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Response to the Commentary on: Do pornography use and masturbation play a role in erectile dysfunction and relationship satisfaction in men?

International Journal of Impotence Research volume 35, pages 585–587 (2023)Cite this article

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This article has been updated

We thank the Editor for the opportunity to respond, and we commend De Win et al. for undertaking research on a needed topic [1]. In response to their commentary, we offer the following points/observations.

  1. 1.

    We begin by reiterating the context and purpose for this study [2] as well as a related study dealing with delayed/inhibited ejaculation in men [3]. Both studies arose out of (a) the need to study the relationships among masturbation frequency, pornography use frequency, and sexual response in a large community sample rather than in clinical groups seeking help, specialized groups with dysfunctions, or individuals representing a tail of the distribution, such as those exhibiting problematic pornography use (PPU), and (b) the need to explore these relationships in a larger multivariate context that includes other variables known to affect sexual response (see ref. [4] for a recent critical review of the literature).

  2. 2.

    The authors of the commentary seem to have missed important information as they read our paper. First, they stated that we listed only the negative effects of pornography. This was not the case, as the reader will discover in scanning the first page of the article. In addition, the Introduction of the article reports the results of various (and numerous) studies having negative, no apparent, and positive effects on sexual response [5,6,7,8,9,10,11,12,13,14,15,16,17]. Second, the authors state that our results “suggest that questions about pornography use should not be part of the assessment process,” but this comment represents an inference on their part. In actuality, we made no such suggestion or recommendation; rather we explain our rationale, present the data, and let the data speak for itself. If professionals determine a need/value for raising this issue in a clinical setting, we respect their judgment. Third and most concerning, however, are the arguments the authors put forth regarding the inadequacy of our measures. Those arguments indicate that they appear to have missed the major point of our study, as we explain in the next two sections.

  3. 3.

    The authors criticize our measures of masturbation and pornography use on the basis that they lack sensitivity. For the record, we explored data on other masturbation measures from our survey, including reasons for masturbating, specific activities (including use of aids such as pornography) engaged in during masturbation, and self-reported reasons for not being able to reach ejaculation/orgasm during masturbation. Given that none of these measures yielded strong effects with our outcome measures of erectile response or delayed/inhibited ejaculation, we focused only on the frequency of masturbation, a variable having obvious face-valid potential. The authors also criticize our study because we did not assess whether participants experienced satisfactory or problematic erections during masturbation; however, we note that we recently published data on this issue, comparing functional and dysfunctional men, although not specifically within the context of pornography use [18]. However, for all dysfunctional men, sexual performance during masturbation was vastly improved over that of partnered sex—in other words, much of the symptomology was attenuated.

    With respect to pornography use, we had two items on our survey, the first queried about the use or non-use of pornography during masturbation and yielded no effects on erectile functioning, ED severity, or delayed ejaculation, so we used only the second item which gauged the frequency of pornography use, as this item showed significant effects within our bivariate analyses. And this now brings us to the critically important point that De Win and colleagues appear to have missed.

  4. 4.

    We note that in our two studies—and this point is clearly explicated in the first sentences of the Discussion sections of each paper—(a) both of our measures (frequency of masturbation and frequency of pornography use) were sufficiently sensitive to detect significant group differences when investigated through simple bivariate analysis. Thus, our first step replicated findings that have been touted in previous studies as providing evidence that both these variables affect sexual response during partnered sex. However, in our papers, we also noted that (b) effect sizes for these differences were small, that is, although the differences were significant, the relevance of these differences was questionable. We then (c) followed these bivariate analyses with multivariate analyses that included other variables known to affect sexual response. In doing so, the associations between masturbation/pornography use and sexual response became non-significant or negligible (significant but very small effect size). In fact, in one of those studies [3], we demonstrated that the explained variance in sexual impairment added by knowing about the respondent’s frequency of pornography use was under 1%. We also demonstrated that this lack of effect held (a) when also looking at ED severity (in addition to erectile functioning), and (b) when target groups were defined in a variety of ways, for example, by sexual dysfunction comorbidity status (a critically important consideration when investigating sexual problems), or by age (as younger groups presumably represent a more vulnerable generation). Thus, an effect that was evident in a bivariate analysis essentially disappeared when included in a multivariate analysis that included other variables known to affect the outcome variable, and equally important, these other variables demonstrated much more robust associations with sexual impairment. This, indeed, was the main takeaway message from our two studies.

  5. 5.

    The interpretation of our findings was, in our view, appropriately balanced. We carefully limited the interpretation of our findings to the particular variables that we were investigating and did not extrapolate beyond that. For example, we readily admitted to this limitation in the article, stating “we did not assess the nature/type/content of the pornography that was being viewed—some types of pornography could have detrimental effects whereas others might not.” Furthermore, in both the Abstract and Discussion, we included nuanced language that recognized that some men (e.g., young and sexually experienced) may experience erectile difficulty or problems reaching ejaculation during partnered sex due to heavy- or over-reliance on pornographic materials for arousal (i.e., a situation that might be defined as “problematic pornography use”). We further stated that “we do not presume that our study provides a definitive answer regarding the relationships among masturbation frequency, pornography use, and erectile functioning, as such relationships likely vary across both generations and cultures [19]. Rather, we encourage other research teams to carry out well-controlled studies using a variety of methodologies that operationally define and assess both outcome variables and predictor/confounding variables.” The challenge will be, as alluded to by the authors of the commentary, explaining why a limited number of individuals might be particularly vulnerable to the negative effects of pornography, an issue that we recently addressed through a study investigating predictors of PPU based on the I-PACE model [20].

  6. 6.

    We are not in a position to evaluate the author’s findings using CYPAT, as a full methodological accounting is not provided. However, as with our study, from the information included in their commentary, their analysis appears to have used a cross-sectional design which allows only for correlational interpretations (also a problem with our study but one that we readily admitted in the Limitations section). In addition, it appears that they conducted a simple bivariate analysis which, as we demonstrate in our study, can result in misleading conclusions. And finally, the CYPAT—an instrument designed to assess potential pornography addiction (CYPAT = Cyber Pornography Addiction Test)—appears to assess PPU and/or addiction, so we are not surprised that individuals scoring high on this instrument (i.e., a specialized group indicating pornography addiction) might experience problems with sexual response during partnered sex. At the same time, we are quite baffled by a statement made by the authors of this commentary, that total scores on this instrument are not “suggestive of problematic consumption or addiction.” In fact, a validation paper for this instrument clearly states that the purpose of the CYPAT was to “develop a brief measure of perceived addiction to Internet pornography,” and further that the “the brief self-report screening scale is composed of 11 items scored on a five-point Likert scale” (1 = never, 5 = always) and that the scale shows convergence with various other scales related to pornography addiction [21].

  7. 7.

    Although we made no specific recommendations in our paper, we cannot help but comment on the recommendation by De Win et al. that physicians should query individuals with an ED complaint about their pornography use. The issue, of course, is an empirical one, but we would guess that this suggestion is impractical and thus unlikely to gain traction in the US. Given the time constraints for patient visits in the US, general practitioners (GP) who encounter an ED presentation typically ask several questions about general health, suggest a PDE-5i, and then make a referral to a specialist (urologist, cardiologist, andrologist, psychologist) if needed, where the issue might be explored more deeply. Given the stigmatization surrounding pornography use (which still remains high in US culture despite widespread use), we cannot imagine a typical GP in the US feeling comfortable broaching the issue of pornography use with the patient, as it would likely cause embarrassment, guilt, and/or shame, particularly in the case of a female physician querying a male patient. Countries other than the USA may, of course, subscribe to different models of clinical investigation and interaction.

We begin by reiterating the context and purpose for this study [2] as well as a related study dealing with delayed/inhibited ejaculation in men [3]. Both studies arose out of (a) the need to study the relationships among masturbation frequency, pornography use frequency, and sexual response in a large community sample rather than in clinical groups seeking help, specialized groups with dysfunctions, or individuals representing a tail of the distribution, such as those exhibiting problematic pornography use (PPU), and (b) the need to explore these relationships in a larger multivariate context that includes other variables known to affect sexual response (see ref. [4] for a recent critical review of the literature).

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Change history

  • 12 December 2022

    Reference 1 has been updated.

References

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Authors and Affiliations

  1. Department of Psychology, Valparaiso University, Valparaiso, IN, USA

    David L. Rowland

  2. Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary

    Krisztina Hevesi

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Reponse led by DR, supported by KH.

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Correspondence to David L. Rowland.

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Rowland, D.L., Hevesi, K. Response to the Commentary on: Do pornography use and masturbation play a role in erectile dysfunction and relationship satisfaction in men?. Int J Impot Res 35, 585–587 (2023). https://doi.org/10.1038/s41443-022-00648-3

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