Porn Addiction: A Source of Sexual Problems

A patient came to see me recently who had been in a sexless marriage for years—and she had recently discovered at least part of the reason. Her husband was addicted to pornography.

This is more common than you think. It's also not a simple problem.

Lots of people—men and women—consume porn at least occasionally. Estimates range from 50 percent to 99 percent of men and 30 percent to 86 percent of women—numbers that are so broad and vague as to only suggest "a lot."

Women tend to watch porn with their partner and to consume softer types—erotica might be a better term. Women usually report feeling greater intimacy with their partner after viewing porn.

Men tend to consume porn alone, and it portrays sometimes aggressive and sometimes deviant forms of sex. A heavy diet of this can cause them to withdraw from intimacy and to feel "increased secrecy, less intimacy and also more depression," says Dr. Ana Bridges, a psychologist at the University of Arkansas in this article.

Porn has been around since time immemorial. What's changed is the amount and type of porn that's available online all the time. We aren't talking about the Playboy or Hustler magazines from a previous generation. This is hard-core, porn-on-steroids content served up in any flavor to satisfy the wildest imagination. These aren't normal bodies; it's not real sex; and it's available any time, day or night.

Although the scientific community has been hesitant to label such consumption as an addiction, and although many people, perhaps most, view porn occasionally without guilt or moral quandary, plenty of anecdotal evidence suggests that a problem is brewing.

Whatever you call it—addiction or compulsion—when an activity becomes uncontrollable and consumes many hours, affects performance at work and compromises intimate relationships and physical or emotional health, then it's a problem.

Therapists and doctors are increasingly seeing patients who report less interest in sex and sometimes an inability to have sex in real life. Erectile dysfunction is showing up in greater numbers, especially in young men who began viewing porn while still in their teens.

Or, like me, health care practitioners are hearing from confused, distraught partners who don't understand what's happening to their partner and to their relationship.

The mechanism that creates the problem is only beginning to be studied and understood. Consuming porn many times a week over a period of months (or years) is a solitary, alienating, guilt-inducing pastime. It frequently changes the way a person interacts sexually with a partner in real life—the person is often more impersonal, distant, and sometimes rough or demanding. Sometimes the person withdraws from the partner altogether.

Heavy porn viewing actually changes brain chemistry. In a small but carefully conducted study, a group of German researchers determined that high levels of porn consumption result in a shrinkage of gray matter in a specific region of the brain. Researchers were unsure whether this reduction was caused by the "wearing and downregulation of the underlying brain structure" due to hours of porn consumption or whether the subjects consumed porn because they had less gray matter in this area to begin with and needed more stimulation to experience pleasure.

Generally, however, the hypothesis is that heavy porn consumption desensitizes the viewer, so that more intense levels of consumption are required to reach the same level of satisfaction.

"You need more and more stimulation as you build up this tolerance, and then comes your reality with a wife or partner, and you may not be able to perform," said Dr. David Samadi, chairman of urology at Lenox Hill Hospital in this article. "It's a problem in the brain, not the penis." As such, drugs for erectile dysfunction, such as Viagra, aren't effective. The penis may engorge, but orgasm doesn't follow.

Obviously, ongoing porn consumption is problematic for a relationship. It can persist for years, with trust and sexual intimacy almost inevitably becoming collateral damage. The situation is confusing, hurtful and debilitating to a partner, in part because the issue is so socially unsavory and so rarely discussed.

I'm thinking it's time to crack open the door and begin talking about porn addiction, how to recognize it and what a partner can do about it.

Barb DePree, MD, has been a gynecologist for 30 years, specializing in menopause care for the past 10. Dr. DePree was named the Certified Menopause Practitioner of the Year in 2013 by the North American Menopause Society. The award particularly recognized the outreach, communication and education she does through MiddlesexMD, a website she founded and where this blog first appeared. She also is director of the Women's Midlife Services at Holland Hospital, Holland, Michigan.