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Is Internet Pornography Causing Sexual Dysfunctions? A Review with Clinical Reports

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They tend to be young men, swamped and feeling they are drowning in the worldwide flood of internet porn. Since then revenues have halved. Not because there is less demand, but because the voracious appetite is being fed by free online porn. One in four internet search engine requests is for sexually explicit material, an estimated 68 million porn searches every day. It is predominantly, but by no means exclusively, the domain of men. And it is just a click of the mouse away, no matter what age, gender or orientation the searcher.

On average, boys are first exposed to porn by the age of For girls it is a year or two later. Others believe it is quite a bit higher. Porn is now thoroughly mainstream among the unders. Grant, Richard and Tom [not their real names] are all typical-looking students at the University of Otago.

Richard has shoulder-length hair and the start of a beard. The other two are clean-shaven with short back and sides. They are a little taken aback when approached at random in Dunedin's George St with questions about young people and porn.

After a few shy smirks and sideways glances at each other, they agree to talk honestly if their names are not used. Each is from a different part of New Zealand, but all have been regularly viewing porn online since they were about 16 years old.

It is pretty much the same story with most guys they know. None are in a relationship, although Richard was dating someone during the summer holidays. The three friends view porn four or five times a week, usually for 15 to 20 minutes before going to bed. The frequency can increase, however, if they are hung over or stressed. Masturbation is always part of the package. During five years of consuming porn they have noticed a marked increase in the image quality and the variety of what is out there.

They are not aware of experiencing any specific negative impacts of fapping. Does that mean he asks partners to do things he has seen online? And I realise it won't be up to that standard. But kind of expecting it,'' he replies. University of Otago Associate Professor Jesse Bering says today's porn is different from that of pre-digital days in three fundamental ways.

Prof Bering, who has written several books on sexuality, says the ''modern urbanisation'' of porn has been made possible by the ''triple A effect: But with an dizzying variety of porn now on tap, and repeated ''hits'' of the brain's pleasure chemical dopamine able to be self-administered with each click of the mouse, the spectre of porn addiction is looming large. The notion is still controversial in some quarters, Prof Bering says.

Some porn users seem unable to ''ration or balance their use judiciously''. But for most people the occasional, or even more than occasional, viewing of porn ''isn't terribly worrisome'', he says. But she is deeply concerned about the negative impact she sees porn having on young people's attitudes to sex, women and relationships. Take, for example, this month's hugely popular film adaptation of the bestseller 50 Shades of Grey.

The aim was to explore the notion of respectful, healthy relationships. And I heard what they said. Mrs Munro stopped and asked what made them think girls liked that. We've seen it,'' they replied. Porn is an informal but formative educator that is no respecter of social or economic boundaries. With pupils now encouraged to bring their own internet-capable devices to school, the risk of first time and repeat exposure to porn is high. Because its impact is already pervasive, porn should be discussed as part of secondary school sexuality education which addresses healthy, respectful relationships, Mrs Munro believes.

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Parents themselves don't know how to handle it,'' she says. Each school develops its own health programmes in consultation with its communities, he says.

This month, national guidelines were issued to clarify teachers' rights if they caught pupils using digital technology inappropriately. For example, it provides no statistical results for the erectile function outcome measure in relation to Internet pornography use.

Additionally, the researchers investigated only hours of Internet pornography use in the last month.

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A better predictor is subjective sexual arousal ratings while watching Internet pornography cue reactivityan established correlate of addictive behavior in all addictions [ 525354 ]. There is also increasing evidence that the amount of time spent on Internet video-gaming does not predict addictive behavior. 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 ].

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. 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.

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.

Clinical Reports While correlation studies are easier to conduct, the difficulty in isolating the precise variables at work in the unprecedented rise of sexual dysfunction in men under 40 suggests that intervention studies in which subjects removed the variable of Internet pornography use would better establish whether there is a connection between its use and sexual difficulties. The following clinical reports demonstrate how asking patients with diverse and otherwise unexplained dysfunctions to eradicate Internet pornography use helps to isolate its effects on sexual difficulties.

Below we report on three active duty servicemen. Two saw a physician for their non-organic erectile dysfunction, low sexual desire, and unexplained difficulty in achieving orgasm with partners. The first mentioned variables 16 and 7listed in the preceding paragraph. The second mentioned 6 and 7. Both were free of mental health diagnoses.

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We also report a third active duty serviceman who saw a physician for mental health reasons. He mentioned variable 6. First Clinical Report A year old active duty enlisted Caucasian serviceman presented with difficulties achieving orgasm during intercourse for the previous six months.

It first happened while he was deployed overseas. He was masturbating for about an hour without an orgasm, and his penis went flaccid.

Is Internet Pornography Causing Sexual Dysfunctions? A Review with Clinical Reports

His difficulties maintaining erection and achieving orgasm continued throughout his deployment. He could achieve an erection but could not orgasm, and after 10—15 min he would lose his erection, which was not the case prior to his having ED issues.

He endorsed viewing Internet pornography for stimulation. Since he gained access to high-speed Internet, he relied solely on Internet pornography. However, gradually he needed more graphic or fetish material to orgasm. He reported opening multiple videos simultaneously and watching the most stimulating parts.

When preparing for deployment about a year ago, he was worried about being away from partnered sex. This device was initially so stimulating that he reached orgasm within minutes. However, as was the case with Internet pornography, with increased use, he needed longer and longer to ejaculate, and eventually he was unable to orgasm at all.

Since returning from deployment, he reported continued masturbation one or more times per day using both Internet pornography and toy. He denied any other relationship issues. She was starting to think that he was no longer attracted to her. Medically, he had no history of major illness, surgery, or mental health diagnoses. He was not taking any medications or supplements.

He denied using tobacco products but drank a few drinks at parties once or twice a month. He had never blacked out from alcohol intoxication.

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He denied a history of sexually transmitted diseases. On physical examination, his vital signs were all normal, and his genital exam was normal appearing without lesions or masses.

At the conclusion of the visit, it was explained to him that use of a sex toy had potentially desensitized his penile nerves and watching hardcore Internet pornography had altered his threshold for sexual stimulation. He was advised to stop using the toy and watching hardcore Internet pornography.

He was referred to urology for further evaluation. By the time he was seen by the urologist a few weeks later, he had cut down on Internet pornography use significantly, although he said he could not completely stop.

He ceased using the toy. Second Clinical Report A year old African American enlisted serviceman with 17 years of continuous active duty presented with difficulty achieving erections for the previous three months.

He reported that when he attempted to have sexual intercourse with his wife, he had difficulty achieving an erection and difficulty maintaining it long enough to orgasm. Ever since their youngest child left for college, six months earlier, he had found himself masturbating more often due to increased privacy. He formerly masturbated every other week on average, but that increased to two to three times per week.

He had always used Internet pornography, but the more often he used it, the longer it took to orgasm with his usual material. This led to him using more graphic material. He denied ever having these issues earlier in the seven years of their marriage.

He was having marital issues because his wife suspected he was having an affair, which he adamantly denied.

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His medical history was only significant for hypertension, which was diagnosed more than two years earlier and had been well controlled with a diuretic: He took no other medications or supplements.

His only surgery was an appendectomy performed three years prior. He had no sexually transmitted diseases or mental health diagnoses. He endorsed smoking three packs of cigarettes per week for over ten years and drinking one to two drinks per week.

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Physical exam revealed vital signs within normal ranges, normal cardiovascular exam, and normal appearing genitals without lesions or masses. At the end of the exam, his issues were attributed to heightened sexual stimulation threshold from exposure to hardcore Internet pornography and frequent masturbation. He was advised to stop watching hardcore Internet pornography and decrease masturbation frequency. He said whenever he was home alone, he found himself watching Internet pornography, which would eventually lead to masturbation.

He was offered a referral to sex behavioral therapy, but he declined. He wanted to try to work on his behavior on his own. Third Clinical Report A year old junior Enlisted Sailor was admitted to the inpatient mental health unit after a suicide attempt by overdose. During his evaluation and treatment he admitted to drinking alcohol even though he was advised to not use alcohol while being treated with antidepressant medications. His history and increasing tolerance were consistent with mild Alcohol Use Disorder due to his use while taking antidepressants.

As part of the addictions portion of his history he was asked about gambling, Internet gaming and pornography addiction. He also realized that he had diminished sexual interest in his wife, manifested by his inability to maintain sustained erections, preferring to view pornography where he had no erectile issues. When he became aware of his excessive use of pornography, he stopped viewing it completely, telling his interviewer he was afraid that if he viewed it to any extent he would find himself overusing it again.

He reported that after he ceased using pornography his erectile dysfunction disappeared. In summary, intervention studies designed to reveal causation by removing the variable of Internet pornography use are much needed to investigate unexplained sexual difficulties in Internet pornography users under Male Sexual Response in the Brain While male sexual response is complex, several key brain regions are critical for achieving and maintaining erections [ 61 ].

Hypothalamic nuclei play an important role in regulating sexual behavior and erections by acting as an integration center for brain and peripheral input [ 62 ]. The hypothalamic nuclei that facilitate erections receive pro-erectile input from the mesolimbic dopamine pathway, which comprises the ventral tegmental area VTA and the nucleus accumbens NAc [ 62 ].

Erections are dependent upon activation of dopaminergic neurons in VTA and dopamine receptors in the NAc [ 6566 ]. Excitatory glutamate inputs from other limbic structures amygdala, hippocampus and the prefrontal cortex facilitate dopaminergic activity in the VTA and NAc [ 62 ].

Reward responsive dopamine neurons also project into the dorsal striatum, a region activated during sexual arousal and penile tumescence [ 67 ]. Dopamine agonists, such as apomorphine, have been shown to induce erection in men with both normal and impaired erectile function [ 68 ].

Thus, dopamine signaling in the reward system and hypothalamus plays a central role in sexual arousal, sexual motivation and penile erections [ 656669 ]. We propose that chronic Internet pornography use resulted in erectile dysfunction and delayed ejaculation in our servicemen reported above. We hypothesize an etiology arising in part from Internet pornography-induced alterations in the circuits governing sexual desire and penile erections. These two brain changes are consistent with chronic overconsumption of both natural rewards and drugs of abuse, and are mediated by dopamine surges in the reward system [ 707172 ].

Internet Pornography as Supernormal Stimulus Arguably, the most important development in the field of problematic sexual behavior is the way in which the Internet is influencing and facilitating compulsive sexual behavior [ 73 ].

Sexually explicit material has been around for a long time, but 1 video pornography is significantly more sexually arousing than other forms of pornography [ 7677 ] or fantasy [ 78 ]; 2 novel sexual visuals have been shown to trigger greater arousal, faster ejaculation, and more semen and erection activity compared with familiar material, perhaps because attention to potential novel mates and arousal served reproductive fitness [ 75798081828384 ]; and 3 the ability to self-select material with ease makes Internet pornography more arousing than pre-selected collections [ 79 ].

A pornography user can maintain or heighten sexual arousal by instantly clicking to a novel scene, new video or never encountered genre. Novelty registers as salient, enhances reward value, and has lasting effects on motivation, learning and memory [ 85 ]. Like sexual motivation and the rewarding properties of sexual interaction, novelty is compelling because it triggers bursts of dopamine in regions of the brain strongly associated with reward and goal-directed behavior [ 66 ].

While compulsive Internet pornography users show stronger preference for novel sexual images than healthy controls, their dACC dorsal anterior cingulate cortex also shows more rapid habituation to images than healthy controls [ 86 ], fueling the search for more novel sexual images. Anxiety, which has been shown to increase sexual arousal [ 8994 ], may also accompany Internet pornography use. In short, Internet pornography offers all of these qualities, which register as salient, stimulate dopamine bursts, and enhance sexual arousal.

Internet Pornography Use as Self-Reinforcing Activity As the reward system encourages organisms to remember and repeat critical behaviors, such as sex, eating, and socializing, chronic Internet pornography use may become a self-reinforcing activity [ 95 ]. Several lines of research have begun to elucidate the overlap in the neural substrates of sexual learning and addiction []. For example, sexual behaviors and addictive drugs activate the same sets of neurons within the same reward system structures NAc, basolateral amygdala, anterior cingulated area [ ].

In contrast, very little overlap exists between other natural rewards food, water and addictive drugs, such as cocaine and methamphetamine [ ].

Thus, methamphetamine use recruits the same mechanisms and neural substrates as does the natural reward of sexual stimulation [ ].

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In another study, cocaine addicts had nearly identical brain activation patterns when viewing pornography and cues related to their addiction, but brain activation patterns when viewing nature scenes were completely different [ ]. Furthermore, both repeated sexual behaviors and repeated psychostimulant administration induce up regulation of Delta FosB, a transcription factor that promotes several neuroplastic changes that sensitize the mesolimbic dopamine system to the activity in question [ ].

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In both addictive drug use and sexual reward, this up regulation in the same NAc neurons is mediated via dopamine receptors [ ]. This process renders the individual hyper-sensitized to stimuli associated with the activity increased incentive salience [ ].