Erectile dysfunction and fertility related to cigarette smoking

Background Many comprehensive review articles on the adverse effects of cigarette smoking on health have been published, but relatively few have focused on the effect of smoking on erectile function and fertility. Data substantiating the damage caused by smoking to the reproductive system may be helpful in enhancing anti-smoking campaigns. Aim To critically review the literature on the effects of smoking on erectile function and fertility. Observations Whilst most of the studies were performed on groups of men with sexual and reproductive disorders and none included a control for alcohol consumption, it appears that the association between cigarette smoking and impotence is significant. The pathogenetic mechanism of smoking-induced erectile dysfunction is associated with vascular (arterial and venous) dysfunction. The biochemical defects remain to be determined. Endothelium-derived relaxing factor, nitric oxide, prostaglandin, prostacycline and thromboxane-changes may explain smoking-induced impotence. Studies concerning the endocrine profile showed elevated serum estradiol levels in smokers. The results of testosterone levels were contradictory. Mosl studies on the association between cigarette smoking and sperm density indicated a 13% to 17% decrease in smokers compared to nonsmokers. Cigarette smokers had also greater numbers of leukocytes in (he seminal fluid and lower sperm penetration assay scores. Although the studies conducted to date do not indicate lhat smoking among males is a risk factor for delayed or difficult conception, this might not be the case in men with marginal semen quality and other risk factors. Conclusions Cigarette smoking is associated with vascular (arterial and venous) impotence, elevated serum estradiol levels and lowered sperm density. These associations are of greater relevance in patients with pre-existing impaired function, as compared to healthy, potent and fertile individuals.