Justin Lehmiller, a regular paid contributor to Playboy Magazine, and now partnering with xHamster, unconvincingly attempts to debunk the well documented rise in youthful erectile dysfunction with this April, 2018 blog post. Since it was published David Ley and Nicole Prause frequently tweet Lehmiller’s blog post as “proof” that youthful ED rates haven’t changed in the last 30 years. According to Ley and Prause this means that porn use cannot cause sexual problems.
It shouldn’t surprise anyone that Lehmiller is a close ally of Nicole Prause, having featured her in at least ten of his blog posts. These and many other Lehmiller blogs perpetuate the same false narratives: porn use causes no problems and porn addiction/porn-induced sexual dysfunctions do not exist. Nicole Prause is probably behind the Lehmiller article, as she is obsessed with debunking PIED, having waged a 3-year war against this academic paper, while simultaneously harassing and libeling young men who have recovered from porn-induced sexual dysfunctions. See documentation: Gabe Deem #1, Gabe Deem #2, Alexander Rhodes #1, Alexander Rhodes #2, Alexander Rhodes #3, Noah Church, Alexander Rhodes #4, Alexander Rhodes #5, Alexander Rhodes #6, Alexander Rhodes #7, Alexander Rhodes #8, Alexander Rhodes #9, Alexander Rhodes#10, Gabe Deem & Alex Rhodes together, Alexander Rhodes#11, Alexander Rhodes #12, Alexander Rhodes #13.
Update (April, 2019): In an attempt to silence YBOP’s criticism, a handful of authors formed a group to steal YBOP’s trademark (headed by Nicole Prause, and including Justin Lehmiller & David Ley). See this page for details: Aggressive Trademark Infringement Waged by Porn Addiction Deniers (www.realyourbrainonporn.com). If you are looking for an analysis of a study that you cannot in the following critique check this page: Porn Science Deniers Alliance (AKA: “RealYourBrainOnPorn.com” and “PornographyResearch.com”). It examines the trademark infringers’ “research page,” including its cherry-picked outlier studies, bias, egregious omission, and deception.
Before we address Lehmiller’s sleight of hand attempting to make porn-induced sexual dysfunction disappear, let’s examine the evidence.
Historical ED rates
Erectile dysfunction was first assessed in 1940s when the Kinsey report concluded that the prevalence of ED was less than 1% in men younger than 30 years, and less than 3% in those 30–45. While ED studies on young men are relatively sparse, this 2002 meta-analysis of 6 high-quality ED studies reported that 5 of the 6 reported ED rates for men under 40 were approximately 2%. The 6th study reported figures of 7-9%, but the question used could not be compared to assessments used for the 5 other studies, and did not assess chronic erectile dysfunction. The anomalous study asked, “Did you have trouble maintaining or achieving an erection any time in the last year?” (Yet this inconsistent study is the one that Lehmiller irresponsibly uses for comparison.)
At the end of 2006 the world of online porn changed. Free, streaming porn tube sites came online and gained instant popularity. This changed the nature of porn consumption radically. For the first time in history, viewers could click to new material or escalate to more extreme material with ease during a masturbation session without any wait.
Nine studies published since 2010
Ten studies published since 2010 reveal a tremendous rise in erectile dysfunctions. This is documented in this lay article and in this peer-reviewed paper involving 7 US Navy doctors – Is Internet Pornography Causing Sexual Dysfunctions? A Review with Clinical Reports (2016). In the 10 studies, erectile dysfunction rates for men under 40 ranged from 14% to 37%, while rates for low libido ranged from 16% to 37%. Other than the advent of streaming porn (2006) no variable related to youthful ED has appreciably changed in the last 10-20 years (smoking rates are down, drug use is steady, obesity rates in males 20-40 up only 4% since 1999 – see this study).
The recent jump in sexual problems coincides with the publication of 35 studies linking porn use and “porn addiction” to sexual problems and lower arousal to sexual stimuli. It’s important to note that the first 5 studies in the list demonstrate causation, as participants eliminated porn use and healed chronic sexual dysfunctions. For some reason, Lehmiller failed to acknowledge the existence of any of this research. In addition to the studies listed, this page contains articles and videos by over 130 experts (urology professors, urologists, psychiatrists, psychologists, sexologists, MDs) who acknowledge and have successfully treated, porn-induced ED and porn-induced loss of sexual desire.
Sexual dysfunctions or not, porn use doesn’t heat up the bedroom; over 70 studies link porn use to less sexual and relationship satisfaction. As far as we know all studies involving males (which is the majority of studies) have reported more porn use linked to poorer sexual or relationship satisfaction. While a handful of published studies correlate greater porn use in females to neutral (or better) sexual satisfaction, the vast majority most have not. See this list of 40 studies involving female subjects reporting negative effects on arousal, sexual satisfaction, and relationships.
Lehmiller’s sleight of hand
Lehmiller carefully selected two mismatched studies, with data separated by 18 years, in an attempt to convince the reader that ED rates have always been around 8% for men under 40:
1) The “way things were study” from 1992 is the one that asked: “Did you have trouble maintaining or achieving an erection any time in the last year?” Rates of yes to this question were between 7-9%.
2) In contrast, this “modern study” with 2010-12 data (from NATSAL) is the one that asked whether men had trouble getting or keeping an erection for a period of three or more months during the last year.” This study reported the following rates of sexual functioning problems in 16-21 year old males:
- Lacked interest in having sex: 10.5%
- Difficulty reaching climax: 8.3%
- Difficulty achieving or maintaining an erection: 7.8%
Lehmiller “summarized” these findings for the vision-impaired as he tried to mislead them:
Although these data were collected in different Western countries and the question wording differed, it’s striking how similar the figures are considering that the data were collected 20 years apart. This suggests that perhaps rates of ED aren’t on the rise among young men after all.
Sorry Justin, but the questions are not “worded differently”; they are completely different questions. The 1992 study asked whether over the course of the last year at any point you had trouble getting it up. This includes when you were drunk, sick, just wanked three times in a row, experienced performance anxiety, whatever. I’m surprised it’s only 7-9%. In contrast, the 2010 study asked whether you had a persistent problem of erectile dysfunction over a period of three months or more. This was for 16-21 year olds, not men 39 and under!
As one recovery-forum member observed, Justin Lehmiller’s “science analysis” is Buzzfeed level clickbait, not science journalism.
But you may ask: Why are the ED rates about 8% in the 2010-2012 study, yet 14-37% in the 9 other studies published since 2010?
- First, 8% isn’t insignificant, as 8% would indicate a 600%-800% increase for men under 40.
- Second, it wasn’t men under 40 – it was 16 to 21 year olds, so virtually none of them should have chronic ED. In the 1940s, the Kinsey report concluded that the prevalence of ED was less than 1% in men younger than 30 years,
- Third, unlike the other 9 studies that employed anonymous surveys, this study used face to face in-home interviews. (It’s quite possible that adolescents would be less than fully forthcoming under such circumstances.)
- The study gathered its data between August, 2010 and September, 2012. Studies reporting a significant rise in under-25 ED first appeared in 2011. More recent studies on 25-and-under sujects report even higher rates (see this 2014 study on Canadian adolescents).
- Many of the other studies used the IIEF-5 or IIEF-6, which assess sexual problems on a scale, as opposed to the simple yes or no (in the past 3 months) employed in Lehmiller’s cherry-picked paper.
Two studies using the exact same questionnaire: 2001 vs. 2011 (GSSAB)
Before leaving this topic, it would be well to look at some of the most irrefutable research that demonstrates a radical rise in ED rates over a decade using very large samples (which increase reliability). All the men were assessed using the same (yes/no) question about ED, as part of the Global Study of Sexual Attitudes and Behavior (GSSAB), administered to 13,618 sexually active men in 29 countries. That occurred in 2001-2002.
A decade later, in 2011, the same “sexual difficulties” (yes/no) question from the GSSAB was administered to 2,737 sexually active men in Croatia, Norway and Portugal. The first group, in 2001-2002, were aged 40-80. The second group, in 2011, were 40 and under.
Based on the findings of prior studies one would predict the older men would have far higher ED scores than the younger men, whose scores should have been negligible. Not so. In just a decade, things had changed radically. The 2001-2002 ED rates for men 40-80 were about 13% in Europe. By 2011, ED rates in Europeans, ages 18-40, ranged from 14-28%!
What changed in men’s sexual environment during this time? Well, major changes were internet penetration and access to porn videos (followed by access to streaming porn in 2006, and then smartphones on which to view it). In the 2011 study on Croatians, Norwegians and Portuguese, the Portuguese had the lowest rates of ED and the Norwegians had the highest. In 2013, internet penetration rates in Portugal were only 67%, compared with 95% in Norway.
In line with clinical, anecdotal, and experimental evidence
The image below appeared in an analysis of ED posts from MedHelp forums. “Nearly 60% of men posting on the forums were under 24 years old. This was a surprising finding for researchers, as erectile dysfunction is generally considered a condition that strikes older men.”
An Irish Times poll asked thousands of readers about ED, and the number of men 24-34 with issues was 28%:
Click on graphics from 2015 Irish Times poll to see ED rates, which show higher rates in young men than in men 35-49!
Documented recovery stories
About 3,000 self-reports of recovery from ED and other sexual dysfunctions after quitting internet porn can be found on these pages:
- Rebooting accounts page 1
- Rebooting accounts page 2
- Rebooting accounts page 3
- ED Recovery Stories 1
- ED Recovery Stories 2
- ED Recovery Stories 3
- ED Recovery Stories 4
- ED Recovery Stories 5
- ED Recovery Stories 6
- ED Recovery Stories 7
- ED Recovery Stories 8
Experts, not employed by Playboy, who recognize and treat porn-induced sexual dysfunctions
Justin Lehmiller may be right in step with a few agenda-driven sexologists, but he’s out of step with professionals who treat men. Since YBOP came online in 2011 over 120 sexual experts (urology professors, urologists, psychiatrists, psychologists, sexologists, MDs) who acknowledge and treat porn-induced sexual problems have published articles or appeared on radio and TV. Note: Urologists have twice presented evidence of porn-induced sexual dysfunctions at annual conferences of the American Urological Association.
- Video of a lecture: Porn-induced ED (parts 1-4) presented at the American Urologic Association Conference, May 6-10, 2016. Urologist Tarek Pacha.
- New findings: Study sees link between porn and sexual dysfunction (2017) – Data from an upcoming study, presented at the 2017 American Urological Association Conference.
List of articles, broadcasts, radio shows, and podcasts that involve sexual experts who confirm the existence of porn-induced sexual dysfunctions (in chronological order):
- Too Much Internet Porn May Cause Impotence, urology professor Carlo Foresta (2011)
- The Young Turks discuss porn-induced ED (2011)
- Porning too much? by Robert Taibbi, L.C.S.W. (2012)
- Does Porn Contribute to ED? by Tyger Latham, Psy.D. in Therapy Matters (2012)
- Urologist Lim Huat Chye: Pornography can cause erectile dysfunction for young men (2012)
- Director of Middlebury College Health Center, Dr. Mark Peluso, sees rise in ED: blames porn (2012)
- Sexual Dysfunction: The Escalating Price of Abusing Porn (2012)
- “Addicted to Viagra: They should be at their most virile, but a growing number of young men can’t cope without those little blue pills” (2012)
- Hardcore corruption of the human hard disk (2012)
- The Dr. Oz Show addresses Porn-induced ED (2013)
- Erectile dysfunction increases among young men, sex therapist Brandy Engler, PhD (2013)
- Internet Porn and Erectile Dysfunction, by Urologist James Elist, F.A.C.S., F.I.C.S. (2013)
- How porn is destroying modern sex lives: Feminist writer Naomi Wolf has an unsettling explanation for why Britons are having less sex (2013)
- Pornography & Erectile Dysfunction, by Lawrence A. Smiley M.D. (2013)
- Urologist Andrew Kramer discusses ED – including porn-induced ED (2013)
- Is Porn Destroying Your Sex Life? By Robert Weiss LCSW, CSAT-S (2013)
- Too Much Internet Porn: The SADD Effect, by Ian Kerner PhD. (2013)
- Solutions for porn-induced erectile dysfunction, by Sudeepta Varma, MD, Psychiatry (2013)
- Dr. Rosalyn Dischiavo on porn-induced ED (2013)
- Did porn warp me forever? Salon.com (2013)
- Radio Show: Young Psychiatrist Discusses His Porn-induced ED (2013)
- Chris Kraft, Ph.D. – Johns Hopkins sexologist discusses porn-induced sexual dysfunctions (2013)
- Why A Sex Therapist Worries About Teens Viewing Internet Porn, by Dr. Aline Zoldbrod (2013)
- Is “Normal” Porn Watching Affecting Your Manhood? by sexologist Maryline Décarie, M.A. (2013)
- ‘Porn’ makes men hopeless in bed: Dr Deepak Jumani, Sexologist Dhananjay Gambhire (2013)
- Need porn diet for three to five months to get an erection again, Alexandra Katehakis MFT, CSAT-S (2013)
- Just Can’t Get It Up: ZDoggMD.com (2013)
- Time-out cures man of Internet porn addiction & ED: CBS video, Dr. Elaine Brady (2013)
- Seven Sharp with Caroline Cranshaw – The damage caused by internet porn addiction (2013)
- Reality is not enough exciting (Swedish), psychiatrist Goran Sedvallson. urologist Stefan Arver, psychotherapist Inger Björklund (2013)
- Why porn and masturbation can be too much of a good thing, Dr. Elizabeth Waterman (2013)
- Dan Savage answers question about porn-induced ED (12-2013)
- Irish Times: ‘I can’t get stimulated unless I watch porn with my girlfriend’ (2016)
- Erection problems from too much porn – Swedish (2013)
- Internet porn wrecking conjugal ties in India (Porn-induced ED), Dr. Narayana Reddy (2013)
- Pornography was the only one who got Donald aroused: Swedish (2013)
- Men who watch too much porn can’t get it up, warns Manchester sex therapist (2014)
- What causes erectile dysfunction?, Dr. Lohit K, M.D (2014)
- Has Porn Ruined Our Sex Lives Forever? The Daily Dose. (2014)
- Suffering from ED? This Reason May Surprise You, by Michael S Kaplan, MD (2014)
- Is porn addiction on the rise in Bangalore? (2014)
- YBOP review of “The New Naked” by urologist Harry Fisch, MD (2014)
- Behind the documentary: Porn-Induced Erectile Dysfunction, Global News Canada (2014)
- ‘Generation X-Rated’ (Porn-Induced ED) – Urologist Abraham Morgentaler (2014)
- Porn-induced erectile dysfunction in healthy young men, Andrew Doan MD, PhD (2014)
- Catastrophic effects of adolescent porn addiction. Wrishi Raphael, MD (2014)
- Porn causing erectile dysfunction in young men, by Global News Canada (2014)
- LIVE BLOG: Porn-induced erectile dysfunction. Dr. Abraham Morgentaler, Gabe Deem (2014)
- Watching porn can cause male sexual dysfunction. Urologists David B. Samadi & Muhammed Mirza (2014)
- Looking at porn on the internet could ruin your sex life, doctor says. Harry Fisch, MD (2014)
- Online Videos Causing IRL Erectile Problems? by Andrew Smiler PhD (2014)
- Do You Masturbate Too Much? Urologist Tobias Köhler, Therapist Dan Drake (2014)
- How Online Sexual Stimulation Can Lead to In Real Life Sexual Dysfunction, by Jed Diamond PhD (2014)
- Too Much Porn Contributing to ED: Urologist Fawad Zafar (2014)
- Is Porn Erectile Dysfunction Fact or Fiction? by Kurt Smith, LMFT, LPCC, AFC (2015)
- When porn becomes a problem (Irish Times). Sex therapists Trish Murphy, Teresa Bergin, Tony Duffy (2015)
- Porn Addiction, Porn Creep and Erectile Dysfunction By Billi Caine, B.Sc Psych, RN (2015)
- Online pornography and compulsive masturbation cause impotence in young, Emilio Loiacono MD (2015)
- Counsellors battle ‘plague of pornography’, psychologists Seema Hingorrany & Yolande Pereira, paediatrician, Samir Dalwai (2015)
- Tinder and the Dawn of the “Dating Apocalypse”, Vanity Fair (2015)
- TEDX talk about porn-induced ED & reclaiming one’s sexuality: “How to Become a Sex God” by Gregor Schmidinger (2015)
- Torn on porn: A look at addiction & pornography. Dr. Charlotte Loppie, University of Victoria Professor in the School of Public Health (2016)
- Nurse wants residents to talk about erectile dysfunction. Lesley Mills, a consultant nurse in sexual dysfunction (2016)
- How internet porn is creating a generation of men desensitised to real life sex. Dr Andrew Smiler, Dr Angela Gregory (2016)
- BBC: Easy access to online porn is ‘damaging’ men’s health, says NHS therapist. Psychosexual therapist Angela Gregory (2016)
- What to Do When You’re Dating a Guy with Problems Below the Belt. Sexologist Emily Morse, Ph.D. (2016)
- Non-prescription Viagra has infiltrated the bedrooms of today’s young black men. Urology professor David B. Samadi & Muhammed Mirza, MD founder of ErectileDoctor.com (2016)
- The Devastating Consequences of Pornography. Dr. Ursula Ofman (2016)
- “Porn addiction could ruin your sex life and here’s why”. Sexual function specialist Anand Patel MD, Sex therapist Janet Eccles, Neuroscientist Dr Nicola Ray (2016)
- Podcast: Porn-induced erectile dysfunction (PIED). By world renowned urologist Dudley Danoff & Dr. Diana Wiley (2016)
- The REAL reason young men suffer from erectile dysfunction, by Anand Patel, MD (2016)
- Turn away! Why pornography can harm your sex life. By urology professor Dr. David Samadi (2016)
- Urology Times asks: “What is driving younger men to seek treatment for ED?” Jason Hedges, MD, PhD (2016)
- Why Men are quitting Internet Porn (porn-induced ED), Andrew Doan, MD, PhD (2016)
- How the proliferation of porn is ruining men’s love lives. By Angela Gregory Lead for Psychosexual Therapy, Chandos Clinic, Nottingham U. Secretary British Society of Sexual Medicine (2016)
- A lot of cases relating to erectile dysfunction relate to pornography addiction and use. Zoe Hargreaves, NHS Psychosexual Therapist (2016)
- The insidious impact of internet porn. by Rose Laing MD (2016)
- Salvaging sex life from erectile dysfunction, Dalal Akoury MD (2016)
- Too much porn can lead to ED, Malaysian men warned. Clinical andrologist Dr Mohd Ismail Mohd Tambi (2016)
- The black and white of blue films: How porn addiction damages relationships. by Sandip Deshpande, MD (2016)
- Private school principals get a lesson in porn. Sexuality educator Liz Walker (2016)
- Six Signs that your Partner has a Pornography Addiction & What you can Do. by Diana Baldwin LCSW (2016)
- Is Porn Good For Us or Bad For Us? by Philip Zimbardo PhD. (2016)
- How Porn is Hijacking the Sex Lives of Our Young Men. by Dr. Barbara Winter (2016)
- A shocking new TV show aired last night and it sees young people encouraged to air their sexual problems and woes. Dr. Vena Ramphal (2016)
- How To Solve Common Sexual Issues, Because They May Be Mental, Physical, Or Both. Eyal Matsliah author of “Orgasm Unleashed” (2016)
- South African therapists and sex educators say interventions are needed to stop today’s youngsters suffering serious health effects later in life due to pornography addiction (2016)
- Cybersex Addiction: A Case Study. Dorothy Hayden, LCSW (2016)
- How Porn Wrecks Relationships, Barbara Winter, Ph.D. (2016)
- Porn Can Help A Relationship, But Proceed With Caution. Amanda Pasciucco LMFT, CST; Wendy Haggerty LMFT, CST (2016)
- How Internet Porn Is Making Young Men Impotent. Sex therapist and associate of Impotence Australia, Alinda Small (2016)
- Video – Can Porn Induce Erectile Dysfunction and Impotence? by Paul Kattupalli MD (2016)
- Video – Guyology founder Melisa Holmes MD talks about how boys develop porn-induced erectile dysfunction with many needing Viagra (2017)
- Video: Hormone expert Dr. Kathryn Retzler discusses porn-induced erectile dysfunction (2017)
- Video: Porn-Induced Erectile Dysfunction by Brad Salzman, LCSW, CSAT (2017)
- Irish children as young as seven are being exposed to porn. Dr Fergal Rooney (2017)
- Excessive Porn Consumption Can Cause Erectile Dysfunction – Myth or Truth? by Takeesha Roland-Jenkins, MS (2017)
- Here’s how porn is affecting Irish relationships. Sex therapist Teresa Bergin (2017)
- Is Technology Ruining Our Brains? (Comedy Central show). Alexandra Katehakis, MFT, CSAT-S, CST-S (2017)
- How to educate our youth about pornography addiction and dangers. Psychosexual therapists Nuala Deering & Dr. June Clyne (2017)
- Excessive Porn Consumption Can Cause Erectile Dysfunction – Myth or Truth? by Takeesha Roland-Jenkins, MS (2017)
- ‘Porn is a public health crisis’: experts call for government inquiry into health effects of porn. Sex therapist Mary Hodson (2017)
- Everything You Need To Know About Porn-Induced Erectile Dysfunction. Dr. Ralph Esposito; Elsa Orlandini Psy.D. (2017)
- Don’t let erectile dysfunction get you down. Psychotherapist Nuala Deering (2017)
- How watching porn can cause erectile dysfunction. Dr Lubda Nadvi (2017)
- This Is How Therapists Treat Young Men With “Porn-Induced Erectile Dysfunction”. Sex therapist Alinda Small, clinical sexologist Tanya Koens, psychotherapist Dan Auerbach (2017)
- TEDx Talk “Sex, Porn & Manhood” (Professor Warren Binford, 2017)
- Online Porn: Fastest growing addiction in the U.S. Sex addiction therapist, Chris Simon (2017)
- Can Watching Too Much Porn Affect Your Sex Life? Jenner Bishop, LMFT; Psychotherapist Shirani M. Pathak (2017)
- Young people report ‘persistent and distressing’ problems with sex lives: study (2017)
- ‘Tidal wave’ of porn addiction as experts warn action is needed to save the next ‘lost generation’. Psychosexual therapist Pauline Brown (2017)
- Young men who view more pornography experiencing erectile dysfunction, study says (Sex therapist Dr. Morgan Francis 2017)
- What You Can Do to Prevent Erectile Dysfunction. Urology professor Aaron Spitz. (2017)
- Erectile dysfunction pills are now the top party drug for British millennials. Sexual psychotherapist Raymond Francis, (2017)
- If you’re having problems “getting it up” you are far from alone and plenty of help is out there. Dr Joseph Alukal (2018)
- Ministry of Health wants more research into impact of pornography. Sex therapist Jo Robertson (2018)
- We need to take ownership of what porn’s doing to NZ kids. Dr Mark Thorpe (2018)
- Performance issues in the bedroom are not just an old man’s problem. Sex therapist Aoife Drury (2018)
- Porn is a ‘Mean Castration of the Male Population’ – Evgeny Kulgavchuk, a Russian sexologist, psychiatrist and therapist (2018)
- Erectile dysfunction: how porn, bike riding, alcohol and ill-health contribute to it, and six ways to maintain peak performance. Urology professor Amin Herati (2018)
- Hard science: how to make your erection stronger. By Nick Knight, MD (2018)
- 9 Ways to Treat Erectile Dysfunction That Aren’t Viagra. Dr. Morgentaler, Clinical Professor of Urology at Harvard (2018)
- Five Unhealthy Lifestyle Habits That Are Affecting Your Libido. by Zvi Zuckerman MD, CST (2018)
- Porn Induced Erectile Dysfunction – Everything You Need to Know. By Daniel Sher, PhD (2018)
- Am I a Porn Addict? by Dr. Sue (2018)
- Does Porn Addiction Cause Male Sexual Dysfunction? by Dr. Robert Weiss (2019)
- Four Surprising Things That Can Cause Trouble in the Bedroom, by Dr. R.Y. Langham (2019)
- Secret sex lives of Gen Z: the hysteria about their ‘lack of sex’ doesn’t add up. Dr Matthew Berry. (2019)
- “Hooked on Porn?” Dr. Nazanin Moali and therapist Wendy Maltz (2019)
- More and more young men experiencing erectile difficulties. Sexologist Emily Power Smith, (2019)
- BBC Woman’s Hour discusses porn’s effects on female viewers, with Neelam Tailor & psychosexual therapist Angela Gregory (2019)
- Your Porn Session Could Be An Addiction & This Psychologist Explains How To Fix It. Luke Vu, PhD (2019)
- Internet porn: the highly addictive narcotic emasculating young men through erectile dysfunction. Urologist Paul Church, Maureen Newberg LCSW (2019)
- How it feels to be a sex therapist. Sex therapist Peter Saddington (2019)
- Generation flop: Porn addiction made me relieve myself at work but flop in bed with ‘normal’ girls. Jeff Foster, MD (2019