How to Tell if It’s Porn or Anxiety That’s Ruining Your Sex Life

On Nov. 29, legislators in the U.K. approved a bill that would limit the amount of access young people would have to online pornography. If given the nod by the other branch of government, the House of Lords, the law will, among other things, force internet providers to eliminate porn from the content they provide, unless the consumer specifically asks for it.

One of the chief aims of the law is to prevent children and teenagers from having access to unlimited amounts of sexually explicit material, which many therapists, parents and child development experts feel can interfere with healthy sexual habits. These experts point to the sharp increase in young people (men, especially) reporting sexual dysfunction since the mid 2000s, when online porn videos became widely available.

In the U.S., there is still wide disagreement over the effects of porn on human sexual function. One of the biggest issues in the dispute, which TIME put on its cover recently, centers on the role of performance anxiety. Are the thousands of young men who complain about having erectile dysfunction affected by their frequent online porn-consumption or something else?

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In case you’re not familiar with the brouhaha, here’s a quick catch-up: Some people argue that a sexual diet that is heavy on porn, particularly of the infinite variety offered online, can change the way the brain responds to sexual cues, conditioning the brain to a certain set of stimuli. Another faction claims, more broadly, that a person can be addicted to porn, not in the chemical sense but in the sense that consumption quickly escalates and becomes very self-destructive. Still others cite studies that suggest that the link between porn and erectile dysfunction only exists in some people, those who feel shame about their porn-watching habits or already have mental health issues. (The American Association of Sexuality Educators, Counselors and Therapists recently released a statement rejecting the notion of sex/porn addiction.) And finally, there are those who claim that concerns about porn are all from misguided moralists stuck in a bygone era, there is zero link between porn and ED and the dysfunction is probably from another cause like performance anxiety, obesity or drug use.

What nobody disagrees with is that there are large number of young men who claim that their porn-watching habits have had a seriously negative effect on their ability to enjoy sex with other flesh and blood humans. These young men complain of erectile dysfunction, inability to climax and a loss of libido.

A recent study, published in Behavioral Sciences, has tried to tease out the links between porn and sexual dysfunction. One of its authors, Andrew Doan, is head of addictions and resilience research at the Naval Medical Center in San Diego and uses three case studies of young men from the Navy as one chapter of the report.

“The Navy is interested in improving the mental health and resilience of service members and their families,” says Dr. Doan, although he notes that this report is not issued by any branch of the military. “We have found that problematic pornography use can lead to problems with resilience, family, work performance, and legal issues.”

Read More: How to Talk to Your Kids about Porn

One way of moving forward on the issue, suggests the study, is to separate out young men who can masturbate successfully without porn and those who cannot. Those who have no hydraulic trouble when they’re on their own and not using porn are more probably suffering from performance anxiety when they try for the same effect with another human. Those who still have erectile issues when they’re on their own, and have no other underlying health issues, might look at their porn consumption.

Doan’s study also does a wide review of other research that looks at the link between porn and sexual dysfunction. “The rapid increase in sexual dysfunctions in men under 40 cannot be adequately explained by smoking, diabetes, obesity, or cardiovascular disease, which are factors commonly associated with men older than 40,” he says.

He does acknowledge that it could be that those who seek out porn might have sexual difficulties in the first place. “There are people with sexual dysfunction who seek out pornography, and there are people with sexual dysfunction caused by excessive pornography. Human beings are complex and each patient needs to be assessed individually,” he says. “We are currently working with Navy urologists to determine the association and incidence of problematic pornography use and erectile dysfunction in young men.”

Doan also runs a faith-based ministry for people who believe they are “addicted to gaming,” which doesn’t automatically mean he’s wrong about porn, but might mean he’s not neutral on the issue. He bristles at any suggestions of bias. “Being a medical scientist, I am data-driven, and my research is focused on improving people’s lives,” he says. “Having a Christian worldview just happens to agree with the data but does not influence the data or my interpretation of the data.”

For now, the jury is still divided on the long term effect, if any, of unlimited free pornography on the web. Some studies suggest, that when watched as a couple, porn could enhance some people’s sex lives. But it seems reasonable to suggest that the best way to figure out if the porn is the problem behind sexual dysfunction is to try to stop watching it for a while and see if there’s any change.

This story has been updated to correct the nature of Dr. Doan’s ministry.