December 22, 2021, 1:47 p.m. Michael Devitt — Although electronic nicotine delivery systems such as vape pens and e-cigarettes have been promoted by some as an alternative to combustible tobacco products, these items also are associated with their own health risks. Last year, the Journal of the American Heart Association published a study that linked e-cigarettes with severe lung damage, while survey results published in the Journal of Adolescent Health implicated e-cigarette use as a significant underlying risk factor for COVID-19 in teenagers and young adults.
A new paper scheduled for publication in the Jan. 1, 2022, issue of the American Journal of Preventive Medicine strongly suggests that e-cigarette use is associated with another negative health effect. The study, first published online Nov. 30, found clear links between frequent e-cigarette use and erectile dysfunction in adults, with the risk of ED occurring independent of other risk factors such as age or cardiovascular disease.
“Given that many people use e-cigarettes as a form of smoking harm reduction or to help them quit smoking, 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,” said Omar El Shahawy, M.D., M.P.H., Ph.D., an assistant professor in the Department of Population Health Section on Tobacco, Alcohol and Drug Use at New York University Grossman School of Medicine, New York, and the study’s corresponding author, in a press release.
In the study, researchers used data from the Population Assessment of Tobacco and Health Study, a nationally representative study of nearly 46,000 U.S. youth and adults aged 12 years and older that examines a number of tobacco use behaviors and related health outcomes. For their analysis, the authors looked at two specific patient populations: a full sample of 13,711 male participants aged 20 years or older, and a restricted sample of 11,207 male participants ages 20 to 65 years with no prior diagnosis of cardiovascular disease.
Participants in both the full and restricted samples had previously answered a question in the PATH study on the incidence of ED. Regarding e-cigarette use, respondents were classified as current, former or current users, with current users further divided into occasional or daily users.
The prevalence of current e-cigarette use was 4.8% in the full sample and 5.6% in the restricted sample. Daily e-cigarette use in these groups was reported at 2.1% and 2.5%, respectively.
Compared with those who never used e-cigarettes, current daily e-cigarette users were significantly more likely to report having ED. In the full sample, participants who used e-cigarettes daily were 2.24 times more likely to report ED; in the restricted sample, they were 2.41 times more likely.
The likelihood of ED also was increased in current occasional users, although not to the same degree. In the full and restricted samples, current occasional e-cigarette users were 28% and 43% more likely, respectively, to report having ED compared with never users.
In addition, the analysis found a strong association between physical activity levels and ED. Compared with those who reported no physical activity, people who were physically active at any weekly frequency level were between 42% and 56% less likely to report having ED. The analysis also showed that the more often a person engaged in physical activity, the lower that person’s odds of reporting ED.
“The study findings indicate that electronic nicotine delivery system use may be associated with ED independent of age, risk factor profile and the presence of CVD,” the study authors concluded. “While ENDS use is still being evaluated for its harm reduction and smoking-cessation potential, ENDS users need to be informed about the possible harms associated with ENDS use and particularly ENDS current daily use, including ED.”
“This study makes it clear that there is a risk for erectile dysfunction associated with the use of electronic nicotine delivery devices,” said Lynn Fisher, M.D., the assistant family medicine clerkship director at the University of Kansas School of Medicine-Wichita and a member of the Academy’s Commission on the Health of the Public and Science. “People who reported occasional to frequent use were over twice as likely to report ED.”
Fisher told AAFP News how family physicians could use the study results to talk with patients about e-cigarettes and different care options.
“I think that we can use this knowledge to leverage behavior changes,” said Fisher. “We can discuss with patients if it is more important to them to continue using e-cigarettes or if it is more important to decrease the risk for ED from smoking cessation. We can then provide them with quit options that can help facilitate that change.”
Fisher said that he does not recommend e-cigarettes as a way of reducing tobacco use, but suggests different approaches.
“I talk with patients about medication options for cessation and the use of quit lines and tobacco counselors. If a patient came to me and was using e-cigarettes as a stepdown approach for stopping tobacco use, I would want to counsel my male patients about the associations with ED,” Fisher said.
Fisher added that he frequently uses a number of AAFP resources such as the Academy’s Ask and Act tobacco cessation webpage, which includes links to a tobacco cessation telehealth guide, a treating tobacco dependence manual, practice toolkits, educational materials for patients and other items.
Finally, Fisher reminded FPs to let patients know that quitting tobacco use is a process that requires time and effort to succeed.
“It is important for patients to know that smoking cessation is a journey,” he said. “It may take multiple attempts to quit to be successful, but something can be learned each time — and now we can add another reason to the list for wanting to quit in our toolbelt.”