Understanding Porn-Induced Erectile Dysfunction (PIED)

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A recently published study of 434 adult males has linked extensive use of pornography to sexual dysfunction. The research, conducted in Europe, looked in-depth at online sexual activities and their effects, asking participants about time spent engaging in online sexual behaviors, types of online sexual activity, masturbation in conjunction with online sexual behaviors, compulsivity (addictive tendencies) related to online sexual activity, reasons for engaging in online sexual behaviors, and consequences related to online sexual activity.

The investigative team found that test subjects spent an average of three hours per week with online sexual activity. Some of the men surveyed spent as little 5 minutes per week, while others engaged in online sexual behaviors as much as 33 hours per week. Unsurprisingly, the most common activity was looking at porn, a behavior engaged in by 99% of the study's participants.

Sexual pleasure was the most common reason for engaging in online sexual activity: 94.4% of test subjects listed sexual satisfaction, 87.2% listed feeling arousal, and 86.5% listed achieving orgasm as an impetus for use. Attempts at mood regulation were also common motivators, with 73.8% hoping to relax and decrease stress, 70.8% wanting to alleviate boredom, 53.0% trying to forget their daily problems, 44.9% looking to assuage loneliness, and 38.1% hoping to ease feelings of depression or sadness.

From the above numbers, it is clear that men usually have multiple motivations for engaging in online sexual behaviors, with escaping emotional discomfort playing almost as prominent a role as enjoyment of sex. Moreover, regression analysis showed that the strongest link between impetus to use and negative consequences was a desire to regulate mood. So men who engage in online sexual behaviors as a way to self-soothe emotional discomfort are more likely to experience problems than men who go online solely for sexual pleasure.

Overall, 27.6% of the subjects were assessed as "problematic" users of online sexual activity (based on self-assessments and a 12 item Internet Addiction Test adapted for online sexual behaviors). Most likely, using commonly accepted sexual addiction diagnostic criteria, not all of these men would qualify as addicted, but they would at least be assessed as "at risk."

For the study's problematic users, erectile dysfunction and lower overall sexual satisfaction were identified as common consequences. Interpreting this finding, the study's authors suggest that men with sexual dysfunction issues might be less confident in their sexual ability and therefore less able to perform and less sexually satisfied with real world partners (thus turning to porn and other online sexual behaviors as a way to avoid their problems).

However, I think a more likely hypothesis, developed based on recent neuroscientific studies and twenty-plus years of clinical work with heavy (often addicted) porn users, is that men who spend a high percentage of their sex lives looking at and masturbating to an endless and constantly changing stream of online imagery, inducing fresh bumps of dopamine and adrenaline with each new photo or video, may become conditioned to this continual sexual hyper-intensity. Thus, a lone real world partner, no matter how attractive and loving, simply cannot compete. And without the needed/desired/conditioned neurochemical rush, heavy porn users can (and often do) experience sexual dysfunction.

This is not the first time researchers have linked problematic porn use with sexual dysfunction. In 2003, an American study of male sex addicts found that 16.7% reported erectile dysfunction. In 2012, a British study of both male and female (though mostly male) sex addicts found that 26.7% reported issues with sexual dysfunction. In 2014, a European study of male sex addicts found that 58% reported issues with sexual dysfunction. (The difference between 2003 and the higher percentages reported in later studies is probably linked to the ever-increasing affordability and accessibility of online pornography.)

Based on research, clinical experience, and anecdotal evidence, I suggest that typical signs of porn-conditioned male sexual dysfunction include:

  • A man is able to get hard and have orgasms with porn, but he struggles with real world partners.
  • A man is able to have sex with real world partners, but orgasm takes a long time.
  • A man's real world partners complain that he seems disengaged during lovemaking (typically because he's replaying clips of porn in his mind as a way to stay hard and reach orgasm).
  • A man says he prefers porn sex to real world sex, finding online imagery more arousing and intense than an in-the-flesh partner.

Unfortunately, most of the men who struggle with PIED don't recognize the link between porn use and their real world relationship woes. Even when they say, "I don't understand what's wrong. I'm fine with porn, but with my girlfriend I just can't get it up," they are somehow unable (or unwilling) to make the connection.

The good news here is that when porn-conditioned men finally do recognize the link between their online sexual behaviors and their real world sexual dysfunction, they can step away from porn and usually within a month or two their dysfunction dissipates. When separated from porn, their brains slowly but steadily return to baseline.

For porn addicts, of course, stepping away is easier said than done. Typically, addicts cannot hope to stop and stay stopped for any meaningful length of time without external support, generally in the form either inpatient or outpatient sexual addiction treatment coupled with a sex addiction focused support group like Sex Addicts Anonymous, Sexual Compulsives Anonymous, Sex and Love Addicts Anonymous, or Sexaholics Anonymous. For those in need, therapist and treatment referrals can be found here and here; more general information about sex/porn addiction can be found here and here.

Robert Weiss LCSW, CSAT-S is Senior Vice President of National Clinical Development for Elements Behavioral Health, creating and overseeing addiction and mental health treatment programs for more than a dozen high-end treatment facilities. He is the author of several highly regarded books. For more information please visit his website at or follow him on Twitter, @RobWeissMSW.