Doctors Redefine Sexual Behavior Addictions

Logo: American Society of Addiction MedicineA major event has occurred in the realm of addiction science and treatment. America’s top addiction experts at The American Society of Addiction Medicine (ASAM) have just released their sweeping new definition of addiction. This new definition ends the debate over whether sex and porn addictions are “real addictions.” They are.

From the ASAM press release:

The new definition resulted from an intensive, four‐year process with more than 80 experts actively working on it, including top addiction authorities, addiction medicine clinicians and leading neuroscience researchers from across the country. … Two decades of advancements in neurosciences convinced ASAM that addiction needed to be redefined by what’s going on in the brain.

It’s likely ASAM acted, in part, because the psychiatrists who are revising the DSM (the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders) have been dragging their feet in bringing the upcoming DSM-5 into alignment with advances in behavioral addiction research. Traditionally, the DSM offers diagnoses based not on underlying disease, but on lists of behaviors. Since DSM authors can’t agree on a list of sexual behaviors that constitute “Hypersexuality Disorder” (which addresses compulsive porn use), they are hamstrung. In fact, they may banish the disorder to the appendix—right as Internet porn use among adolescent boys is becoming nearly universal.

In contrast, the ASAM definition, “looks at the role of the brain in the etiology of addiction—what is happening with brain functioning and specific brain circuitry that can explain the outward behaviors seen in addiction.” It is an acknowledgement that a sexual behavior (e.g., viewing Internet porn daily) may be evidence of pathology in one person’s brain without reflecting pathology in another’s.

Research shows that both behavioral and chemical addictions entail the same major alterations in brain anatomy and physiology. An ASAM spokesman explained:

The new definition leaves no doubt that all addictions—whether to alcohol, heroin or sex, say—are fundamentally the same. Dr. Raju Haleja, former president of the Canadian Society for Addiction Medicine and the chair of the ASAM committee that crafted the new definition, told The Fix, “We are looking at addiction as one disease, as opposed to those who see them as separate diseases. Addiction is addiction. It doesn’t matter what cranks your brain in that direction, once it has changed direction, you’re vulnerable to all addiction.” …Sex or gambling or food addiction [are] every bit as medically valid as addiction to alcohol or heroin or crystal meth.

Here is a brief summary of ASAM’s major points:

  1. Addiction reflects the same brain changes whether it arises in response to chemicals or behaviors.
  2. Addiction is a primary illness. It’s not necessarily caused by mental health issues such as mood or personality disorders. This puts to rest the popular notion that addictive behaviors are always a form of “self-medication” to ease other disorders.
  3. Both behavioral and substance addictions cause the same major changes in the same neural circuitry: Hypofrontality, sensitization, and desensitization.
  4. Engagement in chronic “addictive behaviors” indicates the above brain changes have occurred. Addictive behaviors then become unconscious and habitual.
  5. The new definition eradicates the old “addiction vs. compulsion” distinction, which was often used to deny the existence of behavioral addictions, including Internet porn addiction.

Unlike the brains of gambling, food, videogame addicts, the brains of sex/porn addicts have not yet been scanned. Yet the brain mechanics of behavioral addiction are already so well defined, that experts can say with confidence that sexual behaviors are also potentially addictive. In other words, it’s not the form or quantity of a stimulus, but rather the resulting brain changes, which matter. These excerpts from ASAM’s FAQs explain the science common to all addiction:

QUESTION: What’s different about this new definition?

ANSWER: The focus in the past has been generally on substances associated with addiction, such as alcohol, heroin, marijuana, or cocaine. This new definition makes clear that addiction is not about drugs, it’s about brains. It is not the substances a person uses that make them an addict; it is not even the quantity or frequency of use. Addiction is about what happens in a person’s brain when they are exposed to rewarding substances or rewarding behaviors, and it is more about reward circuitry in the brain and related brain structures than it is about the external chemicals or behavior that “turn on” that reward circuitry.(Emphasis added.)

Addicts share common brain changes, which show up in behavior as unsuccessful attempts to control use, cravings during abstinence periods, and withdrawal symptoms. To date, the underlying brain changes seen in all addicts (desensitization, sensitization, and hypofrontality) have already been observed in the brains of compulsive gamblers, overeaters, videogamers. It’s likely they are present in today’s compulsive porn users as well. If it walks, talks and acts like a duck, it’s a duck.

Another implication of ASAM’s statement is that one cannot define “porn addiction” by time spent viewing or genres watched. Porn addiction exists only if the relevant brain changes have occurred in the viewer. Since brain scans are impractical, ASAM has created a 5-part assessment to help people figure out if their brains have changed. This is similar to assessing diabetes markers in patients complaining of telltale symptoms.

These next two questions from ASAM address sex and food addictions specifically:

QUESTION: This new definition of addiction refers to addiction involving gambling, food, and sexual behaviors. Does ASAM really believe that food and sex are addicting?

ANSWER: Addiction to gambling has been well described in the scientific literature for several decades. In fact, the latest edition of the DSM (DSM-5) will list gambling disorder in the same section with substance use disorders.

The new ASAM definition makes a departure from equating addiction with just substance dependence, by describing how addiction is also related to behaviors that are rewarding. This the first time that ASAM has taken an official position that addiction is not solely “substance dependence.”

This definition says that addiction is about functioning and brain circuitry and how the structure and function of the brains of persons with addiction differ from the structure and function of the brains of persons who do not have addiction. It talks about reward circuitry in the brain and related circuitry, but the emphasis is not on the external rewards that act on the reward system. Food and sexual behaviors and gambling behaviors can be associated with the “pathological pursuit of rewards” described in this new definition of addiction. (Emphasis added.)

QUESTION: Who has food addiction or sex addiction?

ANSWER: We all have the brain reward circuitry that makes food and sex rewarding. In fact, this is a survival mechanism. In a healthy brain, these rewards have feedback mechanisms for satiety or ‘enough.’ In someone with addiction, the circuitry becomes dysfunctional such that the message to the individual becomes ‘more’, which leads to the pathological pursuit of rewards and/or relief through the use of substances and behaviors.

In short, sex addiction exists, and it is caused by the same basic alterations in brain structure and physiology as drug addictions. This makes perfect sense. After all, addictive drugs do nothing but increase or decrease normal biological functions. They hijack neural circuits for natural rewards, so it should be evident that extreme versions of natural rewards (junk food, Internet porn) can also hijack those circuits.

What about porn addicts?

Today’s healthcare providers and popular advice columnists are often misled about the risks of Internet porn use—in part because they know that masturbation (without porn) seldom results in addiction. Trouble is, Internet porn is not mere masturbation. The belief that masturbation and Internet porn are the same demonstrates a lack of understanding of the potential brain effects of constant novelty. Normally, masturbation leads to feelings of satiety. In contrast, Internet porn can override natural satiety. In some brains, overriding natural satiety with extreme stimulation is the slippery slope to addiction-related brain changes. This misunderstanding results in poor advice to patients/clients/readers.

When researchers someday look into the brains of Internet porn addicts, they are sure to see the changes already observed in other kinds of Internet addicts. Alas, porn-addiction research faces daunting challenges:

1.      Control groups of male, non-Internet porn users can no longer be found, and even if they could, review boards would certainly not approve protocols that call for them to watch the kinds of porn for as many hours a day as many of today’s young guys are watching.

2.      Vague questionnaires (unlike brain scans) make it tough for porn users to connect sexual performance problems (or social anxiety, depression or concentration problems) with Internet porn use. After all, porn seems like the world’s most reliable aphrodisiac, and users always feel better while using. How could it be causing the very problems it temporarily cures?

Only with broader knowledge of addiction, its symptoms, and its etiology can researchers and their subjects correctly connect cause with effect. The ASAM statement supports researchers in investigating porn use through the lens of brain changes.

Therapists have new responsibilities

ASAM’s declaration is a step forward in helping to reeducate therapists and their clients. Many were erroneously taught that sexual behavior addictions could not arise from overstimulation of the brain via behavior. Instead, they were trained to assure clients that addiction to sexual behavior was never a risk—unless the client had other (often genetic) disorders.

Yet ASAM authors estimate that genetics only make up about half the cause of addiction. This means that addiction can develop in the absence of pre-existing conditions. In other words, porn-related symptoms such as depression, social anxiety, youthful sexual performance issues and concentration problems need to be viewed as possible consequences of addiction, instead of being presumed always to be their cause.

The new statement thus places responsibility on therapists to help sex and porn-addicted clients make fundamental changes to their behavior. At the moment, many counselors simply refer clients to a doctor for psychotropic and sexual-enhancement drugs—while assuring them that their sexual behavior is typical and harmless.

The ASAM statement is a big step in a sound direction. In the following post, we consider specific symptoms porn users report, which may indicate addiction-related brain changes.

Ominous News for Porn Users: Internet Addiction Atrophies Brains

"Game Over" button

Here’s some headline news for anyone who has been trained that Internet porn use is harmless: Physical evidence of addiction processes is showing up in the brains of avid Internet video-gamers. What’s more, use of online erotica has greater potential for becoming compulsive than online gaming according to Dutch researchers.

According to NIDA head Nora Volkow, MD, and her team these three physical changes define addiction: desensitization (numbing of the brain’s pleasure response), sensitization, and hypofrontality. These same brain changes (which are now showing up in Internet addicts) also show up in pathological gamblers and drug abusers.

For example, cocaine use floods the brain’s reward circuitry with dopamine. Nerve cells respond, more or less quickly, by decreasing their responsiveness to dopamine. As a result, some users feel “off” (desensitization). They crave more intense stimulation (tolerance), and tend to neglect interests, stimuli, and behaviors that were once important to them.

At the same time, because their brains have recorded that cocaine use feels good, they grow hypersensitive to anything they associate with cocaine. White powder, the word “snow,” the neighborhood where they smoked, or friends with whom they used will all trigger spurts of high dopamine in the reward circuitry, driving them to use (sensitization). Also, ΔFosB, a protein that helps preserve intense memories and promotes relapse, accumulates in key brain regions. Incidentally, ΔFosB also rises with sexual activity.

If heavy cocaine use continues, the desensitization of the reward circuitry decreases corresponding activity in the frontal lobes of their brains. Now, the users’ abilities to control impulses and make sound choices weaken, and their frontal cortex may atrophy (hypofrontality). Taken together, decreased pleasure response, marked cravings to use, and compromised impulse control fuel the vicious cycle of addiction.

Behavioral addictions

The study of non-drug addictions is still quite new. Yet already experts have uncovered decisive physical evidence that today’s extreme versions of natural rewards can change the brain in ways that drugs do. “Natural rewards” are activities/substances that entice us because they enhanced our ancestors’ survival, or the survival of their genes.

Moreover, it’s not just a tiny minority with pre-existing disorders who are at risk. Normal, healthy brains can also change. Said a healthy 37-year old, “When I first watched porn online at age 35, I felt like I was going to have an orgasm without an erection. That’s how powerful an effect the it had on me.”

So far, here’s the research scorecard. (Dates indicate when brain-scan research turned up evidence of the last of the three key addiction-related brain changes.)

  • Pathological gambling – studied for 10 years, and added to the upcoming DSM-5 as an addiction (2010)
  • Food addiction – (2010)
  • Internet video-gaming addiction – (2011)
  • Internet porn addiction – still not studied via brain scans

Incidentally, the reason the Internet addiction studies address addiction to gaming, not porn, is that they were done in countries that block access to porn sites—and have for years (China, 2006 and Korea, 2007). Unlike other countries, they don’t have a lot of heavy porn users.

Here are studies showing the three critical, physical changes in the brains of Internet addicts (two just released in June, 2011):

A reduction of striatal D2 dopamine receptors is the main marker for desensitization of the reward circuitry, a hallmark of all addictions. In this study PET scans of men with and without Internet addiction were compared.

“An increasing amount of research has suggested that Internet addiction is associated with abnormalities in the dopaminergic brain system… [In this study] individuals with Internet addiction showed reduced levels of dopamine D2 receptor availability.”

In this study, college students played Internet video games for 6 weeks. Measures were done before and after. Those subjects with the highest cravings also had the most changes in their brains that indicate early addiction process. The control group, which played a less stimulating game, had no such brain changes.

These changes in frontal-lobe activity with extended video-game play may be similar to those observed during the early stages of addiction.”

In this study, researchers found a 10-20% reduction in frontal cortex gray matter in adolescents with Internet addiction. Research on other addictions has already established that decreases in frontal-lobe gray matter and functioning reduce both impulse control and the ability to foresee consequences.

“The presence of relatively immature cognitive control, makes [adolescence] a time of vulnerability and adjustment, and may lead to a higher incidence of affective disorders and addiction among adolescents. As one of the common mental health problems amongst Chinese adolescents, internet addiction disorder (IAD) is currently becoming more and more serious. … The incidence rate of internet addiction among Chinese urban youths is about 14%. … These results demonstrated that as internet addiction persisted, brain atrophy … was more serious.” (Also see this earlier Chinese study.) 

Online porn and video gaming stimulate the brain in comparable ways

Compare these two quotations. Which is about porn addiction and which is about gaming addiction?

We don’t have sex anymore. We don’t go on date nights or anything together. I feel so guilty because I just can’t take it anymore. Ever since 2 weeks into our marriage I was threatening to divorce him.

Three of my friends did realize they had a problem, but 2 of them said they’ve made attempts to quit, and they literally think there’s nothing they can do about it. *

The characteristics that make Internet porn and video gaming so popular are the same characteristics that give both the power to dysregulate dopamine in some brains. Novelty and ‘stimuli that violate expectations‘ both release dopamine, sending the brain the message that the activity is more valuable than it is. Successful video games deliver a rapid-fire of both novelty and surprise. Each new generation of games exceeds the last in these respects.

Today’s porn also delivers both, and constantly ratchets them up. There’s unending novelty and something more startling always beckoning just beyond the next click. There’s also the dopamine released by the “hunt” for the perfect shot. Novelty, shock and hunting absorb the user’s attention because they raise dopamine levels. Intense focus allows users to override their natural satiety mechanisms and, often, to rewire their brains in ways that take a lot of effort to undo. Addiction is “pathological learning.”

Online gamers are sometimes called “adrenaline junkies.” However, adrenaline (which is released in the adrenal glands) appears to have little effect on addiction processes. Dopamine, not adrenaline, is at the heart of all addictions. Fear and anxiety can enhance addiction processes due to neurochemicals released in the brain (such as norepinephrine), but they don’t cause those processes.

Sexual cues can be more compelling than gaming activities

Mock warfare and risky quests were no doubt high priorities for our ancestors. That’s why we find play rewarding enough to get hooked. Yet reproduction is our genes’ top priority. Like food, sex is essential to genetic success.

In terms of effects on the brain, Internet porn use combines elements of consuming highly palatable food and video gaming’s constant stimulation. Like junk food, Internet erotica is a hyperstimulating version of something we evolved to value highly. Today’s erotica is also delivered via a rapid-fire, mesmerizing medium, very similar to online video games. A double whammy in terms of addictiveness.

It’s worth considering what brain researchers have learned about food. When rats had unlimited access to cafeteria food, nearly all of them showed a rapid drop in D2 (dopamine) receptors (numbed pleasure response), and then binged to obesity. The D2-receptor drop apparently motivates mammals to grab as much as possible while the getting is good—whether high-calorie foods or a willing harem.

Keep in mind that unlimited cafeteria-type food stimulation was not the norm during our evolution, until recently. That’s why unlimited access to junk food is risky to rats and humans. Clicking effortlessly to hundreds of hot, novel mates is also an evolutionary anomaly, and 9 out of 10 of college-age men were already using Internet porn three years ago. Risky, given its inherent addictiveness. Also, reversible. When heavy users give up porn, they report increased pleasure from all aspects of life (often after a miserable withdrawal).

Back to food. In recent years, brain researchers have also turned up evidence of all three key addiction processes in the brains of overeaters:

  • Numbed pleasure response: A 2010 study showed that overeating blunts the reward circuitry, increasing the risk for future weight gain. After 6 months, the brains of those who had eaten more “pleasurable” foods (i.e., more fattening) showed less response to pleasure than the others.
  • Sensitization: A 2011 study found that those who score high on a food addiction test (brain activation in response to pictures of food) show brain responses similar to drug addicts’ responses to drugs.
  • Hypofrontality: A 2006 study revealed that obese individuals have brain abnormalities in areas associated with taste, self-control, and reward—including a reduction of gray matter in the frontal lobes (atrophy). It’s likely that overeating causes these changes, as the study mentioned above confirmed brains changes from overeating.

If overstimulation via highly palatable food can cause brain changes in so many humans (30% of Americans are obese, and only about 10% due to metabolic abnormalities according to neuroscientist David Linden), how is it possible that over-stimulation via highly erotic online sexual activity could not change brains? Internet porn use/cybersex is surely no less stimulating than tempting food.

Is history repeating itself?

History is full of examples of “common knowledge” that turned out to be erroneous upon investigation. Consider margarine. Everyone “knew” it was better for you than butter. Experts were so confident of this “fact,” that they didn’t even test it for years, and regularly advised people to substitute margarine for butter.

Finally, experts did test the healthfulness of margarine. It turns out that trans-fatty acids (found in margarine) are among the most dangerous fats. They are far worse for humans than butter.

Critics may claim that it is “unscientific” to suggest that Internet porn can cause addiction processes in the brain just because Internet addiction clearly does. Actually, it’s unscientific to suggest the reverse. All addictions, including behavioral ones (gambling, food, video games) show hypofrontality (atrophy and lack of impulse control). Frankly, what critics now need to supply is solid, scientific evidence showing that Internet porn addiction is an exception to the rule. To suggest there’s still major doubt about its addictiveness is most unscientific, as it presumes there must be some other brain circuitry for porn use that has yet to be discovered.

Sex is healthy, but the assumption that Internet porn use is safe is increasingly tenuous.


* The first remarks are about gaming addiction, the second about porn addiction.

Is Today’s Ejaculation Advice Right for Our Species?

For the last half-century, Western sexologists have advised men to ejaculate as frequently as the urge arises, on a par with nose-blowing. At the same time, doctors assure guys that there’s no risk of excessive ejaculation because they’ll stop when they’ve had enough.

But what if this advice is not supported by the data biologists are turning up? We’ve been fascinated by a debate going on over on Amazon about the realities of primate sex and mating. This debate and the self-reports from young guys on a variety of forums are making us question the standard ejaculation advice.

Personally, we’re not enthused about increasing the world’s population, but it’s hard not to feel sorry for the men we’ve heard from who cannot consummate their marriages, let alone impregnate their wives, as a consequence of their heavy porn use. (Come to think of it, that suggests a strategy for population control. Simply give every guy on the planet an iPhone, and every woman a vibrator.)

Where are we now?

The predictable, though not necessarily intended, result of the standard ejaculation advice is that many younger men believe it is unhealthy not to ejaculate very frequently-at least once a day. (Indeed, authorities in England and Spain have actively campaigned to spread this notion in schools.) Many guys believe that if once is healthy, 2, 3 or 4 times must be even healthier.

In the under-thirty crowd, masturbation and Internet porn use are synonymous, so if 4 ejaculations per day are really healthy…well then, that many Internet-porn sessions are too. Indeed, even after their hormonal rush of puberty and sexual peak have passed, guys can use today’s superstimulating masturbation aids (Internet porn, cam-2-cam, sex toys) to remain veritable geysers of semen…at least until they hit a wall.

Now, many men, as early as age twenty, are complaining of delayed ejaculation, an inability to climax with mates who don’t look/act like their favorite fetish porn star, erectile dysfunction and a host of other symptoms. (Astonishingly, when they stop porn/masturbation for a couple of months, they report dramatic improvements  in confidence, mood, concentration, sexual chemistry and sexual performance.)

If you’re noticing unwanted symptoms, and you’re not sure you want to let your genes down, consider the following biological and anthropological information.

‘My sperm production keeps up with my daily ejaculation frequency.’

Even though Western males apparently masturbate to climax more than any other species, humans are not, in fact, built for prolific ejaculation. According to Promiscuity author Tim Birkhead:

The rate of human sperm production is lower than that of any other mammal so far investigated. The numbers of sperm stored in the epididymis are also low. … Men, in contrast [to chimpanzees] have a more limited capacity and six ejaculations in twenty-four hours is enough to deplete the epididymal sperm stores completely. [pp. 82,84]

Sperm collected via daily masturbation dropped from 150 million on day one, to 80 million on day two, and to 47 million on day three. It takes about 64 days for sperm to mature.

While figures vary across studies, and certainly between men, humans have a low sperm production rate, considering that a sperm count of around 100 million is usually considered necessary for a reasonable chance of fertilization. It is simple to see how habitual frequent ejaculation could lead to chronic depletion and decreased fertility.

Sperm production estimates vary, but it appears that ejaculation every third day would not overtax sperm supplies (assuming they have normalized after very frequent ejaculation). Ejaculation every third day is more than enough action to keep a mate “topped up” with viable sperm, so evolution is likely to have equipped us accordingly. Incidentally, too many sperm can increase miscarriages because fertilization by more than one sperm renders a zygote inviable. “Eject!”

‘If I’m horny, it means I need to ejaculate.’

Not necessarily. Even though human sperm production is low relative to other animals, human males still become aroused in response to promising genetic opportunities regardless of semen reserves (the Coolidge Effect). This reality is what makes possible a binge using Internet porn (with its parade of novel “mates”).

Male zeal for sex and the willingness to risk lives to access potential mates are common across species. After all, the male gender more often faces the potential of zero offspring because the struggle for fertilizations is normally demanding and failure common.

In short, you don’t have to have a mammoth libido, or be a pervert, to have trouble saying “no.” Healthy human brains respond to high-value sexual cues or novel mates. If they didn’t, you wouldn’t be here. In fact, you’re the product of those who wanted sex the most.

Yet what happens when limitless simulated and stimulating sex becomes available to these zealous males in the form of virtual sirens begging for semen from cyberspace?

Research shows that animals will prefer a supernormal stimulus to the natural one. Female birds prefer to brood an oversized wooden egg rather than their own real eggs. A male fish prefers to court a wooden oversized female (bigger size = more eggs) than a real female with real eggs. And humans can easily fall for superstimulating online charmers in lieu of real mates with whom they could potentially reproduce. An evolutionary-biologist friend, who specializes in sexual evolution and the sexes, remarked:

Now, we face the prospect that porn sex will make real sex a poor alternative or even impossible. Moreover, women have vibrators that can also make real sex a poor alternative—and even more so if men cannot achieve erections.

I can almost envision a future in which men and women will live separately, masturbating to porn or with sex toys. Reproduction, when desired, will be done with a turkey baster—assuming computer-illiterate donors can be found. We could even be the first species whose sex drive leads it to masturbating itself to extinction. LOL

Laughable, and yet a recent UK survey reported that among men looking at porn for at least 10 hours a week sixty-one per cent agreed it could make you less interested in sex with a partner (compared with 27 per cent of moderate users and 24 per cent of light users). 

 ‘Even if I overdo it, there are no lingering repercussions.’

We were startled to learn that exhausting semen supplies may have surprisingly long lasting repercussions for human-male fertility. In a study where men ejaculated an average of 2.4 times a day over ten days, their sperm output remained below pre-depletion levels for more than five months

There’s also the risk of long-lasting plastic brain changes in response to super-enticing stimuli. Brain changes can desensitize the individual’s pleasure response and leave him hyper-responsive to sexually explicit material indefinitely…much as an obese person continues to buy chips because his brain’s reward circuitry is shouting, “More!” even as his body is screaming, “Enough!”

Lingering brain changes increase the risk that today’s frequent ejaculators will not, in fact, “stop when they’ve had enough” as the medical profession claims. Binging on Internet porn in search of satisfaction is not unusual among users. One possible result is chronic sperm depletion.

 ‘The suggestion that there can be too much ejaculation is religious moralizing.’

Actually, many sex-positive cultures have taught moderation for millennia. As explained, men have not evolved to be able to have limitless sex without suffering physiological repercussions. Historically, male fervor was held in check by the reality of sexual opportunities with novel mates being rare. Later, when population density rose, male potency was protected by traditions that regulated sexual excess.

In fact, the last half-century’s decision to dismiss the possibility of biological limits represents a sweeping departure. Across the globe and over thousands of years mankind generated a broad array of traditions and taboos to protect male potency and vitality. For example, the ancient Chinese Daoists made a science of sexual health and relationship harmony, without a hint of moralizing.

They were not alone. Almost a century ago, anthropologist A. Ernest Crawley recorded that tribal cultures all over the world believed that temporary abstinence from sex was appropriate in connection with many activities (depending upon the culture). These included hunting, warfare, planting, fishing, harvesting, wine preparation, shamanic deeds, pilgrimage, the first days of marriage, pregnancy, lactation, menstruation, and so forth. Such advice was so widespread that Crawley characterized temporary chastity as an “infallible nostrum for all important undertakings and critical junctures.”

Periodic abstinence was believed to increase male invincibility and vigor. For the same reasons, numerous cultures have also evolved ways of making love that encourage frequent intercourse but infrequent ejaculation (unless conception is desired).

More recently, anthropologists studying cultures in Central Africa reported that the Aka and Ngandu peoples don’t masturbate. (They don’t even have a word for it.) These cultures also traditionally observe a moratorium on sex from the birth of a child until it is able to walk. Despite the fact that adults of both genders obviously relish sex, men’s interludes of frequent ejaculation tend to be limited. (Incidentally, no religious missionary influenced these traditions.)

Is the ejaculation advice of the last half-century suitable for humans?

Perhaps not. In the words of our evolutionary-biologist friend,

Cheering on multiple daily ejaculations as some sort of ‘natural’/ancestral behavior is mistaken. All-in-all the evidence suggests that human sperm production has not evolved for more than a moderate rate of ejaculation, and masturbation is possibly not something that is ‘normal’ on a daily basis, if at all.

It’s likely our false belief in ‘limitless’ human sperm production arose primarily because the brain’s evolved reward mechanism for sex is very strong. Especially for males, reproduction is uncertain. It’s the intensity of sexual pleasure that makes us assume frequent ejaculation is more beneficial than it is.

How could something that feels so great ever be a problem? Answer: Our sexual expression is occurring in an environment very different from the one in which it evolved.

Porn-Induced Erectile Dysfunction Is A Growing Problem

High-speed Internet pornography users in their twenties are increasingly developing sexual performance problems (erectile dysfunction, delayed ejaculation). Said one young man,

“Lots of guys, 20s or so, can’t get it up anymore with a real girl, and they all relate having a serious porn/masturbation habit. Guys will never openly discuss this with friends or co-workers, for fear of getting laughed out of town. But when someone tells their story on a health forum, and there are 50-100 replies from other guys who struggle with the same thing, this is for real.”

Italian urologists recently confirmed the impotence-porn use connection via a large survey. Italian men suffer ‘sexual anorexia’ after Internet porn use. When interviewed about the survey, urologist Carlo Foresta (head of the Italian Society of Andrology and Sexual Medicine and professor at the University of Padua) mentioned that 70% of the young men seeking clinical help for sexual performance problems had been using Internet pornography habitually.

No one yet knows the percentage of Americans affected. However, youthful impotence has implications for condom use and safe sex.

According to Foresta, porn-related impotence is reversible. Yet it appears that recovery requires 4 to 12 weeks of avoiding intense sexual stimulation. Read one man’s recovery story: “Day 64: Successful, great, normal sex.” More recovery accounts.

Of those who ultimately recover by terminating pornography use, many had previously been to doctors, undergone numerous tests, and been declared “just fine” physically. Neither they nor their health care providers considered excessive porn use as a potential cause of their continued performance problems.

Most were assured that “masturbation cannot cause erectile dysfunction.” This was no doubt sound advice before masturbation was coupled with the constant novelty and hyperstimulation of today’s Internet erotic possibilities. However, it may no longer be valid given the effects of superstimuli on the brain.

Among those who recover, progression is surprisingly similar. When the users completely stop using pornography (and masturbation as well for a time, because it is initially so closely associated with porn fantasy), here’s what occurs:

1) Withdrawal symptoms and cravings: Immediately

2) Complete loss of libido and erections: Begins towards the end of week one.

3) Absence of libido and erections, increased flaccidity (“shrinking or lifeless penis”): Continues for 2-6 weeks, dependent upon age and severity of porn use.

4) Gradual return of morning erections, libido and spontaneous erections at other times, no more “semen leakage” during bowel movements, etc.

5) Complete recovery of erectile health, sexual desire for real partners, reports of extremely pleasurable sex, contented condom use even if it was once a problem.

Sufferers typically recover within eight weeks. Those in their late teens generally require a shorter period of avoiding sexual stimulation to bounce back, but they also tend to relapse more often, which extends their recovery. Older men may need a longer period without stimulation in order to recover, but are typically more disciplined. Either way, reports are encouraging:

“I am a 25-year old male, masturbating a lot from 13 and using porn from 14. Gradually, it took more to turn me on: bigger fantasies or harder porn, and I stopped getting hard without touching. During sex I would struggle to get an erection or keep it, especially for intercourse. Over the past 7 years I haven’t held down a relationship, and the main reason for me has been this problem. Now the good news: When I realized the cause, I immediately gave up porn. Over the last 6 weeks I held off masturbating as much as I possibly could. (My best record was 9 days!) It all paid off. I just went away with a girl for the weekend and it was the best ever. I don’t think I’m out of the woods yet. I still get pretty anxious from all the bad experiences over the years. But I just wanted to tell you all it can work, and it’s well worth it!”

“Week 12, age 36 – I’m actually totally impressed how HUGE I get. It has been kinda hard to ignore. I mean, my erections are ROCK HARD and ENORMOUS. I remember asking other guys who went before me about when they noticed the return of their full erections. Well, I think I got mine back.”

Those affected report that escalating pornography tastes preceded their symptoms. Escalation, their withdrawal symptoms during recovery, and the sequence and time-dependence of their recovery all point to a common cause of their impotence, namely overstimulation of the reward mechanism in the brain.

Animal models have established that the mesolimbic dopamine pathway dopaminergic neurons activate the hypothalamic erection centers. It’s likely that porn-induced ED is tied to desensitization of the mesolimbic dopamine pathway. This is a hallmark of all known addiction processes. For a science teacher’s explanation of the science behind porn-related erectile dysfunction, see this video presentation: Erectile Dysfunction and Porn.

Most men are astonished to learn that pornography use can be a source of sexual performance problems. Only after they experiment for themselves do they become fully convinced that pornography use was indeed the source of their dysfunction.

“Day 64: Successful, great, normal sex”

 

MOOD CHART, x = days, y = mood

This guy, who could no longer use a condom successfully due to porn-induced ED, applied the recent scientific findings about how superstimuli can numb the pleasure response of the brain to his use of today’s hyperstimulating porn. He decided to allow his brain to “reboot.” Although each person’s rebooting experience is different (recoveries range from 4 to 12 weeks), his experience was typical and his data especially thorough. Here are excerpts from his blog.

[Week 2] So, I just completed 10 days of no PMO (porn/masturbation/orgasm). The first 5 days were difficult, but astonishing. I got extremely horny, probably as my brain was trying to get me to jack off, like I’ve been doing every day for 20 years, maybe longer. Erections just looking at girls, very hard to resist kissing a girl I was talking to in a bar.

Then after 5 days, it all went away, completely. Since then, I’ve been flat, numb, nothing. Occasional sparks of sexual spirit, but also a kind of glum, flat, nothingness. I wouldn’t say depressed, because I’m optimistic about the future, and I’m happy with the path I’m on, and committed. But more like empty, null. Girls that I was desperate to get with a week ago, now I don’t even feel like texting. I almost feel hostile, angry. The prospect of sex is not appealing.

I think my brain has accepted that I’m not going to be jerking it, so it has stopped the cravings. On the other hand, it doesn’t realize yet that porn is no more, and so it still is not allowing me to get excited by girls in real life. I think that’s going to be a very gradual process, and I’ll probably get intermittent flashes of horniness and arousal, and then absence again, as things gradually rewire.

I’m super-excited to be at day 10. I never even knew there could be a day 3! I thought it was physically impossible for me to not jack off that long. And actually the porn is at day 16, because I stopped looking at it a week before I stopped jerking it.

[Week 3] Earlier today I was getting pretty impatient with the lack of progress in the resensitization department. I mean, it’s only been a once a day habit, right? Why am I taking so long to get over it? But then I did the math. 20 years, 365 days a year, most of those including P – that’s more than a staggering 7,000 PMOs. Now I see why it’s possible that I have some habituation to get over.

[Week 4] Still getting the occasional REALLY STRONG flashback to some of the appealing images from P days. At first I was annoyed that a side effect of this process is getting these flashbacks and annoyed at having to resist them. Then I realized that it’s not a side effect – this IS the process. Every time you successfully resist, that takes you one step nearer to being free of them. That’s how progress is made in this crazy game.

Been driving a lot – late night driving has been one of my solaces in this crappy process. When I come home and I’m full of horn, I get in the car and drive for a couple of hours – on a twisty road, up in some hills, occasionally just on a freeway. Doesn’t really matter. Just sitting there a little preoccupied seems to soothe me somehow. Anyone else do this?

[Week 5] I was in such a good mood today. I literally don’t think I have been in such a good mood in 7 years. And I don’t mean because anything particularly great happened, but just for no reason at all. It’s been so long since I’ve had that buoyancy. I used to have it, and I haven’t seen it for 7 years, and had more or less got to thinking maybe life is inherently gloomy and uninteresting. Historically, I’ve been a very positive person, and the last 7 years have been so weird because it felt like nothing I did would make me feel cheerful inside. Patches of joy here and there, but always short-lived. Today, finally, I was socializing with people, chatting with people because it felt good to connect, to commune. I’ve missed that so much, and I only realize how much now that I’ve had a taste of it again.

I’m 100% sure the problem was the PMO thing. Quite simply, it made everything else boring. The M by itself was bad enough to make me lack-luster since I was 18 probably, but the broadband P I think finally killed any chance any real-world stimuli had of capturing my interest. Maybe I’m exaggerating a bit, but not that much. I’ve been going through the motions of being sociable and interested for the last 7 years, knowing how it was supposed to look, and doing it because I felt like I should, but all the while not giving a shit inside.

So yeah, the last few days, I’ve been getting little dribs and drabs of positive emotions, like when you think you feel a drop of rain every now and then, but you’re not sure. Today was the first day where I had a mood that was really sustained and didn’t disappear after a couple of hours. More like 8 hours and I’m still feeling it. I’m sure there will be lows again (not to be negative, but I’ve seen the neurochemical pendulum in action for long enough now to know this), but right now, this feels pretty damn good….

Stay strong, everyone. This is totally worth it. It may not be the only piece in your puzzle, but if you’ve been doing PMO, then it almost certainly will have been having major unsuspected effects.

[Week 6] A milestone reached the last few days. I actually feel back to normal. I’d got so used to feeling craving, or sad for no reason, or unbalanced, or anxious, or massively horny, or completely dead, or combinations of any of these at one time the last 40 days that I’d forgotten that I hadn’t always felt that way. Then 3 days ago it all just stopped. Just like that. In my journal two days ago, I wrote “Wow – I feel what I can only describe as ‘normal’ today”. That feeling has stayed with me, and none of the craziness has returned.

Now, just because the craving is gone doesn’t mean that I’ve healed my brain yet. It also doesn’t mean that I am safe from relapse! I’ve been fighting hard these last 6 weeks against the beast, and I’ve shut it out, but that doesn’t mean that it won’t come knocking subtly at some stage and try and get in again. I need to maintain lifelong vigilance. My motto: Real women only. For good.

I’m still pretty drained by the whole experience, physical partly, and massively mentally. I’m going to give myself a week or so of brain convalescing (maybe I’m being a wimp, but I really feel like I’ve been through something), and then I think I’ll feel restored enough to start pushing myself again in other areas of life, which have pretty much been on hold the last 6 weeks.

[A couple of days later] Really depressed today. Angry, bitterly critical of the paths I’ve taken in life, and where I’m at now, and of my abilities to go forward.

While I’ve eliminated a false pleasure from my menu of options, there is nothing there yet to replace it, because the other options still lack much power to please me. Also, I’m pretty mentally tired after all this PMO resistance, and I don’t have the strength to be buoyant today. But the cravings really have gone – I feel level headed, just “level headed grumpy” today.

I guess the other thing bothering me is that there definitely was a very significant improvement at the end of week 6, and I thought that meant all this bullsh*t was over. Apparently though, it just meant the crazy period was over. Now it’s replaced by sexual frustration combined with a dull, missing ache, that’s making it hard for me to be winning with women, I suspect because I’m communicating an inner sadness.

[Week 7] “Stupid glumness – 50 days and still missing PMO” To miss P for a few days, fine. But to be missing it 7 weeks later – what a baby! There’s also a second fear – that maybe the glumness is nothing to do with the PMO, and it’s just that my life is f*cked. Except that I don’t think it is, but the fear is still there, because it seems like a rational explanation for glumness.

So, those two demons combine and taunt me. One says, “You baby! Fancy being glum because you’re missing your P!” Then the other one says “Or maybe it’s not the P! Maybe you’re just a loser and you’re glum because you can’t get a decent life together!” Back and forth between them for hours at a time. So I try and prove them both wrong. I go out and meet women. I can hear myself talking to them, aping buoyancy, aping inner feelings of success and normalcy. But the second the performance is over, the dull monotonous drone is back. Glum.

[A few days later] Mood swings:

1) There’s a woman that I’m progressing towards. One day I’ll think about her and think that she is sweet and fun. The next day I don’t give a crap about her. Repeat until thoroughly confused.

2) One day I’ll be really up, great mood, gold is flowing from my lips unbidden. The next day, I’m a tiresome dolt, who gives a crap about no one and about whom no one gives a crap. Repeat until self-image completely unstable.

3) One day I’ll think I’m a cool dude, with tons going for him, and really getting a great life together. Next day, I’ll feel like a poor deluded fool, who thinks he is swimming, when really he’s just scrabbling around in the dust. Repeat until really fed up.

[Week 8] The biggest difference that quitting PMO makes is that it gives you incentive to be brave, to go out and meet girls. If you are whacking it every day to porn, and a real woman barely registers with you, why on earth would you even make the effort to go and talk to her? What do you have to gain? Nothing. What do you have to lose? The possibility of rejection, of humiliation, maybe even hostility and anger from her.

But imagine that you saw a woman that you liked, and I offered you $1,000,000 to go and talk to her – say anything, it doesn’t matter what. If you really believed I would pay up, you would find the courage to talk to her, even if you thought she might laugh at you. What’s changed? She’s going to respond exactly the same way she would have done without my $1m offer – it’s just that now you have an incentive.

[A couple of days later] You built a harem.

You know those science fiction comedies where a couple of teenagers somehow build themselves an ideal robot woman in their basement and fall in love with her? PMO is like that, except that it’s just one guy, and he’s built himself a whole harem of unfeasibly hot women. So when this guy goes outside of his basement, in the normal world, he is not interested at all in the normal women he sees because he’s got a harem of uber-hot women back home. Getting back to them as soon as possible is all he can think about.

Just like those kids in the movie, we have fallen in love with that harem. It is as simple as that. Your brain thinks the harem is real and is behaving accordingly. When you are at home, you are desperately excited to bang girls from your harem. When you are away, you are excited to get home.

You have to break up with the harem.

This process is so tough because it involves BREAKING UP WITH THAT HAREM. Your brain has to accept that you are saying goodbye to all those girls, never to see them again! Your brain fights you for 8 straight weeks, because IT DESPERATELY WANTS TO KEEP ITS HAREM. It will make you sad, angry, miserable, depressed, horny as hell, numb, null – it will drag you through the worst kinds of hell it possibly can to get you to go back to your harem, because it loves them so much. Look at my mood charts – my brain put me through horrible bullshit for 8 straight weeks.

But then, just like when you break up with a girlfriend (well, in fact exactly the same because it is the same), you wake up one day and the fever is gone. The brain says “OK. I get it. *sniff*. I guess they’re really all gone and I’ll never see them again. *sniff*… Hey – that woman waiting in line at the bank is cute though! Hey baby!” And you are healed. You are back in real life, and you have no magic, robotic harem at home.

I will share something embarrassing/amusing but also really important. Exactly a week ago, I had massively strong feelings of missing – you know those feelings you get after a break up with a girl. There’s a song that kept playing in my head, that one that goes ‘I ain’t been missing you at all – no matter what my friends say’. I played it on YOUTube, and listened to it on headphones. I cried for two hours straight, playing it over and over, while memories of all the girls I liked in all the porn I’d seen over the years – my favorite girls, the ones I felt closest to – scrolled around in my head. I was saying goodbye to them. It was like looking through photos of you with your ex-girlfriend after she broke up with you. So yeah, I cried for two hours, maybe more, doing that. Afterwards, I felt a huge sense of calm, peace, closure. They were really gone.

That night out in bars I got 3 numbers, and went out on a date with one of the girls I met the next day.

Eventually, your brain accepts.

So when you ask if it’s hard to continue to not PMO these days. No – it’s really, really easy. My brain knows that those girls are gone. It has accepted. It has given up trying to make me go back to them. It has moved on. Now when I’m at home, my brain knows there is nothing sexual there at all. When I go out, my brain knows there are fine women around that it might want to get with, but that the only way that anything sexual will happen is to have sex with them, because M is no longer on the menu, no longer an option.

But it took 8 weeks to get to that point. In the meantime my brain was screaming bloody murder. And sometimes it stopped screaming, but it’s only so that I got used to it not screaming, so that it could shock me even better when it started screaming again.

That’s also why I say cut out TV. If you’re at home, and a fine woman comes on the TV, your brain says “Hey! There’s a girl from my harem! I guess my harem didn’t disappear after all! Hummana-hummana-hummana.” And you get all excited again. Home has to be dead of women to you. Nothing there. No glimpses, no faces, no bodies, no nothing. World outside: women. Your home: boring as f*ck. That’s the only way your brain gets the message it needs, which is that the harem is no more. Gone.

[A couple of days later] I’ve been scoring my mood on a 0-10 scale: 0 is absolutely shitty, 10 is completely awesome. 8 is solidly great. Imagine you’re driving a BMW at 80mph down the freeway. You can hear its engine purring away happily and powerfully, cruising, but knowing it could easily push up to 120mph if it wanted to. 8/10 is when your engine feels like that engine – powerful, happy, cruising.

My mood has not dipped below an 8 in the last 6 days! The blues, the doldrums, the lack, the despondency – all GONE! This, to me, is amazing. Even reading other peoples’ reboot reports, I had a worry that even after rebooting, mood would still be up and down, especially in the absence of masturbation.

For clarity, I’m not saying I haven’t got frustrated this week, or briefly angry – I have. But it’s been normal frustration, responding to things that you would expect to be frustrating for anyone. There has been a core, immutable power and energy even in frustrating moments. It has felt remarkable to me, almost unbelievable, as I’ve been so used to the PMO ups and down (and of course the numbness before starting this process). But there it is. Solid great mood.

[His final mood chart from shortly after this post is at the beginning of this post]

[Week 9] Day 57 of no MO, day 64 of no P. Successful, great, ‘normal’ sex, with condom.

History: I’ve never liked using condoms. Frequently never got around to sex because I’d lose erection even thinking about having to get one out and use it. Frequently lost erection putting the condom on. Frequently lost erection once inside.

Last night: Stiff 🙂 Stayed as stiff while getting condom out, putting condom on, while starting sex and finding we needed lubrication, through getting the lubrication, putting the lubrication on, having sex. All with exemplary stiffness 🙂 My erection was just so natural, and correlated with being turned on, and felt so right, that somehow I just knew that it would stay with me through the condom shenanigans.

And the sex felt as great as sex used to without a condom. I suspect it was because of the increased drive and increased sensitivity down there. I’m really excited about having sex with a condom with her again, which has never happened before. Sex without condom used to be exciting enough for me to want to repeat. Sex with condom fell the other side of the line and wasn’t worth it. But now I’d be more than happy to repeat the experience, several times 🙂

Orgasm itself: very strong and pleasurable. None of the things I worried about happened. I was able to keep from coming for a perfectly acceptable length of time. In fact, I didn’t even really think about it, it just seemed like a normal, healthy sexual interaction. When I did come, my head didn’t explode and I didn’t rupture any blood vessels anywhere and I didn’t bellow ‘8 FUCKING WEEKS!!’ in her ear like I thought I might. In fact, it was just beautiful, intimate, very pleasurable sex 🙂

Guys, stick at this. The goal that you are striving towards is real and amazing. I guarantee that it is 100% worth the effort and will not disappoint. Allow yourself to believe that this place is worth going through 3,6 even 12 months of misery and bullshit, because it is. It won’t take you that long. It should take 2-3 months. But if it did take a year, hell 5 years, it would still be worth it. Good luck, fellow cock soldiers 🙂

[A few days later] Actually having sex and having more opportunities on the way has vastly cut down, maybe even eliminated frustration. But also, I think that my brain has adapted, has changed its expectations. Part of the reason that you get so frustrated post-PMO is that the brain has been used to a HUGE diet of ‘sex’ (OK, actually wanking to porn), so it thinks that level of stimulation and sexual activity is the norm. After it has thrown its temper tantrum for a while, it gives up and adapts to the new amount of sex in your life, i.e., once in a while

Yeah, I blew some opportunities through desperation because I wasn’t used to having that much desire. I almost couldn’t stop myself trying to kiss girls I was talking to, but you learn to control, and be grateful for, the extra drive.

In summary – your life changes because you are inspired to meet more girls, PLUS your brain adapts to the lower frequency of sexual activity after a while, PLUS you modify your social behavior to take into account the stronger sexual desire you are feeling, so you still come across as cool. It’s a process, i.e., it takes time, but trust me, TOTALLY worth it.

[Subsequent post, a couple weeks later] I feel a little bad about airing my private business, but at the same time I want my brothers in cock to have the positive evidence I am in a position to provide so: Yesterday, sex with a girl. Once with a condom.

Today, sex with another girl. Twice, with a condom, only about 30 minutes apart (I’m 40, people). So strictly speaking, with 2 condoms. All erections very nice and hard, maintained with no problem at all, condom put on in full view of girl (always used to be a danger point for me), even taking my time putting it in once the condom was on (I used to get it in as soon as possible hoping to regain the rapidly flagging erection).

This is miraculous. And I am definitely cured.

Oh, and the sex felt really great. I could happily use condoms for the rest of my life. It felt just like sex without one used to. I’m sure I have more sensitivity in my cock now that I’m not gripping it tightly and boffing it around every evening.

For those asking about ED: I guess I used to have pre-emptive ED. That is, I knew I would get ED, especially if I knew I’d need to use a condom, so I wouldn’t even go for sex, well actually I wouldn’t even pursue a girl. Two months ago, however, I did end up somehow in bed with a hot girl and no erection, which I found humiliating. That’s when I found my way here. Short story – yeah, probably would have had more ED if I hadn’t avoided sex through fear of it.

Thanks again so much to everyone who has shared their stories/thoughts/wisdom!

Rebooting is the path.

More “rebooting” accounts are available at www.yourbrainonporn.com. Learn more about porn-related ED in this video series.