CORRELATION BETWEEN SMOKING AND ERECTILE DYSFUNCTION

MUHAMAD REDZUAN BIN JOKIRAM 030.08.281

FACULTY OF MEDICINE TRISAKTI JAKARTA, JULY 2011

CONTENT

ABSTRACT2

INTRODUCTION.3

SMOKING.4

ERECTILE DYSFUNCTION.6

CORRELATION BETWEEN SMOKING AND ERECTILE DYSFUNCTION10

CONCLUSION14

REFERENCES16

ABSTRACT The association between smoking and erectile dysfunction was evaluated in a cohort of 2,115 Caucasian men, aged 4079 years, randomly selected from Olmsted County, Minnesota. Of the 1,329 men with a regular sexual partner, 173 were current smokers, 836 had previously smoked, and 203 reported erectile dysfunction. Compared with former and never smokers, current smokers in their forties had the greatest relative odds of erectile dysfunction. Compared with men who never smoked, men who smoked at some time had a greater likelihood of erectile dysfunction. One of the US national health goals for 2010 is to decrease the prevalence of smoking in adults. In 2001, an estimated 46.2 million adults were current smokers, and the prevalence of cigarette smoking was higher among men than women. While much of the focus has been on cancer and cardiovascular diseases, these diseases tend to occur at older ages; therefore, younger adults and adolescents may discount the increased risk. Erectile dysfunction (ED) has been reported to be associated with smoking, and antismoking advertising campaigns have tried to use this information to their advantage .(4) Smokers had a higher risk and a lower recovery from ED than nonsmokers. Quitting smoking and risk to start smoking were higher among men with ED. Although the relative risks were nonsignificant, this findings were consistent with the hypothesis that there are two associations between ED and smoking. Firstly, smoking causes ED. Secondly, smoking reduces recovery from ED and. Therefore, there was substantial random variation and the estimated incidence ORs were not statistically significant. These two associations and their relative importance result in the common finding of association between the prevalence of smoking and the prevalence of ED.

CHAPTER 1 : INTRODUCTION Smoking, primarily of tobacco, is an activity that is practiced by some 1.1 billion people, and up to 1/3 of the adult population. The image of the smoker can vary considerably, but is very often associated, especially in fiction, with individuality and aloofness. Even so, smoking of both tobacco and cannabis can be a social activity which serves as a reinforcement of social structures and is part of the cultural rituals of many and diverse social and ethnic groups. Erectile dysfunction (ED) has been reported to be associated with smoking, and antismoking advertising campaigns have tried to use this information to their advantage . Erectile dysfunction (ED) is a common public health problem affecting millions of men worldwide. It has a strong negative effect on interpersonal relationship, well-being and quality of life. The use of tobacco is a major public health problem worldwide, and its effect on sexual life is an often-used fact in anti-smoking campaigns. Association between smoking and ED has been assessed mainly in prevalence studies, which have considerable weaknesses for elucidating the etiology of ED. two longitudinal studies have evaluated the effect of smoking on erectile function. One has clearly shown that smoking does not have an effect on the incidence of ED.and the other has also found no effect in whole sample.while doubling of risk in a subgroup of men free from vascular diseases.(5) Little is known about the frequency of spontaneous recovery, and no study has been published on the effect of smoking on the recovery from ED and the effect of ED on starting or stopping smoking.

CHAPTER 2 : SMOKING DEFINITION Smoking is a practice in which a substance, most commonly tobacco or cannabis, is burned and the smoke is tasted or inhaled. This is primarily practised as a route of administration for recreational drug use, as combustion releases the active substances in drugs such as nicotine and makes them available for absorption through the lungs. It can also be done as a part of rituals, to induce trances and spiritual enlightenment. The most common method of smoking today is through cigarettes, primarily industrially manufactured but also hand-rolled from loose tobacco and rolling paper. Other smoking implements include pipes, cigars, bidis, hookahs, vaporizers and bongs. It has been suggested that smoking-related disease kills one half of all long term smokers but these diseases may also be contracted by non-smokers. A 2007 report states that about 4.9 million people worldwide each year die as a result of smoking. HEALTH EFFECTS Tobacco-related diseases are some of the biggest killers in the world today and are cited as one of the biggest causes of premature death in industrialized countries. In the United States about 500,000 deaths per year are attributed to smoking-related diseases and a recent study estimated that as much as 1/3 of China's male population will have significantly shortened life-spans due to smoking.Smoking one cigarette a day results in a risk of heart disease that is halfway between that of a smoker and a non-smoker. The non-linear dose response relationship is explained by smoking's effect on platelet aggregation. (2) Among the diseases that can be caused by smoking are vascular stenosis, lung cancer,heart attacks and chronic obstructive pulmonary disease. Passive smoking, or secondhand smoking, which affects people in the immediate vicinity of smokers, is a major reason for the enforcement of smoking bans. A common concern among legislators is to discourage smoking among minors and many states have passed laws against selling tobacco products to underage customers. (2)
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The effects of addiction on society vary considerably between different substances that can be smoked and the indirect social problems that they cause, in great part because of the differences in legislation and the enforcement of narcotics legislation around the world. Though nicotine is a highly addictive drug, its effects on cognition are not as intense or noticeable as other drugs such as, cocaine, amphetamines or any of the opiates (including heroin and morphine). Smoking is a risk factor in Alzheimer's Disease. While smoking more than 15 cigarettes per day has been shown to worsen the symptoms of Crohn's Disease, smoking has been shown to actually lower the prevalence of ulcerative colitis PHYSIOLOGY Inhaling the vaporized gas form of substances into the lungs is a quick and very effective way of delivering drugs into the bloodstream (as the gas diffuses directly into the pulmonary vein, then into the heart and from there to the brain) and affects the user within less than a second of the first inhalation. The lungs consist of several million tiny bulbs called alveoli that altogether have an area of over 70 m (about the area of a tennis court).The inhaled substances trigger chemical reactions in nerve endings in the brain due to being similar to naturally occurring substances such as endorphins and dopamines, which are associated with sensations of pleasure. The result is what is usually referred to as a "high" that ranges between the mild stimulus caused by nicotine to the intense euphoria caused by heroin, cocaine and methamphetamines.(1) Inhaling smoke into the lungs, no matter the substance, has adverse effects on one's health. The incomplete combustion produced by burning plant material, like tobacco or cannabis, produces carbon monoxide, which impairs the ability of blood to carry oxygen when inhaled into the lungs. There are several other toxic compounds in tobacco that constitute serious health hazards to long-term smokers from a whole range of causes; vascular abnormalities such as stenosis, lung cancer, heart attacks, strokes, impotence, low birth weight of infants born by smoking mothers. 8% of long-term smokers develop the characteristic set of facial changes known to doctors as smoker's face.(1)

CHAPTER 3 : ERECTILE DYSFUNCTION____________________________________________________

Erection physiology

When a man becomes aroused, his central nervous system stimulates the release of a number of chemicals that relax the smooth muscles in the penis, allowing blood to flow into the tiny poollike sinuses and flood the penis.(1)

The spongy chambers almost double in diameter due to the increase in blood flow. The veins surrounding the corpa cavernosum and corpus spongiosum are squeezed almost completely shut by the pressure of the erectile tissue; they are unable to drain blood out of the penis, causing it to become rigid.(1)

DEFINITION

Erectile dysfunction (impotence) is the inability to get and keep an erection firm enough for sex. Having erection trouble from time to time isn't necessarily a cause for concern. But if erectile dysfunction is an ongoing problem, it may cause stress, cause relationship problems or affect your self-confidence.(2)

CAUSES AND SYMPTOMS

In most cases, erectile dysfunction is caused by something physical. Common causes include:

Heart disease Clogged blood vessels (atherosclerosis) High blood pressure Diabetes Obesity Metabolic syndrome, a condition involving increased blood pressure, high insulin levels, body fat around the waist and high cholesterol

Parkinson's disease Multiple sclerosis Low testosterone Peyronie's disease, development of scar tissue inside the penis Certain prescription medications Tobacco use Alcoholism and other forms of substance abuse
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Treatments for prostate cancer or enlarged prostate Surgeries or injuries that affect the pelvic area or spinal cord

Psychological causes of erectile dysfunction

The brain plays a key role in triggering the series of physical events that cause an erection, starting with feelings of sexual excitement. A number of things can interfere with sexual feelings and cause or worsen erectile dysfunction. These include:

Depression, anxiety or other mental health conditions Stress Fatigue Relationship problems due to stress, poor communication or other concerns

SYMPTOMS

Erectile dysfunction is the inability to maintain an erection firm enough for sex, on an ongoing basis. Symptoms related to erectile dysfunction may include:

Trouble getting an erection Trouble keeping an erection Reduced sexual desire

DIAGNOSIS For many men, a physical exam and answering questions (medical history) are all that's needed before a doctor is ready to recommend a treatment. If your doctor suspects that underlying problems may be involved, or you have chronic health problems, you may need further tests or you may need to see a specialist.(2)
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Tests for underlying problems may include:

Physical exam. This may include careful examination of your penis and testicles and checking your nerves for feeling. Blood tests. A sample of your blood may be sent to a lab to check for signs of heart disease, diabetes, low testosterone levels and other health problems. Urine tests (urinalysis). Like blood tests, urine tests are used to look for signs of diabetes and other underlying health conditions. Ultrasound. This test can check blood flow to your penis. It involves using a wandlike device (transducer) held over the blood vessels that supply the penis. It creates a video image to let your doctor see if you have blood flow problems. This test is sometimes done in combination with an injection of medications into the penis to determine if blood flow increases normally.

Overnight erection test. Most men have erections during sleep without remembering them. This simple test involves wrapping special tape around your penis before you go to bed. If the tape is separated in the morning, your penis was erect at some time during the night. This indicates the cause is of your erectile dysfunction is most likely psychological and not physical.

CHAPTER 4 : THE CORRELATION BETWEEN SMOKING AND ERECTILE DYSFUNCTION Erectile dysfunction (ED) has been reported to be associated with smoking, and antismoking advertising campaigns have tried to use this information to their advantage . Unfortunately, few population-based studies have evaluated the association between smoking and ED in the adult male population. The most commonly cited study in the United States is the Massachusetts Male Aging Study, which evaluated ED in men aged 4070 years with a selfadministered questionnaire. Results from this study indicated that cigarette smoking at baseline almost doubled the likelihood of moderate or complete ED at up to 10 years of follow-up. Former smokers, compared with never smokers, were not at increased risk of ED , but there was no information on dose response, that is, number of cigarettes smoked. Men were simply classified as former smokers, nonsmokers, or current smokers at baseline and follow-up .An earlier study of Vietnam-era veterans, aged 3149 years, found that a higher percentage of smokers reported ED problems than did nonsmokers. However, neither number of years of smoking nor number of cigarettes smoked daily were significant predictors of ED in current smokers in this study . Moreover, the young age of the men evaluated may have limited implications for men who smoke their entire lives. (4) DISCUSSION In this study, smoking was associated with ED. This association was seen in current smokers, although the magnitude of this association decreased across increasingly older age groups. This finding suggests that smoking may have a more apparent impact on erectile function in young male smokers than it does in older male smokers. Importantly, there was also evidence of a dose response by intensity with cumulative exposure among persons who ever smoked.(4) This latter result, in particular, adds greater credence to previous reports of an association between smoking and ED. Unlike previous studies , however, former smokers, especially those who had smoked for more than 29.0 pack-years, were more likely to have ED than nonsmokers were. In addition, unlike the Centers for Disease Control and Prevention study , number of packyears of smoking was significantly associated with ED in former and current smokers. This finding is partially supported by results from a study conducted in community-based populations
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in Brazil, Italy, Japan, and Malaysia. The Health Professionals Follow-up Study also found that smoking was associated with risk of ED. While this study quantified cigarette exposure in current smokers using number of cigarettes per day, this information was not included in the assessment of the relative risk for ED. Interestingly, the relative odds of ED in current smokers decrease with increasing age, when stratified by age. Explanation for this outcome may be survivorship bias, because smokers have higher mortality rates and therefore would be less represented in the sample. Furthermore, men who had undergone prostate surgery or had prostate cancer were excluded at baseline, which may have biased the baseline sample because these conditions are also associated with increasing age.(4) Although the evidence for an association between smoking and ED is growing, the mechanism behind this association is not completely understood. Comorbidities, such as hypertension, hypercholesterolemia, and diabetes, are associated with decreased function of nerves and endothelium, resulting in circulatory and structural changes in penile tissues, arterial insufficiency, and defective smooth muscle relaxation. However, when we adjusted for these factors in our multivariable models, an association between smoking and ED persisted among younger men, suggesting that other mechanisms may prevail. Blood is a vehicle for delivering oxygen and nutrients to our body's tissues and organs. Without it they die. Our blood vessels (circulatory system) are the piping highways in which our blood flows. The inside of each healthy blood vessel is coated with a thin Teflon like layer of cells that ensure smooth blood flow. Carbon monoxide from smoking or second-hand smoke damages this important layer of cells, allowing fats and plaque to stick to vessel walls. Nicotine then performs a double whammy of sorts.(2)

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First, each time new nicotine arrives in our brain it causes the body to activate its fight or flight stress defenses. This in turn causes the immediate release of stored fats into the bloodstream, fats intended to be used to provide the instant energy needed to either fight or flee the saber tooth tiger. But there is no tiger The extra food we consumed during our big meals each day was converted to fat and stored. It was then pumped back into our bloodstream with each new puff of nicotine. It's how we were able to skip meals and what causes many of us to experience wild blood sugar swings when trying to quit. In fact, many of the symptoms of withdrawal - like an inability to concentrate - are due to nicotine no longer feeding us while we continue to skip meals. The heavy blasts of stored fats released by nicotine stick to vessel walls damaged by toxic carbon monoxide. We've recently learned that nicotine itself, inside our vessels, somehow causes the growth of new blood vessels (vascularization) that then provides a rich supply of oxygen and nutrients to the fats and plaques that have stuck to damaged vessel walls. This internal nicotine
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vascularization (vessels within vessels) hardens a smoker's arteries and veins and further accelerates their narrowing and clogging.(2) The damage being done isn't just to the vessels supplying blood to our heart and brain. It's occurring, to one degree or another, inside every vessel in a smoker's body. It affects everything from blood vessels associated with hearing, to the skin's blood supply that shows itself in wrinkles, early aging, hair loss and tooth loss. Since erection is linked with blood flow, every erectile problem is known to be influenced by it. This is why, when something interferes in the process when blood rushes to the penis, a dysfunction takes place and sometimes smoking has something to do with it. It is known that smoking does not affect only the respiratory system but it also damages the body's circulation. Because the cigarettes contain carbon monoxide, the haemoglobin in the blood binds with it and the oxygen carrying capacity is reduced, along with the count of red blood cells. All this factors combined can cause cardiovascular problems, arteriosclerosis and reduced blood flow to the penis. In this way, smoking can be responsible also for low sperm count, sperm mortality and lack of libido.(2) So, if your erectile dysfunction has to do with smoking, you should know that it can't be treated only with chemical based medicines like Viagra. Before trying to treat your problem with erectile dysfunction pills, you should know that the only remedy is to simply quit smoking, especially if you suffer from diabetes or heart troubles. You can find help with the Internet programs or with the de-addiction centres in order to manage quit smoking. Most of all, you should always remember that quitting smoking will not only improve your sexual problems, but it will also have benefices on your general health. In 2001, the Morbidity and Mortality Weekly Report found that current smoking prevalence was highest among persons aged 1824 years (26.9 percent) and aged 2544 years (25.8 percent) and was lowest among those aged >65 years (10.1 percent) .As data suggest, there is a potentially stronger association between smoking and ED in men in these younger age groups.(5)

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CHAPTER 5 : CONCLUSION

Based on data and information obtained Smoking can cause erectile dysfunction directly or indirectly. The first step of the treatment is to quit smoking and to practice a healthy life style. Erectile dysfunction is not the only side effect or health effect you might get. Tobacco is a killer. Smokers and other tobacco users are more likely to develop disease and die earlier than are people who don't use tobacco. If you smoke, you may worry about what it's doing to your health. You probably worry too about how hard it might be to quit smoking. Nicotine is highly addictive, and to quit smoking especially without help can be difficult. In fact, most people don't succeed the first time they try to quit smoking. It may take more than one try, but you can stop smoking. Take that first step: Decide to quit smoking. Set a stop date. And then take advantage of the multitude of resources available to help you successfully quit smoking. A variety of options exist for treating erectile dysfunction. The cause and severity of condition, and underlying health problems, are important factors in recommending the best treatment. To choose the best treatment we need to understand the risks and benefits of each treatment. Partner's preferences also may play a role in treatment choices.

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REFERENCES
1. Sherwood L . Human Physiology From Cell to System . 6th ed . United State of America ; Thomson Brooks/Cole ; 2007, p 444-445, 749-750 2. Kasper D, Braunwald E, Fauchi A. Harrisons Principles of Internal Medicine. 16th ed, New York : McGraw Hill, 2005 3. Erectile dysfunction and quit smoking Acces On 28 JUN 2011 Available at : http://www.mayoclinic.com/health/erectile-dysfunction/DS00162 4. Relationship between smoking and erectile dysfunction Acces On 24 JUN 2011 Available at : http://www.nature.com/ijir/journal/v17/n2/full/3901280a.html 5. Erectile Dysfunction Linked To Smoking Acces On 24 JUN 2011 Available at : http://www.sciencedaily.com/releases/2007/07/070727153458.htm 6. Erectile Dysfunction and Smoking Acces On 29 JUN 2011 Available at : http://ezinearticles.com/?Erectile-Dysfunction-and-Smoking&id=410335

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