Up to a third of young men now experience erectile dysfunction. Some are turning to extreme measures such as penile implants – but is kicking their pornography habit the only solution?

There is an ad campaign adorning the tunnels of the London Underground bearing the slogan “ED IS DEAD” next to a photograph of a wholesome-looking man in his prime. “Don’t worry,” it says in smaller writing beneath. “Ed’s not a guy. It’s a guy thing. It’s short for erectile dysfunction.” The posters are promoting a new brand of sildenafil (most commonly known as Viagra), which we are supposed to think is slaying the problem. But, as it stands, ED is far from dead.

Viagra’s core market used to be older men in poor health, but according to a number of studies and surveys, between 14% and 35% of young men experience ED. “It’s crazy but true,” says Mary Sharpe of the Reward Foundation, an educational charity focusing on love, sex and the internet. “Until 2002, the incidence of men under 40 with ED was around 2-3%. Since 2008, when free-streaming, high-definition porn became so readily available, it has steadily risen.”

To date, the main contributors highlighted by academic studies of ED are poor physical health – the effects of weight, for instance, and high alcohol, tobacco or drug use – and mental-health issues including stress, anxiety, exhaustion and importantly, depression.

But a body of opinion is emerging that frequent exposure to pornography could also be a factor; proponents believe clinical and anecdotal evidence is mounting that links compulsive pornography use and ED. Studies of this are not yet extensive and results are mixed with some finding no connection.

Clare Faulkner, a psychosexual and relationship therapist based in central London, has seen pornography use as a factor in some ED presentations. “I now have ED clients in their early 20s,” she says. Part of the problem with pornography is that it is “a very dissociated experience. Stimulation is coming externally, which can make it very hard to be in your body.” It also perpetuates the myth, she says, that “men are rock hard and women are ready for sex all the time”.

Lone viewers of pornography become accustomed to being fully in control of their sexual experience – which again, says Faulkner, “isn’t replicated in the real world”. Being faced with a real, complicated human being, with needs and insecurities, could be deeply off-putting.

In online forums dedicated to porn-induced erectile dysfunction (PIED), tens of thousands of young men share their struggles to stop using pornography, their progression from soft porn to hardcore and the barriers they face in forming real-life romantic and sexual relationships. It is hard to prove outright that pornography causes ED, but these testimonies replicate findings from the clinical literature: that if men can kick their porn habit, they start to recover their ability to become aroused by real-life intimacy.

Some young men have started their own support movements, such as NoFap (slang for “no masturbating”), founded in the US by Alexander Rhodes. (Sharpe observes that young men now “equate masturbation with pornography – they don’t see them separately”.) Rhodes, now 29, started using internet pornography at around 11 or 12. “I was in the first generation of people who grew up on high-speed internet porn,” he said in a recent online discussion.

By the time he started having sex at 19, he continued: “I couldn’t maintain an erection without imagining porn. High-speed internet porn was my sex education.” Last year, he told an audience at an event hosted by the US’s National Center on Sexual Exploitation: “Children of the United States and much of the developed world are being funnelled through an online experience where exposure to pornography is practically mandatory.”

The young age at which Rhodes started watching pornography is not unusual. In 2016-17, a Middlesex University study of children aged 11 to 16 found that 48% had seen pornography online. Of this group, the vast majority, 94%, had seen such material by age 14.

with 60% of children having first watched it in their own homes. And an Irish study published earlier this year in the journal Porn Studies found that 52% of boys started using pornography for masturbation at the age of 13 or under. Social media can be a gateway, says Sharpe. “Porn stars have Instagram accounts so they’re getting kids to look at them on Instagram, and within their material they’ll say: ‘Look at my latest video.’ One or two clicks and you’re looking at hardcore porn. Kids of 12 or 13 aren’t supposed to be looking at hardcore adult material.”

The Reward Foundation isn’t an anti-pornography organisation, says Sharpe, “but excess porn is changing how children become sexually aroused”. And it is happening in their formative years, “at an age when they’re most vulnerable to mental health disorders and addictions. Most addictions and mental health disorders start in adolescence.” She and Faulkner believe that the rise in pornography use may at least partly explain why millennials are having less sex than the generation before them, according to a study published in the journal Archives of Sexual Behavior.

Gabe Deem, the founder of the pornography recovery group Reboot Nation, speaks openly about his own experiences. When he was 23, he said: “I tried to have sex with a beautiful girl, a woman I was extremely attracted to, and nothing happened. I couldn’t feel any physical arousal and couldn’t get the slightest bit of an erection.”

As with other addictions, says Faulkner: “People need stronger doses to get high. It’s always about pushing the boundaries to get the same excitement. Which means what they’re watching gets more hardcore and potentially frightening. I’ve had clients tell me they’re not comfortable with the material they’re watching.” When researchers study the brains of compulsive pornography users, says Sharpe: “They’re seeing the same brain changes that are common in all addictions.”

Some still dismiss the rise in ED among young men as performance anxiety, but Sharpe says while that may be true for some, “What we’re hearing from clinicians, sex therapists, doctors and people dealing with compulsive sexual behaviour is that more than 80% of issues are porn-related.” The Reward Foundation has been running workshops with healthcare practitioners across the UK and found that doctors and pharmacists don’t even consider asking their young male patients who have ED about their pornography use. “They’re giving them Viagra and that’s not working for many of them,” says Sharpe. “It’s not dealing with the underlying problem.”

When the drugs don’t work, Sharpe has heard of young men getting penile implants (prosthetics implanted in the penis to help erections). “One of the medical participants at one of our workshops last year said a patient had had two such implants.” No one had thought to ask him about pornography use.

On a recent school visit, Sharpe recalls, a teenage boy asked her how many times a day masturbating to porn was too many. “They’re using it all the time,” says Sharpe, “and nobody’s telling them it’s a problem.”

• This article was amended on 11, 15 and 21 March 2019. A figure of 93% for 14-year-olds said to have seen pornography online was replaced with correct Middlesex University study findings. Elsewhere, Alexander Rhodes’ age was corrected to 29 from 31, and it was made clear that the National Center on Sexual Exploitation’s role in an event was to host it, not stage it in-house. Additional information was inserted noting the mixed findings of study results.