Will Electronic Cigarettes Cause Erectile Dysfunction?

A recent study showed that e-cigarettes may be related to erectile dysfunction. If the result is valid, the result is shocking.

A series of recent studies have linked the use of e-cigarettes to a series of negative results, including bone damage, stroke, smoking relapse, and depression, which only started in September. For many reasons, these associations are likely to be false. As discussed above, it seems that we must add another negative consequence of e-cigarettes to this speculative list of diseases.

According to a paper published in November in the American Journal of Preventive Medicine, e-cigarettes may increase your risk of erectile dysfunction (ED):

“The use of electronic nicotine delivery systems seems to be related to erectile dysfunction, not to age, cardiovascular disease, and other risk factors. Although the potential for harm reduction and smoking cessation is still being evaluated, it should be informed about the possible link between e-cigarette use and erectile dysfunction. Existing association.”

The study involved 13,711 male participants 20 years of age or older who reported that they had experience with erectile dysfunction. Only 4.8% of these participants are current e-cigarette users, and only over 2% report daily e-cigarette use. The data for this paper comes from the Tobacco and Healthy Population Assessment (PATH) study, which we have discussed elsewhere. Compared with people who have never used e-cigarettes, people who currently use e-cigarettes every day are more than twice as likely to report ED.

Of course, the media lavishly rendered the results. Media from CNN and Forbes to Insider and People are reporting stories, but they all miss the most interesting and important details of the research. When we consider these, the result looks far less impressive than the title implies.

Vaping, Smoking and Poor ED measures

Study participants were classified as current day (ie, not every day or occasional) or daily e-cigarette smokers, or if they consumed cigarettes “every day or certain days”, they were classified as smokers. In addition to this self-reported information, the researchers did not know how much or which e-liquid was used by the e-cigarette users in their study, nor did they know how many cigarettes each smoker consumed. This is a common problem in e-cigarette research: the definition of e-cigarette use is so broad that it is impossible to establish a dose-response relationship between e-cigarettes and related health outcomes.

Based on a single question, men are also classified as ED: “Many men have problems with intercourse. How would you describe your ability to obtain and maintain an erection to achieve satisfactory intercourse?” Therefore, the study may incorrectly assign Participants were identified as participants with ED, and these participants actually did not or missed other people with mild symptoms. The researchers summarized these data gap issues at the end of the paper, writing,

“The analysis is based on self-reported covariate data, ENDS usage status, and ED status, all of which are affected by misclassification, recall, and deviation from social expectations”

Does e-cigarette precede ED?

Another key issue is that the study only provides a snapshot of people who reported smoking e-cigarettes and experiencing ED. There are no problems with this cross-sectional study design; it can help answer many important questions, but if you are trying to assess the long-term risk of a given exposure (using e-cigarettes in this case), it is useless. To highlight a potential problem, did participants suffer from ED before starting to smoke e-cigarettes? If so, it means that e-cigarettes should not be blamed, although this study cannot explain this possibility.

Related to this is that some exposures other than e-cigarettes may cause participants’ ED. Researchers adjusted their models for several common variables, but they still have blind spots. For example, many prescription drugs cause or contribute to ED, but the study did not include information about the drug or drug use. Even things like alcohol, many of us would not hesitate to consume this highly addictive substance, which was also associated with ED in previous studies. Pornography use is the favorite pastime of millions of American men, and it is also believed to be the cause of ED, especially among young people.

Do these or other factors contribute to the frequency of ED reported in this study? I don’t know, nor do researchers. That’s the problem.

This is another strange thing deep in the paper.

However, this study failed to detect an association between smoking and ED, even when considering current daily smoking versus non-daily smoking (data not shown).

Why do dual users of e-cigarettes and e-cigarettes and cigarettes face a higher risk of erectile dysfunction than smokers? They all consume nicotine, which researchers believe is the most likely cause of ED. They speculate that some smokers may refuse to answer ED questions because they have ED, or they may be light smokers in general. This is certainly possible, but again, this is all speculation.

To be fair, the author does not claim that e-cigarettes cause ED, but there seems to be an association between the two. They also carefully acknowledged some of the restrictions we discussed. E-cigarettes will definitely bring some side effects that have not been discovered so far; as new evidence emerges, we should be open to this possibility. However, if e-cigarettes play any role in the development of male sexual dysfunction, research of this caliber will not tell us any useful information.