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Help and advice on quitting smoking

Smoking and sexual health

Article by Dr. Christian Rollini, head of the Psychosomatic Gynaecology and Sexology Consultation Clinic, University Hospital of Geneva

General observations

Sexual arousal requires good blood circulation, yet tobacco exerts a negative effect on blood circulation by constricting blood vessels. Most of the available studies show that smoking has a negative impact on the arousal phase – erection and lubrication. It is primarily for this reason that tobacco is harmful for sexual health in the medium term. However, we now know that numerous substances contained within smoke may also exert a more immediate effect, leading to a significant reduction in erectile capacity after just one cigarette. Furthermore, smoking can also negatively affect fertility, promote certain sexual diseases and lead to an early menopause.

Effects of smoking on sexual health  

The link between long-term smoking and arousal disorders (erectile dysfunction or lubrication problems) is well known and has been demonstrated (1,2,3). Although sexual health problems may be caused by many things, smoking can and should be seen as a risk factor in itself, especially when an arousal problem suddenly develops. Smoking effectively poses a well-known risk to cardiovascular health (4,5). Given that circulation problems are the main physical cause of erectile dysfunction, it is clear that nicotine and tobacco will have a very negative impact on the sexual health of a smoker thanks to their detrimental effects on blood supply. The correlation between erectile problems and cardiovascular illnesses, as well as the constriction of the penal arteries, underpins the concept of the “sentinel symptom”, given that erectile dysfunction can be an early warning sign of broader cardiovascular illnesses. Erectile dysfunction can therefore appear several years before the first cardiac symptoms. The harmful effect that smoking exerts on the whole network of veins seems to depend on the dosage and on how long the person has smoked. Some studies (6) describe an increase in erection problems as high as 40% among regular smokers.


The blood vessels in the penis cause an erection thanks to a build-up of blood in the spongy tissues of the reproductive organ. If the arteries become obstructed, the blood supply no longer reaches an optimal level and problems can set in. A 25% reduction in blood supply is enough to affect the quality of an erection, whereas the supply in the coronary arteries must generally fall below 50% for physical symptoms of heart disease such as angina to become present. That is why the specialized literature now recognizes that erectile dysfunction in men of all ages can be a useful warning sign of latent cardiovascular problems. Furthermore, the most commonly used medication for treating erectile dysfunction (e.g. Viagra®, Cialis®, Levitra®) act by increasing the blood supply, which emphasizes the importance of good circulation as a major contributor to adequate sexual arousal. Circulation problems in women can also lead to an insufficient level of arousal and, for example, vaginal dryness.

Smoking just one cigarette can affect erection    

Among the innumerable active ingredients in tobacco, nicotine, carbon monoxide and certain free radicals are responsible for the constriction of blood vessels with a more immediate effect, as several recent studies (7) have demonstrated. An occasional cigarette can therefore lead to a significant decrease in erectile performance, for instance an increase of over 20% compared to a non-smoker!

Tobacco is a risk factor

The high instance of smokers among sufferers of erectile dysfunction, significantly higher than in the general population (40% compared to 28%), clearly points to a straightforward correlation between tobacco and erection problems. Epidemiological studies suggest that smokers may be twice as likely to develop erection problems as non-smokers. The risk is obviously higher if we take into account the risks posed by other smoking-related conditions such as diabetes.

Tobacco is harmful for sexual health

As we have seen, most studies have shown that tobacco leads to an impaired arousal phase among men and women. However, the negative effects of tobacco are not limited to arousal and erection problems. Smoking can also affect fertility, effectively decreasing it among both male and female smokers, and as has been well documented, it can also cause problems during pregnancy. The anti-estrogen effect of smoking tends to bring the menopause forward by several years (10). Lastly, many different illnesses such as sexual infections (11) or Peyronie's disease (an abnormality of the penis) can be activated or aggravated by tobacco.


A clear medical recommendation to stop smoking can therefore be formulated, considering the negative impact that smoking has on sexual function. This can be an important motivator for those who wish to stop smoking and regain a functional and fulfilling sex life. It should also be noted that although sexual health problems do not generally affect life expectancy, they are more common than people think and considerably affect the overall health of an individual. They should therefore be subject to proper medical treatment.



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  2. Juenemann KP, Lue TF, Luo JA, Benowitz NL, Abozeid M, Tanagho EA. The effect of cigarette smoking on penile erection. J Urol 1987; 138:438-41.
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  8. J Y Jeremy, D P Mikhailidis : Cigarette smoking and erectile dysfunction. J Roy Soc Health, 1998
  9. Stillman RJ, Rosenberg MJ, Sachs BP, Smoking and reproduction. Fertil Steril. 1986
  10. John G. Spangler, MD, MPH, Smoking and hormone-related disorders. Tobacco use and cessation 1999  11. Cherpes TL, Meyn LA, Krohn MA, Hillier SL, Risk factors for infection with herpes smplex virus type 2 : role of smoking, douching, uncircumcised males, and vaginal flora. Sex Transm Dis. 2003