Relationship Between Smoking and Erectile Dysfunction

R. Shiri; M. Hakama; J. Häkkinen; T.L.J. Tammela; A. Auvinen; J. Koskimäki


Int J Impot Res. 2005;17(2):164-169. 

In This Article

Abstract and Introduction

We estimated the effects of smoking on the risk and prognosis of erectile dysfunction (ED), and of ED on smoking behavior. The follow-up sample consisted of the 1442 men aged 50-75 y, who responded to both baseline and follow-up questionnaires. We estimated the effect of smoking on the incidence of ED among the 1130 men free from ED, ED on risk to start smoking in the 502 nonsmokers, smoking on the prognosis of ED among the 312 with ED and ED on quitting smoking among the 292 current smokers at baseline. Risk of ED increased nonsignificantly with smoking (odds ratio (OR)=1.4), while ED recovery reduced (OR=0.6). Therefore, there was the ratio of 2.3 (1.4/0.6) describing the total effect of smoking on the risk of ED. Both quitting (OR=1.7) and starting (OR=1.9) smoking were rare and nonsignificantly higher in men with ED. Most of the OR estimates on smoking-ED relationships were not statistically significant, probably due to small numbers. There are two bidirectional relations between ED and smoking. Those who smoked had a higher risk of ED than nonsmokers. The men with ED were more likely to start smoking than those free from ED. The estimates of effects were not statistically significant, but they were consistent with each other and with the hypothesis that smoking causes ED and ED causes smoking. The recovery from ED was less in smokers than among nonsmokers, and current smokers with ED were more likely to stop smoking than men free from ED. Numbers were few and estimates of effects were not significant, but consistent with the hypothesis of smoking preventing recovery from ED and ED improving the success of smoking cessation. Such transitions in four directions explain indirectly the known positive association between the prevalence of smoking and the prevalence of ED.

Erectile dysfunction (ED) is a common public health problem affecting millions of men worldwide.[1,2] It has a strong negative effect on interpersonal relationship, well-being and quality of life.[3,4,5,6,7,8,9,10]

Epidemiological findings would be obviously valuable for better understanding of ED and subsequently for developing appropriate service delivery and resource allocation modalities, as well as for developing prevention strategies when modifiable risk factors are established. Despite the recent interest on ED, there is still substantial gap in our knowledge of the etiology of ED.[11,12]

The use of tobacco is a major public health problem worldwide, and its effect on sexual life is an often-used fact in anti-smoking campaigns. Association between smoking and ED has been assessed mainly in prevalence studies, which have considerable weaknesses for elucidating the etiology of ED.[12,13,14,15,16,17,18,19,20,21,22,23] Only two longitudinal studies have evaluated the effect of smoking on erectile function. One has clearly shown that smoking does not have an effect on the incidence of ED,[12] and the other has also found no effect in whole sample,[11] while doubling of risk in a subgroup of men free from vascular diseases.[14]

Little is known about the frequency of spontaneous recovery, and no study has been published on the effect of smoking on the recovery from ED and the effect of ED on starting or stopping smoking. To better understand the mechanisms of causality between smoking and ED, we estimated the effects of smoking on the risk and prognosis of ED, and also the effect of ED on smoking behavior by means of a population-based follow-up study.