The ad starts with a classic scene of seduction: A suave thirty something man in a tuxedo approaches a beautiful woman in an evening gown. He lights a cigarette. It goes limp, and every man in the viewing audience winces. The voice-over says it all: "Now that medical researchers believe cigarettes are a leading cause of impotence, you're going to be looking at smoking a little differently."
The television ad, part of a $21 million anti-smoking campaign by the California Department of Public Health, definitely gets high marks as an attention-grabber. Even men who ignore the threat of lung cancer or heart disease take note whenever the "I" word pops up.
Studies on impotence
Although scientists have long been divided on the possible connection between smoking and impotence, recent studies suggest that cigarettes may indeed affect sexual performance.
After hearing a radio commentator rant about cigarettes, impotence, and "junk science," Tammy Tengs, ScD, decided to clear the air. Tengs, a public health researcher at the University of California at Irvine, wasn't convinced by any previous studies that specifically examined the link between smoking and impotence. So she took a novel approach to the question.
"We looked at every single study in the last two decades that had a lot of impotent men," she says. Nineteen of those studies -- involving a grand total of 3,819 impotent men -- also recorded smoking habits. As reported in Preventive Medicine, Tengs found that 40 percent of the subjects were current smokers, compared with only 28 percent of the general population. Either smoking raises the risk of impotence, or there are a lot of smokers out there with rotten luck.
After looking at the data, Tengs believes the television ad is right on target, with one exception: The man holding the limp cigarette seems too young to fit the typical profile of men affected by impotence. Still, she says, it's fair to point out that men who smoke while they're young may be setting themselves up for a problem down the road.
Effects of nicotine
Even before Tengs' study, male smokers might have made their own troubling observations. First of all, given the short-term and long-term effects of cigarettes, it would be a bit surprising if smoking didn't hamper erections. Nicotine encourages the blood vessels to squeeze tight, potentially slowing the flow of blood to the penis. Even worse, a long-term habit can permanently damage arteries throughout the body, including those that feed the penis. Although impotence is largely a problem of older men, younger men who smoke may discover that they have weaker erections as a result of constricted blood vessels, according to researchers.
Although studies in the past had mixed results, a few of them were real eye-openers. Researchers at Wake Forest University in Winston-Salem, North Carolina -- the heart of tobacco country -- surveyed 59 men with long-standing hypertension. As reported in the January 2001, issue of The Journal of Family Practice, 15 men had erection problems, including eight current smokers and six former smokers. The researchers concluded that men with high blood pressure who smoked were roughly 26 times as likely to be impotent as hypertensive nonsmokers. (Because of the small number of subjects, the estimate should be taken with a grain of salt.)
As alarming as those results are, they can't match the shock value of a small study published back in 1986 in the relatively obscure journal Addiction Behavior. In this study, researchers went right to the heart of the matter: They hooked up penile sensors to 42 male smokers and then showed them erotic movies. Some of the subjects smoked high-nicotine cigarettes before watching the movies, while others ate candy. The unsettling results: Just two cigarettes significantly reduced "penile diameter" during the show. In plain language, that means smaller, softer erections. (At least many smokers have the good sense to save the cigarettes until after sex.)
More recently, in a 2006 Australian study of 8,367 men, researchers reported that smoking increased the likelihood of impotence by 27 percent and concluded it was significantly associated with erectile dysfunction. They also discovered that the more a man smoked, the more likely it was that he would suffer from erectile dysfunction.
It's important to remember that many things other than smoking can lead to erectile dysfunction, including stress, hypertension, alcoholism, diabetes, and prostate surgery. If you're a smoker who has trouble achieving or maintaining an erection, kicking the addiction is just one important step. You should also see a urologist or family doctor for a checkup and advice. With a little help, there's a good chance you can return to a full, satisfying sex life.