Does smoking cause erectile dysfunction?

To best understand how smoking affects penile health, it's a good idea to understand what exactly happens during an erection and how important a healthy vascular system is in this process.

1. The brain is sexually stimulated.
2. This then triggers a signal to be emitted in the paraventricular nucleus of the brain that is located in the hippocampus.
3. These signals are then passed through the central nervous system with the help of autonomic nerves until eventually reaching the prostate gland and corpora cavernosa (in the penis).
4. When these signals reach the corpora cavernosa, it relaxes, which allows blood to fill the porous tissues.
5. As this happens, the muscle fibres in the arteries that carry blood to the penis expand to allow blood to flow more freely towards the penis, resulting in an erection.
6. After a man orgasms, the signals from the brain change, which causes an increase of noradrenaline by the nerves in the genitalia. In response, the penis becomes flacid.

In general, penile blood pressure is low in current smokers, which is largely due to atherosclerosis (hardening of the arteries). This condition occurs when the fatty deposits that build up and harden along the walls of the arteries become so thick that they decrease the flow of blood through that artery. The result of this is that not enough blood is able to travel into the penis to create an erection, leading to erectile dysfunction.

Alongside ED, atherosclerosis is also an overwhelming risk factor in deadly health problems like heart disease and stroke. The risk of these conditions is further compounded if you have hypertension or high cholesterol. A smoking cessation plan is essential for the maintenance of good health long term.

Nicotine also has been directly related to the onset of ED in men. When nicotine stimulates particular hormones in the brain, it also causes penile tissues to rapidly contract. When they contract, the blood flow through the arteries is restricted, which means that blood cannot flow into the penis; this is called acute vasospasm.

Nicotine inhaled through smoking has another effect on the penis, which is called venous dilatation. Basically, nicotine has a direct effect on the valve system that regulates the flow of blood out of the penis after an erection. Because the system does not work correctly, what often happens is that blood flows out of the penis faster than it should, which results in only a very short erection.

Both acute vasospasm and venous dilatation are direct results of the effect of nicotine, which means that if you give up smoking cigarettes, it could make a significant difference to your erectile function.

Another sexual health complication of smoking is lowered fertility levels; this affects both sexes. Even younger men and women will find smoking puts them at higher risk of infertility.

Again, it is all the result of the noxious chemicals in cigarette smoke, in particular, nicotine, carbon monoxide, and cyanide. These ingredients affect all stages of reproduction, from conception to a baby’s development.

Starting with conception, semen quality is reduced if you are a regular smoker. Firstly, your sperm count will drop. A study on public health and sexual function, published in 2015, found that men who smoke more than 20 cigarettes daily experience, on average, a 19% decrease in sperm count. Sperm motility, the ability for sperm to travel the right way along the female reproductive tract, is also affected. Men who smoke regularly have a 16.6% worse sperm motility than nonsmokers.

There is evidence to suggest that smoking damages the DNA of a man’s sperm, which is the cause of its reduced motility. Even after reaching a fertilised egg, this DNA remains altered.

Likewise, smoking speeds up a woman's production of eggs. As women have a finite number of eggs, your fertile years are reduced if you smoke. Interestingly, female smokers experience menopause an average of one year before women who do not smoke.

For information on how to quit smoking and treat sexual dysfunction, please contact a healthcare professional - they will refer you to the relevant men’s health specialist. Alternatively, you can use euroClinix's dedicated erectile dysfunction page. There, you will find the advice you need, as well as prescription sexual medicine (e.g. Sildenafil, Viagra, etc.) to improve your sex life.