Can Pornography Cause Erectile Dysfunction? | Top Tips to Naturally Reverse ED

welcome back to the Reena Malik MD podcast I'm your host Dr Reena Malik urologist and pelvic surgeon today in this video we're going to talk all about erections and erectile dysfunction we're going to start with talking about Anatomy as well as the different causes of erectile dysfunction including the question does pornography cause erectile dysfunction we're also going to review the three different types of erections and if you didn't know there are actually three different types then we're going to discuss how out to prevent or reverse erectile dysfunction are there certain foods you should be eating

and does exercise really make a difference so let's start with Anatomy the first thing to understand is your penis is made up of two spongy bodies called the corpa cavernosa and this is what makes up the erectile tissue and within each of these spongy bodies is a big artery that brings in blood flow and there's also several veins around around the spongy tissues above something called the Tunica alenia and these veins carry blood back out now the tuna albinia is actually a really interesting tissue it wraps around the corpa cavernosa and it also expands when

you have an erection and it has very strong Parts it has an inner circular layer as well as an outer longitudinal layer and it's made up of something called type 1 collagen and they've actually described it as having as strong of tensile strength as steel this is important because when those spongy buddies fill up with blood when you have an erection tuna alenia then stretches and causes compression of the veins around the corpora that prevents blood from leaving the erection and leads to a more firm erection and we call this a tumescence phase so what

happens when you get an erection is typically you see something you hear something or you feel something that makes you feel aroused then the brain sends signals from an area called the hypothalamus to the spinal cord and then down to the nerves to the penis that tells the blood vessels to release certain neurotransmitters specifically one of the big ones is nitric oxide and you're going to hear me talk about this throughout this podcast over and over again nitric oxide is essentially the ignition for erections this then causes the muscles in the corpa to relax which

allows actually several fold increase of blood to flow into those spongy tissues and fill up in the penis this then creates pressure in the corpa making the penis expand and this then compresses those veins and prevents blood from leaving the penis as well then there's an interesting reflex it's called The bulbo cavernosus Reflex and this causes the muscles that are at the base of the penis to contract even more which then causes the erection to get even more firm and full now to give you some scale at Baseline when the penis is flaccid you have

about 20 to 40 mm of mercury of oxygen in the tissues but when you get an erection this nearly triples to 90 to 100 mm of mercury that's really impressive I don't think there's any other organ in the body that has that much Dynamic blood flow so the other interesting thing to know is that the penis is not actually just what you see on the outside it actually goes deep into the pelvis and curves downward which is why if you sometimes get stimulation in the area called the perenium also what people generally call the taint

then sometimes people find that very erotic or pleasurable because there's still erectile tissue all the way down there now every erection is not created equal as I mentioned earlier there are three different types of erections first is a reflexive erection which is typically due to physical stimulation and not in your control then there are psychogenic erections and these are the erections you typically think of right when you get some sort of stimulation whether it's physical auditory Visual and you have an erection in response to that stimulation and lastly there are nocturnal erections which occur during

sleep so first off let's start about talking with about those reflex erections now these are just physiologic processes meaning your body does them on their own and essentially they probably occur because it's a good way to keep oxygenating those erectile tissues and helping you maintain good erectile function over a lifetime and usually these occur due to as I mentioned earlier some sort of tactile stimulation basically a part of the penis or the genitals might get touched which then triggers a reflex so the nerves from the penis go to an area called the spinal erection Center

which is in the lower part of the spinal cord or the sacral spinal cord and this then leads to what's called a random erection and random erections can occur without mental or emotional arousal and these can happen on a daily basis in fact it's obviously more common in adolescents or young men which is likely because they have more higher levels of testosterone now I know this can be somewhat embarrassing so if you find yourself in this situation where you're having a random erection and you want it to go away let me give you a couple

tips the best approach is typically to distract yourself and focus on something else try to focus on breathing which then maybe allows you to relax the body and avoid stimulating the area any further some of the best moments in life are spontaneous unplanned but for the man dealing with moderate to severe erectile dysfunction or Ed preparing for intimacy can rob you and your partner of spontaneity the joy of living in the moment now you can restore that spark in your relationship with the AMS 700 implant a clinically proven permanent solution that's designed for your satisfaction

and your partners it's the number one physician preferred implant it's built to look and feel natural happy Partners agree 92% of patients and 96% of their Partners report sexual activity with the implant being excellent or satisfactory it gives you the ability to respond to your partner's wishes in the moment not minutes or hours later the AMS 700 no pills no injections no waiting for more information visit edcure.org slrms that's EDC e.org slrms sponsored by Boston Scientific on average most men tend to experience somewhere between 3 to five erections a day and some men actually experience

up to 11 erections a day and these are random but most of these happen to occur at night so they're not all reflex erections some of them are nocturnal erections so let's talk about nocturnal erections with those you typically have three to four or more nocturnal erections every single night these start in early adolescence and most of the time you won't even really know that you're having an erection but often times you'll wake up with an erection and this is often called morning wood or morning morning erection and this is because you often wake up

at the end of REM sleep when these are most commonly happening and as I mentioned earlier these are a good thing they're a sign that your penis is functioning normally it's getting good blood flow it's getting good nerve function your hormones are working well and so these are actually very good and not something to be embarrassed about and not something that you need to even worry is a negative thing it's actually a very good sign of over all Health sometimes this can even help you identify if when you're having a problem with erections during the

day is it physiologic meaning that there's something wrong in your body or is it psychogenic because if you're still getting nighttime erections and they're very strong and you wake up with a morning erection and yet you're having troubles it may be more of a psychogenic problem now when you think about psychological problems what are the different causes of erectile dysfunction and as I mentioned one of them is psychogenic so I tell my patients that almost everyone has some degree of psychogenic erectile dysfunction because even if you have a medical problem not being able to get

an erection is extremely stressful right you don't have an erection and then you're thinking about it all the time and then when you try to have sex you're still thinking about it and so ultimately even if your body is not working with you you're always going to have some component of mental anxiety about erections and it can actually be sort of a vicious cycle right you go into having sex you don't have an erection you become stressed you think about it you ruminate about it and then you go to have sex a second time and

the whole time you're just thinking can I get an erection is it going to last is my partner going to like this am I going to be embarrassed and then of course you don't have an erection because you're super stressed and that just cycles and gets worse and worse the most common organic or physiologic problem is called vascular genic erectile dysfunction now this is due to decreased blood flow and this is followed by a whole bunch of other causes and we're going to talk about all these individually but these can include neurologic hormonal or drug

induced so let's start talking a little bit more about psychogenic erectile dysfunction so this is essentially defined as the inability to achieve or maintain an erection during sex because of psychological factors and this can include things like performance anxiety which we talked about relationship problems psychological stress depr depression or even other psychological disorders like schizophrenia for example and in fact many mental health conditions and erectile dysfunction are very commonly Linked In fact in Prior studies they found that people who have erectile dysfunction are two to four times more likely to have depressive symptoms pessimistic attitudes

and an overall negative outlook on life and emotional stress so this is really sad right now performance anxiety as I mentioned is so so common and it's essentially when you're worried about your sexual performance or being able to satisfy your partner which then leads to anxiety which inhibits your ability to get erections now outside of anxiety psychogenic Ed can be due to relationship concerns communication difficulties feelings of guilt and that can be whether it's guilt around around your performance or maybe guilt and other things that are going on in your life it can be related

to low self-esteem and even your cultural or religious beliefs can affect your performance because if you feel like what you're doing is against your religious or cultural beliefs that can have a negative impact on your ability to enjoy the experience trauma can also be a big part of this so if you've experienced trauma whether it's physical mental uh if it's been in a prior relationship it can rear its ugly head during a sexual encounter and that makes it really hard to perform and have erections now if you want to more detail about performance anxiety and

how to treat it check out my YouTube video where I talk all about psychogenic erectile dysfunction in more detail but briefly treatments can include things like cognitive behavioral therapy sensate Focus exercises and even treating the depression or anxiety with medications as well or even trying medications for erectile dysfunction function like selenop or tadalfil to just help make it a little easier to get erections next up is vascular erectile dysfunction so as I mentioned previously nitric oxide is the ignition for erections and Vascular Ed is typically characterized by a decrease in nitric oxide production in the

vessels or the vascular endothelium meaning the lining of the blood vessels and that's what actually creates nitric oxide and when these become unhealthy it can create a whole host of problems one of which is erectile dysfunction so in vasculogenic Ed there's either a reduction in arterial blood flow coming in meaning there's not as much blood coming into the penis or it's leaving too quickly so you get an erection it goes away really fast now why does this happen well when you have vascular medical conditions like high blood pressure high cholesterol heart disease even diabetes this

can make the arteries thicker either due to plaque formation or changes in the arteries themselves and ultimately this makes it harder for blood to flow through them and this causes less good blood flow from getting into the penis and ultimately lower oxygen levels in the penal tissues now the big thing here is over time if you have prolonged issues with blood flow you might notice that your tissue itself changes because sometimes it can cause the smooth muscle content itself of the corpa cavernosa to develop something called fibrosis or Scar Tissue which is irreversible and so

when I talk to you about the things you can do to help prevent Ed I want to make sure you listen very carefully because I don't want you to get to the point where you develop fibrosis of your erectile tissue now I also mentioned Venus leak or blood flow leaving to quickly and often this occurs because the pressure in the penis itself doesn't get high enough mean the arteries don't bring in enough good blood flow and the tuna albinia the special sheath we talked about is not getting expanded enough to push those vessels or compress

them enough and so they're open and the blood just leaves very quickly other things can also cause Venus leak things like neurologic disorders Cancer Treatments radiation and ponis disease ponus disease is when you develop these plaques on your penis and that can cause deformities like curvature or hourglass now usually when you have a minor Venus leak it's not a huge issue because as long as you have good blood inflow it will again expand enough to compress the veins enough and compensate for the weak veins that are maybe not working or functioning as well as they

should the other major condition that causes vascular Ed is diabetes in fact 30% of people people with Ed have diabetes and if you have diabetes you are three and a half times more likely to get erectile dysfunction and almost half of men with diabetes will have Ed next let's talk about Ed due to medications so medications can very commonly cause ED and some of the most common ones are things like anti-depressants such as flutin brand named Zoloft or caline and even anti-anxiety medications like diazapam or Valium and lorazapam or Adavan other classes of medications can

be things like antihistamines even Benadryl and even other medications that you might take for heartburn the other big one is high blood pressure medications or water pills and the most commonly implicated blood pressure medications are thides like hydrochlorizide and chlorthalidone and second would be metalol or propanolol which are beta blockers now this is sort of a challenge right because I want you to treat your blood pressure because if your blood pressure is high your arteries aren't going to work well and you're going to develop vascular Ed anyways so it's really important if you're taking these

anti-depressants or these blood pressure medications talk to your primary care doctor or your psychiatrist to see if you can switch to another anti-depressant or another anti-hypertensive because there's so many options available and others have have lower risks or even no risk at all now other types of medications I haven't mentioned may include things like chemotherapy Parkinson's disease medications painkillers or opioid medications and recreational drugs and we'll talk more about recreational drugs a little bit later but all of these can cause issues with erections particularly when you're using them quite often and for a chronic or

long period of time now another issue is neurologic causes so neurogenic causes are basically things that can affect nerve function to the penis these can include things like spinal cord injury multiple sclerosis or other neurologic conditions another 5% of Ed comes from things like pelvic surgeries such as prostectomy or other surgeries that happen in the pelvis where those nerves to the erections or to the penis are and lastly only a very small percent about 3% are due to hormones so often times people think okay my I'm not getting good erection if I take testosterone it's

going to fix it completely but usually it's very multifactorial and taking testosterone alone will not fix the problem it may help incrementally and your erections may get slightly better but that's not always the only cause and there's usually a multitude of other things going on that are causing difficulties with erections now testosterone is not the only hormone that has problems you can have issues with your thyroid or other hormones that are in your pituitary gland like prolactin which can cause problems with erectile function lastly let's talk about smoking smoking can not only cause ED because

it damages the blood vessels and the nerves but it can also cause your penis to shrink so if that's an endorsement to stop smoking I don't know what is but the reason this happens is because smoking can lower tissue elasticity and cause ultimately smaller erections now the good news is if you stop smoking particularly if you're young you can get your normal healthy erections back and preserve your penal length in fact if you're smoking the risk of getting Ed increases anywhere from 50% to 116% compared to people who don't smoke now what about other things

like alcohol or other drugs so alcohol in large amounts is a sedative and it can cause things like low desire but it can also cause transient erectile dysfunction now that that's sort of where the term whiskey dick comes from if it happens once it's not a huge issue you just know that you shouldn't drink that much however if you're using alcohol chronically on a long term it can affect your hormones it can cause low testosterone something called hypogonadism and it can even affect the nerves that cause neurologic erectile dysfunction so ultimately you want to monitor

your alcohol intake and try to limit your alcohol use to less than one drink a day we know now that there's really no safe amount of alcohol in terms of cancer prevention limiting your alcohol intake as much as possible is great now other drugs like amphetamines cannabis opioids and ecstasy are also risk factors for erectile dysfunction and what they've shown is that people who use for example amphetamines have a two times higher odds of developing erectile dysfunction than people who don't in terms of cannabis consumption typically lower doses people don't really notice it and they

may actually say that it improves libido however in people who use it longterm or use it chronically it can actually affect the endothelium again that lining of the blood vessels which can cause vascular Ed and it also is because there's cannaboid receptors in the hypothalamus and so when you have too much stimulation of those receptors it can disrupt the hypothalamic pituitary gonadal axis causing decreased testosterone production and perhaps decreased erectile function now what about pain meds so if you're chronically using pain meds there's an eight times higher odds of having erectile dysfunction compared to non-users

now this is more common in people who are using things like methadone or heroin but still something to consider it can cause not only Ed but it can also lower ejaculate volumes now what if you're not sexually active I assume you're probably not listening to this podcast but if you are should you still worry about erectile dysfunction and the answer is a resounding yes and the first reason is because erectile dysfunction is typically what we call the canary in the coal mine for cardiovascular disease and this is because the arteries in the penis are significantly

smaller than the arteries to the heart so the arteries to the penis are about 1 to 2 millimet and the artery to the heart are 3 to 4 millim so you're going to see blockages of the arteries in your penis first meaning you're going to have erectile dysfunction long before you ever experience chest pain and so it's really important if you identify erectile dysfunction to go see your primary care doctor get your hemoglobin A1c checked get your triglycerides checked get your cholesterol checked get an EKG make sure there are no other indicators of heart disease

because if you're diagnosed with Ed to Day within 7 years 15% of you may go on to have a heart attack and this is a real serious issue the other thing about the correlation with Ed is there's also a correlation with Ed and cognitive performance and this is because your brain relies on good blood flow just like your penis and your heart do so when you have blood flow problems in your penis you might also have blood flow problems in your brain and this means that you might notice is cognitive dysfunction and that means it

can affect your cognitive abilities like attention and thinking so previously in a study of like 4,000 men they found that men who had Ed over 7 years were 68% more likely to develop Alzheimer's disease and dementia even after they adjusted for cardiovascular risks so that's pretty remarkable another study looked at sort of how um erectile dysfunction over several years affected cognitive function and what they found that if someone has Ed and it gets better they also tend to have improved memory function whereas if someone's erectile function gets worse over time their memory also gets worse

over time so it follows a trend and ultimately the way your penis works is a very good indicator of your overall health okay we're finally getting to the million-dollar question how does pornography affect erections does it cause erectile dysfunction so if you think about pornography in studies I mean only about 70% of men will admit to using pornography however I guess it's probably more than that regardless we know that people use porn for all sorts of different reasons right they use it for sexual desire to satisfy curiosity to spice up their own relationship or even

to just better understand anatomy and so a number of Studies have looked at men who use pornography the frequency with which they use pornography and erectile dysfunction and they have not found a correlation they've also looked at it for premature ejaculation and sexual satisfaction and they found no real correlation of pornography use with Ed with premature ejaculation or sexual satisfaction but there are certain people who are at higher risk of having sexual dysfunction and if they use pornography and that's if they have depressive symptoms anxiety stress maybe some moral incongruence with using pornography so they

may feel religious or they may have some self- perceived problems with pornography so if you think you have a problem you probably do and these things may put you at higher risk of developing psychogenic Ed when you're using pornography and you may notice this if you tend to find yourself preferring masturbation to with pornography rather than having partnered sex this puts you at higher risk also because you might start getting very comfortable and habituated to masturbating in a certain type of way with a certain type of stimulation that you get when watching pornography that you

can't replicate in a real relationship and so this is why you have to be mindful about are you starting to feel this way maybe being Dynamic about how you masturbate or what what sorts of things you fantasize about and using different techniques all right so so now that you know about Ed how can you fix it well in this episode we're going to talk about conservative options so without medication I'm going to make a whole other podcast about treatments and maybe even one about supplements so if you want to learn about supplements please comment either

in the YouTube video comments or on Spotify comments let me know what exactly you want to learn about what specific supplements because there are so so many and some have data and some have done but ultimately I'd love to cover the ones that you want to learn about so let's get back to treatment so first and foremost you want to treat your underlying health issues so if you have high blood pressure get that under control if you have diabetes get that under control if you have high cholesterol get that under control very simply fix those

issues first because without fixing those issues you will not be able to reverse your erectile dysfunction and it's just going to get progressively worse next up exercise so there's been a number of studies that have looked at exercise in fact there's been 11 randomized controlled trials comparing people who either get no instruction to people who are instructed on doing some sort of aerobic exercise intervention or resistant exercise intervention and they compare those and that allows us to see head-to-head when you take people who are very similar if there's really a benefit and these studies ranged

in duration from anywhere from 2 months to 2 years and they include different types of supervised aerobic exercises um they may have provided resources and counseling and typically they were doing about 30 to 60 Minutes of aerobic exercise somewhere between 3 to five times per week so we're going to focus mostly on the aerobic side of things so they typically did things like walking five times a week at least uh with a V2 Max of 55% which means that you should be able to which is sort of like Zone to cardio which means that you

should be able to take a walk and have a conversation with somebody but they would know that you're exercising it's not such a leisurely stroll that somebody can't tell the other exercises they tried were things like cycling treadmill use but they made them do it like I said for three to five times a week and generally they called it moderate intensity so what they found ultimately was that aerobic exercise resulted in statistically significant improvements in erectile function compared to people who didn't do any aerobic exercise and it was generally greater in the men who had

more severe Ed so if they had more severe erectile dysfunction you were going to see a much greater Improvement in erectile function versus someone who had mild ad and that makes sense because if you have mild ad you have less room to improve whereas when you have severe Ed you have a lot more room to improve and so they did see a significant ific Improvement in all three groups mild moderate severe Ed everyone saw an improvement and Exercise Works because it improves blood vessel function and it allows those blood vessels to improve their nitric oxide

production when you have healthier blood vessels they release more nitric oxide which is the ignition for erections and if you incorporate resistance training you're also going to see improvements in your testosterone now I've talked about exercise and testosterone in a full video on YouTube make sure you check that one out if you want to learn more about it because I go over what exactly types of exercise have been studied and what you can expect in terms of improvement now in addition to those things exercise tends to reduce oxidative stress and inflammation which are both contributors

to worsening erections next thing you can do which is completely free is sleep now I think sleep is the most underutilized treatment in medicine for a lot of different conditions but even for erectile dysfunction now in small studies they've looked at sleep and they've shown that improvements particularly in Sleep Quality meaning that you're having uninterrupted sleep you're getting good amounts of deep sleep or REM sleep and you're sleeping for sufficient periods of time usually 7 hours or more means that you're going to have better erections now as I mentioned these studies are pretty small and

observational But ultimately sleep has really good evidence in terms of improving testosterone quite significantly and not only does it improve testosterone and sexual function it's also going to impact your ability to perform the next day improve your mental Clarity your sharpness and your overall mood so there's so many reasons to work on sleep and I've had a couple videos on sleep on my YouTube channel so check those out now what about food everybody wants to know what should I be eating so a 2020 study in jamama which is a very a very reputable medical journal

looked at diet quality and dietary patterns associated with erectile dis function now this is again correlation but they looked at men from 1998 to 2014 so it's a long period of time and they looked at what's called food frequency questionnaires the men were between the ages of 40 and 75 and they had to filled out fill out these food intake questionnaires and so they had 21,000 men who were on average 62 years of age and they were followed for about 10 years to see what they were eating and how that affected an how that correlated

with erectile function and they found that men who had the highest score related to the Mediterranean diet meaning they were following that they had the lowest relative risk of incident erectile dysfunction meaning they were the least likely to develop erectile dysfunction compared to those who had a lower score meaning had poor dietary quality based on this question this Mediterranean diet score now this was true for men who were younger than 60 60 to 70 and even over 70 years so it doesn't matter how old you are when you start eating a healthy diet if you

can commit you will see improvements now what they look at is something called the hazard ratio in terms of just you know your risk of the correlation it was more impressive if you started younger so if you were younger than 60 it was a 22% lower risk of developing Ed if you were between 60 and 70 it went to 18% and if you were over 70 it went to 7% now the best studied diet in terms of healthy diet is the Mediterranean diet so what is the Mediterranean diet well it emphasizes things like plant-based Foods

fruits vegetables whole grains nuts and legumes it uses olive oil as a primary fat source and nuts as I mentioned earlier and consuming fish and poultry in moderate amounts and limiting red meats and they tend to use more herbs and spices rather than Salt now I think the key is to really avoid processed foods and focus on whole natural ingredients now what about specific types of foods like you'll see all these articles online and like these are the five foods you want to eat and actually there's some data behind certain types of foods so one

is called flavonoid rich foods and these are a type of what we call polyphenol and they're abundant in a variety of plant-based Foods they have lots of antioxidants and they tend to reduce inflammation and lower the risk of a variety of diseases and these can include things like apples citrus fruits grapes onions tea dark chocolate and kale and so in one study looking at the same group of men that they did in that prior study about the Mediterranean diets called the health professionals follow-up data looked at 25,000 men and they found that those who had

a higher intake of these flavonoid rich foods had a significantly lower incidence of erectile this function this study was not as remarkable in terms of outcomes as the Mediterranean diets and so what they found was that it reduced your risk of developing Ed by about 9% if you had a higher intake of these flavonoid rich foods what about other sort of food items or things that can help one is omega-3 fatty acids and these are typically from fish and they can help increase nitric oxide availability if you don't eat fish you can try taking Omega-3

supp another food that often comes up is watermelon and the reason watermelon comes up is because it is a rich source of something called citrine and citrine is an amino acid or a protein building block that's metabolized in our bodies to Arginine and arginine is a precursor for nitric oxide again remember nitric oxide is the ignition for erections so a small study found that if you drank somewhere between 3 to six cups of watermelon juice per day for 3 weeks it resulted in an increase in arginine levels in the blood however they didn't specifically look

at erectile dysfunction so if you like watermelon by all means go ahead and have it but if you don't don't force yourself too so bottom line what can you do to prevent or reverse Ed so one increase your physical activity try to have 30 minutes a day or 150 minutes a week of moderate intensity aerobic activity next if you are overweight losing weight has been shown to improve a rectile function so try to lose 5 to 10% of your body weight if you are overweight next improve your diet now we've talked about this quite extensively

in this podcast but what you want to aim to is increase your consumption of fruit and vegetables whole grains and legumes limit your red meat and processed foods and reduce your saturated fat to at least 10% or less of your entire calories increase your intake of monounsaturated polyunsaturated fatty acids and stop drinking sugary drinks so try to drink water or diet drinks if you have to have something that's a little sweet but try to avoid things that have added sugar avoid excessive alcohol consumption try to drink less than seven drinks a week and ideally none

if you want to follow the newer data that shows that there's really no safe amount of alcohol consumption based on canc cancer risk lastly quit smoking and don't do any recreational drugs if you're going to do recreational drugs be sure not to do them chronically or in excess thank you guys so much for listening if you guys are enjoying this podcast or this longer form content do me a favor share this content with your family or friends share it on social media screenshot it do whatever you can to help get the word out because that

helps us grow and share our education with people around the world who really need it and as always we're going to take care of yourself because you're worth it