The Link between Smoking and Impotence: Two Decades of Evidence

Background. Anti-tobacco advertisements now feature the risk of impotence as a reason to avoid or cease tobacco use. The scientific evidence, however, is mixed. To shed light on the controversy, we compiled 2 decades of published data on the link between smoking and impotence. Methods. We searched MEDLINE from 1980 to the present for studies that reported smoking prevalence among impotent male subjects. For each study we recorded the age of subjects, their state of residence, the percentage that were current smokers, and the time period over which study data were collected. For comparison purposes, we estimated age-, state-, and year-specific smoking rates in the general male population using the Behavioral Risk Factors Surveillance System. We performed a meta-analysis using a random effects model. Results. Among the 1008 journal articles examined, we identified 19 studies that reported the smoking habits of 3819 impotent men. Of these 19 studies, 16 indicated a smoking prevalence exceeding that of the general population. The 6 largest studies all revealed a higher prevalence of smoking among impotent men. Meta-analysis reveals that 40% of impotent men were current smokers compared with 28% of men in the general population. Conclusions. Based on almost 2 decades of evidence, tobacco use is an important risk factor for impotence. Anti-tobacco advertisements featuring impotence as a reason to avoid or cease tobacco use are well grounded in scientific fact.