The Tribune

By DR GREGGORY PINTO

Every man will face some form of erectile dysfunction is his lifetime, whether it takes the form of poor quality erections, difficulty maintaining an erection, or premature ejaculation.

To attain and sustain an erection a man requires an adequate penile blood supply and nerve supply and sufficient male hormone testosterone, amongst other physiological components but the psychological and emotion contribution can have a potentially profoundly negative affect on erectile function.

Erectile dysfunction (ED) is often thought of as a disorder affecting older men, but the number of young adult men who experience ED is steadily rising. ED is quickly becoming an equal age opportunity disorder.

The number of young men less than 35 years of age who experience erectile problems was estimated to be less than two to three percent before the year 2002, but current studies have shown that 14 to 35 percent of younger men now face ED.

The culprit is mainly thought to be the steady rise in readily available free streaming pornography. There was a recognised surge in the free availability of high definition porn in the early 2000s.

According to a 2013 study published in the Journal of Sexual Medicine, nearly one in four newly diagnosed patients with erectile dysfunction was less than 40 years old.

The term is porn induced erectile dysfunction (PIED), a condition that has been exhaustively scientifically studied in recent years.

Researchers have studied the brain images of young male compulsive pornography users and they have discovered brain changes that are seen in other addictions such as those to drugs and alcohol.

Porn is rewiring the brains of many young men. Research is showing that watching even three hours of porn a week can cause structural brain changes in regards to sexual stimulation. Watching porn triggers the release of dopamine that causes men to experience pleasure, and when that pleasure is triggered over and over, it leads men to repeatedly seek out the porn that initially created the pleasurable response; similar to a drug addict seeking out the response to cocaine, for example, repeatedly.

Every time a man watches porn, or heightens the experience with masturbation, there is a strengthening of the brain’s arousal pathway to dopamine release and pleasure, during which the pathways connecting arousal to physical arousal from another partner is not used. The end result is that many men who watch porn compulsively do not respond to natural forms of sexual stimulation with a partner and can only be aroused by more pornography.

Scores of men have difficulty achieving and maintaining erections without the input of porn, because their brains need that level of stimulation from porn to achieve arousal. Porn can potentially lead to the desensitisation of men’s sexual arousal to real live women.

It is all not so straightforward as some scientific researchers have proposed that porn actually helps with erectile dysfunction ED.

For most young men with ED, there is likely no single identifiable cause.

In regards to PIED, it is thought to have created unrealistic expectations for young men, and many need to progressively increase sexual stimulation from porn to become aroused and stay aroused. Porn overload can lead some men to no longer being aroused by the presence of a partner.

Reducing the input of porn has shown to allow for the brain to reboot and erectile function within a relationship to improve. The brain is a resilient organ and erectile dysfunction caused by porn can be reversed by removing or reducing the porn exposure.

More young men are being diagnosed as obese and there are higher numbers of young adult men having both hypertension and diabetes. Sickle cell disease causes erectile dysfunction in many afflicted Bahamian men.

Obesity as well as poorly controlled or undiagnosed high blood pressure and diabetes can impair blood and nerve supply to the penis.

Adrenal gland and thyroid disorders can cause erectile disturbances in younger and older men.

The number of young men being diagnosed with low testosterone is higher than ever before. High alcohol intake, smoking, illicit drug use and opiate drug abuse all can potentially lead to erectile dysfunction for young men.

Anxiety and depression potentially could lead to erectile dysfunction in young men too. Nervousness related to performance, fear of unwanted pregnancy or concern regarding maintaining an erection, all could lead to erectile issues.

The issue of erectile dysfunction in young adult men is a complex issue and the direct link to pornography is strongly debated.

There is little doubt, however, that psychogenic erectile dysfunction that is unrelated to any physiological cause, is on the rise among young men

Erectile dysfunction is an embarrassing and often traumatic subject for many men of all ages. The real tragedy is not seeking help when solutions do exist.

Seek confidential and compassionate urology care in regards to any form of erectile dysfunction. No matter what, you can always rise again.

• Dr Greggory Pinto is a Bahamian urologist who has trained in South Africa, Germany and France. He is a member of the European Association of Urologists. Dr Pinto can be reached at Urology Care Bahamas at the Surgical Suite, Centreville Medical Centre, Collins Avenue and Sixth Terrace. Call (242) 326-1929, e-mail welcome@urologycarebahamas.com, or visit the website, www.urologycarebahamas.com.