Nobody talks about impotence. Not even with a doctor – only 10 to 20 percent of affected men seek medical help at all. Certainly not with friends. And definitely not with the date who is currently waiting. But silence comes at a price. And that price is getting higher.
The numbers nobody knows
In Germany, an estimated 4 to 6 million men are affected by erectile dysfunction (ED). Worldwide, doctors expect around 322 million affected individuals by 2025 – a number that would have been unthinkable a generation ago. The Cologne Male Survey, one of the most important German studies on this topic, shows the distribution by age group:
- 30 to 40 years: 2.3% affected
- 40 to 49 years: around 10%
- 50 to 59 years: already every second man with mild to moderate problems
- 60 to 69 years: 34%
- From 70 years: over 50 to 60%
Age remains the main risk factor. But for years, medicine has observed a worrying shift: ED is also increasing in men under 45. And 18 percent of men under 40 have already had experience with potency drugs – sometimes without medical necessity, as a party drug, because they no longer trust their own bodies.
Organic or in the head – a false separation
About 70 percent of cases have organic causes: circulatory disorders, diabetes, high blood pressure. These are the classic explanations that doctors know and treat. What they less often ask: What about the other 30 percent? And what about young men whose vessels are still perfectly functional?
What has changed in the last 20 years
These causes sound medical and immutable – but they are not. Most have a direct connection to modern lifestyles, and the numbers are rising.
Diabetes and obesity: Globally, the number of diabetics has quadrupled since 1980. In Germany today, about 8 to 9 million people live with type 2 diabetes – and the trend is rising. Since diabetes damages blood vessels and nerves, it is one of the most common triggers of ED. Those with diabetes have a two to three times higher risk of ED.
High blood pressure: About 20 to 30 million Germans have high blood pressure – many of them untreated. Here too, lifestyle is the main driver: too little exercise, too much salt, chronic stress, poor sleep.
Young age, old problem: What used to be considered a problem of older men increasingly affects men under 40 today. Studies show that about 25 to 30 percent of men seeking a doctor for ED for the first time are under 40 – two decades ago, this group was hardly relevant.
PDE5 inhibitors – the market explodes: Viagra came onto the market in 1998 – the first PDE5 inhibitor, a class of active ingredients that specifically promotes blood flow to the erectile tissues, thus enabling erection. Initially, it was a taboo subject, mainly older men, prescribed by urologists, associated with shame. That has fundamentally changed. The global market for PDE5 inhibitors (Viagra, Cialis, Levitra, and generics) was estimated at about 4.5 billion US dollars in 2023 – with annual growth rates of 5 to 7 percent. In Germany, since being released from prescription in 2024, Sildenafil generics are available over-the-counter in pharmacies – a sign of how widespread the problem has become.
Psychological factors play a growing role – especially among younger people. 90 percent of men with severe depression have ED. Stress and performance pressure are independent risk factors. And here begins the problem that nobody names: Where does this performance pressure come from? What does the image of sex that young men have today have to do with what their bodies can actually achieve?
What pornography does to the brain
Since the triumph of smartphones, the average age for first pornography consumption is 12 to 13 years – studies from the 2010s confirm this for an entire generation for the first time. What these children see is not sexuality – it is a staging. Perfect bodies, endless stamina, always ready, always hard, always more. And they believe it to be reality.
Pornography works through dopamine – the same neurotransmitter that acts in drugs and gambling. Every new clip, every new scene triggers a release. The brain gets used to it. The threshold rises. What was exciting yesterday is no longer enough today. Researchers call this desensitization – and it has a direct physical consequence: When a real person is opposite, without cuts, without music, without perfect lighting, the brain no longer reacts reliably. The erection fails. Not because the body fails – but because it is oversaturated.
PIED – Porn-Induced Erectile Dysfunction – is an increasingly discussed phenomenon in sexual medicine. Research is still in its early stages because the problem is new: broadband internet and unlimited available pornography have only existed for a generation. The first affected individuals are now in their thirties.
Especially among young men who grew up with readily available pornography, therapists report ED without organic cause. Reliable long-term studies are still lacking, but clinical observations are accumulating.
Chemsex in the Gay Community: A specific factor for gay men: Chemsex – the consumption of drugs such as crystal meth, GHB, or mephedrone in conjunction with sex – is widespread in urban gay communities. In the short term, these substances increase sexual stamina, but in the long term, they significantly damage erectile function. Studies from London and Amsterdam show that 10 to 20 percent of men who practice chemsex then report persistent ED.
Poppers and Erection – the Contradiction: Poppers are vasodilators – in the short term, they promote blood circulation and relax smooth muscles. They are primarily used in the gay community to facilitate anal sex, not as an erectile aid. In fact, poppers can weaken an erection – because blood pressure drops and the body draws blood away from the erectile tissues. In combination with PDE5 inhibitors – life-threatening: This is medically well documented: Poppers + Viagra/Cialis = dangerous drop in blood pressure, in individual cases fatal. However, this combination is common in the gay community.
The distorted expectation in the gay world
In the gay world, another problem arises that has received little attention in research: the tyranny of roles.
Gay sex today is increasingly focused on anal sex. Anal sex is considered the only "real" sex – everything else is undervalued as a preliminary stage, anal fisting is considered the climax. This message, also strongly fueled by porn, sits deep. More and more men register as passive on dating portals – not because they want to, but because they succumb to role expectations and know that their erections are no longer reliable enough for active anal sex. Being passive becomes a solution to a problem that no one talks about and that shouldn't really exist if sex wasn't increasingly seen as ticking off a defined list of achievements from the porn industry's drawer.
Before the date, everything is queried: How much do you cum? How big is your dick? Dirty? SM? Fisting? A checklist of sexual performance characteristics, compiled from a thousand hours of pornography – and never fully achievable; and yet, everything is expected on the first date. What remains is fear. And men who hide behind expectations they cannot fulfill themselves.
I have experienced it too often myself, and increasingly in recent years: Big announcements and boasts before dates – and on the date, no erection sufficient for ejaculation. No one talked about it. The shame ran too deep. Porn wishes for the trash can.
What is lost
How about just loosening up. Bringing curiosity instead of a script for the sex performance. Curiosity about nakedness, about a strange body, its shapes, its smell, its skin. And of course, about the dick, about the balls, which are made for fondling. And then letting the day's desire decide how it comes to a climax.
Kissing. Cuddling. Tenderness. Blowing. Masturbating. The basics that actually build trust, connect emotionally, and work – they are no longer considered enough. Pornography has removed them from the repertoire. Do you seriously think they are just a preliminary stage, a transition, a waste of time on the way to the "actual" act? The more you commit yourselves to sexual performance, the more your desire fades!
Lust does not arise from overstimulation, but from safety, curiosity, and connection. Exploring bodies curiously and lustfully, without a goal, without performance pressure – that is not a preliminary stage. That is sex. A skill that many young men lack. Because they never learned it.
Nobody notices. Nobody talks about it.
Only 10 to 20 percent of men affected by erectile dysfunction seek medical help. Yet 70 to 80 percent of cases could be successfully treated with modern therapies. The silence is no coincidence – it is the result of shame produced by the system. A young man who talks about erectile problems admits that he does not conform to the image of masculinity portrayed by pornography.
The porn industry is silent anyway. It profits from addiction, not from healing.
The counter-proposal - art that animates you
Erotic art works differently. It doesn't show everything – it leaves room. It doesn't overwhelm – it invites. It doesn't create an expectation that must be fulfilled, but rather imagination that is allowed to unfold.
The difference is fundamental: Pornography appeals to reflex. Erotic art appeals to imagination. An image that shows desire without performance pressure reminds us how lust can feel when it is free. When it doesn't have to perform. When it can simply be.
That is the idea behind KUNSTWERK BILDER. Gay eroticism that doesn't overwhelm. That leaves room. That shows what pornography has forgotten: that desire is not a performance.
Sources
[1] urologe-in-hamburg.de – Erektionsstörungen
[2] Cologne Male Survey, cited after ratiopharm.de
[3] klinischeforschung.novartis.de
[4] marienhospital-herne.de
[5] maennergesundheit.info
[6] focus.de – Young, male, impotent
[7] gospring.de
[8] porst-hamburg.de
[9] netdoktor.de
[10] apotheken.de
[11] pmc.ncbi.nlm.nih.gov
[12] biermann-medizin.de – Potency drugs as party drugs
[13] urologie.co.at
[14] volksversand.de
[15] meinbezirk.at
