Smoke and mirrors of e-cigarettes

Dear Dr G,

I understand you are featuring ways to kick bad habits as a New Year's resolution for the benefit of better sexual health in men.

I hope to put Dr G on the spot for help to kick my bad habit of cigarette smoking.

I started smoking when I was 16 years old.

Although I have been cutting down on the number of cigarettes I smoked every year, it has still been ten years since I started.

I am sure all those cigarettes are not doing my overall and sexual health any good.

I am convinced cigarette smoking can result in ED (erectile dysfunction), cancers and heart diseases in long run.

Therefore, I am determined to kick the habit this year and switch to vape as a better alternative.

I have read somewhere that although e-cigarettes itself are not exactly healthy, however comparatively it is the lesser of the two evils.

My only concern is e-cigarettes may cause harm to my health too.

Therefore, I am keen to put Dr G on the spot for some clarification.

Can you tell me what exactly is an e-cigarette and what’s the difference with vaping?

Is it true that e-cigarettes have less toxins and cause less harm?

Do you think it is sensible to use e-cigarettes to stop smoking?

Is there scientific evidence linking e-cigarettes with sexual dysfunction in men?

I have a feeling you are going to tell me my e-cigarette theory is all smoke and mirrors, however I still look forward to your opinions.

Yours truly,

Vaping Vincent

Strong public health campaigns and strict regulation in many countries worldwide have seen rates of tobacco smoking almost halve over the last three decades. However, the number of people vaping or using e-cigarettes every day has grown from 6% in 2016 to 9% in 2019 especially amongst the youth.

This is a trend that’s sounding alarm bells for many health experts globally.

Electronic nicotine delivery systems (ENDS) or otherwise known as e-cigs and vapes are battery-powered devices that heat up liquid creating vapors for inhalation.

When e-cigarettes first became available in many countries, the vaping liquids contained nicotine and a range of chemicals to add flavour.

Although countries like Australia have imposed all nicotine vaping products can only be purchased with a doctor’s prescription, nicotine-free devices and e-liquids can still be legally bought in most parts of the world.

Vaping is often marketed as a better alternative to smoking cigarettes. When e-cigarettes are used by smokers instead of conventional cigarettes, there is evidence in slight improvement in individual short term health.

However, many people who use e-cigarettes also smoke cigarettes, and diseases caused by smoking are unlikely to be reduced by e-cigarettes if the cigarette smoking continues.

In addition, many diseases take a long time to develop, therefore It’s important to remember that just because there is currently no proof that vaping causes disease, this is not proof that it is safe.

Laboratory studies suggest that regular vaping is likely to have bad effects on your health, especially lung function.

Quitting smoking can be difficult, so the best option is not to vape or smoke at all. Many people use e-cigs to try and stop smoking, to reduce the number of cigarettes smoked or to avoid restarting a smoking habit as a gentle cessation strategy.

Although evidence suggest ex-smokers who use nicotine e-cigarettes are more likely to not smoke than those who use other nicotine replacement options such as patches, gum, lozenges, mouth sprays, inhalators and intranasal sprays. However, most studies showing this effect have a moderate or high level of bias and more research is needed.

As the e-cigarette is addictive, this may have an impact on the relationship and intimacy with partners who do not smoke or vape. There is also plenty of evidence to suggest nicotine impairs normal erectile function and negatively affects male sexual performance.

Erectile dysfunction is twice as common among men who vape every day, compared to those who have never vaped. This is likely due to nicotine being a vasoconstrictor and resulting in poor circulations to the penis.

In addition to impairment of sexual health, e-cigarettes are also noted to have adverse impact on the reproductive health in men.

One Italian study revealed that men who vape for more than two years are shown to have smaller testicles are compared to men who do not use E-cigarette.

Other studies also demonstrated the electronic nicotine delivery systems can also result in male infertility as the sperm quality is noted to deteriorate are vaping continues.

The use of ENDS seems to be associated with erectile dysfunction independent of age, cardiovascular disease, and other risk factors.

The causative adversity on reproductive health in men is also clear. While ENDS remain under evaluation for harm reduction and smoking-cessation potential, ENDS users should be informed about the possible association between ENDS use and erectile dysfunction and male infertility.

Men contemplating a new year resolution of smoking cessation by vaping and considering this to be lesser of the two evils often put Dr G on the spot for his opinion.

His opinion is: “The smoke and mirrors of ENDS is evident, complete cessation should be the be all and ENDS all approach!”

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Smoking , Vaping , E-cigarettes

Dr George Lee

Dr George Lee

Dr George Lee is a consultant Urologist and Clinical Associate Professor whose professional interest is in men’s health. This column is a forum to help men debunk the myths and taboos on men’s issues that may be too “hard” to mention. You can send him questions at


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