Psychological ED: What Studies Report

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Short answer: Does masturbation cause erectile dysfunction? In a study of 3,586 men, masturbation frequency was “only weakly and inconsistently related” to erectile function, and frequency of pornography use was unrelated to it, while age, anxiety or depression and chronic illness were the most consistent predictors (Rowland et al., 2023). Studies of self-described “problematic” porn use report an association with erectile dysfunction (ED), but a 1-year study found “no evidence of causal links” (Grubbs and Gola, 2019). The American Urological Association (AUA) guideline names depression, anxiety and relationship conflict as possible contributors to ED (AUA ED Guideline).

This page sets out what each study measured and found, including the ones that disagree. For how common ED is at each age, see our page on ED rates by age, study by study. For causes and treatment options in general, see our complete erectile dysfunction guide.

Does masturbation cause erectile dysfunction?

Two multivariate studies that measured masturbation frequency did not report it as a significant factor in ED.

• Rowland 2023. Researchers analyzed 3,586 men (mean age 40.8) using standardized questionnaires and adjusting for other factors known to affect erections. Masturbation frequency was “only weakly and inconsistently related to erectile functioning or ED severity” (p = 0.11 to 0.39). Higher masturbation frequency was associated with lower sexual and relationship satisfaction (Rowland et al., Int J Impot Res 2023).
• Jacobs 2021. An international online survey analyzed 3,419 men aged 18 to 35. The authors wrote that “masturbation frequency seemed not to be a significant factor when assessing ED” (Jacobs et al., JMIR Public Health Surveill 2021).

The Rowland authors added a caveat: “although verification is needed, we do not dismiss the idea that heavy reliance on pornography use coupled with a high frequency of masturbation may represent a risk factor” in some men, such as younger or less experienced men (Rowland 2023). Masturbation and testosterone is a separate question, covered in our guide to whether masturbation lowers testosterone.

What do studies report about porn-induced erectile dysfunction?

In the studies below, those that measured how often men use porn (Landripet, Prause, Grubbs and Rowland) report little or no link with ED. Those that measured self-reported “problematic” use or a preference for porn over partnered sex (Jacobs, Berger and Grubbs’s cross-sectional data) report an association.

Study	Design and sample	What was measured	Reported finding
Landripet 2015	Online surveys: 2,737 men in Croatia, Norway and Portugal (2011); 1,211 Croatian men (2014)	Frequency of porn use; erectile difficulties, IIEF-5 in the 2014 study	One association in Croatian men in 2011, “small and inconsistent”; none in 2014
Prause 2015	280 men not seeking treatment	Weekly hours viewing sexual films; IIEF with a partner	Viewing hours unrelated to erectile function with a partner
Grubbs 2019	3 samples, including a 1-year, 4-wave study (433 men at the start)	Porn use and self-reported problematic use; IIEF-5	Problematic use linked to ED at a single point in time; no consistent link with use itself; no link with ED trends over the year
Rowland 2023	3,586 men, multivariate analysis	Frequency of porn use; erectile function and ED severity	Porn use frequency unrelated (p = 0.28 to 0.79), including in men 30 or younger
Jacobs 2021	3,419 men aged 18 to 35, online survey, 2019 to 2020	Problematic porn use (CYPAT test); IIEF-5	Higher problematic-use scores linked to a higher probability of ED
Berger 2019	Men and women aged 20 to 40 at a urology clinic	Porn craving and preferences; IIEF	No link with craving; ED in 22.3% of men preferring partnered sex without porn vs 78% of men preferring porn over partnered sex

Studies reporting no clear link

Landripet and Štulhofer concluded that “pornography does not seem to be a significant risk factor for younger men’s desire, erectile, or orgasmic difficulties” (J Sex Med 2015). Prause and Pfaus reported that more viewing hours were related to “stronger desire for sex with a partner” (Sex Med 2015). Grubbs and Gola concluded there is “little or no evidence of an association between mere pornography use and ED” (J Sex Med 2019).

Studies reporting an association

Jacobs and colleagues found that 21.48% (444 of 2,067) of sexually active men in their survey had some degree of ED on the IIEF-5, and that higher scores for problematic porn use were associated with a higher probability of ED after controlling for other factors (Jacobs 2021). Berger and colleagues reported that a “preference for pornography with masturbation” over partnered sex was significantly associated with ED (p = 0.001) (Berger 2019).

A 2016 review by Park and colleagues, which included clinical case reports, proposed porn-related sexual dysfunction as a direction for research. The authors wrote that clinical reports “suggest that terminating Internet pornography use is sometimes sufficient to reverse negative effects, underscoring the need for extensive investigation” (Park et al., Behav Sci 2016).

Why do the studies disagree?

The authors point to several limits themselves. Grubbs and Gola note that their work “relied exclusively on self-report methods, and did not control for medical covariates,” and describe the links they found as “not directional or causal in nature” (Grubbs 2019). The Rowland authors describe earlier results as “inconsistent and frequently based on case studies, clinical reports, and simple binary analyses” (Rowland 2023). The samples also differ: online volunteers, students, a national panel and patients at a urology clinic, as listed in the table above.

What is psychological erectile dysfunction?

The AUA guideline states that “psychological factors (i.e., depression, anxiety, relationship conflict) and psychosexual issues may be primary or secondary contributors to ED.” It describes psychogenic ED this way: “Psychogenic ED is generally driven by a man’s anxiety related to the ability to achieve an erection.” It also notes that “the etiology of ED is often multifactorial” and lists psychosocial issues among common risk factors, alongside vascular disease, tobacco use, neurologic disease, endocrine conditions and medication side effects (AUA ED Guideline, 2018).

What links depression and anxiety with ED?

• Massachusetts Male Aging Study, 1998. In men aged 40 to 70, ED was associated with depressive symptoms after controlling for other factors (odds ratio 1.82, 95% CI 1.21 to 2.73). The authors concluded that the relationship in middle-aged men held after accounting for demographic, lifestyle, health status, medication and hormone factors (Araujo et al., Psychosom Med 1998).
• Massachusetts Male Aging Study, 2000. Following 776 men for 8.8 years, the authors reported that new cases of ED were “much more likely to occur among men who exhibit a submissive personality” (Araujo et al., Am J Epidemiol 2000).
• Rowland 2023. Having anxiety or depression was one of the most consistent predictors of poorer erectile function (p < 0.001), except in the subset of men 30 or younger (Rowland 2023).
• Jiang 2020. UCLA researchers reviewed posts in an online ED forum. In 100 annotated posts, the median author age was 24, 48% believed their ED was psychogenic, 38% reported depressive symptoms, and 20% had tried abstaining from porn or masturbation on their own. 28% reported seeing a health care professional for ED (Jiang et al., Urology 2020).

What does the AUA guideline say about mental health referral?

Guideline Statement 6 reads: “For men being treated for ED, referral to a mental health professional should be considered to promote treatment adherence, reduce performance anxiety, and integrate treatments into a sexual relationship. (Moderate Recommendation; Evidence Level: Grade C)” (AUA ED Guideline).

In its discussion, the guideline adds: “For men with predominantly psychogenic ED, providers should offer a referral to psychotherapy as either an alternative to medical treatment or as an adjunct to medical treatment.” Statement 1 says men presenting with symptoms of ED “should undergo a thorough medical, sexual, and psychosocial history; a physical examination; and selective laboratory testing” (AUA ED Guideline).

When should you talk to a licensed provider?

If erection problems are bothering you, talk to a licensed provider. The AUA guideline says men “should be counseled that ED is a risk marker for underlying cardiovascular disease (CVD) and other health conditions that may warrant evaluation and treatment” (AUA ED Guideline). In the forum study above, 2% of posts mentioned self-harm or suicidal thoughts, and the authors wrote that “depression, self-harm, and suicide emerged as potent concerns” (Jiang 2020). If you are having thoughts like these, you can call or text 988 to reach the 988 Suicide and Crisis Lifeline.

If you already take medicines, our ED medication safety information and the overview of oral ED medications are background reading before that conversation.

Talk to a licensed provider through PrescribedRX

PrescribedRX connects men with state-licensed clinicians who review an online intake. A licensed provider decides whether treatment is appropriate for you. You can see the options and listed prices on our sexual health page, compare services in our guide to online ED treatment, check plan pricing, or answer a few questions to check eligibility. Availability varies by state.

Sources

1. Rowland DL, Castleman JM, Bacys KR, Csonka B, Hevesi K. Do pornography use and masturbation play a role in erectile dysfunction and relationship satisfaction in men? Int J Impot Res. 2023;35(6):548-557 (online 2022). PubMed. Accessed Oct 2026.
2. Landripet I, Štulhofer A. Is pornography use associated with sexual difficulties and dysfunctions among younger heterosexual men? J Sex Med. 2015;12(5):1136-9. PubMed. Accessed Oct 2026.
3. Prause N, Pfaus J. Viewing sexual stimuli associated with greater sexual responsiveness, not erectile dysfunction. Sex Med. 2015;3(2):90-8. PubMed. Accessed Oct 2026.
4. Grubbs JB, Gola M. Is pornography use related to erectile functioning? Results from cross-sectional and latent growth curve analyses. J Sex Med. 2019;16(1):111-125. PubMed. Accessed Oct 2026.
5. Jacobs T, Geysemans B, Van Hal G, et al. Associations between online pornography consumption and sexual dysfunction in young men: multivariate analysis based on an international web-based survey. JMIR Public Health Surveill. 2021;7(10):e32542. PubMed. Accessed Oct 2026.
6. Berger JH, Kehoe JE, Doan AP, et al. Survey of sexual function and pornography. Mil Med. 2019;184(11-12):731-737. PubMed. Accessed Oct 2026.
7. Park BY, Wilson G, Berger J, et al. Is Internet pornography causing sexual dysfunctions? A review with clinical reports. Behav Sci (Basel). 2016;6(3):17. PubMed. Accessed Oct 2026.
8. Araujo AB, Durante R, Feldman HA, Goldstein I, McKinlay JB. The relationship between depressive symptoms and male erectile dysfunction: cross-sectional results from the Massachusetts Male Aging Study. Psychosom Med. 1998;60(4):458-65. PubMed. Accessed Oct 2026.
9. Araujo AB, Johannes CB, Feldman HA, Derby CA, McKinlay JB. Relation between psychosocial risk factors and incident erectile dysfunction: prospective results from the Massachusetts Male Aging Study. Am J Epidemiol. 2000;152(6):533-41. PubMed. Accessed Oct 2026.
10. Jiang T, Osadchiy V, Mills JN, Eleswarapu SV. Is it all in my head? Self-reported psychogenic erectile dysfunction and depression are common among young men seeking advice on social media. Urology. 2020;142:133-140. PubMed. Accessed Oct 2026.
11. American Urological Association. Erectile Dysfunction: AUA Guideline (2018). auanet.org. Accessed Oct 2026.
12. 988 Suicide and Crisis Lifeline. 988lifeline.org. Accessed Oct 2026.

This article is for general information. It is not medical advice and it is not a recommendation for any particular treatment. Whether a treatment is appropriate for you is a decision for a licensed clinician who has reviewed your health history and current medications.