Authors Harte CB and Meston CM
Review Date May 2012
Citation BJU International 2012:109:888-896
Epidemiological studies show that chronic smokers are about 1.5 to 2 times more likely than non-smokers to report erectile dysfunction (ED), after controlling for age and cardiovascular risk factors. It follows that smoking cessation may enhance erectile function but this has not been adequately tested in men with varying levels of erectile function, and using a subjective as well as physiological measures of sexual function.
The study aimed to provide the first empirical investigation of the association between smoking cessation and indices of physiological and subjective sexual health in men, irrespective of erectile function status.
Male smokers, irrespective of erectile dysfunction status, who were motivated to stop smoking (‘quitters’), were enrolled in an 8-week smoking cessation programme involving a nicotine transdermal patch treatment and adjunctive counselling based on the tobacco use and dependence clinical practice guidelines. Participants were assessed at baseline (while smoking regularly), at mid-treatment (while using a high-dose nicotine transdermal patch), and at a 4-week post nicotine patch cessation follow-up. Physiological (circumferential change via penile plethysmography) and subjective sexual arousal indices (continuous self-report), as well as self-reported sexual functioning (measured with the IIEF) were assessed at each visit.
Data were analysed using general linear modelling (Analysis of covariance) to compare successful with unsuccessful quitters at each time point for each outcome variable.
Analyses (described by the authors as ‘intent-to-treat analysis’) indicated that, at follow-up, successful quitters (n= 20), compared with those who relapsed (n= 45), showed enhanced erectile tumescence responses, and faster onset to reach maximum subjective sexual arousal. Although successful quitters displayed across-session enhancements in sexual function, they did not show a differential improvement compared with unsuccessful quitters. Both groups showed a reduction in the proportion with ED (defined by the IIEF) from baseline to follow-up with no significant difference between groups.
Smoking cessation significantly enhances both physiological and self-reported indices of sexual health in long-term male smokers, irrespective of baseline erectile impairment. However a lower prevalence of ED was not found in successful quitters compared to unsuccessful quitters.
The authors hope that these results may serve as a novel means to motivate men to stop smoking.
Points to Note
- This 12-week study involving 65 men showed greater penile tumescence and rate of onset to reach maximum subjective sexual arousal measured four weeks after cessation of nicotine patch use, in those who successfully quite smoking compared to those who relapsed.
- However, self-reported sexual function was not differentially improved in the quitting group, possibly due to the short follow-up period (4 weeks). Also ED was not very common amongst the study participants.
- The results confirm those of other studies and suggest that nicotine hinders male genital response.
- The study was not a randomised trial and the quasi-control group of non-successful quitters may have unmeasured differences to the quitting group responsible for the observed changes.
- The advantage of the study was that it included men with varying sexual function such that the results have relevance not only to men with ED and may be pertinent to younger men who smoke.
- However, the possible motivational effect of the promise of improved erectile function on quitting smoking is yet to be tested.