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Cited by 59Sexual function and dysfunction studiesSmoking Behavior and CessationSexuality, Behavior, and Technology

Acute Effects of Nicotine on Physiological and Subjective Sexual Arousal in Nonsmoking Men: A Randomized, Double-Blind, Placebo-Controlled Trial

Open access
Harte, Christopher B., Meston, Cindy M.·2008·The Journal of Sexual Medicine
DOI 10.1111/j.1743-6109.2007.00637.xPMC PMC2864030
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Abstract

Introduction: Chronic nicotine treatment has deleterious effects on vascular functioning and catecholamine modulation, which may compromise erectile functioning. Evidence that long-term cigarette smoking is an independent risk factor for introducing impotence is robust. However, limited studies have focused on the acute effects of smoking on physiological sexual response, and none have investigated the deleterious effects of isolated nicotine on human sexual arousal. Consequently, pathophysiological underpinnings of tobacco-induced—and particularly, nicotine-induced—erectile dysfunction are not well understood. Aim: To provide the first empirical examination of the acute effects of isolated nicotine on sexual arousal in nonsmoking men. Methods: Twenty-eight sexually functional heterosexual men (mean age 21 years), each with less than 100 direct exposures to nicotine, participated in a double-blind, randomized, placebo-controlled, crossover trial. Participants received either Nicorette polacrilex gum (SmithKline Beecham Consumer Healthcare, Pittsburgh, PA, USA) (6 mg; approximately equivalent to smoking one high-yield cigarette) or placebo gum, matched for appearance, taste, and consistency, approximately 40 minutes prior to viewing an erotic film. Main Outcome Measures: Physiological (circumferential change via penile plethysmography) and subjective (continuous self-report) sexual responses to erotic stimuli were examined, as well as changes in mood. Results: Nicotine significantly reduced erectile responses to the erotic films (P =0.02), corresponding to a 23% reduction in physiological sexual arousal. This occurred in 16 of 20 men with valid physiological recordings. Nicotine had no significant effect on continuous subjective ratings of sexual arousal (P =0.70) or on mood (all Ps > 0.05). Conclusions: Isolated nicotine can significantly attenuate physiological sexual arousal in healthy nonsmoking men. These findings have implications for elucidating physiological mechanisms responsible for the effects of nicotine on sexual dysfunction, and for assisting public health policy in considering the deleterious effects of nicotine on sexual health.

AI snapshot

Written from the paper’s full text.

TL;DR

In a randomized, double-blind, placebo-controlled crossover trial, acute 6 mg nicotine gum significantly reduced physiological erectile response to erotic films in nonsmoking men but did not affect subjective sexual arousal or mood. This provides the first empirical evidence that isolated nicotine can acutely attenuate genital arousal in healthy, young, nonsmoking men.

Key findings

  • Nicotine significantly reduced erectile responses to erotic films: condition × film interaction \(F_{1,19}=8.77\), \(P=0.01\); erotic-film comparison \(t_{19}=-2.53\), \(P=0.02\), corresponding to a 23% reduction in physiological sexual arousal, occurring in 16 of 20 men with valid physiological recordings.
  • Nicotine had no significant effect on continuous subjective ratings of sexual arousal during erotic films (\(t_{20}=0.39\), \(P=0.70\)) or neutral films (\(t_{20}=1.0\), \(P=0.33\)).
  • Mood did not differ significantly between nicotine and placebo conditions (all reported \(P\)s > 0.05), including total mood disturbance (\(t_{24}=-1.32\), \(P=0.20\)).
  • Nicotine increased heart rate and blood pressure and self-reported adverse effects, but post hoc analysis found no statistical relationship between adverse effects and attenuated genital arousal (\(r_{18}=-0.09\), \(P=0.70\); \(R^2=0.008\)).

Methods

  • Twenty-eight sexually functional heterosexual nonsmoking men (mean age 21.3 years; <100 lifetime direct nicotine exposures) completed a randomized, double-blind, placebo-controlled crossover trial; participants received 6 mg nicotine gum or placebo gum approximately 40 minutes before viewing an erotic film.
  • Physiological sexual arousal was measured via penile circumferential change using penile plethysmography and expressed as percentage of full erection; subjective sexual arousal was measured continuously with a hand-controlled mouse device; mood was assessed with the POMS-SF, along with cardiovascular and adverse-effect measures.
  • Analyses used repeated measures ANOVA and paired-samples t-tests, with Bonferroni corrections for mood and adverse-effect analyses; eight participants were excluded from physiological analyses for nonresponding, and seven from subjective analyses, yielding valid physiological data for 20 men and subjective data for 21 men.

Limitations

  • The paper states that the double-blind protocol was partially compromised because nicotine produced discernible heart rate and blood pressure increases, and all participants correctly identified the nicotine session; maintaining experimenter blindness with adrenergic agents was described as largely infeasible.
  • The paper notes that participant expectancies about nicotine could have influenced results, though it argues this is unlikely because subjective mood and sexual arousal did not differ between conditions; it also notes that nicotine gum is a relatively novel route of administration, making strong expected effects on sexual function less likely.
  • The paper states that nicotine dose was not titrated for body weight, resulting in varying plasma nicotine concentrations; it recommends collecting saliva or blood samples to covary by plasma cotinine concentration.
  • Evident from the text: the sample was small, young, healthy, heterosexual, nonsmoking men, limiting generalizability; the study examined acute isolated nicotine rather than chronic smoking or smokers, and physiological analyses were based on 20 men after excluding nonresponders.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1111/j.1743-6109.2007.00637.x

Cites

46 of 46 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

4 of 48 cited sources checked · 2 supported · 1 flagged · accuracy not yet measured

  • Premisecitation
    § Introduction

    Cigarette smoking disrupts veno-occlusive mechanisms.

    “Cigarette smoking decreases penile arterial inflow [12] and disrupts veno-occlusive mechanisms [13], resulting in a deficiency of genital vasoengorgement.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [13] Elhanbly S, Abdel-Gaber S, Fathy H, El-Bayoumi Y, Wald M, Niederberger CS. Erectile dysfunction in smokers: A penile dynamic and vascular study. J Androl. 2004;25:991–995. doi: 10.1002/j.1939-4640.2004.tb03172.x. [DOI] [PubMed] [Google Scholar] source
  • Premisecitation
    § Discussion

    Nicotine instigates cardiovascular constriction by direct stimulation of epinephrine and norepinephrine release from peripheral sympathetic nerve endings.

    “Specifically, nicotine instigates cardiovascular constriction by direct stimulation of epinephrine and norepinephrine release from peripheral sympathetic nerve endings [40].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [40] Grassi G, Seravalle G, Calhoun DA, Bolla GB, Giannattasio C, Marabini M, Del Bo A, Mancia G. Mechanisms responsible for sympathetic activation by cigarette smoking. Circulation. 1994;90:248–253. doi: 10.1161/01.cir.90.1.248. [DOI] [PubMed] [Google Scholar] source

      The Results report that cigarette smoking increased vascular resistance and plasma epinephrine and norepinephrine, and suggest an action at peripheral sympathetic sites. They do not establish direct stimulation by nicotine or release from peripheral sympathetic nerve endings: the proposed mechanisms are release from chromaffin tissues and/or reduced catecholamine reuptake and clearance. No page number is available in our copy. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
  • Premisecitation
    § Introduction

    Smokers are about 1.5-2 times as likely as nonsmokers to report erectile dysfunction, even after controlling for confounding cardiovascular risk factors.

    “Large cross-sectional [4–8] and longitudinal [9] epidemiological studies suggest that smokers are about 1.5–2 times as likely as nonsmokers to report ED, even after controlling for confounding cardiovascular risk factors.”
    Quote in the paperNot a substantial claim1 of 6 sources checked
    • cites [4] Dorey G. Is smoking a cause of erectile dysfunction? A literature review. Br J Nurs. 2001;10:455–465. doi: 10.12968/bjon.2001.10.7.5331. [DOI] [PubMed] [Google Scholar]

      Not checked in the free run.

    • cites [5] Jeremy JY, Mikhailidis DP. Cigarette smoking and erectile dysfunction. J R Soc Health. 1998;118:151–155. doi: 10.1177/146642409811800305. [DOI] [PubMed] [Google Scholar] source
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  • Findingown data
    § Results

    Nicotine had no significant effect on continuous subjective ratings of sexual arousal (P = 0.70).

    “Nicotine had no significant effect on continuous subjective ratings of sexual arousal (P = 0.70) or on mood (all Ps > 0.05).”
    Quote in the paperSubstantial claim
  • Findingown data
    § Results

    There was a significant main effect of time on heart rate (F3,25 = 27.04, P < 0.001).

    “A repeated measures anova with condition (nicotine, placebo) and time (four time measures: one prior to drug administration, one 30 minutes after drug administration, and two during the film sequence) as within-subjects factors revealed a significant main effect of both condition (F1,27 = 7.56, P = 0.01) and time (F3,25 = 27.04, P < 0.001), as well as a significant condition × time interaction (F3”
    Quote in the paperNot a substantial claim
  • Classified as probably not a substantial claim. 41
  • May combine two claims. 18
  • The quote only partly states this claim. 1

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Introduction

    Nitric oxide produced within penile endothelial cells has been identified as the principal neurotransmitter mediating erection.

    “Nitric oxide (NO) produced within penile endothelial cells has been identified as the principal neurotransmitter mediating erection [15,16].”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [15] Burnett AL, Lowenstein CJ, Bredt DS, Chang TS, Snyder SH. Nitric oxide: A physiologic mediator of penile erection. Science. 1992;257:401–403. doi: 10.1126/science.1378650. [DOI] [PubMed] [Google Scholar] source
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      The Abstract distinguishes endothelial NO-like relaxation from neurogenic relaxation and says the latter does not require functional endothelium. The discussion instead suggests that an NO-like factor is released by penile autonomic nerves. It does not identify endothelial-cell NO as the principal neurotransmitter. (LLM, conf=0.88)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data
    § Results

    The final sample had a mean age of 21.3 years (SD 2.70; range 18-27).

    “The final sample (N = 28) had a mean age of 21.3 years (standard deviation [SD], 2.70 years; range 18–27 years), and had a mean of 14.2 years of education (SD, 1.88; range 12–18).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data
    § Results

    The final sample comprised 28 men.

    “The final sample (N = 28) had a mean age of 21.3 years (standard deviation [SD], 2.70 years; range 18–27 years), and had a mean of 14.2 years of education (SD, 1.88; range 12–18).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data
    § Results

    Mean International Index of Erectile Function erectile function score was 29.4 (SD 1.10; range 26-30).

    “IIEF erectile function score † Mean (SD) 29.4 (1.10) Range 26–30”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § Results

    Systolic blood pressure scores were higher within the nicotine condition, but this did not reach statistical significance (t27 = 0.96, P = 0.34).

    “Systolic blood pressure scores were also higher within the nicotine condition, but this did not reach statistical significance (t27 = 0.96, P = 0.34).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data
    § Results

    85.7% of participants reported no passive exposure to tobacco smoke for more than 30 minutes per day at least once per week.

    “The participants reported a mean of 7.1 (SD, 9.52; range 0–30) direct exposures to nicotine during their lifetime, and 85.7% reported no passive exposure to tobacco smoke for more than 30 minutes per day at least once per week.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Participants' self-reported lifetime direct exposures to nicotine accurately reflect their true nicotine exposure.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data
    § Results

    Participants reported a mean of 7.1 lifetime direct exposures to nicotine (SD 9.52; range 0-30).

    “The participants reported a mean of 7.1 (SD, 9.52; range 0–30) direct exposures to nicotine during their lifetime, and 85.7% reported no passive exposure to tobacco smoke for more than 30 minutes per day at least once per week.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Participants' self-reported lifetime direct exposures to nicotine accurately reflect their true nicotine exposure.

  • May combine two claims.

    Findingown data
    § Results

    There were no significant effects of condition on tension, depression, anger, vigor, fatigue, confusion, or overall mood disturbance scores.

    “There were no significant effects of condition for tension (t27 = −1.42, P = 0.17), depression (t26 = −0.55, P = 0.59), anger (t27 = −0.43, P = 0.67), vigor (t26 = 1.75, P = 0.09), fatigue (t26 = −0.13, P = 0.90), and confusion scores (t27 = −0.53, P = 0.60), or for the overall mood disturbance score (t24 = −1.32, P = 0.20)”
    • Also stated in: § Discussion · plain
      “Like self-report measures of sexual arousal, subjective measures of tension, depression, anger, vigor, fatigue, and confusion did not change differentially with respect to nicotine or placebo administration.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data
    § Results

    The sample comprised 57% European American, 11% African American, 25% Latino, 4% Asian, and 4% multiracial.

    “The sample comprised 57% European American, 11% African American, 25% Latino, 4% Asian, and 4% multiracial.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data
    § Results

    Mean nicotine body concentration was 82.5 μg/kg (SD 12.85; range 55.1-105.8).

    “Nicotine body concentration (µg/kg) Mean (SD) 82.5 (12.85) Range 55.1–105.8”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § Results

    Nicotine significantly reduced erectile responses to the erotic films (P = 0.02), corresponding to a 23% reduction in physiological sexual arousal.

    “Nicotine significantly reduced erectile responses to the erotic films (P = 0.02), corresponding to a 23% reduction in physiological sexual arousal.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data
    § Results

    The decrease in physiological sexual arousal with nicotine during erotic films corresponded to a 23% reduction and occurred in 16 of 20 participants.

    “This corresponded to a 23% reduction in physiological sexual arousal and occurred in 16 of 20 participants.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Percentage of full erection (PFE) scores validly measure physiological sexual arousal.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data
    § Results

    No participants reported medical conditions; three reported currently taking medications; one reported a psychiatric condition.

    “No participants reported medical conditions of any kind, three reported currently taking medications (antihistamines, acne medications), and one participant reported a psychiatric condition (attention-deficit hyperactivity disorder).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data
    § Results

    There was no significant film type × film order interaction on square root PFE scores (F1,18 = 0.08, P = 0.78).

    “as noted by the absence of a film type × film order interaction; [F1,18 = 0.08, P = 0.78]”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning
    § Discussion

    Maintaining experimenter blindness in studies investigating cardiovascular effects of adrenergic agents is, for the most part, infeasible.

    “Although rigorous steps were taken to preserve the double-blind protocol, maintaining experimenter blindness in studies investigating cardiovascular effects of adrenergic agents is, for the most part, infeasible.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Study design and conductnone given
    § Discussion

    The assessment of subjective and physiological responses used rigorous quantitative methods.

    “the assessment of subjective and physiological responses using rigorous quantitative methods.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Introduction

    The disruptions in penile vascular function caused by smoking are mediated by a deregulation in endothelium smooth muscle relaxation.

    “These disruptions are mediated by a deregulation in endothelium smooth muscle relaxation [14].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [14] Mazo E, Gamidov S, Anranovich S, Iremashvili V. Testing endothelial function of brachial and cavernous arteries in patients with erectile dysfunction. J Sex Med. 2005;3:323–330. doi: 10.1111/j.1743-6109.2005.00098_1.x. [DOI] [PubMed] [Google Scholar] source

  • Classified as probably not a substantial claim.

    Study design and conductnone given
    § Methods

    Participants and researchers were blind to condition allocation.

    “Participants and researchers were blind to condition allocation.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data
    § Discussion

    There was no statistical relationship between attenuated genital arousal and increased drug symptomatology, indicating that the nicotine-induced reduction in sexual arousal is likely to be directly attributable to underlying biochemical and physiological involvement, rather than sequelae of adverse physical effects.

    “We determined that there was no statistical relationship between attenuated genital arousal and increased drug symptomatology, indicating that the nicotine-induced reduction in sexual arousal is likely to be directly attributable to underlying biochemical and physiological involvement, rather than sequelae of adverse physical effects.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Introduction

    A study examining the direct link between acute nicotine intake and sexual arousal in bovines revealed a significant reduction in erectile response.

    “A study examining the direct link between acute nicotine intake and sexual arousal in bovines revealed a significant reduction in erectile response [20].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [20] Klinge E, Alaranta A, Sjöstrand NO. Pharmacological analysis of nicotinic relaxation of bovine retractor penis muscle. J Pharmacol Exp Ther. 1988;245:280–286. [PubMed] [Google Scholar] source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation
    § Methods

    The International Index of Erectile Function has acceptable internal reliability, test-retest reliability, and validity.

    “The IIEF has been shown to have acceptable internal reliability (Cronbach’s alpha values of 0.73 and higher), test–retest reliability (r = 0.64 to r = 0.84), and validity [29].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [29] 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. doi: 10.1016/s0090-4295(97)00238-0. [DOI] [PubMed] [Google Scholar] source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data
    § Methods

    Bonferroni corrections were used for analyses of self-reported mood and adverse side effects.

    “A two-tailed α of P < 0.05 was considered statistically significant for all analyses with the exception of analyses of self-reported mood, and adverse side effects in which more conservative α levels of 0.007 (P < 0.05/7) and 0.025 (P < 0.05/2) were used, respectively, by employing Bonferroni corrections.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Introduction

    In a meta-analysis of 19 studies over two decades, 40% of men with erectile dysfunction were current smokers compared with 28% of men in the general population.

    “In fact, a meta-analysis of 19 studies over two decades revealed that 40% of men with ED were current smokers compared with 28% of men in the general population [10].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [10] Tengs TO, Osgood ND. The link between smoking and impotence: Two decades of evidence. Prev Med. 2001;32:447–452. doi: 10.1006/pmed.2001.0830. [DOI] [PubMed] [Google Scholar] source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation
    § Methods

    The physiological exclusion criterion is similar to that used by other researchers and yielded exclusion of eight participants, typical of circumferential measurement of erectile response.

    “The physiological exclusion criterion is similar to that used by other researchers [36,37] and yielded the exclusion of eight participants, which is typical of circumferential measurement of erectile response [38].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [36] Chivers ML, Rieger G, Latty E, Bailey JM. A sex difference in the specificity of sexual arousal. Psychol Sci. 2004;15:736–744. doi: 10.1111/j.0956-7976.2004.00750.x. [DOI] [PubMed] [Google Scholar] source
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      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation
    § Introduction

    The link between long-term cigarette smoking and erectile dysfunction is robust and indicates that cigarette smoking is an independent risk factor for introducing vasculogenic impotence.

    “The link between long-term cigarette smoking and erectile dysfunction (ED) is robust and indicates that cigarette smoking is an independent risk factor for introducing vasculogenic impotence [1–3].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [1] Condra M, Morales A, Owen JA, Surridge DH, Fenemore J. Prevalence and significance of tobacco smoking in impotence. Urology. 1986;27:495–498. doi: 10.1016/0090-4295(86)90326-2. [DOI] [PubMed] [Google Scholar] source
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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims. The quote only partly states this claim.

    Study design and conductown data
    § Methods

    Bodyweight was not significantly correlated with physiological or subjective sexual arousal, so no variables were entered as covariates.

    “None of the analyses were statistically significant (all Ps > 0.05), and therefore, no variables were entered as covariates in subsequent analyses.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Bodyweight is inversely proportional to plasma nicotine concentration level.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation
    § Discussion

    Heishman and colleagues found that 4-mg nicotine gum vs. placebo produced both euphoria and negative effects that persisted over the 45-minute session.

    “Heishman and colleagues [42] found that 4-mg nicotine gum vs. placebo produced both euphoria and negative effects that persisted over the 45-minute session.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [42] Heishman SJ, Snyder FR, Henningfield JE. Performance, subjective, and physiological effects of nicotine in non-smokers. Drug Alcohol Depend. 1993;34:11–18. doi: 10.1016/0376-8716(93)90041-n. [DOI] [PubMed] [Google Scholar] source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Introduction

    Mechanisms of chronic tobacco-induced erectile dysfunction are ultimately expressed as vascular phenomena.

    “Pathophysiological underpinnings of chronic tobacco-induced ED have not been clearly delineated; however, these mechanisms are ultimately expressed as vascular phenomena [11].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [11] Jackson G, Rosen RC, Kloner RA, Kostis JB. The second Princeton consensus on sexual dysfunction and cardiac risk: New guidelines for sexual medicine. J Sex Med. 2006;3:28–36. doi: 10.1111/j.1743-6109.2005.00196.x. [DOI] [PubMed] [Google Scholar] source

  • Classified as probably not a substantial claim.

    Study design and conductreasoning
    § Methods

    Nicotine and placebo gum pieces were matched for appearance, taste, and consistency.

    “Nicotine and placebo gum pieces were each wrapped with peppermint-flavored Wrigley’s Extra sugar-free gum (Wm. Wrigley Jr Company, Chicago, IL, USA), such that all pieces were similar in appearance, taste, and consistency.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation
    § Methods

    Penile tumescence is considered the most sensitive index of sexual arousal and the most reliable measure of physiological response.

    “Penile tumescence is considered the most sensitive index of sexual arousal and the most reliable measure of physiological response [32].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [32] Rosen RC, Keefe FJ. The measurement of human penile tumescence. Psychophysiology. 1978;15:366–376. doi: 10.1111/j.1469-8986.1978.tb01393.x. [DOI] [PubMed] [Google Scholar] source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation
    § Methods

    The Profile of Mood States short form subscales have acceptable internal reliability.

    “Internal reliability of the POMS-SF subscales has been shown to be acceptable (Cronbach’s alpha values of 0.80 and higher) [31].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [31] Shacham S. A shortened version of the Profile of Mood States. J Pers Assess. 1983;47:305–306. doi: 10.1207/s15327752jpa4703_14. [DOI] [PubMed] [Google Scholar]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data
    § Methods

    The two experimental conditions were counterbalanced.

    “The study consisted of two counterbalanced experimental conditions, nicotine and placebo, to which eligible participants were randomly assigned.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given
    § Discussion

    All participants correctly identified the session to which they were administered nicotine.

    “Additionally, all participants correctly identified the session to which they were administered nicotine.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Study design and conductnone given
    § Discussion

    The administration of nicotine gum (compared to nicotine nasal spray or transdermal nicotine patch) established a relatively fast and stable peak plasma nicotine concentration.

    “the administration of nicotine gum (compared to nicotine nasal spray or transdermal nicotine patch) to establish a relatively fast and stable peak plasma nicotine concentration”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given
    § Discussion

    The study used a randomized, double-blind, placebo-controlled crossover protocol.

    “the use of a randomized, double-blind, placebo-controlled crossover protocol”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Discussion

    Expectancies about a substance's drug content or its actions may be responsible for observed drug-like effects.

    “Second, expectancies about a substance’s drug content or its actions may be responsible for observed drug-like effects [44].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [44] Kirsch I. Specifying nonspecifics: Psychological mechanisms of placebo effects. In: Harrington A, editor. The placebo effect: An interdisciplinary exploration. Greenwich, CT: JAI Press; 1997. pp. 159–199. [Google Scholar]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Introduction

    Sighinolfi and associates demonstrated a significant improvement in penile blood flow within 24-36 hours of smoking discontinuation.

    “In the first evaluation of the short-term effects of smoking cessation on physiological sexual arousal, Sighinolfi and associates [19] demonstrated a significant improvement in penile blood flow within 24–36 hours of smoking discontinuation.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [19] 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. doi: 10.1016/j.urology.2006.09.026. [DOI] [PubMed] [Google Scholar] source

  • Classified as probably not a substantial claim.

    Study design and conductown data
    § Methods

    The trial was placebo-controlled.

    “Twenty-eight sexually functional heterosexual men (mean age 21 years), each with less than 100 direct exposures to nicotine, participated in a double-blind, randomized, placebo-controlled, crossover trial.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data
    § Methods

    All dependent variables were checked for normality; percentage of full erection was the only variable that violated normality and was square root transformed.

    “All dependent variables were checked for normality using Shapiro–Wilk tests with an α of P < 0.05 denoting a normality violation. PFE was the only variable that violated the normality assumption, and therefore was square root transformed.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning
    § Discussion

    The exclusion of smokers precluded potential long-term cardiovascular disruptions that may have deleterious effects on sexual arousal.

    “The exclusion of smokers precluded potential long-term cardiovascular disruptions that may have deleterious effects on sexual arousal”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data
    § Methods

    Subjective arousal data were excluded if a participant did not attain 15% of maximum possible arousal, yielding exclusion of seven participants.

    “Similarly, a participant’s subjective arousal data were excluded if he did not attain a value of 15% of maximum possible arousal, which yielded the exclusion of seven participants.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation
    § Introduction

    Free radicals and other compounds within cigarettes may decrease the synthesis of nitric oxide directly, or indirectly by targeting precursors, resulting in decreased penile blood inflow.

    “Free radicals and other compounds within cigarettes may decrease the synthesis of NO directly, or indirectly by targeting precursors, resulting in decreased penile blood inflow [17].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [17] McVary KT, Carrier S, Wessells H. Subcommittee on Smoking and Erectile Dysfunction Socioeco-nomic Committee Sexual Medicine Society of North America. Smoking and erectile dysfunction: Evidence based analysis. J Urol. 2001;166:1624–1632. [PubMed] [Google Scholar] source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation
    § Methods

    Gauges were calibrated over six 5-mm steps between sessions to check for reliability.

    “Gauges were calibrated over six 5-mm steps between sessions to check for reliability [33].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [33] Janssen E. Psychophysiological measures of sexual response. In: Wiederman MW, Whitley BE, editors. Handbook for conducting research on human sexuality. Mahwah, NJ: Erlbaum; 2002. [Google Scholar]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim.

    Study design and conductown data
    § Methods

    Eligible participants were randomly assigned to the nicotine and placebo conditions.

    “The study consisted of two counterbalanced experimental conditions, nicotine and placebo, to which eligible participants were randomly assigned.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation
    § Introduction

    Gilbert and colleagues tested 42 male smokers who were randomly assigned to nicotine, placebo, or wait-list conditions.

    “Gilbert and colleagues [18] tested 42 male smokers who were randomly assigned to nicotine, placebo, or wait-list conditions.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [18] Gilbert DG, Hagen RL, D’Agostino JA. The effects of cigarette smoking on human sexual potency. Addict Behav. 1986;11:431–434. doi: 10.1016/0306-4603(86)90022-5. [DOI] [PubMed] [Google Scholar] source

  • May combine two claims.

    Premisecitation
    § Acknowledgements

    Studies have reported that one 4-mg nicotine gum piece increases plasma nicotine levels by approximately 8-10 ng/mL within 30 minutes, and has a half life of approximately 120 minutes.

    “Studies that have used similar nicotine and placebo preparations have reported that, compared with a placebo condition, one 4-mg nicotine gum piece increases plasma nicotine levels by approximately 8–10 ng/mL within 30 minutes, and has a half life of approximately 120 minutes [23–26].”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [23] Hindmarch I, Kerr JS, Sherwood N. Effects of nicotine gum on psychomotor performance in smokers and non-smokers. Psychopharmacology (Berl) 1990;100:535–541. doi: 10.1007/BF02244008. [DOI] [PubMed] [Google Scholar] source
    • cites [24] Hurt RD, Offord KP, Croghan IT, Croghan GA, Gomez-Dahl LC, Wolter TD, Dale LC, Moyer TP. Temporal effects of nicotine nasal spray and gum on nicotine withdrawal symptoms. Psychopharmacology (Berl) 1998;140:98–104. doi: 10.1007/s002130050744. [DOI] [PubMed] [Google Scholar] source
    • cites [25] Rigotti NA. Clinical practice. Treatment of tobacco use and dependence. N Engl J Med. 2002;346:506–512. doi: 10.1056/NEJMcp012279. [DOI] [PubMed] [Google Scholar]

      Not checked in the free run.

    • cites [26] Tutka P, Mosiewicz J, Wielosz M. Pharmacokinetics and metabolism of nicotine. Pharmacol Rep. 2005;57:143–153. [PubMed] [Google Scholar]

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationreasoning
    § Discussion

    The expected relationship between a nicotine replacement therapy product and its effects on sexual function is likely weak.

    “Moreover, given that nicotine administered in gum form is a relatively novel route of administration (compared to cigarettes), the expected relationship between a nicotine replacement therapy product and its effects on sexual function is likely weak.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Nicotine gum is a relatively novel route of administration compared to cigarettes.

  • May combine two claims.

    Study design and conductreasoning
    § Discussion

    Nicotine dose was not titrated for participant body weight, resulting in varying plasma nicotine concentrations.

    “A third limitation is that, because of the method of drug delivery, nicotine dose was not titrated for participant body weight, resulting in varying plasma nicotine concentrations.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data
    § Conclusions

    Nicotine significantly reduces physiological sexual arousal, which provides support to the hypothesis that nicotine may be the primary pharmacological agent responsible for genital hemodynamic disruption, by acting on the nervous system centrally or peripherally.

    “That nicotine significantly reduces physiological sexual arousal provides support to the hypothesis that nicotine may be the primary pharmacological agent responsible for genital hemodynamic disruption, by acting on the nervous system centrally or peripherally.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Percentage of full erection (PFE) scores validly measure physiological sexual arousal.
49 of 49

  • The paper relies on this without support.

    The 30-minute waiting period after nicotine gum administration ensures that nicotine has reached peak plasma nicotine levels.

    “The half-hour waiting period following the administration of nicotine or placebo was used to ensure that nicotine had reached its peak plasma nicotine levels.”

  • The paper relies on this without support.

    Bodyweight is inversely proportional to plasma nicotine concentration level.

    “Because bodyweight is inversely proportional to plasma nicotine concentration level, initial Pearson product moment correlation coefficients were calculated to investigate potential confounding effects of each participant’s body nicotine concentration (in µg/kg) level on physiological and subjective sexual arousal.”

  • The paper relies on this without support.

    The 6 mg nicotine gum dose is approximately equivalent to smoking one high-yield cigarette.

    “Participants received either Nicorette polacrilex gum (SmithKline Beecham Consumer Healthcare, Pittsburgh, PA, USA) (6 mg; approximately equivalent to smoking one high-yield cigarette) or placebo gum, matched for appearance, taste, and consistency, approximately 40 minutes prior to viewing an erotic film.”

  • The paper relies on this without support.

    The sample of 28 young heterosexual men is representative of healthy nonsmoking men generally.

    “Twenty-eight sexually functional heterosexual men (mean age 21 years), each with less than 100 direct exposures to nicotine, participated in a double-blind, randomized, placebo-controlled, crossover trial.”

  • The paper relies on this without support.

    The approximately 1-week interval between experimental conditions is sufficient to prevent carryover effects of nicotine or placebo.

    “The participants were scheduled at approximately the same time during both conditions (i.e., morning, afternoon, or evening), which were scheduled at approximately 1-week intervals.”

  • The paper relies on this without support.

    Participants' self-reported lifetime direct exposures to nicotine accurately reflect their true nicotine exposure.

    “The participants reported a mean of 7.1 (SD, 9.52; range 0–30) direct exposures to nicotine during their lifetime, and 85.7% reported no passive exposure to tobacco smoke for more than 30 minutes per day at least once per week.”

  • The paper relies on this without support.

    No studies have investigated the acute effects of nicotine with respect to subjective sexual arousal.

    “Additionally, no studies have investigated the acute effects of nicotine with respect to subjective sexual arousal.”

  • The paper relies on this without support.

    Percentage of full erection (PFE) scores validly measure physiological sexual arousal.

    “Percentage of full erection was calculated by the equation 1 – ([max – χ]/[max – min]), where max denotes the largest circumferential value (full erection), and min denotes the smallest circumferential value (flaccid state) observed during either the nicotine or placebo conditions.”

  • The paper relies on this without support.

    The acute reduction in laboratory erectile response to nicotine translates to clinically significant erectile dysfunction in real-world settings.

    “The findings of this study have important clinical implications. That nicotine intake significantly impairs erectile function acutely in never smokers could be used as a convincing public health claim to assist in the prevention of cigarette smoking in adolescents and adults.”

  • The paper relies on this without support.

    Nicotine gum is a relatively novel route of administration compared to cigarettes.

    “given that nicotine administered in gum form is a relatively novel route of administration (compared to cigarettes)”
10 of 10

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Age standard deviation differs between text and Table 1

    Minor

    The sample description reports an age standard deviation of 2.70 years, while Table 1 reports 2.76 years for the same final sample of 28 participants.

1 of 1

Cites

Flagged first, then by citations

Research works printed but not linked: 2

  1. Pittilo, 1993, Cigarette smoking, endothelial cell injury and atherosclerosis, J Smok Rel Disord, 4, 17
  2. Janssen, 2002, Psychophysiological measures of sexual response, Handbook for conducting research on human sexuality

Cited by

Sorted by citations

Related

Authors
Harte, C. B., & Meston, C. M.
Affiliations
The University of Texas at Austin (US)
Corresponding author
Meston, Cindy M.
ORCID
Venue
The Journal of Sexual Medicine
Publisher
Oxford University Press (OUP)
Published
2008-01-01
Volume
5
Issue
1
Pages
110-121
ISSN
  • 1743-6095 (ISSN-L)
  • 1743-6109
DOI
10.1111/j.1743-6109.2007.00637.x
PMC
PMC2864030
OpenAlex
W2149085715
Semantic Scholar
f7884a536e4a20cef872559cee246c5b3bda29e7
Cited by
59
References
45
Citations by year
2026: 1 · 2025: 2 · 2024: 5 · 2023: 4 · 2022: 1 · 2021: 3 · 2020: 3 · 2019: 1 · 2018: 1 · 2017: 3 · 2016: 3 · 2015: 3 · 2014: 8 · 2013: 4 · 2012: 4
FWCI
1.72
Type
journal article
Language
en
Open access
Licence
academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
Locations
  • The Journal of Sexual Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Center for Complementary and Alternative Medicine (5 RO1 AT00224-02)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Sexual function and dysfunction studies
  • Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
  • Social Sciences › Psychology › Clinical Psychology › Sexuality, Behavior, and Technology
Keywords
nicotine, sexual arousal, erectile dysfunction, penile plethysmography, erotic films, mood, tobacco use, sexual health
MeSH terms
Acute Disease, Adult, Double-Blind Method, Drug Administration Routes, Erotica, Humans, Erectile Dysfunction, Libido, Male, Nicotine, Prospective Studies, Smoking, Photoplethysmography, Cross-Over Studies

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-11-06.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-11-06.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

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