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About 30 million men in the United States suffer from erectile dysfunction.  In addition about 34 million adults, or 14% of the adult population, smoke cigarettes. Cigarette smoking is an important cause of erectile dysfunction.  

The first study that called attention to the relationship between ED and smoking was the Massachusetts Male Aging Study.  This study was based upon questionnaires sent to men aged 40 to 70.  The study found that cigarette smoking doubles the risk of ED. 

Erectile Dysfunction Due to Smoking Is Dose-Dependent

Furthermore, the adverse effect of smoking upon ED is proportional to the number of cigarettes that you smoke.  A study of 8300 Australian men showed that those who smoke less than 20 cigarettes per day have a risk of ED that is 1.24 times the overall population.  Patients who smoke more than 20 cigarettes a day have a 1.39 times greater risk of ED.   

Duration of Smoking

Patients who have smoked less than 10 years have a risk of ED that is 1.3 times greater than average.  Those who smoked more than 10 years have a risk that is 1.5 times greater than average.  

Cigarettes and Diabetes

Cigarettes have a greater adverse effect upon ED in those patients with diabetes.  In a study of 9700 Italian men with diabetes, those who smoked have a 1.5 times greater risk of ED than the average diabetic.  The study concluded that diabetes worsens the harmful effects of smoking upon ED.  

Smoking Before Sex Worsens Performance

In order for the erection to take place, the arteries to the penis must dilate.  Blood then rushes to the penis and the erection results. This process is stimulated by the parasympathetic nervous system.  The parasympathetic nervous system causes the smooth muscle in the wall of the penile artery to relax.  

Nicotine, on the other-hand, stimulates the sympathetic nervous system.  This occurs because nicotine leads to the release of epinephrine and norepinephrine in the blood.  The sympathetic nervous system causes constriction of the penile arteries. Blood flow to the penis is reduced and this can prevent the erection.  Do not smoke before sex.

Smoking Decreases the Quality of the Erection

Smoking has been shown to reduce the quality of night time erections.  One study compared the quality of night time erections in smokers versus non – smokers. The study utilized the Rigiscan device to measure the duration and quality of the male erection.  The Rigiscan consists of 2 loops that fit around the penis. The loops connect to a computer that records the quality and duration of the erection during sleep.  

The study found that cigarette smoking adversely affects both the quality and the duration of the erection.  The magnitude of this effect was proportional to the number of cigarettes smoked and the duration of cigarette smoking.   

Passive or Second Hand Smoke

Second hand smoke increases erectile dysfunction.  The Massachusetts Male Aging Study showed that passive exposure to cigarette smoke increases the risk of ED.  Passive smoking is comparable to smoking 10 to 18 pack years of cigarettes.  

Quitting Smoking

The cessation of smoking results in an improvement in erectile function.  This benefit is greater in the young patient with mild ED. Older patients with severe ED will see less improvement in erectile function when they stop smoking.

Stopping smoking produces an immediate improvement in erectile function.  In addition, erectile function continues to improve for at least one year after you stop.  

Smoking and Testosterone

Most studies show that smoking increases testosterone levels.  This increase is proportional to the number of cigarettes that you smoke per day.  Smoking has not, however, been shown to increase male libido.

Patients who stop smoking are prone to low testosterone levels. These patients should be monitored and they may require testosterone supplementation.  

What Harmful Toxins Are Found in Cigarette Smoke?

Cigarette smoke contains at least 4800 chemicals and many of these are toxic to your health. Nicotine is believed to be the toxin that is most responsible for erectile dysfunction. Other toxins in cigarette smoke include ketones, aldehydes, carbon monoxide, arsenic, benzene, ammonia, cyanide, formaldehydes, free radicals, and several metals including aluminum, cadmium, copper, chromium, lead and nickel.

How Does Smoking Interfere with Erectile Function?

Smoking decreases blood flow to the penis.  The erection is a vascular event and blood must be able to flow to the penis for a good erection.  Cigarettes interfere with the flow of blood in several ways.  

Smoking Interferes with Endothelial Function

Nitrous oxide (NO) is the most important chemical messenger for the erection process.  Smoking reduces NO levels by inhibiting the enzyme that makes NO – Nitrous Oxide Synthetase.

Smoking Alters the Structure of the Artery

Smoking causes the deposition of the protein collagen into the wall of the artery.  Smoking also reduces the amount of smooth muscle in the wall of the artery. This damage to the artery reduces the flow of blood to the penis.

Smoking Increases Atherosclerosis

Smoking can lead to the deposition of arterial plaque.  Smoking leads to an influx of harmful inflammatory cells into the wall of the artery.  In addition, smoking causes oxidative stress by increasing the levels of free radicals.  These effects lead to the formation of atherosclerotic plaque. Arterial plaque reduces penile blood flow and interferes with the erection.