Smoking and Erectile Dysfunction: Can Quitting Help?

Yes. Smoking is a well-known cause of erectile dysfunction (ED). The chemicals in cigarette smoke damage the lining of your blood vessels and cut the blood flow an erection needs, and the risk climbs the more and the longer you smoke. The good news is that quitting often helps, especially for younger men and lighter smokers, and it protects your heart at the same time.

How does smoking cause erectile dysfunction?

An erection is mostly about blood flow. When you are aroused, nerves signal the thin inner lining of the blood vessels in the penis, called the endothelium, to release a chemical messenger called nitric oxide. Nitric oxide relaxes the smooth muscle in the arteries and the spongy erectile tissue, so blood rushes in and stays there.

Cigarette smoke attacks this system at several points. A review of research on smoking and ED explains that smoke damages the endothelium, lowers the amount of nitric oxide available, and creates oxidative stress, a kind of chemical wear and tear on cells. Over the years, smoking also stiffens artery walls and speeds up the buildup of fatty plaque (atherosclerosis), which narrows the small arteries that feed the penis. The result is less blood flow and weaker erections.

Is it the nicotine or the smoke?

Both play a part. Burning tobacco releases many harmful chemicals that drive much of the oxidative stress and vessel damage described above. Nicotine adds its own effect. It is a vasoconstrictor, which means it squeezes blood vessels narrower, and it has been linked to poorer function of the vessel lining.

Some of the harm eases fast. In lab testing, heavy smokers who stopped for just 24 to 36 hours showed better erection responses. Years of plaque and stiff arteries take much longer to improve, and they may not fully reverse.

Does vaping cause erectile dysfunction too?

Vaping is newer, so the evidence is thinner, but it is not a free pass. Most e-cigarettes deliver nicotine. A review of alternative tobacco products and urologic health points out that nicotine narrows blood vessels, that animal studies suggest e-cigarette vapor can affect erections, and that vapor may still harm the lining of blood vessels, though probably less than smoke does. The authors called for more research.

Since then, a large national US survey of adult men (the PATH Study) found that men who vaped every day were roughly twice as likely to report ED as men who had never vaped. A survey like this shows a link, not proof of cause. If you switched to vaping to protect your sex life, the safer goal is to be free of nicotine altogether.

Does it matter how much you smoke?

Yes. Researchers see a dose-response pattern: the more cigarettes and the more years, the higher the risk and the more severe the ED tends to be. Doctors measure lifetime smoking in pack-years: a pack a day for 20 years equals 20 pack-years.

A Boston community survey of more than 2,300 men found a clear rise in ED risk once men reached about 20 pack-years.
Another study found a clearly higher risk in men with about 29 pack-years, while men with fewer than 12 pack-years looked much like nonsmokers.
Among younger men, heavy smokers (more than 20 cigarettes a day) were about twice as likely to have severe ED as lighter smokers.

These numbers are averages, not a prediction for any one man. Diabetes, high blood pressure, high cholesterol, heavy drinking and stress also affect erections, so smoking is often one piece of a bigger picture.

Will my erections improve if I quit smoking?

For many men, yes, though results depend on your age, your smoking history and how much damage is already there:

Many men notice a difference within months. In one study of men with ED who quit, more than half reported better erections at 6 months. That was about twice the rate seen in men who could not quit, and the gains lasted at least a year.
Younger men tend to gain the most. In another study of men with no other ED risk factors, those who quit with the help of an 8-week nicotine replacement program had better erections a year later. The improvement was seen in men under 50, and men who already had severe ED did not get their function back.
Some risk can linger. Some studies show former smokers still have higher ED rates than men who never smoked, so quitting sooner beats quitting later.

Quitting will not erase every year of smoking, but it stops the damage from piling up and gives your blood vessels a real chance to heal.

Why can ED be an early warning sign for your heart?

The arteries in the penis are smaller than the arteries that feed the heart. When smoking and other risk factors start to harm blood vessels throughout the body, the same level of damage cuts blood flow to the penis sooner and more noticeably. As a cardiology journal article on ED and heart risk explains, ED often shows up before heart problems such as heart attacks, and it can be an early marker that a man is at higher risk of heart disease.

If you smoke and notice erection problems, treat them as a warning signal. Ask your doctor to check your blood pressure, cholesterol and blood sugar. Quitting smoking is one of the most important steps you can take for both your heart and your erections.

What help is available to quit smoking?

You do not have to quit on willpower alone. The CDC guide to quitting smoking says that using counseling and medicine together gives smokers the strongest chance of quitting for good. Options include:

Free coaching: call 1-800-QUIT-NOW to reach a quitline for free, confidential help building a quit plan. The CDC also points to free online help at Smokefree.gov and free text-message programs.
Nicotine replacement: nicotine patches, gum and lozenges are sold in most US drugstores. Nicotine inhalers and nasal sprays are prescription forms.
Prescription quit pills: varenicline and bupropion are options to discuss with your doctor.

Ask your doctor or pharmacist which choice suits you, especially if you have heart disease or take other medicines.

Can ED medicines help while you quit?

Often, yes. Sildenafil (the active ingredient in Viagra) and tadalafil (the active ingredient in Cialis) belong to a group called PDE5 inhibitors. They strengthen the nitric oxide signal that smoking weakens, which helps more blood flow into the penis during arousal. They only work when you are sexually aroused, and they do not repair the damage smoking causes, so they make the most sense alongside quitting, not instead of it.

Tadalafil can work for up to 36 hours, while sildenafil’s effect is much shorter. Our sildenafil vs tadalafil guide compares them in detail, and if you would rather not plan around a pill, see our guide to daily vs as-needed tadalafil. Indian generics such as Cenforce 100 (sildenafil, from $75) and Vidalista 20 (tadalafil, from $80) contain the same active ingredients as Viagra and Cialis and are made and licensed in India. See more options in our ED medication range.

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These are prescription medicines. Never take them with nitrates such as nitroglycerin (glyceryl trinitrate) for chest pain, because the combination can cause a dangerous drop in blood pressure. Since smoking is hard on the heart, ask your doctor whether your heart is healthy enough for sex before you start.

When should you see a doctor?

See a doctor if erection problems keep happening, even if you are fairly sure smoking is the reason. Get checked sooner if:

ED started suddenly, or after an injury or prostate surgery
you have other new symptoms along with ED, such as changes in how you urinate
you get chest pain, pressure or shortness of breath with activity, including during sex (call 911 if chest pain does not go away)
you have diabetes, high blood pressure, high cholesterol or a family history of early heart disease
an erection lasts more than 4 hours after taking an ED medicine, which needs emergency care

Frequently asked questions

How long after quitting smoking does ED get better?

It varies. Some blood-vessel effects ease within days, and many men who quit notice better erections within about 6 months. Younger men and lighter smokers tend to improve the most.

Can smoking just a few cigarettes a day cause ED?

Risk rises with how much you smoke, so light smoking carries less risk than heavy smoking, but it still exposes your blood vessels to smoke and nicotine. Cutting down helps; quitting completely is the goal.

Is erectile dysfunction from smoking permanent?

Not always. Many men improve after quitting, especially younger men with milder ED. Severe ED after many years of smoking is less likely to fully reverse, but treatment can still help.

Do nicotine patches cause ED?

Patches still contain nicotine, but they deliver it without smoke and are meant for short-term use. In one study, men who quit with nicotine replacement had better erections a year later. Follow the package directions.

Do ED pills work if I still smoke?

They can help many men whose ED is linked to blood flow, but they cannot stop smoking from causing more damage. If they seem to work less well over time, see your doctor and make a quit plan.

This article gives general information only and is not medical advice. Prescription medicines, such as ED pills and prescription quit-smoking medicines, should be used under a doctor’s care.