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Study points to association between e-cigarette use and erectile dysfunction


“Our findings underscore the need to study patterns of e-cigarette use that are relatively safer than smoking,” said lead author Omar El Shahawy, MD, PhD, MPH.

Recent study results found a significant association between electronic nicotine delivery systems (ENDS), or e-cigarettes, and erectile dysfunction (ED).1

In this study, current daily ENDS users were more likely to self-report ED than users who never used ENDS. This was consistent in both the full (AOR=2.24, 95% CI=1.50, 3.34) and restricted samples (AOR=2.41, 95% CI=1.55, 3.74).

“Given that many people use e-cigarettes as a form of smoking harm reduction or to help them quit smoking,” explained lead author Omar El Shahawy, MD, PhD, MPH, in a news release,2 “we need to fully investigate the relationship between vaping products and erectile dysfunction, and thus better understand the potential implications for men’s sexual health.”

Investigators performed an analysis of the data from Wave 4 (2016-2018) of the Population Assessment of Tobacco and Health (PATH) study.3 PATH was launched in 2011 by the National Institute of Health (NIH) and FDA in the form of a self-reported questionnaire to help researchers understand more about the use of tobacco among a large population.

For this study’s purpose, PATH data were only extracted from participants who were at least 20 years of age and had responded to the erectile dysfunction question in the survey. The data of 13,711 males were included and divided into 2 groups: the full sample and the restricted sample, or participants aged 20 to 65 years with no prior cardiovascular disease diagnosis.

Multivariable logistic regression models were used to evaluate the association of ENDS use and ED, adjusting for various risk factors.

Findings showed that 20.7% of the participants from the full sample and 10.2% of participants from the restricted sample experienced ED. ENDS use occurred in 4.8% of the full sample population and 5.6% of the restricted sample population, with 2.1% and 2.5% reporting daily ENDS use, respectively.

In addition, both cardiovascular disease history and the age group of 65 and older were significantly associated with ED (AOR=1.39, 95% CI=1.10, 1.77; AOR=17.4, 95% CI=12.5, 24.91). Physical activity was associated with a decreased likelihood of ED in both samples (AOR range=0.44-0.58).

“Our findings underscore the need to study patterns of e-cigarette use that are relatively safer than smoking,” concluded El Shahawy, an assistant professor in of population health at NYU Langone. “Our analyses accounted for the cigarette smoking history of participants, including those who were never cigarette smokers to begin with, so it is possible that daily e-cigarette vaping may be associated with higher odds of erectile dysfunction regardless of one’s smoking history.”

According to the investigators, 2 limitations of the study were the self-reported aspect of the data collection and the lack of data indicating whether the participants were taking medications that could have been associated with ED.

El Shahawy stressed the importance of further research on this topic, such as the effect of different types of ENDS on ED or how the discontinuation of ENDS is associated with ED.


1. El-Shahawy O, Shah T, Obisesan OH, et al. Association of e-cigarettes with erectile dysfunction: The population assessment of tobacco and health study. Am J Prev Med. 2022;62(1):26-38. doi:10.1016/j.amepre.2021.08.004

2. E-cigarettes may be independently linked to erectile dysfunction, new research finds. News release. NYU Langone Health. December 1, 2021. Accessed January 12, 2022. https://nyulangone.org/news/e-cigarettes-may-be-independently-linked-erectile-dysfunction-new-research-finds

3. PATH: Population Assessment of Tobacco and Health. https://pathstudyinfo.nih.gov/

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