Erectile Dysfunction Linked to Daily e-Cigarette Use in Population-based Study

Daily e-cigarette use was associated with more than twice the odds of reporting erectile dysfunction vs never using e-cigarettes, independent of other common ED risk factors.

Men who used e-cigarettes daily were more than twice as likely to report erectile dysfunction (ED) than those who never used e-cigarettes, according to findings published in the American Journal of Preventive Medicine.

The association was found to be consistent independent of age, presence of cardiovascular disease (CVD), and other common ED risk factors, according to authors led by Omale El-Shahawy, MD, MPH, PhD assistant professor in the Department of Population Health  Department of Population Health at NYU Langone Health. Their findings led authors to urge clinicians to inform ENDS users about the possible link with ED—which they say impacts 1 in 5 men older than age 20 years in the US.

Cigarette smoking has long been associated with ED and with CVD, but research is scant on any similar association among men who use electronic nicotine delivery systems (ENDS), study authors write.

“Given that many people use e-cigarettes as a form of smoking harm reduction or to help them with smoking cessation, we need to fully investigate the relationship between vaping products and erectile dysfunction, and potential implications for men’s sexual health,” said El-Shahawy in a NYU Langone press statement. He added that the study included participants who had not been smokers before using ENDS, suggesting that the odds of ED may be higher regardless of smoking history.

El-Shahawy and colleagues analyzed information from the Population Assessment of Tobacco and Health, a nationally representative study of nearly 46 000 US adults that examines tobacco use and health outcome.

Using data from the 2016 to 2018 dataset, the analysis included 13 711 men aged ≥20 years who responded to a question regarding erectile dysfunction. Most participants self-reported as heterosexual or straight (95%) and non-Hispanic white (66%). The association between ENDS and ED was examined in the full sample and also in a restricted group of 11 207 men aged 20 to 65 years who had no prior CVD history.

The respondents self-reported current and previous smoking habits and were classified as never, former, and current (occasional or daily) users. Never smokers were characterized as smoking fewer than 100 cigarettes in their lifetime.

Overall, 53% of respondents were former cigarette smokers, 21% were current smokers and 14% used other tobacco products. Current ENDS use, investigators found, was reported by 4.8% of the overall sample and 4.7% of the sample restricted to men with no prior CVD history. Among them, 2.1% and 2.5%, respectively, reported daily use. Investigators found no substantive variation in other covariates between the 2 groups.

El-Shahawy et al write that among participants in the overall sample, 20.7% reported ED and in the restricted sample 10.2% reported the condition.

The researchers found that daily users were more likely to report ED than never users in both the full sample (adjusted OR = 2.24; 95% CI, 1.5-3.34) and the restricted sample (aOR = 2.41; 95% CI, 1.55-3.74).

Analysis of the full sample found that participants with history of CVD and those aged ≥65 years were more likely to report erectile dysfunction (aOR = 1.39; 95% CI, 1.1-1.77) vs those with in the restricted sample (aOR = 17.4; 95% CI, 12.15-24.91). Physical activity at any frequency was associated with lower odds of ED among all study respondents, according to the findings.

The authors found that the ED-ENDS use association remained among men aged younger than 65 years with a normal body mass index and without CVD, suggesting the association persists despite a “relatively healthy population,” they wrote.

“There is a need to continue evaluating the full range of ENDS as a tobacco harm reduction strategy,” write authors in the study conclusion. Further studies, they add, are needed to “contextualize the e-cigarette use pattern that is relatively safer than smoking.”

Study limitations, according to the investigators, include that the analyses were based on self-report of ENDS use and ED status, leaving open the possibility of misclassification and desirability bias, and also that there were no data on use of medications associated with ED, eg, beta blockers or antidepressants.


Reference: El-Shahawy O, Shah T, Obisesan OH, et al. Association of e-cigarettes with erectile dysfunction: the Population Assessment of Tobacco and Health Study. Am J Preventive Med. 2021;doi:10.1016/j.amepre.2021.08.004.