Does Science Support PIED? (Part 2)

In Part One of our two-part series looking at the science behind PIED, we saw how repeated porn consumption rewrites our sexual template, decreasing our arousal by single sexual partners. In this post, we will explore the results of scientific studies that have occurred globally.

Does Science Support Porn-Induced Erectile Dysfunction? (Part 2)

Does Pornography Cause Erectile Dysfunction?

The use of pornography while also experiencing erectile dysfunction could simply be seen as correlated actions but not necessarily actions that show causation.

In other words, the correlation argument might say, “I’m a Christian who uses porn, which makes me feel horribly guilty, and I know it has hurt my relationship with my wife. All of this means our sex life is a mess, I’m constantly anxious that she might catch me, and I therefore I suffer from erectile dysfunction.”

Pornography use and erectile dysfunction are thereby correlated–they are connected and have some mutuality; but there are many other variables contributing to the erectile dysfunction.

But, what does the science prove? Let’s first establish some baseline figures for men prior to the creation of online, streaming pornography.

ED Rates Before Online, Streaming Porn

In 1999, a major cross-sectional study reported “trouble maintaining or achieving an erection” in 7% of men ages 18-29 in the United States. In 2002, a meta-analysis of 23 erectile dysfunction studies from Europe, the USA, Asia, and Australia reported consistent ED rates of 2% in men under 40 (except for the preceding study).

It is widely accepted that streaming pornography began in 2006. For reference, Pornhub, the largest pornographic website in terms of number of videos and viewers, launched in 2007.

ED Rates “A.T.” [After Tube]

Now that “tube” sites are the norm (sites that allow users to upload content), a 2016 study on Canadian adolescents showed that 45.3% admitted to problems in erectile functioning.

The Global Study of Sexual Attitudes and Behavior (GSSAB) administered a yes/no questionnaire about ED to 13,618 sexually active men in 29 countries in 2001-2002. This first group was aged 40-80.

A decade later, in 2011, the same “sexual difficulties” (yes/no) questionnaire from the GSSAB was administered to 2,737 sexually active men in Croatia, Norway, and Portugal. This second group was 40 and under.

Based on the findings of prior studies, one would predict the older men would have far higher ED scores than the younger men, whose scores should have been negligible. Not so. In just a decade, things had changed radically. The 2001-2002 ED rates for men 40-80 were about 13% in Europe. By 2011, ED rates in young Europeans, 18-40, ranged from 14-28%.

Although none of the content is peer-reviewed, an analysis of questions asked on “MedHelp.org ED Forums” showed that nearly 60% of visitors who mentioned their age, were younger than 25. “Porn” was the most prominent word used in the forum by these participants when describing their current erectile dysfunction situation.

Peer-Reviewed Analysis of Porn and Erectile Dysfunction

Still not convinced? Read some of the findings from these three peer-reviewed studies below. Additional peer-reviewed studies can be read at Gary Wilson’s YourBrainOnPorn.com.

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

In 2016, in Behavioral Sciences, an eight-member research team published the article, “Is Internet Pornography Causing Sexual Dysfunctions? A Review with Clinical Reports.” The abstract states: “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.

Their peer-reviewed work gathered the results of studies performed globally by counselors, urologists, psychologists, and sociologists. Some of the information scrutinized in the review included analysis of the following studies:

  • A 2015 study on men (mean 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.”
  • Kinsey Institute researchers were among the first to report pornography-induced erectile dysfunction and pornography-induced abnormally low libido, in 2007. Half of the subjects recruited from bars and bathhouses, where video pornography was “omnipresent,” were unable to achieve erections in the lab in response to video porn. Once more extreme types of porn were introduced, some were able to become sexually aroused. But, for a quarter of the subjects, no amount of variation in the genre of porn used caused sexual arousal.¹
  • A 2015 study of men (average age 41.5) seeking treatment for abnormally high libido (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.
  • In a 2014 functional MRI study, Dr. Valerie Voon, et al. found that when compulsive pornography users were shown sexually explicit films, they exhibited similar brain activity as substance abusers responding to drug cravings. Additionally, Voon et al.’s subjects (mean age 25) “had greater impairments of sexual arousal and erectile difficulties in intimate relationships but not with sexually explicit materials.”

One of the more fascinating steps taken by the review team was to intervene with three active servicemen who visited a Navy physician. Two saw a physician for their non-organic erectile dysfunction, low sexual desire, and unexplained difficulty in achieving orgasm with partners. The third visited for mental health reasons. Their ages were 20, 24, and 40. All three used pornography, masturbated regularly to porn, and found their female partners no longer sexually stimulating. All three were asked to remove or significantly decrease the amount of pornography consumed. In two of the servicemen, both saw their erectile dysfunction disappear. The third serviceman was not able to stop watching porn and was continuing to “work on his behavior on his own.”

According to the review team, “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 40.” A full explanation of the clinical experience can be found in section 2.0 of the review.

Italian Society of Andrology and Sexual Medicine

In 2011, the Italian Society of Andrology and Sexual Medicine (SIAMS), the largest urology organization in Italy, released results from a survey of 28,000 European men showing that young men who indulge in “excessive consumption” of Internet porn gradually become immune to explicit images.

Over time, these men experienced a loss of libido, impotence, and a notion of sex that is totally divorced from real-life relations.

“It starts with lower reactions to porn sites, then there is a general drop in libido and in the end it becomes impossible to get an erection,” said Carlo Foresta, head of the Italian Society of Andrology and Sexual Medicine (SIAM).

Many respondents became hooked on porn as early as 14, exhibiting symptoms of so-called “sexual anorexia” by the time they reached their mid-twenties.

In 2016, Dr. Foresta co-authored a study titled Adolescents and Web Porn: A New Era of Sexuality, which studied 1,492 teens entering their final year of high school and found “19% of overall pornography consumers report an abnormal sexual response, while the percentage rose to 25.1% among regular consumers.”

Related: Is Porn Use Causing Erectile Dysfunction in Teens and Young Men

French Study by Leading Sexologists

The top sexologists in Europe published a paper in 2016 whereby the current President of the European Federation of Sexology shared his clinical experience with 35 men who developed erectile dysfunction and/or anorgasmia, and his therapeutic approaches to help them.

The author states that most of his patients used porn, with several being addicted to porn. The results? “Initial results for these patients, after treatment to “unlearn” their masturbatory habits and their often associated addiction to pornography, are encouraging and promising. A reduction in symptoms was obtained in 19 patients out of 35. The dysfunctions regressed and these patients were able to enjoy satisfactory sexual activity.” In other words, they removed porn and regained the ability to have meaningful sex.

PIED Naysayers

In debating the existence of porn-induced ED, doubters make this point: “Some guys who watch Internet porn develop ED–so–correlation does not equal causation.”

According to Gary Wilson, the problem with that statement is it doesn’t address the rest of the facts, such as:

  1. All subjects had been using porn for years with no problems getting erections early on.
  2. Few report any moral or religious misgivings, or guilt, surrounding their porn use.
  3. Subjects experienced a gradual decline is sexual function, often over the course of years.
  4. Many subjects had seen medical professionals, and had tried various therapies or regimens, with no success.
  5. Subjects could not attain an erection without porn, but many could with porn.
  6. When they abstained, most subjects experienced similar psychological and physical symptoms, which mimic withdrawal from a substance addiction.
  7. The clincher: All had only one variable in common. When that single variable was removed (masturbation to porn)–nearly all regained erectile health. (If they did not regain erectile health and libido, the cause of their ED was likely not porn use.)
  8. Men who regain erectile health and then return to regular porn use, experience a return of ED, once again settling the issue of causation.

Nicole Prause and Jim Pfaus issued a manuscript in 2015 titled, “Viewing Sexual Stimuli Associated with Greater Sexual Responsiveness, Not Erectile Dysfunction,” where they attempted to show that pornography use actually increases male sexual responsiveness. A complete explanation of the critiques written in response to the manuscript can be found here.

The Largest Porn-Induced ED Study Is Happening Now!

If you skim through the comments and forums hosted on Gary Wilson’s website, NoFap, or Reboot Nation, what you find is page after page of stories from men who are down, depressed, struggling, broken, confused, and wondering, “What’s wrong with my body? Why can’t I have sex with real women?”

For those who have decided to stop watching porn as a step in eliminating their erectile dysfunction, they are participating in the world’s largest scientific study on porn-induced erectile dysfunction. And, in the words of Gary Wilson, “This ongoing experiment examining porn-induced ED is valid, reproducible, and empirical.”

The Unofficial PIED Test Subjects

  • Participants of the unofficial study include thousands of otherwise healthy young men in their early 20s with only one variable in common: years of masturbation to Internet porn. (Covenant Eyes chronicled the stories of many of these men in the blog post: “Porn-Induced ED: Is It Possible?”)
  • The subjects differ in backgrounds, ethnicity, diets, exercise regimens, religious beliefs, moral beliefs, country of origin, education, and economic status.
  • These young men cannot achieve an erection without porn use, and gradually, some can no longer achieve an erection with porn use.
  • Many have seen multiple health-care practitioners, and most have tried a number of approaches to cure their copulatory ED with no results.
  • Most state that they cannot believe that porn use could have caused ED. Some are very skeptical prior to starting their experiment of giving up masturbation to porn.
  • The cause of their ED was not performance anxiety, as they failed to achieve full erections while attempting to masturbate without porn. Additionally, many subjects have no moral or religious misgivings about pornography, thereby eliminating guilt as a contributor to ED.

The PIED Recovery Regimen

  • All eliminate porn use.
  • Most (but not all) temporarily eliminate, or drastically reduce, the frequency of orgasms.
  • Some decide to add other positive behaviors like exercise into their routines.

The Unofficial PIED Recovery Results

Nearly every subject reports a similar constellation of physical and psychological symptoms when they stop porn use/masturbation, a similar time-frame for the appearance of symptoms such as agitation, cravings, complete loss of libido, gradual recovery, and need 2-6 months (or longer) to regain erectile function. This suggests a very specific set of physical brain changes, and not a psychological “issue.” The usual pattern of recovery is as follows:

  1. Subjects experience varying withdrawal symptoms that parallel drug/alcohol withdrawal, such as cravings, anxiety, lethargy, depression, brain fog, sleeping abnormalities, restlessness, agitation, aches, pains, etc.
  2. Within 1-2 weeks, most subjects experience what is called “the flatline”–low libido, and perceived changes in genital sensation or size.
  3. The flatline slowly abates and libido gradually increases, morning erections and spontaneous erections often show up, attraction to real partners increases, etc.
  4. Lengths of full recovery generally vary from a few weeks to over 12 months. Most are in the 2-9 month range for chronic, longstanding ED.

Summary of the PIED Experiment

Young healthy men, with unexplained ED and only one variable in common (Internet porn use), attempt multiple regimens and treatments with no success. The subjects remove the one variable they have in common and almost all experience the same results: remission of their medical condition.

That’s an experiment with unequivocal results. This is empirical evidence.

Conclusion: Does Science Support Porn as a Cause of Erectile Dysfunction?

We believe the answer is yes. Naysayers suggest the need for “peer-reviewed studies” to confirm the existence of porn-related ED before we can say it exists. YourBrainOnPorn.com is accumulating those here. However, according to Mr. Wilson, “It’s painfully obvious that no researcher can conduct a study where one group of young healthy men use Internet porn for 10 years, and a comparable control group does not, with erectile function assessed through masturbation to sensation only (no porn). There’s only one way to confirm whether erectile dysfunction is porn-induced (PIED) or not: Eliminate porn use for an extended period of time and see if the sufferer regains normal erectile functioning.”

In other words, it may be that the only possible experiment is well under way–with thousands of results now reported.

What do you think? Maybe you’ve read enough and it is time to learn about PIED solutions. Most guys who follow certain steps regain their ability to maintain an erection during partnered sex. Those who are most successful not only STOP a few habits but they also ADD a few new habits as part of the rewiring process.

Begin Your PIED Recovery Journey

Are you ready to begin your recovery from PIED? We’ve created a series of daily emails that will encourage you on your way to PIED recovery. It’s practical and it’s for anyone.

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Significant portions of this blog post have been provided by Gary Wilson, Founder of www.yourbrainonporn.com and author of Your Brain on Porn: Internet Pornography and the Emerging Science of Addiction.


¹Janssen, E.; Bancroft, J. The Dual-Control Model: The role of sexual inhibition & excitation in sexual arousal and behavior. In The Psychophysiology of Sex; Janssen, E., Ed.; Indiana University Press: Bloomington, IN, USA, 2007; pp. 197–222.