Erectile dysfunction has many different pathogenetic mechanisms, but numerous studies have shown that the most common form is arteriogenic (vascular). Unfavorable risk factors play a significant role in the development of this disease, having a certain impact on the vascular wall – excessive body weight, sedentary lifestyle, chronic stress, alcohol abuse, and smoking.

It is also worth noting that men who did not smoke often start smoking after the development of ED, while smokers tend to quit smoking after developing erectile dysfunction.

The Influence of Cigarettes

Among various factors, smoking is the most prevalent. Despite the well-known negative effects and warning images on packaging, a huge number of men and women continue this harmful habit. Nearly one in four smokers dies prematurely, losing 10 to 15 years of their life. This is due to the components of tobacco smoke:

  • Tobacco tar. One kilogram of tobacco, typically smoked by a person in a day, contains 70 milliliters of tar. Accordingly, more than 8 liters pass through a person's lungs annually – no organism can withstand such a large amount of carcinogenic substances.
  • The smoke itself. It contains over 5000 harmful substances, 50 of which are potentially carcinogenic (causing cancer).

It should be noted that tobacco product manufacturers often focus only on the most common and "classic" consequences – lung cancer, miscarriage, heart attack. However, the link between smoking and erectile dysfunction (ED) is well-established in many studies.

It's also noted that the risk of ED increases not only with the duration of smoking but also with the number of cigarettes smoked per day – men who smoke 10 cigarettes a day have a one and a half times higher risk of developing ED.

Mechanisms Linking Erectile Dysfunction and Smoking

There are several theories on how smoking can affect the quality and duration of an erection.

  1. Decreased production of NO and endothelium-dependent vascular relaxation. Both are responsible for arterial dilation and preventing their spasm. Without them, blood vessels constrict, cutting off blood flow to organs and tissues. This results in ischemia of the penile muscles and inadequate filling of the cavernous bodies, responsible for erection.
  2. Each cigarette smoked raises both systolic and diastolic blood pressure, negatively affecting arterial wall elasticity.
  3. Cigarette smoke components increase platelet adhesion and aggregation, promoting thrombosis. Thrombi block blood flow in peripheral arteries, causing ischemia and insufficient erection.
  4. Carbon monoxide in tobacco smoke binds to hemoglobin, which should deliver oxygen to tissues to prevent cell death. However, when bound with CO, its interaction with oxygen becomes completely impossible.
  5. Smoking leads to increased cholesterol and low-density lipoproteins – both are primary in forming atherosclerotic plaques. They clog the vascular lumen, leading to the same effects as thrombi.
  6. Daily smoking increases the risk of developing depressive and anxiety disorders. Apathy, depression, disinterest in sexual activity is a psychogenic component of erectile dysfunction.


Naturally, the most important component of therapy in such cases of erectile dysfunction is quitting smoking. The exact period after which erection adequacy begins to improve is still being studied and remains unknown. However, some studies report that after a 24-hour smoking pause, there is an increase in penile rigidity. But one should not expect quick and immediate results from quitting – long-term smoking negatively affects the possibilities of pharmacological therapy.

Depending on the specific individual case, the doctor may prescribe the following types of drugs:

  • Phosphodiesterase type 5 inhibitors (PDE5) – however, the absence of a positive effect after a single dose of sildenafil is occasionally noted;
  • Intracavernous injections of papaverine;
  • Melanocortins – melanocyte-stimulating hormones;
  • L-arginine – a substrate for NO synthesis.

It should be noted that ED patients require a special approach to treatment, as each unsuccessful sexual act exacerbates the psychogenic component of the problem and reduces trust in the therapy. Therefore, it's logical to complement pharmacotherapy with visits to a psychologist, psychotherapist, or sexologist, to increase the man's desire to continue treatment, without which it is impossible to restore previous erection and sexual activity.

Additional Therapy

Even with quitting smoking in cases of erectile dysfunction, it's important to remember diseases that have already arisen due to long-term smoking – it's crucial to take medication to correct them. Most often, this includes chronic obstructive pulmonary disease and chronic obstructive bronchitis, so the patient may additionally be prescribed bronchodilators and glucocorticosteroids.

The patient may also have developed cancer (lung, larynx, stomach, or other organs) – as known, cancer is one cause of erectile dysfunction.

In some cases, a worsening erection becomes one of the first signs of ongoing or progressing pathology, as smokers often become accustomed to constant coughing and phlegm. But erectile dysfunction will inevitably lead them to consult a doctor.