A team of urologists, neuroscientists and psychiatrists from the US Navy has reported in a new review published in Behavioral Sciences that sexual difficulties appear to be increasing sharply among young men (under 40) in recent years. For example, 15 years ago erectile dysfunction rates were negligible (2-5%) in sexually active men under 40. Now, researchers are reporting rates as high as 30% in this same age group. Many of these men are able to attain erections and ejaculate when viewing porn, but experience sexual dysfunctions (difficulty climaxing, low sexual desire, sexual dissatisfaction, ED) during partnered sex.

The rapid increase in sexual dysfunctions in men under 40 cannot be adequately explained by smoking, diabetes, obesity, or cardiovascular disease, factors commonly associated with such problems in older men. These factors have not increased proportionately. However, a major change in men's sexual environment has been the advent of streaming porn at the end of 2006.

Kinsey Institute researchers were among the first to report porn-induced erectile- dysfunction (PIED) and porn-induced abnormally low libido. In 2007, they noted that high exposure to pornography videos apparently resulted in lower sexual responsivity and an increased need for more extreme, specialized or "kinky" material to become aroused, but did not investigate further. More recently, a series of papers and various experts have pointed to a link between sexual difficulties and internet pornography use. These are discussed in the review.

This paper is important because it proposes an etiology (cause of disease) for how internet porn use could create problems even in healthy viewers, especially those who start using it during key developmental periods of puberty and adolescence. Research is showing that the younger the age at which men are first exposed to internet porn, the greater their preference for it over partnered sex, the less enjoyment they report from partnered sex, and the more porn they use. This suggests that today's internet porn may be conditioning sexuality in unanticipated ways, which in some men shows up as sexual dysfunctions during partnered sex and debilitating distress.

Citing extensive neuroscience research, the authors hypothesize that today's internet porn users may become hyper-reactive to porn-related cues, such that the motivational systems of the brain assign undue salience (importance) to porn. This, in turn, can set up what is called a "negative prediction error" when users engage in sex with a partner. This results in partnered sex failing to meet users' artificially induced expectations of endless novelty, a voyeur's perspective, particular acts, etc. If real sex, even with a desired partner, registers as disappointing in comparison with internet porn use, the sexual centers of the brain may not produce adequate neurochemical response to attain and maintain an erection or climax without difficulty.

Research shows that video erotica is more arousing than still images, and novel sexual visuals trigger greater arousal, faster ejaculation, and more semen and erection activity compared with familiar material. The video format and endless novelty of internet porn not only make it potentially more compelling, but Cambridge researchers have also shown that novelty speeds habituation and tolerance in some porn users, which could fuel escalation to more extreme material. Indeed, a 2016 study reported that half of respondents had escalated to pornographic material that was once uninteresting.

The authors call for intervention studies, which would clarify whether the activity of internet porn viewing is potentially risky for some, otherwise healthy, users. Researchers have not yet asked groups of subjects to remove the variable of internet porn use to investigate its possible effects on sexual health, as the doctors did of their patients in clinical reports included in the review.

The authors also warn that healthcare providers should be cautious of assuming that poor mental health is the cause of otherwise unexplained sexual dysfunction in men under 40. If a man can achieve and sustain a satisfactory erection and climax as desired when masturbating without using internet porn, and only has difficulty when with a partner, his issue is likely be classic "performance anxiety," and not porn-related. However, if he cannot sustain an erection and climax without internet porn, he may want to take an extended timeout from porn use to see if his sexual difficulties clear up.

Without employing such a test, there is a risk of false diagnoses of "performance anxiety," and a risk of prescribing needless psychoactive medications and phosphodiesterase-5 inhibitors, such as Viagra® or Cialis®. The latter may ultimately not provide relief of symptoms if the underlying cause of the dysfunction has not been addressed.

Article:Is Internet Pornography Causing Sexual Dysfunctions? A Review with Clinical Reports, Brian Y. Park, Gary Wilson, Jonathan Berger, Matthew Christman, Bryn Reina, Frank Bishop, Warren P. Klam and Andrew P. Doan, Behavioral Sciences, doi:10.3390/bs6030017, published 5 August 2016.