Can Smoking Cigarettes Cause Impotence?

Impotence or erectile dysfunction is the inability to reach an erection or maintain its hardness.

It is a concerning problem in males because sometimes their erections are not enough for satisfactory sex.

A large number of men in the United States have sexual impotence. The number is around 18%, and some are very young when they experience their first symptoms.

There are many possible causes of erectile dysfunction. One of the theories points out at a hormonal imbalance, vascular insufficiency, or neurologic problems. But other authors point out that psychogenic factors are the most common cause.

In reality, there’s an interplay of factors, and vasculopathy plays a significant role. Vasculopathy is a general term used to describe any disease affecting blood vessels.

Many studies have suggested that cigarette smoking increases the risk of vasculopathy.

Additional factors, such as high serum lipids, hypertension, sedentarism, and obesity, also contribute to the problem. These men may end up with recurring episodes of erectile dysfunction in different degrees of severity.

According to surveys, patient awareness about smoking and ED is very low. Only 24% of patients understand that cigarette smoke is a cause of erectile dysfunction. That’s why we considered it very important to cover this topic, exploring the link or ED and smoking (1).

The link between smoking and ED

As mentioned above, early studies about smoking pointed out vascular changes in the penile tissue. These changes contribute to erectile dysfunction. But that’s only one risk factor. A complete overview of ED and smoking requires evaluating not one but five mechanisms:

  • Endothelial dysfunction: The endothelium is the inner lining of the blood vessels. It is useful to keep the blood inside the arteries and veins but does much more than that. The endothelium synthesizes vasoactive substances that control circulation. They relax or contract the smooth muscle of the penis and the rest of the body. By relaxing the muscle of the penis with nitric oxide, the endothelium facilitates erection.

    What smoking does is harming the normal function of the endothelium. The usual synthesis of nitric oxide is compromised, and there’s a reduction of this substance. Thus, there’s not enough vasodilation, and the penis does not fill with blood. According to studies, smoking also damages the elastic fibers of the endothelium in the penis. Moreover, they mention that smoking increases the migration of white blood cells. This is an inflammatory response that contributes to fat plaques in the blood vessels (2).

  • Changes in penile blood flow: Penile erection depends on blood vessels and healthy circulation. There should be a correct inflow of arterial blood combined with proper drainage of the venous return. According to Doppler studies that evaluate blood flow, ED patients usually have lower penile blood flow.

    One useful tool to assess this is the penile-brachial index. This is only a comparison of the blood pressure in the penile and brachial artery. A lower penile-brachial index is associated with ED. According to studies, smokers have a significant reduction in the penile-brachial index. This finding has been confirmed in small and large studies, with atherosclerosis as a likely cause (3).

    The four most important arteries in the penis have atherosclerosis in 67% of patients with ED. An impressive 82% of them are smokers (4). Inflammation triggered by smoking accelerates atherosclerosis and causes this problem. It is also essential to keep in mind that this is not an isolated event in the penis. The rest of the body suffers similar effects after smoking.

  • Functional changes in the autonomic nervous system: Another critical component of erection is the nervous system. The parasympathetic nervous system is activated, and then erection occurs. According to many authors, there’s a constriction of blood vessels mediated by the nervous system. Instead of activating the parasympathetic nervous system, nicotine activates its counter effects. The sympathetic nervous system does the opposite. It uses epinephrine, a neurotransmitter that’s been tagged as the erection killer. It causes vasoconstriction and contributes to erection problems (5).

  • Chemical and histologic changes: If we take the erectile tissue into the microscope, there are changes, too. The histologic makeup of the penis changes in smokers compared to non-smokers. The proportion of smooth muscle decreases, and collagen density increases. There are serious degenerative changes with a lower number of nerve fibers and capillaries (6).

    The effects of smoking are also found in our hormones, especially in testosterone levels. Smoking reduces our testosterone and increases our free radicals. Testosterone is essential for our sexual drive and contributes to erections. Free radicals cause damage to the smooth muscle of the corpora cavernosa. They are necessary for erections, and any structural problem is a likely cause of ED (7).

  • Interaction with additional risk factors: As noted above, ED is often an interplay of risk factors. Most patients with ED will not come to the urologist’s office with only one risk factor. They may be smokers with advanced age and anxiety problems. Or maybe smokers using hypertension medications with ED as a side effect. Other risk factors include diabetes and heart disease (coronary artery disease). All of them contribute to smoking and cause erectile problems.

What does the research say?

This relationship has been studied in cohort studies, cross-sectional studies, and isolated cases. Most of them report similar results, pointing out smoking as a significant risk factor.

For example, we can highlight a study called the Vietnam Experience Study. It evaluated data from 4,462 Army Vietnam veterans through a series of surveys. People who never smoked had a 2.2% prevalence of ED. Current smokers had almost twice the risk (3.7%). The correlation stayed relevant when confounders were taken away (8).

Other studies made in Spain, Italy, Finland, and other countries have confirmed this association. Some studies would also suggest that smokers have more difficulties recovering from ED than non-smokers with the same problem.

Another important question is whether there is a dose-response relation. In other words, is a heavy smoker more at risk than occasional smokers? As a response, most studies show that the erectile function is even worse in heavy smokers.

For example, in an Italian research, the duration of smoking increased the risk of ED. The odds ratio for erectile dysfunction in people who smoked for less than 20 years was 1.2. Comparatively, the odds ratio in people who smoked for longer than 20 years was 1.6 (9).

But if that’s the case, is passive smoking, another risk factor for erectile dysfunction? According to studies of secondhand smoke, the penile-brachial index in these individuals was equally decreased compared to active smokers (10). Thus, it appears that both active and passive smoking are associated with ED.

More information might be required to evaluate the effects of passive smoking, though. The studies have had a proper methodology, but they need to be replicated to reach more significance.

How to naturally reverse ED

Smoking cessation should be the first modification in patients with erectile dysfunction who smoke. Many studies agree that quitting smoking can help patients recover their erectile function faster.

One of them evaluated nocturnal penile tumescence (NPT), a reliable measure of erectile physiology. They showed that 6 weeks after quitting tobacco products, 35% of patients recovered their normal NPT. This means that their physiology was at least partially recovered (11).

Other case reports show similar results. These investigators have found that erectile function recovers faster if you stop smoking. Even a 24-hour smoke-free period has partial effects on erectile parameters. It improves patients’ NPT and has acute effects on how blood circulation works.

However, in some cases, a very long smoking life can lead to long-term vascular effects. In these cases, smoke cessation may not be enough to counter the effects of long-life smoking.

But what else can you do to recover your erectile function naturally?

  • Vacuum erection devices: You could simply use a vacuum erection device. These are cylindrical gadgets that house and pump the penis with negative pressure. What they do is drawing blood into the penis, triggering an erection. After blood is redirected to the penis, you can use a constriction band. They are placed at the base of the penis to prevent the blood from returning to the general circulation. This is a useful alternative for mild and moderate cases of ED. However, some patients report bruising and other uncomfortable effects.

  • Herbs and natural remedies: One of the most widely recommended herbs for erectile difficulties is Panax ginseng. It does have studies that validate its function. However, keep in mind that this is a long-term solution, not like Viagra. Another useful alternative you can try is L-citrulline. This substance is vital to stimulate nitric oxide production. It helps with muscle relaxation in the pelvic region, reducing ED episodes in some patients. We can obtain L-citrulline naturally in salmon, watermelon, and chickpeas. Another option is using L-citrulline supplements.

  • Acupuncture: Some patients report significant improvements after using this alternative. This is a natural alternative that only requires sticking needles into the skin for a limited time. Acupuncture technicians have their own explanations in terms of body energy. But even scientific studies have shown that there’s an improvement in some patients.

  • Lifestyle modifications: Not smoking is fundamental, but it is one of many lifestyle modifications you may adopt. It is important to evaluate the medications you’re using and other ED risk factors you may have. Talk to your doctor to know if you can change your prescription to improve your erectile function. Another recommendation is to avoid physical inactivity. Exercise can be beneficial to accelerate your recovery from erectile dysfunction. You might also find improvements with a healthy diet, one with low levels of saturated fats.

  • Psychotherapy: In many cases, erectile dysfunction has a strong psychological basis. That’s why psychotherapy is fundamental to complete the treatment in many cases. In some patients, psychotherapy only is the best alternative to improve their condition. There are many techniques and options to consider. For example, cognitive behavior therapy may work to find out what is causing erectile problems. Mindfulness-based interventions are also beneficial to calm down and reduce anxiety. In some cases, psychosexual counseling and couple therapy are both helpful to recover your sexual function.

In any case, it is imperative to talk to your doctor if you have continuous episodes of erectile dysfunction. It doesn’t matter how old you are.

Talk to your doctor if you’re starting to feel concerned about your sexual health. In some cases, using Viagra irresponsibly causes erectile problems. And even if it is not a problem for you, when sexual dysfunction is starting to affect your relationship, it is time to do something about it.


Cigarette smokers have an increased risk of erectile dysfunction. Nicotine addiction does not only increase your risk of cardiovascular disease. It causes vascular disease, oxidative stress, nervous system changes, and hormonal changes resulting in erectile dysfunction. Thus, male smokers should consider quitting their smoking habit if they want to recover from ED faster.

Smoking cessation is probably the most essential lifestyle modification in these patients. However, remember that psychological factors play a significant role, too. It is also important to evaluate your medications and other aspects of your lifestyle. If you have doubts or concerns about your sexual health, do not hesitate to talk to your doctor.

Talking about erectile dysfunction is never easy, but you will feel better after you do. Even more when you work out the problem and start considering new solutions along with your doctor.


  1. Bjurlin, M. A., Cohn, M. R., Freeman, V. L., Lombardo, L. M., Hurley, S. D., & Hollowell, C. M. (2012). Ethnicity and smoking status are associated with awareness of smoking related genitourinary diseases. The Journal of urology, 188(3), 724-728.
  2. Tostes, R. C., Carneiro, F. S., Lee, A. J., Giachini, F. R., Leite, R., Osawa, Y., & Webb, R. C. (2008). Cigarette smoking and erectile dysfunction: focus on NO bioavailability and ROS generation. The journal of sexual medicine, 5(6), 1284-1295.
  3. Hirshkowitz, M., Arcasoy, M. O., Karacan, I., Williams, R. L., & Howell, J. W. (1992). Nocturnal penile tumescence in cigarette smokers with erectile dysfunction. Urology, 39(2), 101-107.
  4. Virag, R., Bouilly, P., & Frydman, D. (1985). Is impotence an arterial disorder?: A study of arterial risk factors in 440 impotent men. The Lancet, 325(8422), 181-184.
  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.
  6. Mersdorf, A., Goldsmith, P. C., Diederichs, W., Padula, C. A., Lue, T. F., Fishman, I. J., & Tanagho, E. A. (1991). Ultrastructural changes in impotent penile tissue: a comparison of 65 patients. The Journal of urology, 145(4), 749-758.
  7. Saigal, C. S., Wessells, H., Pace, J., Schonlau, M., & Wilt, T. J. (2006). Predictors and prevalence of erectile dysfunction in a racially diverse population. Archives of internal medicine, 166(2), 207-21
  8. Mannino, D. M., Klevens, R. M., & Flanders, W. D. (1994). Cigarette smoking: an independent risk factor for impotence?. American journal of epidemiology, 140(11), 1003-1008.
  9. Parazzini, F., Fabris, F. M., Bortolotti, A., Calabrò, A., Chatenoud, L., Colli, E., … & Mirone, V. (2000). Frequency and determinants of erectile dysfunction in Italy. European urology, 37(1), 43-49.
  10. Celermajer, D. S., Adams, M. R., Clarkson, P., Robinson, J., McCredie, R., Donald, A., & Deanfield, J. E. (1996). Passive smoking and impaired endothelium-dependent arterial dilatation in healthy young adults. New England Journal of Medicine, 334(3), 150-155.
  11. Elist, J., Jarman, W. D., & Edson, M. (1984). Evaluating medical treatment of impotence. Urology, 23(4), 374-375.


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