After tracking erectile dysfunction (ED) risk among nearly 25,000 men aged 20 and older, investigators found that even vapers with no history of heart disease or other health issues typically associated with impotence saw their risk shoot up more than twofold.
The finding suggests that while electronic cigarettes may offer some users a helpful pathway towards kicking a cigarette habit, there are potential downsides.
"Any tobacco or nicotine product is not risk-free, especially for those who are thinking of starting to use it," cautioned lead study author Dr. Omar El Shahawy. He's an assistant professor at New York University's Grossman School of Medicine.
For example, "there is abundant evidence that consistent exposure to high nicotine levels [in traditional tobacco products] can impair normal erectile function," El Shahawy noted. "[And] some e-cigarettes have very high nicotine concentrations, especially when using newer generation e-cigarettes that have high nicotine delivery. This made us examine the possible relationship between using e-cigarettes and erectile dysfunction."
To explore ED risk and e-cigarettes, the investigators sifted through data concerning male vapers. The team focused on two pools of patients, two-thirds of whom were white. The first included nearly 14,000 men aged 20 and up, some of whom had a history of heart disease. The second group included roughly 11,000 men between the ages of 20 and 65, none of whom had any prior heart disease diagnosis.
About half of the men in the larger group were former cigarette smokers. About a fifth reported current cigarette use, while 14% said they used other types of tobacco products.
Nearly 5% of those in the larger first group said they vaped to some degree, with 2% saying they did so on a daily basis. In the heart-healthy group 5.6% of the men said they vaped on occasion, with 2.5% saying they did so every day. And some of vapers in both groups reported never having actually smoked traditional cigarettes.
Erectile dysfunction was cited as a problem among 20.7% of the men in the larger group, and more than 10% of the men in the heart-healthy group.
And in the end, vaping in both groups was linked to more than twice the risk for ED, compared with those who said they never vaped.
Noting that traditional cigarettes have long been linked to a higher risk for impotence, El Shahawy said his team expected some degree of higher risk among vapers.
Still, "the surprising part is that the association was consistent in all types of evaluations we did, even when we excluded people with prior heart conditions," he added.
But El Shahawy said more research is needed to understand exactly why.
"At this point, we simply don’t know enough ... whether this may be only due to the nicotine in e-cigarettes, or [whether] there could be other components in the e-liquid that can potentially impact erectile function," he noted.
Meanwhile, he advised those considering vaping to exercise restraint.
"Overall, e-cigarettes are likely less harmful than smoking cigarettes," El Shahawy said. "But e-cigarettes should be used to help reduce overall use of nicotine," rather than embraced as a new habit with its own set of risks.
In fact, "it is not clear that e-cigarettes are safer or a step up from traditional cigarettes," warned Patricia Folan, director of the Northwell Health Center for Tobacco Control in Great Neck, N.Y.
"Although the manufacturers of e-cigarette contend that the products are safe and effective in assisting smokers of traditional/combustible cigarettes in quitting, the research has not demonstrated that," said Folan, who was not involved with the new study.
"Data show that e-cigarettes can cause exacerbations of asthma, serious respiratory illnesses, harm to cardiovascular health, and initiation of nicotine/tobacco products by youth, who most likely would never have smoked," she noted.
As for impotence risk, Folan said "it does make sense that ED might be a side effect, since there have been studies showing harm to cardiovascular health from vape products."
The study was published Dec. 1 in the American Journal of Preventive Medicine.
There's more information on electronic cigarettes at the U.S. Centers for Disease Control and Prevention.
SOURCES: Omar El Shahawy, MD, MPH, PhD, assistant professor, section on tobacco, alcohol and drug use, Department of Population Health, New York University Grossman School of Medicine, New York City; Patricia Folan, DNP, director, Northwell Health Center for Tobacco Control, Great Neck, N.Y.; American Journal of Preventive Medicine, Dec. 1, 2021