Does watching pornography cause erectile dysfunction?

Erections! Pornography! And now that I have your attention, this is an article about erections and pornography

It’s November - and you know what that means. It means that tons of guys in the “manosphere” who follow “bro science” are taking part in “No Nut November” - the challenge not to masturbate for one entire month. Have you heard of this? Do I only know about it because I spend far too much time on the internet? Actually, don’t answer that.

The idea is that too much masturbation—and in particular, too much pornography—causes all sorts of physical and mental health problems, ruining your sex life and your life more generally. Giving it up for a month is seen as a way to reclaim your health and your masculinity (there are also a whole host of wackier beliefs about “semen retention” having all sorts of near-magical health benefits, but let’s not even go there).

It’s all very silly of course, but it’s not just horny fellas on the internet who are worried about the dangers of masturbation and pornography. Louise Perry’s book The Case Against the Sexual Revolution seems to be everywhere at the moment, and it makes some strong claims on this topic. In the book, she writes about:

…the addictive power of porn and the consequent sexual impairment that has skyrocketed within the last twenty years, with erectile dysfunction now affecting between 14 and 35 per cent of young men, in contrast to perhaps 2 or 3 per cent at the beginning of this century.

That’s quite a claim! There can’t be many health conditions that have gone from single-figures to more than a third of the population in 20 years (not counting new infectious diseases like COVID, of course).

So, two questions: is Perry’s claim about erectile dysfunction—which she’s repeated in various other places—true? And if it is true, or even true to some extent, is the increased rate of erectile dysfunction caused by people watching too much porn? Whisper it: could the science actually justify “No Nut November”? Let’s find out.

Limp evidence

What’s the basis for Perry’s claim about “skyrocketing” rates of erectile dysfunction? She gives one citation, and it’s to a 2019 Guardian article entitled “Is Porn Making Young Men Impotent?”. On first glance, it’s not exactly a brilliant source: it’s not an article reporting a new study, but a “lifestyle” piece, and according to a note at the end, the article has had to be corrected on three separate occasions. It does contain the numbers Perry quotes, but it doesn’t say specifically where they come from.

For the higher erectile dysfunction (ED) numbers which apparently come from more recent years, it cites “a number of studies and surveys”, with no link provided. For the notion that ED rates were 2-3% at the start of the century and have risen since, it gives a quotation from someone from the “Reward Foundation”, which is an anti-pornography campaigning group. When I visited their website to try to track down the origin of the numbers, and clicked on the page “physical effects of porn”, I found that among the first sources they cite is… that same Guardian article!

Circular referencing aside, they do also cite a 2014 YouTube video which mentions several more sources, and from going through a few of the studies they mention, I think I managed to track down the basis for the claim. First, there’s a 2002 systematic review of 23 studies which arranges the data by age and concludes that 2% of men under 40 years old (compared to 86% in men over 80) had ED. So that covers the first part, about ED rates being low at the turn of the century.

Then there’s a 2012 study of young Swiss men (18-25 years) who had a medical exam before their compulsory military service. It wasn’t representative, because they were invited to complete a survey about sexual functioning off the back of their military health checkup, and one can imagine a lot of people not being bothered. Regardless, they found that a surprisingly high 30% of the respondents reported erectile dysfunction (though for the vast majority of those, it was mild).

Does that mean that erectile dysfunction rates went from 2% in 2002 to 30% in 2012, more-or-less supporting Perry’s claim? No. The 2012 study notes that their estimates were close to those from a 2005 study that used the same measure; that study, from Vienna, found rates of just over 20% in their age group of 20-30 year-olds. So did rates go from 2% in 2002 to 20% just three years later, and then tick up to 30% by 2012? And then—if we look at this 2016 survey of 16- to 21-year-olds in the UK—did the rate go back down to 7.8%? You can already see how silly this is getting.

If you’re willing enough to cherry-pick, you can find studies to support the narrative that (a) ED has increased dramatically over the past 20 years; (b) ED has decreased dramatically over the past 20 years; (c) there hasn’t been much difference in the prevalence of ED over the past 20 years. In actual fact, the studies are a mess because: they measure or define ED (and different severities of ED) differently from study to study; they often consider different age groups to be “young men” (16 to 21 years, under 40 years, and so on); they’re in different countries; they’re at differing levels of representativeness; among other differences.

We’re going to need more systematic studies that try to line up the studies to work out trends across the last decades - and even then it’s no small task to try to iron out all the differences. Add to that the fact that ED is not exactly the kind of thing people are keen to talk about (and might conceivably have been less likely to want to talk about it in past decades compared to now) and you see how vexed is the question of comparing prevalence studies over time.

And that latter point about differences in the acceptability of coming forward with ED might also explain the other type of study that’s sometimes cited in this debate: the kind that shows that, of the men visiting sexual health clinics, a substantial proportion are young. For example, a study from 2013 found that a quarter of cases of ED at an Italian clinic were under-40s - though it didn’t have a comparison to what was happening at the same clinic, say, 20 years ago.

The authors did a bit of editorialising in the title of the article, calling it a “worrisome picture”. But it’s less worrisome if the rate in younger men hasn’t actually increased and more are simply coming forward because it’s less shameful to do so now. This is just a possibility that I don’t have any evidence for, of course - but it’s just to illustrate that a snapshot study like this doesn’t really prove anything. And for the reasons discussed above, even comparing it to other studies from different places isn’t going to tell us much unless they used very similar methods.

Smut’s ado about nothing

Okay, so the evidence for the trend in ED rates is all over the place, despite the very confident pronouncements from Perry and the Reward Foundation. But we can still ask whether the second part of the claim, about the effects of pornography, is true. That is, even without increasing rates of ED, we can still ask whether people who watch more pornography are more at risk of ED (or more severe ED), and if so whether this is a causal effect. So, are they? And is it?

What we aren’t short of here is anecdotes. Just take a look at the Reward Foundation website, or on places like the “NoFap” Subreddit (to be honest I don’t really recommend doing either of these) and you’ll find endless stories from guys who blame an addiction, or near-addiction, to pornography for their sexual problems. And there are published case reports that seem to support the idea.

But what about actual data, rather than collections of anecdotes? The psychologist Josh Grubbs (who is a Twitter pal of mine) has done loads of good research on this topic. In 2019, he and his co-author published a paper where they took three samples of men (n = 147, aged on average 19; n = 297 aged on average 46; n = 433, aged on average 33) and collected data on their porn use and their erectile functioning.

Here’s the money shot… sorry, I mean, money quote:

In general, among sexually active pornography-using men, serious erectile problems seem rare, a finding that runs counter to a popular narrative suggesting that pornography use is driving an epidemic of ED.

Indeed, they found that mere pornography use wasn’t linked to ED issues either at the same time of measurement or a year later. There was, however, a link between self-reported problematic use of porn—feelings of addiction or compulsion—and higher rates of ED (Grubbs also has a more recent review paper that makes a similar point).

There’s also this study from Hungary that came out earlier this year: even with a pretty large sample (n = 3,586), they struggled to find any statistically-significant correlation between porn use and erectile dysfunction, and they had similarly flat results when restricting the analysis to the under-30s. Again, though, it is all self-report, and the sample wasn’t representative, so caveat emptor.

In the cases where you do find a correlation of ED with porn use—like in the Grubbs paper above, for “problematic” use—it’s still tricky to understand what’s going on. Of course, one interpretation would be that watching porn to problematic levels caused ED to develop. But you’re asking the men themselves for their opinion here: why would we expect them to have access to the accurate answer about the cause of their own health conditions? Maybe they developed an erectile problem for some other reason and then blamed the pornography use for it. Or only started referring to their pornography use as problematic after they developed ED for an unrelated reason. Or maybe the problem with sexual function caused the problematic porn use, rather than the other way around.

That lack of causal understanding is what hampers a lot of the research on this question: even if you do find a decent-sized correlation between porn use and erectile problems—and as we’ve seen, even that isn’t assured—how can you know what caused what?

As the Grubbs paper notes, there’s at least one lab study which found an increase, not a decrease, in sexual functioning in the short term after watching pornography - but we should note that the study has been criticised for having incomplete reporting of its results. In any case, it’s probably the medium-to-long term that we’d be more interested in here. I’m not aware of any experimental research on this timescale, and given how difficult it would be to pull off… sorry, I mean, perform, I doubt that any exists.

A final point. Let’s grant that there is an increase in the rate of ED, and let’s agree that the evidence it’s caused by porn consumption is weak. What could be causing it? Well, there are quite a few candidates: there’s evidence for correlations with obesity, diabetes, smoking, drinking, and lack of exercise, anxiety, and more; and the evidence for any of these is a lot stronger and a lot clearer than that for pornography consumption.

That is, without porn or porn addiction in the picture, it’s hardly as if we’d be out of ideas in explaining any ED increase. And as with so many of these medical issues, it’s likely caused by a combination of many of these factors (not to mention the fact that some men are unlucky enough to be born with higher genetic risk for the disorder).

Onan the Barbarian

I suppose if you really believed that there was hard… sorry, I mean rock-solid… evidence that there was a swelling in the numbers of… sorry. Let me start that again.

I suppose if you really believed that that the number of cases of erectile dysfunction was dramatically higher than 20 years ago, and you really believed that pornography was the cause, it might justify raising the alarm - and maybe even justify exaggerating the case just to get the word out. But if you look into either aspect of this argument—the fact that there’s an epidemic of ED, or the fact that it’s caused by pornography—the whole thing seems incredibly shaky.

Of course, ED is just one bad effect that pornography is supposed to have, and it’s an effect on the actual user of the porn - as opposed to their sexual partners, the performers in the porn itself, or society in general. There are probably Substack posts to be written about any or all of them, and I might get round to that in future. For now though, it’s shocking—shocking!—to discover that this prominent argument in favour of No Nut November doesn’t have much evidence behind it.

Incidentally, it is interesting that a major anti-porn argument nowadays is that it causes erectile dysfunction, because I distinctly remember a time where the main focus was that porn turns men into enraged, barbaric sex offenders. The charitable interpretation is that it might have these opposite effects on different people - but I must say I haven’t seen any decent evidence for that, either.

I wonder if this is similar to a case I made elsewhere a while back about violent videogames: that people are mistaking their aesthetic or moral disgust reactions about pornography—which are often very well-justified!—for evidence of its harms. It’s perfectly fine to criticise something for being ugly or unpleasant, but that case can be made without exaggerating the strength of the data on what effects it might have. There’s nothing wrong with being a cultural critic. It’s just that cultural critics aren’t—and don’t need to be—scientists.

Image credit: TBH I’ve no idea. It’s been an internet meme for decades.