Response to Jim Pfaus’s “Trust a Scientist: Sex Addiction Is a Myth”

PFAUS: “Here’s why: addicts withdraw……The same goes for a guy obsessed with watching porn. He might prefer to endlessly watch porn, but when he’s unable to, no withdrawal indicative of addiction occurs. He’ll never be physically addicted.”

RESPONSE: Pfaus spends considerable text suggesting that “withdrawal symptoms” equal “addiction”. First, it is well established in the addiction field that neither the presence nor absence of withdrawal symptoms determines the existence of an addiction. That said, porn addicts consistently report withdrawal symptoms that mirror drug withdrawal. Please see multiple reports on these pages:

• What does withdrawal from porn addiction look like?
• PDF of self-reported withdrawal symptoms

Pfaus may claim these are only anecdotes, yet no published paper has yet asked porn addicts about the withdrawal symptoms they experience when they abstain from porn use.

In saying that “physical symptoms” must be present for an addiction to exist, Pfaus is confusing addiction with physical dependence. For example, millions of individuals take chronically high levels of pharmaceuticals such as opioids for chronic pain, or prednisone for autoimmune conditions. Their brains and tissues have become dependent on them, and immediate cessation of use could cause severe withdrawals symptoms. However, they are not necessarily addicted. Addiction involves multiple well-indentified brain changes that lead to what we know as the “addiction phenotype”. If the distinction is unclear, I recommend this simple explanation by NIDA -

Pfaus’s “withdrawal = addiction” argument falls apart when we consider that nicotine is often listed as the most addictive substance, and yet causes relatively mild withdrawal symptoms. Finally, the DSM-5 has added pathological gambling into the newly created behavioral addiction category, ending the argument that only drugs can cause and addiction, and with it the claim that “dependence” equals addiction. See this DSM-5 publication.

PFAUS: “As such, the anti-fapper narrative is usually the only point discussed: Guys stop masturbating after they stop downloading porn, and after a few days, they say they’re able to get normal erections again.”

RESPONSE: Pfaus falsely claims it takes a “few days” for men with porn-induced ED to regain normal erectile functioning. Instead, it generally takes months, and up to two years, in some cases, for young men to achieve normal erections again. Pfaus has often spun the nonsensical story that porn-induced ED is cause by a refractory period. I’ve never heard of a 9-month refractory period for a 23-year old. Readers might find interesting this peer-reviewed paper describing porn-induced anorgasmia/loss of libido in a 35-year-old healthy man. It took 8-months of no porn for him to regain normal sexual functioning.

PFAUS: “This coincides with the somewhat popular idea that watching porn leads to erectile dysfunction, a position that porn-addiction advocates such as Marnia Robinson and Gary Wilson state emphatically.”

RESPONSE: First, my book Your Brain on Porn: Internet Pornography and the Emerging Science of Addiction, which came out last year, addresses porn related sexual dysfunctions such as difficulty orgasming and sustaining erections. It has been endorsed by various experts. And I recommend it to anyone who wants to understand what is going on on recovery forums, as well as the relevant science (more of which has come out since, and all of which aligns with what I wrote).

Second, it’s not just Gary Wilson. On this page readers can see articles and videos by about 60 experts (urology professors, urologists, psychiatrists, psychologists, sexologists, MDs) who have successfully treated porn-induced ED and porn-induced loss of sexual desire. Several studies support what these experts have observed:

1) “Neural Correlates of Sexual Cue Reactivity in Individuals with and without Compulsive Sexual Behaviours (2014)” — This fMRI study by Cambridge University found sensitization in porn addicts which mirrored sensitization in drug addicts. It also found that porn addicts fit the accepted addiction model of wanting “it” more, but not liking “it” more. The researchers also reported that 60% of subjects (average age: 25) had difficulty achieving erections/arousal with real partners, yet could achieve erections with porn. From the study:

“CSB subjects reported that as a result of excessive use of sexually explicit materials….. experienced diminished libido or erectile function specifically in physical relationships with women (although not in relationship to the sexually explicit material)”

“Compared to healthy volunteers, CSB subjects had greater subjective sexual desire or wanting to explicit cues and had greater liking scores to erotic cues, thus demonstrating a dissociation between wanting and liking. CSB subjects also had greater impairments of sexual arousal and erectile difficulties in intimate relationships but not with sexually explicit materials highlighting that the enhanced desire scores were specific to the explicit cues and not generalized heightened sexual desire.”

2) “Brain Structure and Functional Connectivity Associated With Pornography Consumption: The Brain on Porn (2014)”- A Max Planck study which found 3 significant addiction-related brain changes correlating with the amount of porn consumed. It also found that the more porn consumed correlated with less reward circuit activity in response to brief exposure (.530 second) to vanilla porn.

Lead author Simone Kühn said:

“That could mean that regular consumption of pornography more or less wears out your reward system.”

Simone Kühn continued:

“We assume that subjects with a high porn consumption need increasing stimulation to receive the same amount of reward.”

Kühn says existing psychological, scientific literature suggests consumers of porn will seek material with novel and more extreme sex games:

“That would fit perfectly the hypothesis that their reward systems need growing stimulation.”

3) “Modulation of Late Positive Potentials by Sexual Images in Problem Users and Controls Inconsistent with “Porn Addiction” (2015)” — An EEG study comparing the subjects from an earlier study by the same research lab to an actual control group. The results: Compared to controls, porn addicts had less response to one-second exposure to photos of vanilla porn. The lead author, Nicole Prause, claims these results debunk porn addiction. However, these findings align perfectly with Kühn & Gallinat (2014), which found that more porn use correlated with less brain activation in response to pictures of vanilla porn. In other words, “porn addicts” were desensitized and needed greater stimulation than non-addicts. Two peer-reviewed papers agree with my analysis of this study:

• Neuroscience of Internet Pornography Addiction: A Review and Update (2015)
• Neurobiology of Compulsive Sexual Behavior: Emerging Science (2016)

4) “Adolescents and web porn: a new era of sexuality (2015)” — An Italian study that analyzed the effects of Internet porn on high school students, co-authored by urology professor Carlo Foresta, president of the Italian Society of Reproductive Pathophysiology. The most interesting finding is that 16% of those who consume porn more than once a week report abnormally low sexual desire compared with 0% in non-consumers (and 6% for those who consume less than once a week).

5) “Patient Characteristics by Type of Hypersexuality Referral: A Quantitative Chart Review of 115 Consecutive Male Cases (2015)” — Study on men (average age 41.5) with hypersexuality disorders, such as paraphilias and chronic masturbation or adultery. 27 were classified as “avoidant masturbators,” meaning they masturbated (typically with porn use) one or more hours per day or more than 7 hours per week. 71% reported sexual functioning problems, with 33% reporting delayed ejaculation. What sexual dysfunction do 38% of the remaining men have? The study doesn’t say, and the authors have ignored requests for details. The two other primary choices for male sexual dysfunction are ED and low libido.

6) Erectile Dysfunction, Boredom, and Hypersexuality among Coupled Men from Two European Countries (2015) — Survey reported a strong correlation between erectile dysfunction and measures of hypersexuality. The study omitted correlation data between erectile functioning and pornography use.

7) (not peer-reviewed) Here’s an article about an extensive analysis of comments and questions posted on MedHelp concerning erectile dysfunction. What’s shocking is that 58% of the men asking for help were 24 or younger. Many suspected that internet porn could be involved as described in the results from the study -

EXCERPT: The most common phrase is “erectile dysfunction” — which is mentioned more than three times as often as any other phrase — followed by “internet porn,” “performance anxiety,” and “watching porn.” Clearly, porn is a frequently discussed subject: “I have been viewing internet pornography frequently (4 to 5 times a week) for the past 6 years,” one man writes. “I am in my mid-20s and have had a problem getting and maintaining an erection with sexual partners since my late teens when I first started looking at internet porn.”

Reality check. All studies assessing young male sexuality since 2010 report historic levels of sexual dysfunctions, and startling rates of a new scourge: low libido. All documented in this article.

Erectile dysfunction rates ranged from 27 to 33%, while rates for low libido (hypo-sexuality) ranged from 16% to 37%. The lower ranges are taken from studies involving teens and men 25 and under, while the higher ranges are from studies involving men 40 and under.

Prior to the advent of free streaming porn, cross-sectional studies and meta-analysis consistently reported erectile dysfunction rates of 2–5% in men under 40. That’s nearly a 1000% increase in youthful ED rates in the last 20 years. What variable has changed in the last 20 years that could account for this astronomical rise?

PFAUS: “These types of advocates are wedded to the idea that porn is an uncontrolled stimulus the brain gets addicted to because of the dopamine release it causes. According to their thinking, anything that causes dopamine release is addictive.”

RESPONSE: A false statement by Pfaus. Of course, I never said that “anything that causes dopamine release is addictive”. I’m guessing that Pfaus, of all researchers, realizes that sexual activity is a unique natural reward. Sexual activity induces the highest levels of nucleus accumbens dopamine naturally available. The same goes for endogenous opioids. In fact, Pfaus has published studies showing that sexual activity leads to conditioned place preference (CPP). Conditioned place preference is used to assess the addictiveness of substances. Studies on rats have demonstrated that sex is a unique stimulus in that it activates the same reward system neurons as addictive drugs such as meth. By comparison, other natural rewards (food, water) may only overlap 10–20% with the sex/addictive drug neurons.

I suggest the following study, which compared the neurobiology of sexual activity with the neurobiology of sensitization to addictive drugs. (By the way sensitization is the core brain change involved in addiction, as proposed by the incentive motivation theory of addiction.) “Natural and Drug Rewards Act on Common Neural Plasticity Mechanisms with ΔFosB as a Key Mediator (2013)”. An excerpt from conclusion -

“Thus, natural and drug rewards not only converge on the same neural pathway, they converge on the same molecular mediators, and likely in the same neurons in the nucleus to influence the incentive salience and the “wanting” of both types of rewards.”

This means that addictive drugs and sex activity induce the same brain changes on the same neurons that lead to craving and wanting for “IT”, whether that “IT” is drugs or sex.

PFAUS: “For instance, according to proponents of the sex addiction industry, the more porn someone watches, the more they’ll experience erectile dysfunction.”

RESPONSE: It’s already established in studies on both internet porn addiction ( 1, 2, 3) and internet videogaming addiction, that symptoms do not correlate with “hours of use.” Instead of just current hours of use, a combination of variables appear to correlate best with porn-induced ED. These may include:

1. Ratio of masturbation to porn versus masturbation without porn
2. Ratio of sexual activity with a person versus masturbation to porn
3. Gaps in partnered sex (where one relies only on porn)
4. Virgin or not
5. Total hours of use
6. Years of use
7. Age started using porn
8. Escalation to new genres
9. Development of porn-induced fetishes (from escalating to new genres of porn)
10. Addiction-related brain changes or not
11. Presence of hypersexuality/porn addiction

The better way to research this phenomenon, is to remove the variable of internet porn use and observe the outcome. Such research reveals causation instead of correlations open to interpretation. My site has documented a few thousand men who removed porn and recovered from chronic sexual dysfunctions.