Can Nicotine Cause Erectile Dysfunction?

Rachael Zimlich, BSN, RN
·7 min read

Medically reviewed by Matthew Wosnitzer, MD

Nicotine—whether smoked, vaped, or chewed—and erectile dysfunction (ED) are closely linked. This is because nicotine causes the narrowing of blood vessels and reduces circulation throughout the body, including the penis. The restrictions of blood flow to the penis impair your ability to get and sustain an erection, resulting in ED.

This article explains how nicotine affects the body and how it contributes to ED. It also discusses other ways that ED affects sex and offers tips for how to quit smoking once and for all.

<p>Eva-Katalin / Getty Images</p>

Eva-Katalin / Getty Images

Can Nicotine Cause ED?

Nicotine is a highly addictive stimulant found in tobacco. It is the substance that produces feelings of pleasure when it is smoked, vaped, chewed, or used as snuff.

Nicotine is also a potent vasoconstrictor, meaning that it causes blood vessels to narrow, thereby reducing the amount of blood that flows to organs.

Other chemical toxins created from cigarette smoke decrease levels of a compound called nitric oxide in the blood. This is the compound responsible for vasodilation (the widening of blood vessels) which enables the engorgement of the penis with blood during an erection.

Over time, the continued constriction of blood vessels can cause them to stiffen, sometimes permanently.

Vasoconstriction is one central mechanism of ED, most specifically arteriogenic ED characterized by the restriction of blood to the penis.

Other contributing factors include the dysfunction of nerves that regulate the sexual response and erections (neurogenic ED) and psychological issues that affect libido and sexual desire (psychogenic ED). Multiple mechanisms are sometimes involved.

What Is the Risk of ED From Nicotine?

Irrespective of how nicotine enters your body, it has the potential to cause or contribute to ED. Here is what some of the current research says:

  • A 2016 review of studies in the journal Andrologia reported that smoking cigarettes, as an independent risk factor, increases the likelihood of ED by up to three-fold, This is especially true for smokers under the age of 40.

  • A 2022 study in the American Journal of Preventive Medicine found that males between the ages of 20 and 65 who vaped nicotine daily were more than twice as likely to report ED than those who do not vape.

  • While research is lacking, nicotine in smokeless tobacco (including chewing tobacco and snuff) has been long presumed to contribute to ED. A large study from Scandinavia, where tobacco snuff is widely used, reported that snuff can reduce blood vessel dilation by up to 53%.

  • Studies are split on whether secondhand smoke is a risk factor for ED. While some studies have found no relationship between passive smoke and ED, others report a risk of ED in people with long-term exposure to secondhand smoke (an average of eight years).

Risk Is Dose-Dependent

The risk of ED from nicotine is dose-dependent, meaning that the more nicotine that enters your body, the greater the effect.

A 2015 review of studies from Baylor University reported that males who smoked more than 20 cigarettes per day had double the risk of severe ED than those who smoked less.

The duration of smoking also factors into the risk as measured by "pack-years" (the number of years you've smoked multiplied by the number of cigarettes smoked per day).

To this end, a 29-pack-year history of smoking was shown to significantly increase the risk of ED compared to a 12-pack-year history of smoking which has more or less the same level of risk as a non-smoker.

Learn More: Cigarette Smoking and Fibromyalgia

Other Ways Nicotine Affects Sex

Cigarettes affect more than just the ability to achieve or sustain an erection. According to a 2022 study published in BJU International, which involved 6,754 males between the ages of 50 and 75, smoking was associated with an 80% increased risk of low libido (sex drive) compared to not smoking.

The loss of libido in female smokers is well known as it reduces levels of the hormone estrogen, which influences libido. The cause of the loss of libido in male smokers is less understood.

Another small study conducted in 2020 found that nicotine addiction not only increased the risk of ED and low libido but also contributed to delayed orgasm and anorgasmia (inability to achieve orgasm).

Some of these effects may be caused in part by high rates of depression among people with nicotine addiction. According to a 2022 study in the Journal of Family & Community Medicine, smokers with high nicotine dependence showed high levels of severe depression (31.8%) and stress (48.8%) as a result of their addiction.

Related: How Smoking Affects Sleep

Additional Causes of Erectile Dysfunction

Aside from smoking, other possible causes of erectile dysfunction include:

You may experience ED from any one (or a combination) of these conditions. On the flip side, smoking is a contributing factor to diabetes, high blood pressure, and heart disease, whether ED is involved or not.

How to Maintain an Erection

If you have erectile dysfunction, there are several treatment options you can pursue depending on how severe your condition is, including:

Given that the quality of your health influences the risk of ED, there are other lifestyle changes you can make to improve your sexual function:

  • Exercise regularly to improve your cardiovascular fitness.

  • Eat a heart-healthy diet composed of fruits, vegetables, whole grains, lean meat or poultry, fish, and healthy plant-based fats like olive oil.

  • Lose weight if you are overweight or have obesity.

  • Avoid alcohol and recreational drugs.

  • Quit smoking.

You also need to address your mental health if you are feeling anxious or depressed about ED. Stress compounds ED and, in some cases, is the sole cause of ED (especially in younger males).

If you are having trouble achieving or maintaining an erection, speak with your partner and work together to find a solution. This alone can reduce the risk of sexual performance anxiety. Stress reduction techniques like deep breathing exercises, yoga, and meditation may also help.

If anxiety or depression is getting the better of you, consider seeing a therapist who can provide counseling and help pinpoint the underlying psychological causes of your ED.

How to Quit Smoking

Quitting cigarettes is one of the most important things you can do if you have erectile dysfunction. Studies have shown that ED significantly improves within six months to a year of quitting cigarettes, even among heavy smokers.

Quitting smoking is not easy, and doing cold turkey doesn’t always work. In the end, it takes an average of five to seven quit attempts for most people to finally quit.

To improve your chances, speak with your healthcare provider about over-the-counter and prescription smoking cessation aids that can help, including:

  • Nicotine patches, gums, lozenges, inhalers, and nasal sprays

  • Chantix (varenicline), a twice-daily oral pill

  • Zyban (bupropion), a once-daily oral pill

E-cigarettes are not considered an effective quitting tool–and may only continue to contribute to ED. While nicotine patches, gum, lozenges, and sprays may do the same, the benefits of smoking cessation more than outweigh the short-term risks of ED.

Speak with your insurance provider as many smoking cessation aids are fully covered as an Essential Health Benefit under the Affordable Care Act, even after multiple attempts.

In-person and online smoking cessation support groups may also help.

Summary

Smoking can shrink blood vessels and restrict blood flow to the penis, causing erectile dysfunction. Other conditions can contribute, such as diabetes and high blood pressure. There are ED medications that can help, but certain lifestyle changes—most notably quitting cigarettes—can improve your chances of achieving and sustaining erections over the long term.

Read the original article on Verywell Health.