Porn-Induced Erectile Dysfunction (PIED): How a Psychotherapist Can Help

By Dr. Barbara Winter

 

This article is a continuation of Dr. Barbara Winter’s previous post to this site, titled PIED (Porn Induced Erectile Dysfunction): A New Study.

 

In today’s world, young people look at porn, often starting by age 12 or even younger. Many of my current sex and porn addiction patients, as they describe their sexual history, tell me that excessive porn usage hit them early, hard, and fast. They also tell me that by their early 20s they started to wonder why real sex, real touch, and all that is associated with the real-world sexual experience felt underwhelming. My male patients often state that they believe their porn use has created, among other issues, erectile dysfunction. And this is a lot more common than most people might expect. For example, the study cited in my previous post found that 23% of heavy porn users had experienced some level of erectile dysfunction.

This is what we call Porn-Induced Erectile Dysfunction (PIED). Sadly, therapists and medical doctors are finding that short-term solutions like pills and injections are not helpful with PIED (as they are with most other forms of sexual dysfunction. This is because PIED is more psychological than physical. At best, injections and pills are band-aids that cover up the real cause of the problem. And ultimately these short-term solutions will not help porn-addicted men regain their sexual functioning.

Generally, porn viewing (especially at an early age) starts with curiosity. Unfortunately, viewing porn is highly addictive, so what starts as curiosity can easily escalate and become problematic. That said, like other process (behavioral) addictions (gambling, spending, sex, etc.), porn addiction continues and escalates in response to what is going on in the user’s home and life. Typically, there is a desperate and unmet need to connect, courtesy of a dysfunctional, emotionally unresponsive, or disconnected family, with the pain of that unmet need being dulled by the intensity of pornography.

Once porn use sets in as a coping mechanism (as a way to not feel the pain of unmet emotional needs), addiction takes root. Basically, it feels better to turn away from pain by engaging in the sexualized pleasure of porn than to simply stay stuck in the mud. This is why addictions are often referred to as being an attachment disorder. Addicts use a pleasurable behavior to escape the emotional pain of reaching for but not finding real-world intimacy. And like all addictions, the cycle of escape via pornography eventually takes on a life of its own, one that needs unpacking and rebooting as part of treatment.

Over time, the psychological consequences or porn addiction can be devastating. That said, I have had very few clients enter treatment on their own, simply because they’re feeling badly related to their porn use. Most present in treatment because they’ve been found out and now they’re facing external consequences (relationships, work, school, etc.) Either way, by the time they begin therapy, they are usually quite desperate – desperate for a more normal way in which to be.

Through therapeutic dialogue and exploration of their experiences, porn-addicted men can let go of the need to continue the addiction. With specific addiction-related treatments, they can also begin to manage the symptoms that plague them. But this is not a simple process; it requires a multifaceted approach that includes not just management strategies (for stopping the behavior) but bottom-up work and a deep dive into their lived experience.

Generally, for men I work with, I offer a combination approach that includes:

  • Sex Therapy
  • Sex-Addiction Therapy
  • Couples Therapy
  • Integrated Sex and Couples Therapy

For those who wish to learn more about recovery from porn addiction, help is available through this website, SexandRelationshipHealing.com, at SeekingIntegrity.com, and through my own website.