Can Nicotine Cause Impotence?
Written by Leann Poston, M.D.
Approximately 15% of adult men smoke cigarettes. Smoking is most common in men between the ages of 25 and 64. According to the 2018 Gallup poll, nine percent of adults surveyed vape for their nicotine exposure, at least occasionally. More than 16 million Americans live with a smoking-related disease. If these statistics are not enough to make you want to kick your smoking habit. The strong link between smoking and erectile dysfunction (ED) may. Smoking is a major risk factor for ED, no matter what your age.
An erection is caused by increased blood flow into the penis following sexual stimulation. Blood becomes trapped in spongy spaces called the corpus cavernosa in the shaft of the penis. When blood fills the corpus cavernosa, pressure in the penis rises, resulting in an erection.
Nicotine is just one of the thousands of chemicals in cigarette smoke. It is a vasoconstrictor, which means it narrows blood vessels and decreases blood flow. Reduced blood flow into the penis causes ED.
Nicotine and other chemicals in cigarette smoke can irritate and damage the lining of small blood vessels.
Diabetes, high blood pressure, and high cholesterol levels also damage the lining of blood vessels. All of these cardiovascular risk factors increase the risk for ED and cardiovascular disease, which can lead to strokes and heart attacks. ED can be an early indicator of cardiovascular disease.
Although smoking is a significant risk factor for ED, other lifestyle factors, such as diet and exercise, can also impact whether and how often you might experience ED.
Research and Statistics
Studies on the association between smoking and ED have included populations in China, the Middle East, Europe, and the Americas. Most of these studies showed a statistically significant correlation between smoking and ED (Kovac et al., 2014).
In the Male Health Professionals Study, 22,086 men were followed for 14 years. The relative risk of developing ED in smokers was 1.4. Smokers were 40 percent more likely to develop ED than nonsmokers (Bacon et al., 2006).
The more cigarettes per day that men smoked, the stronger the association between smoking and ED. Younger men who were otherwise healthy had double the risk of ED when they smoked over 20 cigarettes per day (Kovac et al., 2014).
ED affects about 15 to 30 million men in the U.S. Half of all men between the ages of 40 and 70 have at least transient ED or inadequate erections. If men can break the smoking habit earlier in life, they are more likely to regain full erectile function.
Read More: Let’s Talk About Erectile Dysfunction
Nitric Oxide Levels
Nitric oxide is a small molecule that has an important role in maintaining blood flow throughout the body, including into the penis.
After sexual stimulation, nitric oxide is released from nerve endings near small blood vessels in the corpus cavernosa. It triggers a chemical reaction that dilates blood vessels and increases blood flow into the penis. As a result, blood is trapped in the corpus cavernosa, resulting in an erection.
The production of nitric oxide is decreased after exposure to cigarette smoke. As chemicals in cigarette smoke are broken down, they also produce free radicals. Free radicals are unpaired electrons that can increase the risk of cancer and other diseases. Free radicals decrease nitric oxide levels in the corpus cavernosa (Kovac et al., 2014).
Any factors that interfere with blood flow entering or leaving the penis or decrease nitric oxide levels are prime factors for causing ED. The chemicals in smoke can decrease blood flow into the penis, reduce nitric oxide levels, and cause atherosclerosis, deposition of fatty plaques on the inner walls of blood vessels. All three of these processes increase the risk of ED.
In addition, the chemicals in smoke increase the risk of blood clotting, reduce antioxidants in the blood and alter the way glucose and fats are metabolized in the body. Even though the exact mechanism of how smoking leads to ED has not been completely worked out, all these factors are likely contributory.
Smoking is also a risk factor for high blood pressure and high cholesterol levels. High blood pressure and cholesterol levels damage blood vessels, potentially reducing blood flow into the penis (Pourmand et al., 2004).
Reduced blood flow can increase the time it takes to achieve an erection and reduce the rigidity of the erection.
Although it is clear nicotine is a risk factor for ED because of its effects on blood flow and nitric oxide levels, the association between nicotine and libido or sexual response was less clear. A study enrolled 28 men who had minimal past exposure to nicotine. They were given nicotine gum, and their sexual response was measured and compared to men without nicotine exposure. Nicotine exposure reduced their erectile responses to erotic films (Harte & Meston, 2010).
Options for Quitting
Breaking any habit, including smoking, is difficult, but the payoff is the ability to look forward to a healthier future.
According to the National Heart, Lung, and Blood Institute, you should:
Develop a Plan
Make a list of reasons you want to quit smoking and why those reasons are important to you. Identify your triggers. What barriers can you put in place now to reduce your exposure to these triggers?
Identify Your Support
Make a list of people you can count on to support you in your endeavor to quit smoking. Who can talk you out of it? Who can distract you when you feel like smoking?
Get Medical Help
There are many prescription and over-the-counter medications that can support you as you withdraw from nicotine. Get advice from your doctor on which options are likely to work best for you.
Be aware that nicotine can also increase the risk of ED, so a two-step process may be needed —quit smoking and then quit nicotine (Harte et al., 2008).
Develop New Habits
Smoking served a purpose for you. Identify its purpose. Was it for weight loss, to decrease anxiety, or to keep your hands busy?
After identifying what purpose smoking and nicotine served for you, look for healthier alternatives that can fill the void. Studies show even a single puff can cause you to relapse. There is also evidence that using one addictive substance, such as alcohol, can increase your risk of relapse for another.
Make a Plan in Advance for How to Handle Withdrawal Symptoms
Having a plan in advance can give you confidence when you feel like your resolve to quit is slipping.
How Quickly Will You See Results?
Quitting smoking will prevent any further damage to blood vessels. Though some studies suggest that the risk of ED may remain increased even after quitting, others indicate that some vascular damage is reversible if you stop smoking before middle age and do not restart (Kovac et al., 2014).
In a study of 143 men with ED who quit smoking, at six months, over half reported increased erectile function (Chan et al., 2010). In another study, men who used an 8-week nicotine replacement therapy to stop smoking reported significantly improved erectile function at a year (Pourmand et al., 2004). The severity of ED and age were both factors that affected the outcome.
A short abstinence period also seems to be beneficial. Men who are heavy smokers and stopped smoking for 24 to 36 hours reported a significant improvement in blood flow into the penis (Kovac et al., 2014).
Researchers commented in several studies that the length of follow-up might not have been long enough to see the full benefits of quitting smoking. Abstinence from smoking will improve heart function and decrease the risk of cardiovascular disease. It will also reduce the risk of cancer and lung disease.
If there is a waiting period before you see the benefits of not smoking, other treatment options for ED can help in the meantime. Call one of the healthcare professionals at Invigor Medical to learn more about Trimix and other treatment options for ED.
While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.
1. Kovac, J. R., Labbate, C., Ramasamy, R., Tang, D., & Lipshultz, L. I. (2015). Effects of cigarette smoking on erectile dysfunction. Andrologia, 47 (10), 1087–1092. https://doi-org.proxy.oplin.org/10.1111/and.12393
2. Bacon CG, Mittleman MA, Kawachi I, Giovannucci E, Glasser DB, Rimm EB. A prospective study of risk factors for erectile dysfunction. J Urol. 2006 Jul; 176 (1):217-21. doi: 10.1016/S0022-5347 (06) 00589-1. PMID: 16753404.
3. Chan SS, Leung DY, Abdullah AS, Lo SS, Yip AW, Kok WM, Ho SY, Lam TH (2010) Smoking-cessation and adherence intervention among Chinese patients with erectile dysfunction. Am J Prev Med 39:251–258.
4. Pourmand GAM, Rasuli S, Maleki A, Mehrsai A (2004) Do cigarette smokers with erectile dysfunction benefit from stopping?: A prospective study. BJU Int 94:1310–1313.
5. Harte, C. B., & Meston, C. M. (2008). Acute effects of nicotine on physiological and subjective sexual arousal in nonsmoking men: a randomized, double-blind, placebo-controlled trial. The journal of sexual medicine, 5 (1), 110–121. https://doi.org/10.1111/j.1743-6109.2007.00637.x
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