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By Marc Braman, MD, MPH

Is Internet Pornography Causing Sexual Dysfunctions? A Review with Clinical Reports. Park BY, Wilson G, Berger J, Christman M, Reina B, Bishop F, Klam WP, Doan AP. Behav Sci (Basel). 2016 Aug 5;6(3). pii: E17. doi: 10.3390/bs6030017. Erratum in: Behav Sci (Basel). 2018 Jun 01;8(6):.

Masturbation and Pornography Use Among Coupled Heterosexual Men With Decreased Sexual Desire: How Many Roles of Masturbation? Carvalheira A, Træen B, Stulhofer A. J Sex Marital Ther. 2015;41(6):626-35. doi: 10.1080/0092623X.2014.958790. Epub 2014 Oct 16.

Predictors of female sexual dysfunction: a systematic review and qualitative analysis through gender inequality paradigms. McCool-Myers M, Theurich M, Zuelke A, Knuettel H, Apfelbacher C. BMC Womens Health. 2018 Jun 22;18(1):108. doi: 10.1186/s12905-018-0602-4.

Psychological symptomatology, self-esteem and life satisfactions of women from polygamous and monogamous marriages in Syria. Al-Krenawi A, Kanat-Maymon Y. Sage Journals. 2015 Feb 23;60(1):196-207. doi:10.1177/0020872814562478.

Sexual Frequency Predicts Greater Well-Being, But More is Not Always Better. Muise A, Schimmack U, Impett EA. Social Psychological and Personality Science. 2015 Nov 18;7(4):295-302. doi:10.1177/1948550615616462.

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MB (Marc Braman, MD, MPH):

You are 10 years old.  You just saw a Superman movie.  You have made a cape out of an old towel your mother let you play with.  You think you are going to leap over tall buildings in a single bound!  Do you?

What if you got a full realistic Superman costume from the toy store?  A proper cape, a big “S” on your chest.  Would that boost your abilities?  What if Johnny swears he leaped over Mrs. Smith’s house next door with his Superman outfit?  Are you good to go?

What is reality?  And are our expectations meshing with reality?  What does this have to do with ED?

Most men want to be “superman” sexually.  We live in a time and society that is hyper sexual.  Sex is used to sell beer that makes you fat and kills your sex life.  Sex is in the movies we entertain ourselves with. Sex is everywhere on the internet and porn has become a huge industry and presence.  Sex, sex, sex.  Everywhere is sex.

Spam and ads for male “performance” and “enlargement” pills, potions, and devices come at you from all angles.

All of this leaves guys thinking that normal, or being a real man, is to have a grossly abnormally large penis that gets used for a wide variety of sexual acts many times a day.  And when that isn’t the reality they experience they feel deficient, they are embarrassed, they don’t feel like a “real man”.

In reality, couples are satisfied with a sex life that varies quite a bit.  On average, sex once or twice week is pretty typical.  But more or less is perfectly fine and normal.  If we were to go by the biology of the menstrual cycle, what happens approximately monthly, we would say that maybe sex should be once a month.  Though, I think, most of us would vote for more often than that.

There is also data accumulating that problems are being created with the unusual kinds of sex and kinds of relationships being more in the public sphere instead of just in brothels and in the dark.  It is affecting our expectations of sex.

Porn sex isn’t real sex — I hope you realize that.  It is sexual acts, devoid of the humanity and relationships that make for really good and repeatable sex.  When people expect their partner (usually men expecting the women) to “perform” like in the porn they watched, things don’t go well in the relationship.  Humanity, real caring, and the relationship gets lost.

This is true also of “open” marriages or relationships — where you live together but have sex with other people when you want to.  Clinically, you see extreme stress and dysfunction in the lives and psyches of people in “open” relationships.  They are probably better understood as an “open” wound that is always fresh and can’t heal.

If you think you have ED because you can’t have an erection for sex 20 times a day, or you have “performance” anxiety, it is really important to evaluate the picture in your mind of what sex is supposed to be.  The common current picture is much more fantasy than reality.  Only reality actually works.

Sometimes the best treatment for ED or other sexual dysfunction is realizing we are living in la-la land, and to get back to reality.  Click your ruby red slippers three times together if you want.  Basically, don’t believe most of what you see and read.  Have realistic expectations and real, relationally satisfying sex as often as actually works with the wife you love.

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