Your sex life up in smoke

By Madeleine Castellanos, M.D.

There was a time when nothing went together like sex and a cigarette. But today we know that cigarettes are the nation's largest killer, with more than 400,000 people dying in the U.S. each year due to smoking-related illnesses. But what many people don't realize is that before cigarettes kill you for good, they will first kill your sex life. As a doctor, I want to give you the facts and another reason to quit smoking today.

Cigarettes can be just as fatal to your sex life due to the components found in the smoke itself and especially the active ingredient nicotine and its effects on blood flow. In fact, smokers are about twice as likely to develop erectile dysfunction than non-smokers. The World Health Organization estimates that about 1.1 billion people throughout the world smoke cigarettes, with more than 46 million of these in the U.S. alone. No surprise then that nearly 40 million Americans identify themselves as being stuck in sexless marriages. How many of these people are smokers?

Good sexual functioning depends on good blood flow. Nicotine, however, is a very potent vasoconstrictor, affecting blood vessels in two ways. First, as a stimulant, it causes direct arterial spasm, affecting arteries of the heart, lungs, eyes, internal organs, arms, legs, and of course, the genitals. Next, it damages the lining of the blood vessels, impairing the ability of those vessels to relax and allow more blood flow. Nicotine also interferes with the mechanism within the veins that help maintain an erection. All this adds up to decreased blood available for an erection and an inability to keep that blood from leaking back out.

Since nicotine is such a powerful and quick constrictor of blood vessels, it has almost immediate effects on genital blood flow. Studies using Doppler imaging have shown that the deeper arteries supplying blood to the penis immediately respond to cigarette smoke by clamping down so that no blood flow is visible after just two cigarettes. Note that this is about the same amount of nicotine that would be found in most nicotine gums or is slowly released from a nicotine patch. Although these spasm effects of nicotine do reverse after one quits smoking or stops using nicotine replacement, there is also long-term damage to the lining of the arteries, as well as the nerves. 

This damage, which is caused by the nicotine along with some of the other smoke components, increases over time to the point where it is irreversible. Some of these components include:

This cumulative damage keeps the arteries from responding to sexual stimulation so that there is no further relaxation of those blood vessels to allow proper blood flow for an erection. In fact, researchers have found that the decrease in nighttime erections is directionally proportional to the number of cigarettes one smokes.

Even though it is not immediately obvious, men aren't the only ones affected. Nicotine and other smoke components have the same effect on genital blood flow in women as they do in men. Fortunately, the risk of permanently affecting your sex life by smoking cigarettes is real and preventable. Although using nicotine replacement therapy is a proven method to help smokers eventually quit, it should not be used as a long-term substitute for cigarettes because of its powerful effects on genital blood flow and its damage to one's sex life. Understanding the risks can help you make informed decisions that can affect you for years to come.

So instead of reaching for a cigarette after sex, reach for your partner. A good cuddle is much healthier.

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