In a casual conversation I was having with a marriage counselor, he mentioned that a growing number of young couples are struggling with impotence. The main cause is watching too much pornography.
Now, it is no surprise that adolescents would watch pornography. Since the dawn of time young men have been seeking arousal from pornographic images. With the advent of the Internet, the availability and variety of images is endless. Teens are able to access pornography on their phones, tablets, computers, and cable. It’s next to impossible for parents to block all access because every adolescent has one form of technology or another; if he doesn’t have access at home, it surely can be seen at a friend’s house.
The physiologic effect of pornography is an excessive release of dopamine that binds to dopamine receptors and causes a maximal state of arousal. These receptors over time become less and less sensitive, so when these young men engage in intercourse, the stimulation is much less, and they are unable to have an erection. Many men do not make the connection between the pornography and their erectile dysfunction, so they may go years without seeking help.
There is a growing trend among younger men to use Viagra and Cialis, according to statistics (Int. J. Impot. Res. 2004;16:313-8). Most are using them for sexual enhancement, but others are seeking them for performance anxiety which may be related to their dysfunction associated with pornography. The problem is, pornography-induced erectile dysfunction is not an issue of blood flow, so these drugs are not helpful in most cases. Since the issue is the sensitivity of the dopamine receptors, the only treatment is to reduce or stop watching pornography, thus allowing the dopamine receptors to become more sensitive.
Now, as a physician, this clearly is an awkward topic to bring up during a routine health physical. But if left unsaid, this behavior could clearly lead to years of dysfunction. What I have found to be a simple solution to the “not so popular topics” is to present a handout with a topic simply stated and easy to read. This allows you to give patients the information without the embarrassment. The purpose is just to identify what is normal and what is not so normal so a patient knows to seek help if the problem occurs. Quick fixes also should be listed if known, especially if the quick fix is just to stop the behavior.
Other topics – such as bacterial vaginosis, the morning after pill, acne, and gynecomastia – can be addressed similarly because teens don’t know what they don’t know, so they may not even consider asking. Many women don’t realize that bacterial vaginosis requires a prescription medication and so may remain symptomatic for long periods of time.
Education is key. As pediatricians, arming our patients with knowledge allows them to at least ask the appropriate questions, which hopefully will get them the right answer.
Dr. Pearce is a pediatrician in Frankfort, Ill. E-mail her at pdnews@frontlinemedcom.com.