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Smoking and ED: What You Need to Know

12 min read
Smoking and ED: What You Need to Know

When it comes to health, smoking has a bad image. The habit has strong links with lung cancer, high blood pressure, and cardiovascular disease - but while these links are well-known, fewer people understand the link between smoking and erectile dysfunction (ED).

Here, we'll take a detailed look at how smoking can contribute significantly to men developing erectile dysfunction. We'll look in detail the damage smoking does, the science that proves the links to ED, and the positive impact that stopping smoking can have on sexual function, even later in life.

Why can smoking cause impotence or ED?

Cigarette smoking can contribute to erectile dysfunction for several reasons - but most of them relate to the impact smoking has on the cardiovascular system and blood flow. Put simply, your penis requires additional blood to become erect - and smoking cigarettes restricts that additional blood entering the penis in a number of ways.

Let's take a more scientific look at each biological mechanism that cigarette smoke can inhibit.

Smoking's effect on your blood vessels

1. Reduced blood flow

The chemicals in cigarettes, including nicotine, can cause the blood vessels to narrow (a process known as vasoconstriction). This narrowing reduces blood flow throughout the body, including to the penis, which is crucial for achieving and maintaining an erection.

2. Damage to blood vessels

Smoking can damage the lining of blood vessels, a condition known as endothelial dysfunction. This makes the arteries stiff and narrow, further limiting blood flow. Healthy blood vessels are essential for the erectile response, as they need to widen to allow more blood flow into the penis during an erection.

3. Impact on nitric oxide production

Nitric oxide is a molecule that plays a key role in initiating and maintaining erections by helping blood vessels in penile muscle relax and widen. Smoking decreases the body's production of nitric oxide - therefore impairing erectile function.

4. Contribution to atherosclerosis

Smoking accelerates atherosclerosis, a condition characterized by plaque buildup inside the arteries, which can lead to narrowed and hardened arteries. When the arteries that supply blood to the penis are affected, it can result in ED.

5. Overall health damage

Smoking is also linked to a range of other significant health issues, including hypertension (high blood pressure), heart disease, chronic obstructive pulmonary disease (COPD), and diabetes, which can all contribute to poor vascular health and are therefore independent risk factors for erectile dysfunction.

What research backs up the connection between smoking and ED?

Today, many states have restrictions on smoking in public places, and general attitudes toward smoking are becoming less and less favorable. According to the most recent figures, just 12% of U.S. adults are regular smokers  - and the same study shows that 76% of U.S. adults consider cigarettes to be "very harmful" to people who use them.

While this public sentiment matters, it's important to make sure any health claims are backed up by real peer-reviewed science.

We've explored some of the sexual health effects faced by cigarette smokers above - but it's useful to understand the science that connects cigarette smoking and ED symptoms too.

Take a closer look at key studies that have been carried out into both biological and psychological factors:

Biological factors

1. Vascular health

In the 2010 study How Tobacco Smoke Causes Disease, smoking is proven to damage vascular health and heart health in a number of ways - most significantly around vascular health.

This reduced blood flow is crucial for achieving and maintaining an erection, creating a direct link between smoking and erectile dysfunction (ED).

Smoking damages the lining of blood vessels, leading to atherosclerosis - narrowing and hardening of the arteries - which impairs blood flow throughout the body, including to the penis. This reduced blood flow is crucial for achieving and maintaining an erection, creating a direct link between smoking and erectile dysfunction (ED).

2. Endothelial dysfunction

In the 2020 study Smoking and Endothelial Dysfunction, researchers reviewed and updated research on smoking and oxidative stress in endothelial cells - showing a clear link between the two.

Smoking contributes to endothelial dysfunction by damaging the inner lining of blood vessels, reducing their ability to produce nitric oxide, a key molecule that helps the soft muscle in the penis relax to allow blood to enter when a person is sexually aroused. Without proper 'relaxation' (medically known as 'dilation') of the blood vessels, blood flow to the penis is restricted, making it difficult to achieve or maintain an erection, leading to erectile dysfunction (ED).

3. Neurological impact

In a 2021 study called Tobacco and Nervous System Development and Function, researchers published new findings gathered between 2015-2020, showing how tobacco smoke contributes to neurodegenerative diseases (i.e. those that effect the body's nervous system).

Damage to the nervous system from smoking is shown disrupt the precise neural pathways and signals necessary for an erection.

When these signals are disrupted, the ability to achieve and maintain an erection is compromised, creating or worsening symptoms of erectile dysfunction (ED) by limiting proper blood flow to the penis.

4. Hormonal changes

Although various studies show the link between smoking and hormone imbalances, the most significant impact on men's hormonal health is shown in studies that focus on testosterone levels in men.

Another study found that smokers actually showed faster age-related decline in testosterone compared to non-smokers.

This is where it's easy to be misled if you take just a quick glance at the science. A 2006 study of more than 3,000 men showed that smoking appeared to be linked to increased testosterone levels. However, a limitation of the study acknowledges that naturally higher testosterone levels in men often relate to riskier behavior - which may likely include smoking. Another study found that smokers actually showed faster age-related decline in testosterone compared to non-smokers.

So, while there's some evidence linking smoking to higher testosterone production, smoking is still shown to impact men's testosterone levels as they age - which is important, because this is a time when other age-related factors are likely to also be contributing to erectile dysfunction.

Why is all this talk of testosterone important? Reduced testosterone can damage a person's sex drive, making it harder to get and keep an erection. When this hormone-inspired reduced libido happens alongside other physical factors, it can have an even more significant impact on ED.

Psychological factors

1. Stress and anxiety

While many people consider smoking to be a stress reliever, a ground-breaking study carried out in 1999 called Does Cigarette Smoking Cause Stress? actually found that the impact on the body was the opposite. By looking at stress levels of smokers vs non-smokers, researchers found that nicotine dependency seems to increase stress, with smoking cessation leading to reduced stress.

Physiologically, stress and anxiety trigger the release of adrenaline, which narrows blood vessels.

Although we've categorized stress and anxiety as a psychological factor relating to smoking and erectile dysfunction, stress and anxiety can affect erectile function through both psychological and physiological pathways. Psychologically, stress and anxiety can distract the mind and reduce the chance of sexual arousal, essential for gaining an erection. Physiologically, stress and anxiety trigger the release of adrenaline, which narrows blood vessels. This reduces blood flow to the penis, crucial for maintaining an erection.

2. Self-esteem and body image

A 2019 study published in Addictive Behaviors Reports shows a link between low self-esteem and smoking status - with smokers tending to have lower self-esteem than non-smokers.

While low self-esteem and a negative body image is likely to contribute a lower sex drive, smoking is thought to make self-esteem issues worse - due to stigma within society about smoking, health issues, and physical changes like bad breath or skin damage. By further decreasing self-confidence in these ways, psychological arousal is also likely to be further damaged, potentially leading to an increased risk of erectile dysfunction issues.

3. Impact on relationships

Perhaps surprisingly, even major tobacco companies acknowledge the psychological risks of smoking. In a whitepaper commissioned by Philip Morris International, 7 out of 10 people described having issues with their other half due to their smoking 

A leading UK pharmacy company explored relationship issues that can result in erectile dysfunction and identified "Stress and anxiety at home e.g. money problems, family conflicts" and "Arguments with your partner" as their two top issues. While smoking is likely to be just one factor that has an impact on a relationship, it's clear that it is an issue for many people - and this kind of tension can have a significant impact a person's ability to successfully achieve and erection.

4. Behavior and attitudes

Clinically, smoking is considered a "high-risk behavior" - defined by medical professionals an "act that increases the risk of disease or injury, which can subsequently lead to disability, death, or social problems." In a 2019 study, researchers discovered that heavy smokers were more likely to engage in other risky behaviors, including heavy alcohol use and unhealthy eating.

While the impact of smoking on ED is significant, it is also likely to result in other issues that stem from similar risky behaviors.

We've explored the medical links between both alcohol and ED and obesity and ED in their own in-depth guides - and the findings are clear, both have significant proven medical links to erectile dysfunction. While the impact of smoking on ED is significant, it is also likely to result in other issues that stem from similar risky behaviors.

Can quitting smoking get back to normal erectile function?

Quitting smoking has a significant positive impact on both the physical and psychological health factors that are linked to erectile dysfunction.

In many cases, healthy erectile function will resume completely - although it's important to note that improvements can vary between people significantly. Factors that are linked to the chance of recovery include how long a person has smoked, the number of cigarettes they have smoked, other risky behaviors they may engage in, and their overall health.

Let's take a closer look at how cigarette smokers with erectile dysfunction benefit from stopping - including how a person's smoking history may play a part:

Biological Factors

Vascular health

Quitting smoking often leads to significant improvements in vascular health. The process of reversing the damage to blood vessels begins soon after quitting, enhancing blood flow not just to the heart and other vital organs but also to the penis - leading to better erectile function. While atherosclerosis caused by long-term smoking may not fully reverse, the progression can be halted and partially improved, leading to noticeable benefits in erectile function.

Endothelial dysfunction following smoking cessation

After quitting smoking, the endothelium can start to heal, and its ability to produce nitric oxide is likely to improve, allowing for better vasodilation and blood flow to the penis and a restoring of the biological mechanism required for an erection. Complete reversal will depend on the extent of previous damage and a person's overall health - but significant improvements are often observed.

Neurological factors

The nervous system's recovery after quitting smoking can vary. If smoking has led to nerve damage, some of the effects may slowly reverse. However, stopping smoking can stop further damage and may allow for partial recovery of nerve function over time, leading to improved erectile function. The best way to prevent long-term neurological damage is stopping as soon as possible.

Hormonal changes that follow quitting

Quitting smoking can lead to the normalization of many hormonal imbalances, including testosterone levels. This can have a positive effect on libido and sexual function. While age and other factors also affect testosterone levels, quitting smoking removes a significant negative influence on hormonal health.

      Psychological Factors

      Quitting decreases stress and anxiety

      As discussed earlier, smoking does not reduce stress and anxiety, and therefore many individuals experience a reduction in stress and anxiety levels after quitting smoking Since stress is one of the most common psychological causes of ED, improving the body and brain's ability to handle stress and anxiety can enhance sexual performance and satisfaction.

      Self-esteem and body image when you quit

      Quitting smoking often leads to improvements in self-esteem and body image, thanks to better physical health and the accomplishment of overcoming an addiction. These positive psychological changes can reduce performance anxiety in the bedroom and improve sexual function.

      Quitting smoking and relationships

      Since smoking can be a significant source of relationship tension, stopping is likely to ease this tension. A partner who doesn't approve of smoking or the side effects is likely to be encouraged by the fact you're making an effort to stop too - potentially increasing intimacy and creating conditions that are more likely to lead to sex.

      Quitting and the effect on other risky behaviors

      In many cases, risky behaviors act as psychological triggers for other risky behaviors - so removing one can be a very positive step in reducing or stopping others. This can be further enhanced with some simple CBT methods that can reinforce new patterns of behavior.

          Managing expectations around ED after you quit smoking

          As you can see, many ED symptoms that relate to smoking may be quickly and effectively reversed by stopping smoking. However, it's important to acknowledge that it may not be possible to reverse all damage caused by smoking - and that smoking might not be the only lifestyle factor you need to change.

          Some effects may be irreversible - especially extensive vascular damage or forms of nerve damage caused by long term smoking. For these medical conditions, early cessation of smoking is the only known preventative factor.

          If you're a smoker and you're experiencing ED, it can also be tempting to consider smoking as the only problem that stands in the way of full erectile health - but this isn't always the case. Other health conditions (e.g., obesity, diabetes, hypertension), age, and lifestyle choices (e.g., diet, alcohol, physical activity) can also have a significant effect on your ability to get and maintain an erection. As such, it's a good idea to consider quitting smoking as part of a larger striving towards better health - one that your doctor will almost certainly be able to support you with.

          Tips to quit smoking

          Whether you're experiencing erectile dysfunction symptoms and suspect they relate to smoking - or you simply want to ensure a healthier future - it's tempting to simply say "I quit!", throw away any remaining cigarettes, then try to stick to your plan. In reality, though, a smoking addiction usually requires a more psychological approach to quitting.

          It's important that you don't beat yourself up for not being able to immediately stop smoking. Instead, you should recognize the power of the addiction and use a series of helpful tips that to support your decision.

          Look at what triggers your smoking habit Identify specific situations, emotions, or activities that increase your urge to smoke, like stress, coffee, or social settings.

          Recognizing your triggers allows you to avoid them or find healthier coping mechanisms, reducing unplanned smoking instances.

          Understand your smoking patterns Keep a diary  to track when and why you smoke, noting the time of day, your activities, and how you feel.  Understanding patterns helps you anticipate cravings and break the cycle with alternative actions, weakening the habit's hold over you.
          Set a quit smoking date  Choose a specific, near-future date to stop smoking entirely, allowing yourself time to prepare mentally and physically A set date creates a concrete goal and deadline, building commitment and a sense of urgency to take the necessary steps to quit.
          Tell people you’re quitting Inform friends, family, and colleagues about your decision to quit smoking, asking for their support and understanding. Sharing your goal creates a support network and adds accountability, making you less likely to give in to temptation.
          Interrupt the cravings  When a craving hits, immediately engage in a distracting activity like walking, deep breathing, or drinking water.  helps to pass the craving without smoking, gradually reducing the frequency and intensity of cravings.
          Use stop smoking aids Consider nicotine replacement therapy (NRT), prescription medications, or nicotine gum to manage withdrawal symptoms and cravings. These aids help reduce nicotine withdrawal symptoms and cravings, making it easier to focus on breaking the psychological habit of smoking.
          Devise a plan to quit smoking Create a detailed strategy for quitting, including setting a quit date, identifying triggers, choosing cessation aids, and planning for challenges. A personalized plan addresses your unique smoking habits and challenges, providing a roadmap and increasing your chances of success.
          Reward yourself Set up rewards for milestones in your quit journey, like a special treat or purchase with the money saved from not buying cigarettes. Rewards reinforce positive behavior and offer tangible incentives for reaching milestones, boosting motivation and satisfaction.
          Understand that relapse is part of the process Accept that most smokers try several times before quitting for good and view any relapse as a learning opportunity. Understanding relapse as a step towards quitting permanently reduces feelings of failure and prepares you to tackle triggers more effectively next time.

          Smoking and Erectile Dysfunction: Summary

          Smoking has a number of serious implications for a person's health. The healthy erectile function relies on a healthy blood flow to the penis - so since so many of the conditions that can be brought on by smoking can damage the vascular system, it's easy to see why there are also many links between smoking cigarettes and developing erectile dysfunction. It's not just physical symptoms that result from smoking that have an impact on ED though.

          Smoking contributes to a series of psychological conditions and social situations too.

          These psychological and social factors will often compound physical ED factors - making the problem even more serious. The good news is, that many of the issues connected smoking to erectile dysfunction can be reduced or reversed by quitting. Quitting isn't easy - it often requires a series of strategies that help you understand your tobacco use and help you overcome cravings. It's important to understand that quitting often takes a number of attempts too - so it's important not to give up on giving up.

          When you do quit, you can expect to see a number of quick improvements in your health.

          However, smoking isn't the only factor that contributes to erectile dysfunction - so, when the time is right, it's a good idea to carry on your positive changes to extend into other lifestyle factors that can result in ED, especially looking at the food you eat and your levels of alcohol consumption.

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