There is little agreement among researchers, sex therapists, and physicians that watching a lot of porn will, with certainty, lead to erectile dysfunction in men. Some findings unequivocally assert that a direct relationship exists; conversely, other studies' outcomes report no association (see Grubbs, 2019, Hatch, 2022, Rowland, 2022).

Additionally, various studies focus on different aspects of motivations and offer many, sometimes contradictory, reasons for what, if anything, regarding porn overconsumption or porn addiction influences erectile dysfunction. Variables measured in the research include sexual dysfunction, sexual compulsivity, sexual sensation seeking, and underlying depression or self-esteem issues, all affecting the outcomes of studies. However, one variable overlaps in some of the research; agreement exists among studies that find links between watching porn and masturbation and its effects on performance during partnered sex.

"...[H]eavy reliance on pornography use coupled with a high frequency of masturbation may nevertheless represent a risk factor for diminished sexual performance or poor relationship satisfaction in some men (e.g., in younger, less experienced men or where mitigating cultural factors may play a role. [Rowland, 2019]) "Rates of erectile dysfunction were lowest in those preferring partnered sex without pornography and increased significantly when pornography was preferred over partnered sex" (Military Medicine).

Among the limitations cited in studies that used online and self-report measures is their vulnerability to bias. Participants may be more likely to convey a more positive perception of themselves when there is no live interview or proctor present; self-misrepresentation and defensiveness are more likely to occur.

Computer and cell phone image viewing are generally the usual and preferred modalities for watching porn. Because many men prefer masturbation while watching porn which may increase the potentiality for erectile dysfunction in real (human) sexual encounters, they are subsequently experiencing relational loss and an increase in overall dissatisfaction with their partners. Some men are seeking help for it.

Porn, in its ubiquity, has given many men an opportunity to reflect on the quality of the relational lives they want to lead, particularly when porn consumption trumps relational sex and has diminished overall time spent with their partner.

Faced with continual challenges by contradicting information, research findings, and no shortage of opinions, this created a window of opportunity. People face the vapidness and falsehood associated with quick fixes and substitutions for real life; external solutions (i.e., porn) work well for a short time until they become symptoms of more significant needs, or are used compulsively or exclusively. There is no substitution for connection and love, and because we are human, we desire closeness. Many feel sad or guilty when they feel disconnected or behave in a way that interferes, disrespects, or dishonors loved ones around them. We can learn much from men seeking mental health treatment to reduce porn consumption and increase intimacy with their partners.

The years of COVID response were the impetus behind many seeking positive changes in their lives; porn also proliferated. Perhaps loneliness was at the root, and porn fostered, as facsimile, a solution to meeting with friends and family via Zoom. Boredom was a typical response among many who turned to porn, food, or substances to feel stimulated, soothed, connected to something, or just put to sleep. Some, however, turned and reflected inward to understand and improve what was real and lasting around them—people and their relationships with them. Indeed, there is a group of individuals so deeply emotionally damaged in childhood that they have and will continue to struggle throughout their lifetime to know what trust, safety in the proverbial arms of another, and mutual respect feel like; they may never know, and the disengagement brought on by COVID was merely a reinforcement of what they already experienced. Porn, for these people, provides an attempt to be close to someone, even if the someone is two-dimensional and putting on a performance.

Quality of life issues continues to be a driving force for many to make positive changes. Due to the debilitating medical and mental effects of COVID accosting the entire global population, there were deeply shared experiences of fear, pain, and suffering. It seemed people became more comfortable with expressing their feelings or depressed or anxious mood overtly; seeking help made sense, and mental health treatment became significantly less stigmatized. At the same time, people began to question their commitment to their own lives and relationships. Men seeking help for overconsumption of porn became less stigmatized, guilt-ridden, and shameful.

Interestingly, though not surprisingly, cottage industries were established, even in medicine and mental health, to address the need, whether out of compassion and serving the greater good, or to make a profit. Online text sessions, robots, and AI psychotherapy are omnipresent, reinforcing for some the notion that fake is good. Detachment is the modus operandi as online algorithms attempt to help people with their pain, loneliness, and relational despair. At least video porn involves a live person, whether live or taped. Some argue that some form of mental health treatment, even if not live, can reach those whose access is prohibitive due to location (i.e., rural communities) and finances (online therapy can be less costly, primarily when provided by a newly trained therapist.) However, substituting live therapy for alternatives hardly seems like a solution to excessive porn consumption; apples for oranges often is not the solution.

In the mix of all that is genuinely fake are real groups of people who want to know, feel, or at least be curious about what it takes to be fully in a relationship with one person. More men are showing up in person in therapy offices.

These are the relational outliers, those who have become aware and believe in their potential to maximize their quality of partnered life. What makes some rise above the rest while others stay stagnant or accepting of the status quo? An outlier, a term popularized by author Malcolm Gladwell, refers to an observation that lies an abnormal distance from other values in a random sample from a population. Typical must be identified and generally agreed upon for abnormal to be determined.

Outliers are outsiders, and our technological world supports unanimity in how we think, feel, believe, desire, and behave. Outliers seek the more demanding but rewarding payoff. Technology can never replace the touch, feel, tenderness, passion, and desire versus lust which comes from live sex and knowing what it means to engage with someone or seek a deeper connection with a partner. The need for connection is a human priority; porn offers one solution, but the realization for some that it is also empty encourages a return to the therapeutic couch in search of the relational bed.