Smoking and erectile dysfunction: Evidence based analysis

Purpose: We examined available evidence concerning the role of smoking in t he development of erectile dysfunction. This task involved a complete revie w of the smoking literature as it pertained to erectile dysfunction and sel ect endothelial diseases. Materials and Methods: We comprehensively reviewed the literature, includin g PubMed and recent abstract proceedings from national meetings relevant to smoking, erectile dysfunction and endothelial diseases. The quality of the evidence was assessed by methods used to develop clinical practice guideli nes. Our review involved an objective evaluation of the basic science liter ature and clinical studies. When necessary, we examined studies of endothel ial diseases other than erectile dysfunction because of obvious gaps in the literature. Results: There are strong parallels and shared risks among smoking, coronar y artery disease, atherosclerosis and erectile dysfunction. Clinical and ba sic science studies provide strong indirect evidence that smoking may affec t penile erection by the impairment of endothelium dependent smooth muscle relaxation. The association of erectile dysfunction with risk factors such as coronary artery disease and hypertension appears to be amplified by ciga rette smoking. Smoking may increase the likelihood of moderate or complete erectile dysfunction 2-fold. The prevalence of erectile dysfunction in form er smokers was no different from that in individuals who had never smoked, implying that smoking cessation may decrease the risk of erectile dysfuncti on. Case studies and retrospective series have shown an association of smok ing with erectile dysfunction. Conclusions: Available evidence on the association of smoking with erectile dysfunction is not complete insofar as association linking factors are con cerned. However, the evidence of such an association is likely due to the c onsistency of the relationship of smoking and endothelial disease, and the strength of the association of erectile dysfunction with other endothelial diseases.