Microsoft word - tobacco use and impotence 1-10-08.doc

If you smoke, you’re playing Russian roulette with your sexual function.
Dr. John Mulhall, Director, Center for Sexual Health, Loyola University Medical Center There’s absolutely no question about it. It causes it very commonly.
Dr. Culley Carson, Urology Department Chairman, University of North Carolina If you smoke, you’re about twice as likely to have erectile dysfunction.
Dr. John McKinlay, New England Research Institute Smoking is clearly hazardous to your erection.
Dr. Lawrence Levine, Rush Medical Center, Director of Male Sexual Function Program I feel confident that smoking does and can cause impotence.
Dr. Randolph Smoak, Chair, Board of Trustees, American Medical Association [All quotes from the “60 Minutes” program on smoking and impotence (CBS: November 8, 1998)]
Is It More Than Just An Embarrassing Problem?

What you have to understand is that the penile arteries are tiny arteries--about a third that of a coronary
artery--so it’s not unusual for people to have erection problems preceding any other vascular problem,
whether it be heart attacks or strokes.

Dr. John Mulhall, Director, Center for Sexual Health, Loyola University Medical Center (60Minutes)
We are finding that erectile dysfunctional or impotence may be a precursor or an indicator of oncoming
cardiovascular disease, so rather than dismissing it as just simply normal aging and nothing to get alarmed
about, we’re beginning to take this very, very seriously.

Dr. John McKinlay, New England Research Institute (60 Minutes, November 8, 1998 )
Is It A Problem That Young Smokers Need To Worry About?
60 MINUTES: Teen-agers who smoke two packs a day could have these problems before they're 30. If you
have teen-age boys, what would you tell them about smoking, truly?
Dr. Alan Greenfield, Boston Radiologist: Well, I have told them that I believe that the greatest risk they run
from smoking is the risk of impotence. While cancer and heart disease are risks in the longer term.
Other Reports in the Media
Are you ready for the cigarette health warning that could turn millions of men into non-smokers overnight?
Smoking will reduce the size of your penis.

John Illman, “Health Warning: Smoking Can Seriously Shrink Your Manhood,” Guardian Media Group, (July 26, 1998) A potent new weapon is surfacing in the battle against smoking: impotence . . . Scientists have known about links between smoking and sexual problems for several years. But doctors and health-advocacy groups – in some cases emboldened by the global publicity for the drug Viagra – are just now beginning to trumpet the warnings. Suein L. Hwang & Nick Cumming-Bruce, “How Impotence Became Weapon Against Smoking,” The Wall Street Journal (November 9, 1998) Starting from 5 November 1998 . . . Thailand will be the first nation to have sex warnings printed on the cigarette packets. There is evidence to show that smoking affects men’s reproductive, urinary and sexual functions. It deforms sperm and thus cuts down blood flow to the penis and might be related to higher incidence of miscarriage in cases where the father is a smoker. “Sex Warning To Be Printed On Cigarettes,” Information Access Company (October 28, 1998) 1400 I Street NW · Suite 1200 · Washington, DC 20005 Phone (202) 296-5469 · Fax (202) 296-5427 · Tobacco Use & Impotence / Page 3

Despite attempts by tobacco advertisers to make smoking appear sexy, scientists say its effect can be just
the opposite – impotence . . . And smokers should not look to Viagra, the anti-impotence drug, as a panacea.
Viagra “will not be as effective in smokers because the smoking . . . will decrease the responsiveness of
blood vessels,” [Chairman of the Urology Department at the University of North Carolina Dr. Cully] Carson
said. “And Viagra depends on the responsiveness of blood vessels to function.”

Reuters, “Add Impotence to the List of Smokers’ Ills Report” (November 6, 1998). A doctor spearheading Thailand’s anti-smoking drive said cigarette packs labeled “smoking causes impotence” . . . had prompted a torrent of queries, mostly from worried women married to smokers. Dr. Prakit Vateesatogkit . . .said his office had been inundated with calls from women seeking suggestions as to how they can get their husbands to quit. . . . A heavy smoker, Sombat Polyiem, 31, agreed that the latest warning would be effective. “My wife has repeatedly urged me to stop smoking since the news about the impotence warning appeared in the papers,” said Sombat, a motorcycle taxi driver. “I’m afraid of becoming impotent.” Sutin Wannabovorn, “Impotence Warning on Cigarettes Worries Thai Women,” Reuters What Do the Tobacco Companies Have To Say About All This?

60 MINUTES: We wanted to ask the tobacco companies about their sexy ads and about the link between
smoking and impotence, but every one of them declined to talk to us about it.

Cigarette makers, who have devoted huge sums to strengthen smoking's macho, sexy image, are mum on
the subject. “We don’t have anybody who has done any work in that area,” a spokesman for RJR Nabisco
Holdings Corp.’s Reynolds tobacco unit says. “"That’'s about all we’ve got to say about it.” A spokesman for
Philip Morris Cos. declined to comment.
Hwang & Cumming-Bruce, “How Impotence Became Weapon Against Smoking,” The Wall Street Journal (November 9, 1998)
Scientific Research on Tobacco Use and Impotence

In vitro and animal studies, and some epidemiological evidence based on volunteers and patients, have
supported a link between smoking and ED [erectile dysfunction]. . . These studies indicate that smoking is an
independent risk factor for vasculogenic impotence and underline the possibility that smoking may act in a
synergistic/additive manner with other risk factors.
Bortolotti, A., et al., “The Epidemiology of Erectile Dysfuntion and Its Risk Factors,” International Journal of Epidemiology 20: 323-334 (1997). A 2007 study’s findings done using results from the Boston Area Community Health (BACH) survey supports the association between smoking and erectile dysfunction. The study assessed over 2000 men between the ages of 30 and 79 and found that cumulative pack-years of smoking increased the risk of erectile dysfunction. Kupelian, V. et al., “Association between smoking, passive smoking, and erectile dysfunction: Results from the Boston Area Community Health (BACH) Survey,” European Urology 52:416-422 (2007). A study examining the link between cigarette smoking and impotence in over 7000 Chinese men found a statistically significant dose-response relationship between the two. The study found that the more cigarettes smoked per day, the higher the odds of erectile dysfunction, compared to non-smokers. The study also suggests that smoking prevention should be an important approach for reducing the risk of impotence. He, J. et al., “Cigarette Smoking and Erectile Dysfunction among Chinese Men without Clinical Vascular Disease,” American Journal of Epidemiology 166(7):803-809 (2007). Campaign for Tobacco Free Kids, January 2008

Other Studies on Tobacco Use and Impotence
Kupelian, V. et al., “Association between smoking, passive smoking, and erectile dysfunction: Results from the Boston
Area Community Health (BACH) Survey,” European Urology 52:416-422 (2007).
He, J. et al., “Cigarette Smoking and Erectile Dysfunction among Chinese Men without Clinical Vascular Disease,” American Journal of Epidemiology 166(7):803-809 (2007). Tobacco Use & Impotence / Page 3

Millet, C. et al., “Smoking and erectile dysfunction: findings from a representative sample of Australian men,” Tobacco
15:136-139 (2006).
Gades, N. M. et al., “Association between Smoking and Erectile Dysfunction: A Population-based Study,” European
161(4):346-351 (2005).
Mirone, V. et al., “Cigarette Smoking as Risk Factor for Erectile Dysfunction: Results from an Italian Epidemiological
Study,” European Urology 41:294-297 (2002).
Xie, Y. et al., "Effect of Long-term Passive Smoking on Erectile Function and Penile Nitric Oxide Synthase in the Rat,"
Journal of Urology 157(3): 1121-26 (March 1997).
Mannino, D. et al., “Cigarette Smoking: An Independent Risk Factor for Impotence?” American Journal of Epidemiology
140(11): 1003-1008 (December 1, 1994).
Feldman, Henry A., et al., "Impotence and Its Medical and Psychosocial Correlates: Results of the Massachusetts Male
Aging Study," Urology 151: 54-61 (January 1994).
Mikhailidis, D.P. and J.Y. Jeremy, "Smoking and Erectile Impotence," International Angiology 12: 297-298 (1993).
Hirshkowitz, M. et al., “Nocturnal Penile Tumescence in Cigarette Smokers With Erectile Dysfunction,” Urology 39(2):
101-107 (February 1992).
Shabsigh, R. et al., “Cigarette Smoking and Other Vascular Risk Factors in Vasculogenic Impotence,” Urology 38(3):
227-31 (September 1991).
Rosen, M.P. et al., “Cigarette Smoking: An Independent Risk Factor for Atherosclerosis in the Hypogastric-Cavernous
Arterial Bed of Men with Arteriogenic Impotence,” Journal of Urology 145(4): 759-63 (April 1991).
Forsberg, L. et al. “Severe Arterial Insufficiency in Impotence Confirmed with an Improved Angiographic Technique: the
Impact of Smoking and Some Other Etiologic Factors” European Urology 16(5): 357-60 (1989).
Shabsigh, R., et al., "Evaluation of Erectile Impotence," Urology 32: 83-90 (1988).
Glina, S. et al. “Impact of Cigarette Smoking on Papaverine-induced Erection. Journal of Urology 140(3): 523-24
(September 1988).
Juenemann, K.P. et al. “The Effect of Cigarette Smoking on Penile Erection,” Journal of Urology 138(2): 438-41 (August
Bornam M.S. et al. “Smoking and Vascular Impotence. A reason for Concern.” South African Medical Journal 70(6): 329-
30 (September 13, 1986).
Condra, M. et al. ”Prevalence and Significance of Tobacco Smoking in Impotence,” Urology 27(6): 495-98 (June 1986).
Virag, R. et al., "Is Impotence an Arterial Disorder? A Study of Arterial Risk Factors In 440 Impotent Men," Lancet 26:
181-184 (1985).
Forsberg, L. et al., "Impotence, Smoking, and Beta-Blocking Drugs," Fertility and Sterility 31(5): 589-91 (May 1979).
Golding, J.F. & G.L. Mangan, "Effects of Cigarette Smoking on Measures of Arousal, Response Suppression, and
Excitation/Inhibition," International Journal of Addiction 17(5): 793-804 (July 1982).
Studies on Tobacco Use and Penile Cancer

Harish, K. & R. Ravi, "The Role of Tobacco in Penile Carcinoma," British Journal of Urology 75(3): 375-77 (March 1995).
Hellberg, D., et al., "Penile Cancer: Is There an Epidemiological Role for Smoking and Sexual Behavior?," British Medical
(Clinical Research Edition) 295(6609): 1306-1308 (November 1987).
Abstracts of many of the listed studies can be found at the PubMed website:


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