiatrists, psychologists, sexologists, MDs) who acknowledge and have successfully treated porn-induced ED and porn-induced loss of sexual desire.

The rest of this response will consist of excerpts from the Claire Downs article followed by YBOP comments.

Tries to debunk urology professor Carlo Foresta, but mixes up two completely separate studies

In a failed attempt to “debunk” the Foresta findings, Downs cites a 2015 Foresta study, yet all her excerpts come from a 2011 Foresta press release that has nothing to do with the 2015 study. Sloppy.

CLAIRE DOWNS: Believers in the “epidemic” of PIED often cite one 2015 study from the International Journal of Adolescent Medicine and Health. It surveyed 28,000 Italian men about pornography and masturbation tendencies. The study concluded that boys—first exposed to porn around age 14 on average—experienced a drop in libido and a decreased interest in IRL sexual partners later in life.

Here’s the catch, though: It didn’t. This conclusion is how websites like the Blaze reported the study. Participants’ libido levels were never actually measured—the “study” was simply an opinion survey.

When Downs said “Believers in the “epidemic” of PIED often cite one 2015 study,” she linked to this study: Adolescents and web porn: a new era of sexuality (2015). This Foresta study analyzed the effects of internet porn on high school seniors (age 18). Incidentally, Dr. Foresta is the President (or past President) of the Italian Society of Reproductive Pathophysiology. His team’s most interesting finding is that 16% of those who consume porn more than once a week report abnormally low sexual desire, compared with 0% in non-consumers (and 6% for those who consume less than once a week).

However, the second link (“websites like the Blaze reported the study”) and all her excerpts refer only to a 2011 press release from the Italian Society of Andrology and Sexual Medicine (SIAMS). See Too Much Internet Porn May Cause Impotence, urology professor Carlo Foresta (2011) for several more articles covering that SIAMS press release.

This 2014 PDF of a Foresta lecture, contains more observations and statistics, including a dramatic rise in the percentage of teens reporting sexual problems and loss of libido. Foresta also mentions his upcoming study, “Sexuality media and new forms of sexual pathology sample 125 young males, 19-25 years.” Italian name: “Sessualità mediatica e nuove forme di patologia sessuale Campione 125 giovani maschi”

Because of her amateurish error, everything Downs says about “the 2015 study” is incorrect. This is just one of several glaring inaccuracies and omissions made by Claire Downs.

Downs employs ad hominem and false statements to blow off a peer-reviewed paper involving 7 US Navy medical doctors

In the next paragraph Downs resorts of to false statements and ad hominem:

CLAIRE DOWNS: Another paper, “Is Internet Pornography Causing Sexual Dysfunction?” was cited in this Herald article warning about a generation who grew up on porn. Upon further investigation, one of the authors of that paper was Gary Wilson, the founder of YourBrainOnPorn.com, which leads political and religious campaigns against pornography.

For some strange reason Downs forgot to mention that the paper’s other authors are seven US Navy medical doctors, including 2 urologists, 2 psychiatrists, and an MD with a PhD in neuroscience from John Hopkins. Oops.

Downs also omitted the fact that our review of the literature provides recent data revealing a tremendous rise in youthful sexual problems. It also reviews the neurological studies related to porn addiction and sexual conditioning, both of which appear to be substantial risks for some of today’s Internet porn users. The doctors provide 3 clinical reports of men who developed porn-induced sexual dysfunctions. Two of the three men healed their sexual dysfunctions by eliminating Internet porn use. The third man experienced little improvement as he was unable to abstain from porn use.

The old adage is “Always try ad hominem when you cannot address the substance.” Or in Downs case, “Why bother to fact-check a ghost-written article?” I do not lead political or religious campaigns against porn. I’m an atheist, as were my parents, and my politics are far-left liberal. This widely known fact is stated on the About Us page. A lesser known fact is that my very liberal Seattle-raised father taught sex education.

I have explained in multiple interviews my history and how I ended up creating www.yourbrainonporn in 2011. (For more see this 2016 interview of me by Noah B. Church.) I had no opinion on porn. Through a fluke in search engine categorization, around 2007 (shortly after the advent of streaming tube porn), men complaining of porn-induced erectile dysfunction and low libido for real partners began posting on my wife’s rather obscure forum created for discussions around sexual relationships. Over the next few years many otherwise healthy men on that forum healed their sexual dysfunctions by giving up porn. Eventually we blogged about this phenomenon, because so many men found reading their peers’ experiences helpful. Soon my wife’s forum was overflowing with relatively young men seeking to heal the unexpected effects of their internet porn use. During this period, we cannot count how many times we asked academic sexologists to look into this phenomenon. They refused.

Sadly, many of the men suffering from porn-induced sexual dysfunctions had been suicidal when they arrived, fearing that they were broken for life. In the face of continued stonewalling by the experts who should have been investigating the sufferers’ circumstances, we felt a need make a cyberspace available that presented the relevant science and the stories of the men who recovered from a range of porn-induced sexual dysfunctions (chiefly delayed ejaculation, loss of attraction for real partners, and fleeting or unreliable erections). Www.yourbrainonporn.com was born. If it campaigns for anything, it would be sexual health.

Claire Downs cites two highly criticized papers while ignoring 2 dozen contradictory studies.

As stated above, Downs omitted 24 studies linking porn use/sex addiction to sexual problems and lower arousal to sexual stimuli. More importantly, Downs omitted 5 studies demonstrate porn use causing sexual problems (the first 5 studies in the list). In all 5 studies young patients with chronic sexual dysfunctions eliminated porn use and healed their sexual problems

Ignoring the 5 papers suggesting that cessation of Internet porn use reversed sexual dysfunctions, and 19 other studies that link internet porn use to sexual dysfunctions and low arousal, Claire Downs instead cited 2 papers as “reputable sources”: Prause & Pfaus, 2015 and Landripet & Stulhofer, 2015. First, neither paper was an actual study. Prause & Pfaus, 2015 cobbled together data from older papers that had nothing to do with erectile dysfunction. As you will see, none of the data from the 4 older papers came close to matching the number of subjects or claims made that composite paper. Landripet & Stulhofer, 2015 was a brief communication that omitted several relevant correlations that were reported at a conference. Both papers have been criticized in the peer-reviewed literature, and elsewhere. Relevant excerpts from the Downs article:

CLAIRE DOWNS: It’s much easier to find reputable sources that support and promote pornography’s virtues. For example, this 2015 study, conducted by researchers at the Sexual Psychophysiology and Affective Neuroscience Laboratory found no relationship between ED and the number of sex films men view. In one case, Dr. Nicole Prause found stronger sexual arousal in men who reported viewing more pornography at home.

Another 2015 cross-sectional online study of nearly 4,000 European men, published in the Journal of Sexual Medicine, found no significant risk factor related to ED and porn and even cited “greater sexual responsiveness” in porn viewers.

Both papers were discussed at length in the review of the literature co-authored by the 7 US Navy doctors and myself, which I will excerpt below. I have a lot to say about both papers, so I have created separate sections for each. Let’s get one thing out of the way: neither paper found that porn use was correlated with “greater sexual responsiveness,” despite what Downs has been told by her sources. I will start with the second paper because we addressed it first in our review of the literature.


PAPER 1: Prause & Pfaus, 2015.

I provide the formal critique by Richard Isenberg, MD and a very extensive lay critique, followed by my comments and excerpts from the  paper co-authored by US Navy doctors:

The claim: Contrary to Downs’s claim (and Prause & Pfaus’s claim), the men who watched more porn did not have “stronger responses in the lab.” None of the 4 studies underlying the paper’s claims even assessed genital or sexual responses in the lab. What Prause & Pfaus claimed in their paper was that men who watched more porn rated their excitement slightly higher while watching porn. The key phrase is “while watching porn.”  That is, not while having sex with an actual person.

Arousal ratings while viewing porn tell us nothing about one’s arousal or erections when not viewing porn (which is when most guys with porn-induced sexual dysfunctions show impaired sexual function). Such ratings also tell us nothing about porn-induced ED, which is the inability to become sufficiently aroused without using porn. That said, details from Prause & Pfaus, 2015 reveal that they could not have accurately assessed their subjects’ arousal ratings (much more below).

For argument’s sake let’s suppose that men viewing more porn rated their arousal a bit higher than men who viewed less. Another, more legitimate, way to interpret this arousal difference between the two porn-use groups is that men who watched the most porn experienced slightly greater cravings to use porn. This is quite possibly evidence of sensitization, which is greater reward circuit (brain) activation and craving when exposed to (porn) cues. Sensitization (cue-reactivity and cravings) is a prime addiction-related brain change.

Several recent Cambridge University brain studies demonstrated sensitization in compulsive porn users. Participants’ brains were hyper-aroused in response to porn video clips, even though they didn’t “like” some of the sexual stimuli more than control participants. In a dramatic example of how sensitization can affect sexual performance, 60% of the Cambridge subjects reported arousal/erectile problems with partners but not with porn. From the Cambridge study:

[Porn addicts] reported that as a result of excessive use of sexually explicit materials…..they experienced diminished libido or erectile function specifically in physical relationships with women (although not in relationship to the sexually explicit material).

Put simply, a heavy porn user can report higher subjective arousal (cravings) yet also experience arousal/erection problems with a partner. Certainly, his arousal in response to porn is not evidence of his “sexual responsiveness” or erectile functioning with a partner. See these studies reporting sensitization/cravings or cue-reactivity in porn users/sex addicts: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20.

The reality behind Prause & Pfaus 2015: This wasn’t a study on men with ED. It wasn’t a study at all. Instead, Prause claimed to have gathered data from four of her earlier studies, none of which addressed erectile dysfunction. It’s disturbing that this paper by Nicole Prause and Jim Pfaus passed peer-review as none of the data in their paper matched the data in the underlying four studies on which the paper claimed to be based. The discrepancies are not minor gaps, but gaping holes that cannot be plugged. In addition, the paper made several claims that were patently false or not supported by their data.

We begin with false claims made by both Nicole Prause and Jim Pfaus. Many journalists’ articles about this study claimed that porn use led to better erections, yet that’s not what the paper found. In recorded interviews, both Nicole Prause and Jim Pfaus falsely claimed that they had measured erections in the lab, and that the men who used porn had better erections. In the Jim Pfaus TV interview Pfaus states:

“We looked at the correlation of their ability to get an erection in the lab.”

“We found a liner correlation with the amount of porn they viewed at home, and the latencies which for example they get an erection is faster.”

In this radio interview Nicole Prause claimed that erections were measured in the lab. The exact quote from the show:

“The more people watch erotica at home they have stronger erectile responses in the lab, not reduced.”

Yet this paper did not assess erection quality in the lab or “speed of erections.” The paper only claimed to have asked guys to rate their “arousal” after briefly viewing porn (and it’s even not clear from the underlying papers that this simple self-report was asked of all subjects). In any case, an excerpt from the paper itself admitted that:

“No physiological genital response data were included to support men’s self-reported experience.”

In other words, no actual erections were tested or measured in the lab!

In a second unsupported claim, lead author Nicole Prause tweeted several times about the study, letting the world know that 280 subjects were involved, and that they had “no problems at home.” However, the four underlying studies contained only 234 male subjects, so “280” is way off.

A third unsupported claim: Dr. Isenberg’s Letter to the Editor (linked to above), which raised multiple substantive concerns highlighting the flaws in the Prause & Pfaus paper, wondered how it could be possible for Prause & Pfaus 2015 to have compared different subjects’ arousal levels when three different types of sexual stimuli were used in the 4 underlying studies. Two studies used a 3-minute film, one study used a 20-second film, and one study used still images. It’s well established that films are far more arousing than photos, so no legitimate research team would group these subjects together to make claims about their responses. What’s shocking is that in their paper Prause & Pfaus unaccountably claim that all 4 studies used sexual films:

“The VSS presented in the studies were all films.”

This statement is false, as clearly revealed in Prause’s own underlying studies. This is the first reason why Prause & Pfaus cannot claim that their paper assessed “arousal.” You must use the same stimulus for each subject to compare all subjects.

A fourth unsupported claim: Dr. Isenberg also asked how Prause & Pfaus 2015 could compare different subjects’ arousal levels when only 1 of the 4 underlying studies used a 1 to 9 scale. One used a 0 to 7 scale, one used a 1 to 7 scale, and one study did not report sexual arousal ratings. Once again Prause & Pfaus inexplicably claim that:

“Men were asked to indicate their level of “sexual arousal” ranging from 1 “not at all” to 9 “extremely.”

This statement, too, is false, as the underlying papers show. This is the second reason why Prause & Pfaus cannot claim that their paper assessed “arousal” ratings in men. A study must use the same rating scale for each subject to compare the subjects’ results. In summary, all the Prause-generated headlines about porn use improving erections or arousal, or anything else, are unwarranted.

Prause & Pfaus 2015 also claimed they found no relationship between erectile functioning scores and the amount of porn viewed in the last month. As Dr. Isenberg pointed out:

“Even more disturbing is the total omission of statistical findings for the erectile function outcome measure. No statistical results whatsoever are provided. Instead the authors ask the reader to simply believe their unsubstantiated statement that there was no association between hours of pornography viewed and erectile function. Given the authors’ conflicting assertion that erectile function with a partner may actually be improved by viewing pornography the absence of statistical analysis is most egregious.”

In the Prause & Pfaus response to the Dr. Isenberg critique, the authors once again failed to provide any data to support their “unsubstantiated statement.” As this analysis documents, the Prause & Pfaus response not only evades Dr. Isenberg’s legitimate concerns, it contains several new misrepresentations and several transparently false statements. Finally, our review of the literature commented on Prause & Pfaus 2015:

“Our review also included two 2015 papers claiming that Internet pornography use is unrelated to rising sexual difficulties in young men. However, such claims appear to be premature on closer examination of these papers and related formal criticism. The first paper contains useful insights about the potential role of sexual conditioning in youthful ED [50]. However, this publication has come under criticism for various discrepancies, omissions and methodological flaws. For example, it provides no statistical results for the erectile function outcome measure in relation to Internet pornography use. Further, as a research physician pointed out in a formal critique of the paper, the paper’s authors, “have not provided the reader with sufficient information about the population studied or the statistical analyses to justify their conclusion” [51]. Additionally, the researchers investigated only hours of Internet pornography use in the last month. Yet studies on Internet pornography addiction have found that the variable of hours of Internet pornography use alone is widely unrelated to “problems in daily life”, scores on the SAST-R (Sexual Addiction Screening Test), and scores on the IATsex (an instrument that assesses addiction to online sexual activity) [52, 53, 54, 55, 56]. A better predictor is subjective sexual arousal ratings while watching Internet pornography (cue reactivity), an established correlate of addictive behavior in all addictions [52, 53, 54]. There is also increasing evidence that the amount of time spent on Internet video-gaming does not predict addictive behavior. “Addiction can only be assessed properly if motives, consequences and contextual characteristics of the behavior are also part of the assessment” [57]. Three other research teams, using various criteria for “hypersexuality” (other than hours of use), have strongly correlated it with sexual difficulties [15, 30, 31]. Taken together, this research suggests that rather than simply “hours of use”, multiple variables are highly relevant in assessment of pornography addiction/hypersexuality, and likely also highly relevant in assessing pornography-related sexual dysfunctions.”

This review also highlighted the weakness in correlating only “current hours of use” to predict porn-induced sexual dysfunctions. The amount of porn currently viewed is just one of many variables involved in the development of porn-induced ED. These may include:

  1. Ratio of masturbation to porn versus masturbation without porn
  2. Ratio of sexual activity with a person versus masturbation to porn
  3. Gaps in partnered sex (where one relies only on porn)
  4. Virgin or not
  5. Total hours of use
  6. Years of use
  7. Age started using porn voluntarily
  8. Escalation to new genres
  9. Development of porn-induced fetishes (from escalating to new genres of porn)
  10. Level of novelty per session (i.e. compilation videos, multiple tabs)
  11. Addiction-related brain changes or not
  12. Presence of hypersexuality/porn addiction

The better way to research this phenomenon, is to remove the variable of internet porn use and observe the outcome, which was done in the case studies in which men removed internet porn use and healed. Such research reveals causation instead of fuzzy correlations open to conflicting interpretation. My site has documented a few thousand men who removed porn and recovered from chronic sexual dysfunctions.


PAPER 2: Landripet & Štulhofer, 2015.

Landripet & Štulhofer, 2015 was designated as a “brief communication” by the journal that published it, and the two authors selected certain data to share, while omitting other pertinent data (more later). As with Prause & Pfaus, the journal later published a critique of Landripet & Štulhofer: Comment on: Is Pornography Use Associated with Sexual Difficulties and Dysfunctions among Younger Heterosexual Men? by Gert Martin Hald, PhD

As for the claim that Landripet & Štulhofer, 2015 found no relationships between porn use and sexual problems. This is not true, as documented in both this YBOP critique and the US Navy review of the literature. Furthermore, Landripet & Štulhofer’s paper omitted three significant correlations they presented to a European conference (more below). Let’s start with the first of three paragraphs from our paper that addressed Landripet & Štulhofer, 2015:

A second paper reported little correlation between frequency of Internet pornography use in the last year and ED rates in sexually active men from Norway, Portugal and Croatia [6]. These authors, unlike those of the previous paper, acknowledge the high prevalence of ED in men 40 and under, and indeed found ED and low sexual desire rates as high as 31% and 37%, respectively. In contrast, pre-streaming Internet pornography research done in 2004 by one of the paper’s authors reported ED rates of only 5.8% in men 35–39 [58]. Yet, based on a statistical comparison, the authors conclude that Internet pornography use does not seem to be a significant risk factor for youthful ED. That seems overly definitive, given that the Portuguese men they surveyed reported the lowest rates of sexual dysfunction compared with Norwegians and Croatians, and only 40% of Portuguese reported using Internet pornography “from several times a week to daily”, as compared with the Norwegians, 57%, and Croatians, 59%. This paper has been formally criticized for failing to employ comprehensive models able to encompass both direct and indirect relationships between variables known or hypothesized to be at work [59]. Incidentally, in a related paper on problematic low sexual desire involving many of the same survey participants from Portugal, Croatia and Norway, the men were asked which of numerous factors they believed contributed to their problematic lack of sexual interest. Among other factors, approximately 11%–22% chose “I use too much pornography” and 16%–26% chose “I masturbate too often” [60]

As my co-authors, the Navy doctors, and I described, this paper found a rather important correlation: Only 40% of the Portuguese men used porn “frequently,” while the 60% of the Norwegians used porn “frequently.” The Portuguese men had far less sexual dysfunction than the Norwegians. With respect to the Croat subjects, Landripet & Štulhofer, 2015 acknowledge a statistically significant association between more frequent porn use and ED, but claim the effect size was small. However, this claim may be misleading according to an MD who is a skilled statistician and has authored many studies:

Analyzed a different way (Chi Squared), … moderate use (vs. infrequent use) increased the odds (the likelihood) of having ED by about 50% in this Croatian population. That sounds meaningful to me, although it is curious that the finding was only identified among Croats.

In addition, Landripet & Štulhofer 2015 omitted three significant correlations, which one of the authors presented to a European conference. He reported a significant correlation between erectile dysfunction and “preference for certain pornographic genres”:

Reporting a preference for specific pornographic genres were [sic] significantly associated with erectile (but not ejaculatory or desire-related) male sexual dysfunction.”

It’s telling that Landripet & Štulhofer chose to omit this significant correlation between erectile dysfunction and preferences for specific genres of porn from their paper. It’s quite common for porn users to escalate into genres (or fetishes) that do not match their original sexual tastes, and to experience ED when these conditioned porn preferences do not match real sexual encounters. As we pointed out above, it’s very important to assess the multiple variables associated with porn use – not just hours in the last month or frequency in the last year.

The second significant finding omitted by Landripet & Štulhofer 2015 involved female participants:

Increased pornography use was slightly but significantly associated with decreased interest for partnered sex and more prevalent sexual dysfunction among women.”

A significant correlation between greater porn use and decreased libido and more sexual dysfunction seems pretty important. Why didn’t Landripet & Štulhofer 2015 report that they found significant correlations between porn use and sexual dysfunction in women, as well as a few in men? And why hasn’t this finding been reported in any of Štulhofer’s many studies arising from these same data sets? His teams seem very quick to publish data they claim debunks porn-induced ED, yet very slow to inform women about the negative sexual ramifications of porn use.

Finally, Danish porn researcher Gert Martin Hald’s formal critical comments echoed the need to assess more variables (mediators, moderators) than just frequency per week in the last 12 months:

“The study does not address possible moderators or mediators of the relationships studied nor is it able to determine causality. Increasingly, in research on pornography, attention is given to factors that may influence the magnitude or direction of the relationships studied (i.e., moderators) as well as the pathways through which such influence may come about (i.e., mediators). Future studies on pornography consumption and sexual difficulties may also benefit from an inclusion of such focuses.

Bottom line: All complex medical conditions involve multiple factors, which must be teased apart before far reaching pronouncements are appropriate. Landripet & Štulhofer’s statement that, “Pornography does not seem to be a significant risk factor for younger men’s desire, erectile, or orgasmic difficulties” goes too far, since it ignores all the other possible variables related to porn use that might be causing sexual performance problems in users, including escalation to specific genres, which they found, but omitted from the “Brief Communication.” Paragraphs 2 & 3 in our discussion of Landripet & Štulhofer, 2015:

Again, intervention studies would be the most instructive. However, with respect to correlation studies, it is likely that a complex set of variables needs to be investigated in order to elucidate the risk factors at work in unprecedented youthful sexual difficulties. First, it may be that low sexual desire, difficulty orgasming with a partner and erectile problems are part of the same spectrum of Internet pornography-related effects, and that all of these difficulties should be combined when investigating potentially illuminating correlations with Internet pornography use.

Second, although it is unclear exactly which combination of factors may best account for such difficulties, promising variables to investigate in combination with frequency of Internet pornography use might include (1) years of pornography-assisted versus pornography-free masturbation; (2) ratio of ejaculations with a partner to ejaculations with Internet pornography; (3) the presence of Internet pornography addiction/hypersexuality; (4) the number of years of streaming Internet pornography use; (5) at what age regular use of Internet pornography began and whether it began prior to puberty; (6) trend of increasing Internet pornography use; (7) escalation to more extreme genres of Internet pornography, and so forth.


A 500% – 1000% increase in youthful ED since 2010 cannot be explained away by the usual factors

Studies assessing young male sexuality since 2010 report historic levels of sexual dysfunctions, and startling rates of a new scourge: low libido. Documented in this lay article and in our review, Is Internet Pornography Causing Sexual Dysfunctions? A Review with Clinical Reports (2016).

Prior to the advent of free streaming porn (2006), cross-sectional studies and meta-analysis consistently reported erectile dysfunction rates of 2-5% in men under 40. Erectile dysfunction rates in 9 studies published since 2010 range from 14% to 35%, while rates for low libido (hypo-sexuality) range from 16% to 37%. Some studies involve teens and men 25 and under, while other studies involve men 40 and under. That’s nearly a 500%-1000% increase in youthful ED rates in the last 10 years. What variable has changed in the last 15 years that could account for this astronomical rise? Downs implies that the same old variables related to youthful ED are to blame for this jump in sexual problems:

CLAIRE DOWNS: ED is unfortunately common, and it’s not just a result of getting old. Although age increases the likelihood of experiencing dysfunction, one in four men under the age of 40 will seek treatment for ED. Whether chronic or temporary, erectile dysfunction is caused by a myriad of things like drug use, medication side effects, mental issues, and relationship communication problems, as well as heart disease, sleep disorders, and nerve injuries.

As explained in our paper, smoking, diabetes and heart disease rarely cause ED in men under 40 (citation 16). It takes years of smoking or uncontrolled diabetes to manifest neuro-vascular damage severe enough to cause chronic ED. From our paper:

Traditionally, ED has been seen as an age-dependent problem [2],and studies investigating ED risk factors in men under 40 have often failed to identify the factors commonly associated with ED in older men, such as smoking, alcoholism, obesity, sedentary life, diabetes, hypertension, cardiovascular disease, and hyperlipidemia [16].

As for “medications, smoking, alcohol and drug use,” none of rates of these correlative factors have increased over the last 15 years (smoking has actually decreased). From the US Navy paper:

However, none of the familiar correlative factors suggested for psychogenic ED seem adequate to account for a rapid many-fold increase in youthful sexual difficulties. For example, some researchers hypothesize that rising youthful sexual problems must be the result of unhealthy lifestyles, such as obesity, substance abuse and smoking (factors historically correlated with organic ED). Yet these lifestyle risks have not changed proportionately, or have decreased, in the last 20 years: Obesity rates in U.S. men aged 20–40 increased only 4% between 1999 and 2008 [19]; rates of illicit drug use among US citizens aged 12 or older have been relatively stable over the last 15 years [20]; and smoking rates for US adults declined from 25% in 1993 to 19% in 2011 [21].

As for “mental issues: depression, anxiety, nervousness,” none of these cause erectile dysfunction, they are simply weakly correlative to ED. In fact, some studies report that depressed and anxious patients have higher sexual desire. Other studies suggest the obvious: depression doesn’t cause ED; having ED increases scores on depression tests. From the US Navy paper:

Other authors propose psychological factors. Yet, how likely is it that anxiety and depression account for the sharp rise in youthful sexual difficulties given the complex relationship between sexual desire and depression and anxiety? Some depressed and anxious patients report less desire for sex while others report increased sexual desire [22, 23, 24, 25]. Not only is the relationship between depression and ED likely bidirectional and co-occurring, it may also be the consequence of sexual dysfunction, particularly in young men [26].

As we said in our paper’s conclusion:

Traditional factors that once explained sexual difficulties in men appear insufficient to account for the sharp rise in sexual dysfunctions and low sexual desire in men under 40.

Finally, this 2018 study on urology patients under the age of 40 found that patients with ED did not differ from men without ED, thus debunking Claire Downs assertions (Factors For Erectile Dysfunction Among Young Men–Findings of a Real-Life Cross-Sectional Study):

Overall, 229 (75%) and 78 (25%) patients had normal and impaired Erectile Function (EF); among patients with ED, 90 (29%) had an IIEF-EF score suggestive for severe ED. Patients with and without ED did not differ significantly in terms of median age, BMI, prevalence of hypertension, general health status, smoking history), alcohol use, and median IPSS score. Similarly, no differences were reported in terms of serum sex hormones and lipid profile between the two groups.

These findings showed that young men with ED do not differ in terms of baseline clinical characteristics from a comparable-age group with normal EF, but depicted lower sexual desire scores, clinically suggesting a more probable psychogenic cause of ED.

For some reason those with ED had low sexual desire (should’ve asked about porn!) To repeat, Claire Downs, like other porn-induced ED deniers, argue that young men’s ED is caused by the exact same risk factors that are related to ED in men over 40. These claims do not match the peer-reviewed literature.

Before confidently claiming that today’s porn consumers have nothing to worry about from Internet porn use, researchers still need to account for the very recent, sharp rise in youthful ED and low sexual desire, the many studies linking porn use to sexual problem, the thousands of self reports and clinician reports of men healing ED by eliminating a single variable: porn.

Downs may wish to update her article in The Daily Dot accordingly.

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