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Excerpts from SMOKE BUT NO FIRE:
old research that is just now being talked about publicly shows that smoking and secondhand smoke
may cause sexual dysfunction

60 Minutes [11/8/98]

MIKE WALLACE: By now you know that cigarette smoking can kill you, but you probably don't know what many doctors say they have known for years: That smoking can also kill your sex life. Numerous studies now show a strong link between cigarette smoking and impotence. We were astonished we hadn't learned about this before, so we went to the chairman of the urology department at the University of North Carolina, Dr. Culley Carson.

WALLACE: Flat out, does smoking cause impotence?

Dr. CULLEY CARSON: There's absolutely no question about it. It causes it very commonly.

WALLACE: Why in the world didn't I know about it? And I'll bet you that millions of Americans looking in at this moment...

Dr. CARSON: Yeah.

WALLACE: ...had no idea about this.

Dr. CARSON: That's an interesting question, because people in the field of erectile dysfunction kn--have known about it for many years--at least a decade--and it really hasn't made it to the public knowledge.

WALLACE: (Voiceover) And the fact that smoking, by itself, is enough to cause impotence is now the official conclusion of the American Medical Association, according to the AMA's chairman, who is aptly named Dr. Randolph Smoak.

Dr. RANDOLPH SMOAK: I feel confident that smoking does and can cause impotence.

Dr. SMOAK: And now we know so much more about it, this type of problem of impotence associated with tobacco.

WALLACE: (Voiceover) Up to now, he says doctors had focused on smoking's more lethal consequences, cancer and heart disease.

Dr. SMOAK: We have not paid attention to impotence because it didn't kill people, but it severely incapacitated men prematurely.

WALLACE: (Voiceover) And doctors who specialize in treating sexual problems agree that it does.

Dr. LAWRENCE LEVINE: Smoking is clearly hazardous to your erection.

Dr. JOHN MULHALL: Unquestionably.

WALLACE: No doubt in your mind?

Dr. MULHALL: No doubt in my mind.

WALLACE: (Voiceover) Doctors tell us that smoking causes impotence for the same reason it causes heart attacks and strokes. The toxins in cigarette smoke can damage blood vessels, thus reducing blood flow in your arteries. An erection, of course, requires a surge of blood to the penis. Healthy arteries expand to allow the increased flow. But smoking can harden arteries so they won't expand as much. Also, over time, smoking can cause plaque to build up, clogging the arteries, further reducing blood flow. Dr. Lawrence Levine, director of the Male Sexual Function Program at Rush Medical Center in Chicago, calls smoking 'an erection buster.'

Dr. LEVINE: If we injure the blood vessels with such things as smoking, then the blood flow will be restricted and we won't be able to get good flow into the penis, and an--an--an in--inadequate erection will result. The process is a progressive one. It's not necessarily an on-and-off process. He finds it more difficult to either obtain--or more commonly what happens first is more difficulty in maintaining the erection, because the trapping mechanism of blood within the penis is altered as well.

WALLACE: (Voiceover) And according to Dr. John Mulhall, director of the Center for Sexual Health at the Loyola University Medical Center in Chicago, millions of men, for a variety of reasons, are having these problems.

Dr. McKINLAY: Compared with non-smokers, if you smoke, you're twice--around about twice as likely to have erectile dysfunction or impotence.

WALLACE: This is proven?

Dr. McKINLAY: If you--if--oh, yes, this is from our study. A smoker gets twice as much impotence as a non-smoker.

WALLACE: (Voiceover) The US Centers for Disease Control found similar results in a study of more than 4,000 men in 1994. And doctors now say that erectile trouble today could be a warning of more serious problems tomorrow.

Dr. MULHALL: What you have to understand is that the penile arteries are tiny arteries--about a third that of a coronary artery--so it's not unusual for people to have erection problems preceding any other vascular problem, whether it be heart attacks or strokes.

Dr. McKINLAY: We are finding that erectile dysfunctional or impotence may be a precursor or an indicator of oncoming cardiovascular disease, so rather than dismissing it as just simply normal aging and nothing to get alarmed about, we're beginning to take this very, very seriously.

WALLACE: (Voiceover) Also serious, Dr. McKinlay says, is a sharp rise in teen-age smoking. Every day, 6,000 American teen-agers try their first cigarette.

Dr. McKINLAY: We have a major problem coming down the pike, and smoking and erectile dysfunction is going to be a public health--a major public health concern in the future.

WALLACE: (Voiceover) And the more you smoke, the greater your risk of impotence, according to a study by Boston radiologists Dr. Alan Greenfield, on the left, and Dr. Max Rosen. They concluded that teen-agers who smoke two packs a day could have these problems before they're 30.

If you have teen-age boys, what would you tell them about smoking, truly?

Dr. ALAN GREENFIELD: Well, I have told them that I believe that the st--the greatest risk they run from smoking is the risk of impotence. While cancer and heart disease are risks in the longer term...that the first and most important thing that will mean the most to them right now is the risk that--of impotence that I believe exists in smokers.

WALLACE: And smoking has been linked to impotence around the world. Studies in France and Sweden and South Africa have found a significantly greater percentage of smokers in impotent groups than in the general population. Many American urologists, including Dr. John Mulhall, say a high percentage of their impotent patients are smokers.

WALLACE: (Voiceover) All this is particularly ironic when you look at cigarette ads which try to make smoking look sexy and seem to imply that the more you smoke, the more you'll score.

WALLACE: (Voiceover) We wanted to ask the tobacco companies about their sexy ads and about the link between smoking and impotence, but every one of them declined to talk to us about it. Dr. William Farrone was a director of research and development at Philip Morris until 1984. He tells us the tobacco companies have known for more than 20 years that doctors were linking smoking to impotence.

Dr. WILLIAM FARRONE: There was a general recognition that literature existed that said that cigarettes caused impotence. The industry kept very close track of all literature--scientific and public--concerning smoking and health.

WALLACE: (Voiceover) Doctors are not saying that all smokers will become impotent. The point, they say, is that half the men over 40 do have some problems, and that if you smoke you're about twice as likely to be one of them.

Dr. LEVINE: And I think it's just playing with fire, so to speak, that you're hoping upon hope that the problem won't affect you before you don't care to have relations anymore.

Dr. MULHALL: I tell the patients, 'If you smoke, you're playing Russian roulette with your sexual function.'

WALLACE: (Voiceover) There is less research on women, but these same doctors say smoking probably causes sexual problems for women, too, because smoking can reduce the blood flow to the female pelvic area, which could hinder arousal and orgasm.

Dr. MULHALL: The female genitals, just like the male genitalia, require blood flow to function properly. Anything that interferes with that blood flow--cigarette smoking being one of them--can cause dysfunction.

WALLACE: (Voiceover) Another concern for women and for men comes from a study Dr. McKinlay's group has just completed which shows that secondhand smoke at home may also cause sexual problems.

Dr. McKINLAY: If you don't smoke yourself and you live with a smoker, also, you're about twice as likely to have impotence.

Dr. McKINLAY: A partner who smokes. And that figures. You know better than I how much people watch television, but let's say it's four or five hours a day. Sitting next to a smoker and getting a dose of sidestream smoke probably is like smoking yourself, in terms of its an effect on impotence.

WALLACE: It's astonishing.

Dr. McKINLAY: Mm-hmm. For years, for me, a woman who smoked was always a turnoff. Now we have some epidemiologic data to support that hypothesis.

WALLACE: Does Viagra work as well for smokers as it does for non-smokers?

Dr. CARSON: It will not be as effective in smokers because the smoking, the cigarettes, the tobacco use, will decrease the responsiveness of the blood vessels, and Viagra depends on the responsiveness of blood vessels to function.

WALLACE: (Voiceover) Some of you probably remain skeptical, so we go back to the chairman of the American Medical Association, Dr. Randolph Smoak.

Dr. SMOAK: I truly believe that we'll find this is a problem of in--greater frequency than probably we're aware of at this current time.

WALLACE: There are bound to be lots of people sitting around at this moment saying, 'I just don't believe this fellow. I have been smoking and making love quite satisfactorily all my life. What's he talking about? We don't believe you.'

Dr. SMOAK: When the time comes that they no longer can have an erection, they may well look back upon this and say, 'Well, I didn't believe it then, but I'll believe it now. I wish I had believed it at that time.'

WALLACE: Three days ago, Thailand became the first country in the world to add to its cigarette warning label, quote, "Smoking causes impotence."

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