Smoking and Impotence

The most common causes of the organic component in erectile dysfunction or impotence are vascular abnormalities associated with atherosclerosis and diabetes mellitus. Atherosclerosis causes 40% of cases of erectile dysfunction, and in cases of diabetes mellitus the prevalence of erectile dysfunction is 50%. Smoking is significantly associated with the development of both atherosclerosis and diabetes mellitus.

BBC News about smoking and impotence

Cigarette packets should tell smokers to expect impotence rather than heart disease or cancer, says the British Medical Association.

Doctors' leaders believe that warning younger smokers of the link between lighting up and erectile dysfunction would be a far more effective deterrent than any prospect of far more serious disease later in life.

It is thought that smoking is responsible for impotence in 120,000 men in the UK aged between 30 and 49.

Health Minister Tessa Jowell said that she would be pressing for clear labelling at a European health ministers' meeting which will discuss the issue next week.

She said: "It is important to communicate to the public the range of conditions that smoking causes, and most people don't know that smoking can cause impotence."

The message is that smoking can damage your sex life The call has also been backed both by Action on Smoking and Health (ASH) and the Impotence Association.

Ann Craig the managing director of the Impotence Association, told the BBC: "What we want is for girls to look at young men and think: 'He smokes - he's going to be impotent - I'm not interested.'

"This would be especially effective for the under 40s. Certainly if I tell younger men that they could become impotent, and it could happen next year, then they listen, and they stop."

Sex lives The connection between smoking and impotence is well-established, but a MORI poll conducted for ASH revealed that 88% of smokers have no idea of the link.

Dr Bill O'Neill, tobacco adviser to the BMA, said that the prospect of heart disease or cancer in 30 years time was not as powerful as the chance of impotence in 10 years time.

He said: "Young men are notoriously resistant to health warnings and think they will have given up smoking long before cancer or heart disease catches up with them.

"But the prospect that they might wreck their sex lives just might make them stop and think."

No NHS treatment

The same process by which smoking causes heart diseases is responsible for impotence.

The BBC's Health Correspondent Richard Hannaford: "A study found that smokers were twice as likely to become impotent" Atherosclerosis, or hardening of the arteries, can narrow the smaller blood vessels leading to the penis.

In addition, nicotine makes blood vessels into and out of the penis narrow still further. While this effect stops immediately the man quits smoking, the arterial hardening takes some time to reverse.

The figures will shock many male smokers

Although drugs such as Viagra, and other impotence treatments can improve blood flow to the penis, new government regulations mean that men whose impotence has been caused by smoking cannot be treated on the NHS.

A spokesman for smokers' rights group FOREST said: "The one sure way to ruin your sex life is by becoming an anti-smoking bore."

Cigarettes sold in Thailand already carry impotence warnings.

Smoking and Erectile Dysfunction in Men

Terms

Impotence, or penile erectile dysfunction, is the repeated inability to have or maintain an erection. The condition affects roughly 1 in 10 men between the ages of 21 and 75 - that's about two million men in the UK alone. In up to 75% of cases, the cause is physical.

50% Increased Risk in Smokers

Smoking increases the risk of erectile dysfunction by around 50% for men in their 30s and 40s. Diabetes, high cholesterol levels and drugs used to treat high blood pressure are also important risk factors.

120,000 UK Men in their 30s and 40s impotent due to smoking

On the basis of these risks and the prevalence of smoking in the UK, Action on Smoking and Health (ASH) and the British Medical Association (BMA) estimate that up to 120,000 UK men in their 30s and 40s are impotent as a direct consequence of smoking. This figure is likely to be an underestimate, because it does not include impotence due to previous smoking in men who no longer smoke.

Mechanisms

During an erection, large quantities of blood flow, under pressure, into the penile arteries. This causes the veins which drain the penis to become compressed, so preventing the immediate outflow of blood. This process is significantly impaired by smoking.

Less blood flows into the penis if the inflow route is blocked by long term build-up of fatty deposits in the arteries (atherosclerosis) caused, in part, by smoking.

Rapid contractions in penile tissue, a direct an immediate result of nicotine stimulation in the brain, restrict arterial blood flow into the penis. This is known as acute vasospasm.

The valve mechanism that traps blood in the penis is impaired as a result of nicotine in the blood stream. This is known as venous dilation.

Other impacts

The damage caused by smoking to male sexual health also includes:

Reduced volume of ejaculate

Lowered sperm count

Abnormal sperm shape

Impaired sperm motility

Prospects for recovery

Smoking is a major and avoidable hazard for sexual health. Given that two of the three main side effects of smoking on erectile function are acute responses to nicotine, then immediate improvements on stopping smoking are possible.

88% Smokers Unaware of Risks

Polling undertaken by MORI for ASH in March 1999 reveals that only 12% of smokers (13% men, 11% women) name smoking as a cause of male impotence.

What should be done?

Labels on cigarette packs and other tobacco products should contain warnings about the threat to men's sexual health. A new European Union Directive will soon replace the existing Directive (89/622/EEC) which specifies the current warnings. Cigarettes sold in Thailand now carry impotence warnings, and the idea is also under consideration in Hong Kong.

New warnings on packs

The following warnings should be added to approved list of warnings that can be specified in the new Directive:

WARNING: SMOKING CAUSES MALE SEXUAL IMPOTENCE

WARNING: SMOKING DAMAGES SPERM

WARNING: SMOKING MAY DAMAGE YOUR SEX-LIFE

Who suffers?

A major study in the US found that one in every 13 US men between 20 and 39 is impotent. This number increases with age to roughly 1 in 10 men across the whole adult population.2 - that's the equivalent of two million men in the UK alone.

Causes of impotence

Impotence is associated with a range of conditions including high cholesterol levels, drugs used to treat high blood pressure and diabetes, however there is strong evidence to demonstrate that the effects of all physical factors are made worse by smoking.

Blood flow is the main problem...

Circulatory or vascular problems are the most common physical cause of impotence. These affect the normal flow if blood into and out of the penis, resulting in lowered blood pressure in the penile arteries. Smoking inhibits sexual function in three ways:

...inadequate blood in-flow

Over 20% of impotent smokers have evidence of abnormally low penile blood pressure (PBI)5: This decreases inflow of blood to the penis. Low BPI is often caused by atherosclerosis (build up of fatty deposits) in the pudendal and common penile arteries, thought to be the result of arterial lesions caused in part by smoking.6 A study of a group of smokers with an average age of 35 years showed that cigarette smoking was closely associated with atherosclerosis in the internal and main arteries supplying the penis. 7 For every 'pack year' 8 a smoker increases the risk of atherosclerosis of these arteries by 2-3%.9

Further reductions in blood flow can result from acute vasoconstriction or vasospasm within the penile arteries as a direct result of nicotine intake.10

...excessive blood out-flow

Excessive venous outflow from the penis can reduce the time an erection is maintained. One study showed that nicotine in the blood stream encourages the venous chamber to dilate. This impairs the valve or veno-occlusive mechanism by which blood is trapped in the penis. Excessive blood outflow from the penis can also be related to other factors including insufficient relaxation of the penile muscular tissue, which can be caused by anxiety.

Smoking and general vascular disease

Cigarette smoke contains some 4,000 chemicals. Several of these are implicated in damage to the vascular (circulatory) system, including carbon monoxide, nicotine11 and 1,3-butadiene12. The ultimate consequence of this is a toll of 40,300 premature deaths every year in the UK due to heart and circulation diseases.13 Damage to the arteries and veins supplying the penis, is simply a manifestation of systemic arterial damage.

Smoking amplifies other impotence risks

Evidence suggests that cigarette smoking significantly increases other risk factors for impotence. A study of 1,290 men who had received treatment for impotence in Massachusetts, USA14, showed that smokers were over twice as likely to become impotent as non-smokers - 56% compared with 21%. Cigarette smoking was also associated with a significantly greater likelihood of complete impotence in men with high blood pressure (hypertension), heart disease and arthritis. Smoking does not therefore, merely add to other risk factors, but compounds them.15

Impotence as an early warning

There is compelling evidence to suggest impotence indicates more serious underlying vascular problems. Damage to the small blood vessels of the penis manifested as erectile dysfunction may offer an early warning signal that a smoker is risking serious damage to the main arteries in the heart. In this way the penis is acting as a 'canary', signaling a more serious threat to the heart and general circulatory system.

Smoking increases impotence risk by 50%

There are various estimates of the relative risk of impotence among smokers and non-smokers. A study of 4,462 Vietnam War veterans between the ages of 31 and 49 showed an 80% increase in the risk of impotence among smokers compared with men who had never smoked.16 Even when adjusted for several other confounding factors,17 the findings showed a 50% increased risk.

More smokers at impotence clinics

Among 178 patients attending an impotence clinic in the USA, the number of current smokers and ex-smokers (82%) was significantly higher than would be expected among men in the general population (58%).18 In each group, and at all levels of tobacco use, impotent patients smoked more then would have been expected from population estimates. Only 19% of these patients had never smoked compared with 42% in the general population.

The same study showed that the average PBI was lower among patients who had smoked than among those who had not. A significantly higher proportion (20.9%) of impotent patients with a history of smoking had abnormally low BPI compared with patients who had never smoked. The findings also suggested an association between length of smoking habit and abnormally low BPI.

120,000 UK men in their 30s and 40s impotent due to smoking

On the basis of the increased risk faced by smokers, the known rates of smoking among men, and reported levels of impotence in the UK, ASH and the BMA estimate that around 120,000 UK men in their 30s and 40s are needlessly impotent as a result of smoking. Although both smokers and non-smokers can become impotent, these represent additional cases directly attributable to smoking and no other cause. The calculation is outlined in Appendix 1: Calculation of smoking attributable impotence.

Low level of awareness among smokers

A poll commissioned by ASH and undertaken by MORI in March 1999 shows a low level of awareness of the risk of impotence arising from smoking.19 The survey shows that a substantial 88% majority of smokers (87% of men and 89% of women) do not name smoking as a cause of impotence. Even when prompted with a list of possible factors including smoking, over two-thirds (67%) do not identify smoking as a risk (65% of men and 70% of women). ASH and the BMA believe that the low level of awareness among smokers makes a compelling case for new warnings on packets of cigarettes and other tobacco products.

Smoking also affects other areas of men's sexual health

Medical research links smoking with other areas of male sexual health, including reduced volume of ejaculate, lowered sperm count, abnormal sperm shape and impaired sperm motility20,21,22. Smoking is also linked to pyospermia, a condition manifested in swollen testes with excess white blood cells (pus) present in ejaculate.23

Views of specialists

Men's erection problems are not only a problem for them, they are very real problem for women too. Women often reach their sexual peak at a later age than men do, by which time the cumulative effects of smoking can have started to affect their men's ability to get an erection. This can cause deep distress, and is sometimes enough of a problem to cause women to look elsewhere. If men realised how smoking affects their performance, I'm sure many more would find the determination to give up.

Deidre Saunders Sun Newspaper Problem Page

Professor Alan Riley Former-Chairman Impotence Association of Great Britain

Just as cigarettes damage your heart, every cigarette you smoke reduces the volume of blood flow to the penis. In many cases this damage cannot be reversed and the result is impotence. Young men think they are invincible, but as long as they carry on smoking, the damage is getting worse.

We are finding that erectile dysfunctional or impotence may be a precursor or an indicator of oncoming cardiovascular disease, so rather than dismissing it as just simply normal aging and nothing to get alarmed about, we're beginning to take this very, very seriously.

Dr. John McKinlay, New England Research Institute, United States25

What you have to understand is that the penile arteries are tiny arteries -- about a third that of a coronary artery -- so it's not unusual for people to have erection problems preceding any other vascular problem, whether it be heart attacks or strokes.

Dr. John Mulhall, Director, Center for Sexual Health, Loyola University Medical Center, United States