How Cigarette Smoking Can Contribute to Erectile Dysfunction

Smoking cigarettes has long been considered an important independent risk factor for erectile dysfunction (ED). Nevertheless, approximately one-third of men worldwide are active smokers, and many are unaware that smoking can contribute to ED.

The following is a short explanation of the multiple ways in which smoking may contribute to ED.

• Smoking damages the body’s blood vessels. It is well-established that smoking damages the blood vessels and other tissues throughout the body. Healthy blood flow to the penis is important for getting and maintaining an erection, so the process can be hampered when the blood vessels are compromised.
• It decreases the availability of nitric oxide (NO). NO is a compound in the body that is important for erections because it helps widens blood vessels and relax smooth muscle. Since smoking decreases NO production, it can impair erectile functioning as a result.
• Tobacco and nicotine increase inflammatory markers. Smoking can contribute to chronic low-grade inflammation in the body and can cause overactivation of the immune system. These things can in turn lead to an increased risk of ED.
• Smoking increases activation of the sympathetic nervous system. Everyone has both a sympathetic and a parasympathetic nervous system. The sympathetic nervous system activates the body’s “fight or flight” response during stressful times or dangerous situations. On the other hand, the parasympathetic nervous system relaxes the body and supports automatic processes such as heart rate, blood pressure, digestion, urination, and reproductive processes such as erections in men. Therefore, increased sympathetic activity due to smoking may make getting an erection more difficult. Fortunately, the balance between the sympathetic and parasympathetic nervous systems is restored once a person quits smoking.

Numerous studies have shown that men who smoke are at higher risk for ED. What’s more, erectile difficulties are often worse for men who are heavy smokers and those who have smoked for a long time. However, quitting smoking can have a positive effect on a person’s erectile function while improving a person’s overall health.

If you are a smoker and would like to quit smoking, talk to your health care provider about tools and resources that may be able to help such as nicotine replacement products, online smoking cessation forums, and/or a referral to an active smoking cessation group. Keep in mind that your erectile function will likely improve when you quit smoking, but you can also talk to your provider about treatments for ED at this time.

For more information on this topic, please read this publication from The Journal of Sexual Medicine:

Association of Quantity and Duration of Smoking with Erectile Dysfunction: A Dose–Response Meta-Analysis

References:

Allen, M.S., & Tostes, R.C. (2023). Cigarette smoking and erectile dysfunction: an updated review with a focus on pathophysiology, e-cigarettes, and smoking cessation. Sexual Medicine Reviews, 11(1), 61-73. https://doi.org/10.1093/sxmrev/qeac007