Updated 24 January 2014

Smoking and erectile dysfunction

Erectile dysfunction (ED) is defined as the recurrent or persistent inability to achieve and/or maintain an erection adequate for satisfactory intercourse.

ED is considered to be a significant public health problem and is estimated to affect more than 150 million men worldwide.(2)

Causes of erectile dysfunction include diabetes, high blood pressure, high cholesterol, obesity, stroke, previous surgery (e.g. prostate surgery), hormone problems, emotional issues and prescription medicines. Too much alcohol, unhealthy diet, low levels of exercise, recreational drug use, and smoking are also implicated in ED.(3)

Smokers are about 1.5-2 times more likely to report erectile dysfunction than non-smokers. In fact, 40% of men with ED are current smokers, versus 28% of men in the general population.(4)

Long-term smoking is an independent risk factor for erectile dysfunction.(4)

Cigarette smoke contains over 40,000 chemicals – some of them commonly found in nail polish remover (acetone), cleansing solutions (ammonia), rat poison (arsenic), car exhaust fumes (carbon monoxide), car batteries (lead) and road surfaces (tar). These chemicals damage the blood vessels, by narrowing the arteries, making it much harder for the blood to flow into the penis. In addition, nicotine itself has a direct negative effect on penile blood vessels. Reduced blood flow to the penis makes getting and keeping an erection more difficult.(3)

Penile erection depends largely on the adequate inflow of blood to the erectile tissue(1) – smoking affects the vascular system and decreases penile arterial blood flow.(4) This decreased penile blood flow may have significant long-term effects on erectile functioning.(4)

Compared with former- and never-smokers, current smokers in their forties have the greatest relative odds of developing ED. Cigarette smoking almost doubles the likelihood of moderate or complete ED.(5)

Former smokers, especially those who smoked more than 29 pack-years are more likely to have ED than non-smokers.(5) (To calculate your pack years, multiply the number of packs of cigarettes smoked per day by the number of years smoked, e.g. 30 pack-years is equal to smoking 20 cigarettes (1 pack) per day for 30 years, or 2 packs of cigarettes per day for 15 years etc).

Cigarette smoking has a strong dose-dependent association with ED (the more you smoke, or the longer you have smoked, the higher the risk of ED). A significant number of patients could benefit from stopping smoking. Smokers should be encouraged to quit smoking when younger, before the disease becomes advanced.(1)

Smokers who stopped smoking for one year had significantly better ED status than current smokers.(1)

1. Pourmand G, Alidaee MR, Rasuli S, Maleki A, Mehrsai A. Do cigarette smokers with erectile dysfunction benefit from stopping?: a prospective study. BJU International 2004;94:1310-1313
2. Harte CB, Meston CM. Association between smoking cessation and sexual health in men. BJU International 2011;109:888-896
3. NHS Foundation Trust. Information for patients: Smoking and Erectile Dysfunction. [Internet]; April 2011 [cited 2013 April 29]. Available from:
4. Harte CB, Meston CM. Acute Effects of Nicotine on Physiological and Subjective Sexual Arousal in Nonsmoking Men: A Randomized, Double-Blind, Placebo-Controlled Trial. J Sex Med 2008;5:110-121
5. Gades NM, Nehra A, Jacobson DJ, McGree ME, Girman CJ, Rhodes T et al. Association between Smoking and Erectile Dysfunction: A Population-based Study. Am J Epidemiol 2005;161:346-351

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