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CORRELATION BETWEEN SMOKING AND ERECTILE
DYSFUNCTION
MUHAMAD REDZUAN BIN JOKIRAM
030.08.281
FACULTY OF MEDICINE
TRISAKTI
JAKARTA, JULY 2011
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CONTENT
ABSTRACT………………………………………………………………………………………2
INTRODUCTION……………………………………………………………………………….3
SMOKING……………………………………………………………………………………….4
ERECTILE DYSFUNCTION………………………………………………………………….6
CORRELATION BETWEEN SMOKING AND ERECTILE DYSFUNCTION…………10
CONCLUSION…………………………………………………………………………………14
REFERENCES…………………………………………………………………………………16
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ABSTRACT
The association between smoking and erectile dysfunction was evaluated in a cohort
of 2,115 Caucasian men, aged 40 – 79 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
dysfunction.
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 :
INTRODUCTION
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
life.
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
smoking.
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CHAPTER 2 :
SMOKING
DEFINITION
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.
HEALTH EFFECTS
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
PHYSIOLOGY
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 m² (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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DEFINITION
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)
CAUSES AND SYMPTOMS
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
SYMPTOMS
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
DIAGNOSIS
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 and
checking your nerves for feeling.
Blood tests. A sample of your blood may be sent to a lab to check for signs of heart
disease, diabetes, low testosterone levels and other health problems.
Urine tests (urinalysis). Like blood tests, urine tests are used to look for signs of
diabetes 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 remembering
them. 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 :
THE CORRELATION BETWEEN SMOKING AND ERECTILE DYSFUNCTION
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 40 – 70 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 31 – 49 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)
DISCUSSION
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 association between 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
age.(4)
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 18 – 24 years (26.9 percent) and aged 25 – 44 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 :
CONCLUSION
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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REFERENCES
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 2011
Available at : http://www.mayoclinic.com/health/erectile-dysfunction/DS00162
4. Relationship between smoking and erectile dysfunction Acces On 24 JUN 2011
Available at : http://www.nature.com/ijir/journal/v17/n2/full/3901280a.html
5. Erectile Dysfunction Linked To Smoking Acces On 24 JUN 2011
Available at : http://www.sciencedaily.com/releases/2007/07/070727153458.htm
6. Erectile Dysfunction and Smoking Acces On 29 JUN 2011
Available at : http://ezinearticles.com/?Erectile-Dysfunction-and-Smoking&id=410335