Smoking
Cigarette smoke damages the endothelium directly. Nicotine causes acute vasoconstriction; the combustion products drive oxidative stress and accelerate atherosclerosis. In the narrow penile arteries, the effect shows up early.
- The association is dose-dependent — more cigarettes and more years mean higher risk.
- Studies of smoking cessation show measurable improvement in erectile function, with the greatest recovery in younger men and those with shorter smoking histories.
- Improvement is not immediate. Endothelial recovery takes months, and established atherosclerosis does not disappear.
- Nicotine replacement is far less harmful than smoking. If it helps you quit, use it.
Alcohol
- In the moment
- Alcohol is a central nervous system depressant. It reduces arousal signalling and directly impairs erection — the phenomenon commonly known as 'brewer's droop'. It also blunts sensation and can delay or prevent orgasm.
- Over years
- Chronic heavy drinking causes peripheral neuropathy, lowers testosterone, damages the liver — which alters hormone metabolism — and is associated with persistent erectile dysfunction that may not fully reverse.
- Moderate drinking
- Light to moderate intake has not been convincingly linked to erectile dysfunction, and some studies suggest a neutral or slightly favourable association. That is not a reason to start drinking.
Other recreational drugs
| Substance | Effect on erectile function |
|---|---|
| Cannabis | Mixed evidence, but regular heavy use is associated with erectile dysfunction and reduced sperm quality. |
| Opioids | Strongly suppress testosterone production. A common, reversible and frequently missed cause of hypogonadism. |
| Cocaine and stimulants | Acute vasoconstriction and, with chronic use, vascular damage and marked impairment of sexual function. |
| Anabolic steroids | Shut down natural testosterone production. Recovery after stopping can take many months, occasionally longer. |
| Amyl nitrite ('poppers') | Absolutely contraindicated with PDE5 inhibitors. The combination can cause a catastrophic drop in blood pressure. |
FAQ
Frequently asked questions
Will quitting smoking fix my ED?
It improves erectile function measurably in studies, especially for younger men with shorter smoking histories. It may not fully resolve established damage, but it stops it getting worse.
How long after quitting will I notice?
Endothelial function begins improving within weeks, but meaningful change in erectile function typically takes months.
Is it safe to drink alcohol with Viagra?
A drink or two is generally fine. Heavy drinking impairs erections directly and adds to the blood-pressure-lowering effect of the medication.
Does cannabis cause ED?
The evidence is mixed, but regular heavy use is associated with erectile dysfunction. Occasional use is less clearly linked.
Sources
What this is based on
We link to primary sources — clinical guidelines, regulator publications and peer-reviewed research — wherever possible. Links open on third-party sites we do not control.
- [01]National Institute of Diabetes and Digestive and Kidney Diseases. Definition & Facts for Erectile Dysfunction.
- [02]Mayo Clinic. Erectile dysfunction — symptoms and causes.
- [03]American Urological Association. Erectile Dysfunction: AUA Guideline (2018).