The New Straits Times, November 23, 1998
Q: I am a smoker and am worried about the recent news from Thailand linking impotence with smoking. Could you elaborate?
A: On Nov 5, 1998, Thailand become the first country in the world to have "cigarette smoking causes sexual impotence" printed on the side of cigarette packets.
Under a new ministerial announcement issued under the 1992 Tobacco Products Control Act, tobacco manufacturers will also have to print warnings across one third of the top of both the front and back of cigarette packets. Under the Act, the labels have been made bigger. The words have to be in white, on a black background. The warnings must cover at least 30 per cent of the surface area of a pack. This is a bold step by the Ministry.
In addition, the sexual impotence warning is only one among 10 messages that can be chosen by tobacco firms. The others:
- Smoking causes lung cancer
- Smoking causes heart failure
- Smoking causes pulmonary emphysema
- Smoking causes cerebrovascular disease
- Smoking leads to other narcotic addictions
- Smoking reduces sexual ability
- Smoking causes premature ageing
- Smoking kills
- Smoking is harmful to your family and friends
- Smoking is harmful to foetuses
Thailand made the decision to include the label on impotence after studying a number of scientific reports.
For example, reports by Dr Hans Nagler of the Beth Israel Medical Centre and the Albert Einstein College of Medicine, both in New York, showed sufficient evidence that smoking affects men's reproductive, sexual and urinary functions.
Dr Nagler said nicotine levels found in the semen of smokers were higher than those found in their bloodstream, indicating that once absorbed into the bloodstream, nicotine accumulated in seminal fluid.
Smoking also changes the shape of sperm, said Nagler's report, and this could be related to the greater incidence of miscarriage, congenital malformation and birth defects among children born to male smokers.
In fact, a report by the American Council on Science and Health in 1996 said there was "considerable evidence that smoking decreases sperm production, deforms sperm, changes sperm mobility, and seriously reduces blood flow to the penis, in some instances causing impotence." Smoking just two cigarettes causes almost immediate constriction of blood vessels (acute vasospasm) of the penile arteries.
According to Dr Sheldon Burmet, founder and director of the Male Sexual Dysfunction Institute in Chicago, "many causes of impotence are related to vascular problems. Smoking affects sexuality by damaging blood vessels responsible for initiating and maintaining erections in men."
"Smoking produces (vaso)spasms that cause the wall of the arteries to get thick and muscular, similar to well-exercised biceps. This thickening narrows the inside of the vessel and limits blood flow to the penis, reducing the rigidity and generation of erections.
"Additionally, spasms triggered by cigarette smoking can bring about hypertension and the hardening of the arteries, which also reduces blood supply to the penis."
Components of cigarette smoke that find their way into seminal fluid may contain substances that inhibit a naturally occurring enzyme which is necessary for sperm to move normally, according to reports compiled and reviewed by Nagler.
He also noted that there was some evidence that smoking may increase the level of prolactin, a hormone associated with smaller testicles and possibly with decreased sperm mobility. Studies also show that smoking reduces the volume of ejaculate and impairs sperm count, which could lead to an increased risk of infertility.
This latest strategy by the Thai government is already showing some positive results, especially in spouses of smokers. According to Dr Prakit Vateesatogkit, secretary of the Thai Action on Smoking and Health Foundation, his office had been inundated with calls from women seeking suggestions as to how they could get their husbands to quit smoking.
It seems people are more concerned with losing sexual prowess than with inviting fatal diseases like heart attack and lung cancer. But the message is the same: if you are a non-smoker, you may have so much of a chance of becoming impotent, or contracting other diseases; but if you choose to smoke, your risk will be higher - sometimes up to twice as much.
Although in Malaysia we continue to lament the lack of political will to take measures comparable to the Thai ones, Malaysians can nevertheless benefit by taking their cue from recent initiatives in the neighbouring country. The time has come, perhaps, that in matters relating to tobacco and health, we should be more responsible for our own health, and learn from the experiences of others.
