Tobacco and Erectile Dysfunction

1. Module: Tobacco and the Uropoetic System TOBACCO AND ERECTILE DYSFUNCTION

2. Objectives of the Mini Lecture Goal of Mini-Lecture: Provide students with knowledge about the association between tobacco use and erectile dysfunction. Learning Objectives: Students will be able to: • Describe the burden of erectile dysfunction in smokers. • Explain the association between smoking and erectile dysfunction. • Explain the importance of smoking cessation for erectile dysfunction.

3. Contents Core Slides • The Burden of Erectile Dysfunction • Smoking and Sexual Health in Men • Smoking as a Risk Factor for Erectile Dysfunction • Smoking and Erectile Dysfunction • Pathophysiology of Smoking and Erectile Dysfunction • Smoking Cessation and Erectile Dysfunction

4. The Burden of Erectile Dysfunction Global Study of Sexual Attitudes and Behaviors (GSSAB) • Global sexual dysfunction in men: early ejaculation (14%) and erectile dysfunction (10%). • Erectile dysfunction in Asia: 2% in Singapore to 33% in the Philippines. In Indonesia = 11%. • 27% of respondents in Indonesia reported at least one sexual dysfunction problem.1,2 • Prevalence of erectile dsyfunction in the US (NHANES study): 6.5% in men 20-39 years to 77.5% in men 75 years old and older.3 1. Nicolosi et al. 2004; 2. Nicolosi et al. 2005; 3. DeRogatis and Burnett 2008

5. Smoking and SexualHealth in Men • Smoking → atherosclerosis and changes in arterial endothelium → influences on reproductive health1: • Erectile dysfunction • Reduction in semen quality • Reduced response to fertility treatment • Foetal malformation • Smoking: independent risk factor for erectile dysfunction.2 1. Peate 2005; 2. Hatzimouratidis 2007

6. Smoking as a Risk Factor forErectile Dysfunction1,2 • Current smokers and ex-smokers have higher risk for erectile dysfunction compared to non-smokers. • Current smokers have 70% higher risk for erectile dysfunction compared to non-smokers. • The risk is positively associated with the duration and intensity of smoking. • The risk increases in patients with heart disease, treated hypertension, and diabetes. 1. Hatzimouratidis 2007; 2. Kupelian et al. 2007

7. Smoking and Erectile Dysfunction • Both active and passive smoking increases the risk of ED, which shares some atherogenic risk factors with coronary heart diseases.1,2 • Smoking increases the risk of ED by 50% (OR = 1.5; 95% CI = 1.3-1.7), and quitting will reduce the risk by 30% (OR = 1.2; 95% CI = 1.1-1.3)3 1. Feldman et al. 2000; 2. Tengs et al. 2001; 3. Bacon et al. 2006

8. Pathophysiology of Smokingand Erectile Dysfunction • Cigarette smoking decreases nitric oxide (NO) bioavailability and increases reactive oxygen species (ROS).1,2 • Effect of cigarette smoking on the vascular system: • Short term effects: decreased arterial flow to the penis and acute vasospasm of the penile arteries. • Long term effects: damage to the vascular endothelium and peripheral nerves, ultrastructural damage to the corporal tissue, impairment of endothelium-dependent smooth muscle relaxation.1 1. Tostes et al. 2008; 2. Saenz de Telada et al. 2005

9. Smoking Cessation and Erectile Dysfunction • Cessation should be an integrated strategy for clinical treatment for erectile dysfunction. • Penile hemodynamics improve soon after cessation, which can later improve erectile function. • The mechanisms and reversibility of the process are yet to be studied.1 • Cessation of smoking should be advised along with other health behaviors, i.e. exercise and avoidance of excessive alcohol in order to preserve normal endothelial function.2 1. Sighinolfi et al. 2007; 2. Meldrum et al., 2010

10. The most important health message a doctor can give to patients is to quit smoking.