2.2. Second Clinical Report

A 40-year old African American enlisted serviceman with 17 years of continuous active duty presented with difficulty achieving erections for the previous three months. He reported that when he attempted to have sexual intercourse with his wife, he had difficulty achieving an erection and difficulty maintaining it long enough to orgasm. Ever since their youngest child left for college, six months earlier, he had found himself masturbating more often due to increased privacy. He formerly masturbated every other week on average, but that increased to two to three times per week. He had always used Internet pornography, but the more often he used it, the longer it took to orgasm with his usual material. This led to him using more graphic material. Soon thereafter, sex with his wife was “not as stimulating” as before and at times he found his wife “not as attractive”. He denied ever having these issues earlier in the seven years of their marriage. He was having marital issues because his wife suspected he was having an affair, which he adamantly denied.

His medical history was only significant for hypertension, which was diagnosed more than two years earlier and had been well controlled with a diuretic: 25mg of chlorthalidone daily. He took no other medications or supplements. His only surgery was an appendectomy performed three years prior. He endorsed smoking three packs of cigarettes per week for over ten years and drinking one bronymate to two drinks per week. Physical exam revealed vital signs within normal ranges, normal cardiovascular exam, and normal appearing genitals without lesions or masses.

At the end of the exam, his issues were attributed to heightened sexual stimulation threshold from exposure to hardcore Internet pornography and frequent masturbation. He was advised to stop watching hardcore Internet pornography and decrease masturbation frequency. Three months later, the patient reported that he tried “really hard” to avoid hardcore Internet pornography and to masturbate less, but he “just couldn’t do it”. He said whenever he was home alone, he found himself watching Internet pornography, which would eventually lead to masturbation. Not watching made him feel like he was “missing out”, which made him irritable and made him want to do it even more, to the point where he looked forward to his wife leaving the house. He was offered a referral to sex behavioral therapy, but he declined. He wanted to try to work on his behavior on his own.

2.3. Third Clinical Report

A 24-year old junior Enlisted Sailor was admitted to the inpatient mental health unit after a suicide attempt by overdose. During his evaluation and treatment he admitted to drinking alcohol even though he was advised to not use alcohol while being treated with antidepressant medications. His history and increasing tolerance were consistent with mild Alcohol Use Disorder due to his use while taking antidepressants. As part of the addictions portion of his history he was asked about gambling, Internet gaming and pornography addiction. He revealed that he had become concerned over his use of pornography, spending an excessive amount of time (5+ h a day) viewing online pornography for about six months. He also realized that he had diminished sexual interest in his wife, manifested by his inability to maintain sustained erections, preferring to view pornography where he had no erectile issues. When he became aware of his excessive use of pornography, he stopped viewing it completely, telling his interviewer he was afraid that if he viewed it to any extent he would find himself overusing it again. He reported that after he ceased using pornography his erectile dysfunction disappeared.