Cigarette smoking causes erectile dysfunction, a point highlighted in the California Tobacco Control Program’s 1998 ad, “Gala Event” (below). There are multiple pathways between smoking and erectile dysfunction, including adverse effects of nicotine, depression in testosterone, increased risk of cardiovascular and other disease and adverse effects on the ability of arteries to dilate (get larger). E-cigarettes have a lot of the same effects, so one would expect e-cigarette users to also be at increased risk of erectile dysfunction.
Now Omar El-Shahaway and colleagues have looked in the FDA’s large Population Assessment of Tobacco and Health dataset and found that, controlling for a wide range of factors, men who use e-cigarettes have about double the odds of reporting erectile dysfunction.
Their paper, “Association of e-cigarettes with erectile dysfunction: The Population Assessment of Tobacco and Health study,” just published in American Journal of Preventive Medicine, assessed the association between e-cigarette use and self-reported erectile dysfunction. The found that among men 20 years old and older, current daily e-cigarette users were more likely to report erectile dysfunction than never users in both the full sample (AOR=2.24, 95% CI=1.50, 3.34) and and in a restricted sample that was limited to men with no history of cardiovascular disease 20-65 years old (AOR=2.41, 95% CI=1.55, 3.74) samples.
These risk estimates control for a wide range of factors, including the men’s smoking cigarettes. The fact that the risks associated with e-cigarette use are detectable even among smokers adds to the evidence that dual use (vaping and smoking at the same time) is more dangerous than just smoking. This is important because rather than “switching completely” many e-cigarette users keep smoking.
Hopefully, the FDA will consider this new information when assessing whether to authorize Juul and other e-cigarettes for sale in the US.
Here is the abstract for the paper:
Smoking is independently associated with erectile dysfunction and cardiovascular disease. Given existing similarities in the constituents of e-cigarettes or ENDS and cigarettes, this study examines the association between ENDS use and erectile dysfunction.
Data from Wave 4 (2016–2018) of the Population Assessment of Tobacco and Health study were analyzed in 2020. Male participants aged ≥20 years who responded to the erectile dysfunction question were included. Multivariable logistic regression models examined the association of ENDS use with erectile dysfunction within the full sample and in a restricted sample (adults aged 20–65 years with no previous cardiovascular disease diagnosis) while adjusting for multiple risk factors.
The proportion of erectile dysfunction varied from 20.7% (full sample) to 10.2% (restricted sample). The prevalence of current ENDS use within the full and restricted samples was 4.8% and 5.6%, respectively, with 2.1% and 2.5%, respectively, reporting daily use. Current daily ENDS users were more likely to report erectile dysfunction than never users in both the full (AOR=2.24, 95% CI=1.50, 3.34) and restricted (AOR=2.41, 95% CI=1.55, 3.74) samples. In the full sample, cardiovascular disease history (versus not present) and age ≥65 years (versus age 20–24 years) were associated with erectile dysfunction (AOR=1.39, 95% CI=1.10, 1.77; AOR= 17.4, 95% CI=12.15, 24.91), whereas physical activity was associated with lower odds of erectile dysfunction in both samples (AOR range=0.44−0.58).
The use of ENDS seems to be associated with erectile dysfunction independent of age, cardiovascular disease, and other risk factors. While ENDS remain under evaluation for harm reduction and smoking-cessation potential, ENDS users should be informed about the possible association between ENDS use and erectile dysfunction.
The full citation is
Omar El-Shahawy, Tanmik Shah, Olufunmilayo H. Obisesan, Meghan Durr, Andrew C. Stokes, Iftekhar Uddin, Ria Pinjani, Emelia J. Benjamin, Mohammadhassan Mirbolouk, Albert D. Osei, Tom Loney, Scott E. Sherman, Michael J. Blaha. Association of E-Cigarettes With Erectile Dysfunction: The Population Assessment of Tobacco and Health Study,
American Journal of Preventive Medicine, 2021, ISSN 0749-3797, https://doi.org/10.1016/j.amepre.2021.08.004. It is available here.
Here is a good news story summing up the study.