A retired neurologists opinion

There's another forum I have visited lots in the past owned by a retired doctor of neurology. The forum is for people with anxiety and anxiety related symptoms, but since the owner is a neurologist, I thought I'd ask his opinion on porn-induced ED and what he has to say. I tried to be as objective as possible when asking my questions, not taking sides either way.

I'll admit right now that I may have presented some of the "facts" wrong, but since he's a doctor of over 40 years I'm certain he could figure out what I was trying to say. Jusst a note: the forum is an anxiety forum, so I do mention some anxiety-related things in this message. Anyway, my message was:

Hello Dr. ****,

This post might seem off-topic and out of the scope of this forum, but please bear with me because I do have some reasons for posting it that I think relate to anxiety, the nervous system and eventually leading back to symptoms related to the heart and palpitations.

Okay, so to start off with this will be unrelated. Lately I have noticed a problem with my sex drive and my ability to achieve erections. Alright, I know this is WAY out of the scope of this forum, but please bear with me here because you're the only neurologist I can actually contact and I do have a point. I've been, perhaps unwisely, Googling around. I remembered a 16 minute "TED Talks" video (http://www.youtube.com/watch?v=wSF82AwSDiU) I watched (and shrugged off) many months ago by a man named Gary Wilson, a science teacher of 20 years teching physiology and astronomy. He has a profile on Psychology Today (http://www.psychologytoday.com/experts/gary-wilson), where he contributes articles.

Gary Wilson claims that over the last 5-10 years (since the global use of high-speed Internet) there have been widespread cases of erectile dysfunction in young men who are addicted to pornography. He claims that there is a physical reason for the inability of the afflicted men to achieve an erection, and it is due to the brains "reward circuitry". He makes the argument that the brains of the addicted individuals have become desensitised to the sexual stimulation once provided and says that the individuals in question are constantly seeking novelty (new excitement), new levels of extremity and constant "thrills" such as new genres, fetishes, types of porography, or whatever.

The proposed mechanism of action is dopamine. Gary Wilson makes the case that dopamine is responsible for the arousal felt, and he claims that the synapses of nerve cells become desensitised to the effects of dopamine, thus meaning the affected men require new novelty and new ways to excite themselves in order to maintain dopamine levels and thus normal levels of sexual arousal. He says that because of the desensitisation, the men require more extreme pornography and more "buzz", thus addiction begins to set in. I belive he claims that this problem with dopamine is the reason why the addicted men struggle to achieve an erection with real sex and when masturbating without pornography.

I have to say right now that there is no scientific consensus and a significant lack of evidence to build a case on. Most of the evidence thus far is anecdotal and may be controdictory. I don't know anything about the science of the proposed mechanism of action and don't have a clue whehther or not Gary Wilson is promoting pseudoscience or is actually on to something. All I know is that I have realised that I too have had erectile problems, and I too have been slowly and slowly getting more addicted to pornography, sinking deeper and deeper in to more extreme genres/fetishes/thrills/whatever.

Gary Wilson says one of the effects of masturbation and pornography addiction is anxiety and mental health deterioration, of which I cannot elaborate on. Depression is something he hints at, social anxiety is also something he talked about.

So, my main point of posting this is because recently I had sex with a girl and couldn't even get it up to half way. Something is wrong with me because I'm only 24, and, I've not noticed it before, but I almost never achieve a complete and full erection anymore and when I do get it up, it's almost always forced up with more and more extreme visual stimulation.

Gary Wilson offers the only acceptable hypothesis I have been able to find and something I can relate to very closely. There is a "support forum" called "http://www.yourbrainrebalanced.com/" where men, mostly young men (30 and under), all have one thing in common: erectile dysfunction and pornography addiction.

So, back to this forum and anxiety. Dr. ****, do you think anything I have mentioned here is worth looking into any further? I DO have a problem getting it up quite regularly (I force erections with strong, forceful masturbation), I masturbate far too much (twice a day or more) and I have noted that my sexual tastes have slowly but surely degraded to the point where I cant "get off" to anything regular, it has long as its extremer than normal sex. Is it possible that the anxiety I have suffered with in the past is related to this addiction? Gary Wilson does not elaborate on the anxiety/depression side of his hypothesis, just claims that they are side-effects of the addiction and noted that most of the addicts had anxiety or depression.

I would also like to enquite about the dopamine issue Gary Wilson talks about. He says that physical addiction is cause by desensitivity to dopamine, which alters the brain structure in the reward circuitry. I am wondering if there may be something similar in anxiety sufferers? Similar in that, those who suffer are constantly seeking out new ways to protect themselves, new ways to "reward" themselves with relief. Health anxiety sufferers are always trying to get a new answer or a new perspective on their health. Is it possible that this "need" for assurance is related to dopamine and the reward circuitry in the brain? In other words, physical changes have taken place in the brain requiring more and more dopamine to provide the same levels of relief, thus requiring more and more questions, more and more health tests, more assurance, etc.?

I'll be frank and admit now that anxiety was not the reason I posted this thread and I actually wanted your opinion on the ED problem over anxiety. I also must apologise once again for posting something very off-topic and citing a long video (16m), a lengthy article and a 100 page PDF file (below). I don't expect you to read or watch any of it, I'm just not sure who else I can ask for guidance on this problem of mine.

Thank you for your time Doctor ****.

REFERENCES:

http://www.reuniting.info/download/pdf/TheGreatPornExp.pdf
http://www.yourbrainonporn.com/doing-what-you-evolved-to-do

 

His response:

Okay, well the theoretical premise proposed by this science lecturer is absolutely nothing more than the application of the well-known and studied neurological basis for drug addiction upon pornography addiction, which unfortunately is entirely unsupported by scientific fact with regard to the latter.

First of all, in the instance of sexual arousal dopamine is countered by the hormone prolactin, which produces the normally experienced sexual refractory period following sexual activity and climax. Dopamine initially acts upon the mesolimbic region of the brain to induce sexual arousal and pursuit of climax. Predilection mainly in the form of visual and tactile stimuli, augmented by olfactory, auditory and even gustatory sensory feedback can all work collectively to produce sexual arousal.

In most contexts, sexual arousal is commonly experienced via proximity to the source of one's predilections , ie the opposite sex or same sex. Arousal does, however, often arise in the absence of direct proximity and is derived purely by mentation which is supported by sensory stimuli of various types, pornography being the most common example with respect to visual feedback.

The problem in instances of diminished libido and erectile dysfunction which are not manifested secondary to underlying medical conditions is actually nothing more than the inadvertent voluntary influence over a basic human drive. This is really no different than the response observed in exerting voluntary influence over autonomic functions such as respiration or reflexive actions such as eye-blink. Human sexual arousal is a basic drive and it's parameters of response can be affected by intellectualization of the process. In other words, the natural responses of sexual arousal to stimuli of direct proximity become distorted within the context of more purely cognitive forms, which over time can become expansive and in some cases, extremely complex.

This exchange can sometimes result in extinguishing to variable extent the more archaic and fundamental mechanisms of sex drive. Realize that in animals, inclusive of man, the typical premise of estrus demonstrated in females will attract the male counterpart. In lower animal forms, the ensuing sexual courtship is quite reflexive in nature whereas in man it can be quite complex given the extent of social influences which play a role in human sexual attraction in a manner far more complex than in the lower animal forms.

I mention all of this to merely point out that if you substitute the normal parameters of sexual arousal in its natural context, then its ability to perform naturally often becomes impaired. The presence of anxiety also produces inhibitory effects upon physiological factors that control erectile function, which sets in motion an entirely different influence related to social standards of performance.

Thinking about the act of sex(intellectualization), rather than simply engaging in sex, produces the elements which rise to ultimately blunt the normal fundamental sex drive and performance capacity. In such instances, the intellectualization of the sex drive will produce the very same effects as other elements of life activity based upon the regions of the brain related to imagination, spatial imagery, etc.

In other words, sex becomes boring when it is intellectualized and falls prey to the influence more of the mind than the brain. The more intellectualized sex is, the more blunted the natural sexual drive becomes and thus, the greater the need for novelty to reproduce sexual arousal under guidance of the imagination rather than within the context of a basic drive.

None of the phenomenon being discussed here, however, will result in a neurochemistry imbalance. My suggestion here is to impart less cognitive engagement in sexual arousal and more effort toward allowing the normal sex drive to act of its own volition. Masturbation is entirely normal and the use of alternative stimuli only produces impairment when it becomes favored over the natural forms.

I see nothing of your dilemma to suggest that anything biological is a causal factor here.

Best regards,

********** ****, MD (ret.)

 

So, basically his answer is the usual drill we hear from doctors, that non-"medical" ED is just performance anxiety and we should just get over it and "relax and just do it"?

If only it was that simple.. it is 100% clear to me that porn-induced ED is something completely different from the "intellectualization" as the doctor just described it.

Unless masturbation to porn and fantasy multiple times a day for years is considered intellectualization of sex too.

 

for me i dont want to debunk the guy who will know more than me and this whole thing is new and we are really lab rats in all of this.

what i would point to though is one of the last lines in his reply:

'Masturbation is entirely normal and the use of alternative stimuli only produces impairment when it becomes favored over the natural forms'

this for me really is where the problem lies. i did not intend for this to happen but gradually it did happen without me noticing it

 

I'm not in a position to take sides right now, but I very much appreciate the doctor's opinions. He did say:

Which may be compelling because he is basically saying it is a problem when it becomes the favoured method of sexual activity. I also think this line is very interesting:

Being a neurologist, I would assume the doctor would know a little about the brain and nervous system. If he is saying pornography addiction is not able to result in a neurochemistry problem (i.e. a dopamine problem), I certainly can't disagree with his opinion. However, as a man of science and medicine, I'm certain if published works were available, he would be more than willing to change his position if the evidence suggested such an eventuality.

Again, I am not taking sides on this phenomenon for a number of reasons. Firstly to stay objective and fair, second because I haven't been abstaining from pornography long enough to see any benefits for myself and thirdly because there is in fact a profound lack of evidence in the medical literature. Of course there is always a lack of evidence for new discoveries, which is why I'm staying neutral.

Also, I appreciate your reply and experimental data Underdog. However, 1 man's word is not enough to sway the argument. How many people around here can claim to have recovered by way of avoiding porn, masturbation and orgasm?

 

This theory is just as credible as Gary's, and it's absolutely true there's not enough satisfactory evidence to make a definitive claim as to why porn addition and porn-induced ED occurs. This doctor doesn't appear to disagree with the notion that porn negatively affects sexual ability, but merely posits that the cause isn't rooted in actual neurological alterations but rather it's a replacement of natural sexual norms with artificial ones (essentially that it's rooted in behavioral, not physiological causes).

However, this doesn't change anything! Whether substantial neurochemical changes or environmental factors is the cause, the solution to the problem, addiction and the erectile dysfunction, would be to abstain from porn and adopt a natural sexual lifestyle. This doctor's theory doesn't devalue the rebooting process; rebooting is effective and there's enough empirical and anecdotal evidence to suggest this is true, but it's merely the theoretical framework that's open for debate.

To give a scientific analogy, think of when those who are hostile to science attempt to discredit evolution by stating it's "just a theory." Evolution by natural selection is a fact because it's supported by empirical evidence, but there are theoretical frameworks used as explanatory tools: that it happens is a fact, but why it happens is sometimes uncertain (we can't see precisely why certain animals evolved certain traits, but it's a fact that they did). So anti-intellectuals attempt to dismiss the fact as theory, which isn't the case. Likewise, in this case, this doctor is offering a different theoretical framework without dismissing the idea that ED does occur from pornography (he agrees that we can "become impaired"). It's true that animals simply engage in sex, whereas porn is an internalization; animals don't fantasize about sex, or seek sexual entertainment, they just do it. We're programmed to be the same way, and porn has disturbed the way we've evolved to have sex. The point is that adopting natural, healthy sexual habits is the cure. Whether or not one theory or the other is correct, or a combination of both, Gary is certainly a pioneer for empowering people to change (whether it's our brains or just our behavior that is changing).

 

Well he is unimformed on the latest findings on the subject and unfortunately does not know that even THE INTERNET physically changes our brains, (Facebook, Twitter, video games) so to say he can't see how the physiology of our brain can change while watching porn and having orgasms to it, and to fail to see how it can change our brain by causing "desensitization" is crazy to me!
He needs to get caught up in the field of neuroscience.

Now, I could not get an erection with a perfect looking girl in real life, I could not get an erection to my imagination and hand no matter how hard I tried! But after 6 months of no porn and masturbation I could.

If the Internet changes brains, only someone who is ignorant would say porn and masturbation doesn't. A "retired" neurologist probably doesn't spend his time keeping up with the field of study. As Gary Wilson points out all addictions change tha brain in the same major ways. So it would only be pseudoscience to suggest porn is the exception....

Give up porn people
Much love

 

OK cool. does this mean I can PMO as per usual?

 

Gabe, I happen to know the doctor is in fact active in the field of neurology. Retired perhaps, but not inactive. You have made a bold claim that he needs to "catch up in the field of neurology", and some unfounded assertions:

I would like to invite the doctor to participate in this discussion. I'm doubtful he will entertain debate on this message board with us laymen, but I'll request he join and perhaps Gary Wilson himself could join in too offering any current research, evidence and documented data? That would be an interesting discussion to see.

 

I would love for him to join.
However i dont see my statement as a bold claim. I do not see how it can be said that "None of the phenomenon being discussed here, however, will result in a neurochemistry imbalance." To me, that is a bold claim, in light of the fact that the Internet has been proven to cause a "neurochemistry imbalance" involving our brains reward circuitry and dopaminergic system.

If surfing Facebook can cause desensitization to dopamine, surfing porn will too.

 

All of us are CLEARLY suffering from these very ailments. How can they be denied?

 

The way I understood what the neurologist said in this context is perhaps different
[quote] My suggestion here is to impart less cognitive engagement in sexual arousal and more effort toward allowing the normal sex drive to act of its own volition.[/quote]

From what I understood he says here is that we should decrease the amount of arousal spent on artificial stimuli, in other words we allow our brains to overpower our receptors with intense arousal with porn instead of real women.

The last part of his sentence is interesting,(allowing more effort for the normal sex drive to act on its own compared to cognitive (i.e. porn)) he's suggesting us porn addicts had too much of a good thing(which lets face it, we have) and that we engage in sexual arousal because of the opportunity to do so (which is multiple times a day almost everyday, at least for me)

I don't know the statistics on other males that don't have a problem with porn induced ED but I'm wondering what their PMO schedules are like. Is it everyday? or every week?

 

I'll be honest - reading the description of my "hypothesis", and the non-answer by the neurologist left me feeling cold.

(Warning - all the article posted have multiple links to citations. If the links go to our articles - those articles contain citations.)

First, my TED talk is not really about porn-induced ED, and my hypothesis for porn-induced ED is addiction, not dopamine. Porn-induced ED is far more than desensitization, as it involves multiple addiction-related brain changes, and alterations in the hypothalamic erection centers which run on dopamine D2 receptors.

I also have written articles about the neurobiology of porn addiction and social anxiety. Please see - Porn, Masturbation and Mojo: A Neuroscience Perspective - Ex-porn users usually get their mojo back. Why?
http://www.yourbrainonporn.com/porn-masturbation-and-mojo-neuroscience-perspective


Here's what you should have given the neurologist. Really get that unless your specialty is addiction, you may have no clue about addiction neurobiology - whether you are a neurologist or not.

This is a new phenomenon, which he has never heard of, so he equates it with MASTURBATION. That's all he knows. His answer had nothing to do with "my hypothesis", since his doesn't include, high speed internet porn, neuroplasticity, addiction mechanisms, adolescent brain plasticity, or the neurobiology of erections.

A) the basics of behavioral addictions, and how Internet porn is unique
1) Start here for an overview of key concepts
http://www.yourbrainonporn.com/doing-what-you-evolved-to-do

2) Porn Then and Now: Welcome to Brain Training
http://www.yourbrainonporn.com/porn-then-and-now-welcome-to-brain-training

3) Porn, Pseudoscience and ΔFosB
http://www.yourbrainonporn.com/node/985

4) Porn, Novelty and the Coolidge Effect
http://www.yourbrainonporn.com/porn-novelty-and-the-coolidge-effect

B) How the adolescent brain is unique, plasticity and sexual conditioning
1) Sexual brain training matters—especially during adolescence
http://yourbrainonporn.com/why-shouldnt-johnny-watch-porn-if-he-likes

2) Is Internet porn making male sexuality more plastic?
http://www.yourbrainonporn.com/can-you-trust-your-johnson

C) Then all the neuroscience confirming these brain changes in Internet addictions (25 brain studies)
1) Recent Internet Addiction Brain Studies Include Porn
http://www.yourbrainonporn.com/node/858

D) The experts stating that sexual behavior addictions exist:
1) Toss Your Textbooks: Docs Redefine Sexual Behavior Addictions
http://yourbrainonporn.com/toss-your-textbooks-docs-redefine-sexual-behavior-addictions



Only after reading the above can we start the discussion. Let's talk about ED

This is our most important article about porn induced-ED and its focus is sensitization, NOT desensitization. We had Eric Nestler read this article, and he gave his OK to it. He is one of the top five addiction neuroscientists in the world. See - http://en.wikipedia.org/wiki/Eric_J._Nestler

1) Why Do I Find Porn More Exciting Than A Partner?
http://www.yourbrainonporn.com/why-do-i-find-porn-more-exciting-partner

This is our very popular PT post, which has almost 900,000 reads even though it was buried by Psychology today.
1) Porn-Induced Sexual Dysfunction Is A Growing Problem
http://yourbrainonporn.com/porn-induced-sexual-dysfunction-is-growing-problem

Please note that the Italian Society of Andrology and Sexual Medicine agrees with us.



Here's what I say to doubters:

First, the Italian Society of Andrology and Sexual Medicine (SIAMS) states that porn-induced ED exists. The largest urology organization in Italy is the one and ONLY group of medical doctors to study this emerging phenomenon. More importantly they cured it by having guys stop porn use for 2-3 months. However, we haven't relied on SIAMS as we were writing articles on porn-induced ED long before their statements went public. http://yourbrainonporn.com/too-much-internet-porn-may-cause-impotence

Second, naysayers suggest that we need "peer-reviewed studies" to confirm the existence, before we can make any claims. That's nonsense, as the only experiment possible is well under way - with thousands of results reported.

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).

However, there an ongoing experiment on porn-induced ED that is valid, reproducible, and empirical.

THE EXPERIMENT - UNEXPLAINED CHRONIC ED IN YOUNG MEN AND ALTERATION OF A SINGLE VARIABLE

The Subjects:

- Thousands of other-wise healthy young men, with only one variable in common: Years of masturbation to Internet porn.

- The subjects differ in backgrounds, ethnicity, diets, exercise regimens, religious beliefs, moral beliefs, country or origin, education, economic status, on & on.

- These young men cannot achieve an erection without porn use, and many can no longer achieve an erections with porn use.

- Most have seen multiple health care practitioners and all have tried a number of approaches with no results.

- Most state that they cannot believe that porn use could have caused ED. Some are very skeptical prior to starting their reboot.

The regimen:

All eliminate porn use.

Most (but not all) eliminate or drastically reduce the frequency of orgasms.

The results:

Nearly every subject reports a similar constellation of physical & psychological symptoms when the stop porn use/masturbation, a similar time-frame for the appearance of symptoms, and 2-5 months to regain erectile function. This indicates a very specific set of physical 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, sleeping abnormalities, restlessness, agitation, aches, pains, etc.

2) Within 1-2 weeks, most subjects experience what is called "the flatline": low libido, perceived changes in genital sensation or size.

3) The flatline slowly abates and men experience a gradual increase in libido, return morning erections, spontaneous erections, attraction to real partners, etc.

4) If the men stick to the regimen, nearly all regain erectile health.

5) Lengths of full recovery vary from a few weeks to a few months. Most are in the 2-4 months range for chronic, long standing ED.

Summary:

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 at its best.



Bottom line:

Naysayers (the neurologist) are unwilling to address the ACTUAL FACTS as described. In debating the existence of porn-induced ED, doubters go no further than this single fact:

1) Some healthy young guys who watch Internet porn develop ED - so "correlation does not equal causation".

They refuse to venture into the rest of the facts, such as:

2) All subjects had been using porn for years with no problems.

3) Few report any moral or religious misgivings, or guilt, surrounding their porn use.

4) Subjects experienced a gradual decline is sexual function - often over the course of years.

5) Most subjects had seen medical professionals, and had tried various therapies or regimens - with no success.

6) When they abstain, nearly all experience similar symptoms - which mimic withdrawal from an 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 & libido, the cause of their ED was unlikely to be porn use.)

8 - Men who regain erectile health, then return to regular porn use, experience a return of ED

 

Hmmm.

My feeling is that when professionals shoot from the hip, they aren't offering professional opinions... they're offering regular opinions. So with all due respect for this doctor, I don't think he offered a professional opinion; just a regular one.

He also made concessions for certain phenomena and patterns to surface, but rejected it for lack of evidence... however, I don't see how anyone can sensibly reject these ideas for lack of evidence since it is such a new phenomenon.

 

That's because there's no money in it.

I sound cynical I know, but now a days private and federal institutions and researchers will not throw money at research that wouldn't give them a return. Today's answer for porn induced ED is Viagra, I hear and see a lot of young folk around my age asking around for it. I'm a bit shocked and perplexed even though I'm suffering from porn induced ed, it still amazes me that this is an epidemic most people and researchers aren't giving serious consideration to what's causing their symptoms.

 

4th & 7th Chapter in Brain that Changes itself is enough to show that this thing exists (brain plasticity to porn). Remember, this book was first publishined in 2007. Perhaps our Dr should read this.

Edit:
Read 4th Chapter here:
http://www.reuniting.info/node/1808

 

Gary Wilson, thank you so much for that extremely thorough follow up.