Cigarette smoking deleteriously affects erectile function, and conversely, quitting smoking improves erectile hemodynamics. Underlying mechanisms by which smoking (or reduction of smoking frequency) may affect erectile physiology are not well understood. This study examined the mediating role of heart rate variability (HRV; a marker of sympathovagal balance) among a sample of male chronic smokers from the United States. Sixty-two healthy men (Mage=38.27 years; s.d.=10.62) were assessed at baseline (while smoking regularly), at mid-treatment (while using a nicotine patch) and at follow-up, 4 weeks after patch discontinuation. Cigarette use, frequency-domain parameters of HRV (low frequency (LF), high frequency (HF), LF/HF ratio) and physiological sexual arousal responses (via penile plethysmography) were assessed at each visit. Results were consistent with mediation, in that greater reductions in cigarette use from baseline to follow-up were associated with longitudinal increases in LF, which in turn showed positive relationships with across-time changes in erectile tumescence. Neither HF nor LF/HF ratio mediated the relationship between smoking and erection. In conclusion, HRV mediated the inverse relationship between reductions in smoking and enhancements in erectile tumescence. Results underscore the possibility that cigarette use may deleteriously affect erectile function peripherally, in part, by disrupting cardiac autonomic function.
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He J, Reynolds K, Chen J, Chen CS, Wu X, Duan X et al. Cigarette smoking and erectile dysfunction among Chinese men without clinical vascular disease. Am J Epidemiol 2007; 166: 803–809.
Tengs TO, Osgood ND . The link between smoking and impotence: Two decades of evidence. Prev Med 2001; 32: 447–452.
Dorey G . Is smoking a cause of erectile dysfunction? A literature review. Br J Nurs 2001; 10: 455–465.
Feldman HA, Johannes CB, Derby CA, Kleinman KP, Mohr BA, Araujo AB et al. Erectile dysfunction and coronary risk factors: Prospective results from the Massachusetts male aging study. Prev Med 2000; 30: 328–338.
Gilbert DG, Hagen RL, D'Agostino JA . The effects of cigarette smoking on human sexual potency. Addic Behav 1986; 11: 431–434.
Harte CB, Meston CM . Acute effects of nicotine on physiological and subjective sexual arousal in nonsmoking men: a randomized, double-blind, placebo-controlled trial. J Sex Med 2008; 5: 110–121.
Harte CB, Meston CM . The inhibitory effects of nicotine on physiological sexual arousal in nonsmoking women: Results from a randomized, double-blind, placebo-controlled, cross-over trial. J Sex Med 2008; 5: 1184–1197.
Harte CB, Meston CM . Association between smoking cessation and sexual health in men. BJU Int 2011; 109: 888–896.
Sighinolfi MC, Mofferdin A, De Stefani S, Micali S, Cicero AF, Bianchi G . Immediate improvement in penile hemodynamics after cessation of smoking: previous results. Urology 2007; 69: 163–165.
Guay AT, Perez JB, Heatley GJ . Cessation of smoking rapidly decreases erectile dysfunction. Endocr Pract 1998; 4: 23–26.
Kapoor D, Jones TH . Smoking and hormones in health and endocrine disorders. Eur J Endocrinol 2005; 152: 491–499.
Pomerleau OF . Nicotine and the central nervous system: biobehavioral effects of cigarette smoking. Am J Med 1992; 93: 2S–7S.
Hering D, Kucharska W, Kara T, Somers VK, Narkiewicz K . Smoking is associated with chronic sympathetic activation in hypertension. Blood Press 19: 152–155.
McVary KT, Carrier S, Wessells H . Subcommittee on Smoking and Erectile Dysfunction Socioeconomic Committee Sexual Medicine Society of North America. Smoking and erectile dysfunction: Evidence based analysis. J Urol 2001; 166: 1624–1632.
Sartori C, Lepori M, Scherrer U . Interaction between nitric oxide and the cholinergic and sympathetic nervous system in cardiovascular control in humans. Pharmacol Ther 2005; 106: 209–220.
La Rovere MT, Pinna GD, Maestri R, Mortara A, Capomolla S, Febo O et al. Short-term heart rate variability strongly predicts sudden cardiac death in chronic heart failure patients. Circulation 2003; 107: 565–570.
Harte CB, Meston CM . Effects of smoking cessation on heart rate variability among long-term male smokers. Manuscript under review 2012.
Stein PK, Rottman JN, Kleiger RE . Effect of 21 mg transdermal nicotine patches and smoking cessation on heart rate variability. Am J Cardiol 1996; 77: 701–705.
Chen CJ, Kuo TBJ, Tseng YJ, Yang CCH . Combined cardiac sympathetic excitation and vagal impairment in patients with non-organic erectile dysfunction. Clin Neurophysiol 2009; 120: 348–352.
Giuliano F, Rampin O . Neural control of erection. Physiol Behav 2004; 83: 189–201.
Harte CB, Meston CM . Association between smoking cessation and sexual health in men. BJU Int 2012; 109: 888–896.
Saunders J, Aasland O, Babor T, de la Fuente J, Grant M . Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption-II. Addiction 1993; 88: 791–804.
Skinner HA . The Drug Abuse Screening Test. Addict Behav 1982; 7: 363–371.
Pagani M, Lombardi F, Guzzetti S, Rimoldi O, Furlan R, Pizzinelli P et al. Power spectral analysis of heart rate and arterial pressure variabilities as a marker of sympatho-vagal interaction in man and conscious dog. Circ Res 1986; 59: 178–193.
Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A . The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology 1997; 49: 822–830.
Heatherton TF, Kozlowski LT, Frecker RC, Fagerstrom KO . The Fagerstrom test for nicotine dependence: a revision of the Fagerstrom tolerance questionnaire. Br J Addict 1991; 86: 1119–1127.
Little RJA, Rubin DB . Statistical Analysis with Missing Data 2nd edn. Wiley-Interscience: Hoboken, NJ, 2002.
Schafer JL, Graham JW . Missing data: our view of the state of the art. Psychol Methods 2002; 7: 147–177.
Preacher KJ, Hayes AF . Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behav Res Methods 2008; 40: 879–891.
Baron RM, Kenny DA . The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol 1986; 51: 1173–1182.
Hayes AF . Beyond Baron and Kenny: Statistical mediation analysis in the new millennium. Commun Monogr 2009; 76: 408–420.
Sobel ME . Asymptotic confidence intervals for indirect effects in structural equation models. Sociol Methodol 1982; 13: 290–312.
Preacher KJ, Hayes AF . SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behav Res Method Instrum Comput 2004; 36: 717–731.
Shrout PE, Bolger N . Mediation in experimental and nonexperimental studies: new procedures and recommendations. Psychol Methods 2002; 7: 422–445.
Minami J, Ishimitsu T, Matsuoka H . Effects of smoking cessation on blood pressure and heart rate variability in habitual smokers. Hypertension 1999; 33: 586–590.
Yotsukura M, Koide Y, Fujii K, Tomono Y, Katayama A, Ando H et al. Heart rate variability during the first month of smoking cessation. Am Heart J 1998; 135: 1004–1009.
Salo TM, Kantola I, Voipio-Pulkki LM, Pelttari L, Viikari JSA . The effect of four different antihypertensive medications on cardiovascular regulation in hypertensive sleep apneic patients—Assessment by spectral analysis of heart rate and blood pressure variability. Eur J Clin Pharmacol 1999; 55: 191–198.
Thayer JF, Yamamoto SS, Brosschot JF . The relationship of autonomic imbalance, heart rate variability and cardiovascular disease risk factors. Int J Cardiol 2010; 141: 122–131.
Murray D, O’Connell C, Schmid L, Perry C . The validity of smoking self-reports by adolescents: a reexamination of the bogus pipeline procedure. Addict Behav 1987; 12: 7–15.
US Bureau of the Census. Native resident population estimates of the United States by sex, race, and Hispanic origin: April 1, 1990 to July 1, 1999. Washington, DC Retrieved 5 February 2010 from http://www.census.gov/population/estimates/nation/nativity/nbtab003.txt2000.
This project was supported by Award Number F31DA026276 from the National Institute on Drug Abuse (NIDA) to Christopher Harte. The contents of this work are solely the responsibility of the author and do not necessarily represent the official views of the NIDA or the National Institutes of Health. Portions of this work were also made possible by Grant Number 1 RO1 HD051676-01 A1 to Cindy M Meston from the National Institute of Child Health and Human Development (NICHD). The contents are solely the responsibility of the authors and do not necessarily represent the official views of the NICHD. This project was also supported by the following fellowships/awards to the first author: The Sexual Medicine Society of North America Student Research Grant; two Graduate Dean’s Prestigious Fellowship Supplements, and a College of Liberal Arts Graduate Research Fellowship, all from the University of Texas at Austin; the American Psychological Association Dissertation Research Award; and The Kinsey Institute Student Research Grant. We thank Tyler Watts, Hillary Perlman, Olivia Bentkowski, Alicia Whitaker, Gail Dalton and Katy Siciliano for help with participant recruitment, screening and data management.
The authors declare no conflict of interest.
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Harte, C., Meston, C. Association between cigarette smoking and erectile tumescence: the mediating role of heart rate variability. Int J Impot Res 25, 155–159 (2013). https://doi.org/10.1038/ijir.2012.43
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