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    JAKARTA, JULY 2011

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    The association between smoking and erectile dysfunction was evaluated in a cohort

    of 2,115 Caucasian men, aged 4079 years, randomly selected from Olmsted County, Minnesota.

    Of the 1,329 men with a regular sexual partner, 173 were current smokers, 836 had previouslysmoked, and 203 reported erectile dysfunction. Compared with former and never smokers,

    current smokers in their forties had the greatest relative odds of erectile dysfunction. Compared

    with men who never smoked, men who smoked at some time had a greater likelihood of erectile


    One of the US national health goals for 2010 is to decrease the prevalence of

    smoking in adults. In 2001, an estimated 46.2 million adults were current smokers, and the

    prevalence of cigarette smoking was higher among men than women. While much of the focus

    has been on cancer and cardiovascular diseases, these diseases tend to occur at older ages;

    therefore, younger adults and adolescents may discount the increased risk. Erectile dysfunction

    (ED) has been reported to be associated with smoking, and antismoking advertising campaigns

    have tried to use this information to their advantage .(4)

    Smokers had a higher risk and a lower recovery from ED than nonsmokers. Quitting smoking

    and risk to start smoking were higher among men with ED. Although the relative risks were

    nonsignificant, this findings were consistent with the hypothesis that there are two associations

    between ED and smoking. Firstly, smoking causes ED. Secondly, smoking reduces recovery

    from ED and. Therefore, there was substantial random variation and the estimated incidence ORs

    were not statistically significant. These two associations and their relative importance result in

    the common finding of association between the prevalence of smoking and the prevalence of ED.

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    CHAPTER 1 :


    Smoking, primarily of tobacco, is an activity that is practiced by some 1.1 billion people,

    and up to 1/3 of the adult population. The image of the smoker can vary considerably, but is very

    often associated, especially in fiction, with individuality and aloofness. Even so, smoking of both

    tobacco and cannabis can be a social activity which serves as a reinforcement of social structures

    and is part of the cultural rituals of many and diverse social and ethnic groups. Erectile

    dysfunction (ED) has been reported to be associated with smoking, and antismoking advertising

    campaigns have tried to use this information to their advantage .

    Erectile dysfunction (ED) is a common public health problem affecting millions of men

    worldwide. It has a strong negative effect on interpersonal relationship, well-being and quality of


    The use of tobacco is a major public health problem worldwide, and its effect on sexual life is

    an often-used fact in anti-smoking campaigns. Association between smoking and ED has been

    assessed mainly in prevalence studies, which have considerable weaknesses for elucidating the

    etiology of ED. two longitudinal studies have evaluated the effect of smoking on erectile

    function. One has clearly shown that smoking does not have an effect on the incidence of ED.and

    the other has also found no effect in whole sample.while doubling of risk in a subgroup of men

    free from vascular diseases.(5)

    Little is known about the frequency of spontaneous recovery, and no study has been published on

    the effect of smoking on the recovery from ED and the effect of ED on starting or stopping


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    CHAPTER 2 :



    Smoking is a practice in which a substance, most commonly tobacco or cannabis, is burned and

    the smoke is tasted or inhaled. This is primarily practised as a route of administration for

    recreational drug use, as combustion releases the active substances in drugs such as nicotine and

    makes them available for absorption through the lungs. It can also be done as a part of rituals, to

    induce trances and spiritual enlightenment.

    The most common method of smoking today is through cigarettes, primarily industrially

    manufactured but also hand-rolled from loose tobacco and rolling paper. Other smoking

    implements include pipes, cigars, bidis, hookahs, vaporizers and bongs. It has been suggested

    that smoking-related disease kills one half of all long term smokers but these diseases may also

    be contracted by non-smokers. A 2007 report states that about 4.9 million people worldwide each

    year die as a result of smoking.


    Tobacco-related diseases are some of the biggest killers in the world today and are cited as one

    of the biggest causes of premature death in industrialized countries. In the United States about

    500,000 deaths per year are attributed to smoking-related diseases and a recent study estimated

    that as much as 1/3 of China's male population will have significantly shortened life-spans due to

    smoking.Smoking one cigarette a day results in a risk of heart disease that is halfway between

    that of a smoker and a non-smoker. The non-linear dose response relationship is explained by

    smoking's effect on platelet aggregation.(2)

    Among the diseases that can be caused by smoking are vascular stenosis, lung cancer,heart

    attacks and chronic obstructive pulmonary disease.

    Passive smoking, or secondhand smoking, which affects people in the immediate vicinity of

    smokers, is a major reason for the enforcement of smoking bans. A common concern among

    legislators is to discourage smoking among minors and many states have passed laws against

    selling tobacco products to underage customers.(2)

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    The effects of addiction on society vary considerably between different substances that can be

    smoked and the indirect social problems that they cause, in great part because of the differences

    in legislation and the enforcement of narcotics legislation around the world. Though nicotine is a

    highly addictive drug, its effects on cognition are not as intense or noticeable as other drugs such

    as, cocaine, amphetamines or any of the opiates (including heroin and morphine).

    Smoking is a risk factor in Alzheimer's Disease. While smoking more than 15 cigarettes per day

    has been shown to worsen the symptoms of Crohn's Disease, smoking has been shown to

    actually lower the prevalence of ulcerative colitis


    Inhaling the vaporized gas form of substances into the lungs is a quick and very effective way of

    delivering drugs into the bloodstream (as the gas diffuses directly into the pulmonary vein, then

    into the heart and from there to the brain) and affects the user within less than a second of the

    first inhalation. The lungs consist of several million tiny bulbs called alveoli that altogether have

    an area of over 70 m (about the area of a tennis court).The inhaled substances trigger chemical

    reactions in nerve endings in the brain due to being similar to naturally occurring substances

    such as endorphins and dopamines, which are associated with sensations of pleasure. The result

    is what is usually referred to as a "high" that ranges between the mild stimulus caused by

    nicotine to the intense euphoria caused by heroin, cocaine and methamphetamines.(1)

    Inhaling smoke into the lungs, no matter the substance, has adverse effects on one's health. The

    incomplete combustion produced by burning plant material, like tobacco or cannabis, produces

    carbon monoxide, which impairs the ability of blood to carry oxygen when inhaled into the

    lungs. There are several other toxic compounds in tobacco that constitute serious health hazards

    to long-term smokers from a whole range of causes; vascular abnormalities such as stenosis, lung

    cancer, heart attacks, strokes, impotence, low birth weight of infants born by smoking mothers.

    8% of long-term smokers develop the characteristic set of facial changes known to doctors as

    smoker's face.(1)

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    CHAPTER 3 :

    ERECTILE DYSFUNCTION____________________________________________________

    Erection physiology

    When a man becomes aroused, his central nervous system stimulates the release of a number of

    chemicals that relax the smooth muscles in the penis, allowing blood to flow into the tiny pool-

    like sinuses and flood the penis.(1)

    The spongy chambers almost double in diameter due to the increase in blood flow. The veins

    surrounding the corpa cavernosum and corpus spongiosum are squeezed almost completely shut

    by the pressure of the erectile tissue; they are unable to drain blood out of the penis, causing it to

    become rigid.(1)

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    Erectile dysfunction (impotence) is the inability to get and keep an erection firm enough for sex.

    Having erection trouble from time to time isn't necessarily a cause for concern. But if erectile

    dysfunction is an ongoing problem, it may cause stress, cause relationship problems or affect

    your self-confidence.(2)


    In most cases, erectile dysfunction is caused by something physical. Common causes include:

    Heart disease Clogged blood vessels (atherosclerosis) High blood pressure Diabetes Obesity Metabolic syndrome, a condition involving increased blood pressure, high insulin levels,

    body fat around the waist and high cholesterol

    Parkinson's disease Multiple sclerosis Low testosterone Peyronie's disease, development of scar tissue inside the penis Certain prescription medications Tobacco use Alcoholism and other forms of substance abuse

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    Treatments for prostate cancer or enlarged prostate Surgeries or injuries that affect the pelvic area or spinal cord

    Psychological causes of erectile dysfunction

    The brain plays a key role in triggering the series of physical events that cause an erection,

    starting with feelings of sexual excitement. A number of things can interfere with sexual feelings

    and cause or worsen erectile dysfunction. These include:

    Depression, anxiety or other mental health conditions Stress Fatigue Relationship problems due to stress, poor communication or other concerns


    Erectile dysfunction is the inability to maintain an erection firm enough for sex, on an ongoing

    basis. Symptoms related to erectile dysfunction may include:

    Trouble getting an erection Trouble keeping an erection Reduced sexual desire


    For many men, a physical exam and answering questions (medical history) are all that's

    needed before a doctor is ready to recommend a treatment. If your doctor suspects that

    underlying problems may be involved, or you have chronic health problems, you may need

    further tests or you may need to see a specialist.(2)

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    Tests for underlying problems may include:

    Physical exam. This may include careful examination of your penis and testicles andchecking your nerves for feeling.

    Blood tests. A sample of your blood may be sent to a lab to check for signs of heartdisease, diabetes, low testosterone levels and other health problems.

    Urine tests (urinalysis). Like blood tests, urine tests are used to look for signs ofdiabetes and other underlying health conditions.

    Ultrasound. This test can check blood flow to your penis. It involves using a wand-like device (transducer) held over the blood vessels that supply the penis. It creates a

    video image to let your doctor see if you have blood flow problems. This test is

    sometimes done in combination with an injection of medications into the penis to

    determine if blood flow increases normally.

    Overnight erection test. Most men have erections during sleep without rememberingthem. This simple test involves wrapping special tape around your penis before you

    go to bed. If the tape is separated in the morning, your penis was erect at some time

    during the night. This indicates the cause is of your erectile dysfunction is most likely

    psychological and not physical.

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    CHAPTER 4 :


    Erectile dysfunction (ED) has been reported to be associated with smoking, and antismoking

    advertising campaigns have tried to use this information to their advantage .

    Unfortunately, few population-based studies have evaluated the association between smoking

    and ED in the adult male population. The most commonly cited study in the United States is the

    Massachusetts Male Aging Study, which evaluated ED in men aged 4070 years with a self-

    administered questionnaire. Results from this study indicated that cigarette smoking at baseline

    almost doubled the likelihood of moderate or complete ED at up to 10 years of follow-up.

    Former smokers, compared with never smokers, were not at increased risk of ED , but there was

    no information on dose response, that is, number of cigarettes smoked. Men were simply

    classified as former smokers, nonsmokers, or current smokers at baseline and follow-up .An

    earlier study of Vietnam-era veterans, aged 3149 years, found that a higher percentage of

    smokers reported ED problems than did nonsmokers. However, neither number of years of

    smoking nor number of cigarettes smoked daily were significant predictors of ED in current

    smokers in this study . Moreover, the young age of the men evaluated may have limited

    implications for men who smoke their entire lives.(4)


    In this study, smoking was associated with ED. This association was seen in current smokers,

    although the magnitude of this association decreased across increasingly older age groups. This

    finding suggests that smoking may have a more apparent impact on erectile function in young

    male smokers than it does in older male smokers. Importantly, there was also evidence of a dose

    response by intensity with cumulative exposure among persons who ever smoked.(4)

    This latter result, in particular, adds greater credence to previous reports of an associationbetween smoking and ED. Unlike previous studies , however, former smokers, especially those

    who had smoked for more than 29.0 pack-years, were more likely to have ED than nonsmokers

    were. In addition, unlike the Centers for Disease Control and Prevention study , number of pack-

    years of smoking was significantly associated with ED in former and current smokers. This

    finding is partially supported by results from a study conducted in community-based populations

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    in Brazil, Italy, Japan, and Malaysia. The Health Professionals Follow-up Study also found that

    smoking was associated with risk of ED. While this study quantified cigarette exposure in

    current smokers using number of cigarettes per day, this information was not included in the

    assessment of the relative risk for ED.

    Interestingly, the relative odds of ED in current smokers decrease with increasing age, when

    stratified by age. Explanation for this outcome may be survivorship bias, because smokers have

    higher mortality rates and therefore would be less represented in the sample. Furthermore, men

    who had undergone prostate surgery or had prostate cancer were excluded at baseline, which

    may have biased the baseline sample because these conditions are also associated with increasing


    Although the evidence for an association between smoking and ED is growing, the mechanism

    behind this association is not completely understood. Comorbidities, such as hypertension,

    hypercholesterolemia, and diabetes, are associated with decreased function of nerves and

    endothelium, resulting in circulatory and structural changes in penile tissues, arterial

    insufficiency, and defective smooth muscle relaxation. However, when we adjusted for these

    factors in our multivariable models, an association between smoking and ED persisted among

    younger men, suggesting that other mechanisms may prevail.

    Blood is a vehicle for delivering oxygen and nutrients to our body's tissues and organs. Without

    it they die. Our blood vessels (circulatory system) are the piping highways in which our blood

    flows. The inside of each healthy blood vessel is coated with a thin Teflon like layer of cells that

    ensure smooth blood flow. Carbon monoxide from smoking or second-hand smoke damages this

    important layer of cells, allowing fats and plaque to stick to vessel walls. Nicotine then performs

    a double whammy of sorts.(2)

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    First, each time new nicotine arrives in our brain it causes the body to activate its fight or flight

    stress defenses. This in turn causes the immediate release of stored fats into the bloodstream, fatsintended to be used to provide the instant energy needed to either fight or flee the saber tooth

    tiger. But there is no tiger

    The extra food we consumed during our big meals each day was converted to fat and stored. It

    was then pumped back into our bloodstream with each new puff of nicotine. It's how we were

    able to skip meals and what causes many of us to experience wild blood sugar swings when

    trying to quit. In fact, many of the symptoms of withdrawal - like an inability to concentrate - are

    due to nicotine no longer feeding us while we continue to skip meals.

    The heavy blasts of stored fats released by nicotine stick to vessel walls damaged by toxic carbon

    monoxide. We've recently learned that nicotine itself, inside our vessels, somehow causes the

    growth of new blood vessels (vascularization) that then provides a rich supply of oxygen and

    nutrients to the fats and plaques that have stuck to damaged vessel walls. This internal nicotine

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    vascularization (vessels within vessels) hardens a smoker's arteries and veins and further

    accelerates their narrowing and clogging.(2)

    The damage being done isn't just to the vessels supplying blood to our heart and brain. It's

    occurring, to one degree or another, inside every vessel in a smoker's body. It affects everything

    from blood vessels associated with hearing, to the skin's blood supply that shows itself in

    wrinkles, early aging, hair loss and tooth loss.

    Since erection is linked with blood flow, every erectile problem is known to be influenced by it.

    This is why, when something interferes in the process when blood rushes to the penis, a

    dysfunction takes place and sometimes smoking has something to do with it. It is known that

    smoking does not affect only the respiratory system but it also damages the body's circulation.

    Because the cigarettes contain carbon monoxide, the haemoglobin in the blood binds with it and

    the oxygen carrying capacity is reduced, along with the count of red blood cells. All this factors

    combined can cause cardiovascular problems, arteriosclerosis and reduced blood flow to the

    penis. In this way, smoking can be responsible also for low sperm count, sperm mortality and

    lack of libido.(2)

    So, if your erectile dysfunction has to do with smoking, you should know that it can't be treated

    only with chemical based medicines like Viagra. Before trying to treat your problem with

    erectile dysfunction pills, you should know that the only remedy is to simply quit smoking,

    especially if you suffer from diabetes or heart troubles. You can find help with the Internet

    programs or with the de-addiction centres in order to manage quit smoking. Most of all, you

    should always remember that quitting smoking will not only improve your sexual problems, but

    it will also have benefices on your general health.

    In 2001, the Morbidity and Mortality Weekly Report found that current smoking prevalence was

    highest among persons aged 1824 years (26.9 percent) and aged 2544 years (25.8 percent) and

    was lowest among those aged >65 years (10.1 percent) .As data suggest, there is a potentially

    stronger association between smoking and ED in men in these younger age groups.(5)

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    CHAPTER 5 :


    Based on data and information obtained Smoking can cause erectile dysfunction

    directly or indirectly. The first step of the treatment is to quit smoking and to practice a healthy

    life style. Erectile dysfunction is not the only side effect or health effect you might get.

    Tobacco is a killer. Smokers and other tobacco users are more likely to develop disease

    and die earlier than are people who don't use tobacco. If you smoke, you may worry about what

    it's doing to your health. You probably worry too about how hard it might be to quit smoking.

    Nicotine is highly addictive, and to quit smoking especially without help can be difficult. In

    fact, most people don't succeed the first time they try to quit smoking. It may take more than one

    try, but you can stop smoking.

    Take that first step: Decide to quit smoking. Set a stop date. And then take advantage of the

    multitude of resources available to help you successfully quit smoking.

    A variety of options exist for treating erectile dysfunction. The cause and severity of condition,

    and underlying health problems, are important factors in recommending the best treatment. To

    choose the best treatment we need to understand the risks and benefits of each treatment.

    Partner's preferences also may play a role in treatment choices.

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    1. Sherwood L . Human Physiology From Cell to System . 6th ed . United State of America; Thomson Brooks/Cole ; 2007, p 444-445, 749-750

    2. Kasper D, Braunwald E, Fauchi A. Harrisons Principles of Internal Medicine. 16th ed,New York : McGraw Hill, 2005

    3. Erectile dysfunction and quit smoking Acces On 28 JUN 2011Available at :

    4. Relationship between smoking and erectile dysfunction Acces On 24 JUN 2011Available at :

    5. Erectile Dysfunction Linked To Smoking Acces On 24 JUN 2011Available at :

    6. Erectile Dysfunction and Smoking Acces On 29 JUN 2011Available at :