International Journal of
Reproductive Biomedicine
Sat, Jun 13, 2026
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Volume 24, Issue 4 (April 2026)
IJRM 2026, 24(4): 359-360 |
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Nasirian M. The necessity of understanding the seriousness of the impact of smoking on reproductive health: A letter to the editor. IJRM 2026; 24 (4) :359-360
URL: http://ijrm.ir/article-1-3776-en.html
URL: http://ijrm.ir/article-1-3776-en.html
Department of Psychiatry, Research Center of Addiction and Behavioral Sciences, Non-Communicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. , nasirian90@gmail.com; m.nasirian@ssu.ac.ir
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Dear Editor
Concerns related to reproductive health affect a substantial proportion of couples and arise from a dynamic interaction of biological, psychological, social, and spiritual influences that shape both reproductive functioning and outcomes. Within this multidimensional context, substance use constitutes an important determinant, as individuals may engage in the consumption of certain substances based on expectations of enhanced sexual functioning. Nevertheless, empirical evidence consistently demonstrates that substances with psychoactive properties are associated with harmful effects throughout various stages of the sexual response process (1).
Among these harmful substances, cigarette smoking may represent a significant factor. Global health data reported by the World Health Organization indicate that tobacco consumption is responsible for > 7 million deaths annually, with the majority resulting from active smoking and a smaller share attributable to involuntary exposure to tobacco smoke (2). In line with these statistics, clinical and epidemiological investigations have identified a considerable prevalence of sexual dysfunction (estimated at nearly 27%) among men who use tobacco products (3).
Despite this evidence, smoking remains globally prevalent, and most couples are unaware that smoking could contribute to their sexual function. In practice, smoking often remains under-recognized by affected couples and, in some cases, insufficiently addressed by healthcare providers. Smoking adversely influences the sexual response cycle through multiple pathophysiological mechanisms. Smoking has been shown to alter endocrine function by reducing circulating levels of testosterone, luteinizing hormone, and follicle-stimulating hormone. Tobacco smoke contains nicotine, carbon monoxide, oxidative agents, and metallic compounds that collectively induce endothelial injury and promote erectile dysfunction by disrupting both the onset and sustainability of erection. These effects are primarily mediated by the potent vasoconstrictive action of nicotine, which may further suppress the activity of endogenous vasoactive mediators, including endothelium-derived relaxing factors (4).
Exposure to toxic substances present in tobacco smoke leads to a marked increase in reactive oxygen species generation, resulting in oxidative stress. This imbalance represents a central mechanism in the disruption of spermatogenesis and affects essential sperm characteristics such as motility, morphology, and concentration. Moreover, oxidative stress compromises sperm DNA integrity, leading to fragmentation and genetic alterations that not only reduce fertility potential but may also increase the likelihood of transmitting genetic abnormalities to offspring (5, 6). Although, oxidative damage increases the risk of transmitting mutations to offspring. But some of the effects of smoking on sexual health, such as erectile dysfunction was better after smoking cessation. Moreover, smoking cessation has been shown to improve the reversibility of some of the tobacco-related damage to sexual health. It should be remembered that the negative effects of smoking on reproductive health are cumulative, with a dose-response relationship in long-term smokers (4, 5).
In addition to its effects on sexual performance, smoking is widely recognized as one of the most significant modifiable risk factors impairing male fertility. Smoking cessation should be considered a core component of the clinical management of sexual dysfunction and infertility, particularly within reproductive health care settings. Available evidence supports the integration of structured smoking cessation interventions, including nicotine replacement therapy, into comprehensive reproductive care. Such strategies may help attenuate the adverse reproductive effects of tobacco use and warrant attention in both preventive and clinical practice. Taken together, these observations highlight the necessity of implementing comprehensive strategies that integrate prevention, education, treatment, and public awareness initiatives targeting the reproductive consequences of smoking.
Acknowledgments
The author declares no financial, professional, or personal interests in any product, service, or company. I am solely responsible for the content and writing of the paper. I also acknowledge the assistance of AI (ChatGPT) utilized in this article for enhancing grammar and readability.
Conflict of Interest
The author declares that there is no conflict of interest.
Concerns related to reproductive health affect a substantial proportion of couples and arise from a dynamic interaction of biological, psychological, social, and spiritual influences that shape both reproductive functioning and outcomes. Within this multidimensional context, substance use constitutes an important determinant, as individuals may engage in the consumption of certain substances based on expectations of enhanced sexual functioning. Nevertheless, empirical evidence consistently demonstrates that substances with psychoactive properties are associated with harmful effects throughout various stages of the sexual response process (1).
Among these harmful substances, cigarette smoking may represent a significant factor. Global health data reported by the World Health Organization indicate that tobacco consumption is responsible for > 7 million deaths annually, with the majority resulting from active smoking and a smaller share attributable to involuntary exposure to tobacco smoke (2). In line with these statistics, clinical and epidemiological investigations have identified a considerable prevalence of sexual dysfunction (estimated at nearly 27%) among men who use tobacco products (3).
Despite this evidence, smoking remains globally prevalent, and most couples are unaware that smoking could contribute to their sexual function. In practice, smoking often remains under-recognized by affected couples and, in some cases, insufficiently addressed by healthcare providers. Smoking adversely influences the sexual response cycle through multiple pathophysiological mechanisms. Smoking has been shown to alter endocrine function by reducing circulating levels of testosterone, luteinizing hormone, and follicle-stimulating hormone. Tobacco smoke contains nicotine, carbon monoxide, oxidative agents, and metallic compounds that collectively induce endothelial injury and promote erectile dysfunction by disrupting both the onset and sustainability of erection. These effects are primarily mediated by the potent vasoconstrictive action of nicotine, which may further suppress the activity of endogenous vasoactive mediators, including endothelium-derived relaxing factors (4).
Exposure to toxic substances present in tobacco smoke leads to a marked increase in reactive oxygen species generation, resulting in oxidative stress. This imbalance represents a central mechanism in the disruption of spermatogenesis and affects essential sperm characteristics such as motility, morphology, and concentration. Moreover, oxidative stress compromises sperm DNA integrity, leading to fragmentation and genetic alterations that not only reduce fertility potential but may also increase the likelihood of transmitting genetic abnormalities to offspring (5, 6). Although, oxidative damage increases the risk of transmitting mutations to offspring. But some of the effects of smoking on sexual health, such as erectile dysfunction was better after smoking cessation. Moreover, smoking cessation has been shown to improve the reversibility of some of the tobacco-related damage to sexual health. It should be remembered that the negative effects of smoking on reproductive health are cumulative, with a dose-response relationship in long-term smokers (4, 5).
In addition to its effects on sexual performance, smoking is widely recognized as one of the most significant modifiable risk factors impairing male fertility. Smoking cessation should be considered a core component of the clinical management of sexual dysfunction and infertility, particularly within reproductive health care settings. Available evidence supports the integration of structured smoking cessation interventions, including nicotine replacement therapy, into comprehensive reproductive care. Such strategies may help attenuate the adverse reproductive effects of tobacco use and warrant attention in both preventive and clinical practice. Taken together, these observations highlight the necessity of implementing comprehensive strategies that integrate prevention, education, treatment, and public awareness initiatives targeting the reproductive consequences of smoking.
Acknowledgments
The author declares no financial, professional, or personal interests in any product, service, or company. I am solely responsible for the content and writing of the paper. I also acknowledge the assistance of AI (ChatGPT) utilized in this article for enhancing grammar and readability.
Conflict of Interest
The author declares that there is no conflict of interest.
Type of Study: Letter to Editor |
Subject:
Fertility & Infertility
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