Abstract
Traditional factors that once explained men’s sexual difficulties appear insufficient to account for the sharp rise in erectile dysfunction, delayed ejaculation, decreased sexual satisfaction, and diminished libido during partnered sex in men under 40. This review (1) considers data from multiple domains, e.g., clinical, biological (addiction/urology), psychological (sexual conditioning), sociological; and (2) presents a series of clinical reports, all with the aim of proposing a possible direction for future research of this phenomenon. Alterations to the brain's motivational system are explored as a possible etiology underlying pornography-related sexual dysfunctions. This review also considers evidence that Internet pornography’s unique properties (limitless novelty, potential for easy escalation to more extreme material, video format, etc.) may be potent enough to condition sexual arousal to aspects of Internet pornography use that do not readily transition to real-life partners, such that sex with desired partners may not register as meeting expectations and arousal declines. Clinical reports suggest that terminating Internet pornography use is sometimes sufficient to reverse negative effects, underscoring the need for extensive investigation using methodologies that have subjects remove the variable of Internet pornography use. In the interim, a simple diagnostic protocol for assessing patients with porn-induced sexual dysfunction is put forth.
Highlights
We propose that chronic Internet pornography use resulted in erectile dysfunction and delayed ejaculation in our servicemen reported above
In line with the suggestion that some Internet pornography users’ reward systems may be hypoactive in response to partnered sex, a 2014 functional magnetic resonance imaging (fMRI) study of non-compulsive Internet pornography users by Kühn and Gallinat found that the right caudate of the striatum was smaller with more hours and years of Internet pornography viewing [134].The caudate appears to be involved in approach-attachment behaviors and is strongly implicated in motivational states associated with romantic love [164,165]
Both the literature and our clinical reports underscore the need for extensive investigation of Internet pornography's potential effects on users, ideally by having subjects remove the variable of Internet pornography in order to demonstrate potential effects of behavioral modification
Summary
Up until the last decade, rates of ED were low in sexually active men under 40, and did not begin to rise steeply until thereafter [1,2]. 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 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
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