Can Smoking Cause ED? Smoking, Vaping, and Erectile Function

If smoking and changes in erections happen around the same time, smoking may be one factor, but it cannot identify the cause on its own. For example, a change in morning erections cannot be explained by looking only at how many cigarettes you smoked the day before.

An erection depends on blood flowing into the penis, so vascular health is part of the picture. Research has repeatedly reported an association between cigarette smoking and ED, and clinical guidelines list smoking among the associated risk factors (Cao et al., 2013; EAU, 2026).

Studies have also reported an association between e-cigarettes or vaping and ED. The evidence is not as extensive as it is for cigarettes, and it does not establish cause and effect (El-Shahawy et al., 2022; Sailis et al., 2026).

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What research says about smoking and erectile function

A 2013 meta-analysis examined four prospective studies and four case-control studies involving 28,586 people. In the prospective studies, the odds of ED were 1.51 times higher among current smokers and 1.29 times higher among former smokers than among people who had never smoked (Cao et al., 2013).

Another dose-response meta-analysis combined one cohort study and nine cross-sectional studies, with 50,360 participants. It reported 1.14 times the odds of ED for each additional 10 cigarettes smoked per day (Cao et al., 2014).

These are associations observed across groups, not a way to calculate one person’s chance of ED or identify its cause from cigarette count alone. Most of the evidence is observational, and factors besides smoking can also be involved.

Where blood-vessel function fits

During an erection, blood vessels widen and blood flows into penile tissue. A systematic review described impaired endothelial function, reduced nitric-oxide availability, and oxidative stress as possible pathways linking smoking with ED (Verze et al., 2015).

These mechanisms help explain the association; they do not identify the cause of an individual’s symptoms. The European Association of Urology also describes ED as having multiple possible vascular, metabolic, and psychological factors, and includes smoking among associated risk factors (EAU, 2026).

Can erectile function improve after quitting?

One prospective study reported improvement after quitting. It followed for a year smokers with ED who sought nicotine replacement therapy and had none of several major risk factors. Erectile function improved in at least 25% of those who quit; no improvement was reported in the group that continued smoking (Pourmand et al., 2004). A systematic review also included studies supporting improvement after cessation (Verze et al., 2015).

The study followed a selected group under specific conditions. It does not show that everyone who quits will see erectile function return, or predict when a change might happen.

Cutting back is not the same as quitting

Reducing the number of cigarettes can be an interim step toward stopping. A public health report says that cutting down while continuing to smoke does not substantially lower health risks and should be treated as a temporary step toward quitting completely (U.S. Surgeon General, 2020).

Research on ED has not shown that cutting back produces the same changes as quitting. For health, complete cessation is the goal; a healthcare professional or smoking-cessation service can help if quitting is difficult.

Is the evidence on vaping the same as for cigarettes?

In a cross-sectional analysis of the U.S. PATH Study, men who used electronic nicotine products daily had higher odds of reporting ED than men who had never used them (El-Shahawy et al., 2022). A cross-sectional study cannot establish which came first or fully account for other factors.

A 2026 review found that direct research on e-cigarettes and ED remains limited, with too few long-term studies to establish causation or a dose-response relationship (Sailis et al., 2026). The evidence for vaping is not interchangeable with the evidence for cigarettes, but the current limits also do not establish that vaping has no effect.

If you are thinking about quitting or ED persists

For a few days, note how many cigarettes you smoke, when you smoke, and what tends to trigger the urge. This can make it easier to describe your situation when asking for help. If quitting alone is difficult, a healthcare professional or smoking-cessation service can discuss support.

If erection difficulties continue, talk with a healthcare professional rather than assuming smoking is the only cause. Blood pressure, blood glucose, medications, stress, and other factors may also need consideration.

The Male Condition Check can help organize lifestyle factors. 14-day tracking lets you review sleep and activity on the same dates as your condition.