FirstMed Consulting Blog

The importance of smoking has recently been highlighted with regards to male impotence. The low level of awareness that impotence can be caused by smoking was iterated in a survey undertaken in 1999 by MORI whereby 88% of smokers do not list smoking as a risk factor for impotence and even when given smoking in a list of options of possible risk factors, two thirds do not identify it as a risk. It has been estimated that in the UK approximately 120,000 men between 30 and 50 are impotent as a result of smoking. Not only linked to erectile dysfunction, smoking can also lead to a reduction in the volume of ejaculate, a reduced number of sperm, abnormally shaped sperm and a reduction in the response to any fertility treatments undergone.

Cigarette smoke contains more than 4000 chemicals and many of these have been implicated as a cause of disease to the vascular (blood) system. With regards to the penis this directly impacts on the arteries and veins that supply blood to the penis. The importance is realised when looking at how an erection is achieved. During an erection, initially blood flow to the penis is increased leading to enlargement of the penile tissue that in turn compresses the veins preventing the immediate outflow of blood. Smoking can affect this is a number of ways.

Firstly, penile blood pressure has been found to be low in more than 20% of men with erectile dysfunction. This is related to atherosclerosis of the pudendal and common penile arteries (those that supply the blood to the penis). Atherosclerosis is when there is fatty deposits along the walls of arteries which in part can occur due to smoking and leads to a decrease in the blood flow through the artery.

In addition to this, there is also an effect directly related to the acute effects of nicotine. Nicotine causes the penile tissue to rapidly contract as a direct effect of the nicotine on the brain, which in turn restricts the arterial blood flow to the penis. This phenomenon is referred to as acute vasospasm. However, as this is a direct response to the nicotine in cigarettes immediate improvements is possible if smoking is stopped.

The third major effect smoking has on erectile function and dysfunction again relates to the blood supply to the penis, only this time the veins. Venous dilatation can occur as a result of the nicotine in the cigarettes meaning that the valve system that regulates the flow of blood is impaired and as a consequence blood flows out of the penis more quickly therefore making it difficult to get and maintain an erection. As this too is as a direct effect of nicotine, stopping smoking could lead to an immediate improvement.