Smoking causes erectile dysfunction

If you smoke and you’re concerned about erectile dysfunction (ED), there’s no better time to quit than now.

Men who smoke are about twice as likely to develop ED as nonsmokers. Smoking hampers circulation to all areas of the body, including the genitals, making it tougher to get and keep an erection.

Once you quit smoking, your health starts to improve immediately. Your blood pressure improves. Your chance of a heart attack goes down. Most importantly for ED prevention, your circulation begins to improve within 2 to 12 weeks.

How do you quit? Here are some tips to get you started:

  • Pick a date to quit and then prepare for the date.
  • Remove all cigarettes, ashtrays, matches, and lighters from your home, office, and car.
  • If you smoke more than nine cigarettes a day, ask your doctor about medications that can help you quit smoking.
  • When you have an urge to smoke, tell yourself, “Smoking is no longer an option,” and do something to distract yourself.
  • Change your routines. Try to avoid people or situations that make you want to smoke.
  • Seek the support of family, friends, and co-workers. Tell everyone around you that you’re going to stop smoking.
  • Spend time doing relaxing activities to reduce stress.
  • Exercise.
  • Spend more of your time in places that don’t permit smoking.
  • Keep plenty of low-calorie snacks handy.
  • Remind yourself of the benefits of not smoking, including improved sexual function.

You may have some withdrawal symptoms, but these usually last less than 2 weeks.

There will also be some difficult urges that you will successfully deal with.

Some people gain weight when they quit, but you can maintain your weight by getting regular exercise and limiting the amount of fat in your diet.

Smoking and Erectile Dysfunction: Quitting Helps

A June 2016 study also found that men who smoke have more damage to their sperm than nonsmokers. In the study, published in the journal BJU International compared 20 non-smoking and 20 men who smoke. Smokers had a higher percentage of damaged sperm, possibly due in part to inflammation observed in the testes and accessory glands. Smoking appeared to decrease health activity in the sperm, and caused more DNA fragmentation in the sperm. These problems with the men’s sperm could influence their fertility.

Another 2011 study involved 65 sexually active male smokers who wanted to quit and were willing to have their erections measured in the lab. The participants were enrolled in an eight-week quit program, which involved using nicotine patches (and no other drugs) and counseling, and were brought in for erectile testing three times: before the quit date, halfway through the program, then again one month after the program’s conclusion. To test men’s erections, the researchers used a device called a penile plethysmograph, which measures changes in circumference and hardness, while the men watched porn.

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Thirty-one percent of the men had successfully stopped smoking by the end of the study. Compared with men who relapsed, those who remained nicotine-free had wider, firmer erections and reached maximum sexual arousal (but, importantly, not climax!) much more quickly. These improvements were not seen, however, until after the men had stopped using the nicotine patches.

Twenty percent of the participants reported having erectile dysfunction (ED) at the start of the study. By the end, 75% of these men who had quit smoking, no longer suffered erectile problems. But 61% of men with ED who had not stopped smoking also saw improvement in their condition. The difference between the two groups was not statistically significant, however, researchers said.

Despite the fact that the researchers’ objective measurements showed improvements in sexual health among the quitters, there was no change in men’s own ratings of their sexual functioning, including perceptions of arousal, orgasmic function and strength of erection.

“It might take longer for men to actually notice their level of difference subjectively outside of the lab, which is also dependent on their relationship with their sexual partner,” study co-author Christopher Harte, of the VA Boston Healthcare System, told Reuters.

The current study isn’t the first to connect smoking with sexual health. Smoking is known to damage blood vessels and hinder proper blood flow, which can also affect erectile function. Just this week, researchers from the Mayo Clinic found that men who made lifestyle changes to improve their cardiovascular health — by lowering cholesterol and blood pressure, losing weight and exercising — also improved their symptoms of ED.

The new findings, published in the British Journal of Urology International, suggest it’s not just smoking, but nicotine itself that causes erectile problems, since improvements in men’s erections weren’t seen until after use of the patch was stopped.

The good news is that doctors may now have a new strategy to help people quit smoking. For many people, the long-term fear of cancer or heart disease isn’t enough to motivate them to quit — or, worse, it can backfire by increasing stress and, in turn, the urge to smoke — but the promise of immediate and measurable improvements where it counts might be just the incentive male smokers need.

So, guys, the next time you have the urge to light up a post-coital Lucky, you might stop to think about whether it’ll keep you from your next chance to crave one.

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8 Musts for a Man’s Sex Life

Think your sex life is foolproof? Think again — occasional erection problems can be triggered by anything from bedroom jitters to a night out boozing.

But for the 10 percent of men with long-term erectile dysfunction, could anything have been done to prevent the condition in the first place? Perhaps. To keep ED from striking, follow this step-by-step prevention guide.

  1. Kick the habit (no ifs, ands, or butts!). No. 1 on your ED prevention list? Stop smoking. For men under the age of 40, smoking is the biggest cause of erectile dysfunction. That’s because maintaining an erection requires a healthy blood supply, and nicotine causes your blood vessels to contract (which causes the penis to shrink). The longer you’re a smoker, the more difficult it is to treat or reverse erectile dysfunction.

    Need help quitting? We’ve nailed down the stop-smoking techniques that really work (and those that are just wastes of time and money): The Best and Worst Ways to Quit Smoking.

  2. Move more. Regular exercise is a must for both your heart and circulation — and because of that, it’s also an important way to prevent ED. Regular exercise can improve blood flow to the penis, as well as to the rest of your body. Not to mention, working out increases your energy, lowers blood pressure, reduces stress, helps you sleep better, and makes you feel (and look!) more attractive — which are all helpers in avoiding erection problems.
  3. Take it easy on the alcohol. Sure, kicking back with a little booze is a great way to de-stress — but in large amounts, alcohol is a depressant. That means the more you drink, the more likely the alcohol will lead to erectile dysfunction (depression is one of the biggest causes of ED). This effect increases as you get older, so older men who are at greater risk for erection problems should take steps to limit the number of alcoholic beverages they consume. Talk to your doctor to find out if you should aim for less than the two-drinks-per-day maximum that’s often advised for men.
  4. Eat these foods. A number of studies show that obesity, high cholesterol, diabetes, heart disease, and high blood pressure are linked to erectile dysfunction. Since a healthy diet is one of the best ways to protect against these diseases, it makes sense for your sexual health to eat healthily. What foods should be a part of your ED-prevention diet? Lots of fruits and vegetables, plenty of fiber, and very little saturated fat. If you’re struggling with your weight or cholesterol, ask your doctor for help.
  5. Protect your penis. Although the penis is not a bone, it can fracture. When the penile chamber that fills with blood during an erection ruptures, it fractures the penis — and this can be a major cause of erection problems. And if you don’t seek immediate treatment, penile fractures can lead to scarring, deformity, and erectile dysfunction. So think twice before having over-the-top, acrobatic sex (especially if the woman’s on top). If a penile injury occurs with bruising, pain, or swelling, call your doctor or go to an emergency room.
  6. Brush your teeth. Turns out, erectile dysfunction and chronic gum disease share many of the same risk factors. In one recent study, 80 percent of men who had severe erectile dysfunction (caused by poor penile blood supply) also had chronic gum disease. Keeping your mouth healthy with flossing, brushing, and regular dental visits is one more way to keep your sex life in tip-top shape.
    1. Kick your feet back. Stress and anxiety are frequent contributors to erection problems. That’s because stress causes your body to release stress hormones that are good for your “fight or flight” response, but bad for your blood flow because it causes blood vessels to contract. To prevent ED, find ways to reduce stress (without resorting to drugs, cigarettes, or alcohol, of course).
  7. Get your Zzzs. Fatigue can be a detriment your sex life — so getting plenty of rest before a romp in the hay is always a good idea. But if you’re struggling to get a good night’s sleep and feeling drained throughout the day, you could have a condition called sleep apnea (which is signaled by very noisy snoring and periods of interrupted breathing). Studies show that men with erectile dysfunction are more than twice as likely to have sleep apnea, so if your wife is sleeping in the other room because of your snoring, talk to your doctor.

Tobacco Education: Emphasizing Impotence as a Consequence of Smoking

In 2000, Thailand became the first country to go beyond advertising by placing impotence warnings and pictures on cigarette labeling. Subsequently, Canada and Brazil implemented similar warnings on their cigarette packages. Currently, the United Kingdom is considering adding various picture warnings to cigarette packages, some of which say that “smoking may reduce the blood flow and causes impotence.” Data regarding the results of cigarette labeling indicate that graphic cigarette warning labels reach their intended audience and serve as an effective population-based smoking-cessation intervention. Unfortunately, U.S. requirements are lagging behind other countries, as cigarette manufacturers are only required to include traditional warnings from the U.S. Surgeon General regarding heart disease, lung cancer, emphysema, and complications with pregnancy.

Threat of impotence as a Motivator for Smoking Cessation.

On the basis of the association between smoking and impotence and data supporting the benefits of smoking cessation on impotence, it seems logical that this topic be included in smoking-cessation programs. Moreover, data support that there is a need for this information to be communicated to smokers, as a majority of men appear to be unaware that smoking increases ED risk. In a survey of Hong Kong men, only 13.9% were aware of the link between impotence and smoking, and only 12% of British smokers were aware in a 1999 survey. Results of a study conducted by Shiri et al. indicated that smokers with ED were more likely to stop smoking than smokers without ED (23% versus 12.6% stopped, respectively), but the results were not statistically significant likely because of the low numbers of patients in the analysis.

Recently, a small survey in the United States investigated the issue of using impotence as a motivator for smoking cessation. Male smokers ages 18 years and older were surveyed at a local health fair in Denver, Colorado, in April 2004. Surveys were voluntary and anonymous. Participants were surveyed to determine if they knew that smoking increases impotence risk and that regular smoking may reduce impotence drug-treatment response and to assess what effect the risk of impotence would have on their decision to continue smoking.

Sixty-two surveys were completed. Most of the men surveyed were middle age (65% ages 41—60 years) and white (76%). Smoking habits were evenly distributed among 6—10, 11—20, and 21—30 cigarettes smoked per day. The majority of men had attempted to quit smoking at least once, with over one quarter attempting six or more times.

Thirty-four men (55%) stated they were aware that smoking tobacco increases impotence risk, and 56% of the surveyed men maintained that they would be “somewhat more likely” or “much more likely” to stop smoking because of the link between smoking and impotence. Of the men who stated they were unaware of the increased risk of impotence due to smoking, 57% stated they would be somewhat more likely or much more likely to stop smoking. Overall, 39%, 37%, and 19% stated the relationship between smoking and impotence had no effect on their decision to continue smoking, made them somewhat more likely to stop smoking, and made them much more likely to stop smoking, respectively. Three men did not respond to this question.

In total, six men (10%) stated they suffered from impotence; of these, one smoked 6—10 cigarettes per day, two smoked 11—20 cigarettes per day, and three smoked 21—30 cigarettes per day. Three of the impotent men stated they were unaware of the link between impotence and smoking, and five stated that the link made them somewhat more likely or much more likely to stop smoking. Only one impotent man stated that impotence would not affect his decision to continue smoking. Thus, 96% of the men (23 of 24) who planned to continue smoking were not impotent. Overall, 23 men (37%) stated they were aware that smoking could potentially reduce the effects of pharmacologic agents (i.e., sildenafil, vardenafil, and tadalafil) used to treat impotence.

Implications for Pharmacists

Pharmacists and other health care providers involved in smoking-cessation programs are ideally situated to educate patients about the association between smoking and impotence. A majority of men will likely respond to smoking-cessation education that is focused on impotence risk, especially if they are already impotent. Younger smokers may be more likely to alter their smoking habits on the basis of potential impotence risk rather than remote threats of heart and lung disease. Moreover, health education programs in schools could incorporate impotence into their discussions of tobacco risks to encourage youths to avoid tobacco altogether.

The link between smoking and impotence should be used by pharmacists and other health providers to help motivate men to quit smoking.

Smoking and Impotence

The ad starts with a classic scene of seduction: A suave thirtysomething man in a tuxedo approaches a beautiful woman in an evening gown. He lights a cigarette. It goes limp, and every man in the viewing audience winces. The voice-over says it all: “Now that medical researchers believe cigarettes are a leading cause of impotence, you’re going to be looking at smoking a little differently.”

The television ad, part of a $21 million anti-smoking campaign by the California Department of Public Health, definitely gets high marks as an attention-grabber. Even men who ignore the threat of lung cancer or heart disease take note whenever the “I” word pops up.

Studies on impotence

Although scientists have long been divided on the possible connection between smoking and impotence, recent studies suggest that cigarettes may indeed affect sexual performance.

After hearing a radio commentator rant about cigarettes, impotence, and “junk science,” Tammy Tengs, ScD, decided to clear the air. Tengs, a public health researcher at the University of California at Irvine, wasn’t convinced by any previous studies that specifically examined the link between smoking and impotence. So she took a novel approach to the question.

“We looked at every single study in the last two decades that had a lot of impotent men,” she says. Nineteen of those studies — involving a grand total of 3,819 impotent men — also recorded smoking habits. As reported in Preventive Medicine, Tengs found that 40 percent of the subjects were current smokers, compared with only 28 percent of the general population. Either smoking raises the risk of impotence, or there are a lot of smokers out there with rotten luck.

After looking at the data, Tengs believes the television ad is right on target, with one exception: The man holding the limp cigarette seems too young to fit the typical profile of men affected by impotence. Still, she says, it’s fair to point out that men who smoke while they’re young may be setting themselves up for a problem down the road.

Effects of nicotine

Even before Tengs’ study, male smokers might have made their own troubling observations. First of all, given the short-term and long-term effects of cigarettes, it would be a bit surprising if smoking didn’t hamper erections. Nicotine encourages the blood vessels to squeeze tight, potentially slowing the flow of blood to the penis. Even worse, a long-term habit can permanently damage arteries throughout the body, including those that feed the penis. Although impotence is largely a problem of older men, younger men who smoke may discover that they have weaker erections as a result of constricted blood vessels, according to researchers.

Although studies in the past had mixed results, a few of them were real eye-openers. Researchers at Wake Forest University in Winston-Salem, North Carolina — the heart of tobacco country — surveyed 59 men with long-standing hypertension. As reported in the January 2001, issue of The Journal of Family Practice, 15 men had erection problems, including eight current smokers and six former smokers. The researchers concluded that men with high blood pressure who smoked were roughly 26 times as likely to be impotent as hypertensive nonsmokers. (Because of the small number of subjects, the estimate should be taken with a grain of salt.)

As alarming as those results are, they can’t match the shock value of a small study published back in 1986 in the relatively obscure journal Addiction Behavior. In this study, researchers went right to the heart of the matter: They hooked up penile sensors to 42 male smokers and then showed them erotic movies. Some of the subjects smoked high-nicotine cigarettes before watching the movies, while others ate candy. The unsettling results: Just two cigarettes significantly reduced “penile diameter” during the show. In plain language, that means smaller, softer erections. (At least many smokers have the good sense to save the cigarettes until after sex.)

More recently, in a 2006 Australian study of 8,367 men, researchers reported that smoking increased the likelihood of impotence by 27 percent and concluded it was significantly associated with erectile dysfunction. They also discovered that the more a man smoked, the more likely it was that he would suffer from erectile dysfunction.

It’s important to remember that many things other than smoking can lead to erectile dysfunction, including stress, hypertension, alcoholism, diabetes, and prostate surgery. If you’re a smoker who has trouble achieving or maintaining an erection, kicking the addiction is just one important step. You should also see a urologist or family doctor for a checkup and advice. With a little help, there’s a good chance you can return to a full, satisfying sex life.

Interview with Tammy Tengs, a public health researcher at the University of California at Irvine

Tengs, T. and ND Osgood. The link between smoking and impotence: Two decades of evidence. Preventive Medicine. June 2001. 32:447-452.

Spangler, JG et al. Smoking, hypertension, and erectile dysfunction. The Journal of Family Practice. January 2001. 50(1):73.

Cigarette smoke is one of the most well-known toxins negatively affecting human health. Recurrent use has been associated not only with many medical conditions, such as cardiovascular and respiratory diseases, but also with impaired fertility in men.

Essentially it affects all functions related to reproduction including semen volume, sperm motility (movement), sperm morphology (shape), sperm genetic material, and causes erectile dysfunction . You may find our latest blog post on Smoking and How It Affects Your Sperm Quality highly relevant to this topic.

In the last few years, alternative to smoking like e-cigarettes, also known as vaping, has grown in popularity, promising less intake of the hazardous chemicals.

The major goals for the invention of e-cigarettes were to:

  • Reduce the mortality rate associated with traditional smoking
  • Assist smokers in quitting
  • Reduce the cost of regular cigarettes

How innocent is vaping?

To answer this question, we first need to understand what vaping is and how it works. Vaping is mainly inhalation of the vapor generated from an electronic cigarette. Electronic cigarettes were first introduced to the American market in 2007 and are becoming increasingly popular.

The device consists of a mouthpiece, a battery, a microprocessor, a cartridge for containing e-liquid, and a heating component that transforms the liquid into vapor. Since the liquid is used to generate the vapor, where the harm arises from.

E-liquid contains variable percentages of nicotine mixed with concentrated flavors and other chemicals like propylene glycol, glycerol, ethylene glycol, and polyethylene glycol. Especially the information about the ingredients of the liquid has been found to be insufficient by some manufacturers.

E-cigarette manufacturers have made a variety of claims indicating that they are safer than normal cigarettes and that their use facilitates smoking cessation . However, the amount of information is still scarce, and as pointed out in a recent report from the German Cancer Research Center in Heidelberg, the use of e-cigarettes cannot currently be rated as safe.

Can e-cigarettes affect my fertility?

There is not much research on vaping and its effects on fertility – but the limited research out there suggests that it affects fertility in a negative way. One small study, which took place at the University College of London, indicated that the e-liquid in itself could damage sperm cells . The findings were presented at The British Fertility Society, but were never published in a journal for peer-review.

Thus far, there are no published studies investigating the effect on vaping and fertility in males. Animal studies have found that nicotine negatively affects fertility in mammals The only study on e-liquids, which was published in 2016, showed that male rats exposed to e-liquids with and without nicotine for four weeks, showed a significant decrease in sperm count of both groups, with the biggest decrease in the nicotine exposed rats, suggesting that e-liquid may harm fertility even without nicotine .

Even though there is still not much evidence around vaping’s effects on fertility, the existing evidence suggests that some of the chemicals in the e-liquid, even without nicotine, may be harmful for fertility.

Therefore, vaping cannot be considered safe, despite the lack of many harming constituents from regular tobacco. Since nicotine might be one of the harmful components, it is better to assume that not only e-cigarettes, but also chewing tobacco, snuff, and nicotine replacement therapy might harm male fertility. Some of these substances may be used to aid smoking cessation, but we do advise that their use of is minimized or completely avoided, especially for consumers with a goal of conceiving.


    • Perspective The EVALI and Youth Vaping Epidemics B.A. King and Others

      Interventions aimed at curbing two related U.S. epidemics connected with vaping — an outbreak of lung injuries and a continued surge in use by young people — should take into consideration their underlying drivers.

      Jan 17

    • Original Article Role of Vitamin E Acetate in EVALI B.C. Blount and Others

      In a study involving 51 patients with EVALI (electronic-cigarette, or vaping, product use–associated lung injury) in 16 states across the United States, vitamin E acetate was detected in samples of bronchoalveolar-lavage fluid from 94% of the patients but not in samples from a healthy comparator group.

      Dec 20

    • Special Report Vaping Syndromic Surveillance K.P. Hartnett and Others

      Recent increases in e-cigarette, or vaping, product use–associated acute lung injury (EVALI) have been identified. Using the National Syndromic Surveillance Program, which includes about 70% of U.S. EDs, researchers found a gradual increase in EVALI-associated ED visits from January 2017 through early June 2019. A sharp increase was identified in June, peaking in September. A decrease has been observed in the past 2 months.

      Dec 20

Additional Articles on E-Cigarettes and Vaping-Related Disease

  • Correspondence Jan 23, 2020 More on the Pathology of Vaping-Associated Lung Injury
    N Engl J Med 2020; 382:387-390

    This description of untreated vaping-associated lung injury examined at autopsy provides a look at the pathology of the process independent of medical intervention.

  • Correspondence Jan 23, 2020 Pulmonary Illness Related to E-Cigarette Use
    N Engl J Med 2020; 382:384-386

    In these letters, Diaz et al. highlight the potential for severe airway reactivity and perioperative challenges when performing bronchoscopy and BAL in patients with e-cigarette, or vaping, product use–associated lung injury, and Russell and Cevik stress the importance of ruling out infectious causes in these patients. Layden et al. respond.

  • Correspondence Oct 31, 2019 Real-Time Surveillance of Vaping-Induced Pulmonary Disease
    Y. Hswen and J.S. Brownstein N Engl J Med 2019; 381:1778-1780

    This report documents the ongoing surge in cases of severe pulmonary disease associated with e-cigarettes, collecting online information from news aggregators, eyewitness reports, and official alerts.

  • Correspondence Oct 31, 2019 Pathology of Vaping-Associated Lung Injury
    Y.M. Butt and Others N Engl J Med 2019; 381:1780-1781

    This letter describes findings in 17 patients with a history of vaping who had lung biopsies after presenting with symptoms and bilateral pulmonary opacities that led to a clinical diagnosis of vaping-associated lung injury. The lung histopathology is described, along with some preliminary insights into the pathogenesis of acute lung injury.

  • Correspondence Oct 10, 2019 Imaging of Vaping-Associated Lung Disease
    T.S. Henry, J.P. Kanne, and S.J. Kligerman N Engl J Med 2019; 381:1486-1487

    A sampling of imaging findings in patients with lung disease associated with electronic cigarette use is provided.

  • Correspondence Oct 10, 2019 Vaping Trends among Adolescents, 2017–2019
    R. Miech and Others N Engl J Med 2019; 381:1490-1491

    Vaping by adolescents is a concern because of the risks of nicotine addiction and because of reports of an association between vaping and acute lung injury. This nationally representative survey finds sharp increases in the frequency of vaping among 8th-, 10th-, and 12th-grade students.

  • Correspondence Oct 10, 2019 Pulmonary Lipid-Laden Macrophages and Vaping
    S.D. Maddock and Others N Engl J Med 2019; 381:1488-1489

    The use of electronic cigarettes has been associated with pulmonary injury, one feature of which has been lipid-laden macrophages in pulmonary-lavage fluid. Six cases in Utah are reported.

  • Editorial Sep 06, 2019 Vaping-Induced Lung Injury
    D.C. Christiani

    Until the investigation into the cause of this epidemic of vaping-induced respiratory injury is complete, no conclusions can be drawn as to which compound or compounds are the causes of injury. In light of these cases, however, efforts should be made to increase public awareness of the harmful effect of vaping, and physicians should discourage their patients from vaping.

  • Original Article Sep 06, 2019 Vaping-Induced Lung Injury
    J.E. Layden and Others

    Vaping use has rapidly increased. In this report from the Wisconsin and Illinois departments of public health, a severe respiratory illness in otherwise healthy young people is described. Of the 53 case patients identified to date in this ongoing investigation, 94% were hospitalized, 32% were intubated, and 1 person has died.

  • Images in Clinical Medicine Jun 20, 2019 Injury from E-Cigarette Explosion
    M.G. Katz and K.W. Russell N Engl J Med 2019; 380:2460

    A 17-year-old boy presented to the ED with pain and swelling in his jaw 2 hours after an e-cigarette exploded during use. He had extensive lacerations in his mouth, multiple disrupted lower incisors, and bony incongruity of his left mandible.

  • Original Article Feb 14, 2019 E-Cigarettes vs. Nicotine-Replacement Therapy
    P. Hajek and Others N Engl J Med 2019; 380:629-637

    In a randomized trial involving 886 smokers, e-cigarettes were more effective than nicotine-replacement therapy with respect to the 1-year abstinence rate (18% vs. 10%). Throat or mouth irritation was more common in the e-cigarette group, and nausea was more common in the nicotine-replacement group.

  • Correspondence Feb 14, 2019 Youth Vaping in Colorado
    T.S. Ghosh and Others N Engl J Med 2019; 380:689-690

    In a 2017 survey of Colorado high-school students, 27% reported current use of electronic cigarettes (vaping). These students were also more likely to report risky behaviors (including binge drinking and the use of opioid pain medications without a prescription) than nonusers.

  • Correspondence Jan 10, 2019 Adolescent Vaping and Nicotine Use in 2017–2018
    R. Miech and Others N Engl J Med 2019; 380:192-193

    A national survey revealed a large increase in nicotine vaping among high school students; more than 20% of 12th-graders reported that they vaped nicotine in 2018. The increase in adolescent nicotine use from 2017 to 2018 was explained by an increase in vaping; the use of other nicotine products declined.

  • Perspective Sep 20, 2018 Adolescents’ Use of “Pod Mod” E-Cigarettes
    J.L. Barrington-Trimis and A.M. Leventhal N Engl J Med 2018; 379:1099-1102

    Use of a new e-cigarette product class called “pod mods” is rampant among young people. There is reason to be concerned that adolescents’ use of these products could bring a host of adverse health consequences to the current generation of adolescents and young adults.

  • Special Article Jun 14, 2018 Approaches to Smoking Cessation
    S.D. Halpern and Others N Engl J Med 2018; 378:2302-2310

    In a pragmatic trial involving smokers, financial incentives were more effective than free cessation aids; free cessation aids or e-cigarettes were no more effective than usual care. Cessation rates among smokers assigned to financial incentives were less than 3%.

  • Perspective Jan 18, 2018 E-Cigarettes and the Harm-Reduction Continuum
    A.L. Fairchild and Others N Engl J Med 2018; 378:216-219

    In recent years, there has been a trend of acknowledging the importance of a harm-reduction approach in policy discussions about e-cigarettes. But some proposed strategies might well limit, if not entirely undermine, the population benefits associated with e-cigarettes.

  • Review Article Oct 06, 2016 The Health Effects of Electronic Cigarettes
    C. Dinakar and G.T. O’Connor N Engl J Med 2016; 375:1372-1381

    The use of electronic cigarettes is growing, and some hope that they will replace what is felt to be the more dangerous nicotine-delivery system — cigarettes. However, data on the long-term safety of e-cigarettes are still being gathered.

  • Correspondence Oct 06, 2016 Explosion Injuries from E-Cigarettes
    E.G. Brownson and Others N Engl J Med 2016; 375:1400-1402

    This report from a single center describes 15 patients with injuries caused by explosions of e-cigarettes that occurred over a period of less than a year. Patients had a combination of flame burns, chemical burns, and blast injuries.

  • Perspective Jul 21, 2011 E-Cigarette or Drug-Delivery Device? Regulating Novel Nicotine Products
    N.K. Cobb and D.B. Abrams N Engl J Med 2011; 365:193-195

    The FDA intends to regulate e-cigarettes as tobacco products, since the courts blocked it from treating them as drug-delivery devices. Until the FDA asserts its new authority over tobacco, concentrated nicotine products may be sold to consumers, raising safety concerns.

Smoking and sexual health

Smoking just one cigarette can affect erection

Among the innumerable active ingredients in tobacco, nicotine, carbon monoxide and certain free radicals are responsible for the constriction of blood vessels with a more immediate effect, as several recent studies (7) have demonstrated. An occasional cigarette can therefore lead to a significant decrease in erectile performance, for instance an increase of over 20% compared to a non-smoker!

Tobacco is a risk factor

The high instance of smokers among sufferers of erectile dysfunction, significantly higher than in the general population (40% compared to 28%), clearly points to a straightforward correlation between tobacco and erection problems. Epidemiological studies suggest that smokers may be twice as likely to develop erection problems as non-smokers. The risk is obviously higher if we take into account the risks posed by other smoking-related conditions such as diabetes.

Tobacco is harmful for sexual health

As we have seen, most studies have shown that tobacco leads to an impaired arousal phase among men and women. However, the negative effects of tobacco are not limited to arousal and erection problems. Smoking can also affect fertility, effectively decreasing it among both male and female smokers, and as has been well documented, it can also cause problems during pregnancy. The anti-estrogen effect of smoking tends to bring the menopause forward by several years (10). Lastly, many different illnesses such as sexual infections (11) or Peyronie’s disease (an abnormality of the penis) can be activated or aggravated by tobacco.


A clear medical recommendation to stop smoking can therefore be formulated, considering the negative impact that smoking has on sexual function. This can be an important motivator for those who wish to stop smoking and regain a functional and fulfilling sex life. It should also be noted that although sexual health problems do not generally affect life expectancy, they are more common than people think and considerably affect the overall health of an individual. They should therefore be subject to proper medical treatment.


  1. Condra M, Morales A, Owen JA, Surridge DH, Fenemore J. Prevalence and significance of tobacco smoking in impotence. Urology 1986;27:495-8
  2. Juenemann KP, Lue TF, Luo JA, Benowitz NL, Abozeid M, Tanagho EA. The effect of cigarette smoking on penile erection. J Urol 1987; 138:438-41.
  3. Shabsigh R, Fishman IJ, Schum C, Dunn JK. Cigarette smoking and other vascular risk factors in vasculogenic impotence. Urology 1991;38:227-31.
  4. Ambrose JA, Barua RS (2004) The pathophysiology of cigarette smoking and cardiovascular disease: an update. J Am Coll Cardiol 43:1731–1737
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