This new sexual health trend has your patients seeking unverified health benefits

There is a trend among men to refrain from masturbation for a variety of reasons—the “NoFap” movement, as it is known by some, became popular on Reddit and is now a dot-com organization calling itself a “comprehensive community-based porn recovery site.”^[]

What does the research say?

This movement has become highly controversial, as members of the NoFap community have proposed many unproven benefits associated with what they refer to as “semen retention,” or abstaining from masturbation. These purported benefits include increased testosterone levels and improved sperm quality, along with alleged mental health benefits such as improving self-confidence, social/romantic interactions, and energy levels.  

Advocates of the NoFap movement often cite studies in an effort to back up their claims. However, these studies have limitations that weaken their support. 

For example, an older study from China found that men who refrained from masturbation for a week had a 45% boost in testosterone on day 7.^[] This study was very small, with only 28 male participants, and on the day following the testosterone spikes, levels returned to normal. 

A larger study, among both men and women in the US, showed that the “men's findings indicated their [testosterone] might be elevated by their sexual (masturbatory) activity but not vice versa,” meaning that masturbation is what boosts testosterone.^[] In terms of improved sperm quality from abstention, a study from Israel showed that abstaining from masturbation for one day improved sperm quality, and produced a peak in sperm motility. However, After a longer interval (11 to 14 days), the sperm motility declined.^[] 

Clinical implications

Sexual health is an essential conversation in the doctor’s office, and masturbation is a component of sexual health that often goes untouched. Sexual health is not only something that can be meaningful from a disease standpoint, but it is also something that should be discussed as a wellness topic. 

Wellness encompasses many different aspects of a patient’s life, including their mental health, overall sexual satisfaction, and healthy relationships.

Porn addiction and dopamine cycles

The American Psychiatric Association (APA) does not identify porn addiction as a mental health addiction. However, “gambling disorder” and “gaming disorder” were not recognized as mental health disorders, either, until 2013 and 2019, respectively. Presumably, as the scientific community continues to learn more about “obscure” or “taboo” addictions, the APA and DSM-5 will adjust their guides accordingly. 

Pornography, like drugs, food, and other addictive substances, tends to hijack the brain’s reward system by increasing the dopamine output. When an individual continues to engage in pornography, the dopamine setpoint changes and, as a result, the individual needs more pornography consumption to feel the same desired effects. 

“Researchers have found functional magnetic resonance imaging (fMRI) evidence of activation of the same circuitry in cocaine users when they were shown drug-related visual images and subsequently erotic images.”^[]  

Porn addictions also have negative impacts to an individual’s mental health as well as their intimate relationships. In a blog post for FHEHealth, Sachi Ananda, PhD, LMHC, MCAP, a mental health and addiction professional, wrote that the most common mental health issues linked with porn addiction are substance abuse, depression, anxiety, and post-traumatic stress disorders. 

She elucidated these connections: “Some people with depression will use porn for a spike in dopamine. Highly anxious people may use porn as a self-soothing coping skill. Victims of sexual trauma may inadvertently re-traumatize themselves by watching porn. Substance abuse may result from porn addiction, where one feels shame for engaging in it and numbs these emotions through substances."

Given these interrelationships, it would appear that the NoFap movement would have the potential to be beneficial to individuals struggling with an addiction to pornography, although there is no research suggesting that refraining from masturbation is proven to be an effective treatment against addictive behaviors around pornographic material. Like other addictions, concerns about pornography addiction is best addressed by a licensed mental health professional.