A recent study investigated the sexual function of male adult entertainers - a completely unique group, whose job is centred around the very ability to engage in, and maintain, sexual intercourse for long periods of time. 

The study is important because it sheds light on a largely understudied group of men, and provides us with a foundation for understanding their experiences with erection problems. Furthermore, it can allow us to hypothesise on ED within the broader community, particularly young men - a group in which the condition is thought to be on the rise - and form new arguments with a new-found context. 

Treated.com spoke with lead research investigator Dr Justin Dubin, who provided his thoughts on the study and its broader implications. We also spoke with GP Clinical Lead at Treated.com, and sexual health expert, Dr. Daniel Atkinson about what can be learned from the survey and its findings. 

The survey was published by the Department of Urology at the University of Miami, in partnership with the Free Speech Coalition (FSC), an advocacy group for adult performers in the United States. A 40 question survey, called the international index of erectile function (IIEF), was sent to a large database of adult performers provided by the FSC. The index examines four domains of male sexual function: erectile function, orgasmic function, sexual desire and intercourse satisfaction. Inclusion criteria asserted that only respondents who had biological penises could be taken into account in relation to this survey. 

The responses showed that 38.7% of all men surveyed reported suffering with erectile dysfunction that was at least moderate in nature. The average age of respondents was 36 years old and ages ranged from between 19-70.  

The results also showed that 69.4% of men who reported ED used erectile aids (that being, pills and injections). Of these, 41.9% used them for solely work purposes. 

On the subject of injectable erectile aids, Dr Atkinson commented that: “Repeated use of injectable erectile dysfunction treatments could cause corporal fibrosis which may distort an erection or cause it to become painful. The risk of this could be reduced by less frequent use and avoiding injecting at the same site. 

Someone who uses ED treatment regularly in the course of their occupation may become psychologically dependent on them if they start to worry excessively that they may not be able to obtain or sustain an erection with a sexual partner away from their work environment.”

One of the more surprising statistics highlighted in this survey was one surrounding those aged 20-29. 42.1% of respondents in this age bracket reported having erectile dysfunction that was at least moderate. 84.2% of those young men reporting ED used erectile aids like pills or injections. This is significantly higher than estimations among the broader population of this age group. For example, one large global study put ED prevalence among 20-29 year olds at eight percent. A YouGov poll on ED that we undertook in the UK put ED medication usage among 25-34 year olds at 10 percent.

Male performers are a unique population regarding erectile dysfunction in that they have remained completely beyond the scope of focus and attention of the medical community. Most academic studies relating to this area focus on social perceptions of the adult entertainment industry, the consumption of adult pornographic films and the psychological repercussions of doing so. 

It’s important to try to understand the reasons as to why so many young, male adult entertainers report having erectile dysfunction. Younger performers carry less experience than their older counterparts, and this lack of experience could contribute to feelings of anxiety and doubt.

Male performers must be expected to do just that: perform on command, for long periods of time, remaining erect while doing so. They must also do all of this while being watched by several other people, such as the production staff. 

Dr Atkinson suggests that: “The study defines ED as the ‘inability to obtain or maintain an erection sufficient for satisfactory sexual performance’. However, in the adult entertainment industry ‘satisfactory sexual performance’ may be a very different thing to what most men would describe as satisfactory. 

In their work, male adult entertainers may be required to sustain prolonged sexual activity with other adult entertainers, whom they may feel no sexual attraction to. In this sort of scenario, some ED medicines may be being used outside their product license without the patient or prescriber being aware of it.”

Regarding the high reported usage of erectile aids in young men, Dr. Dubin informed us that “ [the reason why erectile aid] usage and ED rates within this younger male population are so high cannot be confirmed, but recent literature has suggested the phenomenon of increased ED rates in younger men populations. 

Unfortunately, our study does not shed any light on the reasons [behind] these increasing rates, but it is consistent with other studies in showing that ED rates in younger men is on the rise.”

There are several studies already that focus on the general population of young men and the effects surrounding the consumption of pornography. Because these men are young, it is argued that psychological issues may play a more significant role when compared with those who experience ED at an older age. 

The study also suggests one of the possible reasons for the level of anxiety in male performers is connected to the environment where they have to perform. As Dr Dubin mentions: “This is a group of men who are asked to engage in sex more frequently, for longer periods of time, and in more unconventional manners, all while a group of people are watching and recording their actions - looking at it from this perspective it really is surprising they all don’t have ED!

On the benefits of the study, Dr Daniel Atkinson says it “may help clinicians who manage ED to ask more specific questions if their patients are male adult entertainers.”