BOSTON — Men who are obsessed with pornography and prefer masturbation to sexual intercourse appear to be at increased risk for erectile dysfunction, a new study suggests.

Although these results need validation, urologists and other clinicians who treat men with erectile dysfunction and other forms of sexual dysfunction should ask patients about their use of pornography, and potentially recommend abstention, said Matthew Christman, MD, a urologist at the Naval Medical Center San Diego, California.

"The latest version of the Diagnostic Statistical Manual of Mental Disorders has added internet gaming disorder. Internet porn has been shown in studies to be more addictive than internet gaming," so it doesn't seem to be much of a stretch to add something related to internet pornography use, said Dr Christman at a press briefing here at the American Urological Association (AUA) 2017 Annual Meeting.

A 2014 US armed forces health surveillance survey found that rates of erectile dysfunction had more than doubled during the preceding decade, from about 6 per 1000 person-years to about 13 per 1000 person-years, he reported. This increase was primarily accounted for by an increase in the incidence of psychogenic, rather than organic, erectile dysfunction, and coincided with the growth of pornography on the internet.

Web sites dedicated to pornography videos were first identified in 2006, "and soon after that, Kinsey Institute researchers became the first group to really identify what they describe as 'pornography-induced erectile dysfunction,' " said Dr Christman.

Various research groups have postulated that sexual behavior acts on the same circuitry in the brain as addictive substances, and that internet pornography is a particularly strong stimulus of that circuitry. It is postulated that internet pornography increases sensitivity to pornographic cues and decreases sensitivity to normal stimuli, he explained.

Probably not a shocker, but men viewed pornography more than women. Dr Matthew Christman

To see whether there is a correlation between addiction to pornography and sexual dysfunction, Dr Christman and coauthor Jonathan Berger, MD, also from the Naval Medical Center San Diego, used an anonymous survey that included questions about sexual function, preferences, and pornography use, as well as the usual demographic and medical history questions.

The survey was offered to 20- to 40-year-old patients who presented to their urology clinic.

A total of 439 men received questionnaires, and 314 (71.5%) responded. In all, 71 women were given the surveys, and 48 (68%) responded. The majority of both male and female responders were active-duty military (96.8% and 58%, respectively).

Men were evaluated for sexual function with the International Index of Erectile Function 15-item questionnaire, and women with the validated Female Sexual Function Index. Addiction to pornography was measured by two validated instruments: the Pornography Craving Questionnaire and the Obsessive Passion Scale.

"Probably not a shocker, but men viewed pornography more than women," Dr Christman said.

Among men, 81% reported viewing pornography at least some of the time compared with 38% of women (P ≤ .001)

There were no significant differences in the duration of pornography episodes, with the majority of both men and women reporting they used it for 15 minutes or less at a time.

Preferred sources for pornography were also similar for men and women, with internet porn on computers being the most common, followed by internet porn on telephones. Women reported using books more frequently than men.

In all, 27% of male respondents had sexual dysfunction, as defined by an International Index of Erectile Function score of 25 or less, and 52% of females had sexual dysfunction, as defined by a Female Sexual Function Index score of 26.55 or less.

When they looked at correlations between erectile dysfunction and preferences for pornography in men, the investigators found that the rate of dysfunction was lowest among the 85% of respondents who reported preferring intercourse without pornography (22%). The incidence of dysfunction increased in men who preferred intercourse with pornography (31%), and was highest among men who preferred masturbation with pornography (79%).

The finding was consistent across all five domains of the sexual dysfunction questionnaire: erection, orgasm, libido, intercourse satisfaction, and overall satisfaction.

There were no significant correlations between pornography use and sexual dysfunction in women, however.

Asked by Medscape Medical News whether a patient's use of pornography mattered clinically, Dr Christman replied that mental health providers at his center who have treated patients for pornography addiction have observed resolution of sexual dysfunction once those patients were able to curtail their pornography use.

I think these investigators are characterizing something that is a real clinical entity. Dr Joseph Alukal

"I think these investigators are characterizing something that is a real clinical entity," said Joseph Alukal, MD, director of male reproductive health at New York University in New York City and moderator of the briefing in which the data were presented.

"This research represents a beginning to asking this question of how we identify these people and treat them," he added.

"The clinical impact of erectile dysfunction is a common problem and a burdensome problem, so if this represents some subset of patients who have this common and burdensome problem, and we can treat them with an intervention as simple as 'you should doing behavior X,' that's important," he said in an interview with Medscape Medical News.

He routinely asks younger patients about pornography use and masturbation habits, and can confirm that for patients with a serious pornography habit, discontinuation can improve their sexual function, he said.

The study was internally supported. Dr Christman, Dr Berger, and Dr Alukal have disclosed no relevant financial relationships. Dr Christman stated that the views expressed in the presentation are those of the authors and do not reflect official policy or position of the US Navy, Department of Defense, or US government.

American Urological Association (AUA) 2017 Annual Meeting: Abstracts PD44-11 and PD69-12, Presented in a briefing May 12, 2017.

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