Q. My friend is trying to quit smoking. He has started having problems getting and maintaining an erection. Could this be related?

A. Quitting smoking would not cause him to lose erections, unless perhaps he is suffering from stress or depression that has been aggravated by his efforts to quit.

On the contrary, smoking itself is more likely to cause erection problems. Smoking is a major cause of atherosclerosis (clogging of blood vessels), which affects the function of the penis. Most of the men I see in their 40 and 50s with erectile dysfunction are smokers. I insist that they stop smoking before I help them with their erections, because many times their erections improve after they quit. In fact, when I tell a man that smoking is slowly destroying the blood supply to the penis and that he will be at risk for erectile dysfunction, most men choose the erection over the cigarette.

Still, smoking is difficult to stop. I suggest he get help from his family doctor. The nicotine in the smoke causes a chemical dependency in his body that needs to be replaced and then slowly removed. The first step is to eliminate the psychological habit of the cigarette in the mouth. This can be done with fake cigarettes or nicotine gum. The chemical dependency can be controlled with nicotine patches. The process is stressful, and if he tries on his own he may fail, leading to anxiety and depression. The best suggestion I have is to get help and quit smoking. Then, if still has erectile dysfunction, he should see a urologist.

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