'Porn stole my sex life.’ It’s a common complaint among the clients I work with – not just the men who’ve found themselves hooked on porn but their partners who find themselves replaced by it, too. Each situation is, of course, unique, but the story is common and one that is becoming more widespread with the ever-growing availability of online porn.

Mike was 46 when he came for help with what he called an addiction to porn. In our first appointment, he described how his wife of 15 years was devastated when she discovered porn on their home computer: catalogues of thousands of images and videos that he’d collected and collated, late at night. Mike was keen to explain that his wife was not a prude and not anti-porn; she was angry and bitter at being denied a sexual relationship with her husband, only to find he had created one elsewhere. Mike talked about how he had struggled when their twins were born eight years ago, which coincided with his starting a new job and their moving house. He’d always enjoyed porn recreationally, but with the stress of work and newborn twins, it became a regular refuge. It began as a quick and easy way to switch off before going to bed, but over time it took longer and longer to find anything sufficiently novel to arouse him. Consequently, he often didn’t get to bed till the early hours and so added exhaustion to his list of reasons why he rarely had sex with his wife. The more upset she became about their lack of intimacy, the guiltier he felt about his secret habit and the harder he tried, unsuccessfully, to give it up. On the few occasions when they did have sex, he found it increasingly difficult to climax without fantasising about the porn he’d recently viewed, and his wife complained about his obvious distraction. What pained Mike most now was discovering that his wife, whom he loved dearly, had spent the last eight years blaming herself.

Mike’s experience of porn wrecking his sex life is a common one, although it’s a question that is still not routinely asked of clients who present with sexual problems. Over the rest of this article we’ll look at the most common sexual difficulties affecting men with problematic porn use, but first, here’s a quick update on the use of the term ‘addiction’.

Addiction or compulsion?

In June this year, the World Health Organization announced that Compulsive Sexual Behaviour Disorder (CSBD) will be included in the next edition of the International Classification of Diseases (ICD-11), which will be adopted at the World Health Assembly in May 2019. CSBD is characterised by a persistent pattern of failure to control intense, repetitive sexual impulses or urges, resulting in repetitive sexual behaviour over an extended period (eg six months or more) that causes marked distress or impairment in personal, family, social, educational, occupational or other important areas of functioning. The ICD-11 also states the behaviour must not be a symptom of another underlying condition and distress must extend ‘beyond moral conflict’. Importantly, CSBD will be classified as an ‘impulse control disorder’, not an ‘addictive disorder’, until further research has been undertaken to identify if the processes involved in the development and maintenance of the disorder are similar to those for behavioural addiction, such as gaming and gambling. However, I have no doubt that, wherever CSBD finally finds its home, the grassroots name will continue to be ‘addiction’, in the same way that ‘substance misuse disorder’ will always be known as ‘drug addiction’, whatever the experts say.

One of the reasons we’re unlikely to see the language change is because of the prevalence of porn addiction recovery networks on the web and other social media platforms. Two of the best-known online self-help forums for overcoming porn addiction, nofap.com and rebootnation.org, have more than 250,000 members, and estimated equal numbers of regular followers. What both of these sites have in common is an ever-growing membership whose main motivation for quitting porn is to get their sex life back.

Porn and sexual dysfunctions

There have been a number of studies exploring the link between sexual dysfunctions and pornography use in men. Porn-induced erectile dysfunction (PIED) made headline news last year when the BBC reported an unprecedented number of young men seeking help for erectile difficulties. A growing body of research also provides evidence of the links between sexual problems and heavy porn consumption. To date, 26 studies have shown that repeated exposure to high levels of sexual stimuli lowers the arousal threshold, leading initially to problems with delayed ejaculation, then erectile dysfunction, and then low libido and reduced satisfaction in partnered sex.

In the early stages, it may be difficult to spot the changes. Our sexuality is influenced by so many different factors, so if it takes a man slightly longer to get an erection or experience orgasm one day, there’s no immediate reason to think it’s a problem. Furthermore, when this happens while he’s watching porn, switching to a different image will almost certainly resolve the issue quickly. The endless novelty means that sexual difficulties are rarely experienced when using online porn. But, as the body gets increasingly sensitised to highly erotic, rapidly changing visual cues, it becomes more desensitised to a regular partner.

When I met Jez, age 24, he was fully aware that his erection difficulties were linked to porn and he had already seen a urologist to rule out any organic problems. He joined one of our recovery courses, successfully gave up porn and learned the art of what we call mindful masturbation. Mindful masturbation is the ability to stay present in the moment, focus purely on physical sensations and not engage with any visual stimulation or fantasy in order to achieve orgasm.

As we were drawing towards the end of therapy, Jez began a new relationship. In previous sexual relationships, he had always relied on Viagra, but he wanted this to be different and to prove to himself that he could enjoy sex without any artificial aids. We talked about how he could transfer his new-found mindful masturbation skills to partnered sex and he courageously chose to tell his boyfriend about the struggles he’d had in the past. His fears of disappointing his new partner did not materialise and he was delighted to share with his new recovery friends that he was thoroughly enjoying an intimate sexual relationship for the first time in his life.

While the link between porn use and reduced sexual performance and satisfaction is obvious for some clients, there are others who may not have made the connection. One review paper suggests healthcare providers could apply a simple test: ask if their patient can achieve and sustain a satisfactory erection and climax when masturbating without the use of internet porn. If he can’t, but can do so easily when using internet porn, ‘then his sexual dysfunction may be associated with its use’.1

Is porn always the problem?

Asking about porn use is important, and if the sexual problems can be resolved by giving up porn, or significantly reducing its use, then stopping may be an obvious first step. But for many men (and women), viewing porn is a pleasurable part of their sexuality and something they don’t want to lose. Porn can cause significant difficulties in couple relationships, especially when one partner discovers the other is enjoying what they perceive as a secret second sex life with porn. They may feel rejected, insecure and betrayed, but an inexperienced counsellor may be too quick to concur that ‘porn has stolen their sex life’. There may be other explanations.

In his book, His Porn, Her Pain, Marty Klein writes: ‘If you don’t want sex with a real person, it’s either because you don’t desire the person you’re with, or because you have issues about sex or closeness. That’s when watching porn is a lot easier than creating good sex.’2 There are many reasons why someone might start experiencing sexual problems within their relationship, and even if one partner is viewing porn, that doesn’t necessarily mean the porn is to blame, and certainly not that they are ‘addicted’.

John’s wife had asked him to seek help for porn addiction. Following an extensive assessment, it became apparent to me that John, age 58, was not a porn addict and he had no desire to stop using it. There was no history of addiction, no evidence of escalation and he was using it purely for sexual relief. His wife regarded his porn use as infidelity and, while he agreed there were times when he preferred to view porn rather than have sex with her, he believed it was his fundamental human right to choose how he enjoyed his sexuality. They began couple counselling to explore their differences of opinion and try to find a way of moving forward together. In joint sessions, it became apparent that they had always struggled to communicate their intimacy needs, including sexual ones, and over the past 20 years their sex life had become increasingly unsatisfying for both of them. They agreed to start a psychosexual sensate focus programme. By the end of therapy, both said they were enjoying a more intimate and rewarding sex life, and they had reached a compromise on John’s porn use – which, incidentally, had significantly decreased.

The misdiagnosis of both porn and sex addiction is one of the main reasons why it has continued to be misunderstood and viewed with suspicion by some professionals. When clients present with sexual dysfunctions or relationship difficulties, it’s essential to ask about pornography use. Indeed, it is my belief that, as use of the internet and social media becomes endemic throughout every area of society, therapists should routinely ask their clients how much they use new technology and explore its impact on their life, regardless of why they present. But the presence of pornography does not automatically mean that it is the cause of their sexual or relational difficulties, even if the client thinks it is. It’s imperative that other explanations are also explored, such as ambivalence about the relationship, attachment issues, unresolved sexual shame or abuse and, of course, possible biological issues. However, when it comes to addiction, it’s often a case of also/and, rather than either/or.

Adopting a biopsychosocial view

Sexual problems and addiction are best viewed through a biopsychosocial lens. Both will have predisposing, precipitating and maintaining factors hiding within a client’s biology, psychology and social environment. And with both, cause and consequence are so closely intertwined that it’s almost impossible to separate them. Like all addictions, porn addiction starts as a pursuit of pleasure but, as neurological pathways rewire in the brain and psychological dependency builds,3 it becomes a primary coping mechanism for life challenges and a way of escaping emotional pain. Then, as compulsive patterns of behaviour take hold, many withdraw from intimate relationships and, over time, more and more life challenges and emotional pains appear. The cycle of addiction was ever thus – more pain leads to more compulsion.

It is, of course, essential to address core issues when working with any sexual problem, but one of the challenges of porn addiction has always been that, until a period of abstinence is achieved, it may be impossible to identify and access the deeper unconscious and relational causes. A further challenge when working with porn addiction is that, while heavy porn use may have caused the sexual difficulties, many addicts will continue to resort to porn fantasies in an attempt to overcome the physical difficulties, creating another endless catch-22 situation.

Reclaiming sex

When we run our recovery programmes, we always start by exploring the group’s hopes and fears. While some fears revolve around the programme ‘not working’, many are linked to fears that it will. The men in our groups are most commonly scared that sex without their compulsive behaviour will be boring and unfulfilling. Some fear that they will never be able to experience desire, arousal or orgasm without pornography. The younger men who have been brought up with internet porn often question if masturbation is physically possible without it.

Of course, it’s not only men who can become hooked on porn or develop compulsive sexual behaviours. Research suggests that 25% of people who struggle with porn and sex addiction are women.4 Female sex and love addiction (FSLA), as it is often referred to, has received considerably less research than male sex addiction, and dedicated services for women continue to lag behind. While treatment protocols are similar, there are differences around socialisation and sexuality, which need to be addressed through a female lens.

For men hooked on porn, dopamine excitement has often become fused and confused with testosterone arousal. One of the first tasks is to help them find their own natural libido. Psycho-education on sexuality as well as addiction is also essential, along with relapse prevention strategies and work on underlying issues. For those in relationships, couple counselling is usually required, and for many, psychosexual therapy to overcome sexual dysfunctions.

I believe that every human being has a right to enjoy their sexuality in a way that is meaningful and enjoyable for them. Sex should be positive, pleasurable, mutually fulfilling when partnered and respectful of self and others. It should build confidence and self-esteem. I also believe that we have the right to choose how we express our sexuality, whether that’s through monogamy, polyamory, celibacy or any other kind of sexual and relationship lifestyle. Pornography, especially when it’s become addictive, can rob people of that choice. Thankfully, we can help them to take it back again.

Recovery course

The Hall Recovery Course is a CORE-evaluated, psycho-educational group programme developed specifically for sex and porn addiction. The course is unique in providing practical skills for recovery, as well as exploring deeper emotional and psychological needs. It also provides an environment that overcomes the shame, isolation and secrecy that maintain addiction. The courses are single-sex and limited to a maximum of eight people. They are facilitated by two accredited and experienced sex addiction specialists. They are available as either a six-day intensive course or a 12-week course, with a follow-up day approximately three months later. The course is not an alternative to individual therapy or to 12-step attendance but provides a fast-track route into recovery and paves the way for deeper psychological work. Groups have been running for nearly 10 years and are available in Amsterdam, Dubai and Johannesburg, as well as the UK.