The harm from smoking to the jewels in the pants

Dear Dr. G,

In the spirit of the New Year, I am determined to become a better version of myself by joining the bandwagon and coming up with some New Year resolutions.

I am not usually one for resolutions, but recent failures in the bedroom have made me reconsider.

I started smoking at 16 years old and have not been adversely affected by cigarettes over the years.

That said, I understand smoking can cause problems and I guess I am lucky not to have faced any issues until now.

I am in my late thirties and have been experiencing erectile difficulties for the past six months.

As this sexual dysfunction persisted, I decided to visit the doctor.

The urologist told me my sexual dysfunction is associated with smoking.

Apparently, nicotine and toxins are destroying my penile tissues.

I am convinced that cigarette smoking can cause cancers and respiratory difficulties, but I am perplexed about how smoking is linked to ED.

I am putting Dr. G on the spot to find out how smoking can harm a man's sex life.

Can you explain what exactly constitutes ED (erectile dysfunction)?

What are the components in cigarettes responsible for ED?

How does smoking cigarettes result in ED?

Finally, can you also tell me whether smoking can affect my fertility?

Looking forward to finding out if the link between smoking and ED is all smoke and mirrors.

Regards, Smoky Steven

The human erection requires adequate relaxation of cavernous smooth muscles and dilation of penile arterioles, allowing inflow and subsequent trapping of blood within the erectile tissue.

This process depends on the nervous system inducing smooth muscle relaxation via nitric oxide actions.

Vascular relaxation allows arterial blood to fill the corpora which, by distension, creates a venous seal to maintain erection.

The physiology of erection is sensitive to vascular changes, and many known cardiovascular risk factors, such as hypertension and diabetes, have been associated with the development of erectile dysfunction.

Cigarette smoking can lead to cardiovascular dysfunction and is now established as an independent risk factor for developing erectile dysfunction, a more ominous form of vascular disease.

The most well understood physiology and signal transduction mechanisms underlying ED involve the NO pathways.

Both NO pathways, the endothelial and neuronal variants, are affected by cigarette smoke.

These mechanisms are known to constrict the blood supply to the penis and induce hardening of the vessels over a prolonged smoking duration.

Research from Baylor University concluded that smokers have a higher risk of developing ED, independent of age and comorbidities.

One study reviewed reported that males who smoked more than 20 cigarettes per day had double the risk of severe ED compared to those who smoked fewer cigarettes.

Other studies found that the duration of smoking significantly increases the risk of ED.

Cigarettes also induce deformity and immotile gametes, which have a big impact on fertility.

A European Urology meta-analysis of 20 studies involving over 5,000 participants confirmed smoking was associated with decreased sperm counts, motility, and morphology.

The study revealed smokers have lower zinc levels in semen, resulting in deformity.

Heavy smoking (more than 20 cigarettes per day) is noted to reduce sperm concentration and motility by 23% and 13%.

The good news is sperm quality does improve, even with short-term cessation of smoking and drinking.

Studies have also suggested a link between smoking and lowered sex drive (libido) in men.

According to a 2022 study involving 6,754 men aged 50-75, current smokers had a higher risk of low sex drive compared to non-smokers.

Some of these effects may be related to mental health.

Nicotine addiction can intensify symptoms of anxiety and depression and induce stress, which can impact sex drive for both men and women.

Strong public health campaigns and strict regulation in many countries worldwide have seen rates of tobacco smoking almost halve over the last three decades.

The big question is whether quitting smoking can reverse some of the processes that contribute to ED.

Interestingly, a short smoking abstinence period of 24-36 hours in heavy smokers can allow for significant improvements in tumescence.

It appears, however, that age modifies the chances of regaining erectile function, as improvements were confined to patients less than 50 years old.

The current literature has yet to reach a consensus on the magnitude of the benefits of smoking cessation specifically about ED.

Furthermore, the severity of a patient's ED and the duration of smoking also predict one's response to quitting.

Erectile dysfunction affects around 20% of all men, with up to 52% of males aged 40-70 years classified as suffering from varying degrees of ED.

In the general population, over half of men over the age of 40 will have some degree of ED.

There is overwhelming evidence in the literature to support the claim that smoking worsens erectile function through vascular mechanisms, primarily the depletion of nitric oxide.

It is yet unclear whether, at a population level, quitting smoking will improve ED rates.

With that said, Dr G’s answer to those wondering about the harm smoking is doing to their sex life and contemplating quitting is that it is never too late - until all is up in smokes in the pants, making it impossible to be what you might have been.