Smoking and ED: what the research shows about cigarettes, vaping and quitting

The short version: smoking is usually filed under lungs, but it shows up in the research on erectile dysfunction too. The National Institutes of Health lists smoking cigarettes among the lifestyle behaviors that may contribute to ED, and the reason it gives runs through blood vessels. This page sets out what the NIH, the U.S. Surgeon General and the published studies say about smoking, vaping and quitting, how strong that evidence is, and what it can and cannot tell you about your own situation. Smoking is one of several everyday habits covered in our guide to lifestyle and ED, and the rest of our lifestyle and natural approaches section looks at exercise, cycling, diet, cannabis and supplements.

Can smoking cause erectile dysfunction?

Smoking is linked to ED, and the U.S. Surgeon General has concluded that the link is causal across the population of men. The NIH’s National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) says certain lifestyle behaviors may contribute to ED, and its list includes “smoking cigarettes”, alongside too little physical activity, drinking too much alcohol and using recreational or illicit drugs (NIDDK, Symptoms & Causes of ED). NIDDK also names smoking cigarettes among the factors that make a man more likely to have ED (NIDDK, Definition & Facts). The 2014 Surgeon General’s report on smoking and health went further. After reviewing the evidence, it concluded that “the evidence is sufficient to infer a causal relationship between smoking and erectile dysfunction” (The Health Consequences of Smoking: 50 Years of Progress, Executive Summary). That is a conclusion about men as a population. It does not say smoking is the reason for any one man’s ED, which is a separate question covered below.

How could smoking affect erections?

The NIH explanation runs through blood vessels. NIDDK says that some conditions that affect the blood vessels, nerves or hormones can lead to ED, and names heart and blood vessel diseases such as atherosclerosis and high blood pressure among the most common (NIDDK, Symptoms & Causes). On smoking specifically, it says: “Smoking cigarettes is linked to heart and blood vessel disease, which can lead to ED” (NIDDK, Treatment for ED). The NIH’s heart and lung institute (NHLBI) describes the vessel side in more detail: the chemicals inhaled when smoking damage the heart and blood vessels in a way that makes atherosclerosis, or plaque buildup in the arteries, more likely, and smoking also raises the risk of peripheral artery disease (NHLBI, How Smoking Affects the Heart and Blood Vessels). NIDDK describes several ED treatments as working by increasing blood flow to the penis, which is why our guide to what ED can signal about your health treats the heart and the erection as parts of the same circulation.

How strong is the link between smoking and ED?

The clearest numbers come from a 2013 systematic review and meta-analysis in PLoS ONE that pooled eight observational studies with 28,586 men from the United States, Egypt, Brazil, Jamaica and Finland. Because the case-control studies disagreed with each other, the authors leaned on the four prospective cohort studies, which followed men over time. In those, current smokers had an odds ratio of 1.51 for ED compared with men who had never smoked, meaning about 1.5 times the odds, with a 95% confidence interval of 1.34 to 1.71. Former smokers also had higher odds than never smokers, with an odds ratio of 1.29 (95% confidence interval 1.07 to 1.47), but lower than current smokers (Cao et al., PLoS ONE 2013).

The same studies, read by smoking status, look like this. Each row is a group-level association from observational research, not a measure of what smoking did to any one man.

Those figures come with limits the authors spell out. The studies measured ED in different ways, including self-designed questionnaires, a validated questionnaire and clinical diagnosis. They adjusted for different background factors, and the authors note it was unclear which factors should be adjusted for and whether the adjusted estimates were more valid than the unadjusted ones. Their conclusion is worded with care: smoking, “especially current smoking, may significantly increase the risk of ED” (Cao et al., 2013). An odds ratio from observational studies describes how often two things go together across a group. It is not a personal prediction.

Does the amount you smoke matter?

The evidence points that way, though it is limited. In a 2004 study in BJU International of 281 smokers with ED who had none of the other common risk factors checked at the start (high blood pressure, high cholesterol, diabetes, psychiatric conditions or a relevant drug history), the severity of ED correlated significantly with smoking exposure measured in pack-years (Pourmand et al., BJU Int 2004). On the blood vessel side, NHLBI says that “any amount of smoking, even occasional smoking”, can damage the heart and blood vessels (NHLBI). Neither source sets a level of smoking that is free of risk for erections.

Is vaping linked to ED?

The research on e-cigarettes is newer and thinner. A 2022 analysis in the American Journal of Preventive Medicine used survey data from the U.S. Population Assessment of Tobacco and Health study, covering men aged 20 and over in 2016 to 2018. Men who used e-cigarettes every day were more likely to report ED than men who had never used them, with an adjusted odds ratio of 2.24 (95% confidence interval 1.50 to 3.34), and the pattern held at 2.41 in a narrower group aged 20 to 65 with no history of cardiovascular disease (El-Shahawy et al., Am J Prev Med 2022).

This was a single survey taken at one point in time, so it shows an association and cannot show which came first. The authors write that e-cigarette use “seems to be associated” with ED independent of age, cardiovascular disease and other risk factors. They also note that e-cigarettes “remain under evaluation for harm reduction and smoking-cessation potential”, and that users should be told about the possible association (El-Shahawy et al., 2022).

What about secondhand smoke?

None of the sources on this page measured ED in men exposed to secondhand smoke, so there is no ED-specific figure to give. What NHLBI does say is that secondhand smoke can damage the heart and blood vessels of people who do not smoke “in the same ways that smoking causes damage to people who do” (NHLBI). Since NIDDK traces the smoking and ED link through heart and blood vessel disease, that is worth knowing, but it is a statement about the heart and vessels, not a measured effect on erections.

Can quitting smoking help ED?

The NIH lists quitting among its ED lifestyle changes. Its treatment guidance lists quitting smoking among the lifestyle changes a health care professional may suggest to help ED symptoms, and its prevention advice says: “If you smoke cigarettes, one of the best things you can do for your ED and your overall health is to quit smoking” (NIDDK, Treatment for ED). NHLBI adds that quitting lowers the risk of getting and dying from heart disease, and over time lowers the risk of atherosclerosis and blood clots (NHLBI).

The direct evidence on erections is smaller. In the 2004 BJU International study, smokers with ED who asked for nicotine replacement were followed for one year. Of the 281 men, 118 stopped smoking and 163 kept smoking, and the two groups did not differ significantly in age or ED status at the start. After a year, ED status improved in at least 25% of the men who quit and in none of those who kept smoking. Men who were older or had more advanced ED at the start improved less (Pourmand et al., 2004). The men chose for themselves whether to quit, so this was not a randomized trial, and improvement was reported in a share of the men who quit, not in all of them. The 2013 meta-analysis points the same way from population data: former smokers had lower odds of ED than current smokers (Cao et al., 2013). Our comparison of natural remedies and medication for ED covers where lifestyle change fits next to other options, and our guide to whether ED can be reversed looks at which causes tend to improve when they are treated.

How long after quitting smoking can ED improve?

No source on this page gives a timeline, and none can promise that ED will improve at all after quitting. The only study here that followed erections after quitting checked once, at one year. By then, ED status had improved in at least 25% of the men who stopped smoking and in none of those who kept smoking, and 2.5% of the men who quit had worse ED, against 6.8% of the men who kept smoking. Men who were older or whose ED was more advanced at the start improved less (Pourmand et al., 2004). On the heart and blood vessel side, NHLBI says that “no matter how much or how long you’ve smoked, quitting will benefit you”, and that over time quitting lowers the risk of atherosclerosis and blood clots (NHLBI). Other habits that act on the same circulation can be worked on at the same time. NIDDK says physical activity increases blood flow through the body, including the penis (NIDDK, Treatment for ED), and our guide to exercise and ED covers what the trials of exercise measured.

Is smoking cannabis the same question?

No. Everything above is about tobacco cigarettes and e-cigarettes. NIDDK’s lifestyle list names “smoking cigarettes” and, separately, recreational and illicit drugs (NIDDK, Symptoms & Causes), and the studies on this page did not measure cannabis. The research on marijuana and erections is its own, more mixed body of work, covered in our guide to cannabis and ED.

Does smoking mean it caused my ED?

Not necessarily, and no study on this page can answer that for one person. ED has many possible causes, and NIDDK lists diabetes, heart and blood vessel disease, hormone issues, nerve conditions, many common medicines, and emotional issues such as anxiety, depression and stress alongside lifestyle behaviors (NIDDK, Symptoms & Causes). The studies above tried to account for some of these, such as age, high blood pressure and diabetes, in different ways. The American Urological Association (AUA) advises that men should be counseled that ED is a risk marker for underlying cardiovascular disease and other health conditions that may warrant evaluation and treatment (AUA ED Guideline). For a smoker, that makes ED a reason for a fuller check of the heart and vessels, not a self-diagnosis. Our guide to how ED is diagnosed explains what that evaluation involves, and other long-term conditions are covered in chronic conditions and ED.

Where can you get help to quit?

A clinician is a good place to start. The CDC says a health care professional can help you decide which quit-smoking treatment is best for you and connect you to programs and resources. It also lists nicotine replacement therapy as an option and names prescription pills you can discuss with your doctor, says that using counseling and medication together gives the best chance of quitting for good, and that the free quitline at 1-800-QUIT-NOW connects you with a coach to make a quit plan (CDC, How to Quit Smoking). If you are also noticing changes in your erections, it is worth raising both in the same visit, and our guide on when to see a doctor about ED covers what that first appointment usually looks like. If raising it feels awkward, our guide to talking to a doctor about ED has wording you can use.

The bottom line

The NIH lists smoking cigarettes as a lifestyle behavior that may contribute to ED and links it to heart and blood vessel disease, which can lead to ED. The 2014 Surgeon General’s report concluded that the evidence is sufficient to infer a causal relationship between smoking and ED, a finding about men as a population rather than any one man’s diagnosis, and pooled long-term studies found about 1.5 times the odds of ED in current smokers. Evidence on vaping is early and comes from one survey. The NIH calls quitting one of the best things a smoker can do for ED and overall health, and a clinician can help with both the quitting and the question of what is behind your own symptoms.

Sources

Every clinical statement on this page traces to a primary or guideline source:

• NIH NIDDK, Symptoms & Causes of Erectile Dysfunction (last reviewed October 2024): smoking cigarettes among the lifestyle behaviors that may contribute to ED, and the other diseases, medicines and emotional issues that can lead to ED.
• NIH NIDDK, Treatment for Erectile Dysfunction (last reviewed October 2024): quitting smoking as a lifestyle change a clinician may suggest; quitting as one of the best things a smoker can do for ED and overall health; smoking linked to heart and blood vessel disease, which can lead to ED.
• NIH NIDDK, Definition & Facts for Erectile Dysfunction (last reviewed October 2024): smoking cigarettes among the factors that make ED more likely.
• NIH NHLBI, How Smoking Affects the Heart and Blood Vessels: smoking damage to the heart and blood vessels and atherosclerosis, peripheral artery disease, any amount of smoking, secondhand smoke, the heart benefits of quitting, and that quitting benefits you no matter how much or how long you have smoked.
• U.S. Department of Health and Human Services, The Health Consequences of Smoking: 50 Years of Progress, A Report of the Surgeon General, Executive Summary (2014): the conclusion that the evidence is sufficient to infer a causal relationship between smoking and erectile dysfunction.
• Cao S, et al. Smoking and Risk of Erectile Dysfunction: Systematic Review of Observational Studies with Meta-Analysis (PLoS ONE, 2013): eight studies (four case-control, four cohort) and 28,586 men; odds ratio 1.51 (95% CI 1.34 to 1.71) for current smokers and 1.29 (95% CI 1.07 to 1.47) for former smokers in prospective cohort studies; differences in ED measurement and adjustment as limitations.
• Pourmand G, et al. Do cigarette smokers with erectile dysfunction benefit from stopping? A prospective study (BJU International, 2004): ED severity correlated with pack-years; after one year ED status improved in at least 25% of 118 men who stopped and none of 163 who continued, and worsened in 2.5% and 6.8% respectively; less improvement with older age and more advanced ED.
• El-Shahawy O, et al. Association of E-Cigarettes With Erectile Dysfunction: The Population Assessment of Tobacco and Health Study (Am J Prev Med, 2022): daily e-cigarette users more likely to report ED than never users (adjusted odds ratio 2.24, 95% CI 1.50 to 3.34, in the full sample, 2.41 in men aged 20 to 65 without cardiovascular disease), from cross-sectional survey data.
• American Urological Association, Erectile Dysfunction Guideline (Burnett et al., J Urol 2018): counseling men that ED is a risk marker for underlying cardiovascular disease and other conditions that may warrant evaluation.
• CDC, How to Quit Smoking: talking with a health care professional, counseling and medication together, and the 1-800-QUIT-NOW quitline.