Erectile dysfunction Part 5: Porn and Masturbation

Erectile dysfunction has become one of the most prevailing sexual disorders of today and one of the most common health concerns men have.

Could it be related to the increased availability of porn and the increased frequency of masturbation?

There is most certainly a strong correlation and lots of scientific evidence to back it up.

Erectile dysfunction has always been considered an “old man’s disorder”, but nowadays guys even under the age of 20 are starting to suffer from it.

Around and before the year 2000, rates of ED were low in sexually active men under 40, and did not begin to rise steeply until thereafter. A major 1999 study reported erectile dysfunction and low sexual desire in only 5% of sexually active men between the age of 18 to 59 (R).

A 2002 meta-analysis reported that less than 2% in men under 40 suffered from ED (R).

But things changed quickly.

A recent 2016 study found that nearly 6 out of 10 of 3962 visitors seeking help on the prominent “MedHelp.org ED Forum”, who mentioned their ages, were younger than 25 (R).

What has so radically changed? Why is there such a massive increase in ED in young men?

Is it a decline in food quality, lack of sunlight, EMF, polyunsaturated fat intake, poor sleep..?

All of these factors and more are involved, but for men under 40, only 15–20% of cases are organic in origin. Meaning, cardiovascular disease, diabetes, etc, contribute to only 15-20% of people under 40 with ED. Something else is at play with the other 80-85%.

I quote from this study:

…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.

Reference

Porn and masturbation play a huge role in this. That’s why I want to focus on those two topics in this article.

A brief history and the close correlation between erectile dysfunction and porn consumption

Although studies don’t directly mention or track it, I think we all can agree that watching porn almost always goes with masturbation.

Before 2006

Based on data from 2001-2002, less than 2% of men under the age of 40 suffered from ED and around 13% of men between the age of 40-80 experienced ED (in Europe) (R).

These data were gathered before Internet “porn tube sites” enabled wide access to sexually explicit videos with no download required.

2006

The first of these “tube sites” appeared in September 2006 (R).

Sexually explicit material has been around for a long time, but video pornography is significantly more sexually arousing than other forms of pornography or fantasy.

Also, the novel sexual visuals have been shown to trigger greater arousal, faster ejaculation, and more semen and erection activity compared with familiar material. The ability to self-select material with ease makes internet pornography more arousing than pre-selected material.

2011

In just a decade, things changed radically. By 2011, ED rates in young Europeans, 18–40, ranged from 14%–28% (R).

2012

Swiss researchers found ED rates of 30% in Swiss men aged 18–24 (R).

2013

An Italian study reported that 1 out of 4 patients seeking help for new-onset ED were younger than 40, with rates of severe ED nearly 10% higher than in men over 40 (R).

2014

A study on Canadian adolescents reported that 53.5% of males aged 16–21 had symptoms indicative of sexual problems (R). Erectile dysfunction was the most common (26%), followed by low sexual desire (24%), and problems with orgasm (11%).

Another study of new diagnoses of ED in active duty servicemen reported that rates had more than doubled between 2004 and 2013 (R). Rates of psychogenic ED increased more than organic ED, while rates of unclassified ED remained relatively stable.

A study of active duty, relatively healthy, male military personnel aged 21–40 found an overall ED rate of 33.2% (R), with rates as high as 15.7% in individuals without posttraumatic stress disorder (R). The researchers also noted that sexual dysfunctions are subject to underreporting biases related to stigmatization (R) and that only 1.64% of those with ED had sought prescriptions for phosphodiesterase-5 inhibitors through the military (R). A second analysis of the military revealed that the increased sexual functioning problems were associated with “sexual anxiety” and “male genital self-image” which is a common result of watching porn (R).

2015

A “Brief Communication” reported ED rates as high as 31% in sexually active men and low sexual desire rates as high as 37% (R).

Another study on men (average age approximately 36), reported that ED accompanied by a low desire for partnered sex is now a common observation in clinical practice among men seeking help for their excessive sexual behavior, who frequently “use pornography and masturbate” (R).

This study of men (average age 41.5) seeking treatment for hypersexuality, who masturbated (“typically with very frequent pornography use”) seven or more hours per week, found that 71% had sexual dysfunctions, with 33% reporting difficulty orgasming (R).

2016

This study assessed sexual problems in adolescents (16–21 years) in five waves over a two-year period. For males, persistent problems (in at least one wave) were low sexual satisfaction (47.9%), low desire (46.2%), and problems in erectile function (45.3%) (R).

Summary of porn use and ED

We can clearly see that the rate of ED and other (inorganic) sexual problems increased with the frequency and duration of porn consumption. Porn and masturbation almost always goes together and we can conclude that it’s not the porn be itself that causes ED, but rather the combination of both.

Why do men watch porn and masturbate?

Three quick reasons off the top of my head are because they got triggered by something they saw, they feel stressed and need some kind of relief and dopamine release (self-medication so to speak) or because of the porn snowball effect (more on that later).

Why do men masturbate:

• For sexual pleasure, because they feel alone and feel like they’ll never get a girlfriend or spouse
• For instant gratification
• To cope with stress – it’s a form of self-medication
• To fall asleep
• Because of boredom
• Due to anxiety. Sexual anxiety might discourage sexual activity and promote reliance on porn and masturbation.
• Because they feel depressed

Let’s talk about brain chemistry. Men that are more likely to watch porn, masturbate and be hypersexual have:

• Elevated glutamate
• Brain inflammation – There is evidence that sex addicts (this counts of masturbation addicts as well) have higher tumor necrosis factor (TNF), with a strong correlation between TNF levels and high scores in hypersexuality rating scales.
• Elevated opioids (e.g. endorphins) – Naloxone, an opioid antagonist, can help reduce the impulsive and compulsive desire to watch porn and masturbate (R). 50mg daily can dramatically lower urges. As this patient said after only one week of use: “a measurable difference in sexual urges. I wasn’t being triggered all the time. It was like paradise.” (R) Sometimes up to 150-200mg daily is needed to really stop the opioid addiction drive.
• Heightened stress. Stress increases the release of CRH from the hypothalamus, which activates the stress cascade.
  • CRH plays a key role in the addiction processes. Men with hypersexual disorders have elevated CRH and have an insensitivity to the negative feedback of cortisol (R). This suggests HPA axis dysregulation in male patients with hypersexual disorder (R). CRH is also inflammatory in the brain and is involved in many mental disorders, such as depression, anxiety, fear, dementia, etc. Progesterone (by boosting allopregnanolone) is one of the body’s most potent CRH antagonists (R).
• Increased volume of the amygdala. In hypersexual subjects, increased activity and volume of the amygdala may reflect overlapping with addiction processes (particularly supporting incentive motivation theories) or be the consequence of chronic social stress mechanisms, such as the behavioral addiction itself. Dr. Ray Peat has long mentioned that excess libido is driven by estrogen. Here is some evidence to support that claim. Estrogen receptor alpha (ERα) is in complexes with heat-shock-proteins (hsp90, hsp70, and hsp56) predominantly in the amygdala (suggested to be involved in mood and cognition), hypothalamus (involved in learning and memory), and septum (R). This is very interesting because stress activates the heat shock proteins which should thus also activate the estrogen receptor (even in the absence of estrogen). Adaptogens such as Schisandra, Rhodiola, Eleuthero, etc, are able to lower estrogen receptors and “reduce” excess libido by quieting the excess activity of the amygdala.

This all makes sense that the excess/abnormal libido is driven by the stress metabolism. Everything mentioned above that’s involved in hypersexuality and porn and masturbation addiction is not normal.

For example, when a plant/animal is stressed it creates seeds much faster or desperately tries to find a mate to reproduce. It’s understandable for the survival of the species. People that are stressed from a young age go through puberty much sooner to make ready for reproduction to ensure the survival of the species. Most kids in the modern world go through puberty at around 12 or even younger, whereas the normal age for puberty starts at 16-18.

The porn snowball effect

The real issues with pornography and masturbation only started escalating after pornography became readily available, even to young boys, due to the internet. The internet has made freely available porn the new norm. Some guys start out all innocently, getting some posters of women in bikinis to hang up on their bedroom walls and/or download kinky PC wallpapers, follow a few celebs and lady friends on Instagram who love showing off their bodies with the least amount of clothes on. But sooner than later, this becomes quite normal for them and isn’t as arousing and doesn’t feel as “naughty” as it once did, because it becomes quite normal to them… they then want to see a little more and a little more; soft porn turns into hard porn and this leads to addiction in both porn and masturbation.

Heck, it doesn’t even have to be intentional. Social media is literally cluttered with soft porn and it’s nearly impossible not to see inappropriate content. That’s one of the biggest reasons why I, as a married man, only run my own business Facebook account and prefer that my wife helps me run my other social accounts so that I can just post but avoid any inappropriate content.

But back to the snowball effect… Through talking to the subjects, researchers discovered that high exposure to pornography videos resulted in lower responsivity and an increased need for more extreme, specialized, or “kinky” material to become aroused.

And the scary part is, the sooner you’re exposed to pornography the worse you’ll be off. The age of first exposure is significantly associated with:

• the need for longer stimulation and more sexual stimuli to reach orgasm when using pornography
• a decrease in sexual satisfaction
• decreased quality of a romantic relationship
• the neglect of basic needs and duties due to pornography use (in personal and professional life)

The highest odds ratios were always observed for age <12 years in reference to exposure at >16 years (R).

The internet’s unique properties of pornography (limitless novelty, the potential for easy escalation to more extreme material, video format, etc.) can desensitize men such a big way that their real-life experience is blunted and unsatisfying. This discourages sexual activity and reinforces the reliance on porn and masturbation.

It’s really a bad vicious cycle.

If a man is used to watching porn and he has low energy and motivation to begin with, he would rather take the easy route and watch “flawless” women online and masturbate, than wanting to do something with his “not so flawless” wife, which he first has to get in the mood.

Personal inhibition levels, social controls, and the lack of willing partners
and sexual scenes that may limit sexual activity in everyday contexts
are obsolete in cyberspace. It is easy for latent desires to be realized in
cyberspace. Internet sexuality may thus serve as a catalyst (p. 29)

Reference

This is a major reason why men keep on doing what they’re doing.

That is why it’s so important to stop watching porn to stop the stress metabolism (lower estrogen, opioids, glutamate, CRH, and inflammation and increase progesterone, thyroid, CO2, and androgens.). These two go together. If you don’t address the root cause, the stress metabolism, then stopping porn would be almost impossible as a person only has so much will-power. Fixing the metabolism will result in a significant reduction in the desire to binge on porn and masturbate. But while fixing the metabolism, it’s also important to willfully stop watching porn and masturbation.

Can porn and masturbation induced ED be reversed?

The answer is yes.

Here are just two of the many severe case reports which were written down in research papers.

An internet pornography user whose tastes had escalated to extreme hardcore pornography sought help for low sexual desire during partnered sex. Eight months after stopping all exposure to pornography the patient reported experiencing successful orgasm and ejaculation and succeeded in enjoying good sexual relations.

Reference

A second case report found:

…spending an excessive amount of time (5+ h a day) viewing online pornography for about six months. He reported that after he ceased using pornography his erectile dysfunction disappeared.

Reference

There are many more stories like this. As you can see it takes time to restore. Months if not sometimes years. It might seem like a long, even impossible journey, but it’s been done before, and anyone can do it if they really want to.

Everyone who reports stopping with pathological porn watching and masturbation reports a great improvement in general well-being as well as their relationships with others and their partner/spouse.

Why it’s best to quit

1. Marriage

Porn and masturbation has a negative effect on your marriage or any intimate relationship. This study found the following:

It reported that frequent pornography consumption at Wave 1 (2006) was strongly and negatively related with participants’ marital quality and satisfaction with their sex life at Wave 2 (2012). The marriages most negatively affected were those of men who were viewing pornography at the highest frequencies (once a day or more). Assessing multiple variables, the frequency of pornography use in 2006 was the second strongest predictor of poor marital quality in 2012.

Reference

And…

We found that the probability of divorce roughly doubled for married Americans who began pornography use between survey waves (N = 2,120; odds ratio = 2.19), and that this relationship held for both women and men. … Additional analyses also showed that the association between beginning pornography use and the probability of divorce was particularly strong among younger Americans, those who were less religious, and those who reported greater initial marital happiness.

Reference

And lastly…

Schneider’s (2000) study concluded that women “overwhelmingly” felt cyberaffairs were as emotionally painful to them as live or offline
affairs, and many viewed the online sexual activity to be just as much adultery or cheating as live affairs. As Bergner and Bridges (2002) identify, there is a consistent theme that surfaces in these women’s experiences and this is that their partner “has taken the most intimate aspect of the relationship, sexuality, which is supposed to express the bond of love between the couple and be confined exclusively to the relationship, and shared it with countless fantasy women”

Reference

In the long run (if a man is married and struggles with porn), it will cause his wife to feel betrayed, undesirable and worthless, and it will also give her a big reason to then start looking for another man because she feels she isn’t good enough for the one she has.

2. Libido changes and sexual dissatisfaction

Of those who consumed internet pornography more than once a week, 16% reported low sexual desire, compared with 0% in non-consumers (and 6% for those who consumed less than once a week) (R).

Masturbating to fantasies and especially pornography activates the exciting system, but leaves the satisfying system starved for “the real thing.”

Porn desensitizes men to reality and to the fake-ness of the porn-industry. Once sensitized to internet pornography, partnered sex no longer meets their conditioned expectations and no longer triggered the release of sufficient dopamine to produce and sustain erections. Human and animal studies suggest that when expectations are unmet, activity in the mesolimbic dopamine pathway is inhibited (R). Low dopamine = low motivation and a greater chance of ED.

Even viewing porn more than once a month can have negative effects (e.g. lower satisfaction), which only gets worse with frequency and intensity (R).

And as I mentioned before, it’s not just watching porn that’s the issue here, it’s masturbation as well. You don’t get sexual anxiety with your hand, but if you have an 80% erection with your partner, there’s a big chance you’ll get sexual anxiety. Thus most men prefer to masturbate instead of feeling embarrassed about their ED.

3. Brain alterations

Porn and masturbation addiction is like most other addictions. You get a spike in dopamine when indulging, but the addiction interferes with working memory performance, causes neuroplastic changes that reinforce use, and reduces grey matter volume in the brain (R).

Porn, and especially the more extreme and violent/distorted/unrealistic porn, distorts your view of women and in your psychology, you see them as sex objects and it will have a direct negative impact on your relationship with your spouse and with any other women you interact with.

4. Life alterations

I’ve worked with many men and seen that watching porn and masturbating is detrimental not only to their own health but also harms them physically, emotionally, spiritually, financially, etc., because it leaks through to every other part of a man’s life. It negatively affects most, if not all, aspects of one’s life. I personally experienced this before I met my wife. 

Watching porn isn’t anything a man can feel proud of and it makes you feel filthy and unworthy. That’s why most men do it in “secret”… Once you feel dirty and unworthy, you start avoiding others, attracting the wrong friends, and avoiding good ones…you start to compromise with other dirty things in life as well and this leads to a downward spiral.

Once you quit porn and masturbation, you’ll be surprised at how free and clean you start to feel. You’ll feel like you can succeed in life and start to get drive again.

It makes a person quite unproductive and replaces healthy and good habits that are worth the time and beneficial to one’s life. Countless men have actually lost multiple jobs due to low productivity because of excessive porn binging.

5. Loneliness

Results from our analyses revealed significant and positive associations between pornography use and loneliness for all three models.

Reference

This is most likely because men watch porn in secret and don’t want to be caught doing it. If you’re always trying to hide something, it can make you more introverted, trying to avoid others so they don’t discover your dirty secret. You might not feel like you’re withdrawing and trying to hide something because it’s a subconscious thing but others (especially women) will pick up on it.

To make it worse, some people, whether they’re religious or not, will usually feel guilty and beat themselves up for doing it, yet they don’t have the willpower to resist the urges.

Thus, someone who feels guilty and wants to hide things doesn’t have the kind of confidence that he’s meant to have.

Lastly, a decent woman can always sense if a man is addicted to porn… so if getting a decent woman is the goal, then she’ll only feel repelled by someone who is addicted to inappropriate images/material of sluts.

6. Penis alterations

With the increased frequency of masturbation, the sensitivity of the penis can decline and lead to a vicious cycle where the man increases masturbation force to counteract the declining sensitivity, therefore leading to worsening sensitivity/ED/delayed orgasm (R).

Thus sex isn’t as pleasurable and stimulating as it should be because your body is more used to your hand doing the work and is used to being “rough handled” (which is also backed up by science).

7. Hormone alterations

Masturbation induces a lower increase in prolactin than intercourse orgasm, which prevents the “satisfaction” of an orgasm (R, R). This is why some men become compulsive masturbators because they just don’t get satisfied enough.

Although orgasms achieved via masturbation don’t alter plasma testosterone, higher testosterone concentrations are observed following the period of abstinence (R).

Furthermore, masturbation induced orgasms don’t increase endorphins, progesterone, estrogen, growth hormone, testosterone, etc. (R, R)

Masturbation orgasm stimulates the release of 2-arachidonoylglycerol, which is an endocannabinoid receptor agonist, involved in addiction (R).

Interestingly, cannabis can increase arousal to erotic stimuli by stimulating dopamine release, but only in individuals with low prolactin (R).

Watching porn causes a rush of dopamine, but then the brain immediately builds a tolerance and you quickly have to look at more and worse in order for the brain to release the same amount of dopamine. This, however, doesn’t happen in a committed sexual relationship with your partner.

This low dopamine state can make internet pornography users become sensitized to cues that are unrelated to sexual content. Here is something hilarious that Dr. Ray Peat said about that (R: 1:19;50):

“It’s irrational if you’re excited by a shoe or a toad or something irrelevant.”

It comes down to being hypersexual for no good reason, or without the proper stimuli, such as a spouse, isn’t normal.

And the more you train yourself to be hypersexual, or to have “high libido” for no reason, then you reinforce that pattern with physical changes in the brain.

A few additional reasons to quit

The effects of repeated exposure to standard, non-violent, and commonly available pornography included (R):

• increased callousness toward women
• trivialization of rape as a criminal offense
• distorted perceptions about sexuality – seeing sex as an act and not an experience. Women become an object.
• increased appetite for more deviant and bizarre types of pornography (escalation and addiction)
• decreased sexual curiosity (with your spouse)
• devaluation of the importance of monogamy
• decreased satisfaction with a partner’s sexual performance, affection, and physical appearance
• doubts about the value of marriage
• decreased desire to have children
• viewing non-monogamous relationships as normal and as a natural behavior
• behavioral and sexual aggression
• increase risk of compulsive masturbation, which leads to ED
• the repulsion of spouses. Spouses of pornography users often report being repulsed by the user’s sexual pursuits (R).

Here are some common things that happen when men watch porn and masturbate (R):

1. The user makes excuses to avoid sexual intimacy with the partner (e.g., not in the mood or too tired).
2. The partner feels hurt, angry, sexually rejected, inadequate, and unable to compete with images and sexy online women (or men) who are willing to do “anything.”
3. During relational sex, the porn user appears distant, emotionally detached, and interested only in his or her own pleasure.
4. The spouse/partner ends up doing most of all of the initiating; either to get their own needs met or in an attempt to get the user to decrease the online activities.
5. The user blames the partner for their sexual problems.
6. The user wants the partner to participate in sexual activities that she or he finds objectionable.

How to stop?

There are certain neurological and brain physiological similarities amongst addicted individuals, such as brain inflammation, elevated CRH, glutamate, serotonin, opioids, endocannabinoids and hypersensitivity to these systems.

So our goal is to lower these and reduce their hypersensitivities.

• Opioid receptor antagonism
  • Medium roast coffee contains the highest amount of an opioid antagonist
  • 100-200mg naloxone daily until symptoms/desires normalize
• Glutamate antagonism
  • Magnesium
  • Zinc
  • Agmatine
  • Schisandra Sinensis
  • Theanine
  • Adamatane and its derivatives – memantine, amantadine, etc.
  • Turmeric
  • Panax ginseng
  • Ziziphus
  • Valerian root
  • Cat’s claw
  • Ginkgo Biloba
• Endocannabinoid system antagonism
  • Low polyunsaturated fat intake (both omega 3 & 6)
  • CBD oil
• HPA axis, especially CRH, antagonism
  • Schisandra Sinensis (R)
  • Rhodiola Rosea (R)
  • Tribulus Terrestris (R)
  • Tropical fruit juice mixture (pomegranate, white guava, and Roselle) (R)

Conclusion

Addiction manifests in a variety of ways and porn and masturbation are two of the most abused additions.

There are two ways to approach this and they go together. First, fix your metabolism and the second, stop watching porn and masturbation. Porn and masturbation work in a snowball effect so it’s best to stop cold turkey and never to look back (pun intended). If you relapse, don’t guilt-trip yourself into sickness, but realize that you should stop sooner than later before you get caught in the snowball effect again. If you relapse, don’t continue to indulge, but quit again.

My stack to break the addition would be:

• Naloxone
• Pregnenolone (and maybe progesterone as well if the pregnenolone isn’t enough)
• Niacinamide
• An adaptogen such as Schisandra Sinensis, Rhodiola Rosea or Tribulus Terrestris, or a blend, such as ADAPT-232.

If you liked this part of my erectile dysfunction article series and haven’t read the other parts yet, be sure to check them out as well:

• Part 1
• Part 2
• Part 3
• Part 4

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