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Smoking and impotence

Systematic review

One of the real problems with giving advice about smoking to young men is that we are telling them not to smoke now because of health problems they may experience decades in the future. Perhaps a more direct approach on cigarette packets would be more helpful. Not 'smoking kills' but rather 'smoking makes you impotent'. A new systematic review of smoking prevalence among impotent men points in that direction [1].

Systematic review

The review searched MEDLINE from 1980 to about 2000 for articles on impotence or erectile dysfunction and which described studies in the United States. The specific US choice was to be able to examine available smoking prevalence data for the general population. From each study the number of impotent men who were current smokers, the definition of impotence, the definition of smoking, ages, and location were taken.

For each study, a tailored comparison group based on age distribution, time and location was derived from smoking prevalence data from an ongoing surveillance system.


There were 19 studies with 3,819 impotent men, ranging in size from 10 to 800 men. Studies usually had a wide age range, with mean age from 35 to 61 years.

In 16 of the 19 studies, smoking rates in impotent men were higher than those in the general male population (Figure 1). Overall the age and location matched smoking prevalence in men was 28%. In impotent men it was 40%, a significant difference of 12% (95% confidence interval 11 to 14%).

Figure 1: L'Abbé plot of smoking rates in impotent men and general male population

The difference between smoking rates in impotent men and the general male population of 12% was accurately measured by the larger, but not the smaller studies (Figure 2). With over 400 men the difference was consistent. With fewer than 100 men the difference ranged from 60% to -9%.

Figure 2: Difference in smoking prevalence in impotent men and general male population by study size


This paper alone does not constitute a definitive link between smoking and impotence in men. But it does go a long way to making the claim, and in the end it may be more influential in terms of making young men think twice about starting smoking, and make older men think about giving it up. Women may also appreciate the information.

Smoking and erectile dysfunction

There are at least two systematic reviews of smoking and erectile dysfunction published in 2001 [2, 3]. The bottom line from these is that smoking doubles the risk of erectile dysfunction in men. Erectile problems are common in men, affecting 10-25%. All the evidence may not yet be in, but men might like to work on the basis that smoking will exacerbate a problem that age and chronic disease will bring to their door at some time.

The evidence that smoking history is stronly related to erectile dysfunctioncontinues to build. Studies from Finland [4] and Italy [5]. Recovery from erectile dysfunction may be more difficult in smokers or ex-smokers, and duration of smoking habit increases the risk of erectile dysfunction. A further Italian study [6] (more than 20 cigarettes a day) was very much more common in men aged 18-44 years with erectile dysfunction (39%) than in the Italian population as a whole, where it was 4% for men of the same age.


  1. TO Tengs, ND Osgood. The link between smoking and impotence: two decades of evidence. Preventative Medicine 2001 32: 447-452.
  2. KT McVary et al. Smoking and erectile dysfunction: evidence based analysis. Journal of Urology 2001 166:1624-32.
  3. G Dorey. Is smoking a cause of erectile dysfunction? A literature review. British Journal of Nursing. 2001 10:455-65.
  4. R Shiri et al. Relationship between smoking and erectile dysfunction. International Journal of Impotence Research 2005 17: 164-169.
  5. V Mirone et al. Cigarette smoking as risk factor for erectile dysfunction: results from an Italian epidemiological study. European Urology 41: 294-297.
  6. A Natali et al. Heavy smoking is an important risk factor for erectile dysfunction in young men. International Journal of Impotence Research 2005 17: 227-230.
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