Nicotine Affects Sexual Health. It’s a classic scene in a Western: a cowboy swaggers in with a cigarette dangling from the side of his mouth. In the movies, this signifies sex appeal, toughness, and charisma, but in the real world, nicotine does exactly the opposite.
Cigarettes, pipes, cigars, and smokeless tobacco contain more than 40,000 chemicals, some of which are known carcinogens (cancer-causing agents). In addition, smoking has been linked to heart attack, stroke, lung disease, and a laundry list of health problems. But nicotine use takes another terrible toll – it has a significant effect on men’s sexual health.
Smoking affects sexual health in men (and women) of all ages. Nicotine causes direct damage to blood vessels, and blood flow to the penis is critical for achieving and maintaining strong erections. In addition to erectile dysfunction, smoking is associated with several other men’s sexual health problems.
All types of tobacco can cause sexual dysfunction, including second-hand smoke exposure and vaping. The good news is that many of the effects of nicotine are reversible. Quitting smoking can improve vascular health and erectile dysfunction as well as reduce the risk of other health complications.
Nicotine may be one of the leading causes of erectile dysfunction in young males
Middle-aged and older men often accept erectile dysfunction as part of the physical changes associated with aging. In younger men, however, ED cannot be so easily explained by the effects of age. Traditionally, erection problems in young men were believed to be predominantly related to psychogenic causes. But now there is increasing evidence that nicotine abuse may be one of the lesser known, but significant causes of erectile dysfunction in younger men. Reduced blood flow to the penis from nicotine use and other unhealthy habits can make it difficult for men to get and keep an erection.
Several studies report that smokers have an increased risk of developing ED compared to nonsmokers, irrespective of age. The Massachusetts Male Aging Study [1] found that cigarette smoking almost doubles the likelihood of developing moderate to severe erectile dysfunction in men of all ages. Interestingly, the results of studies [2] that focused on a predominantly young population indicate that smoking is one of the major causes of erectile dysfunction in young males under the age of 40.
One study [3] investigated a possible link between smoking and ED in more than 2,100 men in Minnesota. The researchers found that men who smoked at some point in their lives are more likely to suffer from erection problems regardless of their age. However, the study also found that current smokers in their 40s have the highest likelihood of developing ED, indicating that nicotine is a significant cause of erectile dysfunction in young men. In fact, a study in Finland [4] found that erectile dysfunction is an early indicator of otherwise silent vascular disease in smokers.
It is worth noting that the effects of smoking on men’s sexual health in general and ED, in particular, are dose-dependent and cumulative. In young men between 18 and 44 years old [5], heavy smoking of more than 20 cigarettes per day is associated with a two-fold increase in the risk of developing severe erectile dysfunction compared to men who smoke less.
Heavy smoking causes more severe ED that may not be reversible after quitting. Cumulative smoking history over a man’s lifetime also has an effect on ED risk. Studies show that the association between smoking and ED becomes significant with 20-pack-years of exposure to cigarette smoke [6] (pack-year smoking history is packs per day multiplied by the number of years smoked).
Quitting nicotine can improve your sexual health and your overall health
Smokers tend to have poorer erection quality and other sexual health problems compared to men who have never smoked and never been exposed to 
passive smoking. Although smoking is being increasingly regarded as one of the most significant erectile dysfunction causes, especially among young men, there is mounting scientific evidence that the damage caused by nicotine is reversible if a man quits smoking and doesn’t restart.
Erection status has been found to improve in up to 25 percent of former smokers [7] one year after quitting, with older men and heavy smokers showing the least improvement. In fact, research [8] has shown that improvement in penile blood flow is almost immediate and occurs within 24-36 hours after cessation of smoking. In heavy smokers, stopping smoking for as little as 24 hours leads to a significant improvement in nocturnal erections [9]. Successfully quitting smoking with 8 weeks of nicotine replacement therapy can lead to sustained improvement in erectile function after one year [7].
The chances of regaining erectile function after cessation of smoking are dependent on a number of factors, including:
- Age (men under 50 are more likely to improve)
- The severity of erectile dysfunction (men with mild ED at baseline are more likely to improve)
- Presence of diabetes and hypertension (men without other vascular risk factors are more likely to improve)
There is no doubt that quitting smoking will have a positive impact on overall health and wellness. All study data points to the fact that men who quit nicotine use can, and often do, experience improved sexual performance and a reduction in ED symptoms. Experts advise that quitting cold turkey is not necessarily the best way to go about it. For some smokers, a gradual reduction in the number of cigarettes can be more appealing and just as effective. Abstinence rates are comparable [10] whether someone quits abruptly or gradually and whether they use nicotine replacement therapy or not.
However, it is important to remember that erectile dysfunction is caused due to the nicotine content of cigarettes. Therefore, using a nicotine replacement patch may not be entirely effective in preventing ED. Following widespread criticism, e-cigarette manufacturers such as Juul Labs are reducing the amount of nicotine in their vaping liquids. Nonetheless, vaping liquids, which contain high doses of nicotine, are not recommended as an alternative to smoking for men who are struggling with poor erection quality, possibly due to nicotine effects.
Smoking can affect other areas of men’s health
As noted, exposure to nicotine in cigarettes causes direct damage to blood vessels. In addition to the vascular damage, nicotine is believed to have a negative effect on sexual arousal. One study [11] found that young men, average age 21 years, with negligible prior nicotine use, had substantially reduced erectile response to arousal after the use of a single nicotine patch equivalent to one high-yield cigarette.
Smoking has other effects on men’s sexual health as well. Smokers have significantly less number and motility of sperm compared to nonsmokers [12]. Smoking has been linked to devastating effects on sperm morphology (shape and structure) and viability (ability to function properly), thereby resulting in reduced male fertility [13].
There is a striking association between smoking and the risk of bladder cancer among both men and women. Current smokers have three times the risk of bladder cancer compared to never smokers. Tobacco smoking is the causative factor in 50 to 65 percent of bladder cancers in men [14]. During surgery for bladder cancer, the prostate gland is removed along with the urinary bladder (to prevent cancer from recurring in the prostate). This leads to an inability to ejaculate (dry orgasms). Nerve damage during the operation can be one of the causes of erectile dysfunction after surgery [15]. Following bladder cancer surgery, it may be necessary to use oral ED drugs such as Viagra, injections or pellets in the penis, or a vacuum pump to draw blood into the penis in order to obtain normal erections.
Smoking is also associated with an increased risk of prostate cancer. A meta-analysis of more than 21,500 men with prostate cancer showed that smoking increases both incidence and mortality [16]. Both former and current smokers have an increased risk of getting prostate cancer, but current smokers have an increased risk of dying from prostate cancer. Smoking has been linked to a more aggressive form of prostate cancer that is more likely to spread throughout the body.
There is sufficient data to indicate that nicotine use affects men’s sexual health in more ways than one. If you’re a smoker looking for a reason to quit, consider this: in addition to raising your risk of cardiovascular complications, lung disease, and cancer, tobacco use could be causing erectile dysfunction and other sexual problems. The time to quit is now. The sooner you stop smoking, the less likely it is to cause severe, irreversible damage.