Effects of smoking on male sexuality

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It has already been known for a long time that tobacco is bad for erectile function in the long term, through the atherogenic effect of cigarette smoke which causes plaques which “clog” the arteries as well as at the level of the coronary vascular system. , responsible for the vascularization of the heart, than on the penile arteries, responsible for the vascularization of the penis and the erection mechanism.

But, studies show that cigarettes also have a negative effect on sexuality through other mechanisms, including in the very short term, and that smoking greatly potentiates the risk of suffering from erectile dysfunction when it comes to erectile dysfunction. are associated with other pathologies deleterious for sexual function.

Smoking increases the risk of erectile dysfunction by 50% on average

A meta-analysis carried out in 2016 and looking at the results of 83 human and animal studies on the relationship between smoking and erectile dysfunction shows that there is now substantial evidence that smoking is a risk factor for erectile dysfunction.

Indeed, it is now demonstrated than smoking, on average:

  • increases the risk of erectile dysfunction in smokers by 51%
  • increases the risk of erectile dysfunction in former smokers by 29%.

Even if a former smoker is always more likely than a non-smoker to present sexual problems, he nevertheless decreases by 22% the risk of erectile dysfunction when he stops smoking.

The more we smoke, the more we increase this risk

In addition, these studies show that there is a dose-response relationship. This means both that:

  • the more cigarettes you smoke, the more it will increase your risk of erectile dysfunction
  • the longer one smokes, the more this risk increases

Thus, researchers were able to demonstrate that:

  • for an increase of 10 cigarettes smoked per day, the risk of erectile dysfunction increases by 14%
  • for an increase in the duration of smoking by 10 years, the risk of erectile dysfunction increases by 15%.

As these two factors combine, one can reach an increased risk of presenting erectile dysfunction more than doubled when one smokes a lot and for a long time:

Duration from smoking in years
Quantity 10 years 20 years 30 years 40 years 50 years
10 cig/j 29 % 44 % 59 % 74 % 89 %
20 cig/j 43 % 58 % 73 % 88 % 103 %
30 cig/j 57 % 72 % 87 % 102 % 117 %
40 cig/j 71 % 86 % 101 % 116 % 131 %
Increased risk of erectile dysfunction in smokers compared to non-smokers depending on the duration and amount of smoking

How to read these figures?

A 44% increase in risk means that you are 1.44 times more likely to have a disorder than a non-smoker. A 100% increased risk means that you are statistically twice as likely to develop erectile dysfunction as if you did not smoke.

We will see below that by cumulating smoking with certain health problems, the risk can increase even more significantly (up to 300%!)

A risk that increases exponentially in the event of chronic pathology

A number of pathologies can lead to erectile dysfunction. This is the case with diabetes, high blood pressure, heart failure and of course prostate cancer.

What is less well known, however, is that smoking while suffering from one of these pathologies will exponentially increase the probability of suffering from a sexual dysfunction.

Tobacco chronic erection pathologies

Thereby :

  • The risk of developing erectile dysfunction after pelvic radiation therapy is increased by 300% in smokers compared to non-smokers who undergo the same radiation therapy
  • The risk of presenting an erectile disorder when one is a smoker is increased by 166% in the event of heart failure (compared to non-smokers also suffering from heart failure), by 135% in the event of arterial hypertension (compared to non-smokers who also have hypertension), 112% in the event of untreated arthritis (compared to non-smokers who also have untreated arthritis) !

Smoking causes long-term increased risk of erectile dysfunction

An action on the blood vessels

One of the mechanisms that explains impotence is the endothelial dysfunction of the penile vasculature induced by smoking.

Indeed, the vascular endothelium and the mucous membrane of the lacunar spaces of the blood vessels normally release vasoactive substances which control the relaxation of smooth muscles, necessary for an erection.

Overall, studies have shown that smoking negatively affects vascular endothelial function of the penile arteries by decreasing nitric oxide synthase (NOS) activity, which decreases the production of nitric oxide (NO), necessary for the vasodilation of the penile arteries and therefore for the erection.

Smoking Induced Endothelial Dysfunction
Smoking Induced Endothelial Dysfunction

The exact mechanism suggested by different studies is that smoke exposure increases the adhesion and migration of monocytes through the vascular endothelium, thereby increasing early atherogenesis and decreasing endothelial production of NO.

In addition, long-term smoking has detrimental effects on the elastic fibers of the inner part of the blood vessels (the media), further reducing erectile capacity, since this is dependent on the blood flow into the blood vessels. erectile bodies.

A change in the composition of erectile tissue

The corpora cavernosa are structures present in the penis and which allow erection. They are made up of erectile tissues, which increase in size and stiffen as they fill with blood.

Cavernous body rod cut
Source : Wikimedia

A histopathological study of erectile tissue found that smokers had degenerative changes, associating decreased smooth muscle content, decreased nerve fibers, decreased sinusoid spaces, and increased collagen density.

cigarette erection

Hormonal changes linked to smoking

Smoking can also cause erectile dysfunction by lowering testosterone levels and increasing superoxide free radicals.
Indeed, experiments carried out on rats show that prolonged exposure to cigarette smoke decreases plasma testosterone levels.
However, testosterone, male sex hormone, has a key role in sexual desire and erection.

Effect of smoking on testosterone and on erection
Effect of smoking on testosterone and on erection

Smoking causes a short-term increase in the risk of erectile dysfunction

In the 1988s, researchers tested the erectile capacity of subjects who were asked not to smoke for a week, then subsequently to smoke 2 high-nicotine cigarettes just before a papaverine test ( an ancestor of sex-active drugs that we know today, such as Viagra or Cialis). 100% of subjects had an erection after injecting 100 mg of papaverine directly into the corpora cavernosa when they had not smoked for a week, while only 33% had an erection after smoking both cigarettes. high nicotine content.

This is because nicotine increases sympathetic tone. However, erection is a reflex phenomenon which is controlled by the parasympathetic autonomic nervous system. These two systems being antagonistic, an activation of the sympathetic system will lead to a decrease in the action of the parasympathetic system.
This anti-erectile phenomenon occurs just a few seconds after ingesting cigarette smoke, and will last for about 30 minutes.

sympathetic and parasympathetic system - erection and nicotine

NB: The sympathetic system is the system activated during a stress, which will allow for example to escape or to face a danger by accelerating the cardiac and respiratory rate and by contracting the muscles, but which is also the cause of anxiety attacks when it activates inappropriately. This is also why a man cannot have an erection when he is under stress, since the activation of the sympathetic system will take over the parasympathetic who is supposed to be able to cause an erection.

Smoking cessation and recovery of satisfactory sexual function

Studies have shown that smoking cessation can stop the progression of erectile dysfunction, can lead to a cure of impotence, but only if exposure to tobacco is limited in time, because of the long-lasting vascular effects. irreversible term on erectile and endothelial tissues.


There is growing evidence that tobacco smoke negatively affects sexual health and erectile function. However, smokers’ awareness that smoking is a risk factor for erectile dysfunction is low: in 2012, out of 535 patients interviewed in a urology department, only 24.2% were aware of this association..

It seems important to question patients who smoke about their erectile function, and to advise them to stop smoking if they present a disorder at this level, and even more if they suffer from another associated chronic pathology such as heart failure, high blood pressure, arthritis or prostate disease.

Finally, it may be interesting to remind our patients that smoking within 30 minutes of intercourse is not advised. This leads to activation of the sympathetic system through the sympathomimetic effect of nicotine, and therefore blockage of the erection (which depends on the parasympathetic system).

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Results of the CPD Sexual Health survey


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Effects of smoking on male sexuality

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