The Effect of Electronic Cigarette Use on Female Sexual Functions

The Effect of Electronic Cigarette Use on Female Sexual Functions | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article The Effect of Electronic Cigarette Use on Female Sexual Functions Mehmet Culha, Tugba Kara This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4153907/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Aim While the effect of tobacco use on female sexual functions is known, the effect of electronic cigarettes on female sexual functions is unknown. The aim of this study is to investigate whether electronic cigarette use influences female sexual functions. Method Female patients over the age of 18 who applied to the Chest Diseases Polyclinic between July and August 2023 were included in the study. Patients were divided into 3 groups according to smoking status. Patients who consume tobacco products, patients who consume electronic cigarettes, and patients who do not smoke. Participants filled out the Female Sexual Function Scale (FSFI), which consists of 19 questions. Participants' sexual function scores were compared between groups. Female Sexual Dysfunction (FSD) rates were evaluated between groups. Results A total of 171 women participated in the study. The mean age of the participants was 34.25 ± 7.51 (19–58). Participants who smoked were divided into two groups: tobacco smokers (n = 56) and electronic cigarette users (n = 44). 71 participants who did not smoke constituted the control group. A total of 72 patients (42.1%) were found to have FSD. When the electronic cigarette group and the control group were compared, the FSFI-orgasm, satisfaction, pain and total FSFI scores of the participants in the e-cigarette group were found to be lower than the control group (p = 0.005 for orgasm, p = 0.029 for satisfaction, p = 0.046 for pain and Total p = 0.040 for FSFI). More FSD was observed in the cigarette group and e-cigarette group than in the control group (26.8% for the control group, 48.2% for the cigarette group, 47.7% for the e-cigarette; p < 0.001). Conclusion FSD can be seen in women who use e-cigarettes as frequently as in women who smoke regular cigarettes, and FSD is seen at a higher rate than in women who do not smoke. Health sciences/Risk factors Health sciences/Pathogenesis/Inflammation cigarette e-cigarette female sexual function orgasm satisfaction Introduction Tobacco is known to be a risk factor for cardiovascular and respiratory diseases, more than twenty different types of cancer, and many other health conditions [ 1 ]. In addition, one million two hundred thousand people die annually due to secondhand smoke [ 2 ]. An electronic cigarette is a cigarette used as an electronic nicotine delivery systems (ENDS) or personal vaporizer, typically containing nicotine and other toxic substances [ 3 ]. Most electronic cigarettes consist of a battery, a heating element, and a liquid storage chamber. The liquid storage chamber contains a liquid containing nicotine, various flavors and other chemicals that help create vapor [ 4 ]. Electronic cigarette users inhale the vapor resulting from this liquid into their lungs. While the evidence-based harms of tobacco are known, the tobacco industry has introduced electronic cigarettes containing potential reduced exposure products (PREPs), which it claims contain fewer toxic chemicals than tobacco [ 5 ]. However, the potential harms to people who use it have not been evaluated. The etiology of sexual dysfunction, a very common but often overlooked health problem in women, is estimated to be multifactorial [ 6 , 7 ]. It has been reported in various sources in the literature that approximately half of women have sexual dysfunction at some point in their lives. However, unfortunately, since female sexuality is not examined as frequently as male sexuality, both its etiology and pathophysiology, and consequently treatment methods, have not been revealed in detail. Factors such as age, weight, hormonal status, Diabetes Mellitus (DM), smoking and alcohol play a role in affecting female sexual function [ 8 ]. However, the effect of electronic cigarettes on female sexual functions is unknown. The aim of this study is to investigate whether electronic cigarette use influences women's sexual functions. Method Female patients over the age of 18 who applied to the Chest Diseases Polyclinic between July and August 2023 were included in the study. The study was approved by the ethics committee of XXX Hospital and written consent was obtained from each patient (Institutional Review Board number: 200/2023). The study was designed in accordance with the Declaration of Helsinki. Patients with previously known Female Sexual Dysfunction, chronic diseases (such as DM, Hypertension (HT)), patients with conditions such as endometriosis, Polycystic Ovary Syndrome (PCOS), patients who did not have regular sexual activity in the last 6 months, and patients who did not agree to participate in the study were excluded from the study. Demographic data of the patients were recorded. Patients were divided into three groups according to smoking status. Patients who consume tobacco products, patients who consume electronic cigarettes, and patients who do not smoke. Participants filled out the Female Sexual Function Scale (FSFI), which consists of 19 questions. FSFI is an inquiry form consisting of 19 questions and 6 sub-dimensions [ 9 ]. As the scores from this 5-point Likert scale decrease, sexual dysfunction increases, and a total score below 26.55 is interpreted in favor of female sexual dysfunction (FSD). FSFI also has a short form with 6 questions [ 10 , 11 ]. Linguistic validation of FSFI was done by Aygın et al. [ 11 ]. Participants' sexual function scores were compared between groups. FSD rates were evaluated between groups. The examination was primarily conducted in two groups: non-smoker and smoker. Afterwards, the participants were examined in three groups: tobacco smokers, electronic cigarette users and non-smokers. Statistical Analysis: The data of the study were evaluated with the SPSS 25.0 (IBM, NY, USA) program. Kolmogorov-Smirnov test was used for distribution. Independent samples t-test, chi-square test, and ANOVA test were used for statistical analysis. Significant p value was determined as < 0.05. With the FSD data in Choi et al.[ 12 ] study, it was planned to include 42 participants for each group with 80% reliability and 5% margin of error. Results A total of 171 women participated in the study. The average age of the participants was 34.25 ± 7.51 (19–58). 59.1% (101/171) of the participants were married, 40.9% were single and had regular sexual intercourse. A total of 100 patients declared that they used cigarettes and electronic cigarettes. Participants who smoked were divided into two groups: tobacco smokers (n = 56) and electronic cigarette users (n = 44). 71 participants who did not smoke constituted the control group. The duration of smoking among smokers was 28.25 ± 11.44 months. The duration of use of e-cigarette users was 22.11 ± 9.02 months (p > 0.05). The participants did not have any known chronic diseases. No significant difference was found between smoker and non-smoker patients in terms of age, income level and education level (p > 0.05). Demographic data of the participants are shown in table 1. According to the completed 19-question FSFI survey, the total FSFI score of the participants was determined as 23.39 ± 10.57 (0.3–34.8). When the cut-off score for female sexual dysfunction was evaluated as < 26.55, a total of 72 patients (42.1%) were found to have FSD. When smoker and non-smoker patients were evaluated with independent sample t-test, FSFI-arousal, lubrication, orgasm, satisfaction, pain subscales and FSFI-total scores were lower in the smoker group than in the non-smoker group (Table-2). Additionally, when evaluated in terms of FSD, the FSD rate was 44% in the smoker group, while this rate was found to be 39.4% in the non-smoker group, and a statistically higher FSD rate was observed in the smoker group (p = 0.013). When the participants were examined in three groups: control group, smoking and electronic cigarette groups, a significant difference was found between the groups in FSFI- arousal, lubrication, orgasm, satisfaction, pain, and total scores (Table-3). In the evaluation of the intergroup scores, all subscales, and FSFI-total scores of the participants in the control group, except the desire subscale, were found to be higher than the participants who smoked normal cigarettes (p < 0.05 for each). When the electronic cigarette group and the control group were compared, the FSFI-orgasm, satisfaction, pain and total FSFI scores of the participants in the e-cigarette group were found to be lower than the control group (p = 0.005 for orgasm, p = 0.029 for satisfaction, p = 0.046 for pain and Total p = 0.040 for FSFI). When the normal cigarette group was compared with the e-cigarette group, a significant difference was found between the FSFI arousal and lubrication subscales (p = 0.021 for arousal, p = 0.039 for lubrication, post hoc Tukey-test) (Table-3). When the groups were compared in terms of FSD, more FSD was seen in the cigarette group and e-cigarette group than in the control group (26.8% for the control group, 48.2% for the cigarette group, 47.7% for the e-cigarette; p < 0.001). No significant difference was found in terms of FSD when comparing the normal cigarette group and the e-cigarette group (p = 0.356). Discussion In our study, women who smoke had more sexual dysfunction, and, contrary to widespread belief, women who used e-cigarettes experienced more sexual dysfunction than women who did not smoke. Women who smoke regular cigarettes have more arousal and lubrication problems than women who use e-cigarettes. Smoking has significant health effects and causes severe damage to all organ systems. A recent analysis stated that approximately 20% of the world's population over the age of 15 smokes [ 13 ]. In addition, while smoking is common in men, the frequency of use in women is also increasing[ 14 ]. Cigarette smoke is a concentrated aerosol of liquid particles composed primarily of nitrogen, oxygen, carbon monoxide (CO) and carbon dioxide. Cigarette smoke contains more than 7000 chemical compounds (> 250 of which are known to be harmful) from many classes, such as aldehydes, aromatic amines, heavy metals, heterocyclic volatile compounds, as well as nicotine, N-nitrosamines and polycyclic aromatic hydrocarbons [ 15 ]. These chemicals in cigarette smoke cause endothelial damage and prevent endothelial vasodilation. E-cigarettes have increased in popularity as a potentially less harmful alternative to smoking tobacco; however, the literature has shown that “electronic cigarette” can cause endothelial damage [ 16 ]. In recent studies, erectile dysfunction due to endothelial damage has been observed especially in men with e-cigarette smoking [ 17 ]. E-cigarettes contain many of the ingredients in regular cigarettes. E-cigarettes deliver the same amount of nicotine into the systemic circuit as regular cigarette smoking, but the absorption rate is lower [ 18 ]. Acrolein and other aldehydes found in regular cigarettes are also found in e-cigarettes, which threaten the cardiovascular system [ 19 ]. Although studies are limited, studies have shown that smoking is associated with sexual dysfunction in women [ 20 , 21 ]. However, there are not enough studies on e-cigarette use and female sexual health. In our study, women using e-cigarettes experienced sexual dysfunction at least as much as women using regular cigarettes. Additionally, the arousal and lubrication subscales pose more problems in women who smoke regular cigarettes[ 12 ]. The main underlying cause of this situation is thought to be due to endothelial damage. Decreasing nitric oxide level with anti-estrogenic effect, increased b-adrenergic receptor formation and endothelial damage occur, resulting in impaired genital blood flow. [ 22 ]. Although e-cigarettes seem innocent, the endothelial damage they cause causes sexual dysfunction in women, just like in men[ 16 ]. Another cause of FSD is that serum estrogen levels are affected by cigarette exposure. Smoking can alter the hepatic metabolism of estradiol to estrone (sulfate), which has incredibly low biological activity. The anti-estrogenic effect of smoking can cause estrogen levels to decrease, which can reduce blood flow to the female genital tract [ 22 ]. This situation causes a decrease in arousal and therefore a decrease in lubrication, the woman has difficulty reaching orgasm and may experience pain during intercourse. Our study is the first to evaluate the effect of e-cigarette use on sexual functions in women. The study has some limitations. The first of these is that there is no evaluation based on the variety of e-cigarettes. Another limitation is that the patients were evaluated only with a questionnaire and serum estrogen levels were not evaluated. Failure to evaluate patients' psychological states and relationships is another limitation. Comparison of premenopausal and postmenopausal patients cannot be made due to the lack of a significant number of patients in both groups. This study is the first study on e-cigarettes and FSD and will shed light on further studies. Conclusion FSD can be seen in women who use e-cigarettes as frequently as women who use regular cigarettes, and FSD is seen at a higher rate than in women who do not smoke. Declarations Conflict of Interest: None Funding: None Acknowledgement: None References Smoking prevalence and attributable disease burden in 195 countries and territories, 1990-2015: a systematic analysis from the Global Burden of Disease Study 2015. Lancet, 2017. 389 (10082): p. 1885-1906. Ekpu, V.U. and A.K. Brown, The Economic Impact of Smoking and of Reducing Smoking Prevalence: Review of Evidence. Tob Use Insights, 2015. 8 : p. 1-35. Goniewicz, M.L., et al., Levels of selected carcinogens and toxicants in vapour from electronic cigarettes. Tob Control, 2014. 23 (2): p. 133-9. Brożek, G.M., et al., The Prevalence of Cigarette and E-cigarette Smoking Among Students in Central and Eastern Europe-Results of the YUPESS Study. Int J Environ Res Public Health, 2019. 16 (13). Etter, J.F. and C. Bullen, A longitudinal study of electronic cigarette users. Addict Behav, 2014. 39 (2): p. 491-4. Basson, R., et al., Report of the international consensus development conference on female sexual dysfunction: definitions and classifications. J Urol, 2000. 163 (3): p. 888-93. Nappi, R., et al., Clinical biologic pathophysiologies of women's sexual dysfunction. J Sex Med, 2005. 2 (1): p. 4-25. Oksuz, E. and S. Malhan, Prevalence and risk factors for female sexual dysfunction in Turkish women. J Urol, 2006. 175 (2): p. 654-8; discussion 658. Rosen, R., et al., The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther, 2000. 26 (2): p. 191-208. Sonbahar, A.E., M.G. Culha, and E. Jannini, The validity and reliability of the Turkish version of the 6-item female sexual function index (FSFI-6) and the relationship between climacturia and female sexual dysfunction. Int J Impot Res, 2021. Aygin, D. and F. Aslan, The Turkish adaptation of the Female Sexual Function Index. Turkiye Klinikleri Journal of Medical Sciences, 2005. 25 : p. 393-399. Choi, J., et al., Dose-response relationship between cigarette smoking and female sexual dysfunction. Obstet Gynecol Sci, 2015. 58 (4): p. 302-8. Bjurlin, M.A., et al., Ethnicity and smoking status are associated with awareness of smoking related genitourinary diseases. J Urol, 2012. 188 (3): p. 724-8. Ng, M., et al., Smoking prevalence and cigarette consumption in 187 countries, 1980-2012. Jama, 2014. 311 (2): p. 183-92. Hać, P., et al., Estimation of smokers' exposure to mercury from combustible tobacco products, based on the approach used in food consumers' exposure estimation. Food Chem Toxicol, 2023. 181 : p. 114053. Pincus, J., et al., E-Cigarette-Associated Endothelial Damage: A Potential Mechanism for Erectile Dysfunction. Sex Med Rev, 2022. 10 (1): p. 168-173. Allen, M.S. and R.C. Tostes, Cigarette smoking and erectile dysfunction: an updated review with a focus on pathophysiology, e-cigarettes, and smoking cessation. Sexual Medicine Reviews, 2023. 11 (1): p. 61-73. Benowitz, N.L. and A.D. Burbank, Cardiovascular toxicity of nicotine: Implications for electronic cigarette use. Trends Cardiovasc Med, 2016. 26 (6): p. 515-23. Bhatnagar, A., E-Cigarettes and Cardiovascular Disease Risk: Evaluation of Evidence, Policy Implications, and Recommendations. Current Cardiovascular Risk Reports, 2016. 10 (7): p. 24. Mima, M., et al., The impact of smoking on sexual function. BJU Int, 2022. 130 (2): p. 186-192. Ju, R., et al., Importance of active and passive smoking as one of the risk factors for female sexual dysfunction in Chinese women. Gynecol Endocrinol, 2021. 37 (6): p. 541-545. Battaglia, C., et al., Cigarette smoking decreases the genital vascularization in young healthy, eumenorrheic women. J Sex Med, 2011. 8 (6): p. 1717-25. Tables Table-1: Demographic characteristics of participants Mean SD Min Max n % Age 34.25 7.51 19 58 Marital Status Single 70 40.9 Married 101 59.1 Income Status Low 16 9.4 Middle 153 89.5 High 2 0.1 Cigarette Use No 71 41.5 Cigarette 56 32.7 e-Cigarette 44 25.7 FSD No 99 57.9 Yes 72 42.1 Table-2: Comparison between all cigarette users and control group Cigarette (+) (n=100) Cigarette (-) (n=71) FSFI Mean Std. Deviation Mean Std. Deviation t p Desire 3,634 1,5209 4,044 1,4055 1.325 0.071 Arousal 2,700 1,6634 3,450 1,3007 2.469 0.001 Lubrication 3,583 2,4287 4,614 1,7497 2.595 0.002 Orgasm 3,132 2,3509 4,552 1,7668 3.830 <0.001 Satisfaction 3,313 2,5453 4,528 1,7550 3.142 <0.001 Pain 3,392 2,6592 4,784 1,9546 3.638 <0.001 Total 19,754 11,7918 25,972 8,7901 3.303 <0.001 Independent sample t-test was used Table-3: Comparison between control group, cigarette, and e-cigarette groups No cigarette Cigarette e-cigarette FSFI Mean Std. Deviation Mean Std. Deviation Mean Std. Deviation p Desire 4,243 1,2733 3,634 1,5209 3,791 1,5353 0,060 Arousal 3,568 1,2091 2,700 1,6634 3,300 1,4086 0,003 Lubrication 4,854 1,6522 3,583 2,4287 4,309 1,8404 0,003 Orgasm 4,700 1,6059 3,132 2,3509 4,364 1,9554 <0,001 Satisfaction 4,657 1,7097 3,313 2,5453 4,364 1,8174 0,001 Pain 5,086 1,7153 3,392 2,6592 4,400 2,1824 <0,001 Total 27,107 8,0964 19,754 11,7918 24,527 9,4991 <0,001 Additional Declarations There is NO conflict of interest to disclose. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4153907","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":283810786,"identity":"cd9bae4c-a469-4527-a3e3-0894edccde6c","order_by":0,"name":"Mehmet Culha","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABDklEQVRIiWNgGAWjYFACNjYIzc7DwPCBxyYBzEkoIEYLMw8D4wyZtAQGED/BgEgtzBw2hyFaGPBokXdvS3vwcweDvMFh3oOfGXLO5/HLdyd+eGDAIM8vdgCrFsMzx44b9p5hMNxwmC9ZuuDM7WLJNt7NEkCHGc6cnYBdy4z0NgneNqDjD/MYSM/suZ244RjvBpCWBIPbuLVI/oVoMf7N++8cSMvmH/i0yEukHZOG2mImzcNzAKRlG15bDHiOpUnLtgFdDtRiOYMnOXFmW+42iwQDCZx+kW9vM5N828Ygz3e8x/jGBx67xH7ms5tv/qiwkeeXxmHLATD1H0NCAqtysC0NOKVGwSgYBaNgFEABAOw0W1dhAyAZAAAAAElFTkSuQmCC","orcid":"https://orcid.org/0000-0003-4059-2293","institution":"University of Health Sciences, Prof. Dr. Cemil Tascioglu City Hospital","correspondingAuthor":true,"prefix":"","firstName":"Mehmet","middleName":"","lastName":"Culha","suffix":""},{"id":283810787,"identity":"8332f7c1-8a0c-4097-872a-61116b5c5b78","order_by":1,"name":"Tugba Kara","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Tugba","middleName":"","lastName":"Kara","suffix":""}],"badges":[],"createdAt":"2024-03-23 10:20:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4153907/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4153907/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":86676776,"identity":"75607f76-5648-493d-803e-62266b8980f2","added_by":"auto","created_at":"2025-07-14 12:18:42","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":424548,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4153907/v1/4a4d6696-0daf-4829-b2d8-a8417ee77447.pdf"}],"financialInterests":"There is \u003cb\u003eNO\u003c/b\u003e conflict of interest to disclose.","formattedTitle":"The Effect of Electronic Cigarette Use on Female Sexual Functions","fulltext":[{"header":"Introduction","content":"\u003cp\u003eTobacco is known to be a risk factor for cardiovascular and respiratory diseases, more than twenty different types of cancer, and many other health conditions [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In addition, one million two hundred thousand people die annually due to secondhand smoke [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAn electronic cigarette is a cigarette used as an electronic nicotine delivery systems (ENDS) or personal vaporizer, typically containing nicotine and other toxic substances [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Most electronic cigarettes consist of a battery, a heating element, and a liquid storage chamber. The liquid storage chamber contains a liquid containing nicotine, various flavors and other chemicals that help create vapor [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Electronic cigarette users inhale the vapor resulting from this liquid into their lungs.\u003c/p\u003e \u003cp\u003eWhile the evidence-based harms of tobacco are known, the tobacco industry has introduced electronic cigarettes containing potential reduced exposure products (PREPs), which it claims contain fewer toxic chemicals than tobacco [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. However, the potential harms to people who use it have not been evaluated.\u003c/p\u003e \u003cp\u003eThe etiology of sexual dysfunction, a very common but often overlooked health problem in women, is estimated to be multifactorial [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. It has been reported in various sources in the literature that approximately half of women have sexual dysfunction at some point in their lives. However, unfortunately, since female sexuality is not examined as frequently as male sexuality, both its etiology and pathophysiology, and consequently treatment methods, have not been revealed in detail. Factors such as age, weight, hormonal status, Diabetes Mellitus (DM), smoking and alcohol play a role in affecting female sexual function [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. However, the effect of electronic cigarettes on female sexual functions is unknown.\u003c/p\u003e \u003cp\u003eThe aim of this study is to investigate whether electronic cigarette use influences women's sexual functions.\u003c/p\u003e "},{"header":"Method","content":"\u003cp\u003eFemale patients over the age of 18 who applied to the Chest Diseases Polyclinic between July and August 2023 were included in the study. The study was approved by the ethics committee of XXX Hospital and written consent was obtained from each patient (Institutional Review Board number: 200/2023). The study was designed in accordance with the Declaration of Helsinki.\u003c/p\u003e\u003cp\u003ePatients with previously known Female Sexual Dysfunction, chronic diseases (such as DM, Hypertension (HT)), patients with conditions such as endometriosis, Polycystic Ovary Syndrome (PCOS), patients who did not have regular sexual activity in the last 6 months, and patients who did not agree to participate in the study were excluded from the study.\u003c/p\u003e\u003cp\u003eDemographic data of the patients were recorded. Patients were divided into three groups according to smoking status. Patients who consume tobacco products, patients who consume electronic cigarettes, and patients who do not smoke.\u003c/p\u003e\u003cp\u003eParticipants filled out the Female Sexual Function Scale (FSFI), which consists of 19 questions. FSFI is an inquiry form consisting of 19 questions and 6 sub-dimensions [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. As the scores from this 5-point Likert scale decrease, sexual dysfunction increases, and a total score below 26.55 is interpreted in favor of female sexual dysfunction (FSD). FSFI also has a short form with 6 questions [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Linguistic validation of FSFI was done by Aygın et al.\u003c/p\u003e\u003cp\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eParticipants' sexual function scores were compared between groups. FSD rates were evaluated between groups. The examination was primarily conducted in two groups: non-smoker and smoker. Afterwards, the participants were examined in three groups: tobacco smokers, electronic cigarette users and non-smokers.\u003c/p\u003e\u003ch2\u003eStatistical Analysis:\u003c/h2\u003e\u003cp\u003eThe data of the study were evaluated with the SPSS 25.0 (IBM, NY, USA) program. Kolmogorov-Smirnov test was used for distribution. Independent samples t-test, chi-square test, and ANOVA test were used for statistical analysis. Significant p value was determined as \u0026lt; 0.05. With the FSD data in Choi et al.[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] study, it was planned to include 42 participants for each group with 80% reliability and 5% margin of error.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 171 women participated in the study. The average age of the participants was 34.25\u0026thinsp;\u0026plusmn;\u0026thinsp;7.51 (19\u0026ndash;58). 59.1% (101/171) of the participants were married, 40.9% were single and had regular sexual intercourse. A total of 100 patients declared that they used cigarettes and electronic cigarettes. Participants who smoked were divided into two groups: tobacco smokers (n\u0026thinsp;=\u0026thinsp;56) and electronic cigarette users (n\u0026thinsp;=\u0026thinsp;44). 71 participants who did not smoke constituted the control group. The duration of smoking among smokers was 28.25\u0026thinsp;\u0026plusmn;\u0026thinsp;11.44 months. The duration of use of e-cigarette users was 22.11\u0026thinsp;\u0026plusmn;\u0026thinsp;9.02 months (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The participants did not have any known chronic diseases. No significant difference was found between smoker and non-smoker patients in terms of age, income level and education level (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Demographic data of the participants are shown in table 1.\u003c/p\u003e \u003cp\u003eAccording to the completed 19-question FSFI survey, the total FSFI score of the participants was determined as 23.39\u0026thinsp;\u0026plusmn;\u0026thinsp;10.57 (0.3\u0026ndash;34.8). When the cut-off score for female sexual dysfunction was evaluated as \u0026lt;\u0026thinsp;26.55, a total of 72 patients (42.1%) were found to have FSD.\u003c/p\u003e \u003cp\u003eWhen smoker and non-smoker patients were evaluated with independent sample t-test, FSFI-arousal, lubrication, orgasm, satisfaction, pain subscales and FSFI-total scores were lower in the smoker group than in the non-smoker group (Table-2). Additionally, when evaluated in terms of FSD, the FSD rate was 44% in the smoker group, while this rate was found to be 39.4% in the non-smoker group, and a statistically higher FSD rate was observed in the smoker group (p\u0026thinsp;=\u0026thinsp;0.013).\u003c/p\u003e \u003cp\u003e When the participants were examined in three groups: control group, smoking and electronic cigarette groups, a significant difference was found between the groups in FSFI- arousal, lubrication, orgasm, satisfaction, pain, and total scores (Table-3). In the evaluation of the intergroup scores, all subscales, and FSFI-total scores of the participants in the control group, except the desire subscale, were found to be higher than the participants who smoked normal cigarettes (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 for each). When the electronic cigarette group and the control group were compared, the FSFI-orgasm, satisfaction, pain and total FSFI scores of the participants in the e-cigarette group were found to be lower than the control group (p\u0026thinsp;=\u0026thinsp;0.005 for orgasm, p\u0026thinsp;=\u0026thinsp;0.029 for satisfaction, p\u0026thinsp;=\u0026thinsp;0.046 for pain and Total p\u0026thinsp;=\u0026thinsp;0.040 for FSFI).\u003c/p\u003e \u003cp\u003eWhen the normal cigarette group was compared with the e-cigarette group, a significant difference was found between the FSFI arousal and lubrication subscales (p\u0026thinsp;=\u0026thinsp;0.021 for arousal, p\u0026thinsp;=\u0026thinsp;0.039 for lubrication, post hoc Tukey-test) (Table-3).\u003c/p\u003e \u003cp\u003eWhen the groups were compared in terms of FSD, more FSD was seen in the cigarette group and e-cigarette group than in the control group (26.8% for the control group, 48.2% for the cigarette group, 47.7% for the e-cigarette; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). No significant difference was found in terms of FSD when comparing the normal cigarette group and the e-cigarette group (p\u0026thinsp;=\u0026thinsp;0.356).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn our study, women who smoke had more sexual dysfunction, and, contrary to widespread belief, women who used e-cigarettes experienced more sexual dysfunction than women who did not smoke. Women who smoke regular cigarettes have more arousal and lubrication problems than women who use e-cigarettes.\u003c/p\u003e \u003cp\u003eSmoking has significant health effects and causes severe damage to all organ systems. A recent analysis stated that approximately 20% of the world's population over the age of 15 smokes [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In addition, while smoking is common in men, the frequency of use in women is also increasing[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCigarette smoke is a concentrated aerosol of liquid particles composed primarily of nitrogen, oxygen, carbon monoxide (CO) and carbon dioxide. Cigarette smoke contains more than 7000 chemical compounds (\u0026gt;\u0026thinsp;250 of which are known to be harmful) from many classes, such as aldehydes, aromatic amines, heavy metals, heterocyclic volatile compounds, as well as nicotine, N-nitrosamines and polycyclic aromatic hydrocarbons [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. These chemicals in cigarette smoke cause endothelial damage and prevent endothelial vasodilation.\u003c/p\u003e \u003cp\u003eE-cigarettes have increased in popularity as a potentially less harmful alternative to smoking tobacco; however, the literature has shown that \u0026ldquo;electronic cigarette\u0026rdquo; can cause endothelial damage [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. In recent studies, erectile dysfunction due to endothelial damage has been observed especially in men with e-cigarette smoking [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eE-cigarettes contain many of the ingredients in regular cigarettes. E-cigarettes deliver the same amount of nicotine into the systemic circuit as regular cigarette smoking, but the absorption rate is lower [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Acrolein and other aldehydes found in regular cigarettes are also found in e-cigarettes, which threaten the cardiovascular system [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough studies are limited, studies have shown that smoking is associated with sexual dysfunction in women [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. However, there are not enough studies on e-cigarette use and female sexual health. In our study, women using e-cigarettes experienced sexual dysfunction at least as much as women using regular cigarettes. Additionally, the arousal and lubrication subscales pose more problems in women who smoke regular cigarettes[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. The main underlying cause of this situation is thought to be due to endothelial damage. Decreasing nitric oxide level with anti-estrogenic effect, increased b-adrenergic receptor formation and endothelial damage occur, resulting in impaired genital blood flow. [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Although e-cigarettes seem innocent, the endothelial damage they cause causes sexual dysfunction in women, just like in men[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAnother cause of FSD is that serum estrogen levels are affected by cigarette exposure. Smoking can alter the hepatic metabolism of estradiol to estrone (sulfate), which has incredibly low biological activity. The anti-estrogenic effect of smoking can cause estrogen levels to decrease, which can reduce blood flow to the female genital tract [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. This situation causes a decrease in arousal and therefore a decrease in lubrication, the woman has difficulty reaching orgasm and may experience pain during intercourse.\u003c/p\u003e \u003cp\u003eOur study is the first to evaluate the effect of e-cigarette use on sexual functions in women. The study has some limitations. The first of these is that there is no evaluation based on the variety of e-cigarettes. Another limitation is that the patients were evaluated only with a questionnaire and serum estrogen levels were not evaluated. Failure to evaluate patients' psychological states and relationships is another limitation. Comparison of premenopausal and postmenopausal patients cannot be made due to the lack of a significant number of patients in both groups. This study is the first study on e-cigarettes and FSD and will shed light on further studies.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eFSD can be seen in women who use e-cigarettes as frequently as women who use regular cigarettes, and FSD is seen at a higher rate than in women who do not smoke.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eConflict of Interest:\u003c/h2\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003eNone\u003c/p\u003e\u003ch2\u003eAcknowledgement:\u003c/h2\u003e \u003cp\u003eNone\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003e\u003cem\u003eSmoking prevalence and attributable disease burden in 195 countries and territories, 1990-2015: a systematic analysis from the Global Burden of Disease Study 2015.\u003c/em\u003e Lancet, 2017. \u003cstrong\u003e389\u003c/strong\u003e(10082): p. 1885-1906.\u003c/li\u003e\n\u003cli\u003eEkpu, V.U. and A.K. Brown, \u003cem\u003eThe Economic Impact of Smoking and of Reducing Smoking Prevalence: Review of Evidence.\u003c/em\u003e Tob Use Insights, 2015. \u003cstrong\u003e8\u003c/strong\u003e: p. 1-35.\u003c/li\u003e\n\u003cli\u003eGoniewicz, M.L., et al., \u003cem\u003eLevels of selected carcinogens and toxicants in vapour from electronic cigarettes.\u003c/em\u003e Tob Control, 2014. \u003cstrong\u003e23\u003c/strong\u003e(2): p. 133-9.\u003c/li\u003e\n\u003cli\u003eBrożek, G.M., et al., \u003cem\u003eThe Prevalence of Cigarette and E-cigarette Smoking Among Students in Central and Eastern Europe-Results of the YUPESS Study.\u003c/em\u003e Int J Environ Res Public Health, 2019. \u003cstrong\u003e16\u003c/strong\u003e(13).\u003c/li\u003e\n\u003cli\u003eEtter, J.F. and C. Bullen, \u003cem\u003eA longitudinal study of electronic cigarette users.\u003c/em\u003e Addict Behav, 2014. \u003cstrong\u003e39\u003c/strong\u003e(2): p. 491-4.\u003c/li\u003e\n\u003cli\u003eBasson, R., et al., \u003cem\u003eReport of the international consensus development conference on female sexual dysfunction: definitions and classifications.\u003c/em\u003e J Urol, 2000. \u003cstrong\u003e163\u003c/strong\u003e(3): p. 888-93.\u003c/li\u003e\n\u003cli\u003eNappi, R., et al., \u003cem\u003eClinical biologic pathophysiologies of women\u0026apos;s sexual dysfunction.\u003c/em\u003e J Sex Med, 2005. \u003cstrong\u003e2\u003c/strong\u003e(1): p. 4-25.\u003c/li\u003e\n\u003cli\u003eOksuz, E. and S. Malhan, \u003cem\u003ePrevalence and risk factors for female sexual dysfunction in Turkish women.\u003c/em\u003e J Urol, 2006. \u003cstrong\u003e175\u003c/strong\u003e(2): p. 654-8; discussion 658.\u003c/li\u003e\n\u003cli\u003eRosen, R., et al., \u003cem\u003eThe Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function.\u003c/em\u003e J Sex Marital Ther, 2000. \u003cstrong\u003e26\u003c/strong\u003e(2): p. 191-208.\u003c/li\u003e\n\u003cli\u003eSonbahar, A.E., M.G. Culha, and E. Jannini, \u003cem\u003eThe validity and reliability of the Turkish version of the 6-item female sexual function index (FSFI-6) and the relationship between climacturia and female sexual dysfunction.\u003c/em\u003e Int J Impot Res, 2021.\u003c/li\u003e\n\u003cli\u003eAygin, D. and F. Aslan, \u003cem\u003eThe Turkish adaptation of the Female Sexual Function Index.\u003c/em\u003e Turkiye Klinikleri Journal of Medical Sciences, 2005. \u003cstrong\u003e25\u003c/strong\u003e: p. 393-399.\u003c/li\u003e\n\u003cli\u003eChoi, J., et al., \u003cem\u003eDose-response relationship between cigarette smoking and female sexual dysfunction.\u003c/em\u003e Obstet Gynecol Sci, 2015. \u003cstrong\u003e58\u003c/strong\u003e(4): p. 302-8.\u003c/li\u003e\n\u003cli\u003eBjurlin, M.A., et al., \u003cem\u003eEthnicity and smoking status are associated with awareness of smoking related genitourinary diseases.\u003c/em\u003e J Urol, 2012. \u003cstrong\u003e188\u003c/strong\u003e(3): p. 724-8.\u003c/li\u003e\n\u003cli\u003eNg, M., et al., \u003cem\u003eSmoking prevalence and cigarette consumption in 187 countries, 1980-2012.\u003c/em\u003e Jama, 2014. \u003cstrong\u003e311\u003c/strong\u003e(2): p. 183-92.\u003c/li\u003e\n\u003cli\u003eHać, P., et al., \u003cem\u003eEstimation of smokers\u0026apos; exposure to mercury from combustible tobacco products, based on the approach used in food consumers\u0026apos; exposure estimation.\u003c/em\u003e Food Chem Toxicol, 2023. \u003cstrong\u003e181\u003c/strong\u003e: p. 114053.\u003c/li\u003e\n\u003cli\u003ePincus, J., et al., \u003cem\u003eE-Cigarette-Associated Endothelial Damage: A Potential Mechanism for Erectile Dysfunction.\u003c/em\u003e Sex Med Rev, 2022. \u003cstrong\u003e10\u003c/strong\u003e(1): p. 168-173.\u003c/li\u003e\n\u003cli\u003eAllen, M.S. and R.C. Tostes, \u003cem\u003eCigarette smoking and erectile dysfunction: an updated review with a focus on pathophysiology, e-cigarettes, and smoking cessation.\u003c/em\u003e Sexual Medicine Reviews, 2023. \u003cstrong\u003e11\u003c/strong\u003e(1): p. 61-73.\u003c/li\u003e\n\u003cli\u003eBenowitz, N.L. and A.D. Burbank, \u003cem\u003eCardiovascular toxicity of nicotine: Implications for electronic cigarette use.\u003c/em\u003e Trends Cardiovasc Med, 2016. \u003cstrong\u003e26\u003c/strong\u003e(6): p. 515-23.\u003c/li\u003e\n\u003cli\u003eBhatnagar, A., \u003cem\u003eE-Cigarettes and Cardiovascular Disease Risk: Evaluation of Evidence, Policy Implications, and Recommendations.\u003c/em\u003e Current Cardiovascular Risk Reports, 2016. \u003cstrong\u003e10\u003c/strong\u003e(7): p. 24.\u003c/li\u003e\n\u003cli\u003eMima, M., et al., \u003cem\u003eThe impact of smoking on sexual function.\u003c/em\u003e BJU Int, 2022. \u003cstrong\u003e130\u003c/strong\u003e(2): p. 186-192.\u003c/li\u003e\n\u003cli\u003eJu, R., et al., \u003cem\u003eImportance of active and passive smoking as one of the risk factors for female sexual dysfunction in Chinese women.\u003c/em\u003e Gynecol Endocrinol, 2021. \u003cstrong\u003e37\u003c/strong\u003e(6): p. 541-545.\u003c/li\u003e\n\u003cli\u003eBattaglia, C., et al., \u003cem\u003eCigarette smoking decreases the genital vascularization in young healthy, eumenorrheic women.\u003c/em\u003e J Sex Med, 2011. \u003cstrong\u003e8\u003c/strong\u003e(6): p. 1717-25.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable-1: Demographic characteristics of participants\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"415\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.60576923076923%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"18.509615384615383%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.336538461538462%\" valign=\"bottom\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.336538461538462%\" valign=\"bottom\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.9326923076923075%\" valign=\"bottom\"\u003e\n \u003cp\u003eMin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.413461538461538%\" valign=\"bottom\"\u003e\n \u003cp\u003eMax\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.451923076923077%\" valign=\"bottom\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.413461538461538%\" valign=\"bottom\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.60576923076923%\" valign=\"bottom\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.509615384615383%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.336538461538462%\" valign=\"bottom\"\u003e\n \u003cp\u003e34.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.336538461538462%\" valign=\"bottom\"\u003e\n \u003cp\u003e7.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.9326923076923075%\" valign=\"bottom\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.413461538461538%\" valign=\"bottom\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.451923076923077%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.413461538461538%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.60576923076923%\" valign=\"bottom\"\u003e\n \u003cp\u003eMarital Status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.509615384615383%\" valign=\"bottom\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.336538461538462%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.336538461538462%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.9326923076923075%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"8.413461538461538%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.451923076923077%\" valign=\"bottom\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.413461538461538%\" valign=\"bottom\"\u003e\n \u003cp\u003e40.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.60576923076923%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"18.509615384615383%\" valign=\"bottom\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.336538461538462%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.336538461538462%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.9326923076923075%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"8.413461538461538%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.451923076923077%\" valign=\"bottom\"\u003e\n \u003cp\u003e101\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.413461538461538%\" valign=\"bottom\"\u003e\n \u003cp\u003e59.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.60576923076923%\" valign=\"bottom\"\u003e\n \u003cp\u003eIncome Status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.509615384615383%\" valign=\"bottom\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.336538461538462%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.336538461538462%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.9326923076923075%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.413461538461538%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.451923076923077%\" valign=\"bottom\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.413461538461538%\" valign=\"bottom\"\u003e\n \u003cp\u003e9.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.60576923076923%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"18.509615384615383%\" valign=\"bottom\"\u003e\n \u003cp\u003eMiddle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.336538461538462%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.336538461538462%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.9326923076923075%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"8.413461538461538%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.451923076923077%\" valign=\"bottom\"\u003e\n \u003cp\u003e153\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.413461538461538%\" valign=\"bottom\"\u003e\n \u003cp\u003e89.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.60576923076923%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.509615384615383%\" valign=\"bottom\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.336538461538462%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.336538461538462%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.9326923076923075%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.413461538461538%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.451923076923077%\" valign=\"bottom\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.413461538461538%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.60576923076923%\" valign=\"bottom\"\u003e\n \u003cp\u003eCigarette Use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.509615384615383%\" valign=\"bottom\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.336538461538462%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.336538461538462%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.9326923076923075%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"8.413461538461538%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.451923076923077%\" valign=\"bottom\"\u003e\n \u003cp\u003e71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.413461538461538%\" valign=\"bottom\"\u003e\n \u003cp\u003e41.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.60576923076923%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"18.509615384615383%\" valign=\"bottom\"\u003e\n \u003cp\u003eCigarette\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.336538461538462%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.336538461538462%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.9326923076923075%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"8.413461538461538%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.451923076923077%\" valign=\"bottom\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.413461538461538%\" valign=\"bottom\"\u003e\n \u003cp\u003e32.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.60576923076923%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"18.509615384615383%\" valign=\"bottom\"\u003e\n \u003cp\u003ee-Cigarette\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.336538461538462%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.336538461538462%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.9326923076923075%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"8.413461538461538%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.451923076923077%\" valign=\"bottom\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.413461538461538%\" valign=\"bottom\"\u003e\n \u003cp\u003e25.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.60576923076923%\" valign=\"bottom\"\u003e\n \u003cp\u003eFSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.509615384615383%\" valign=\"bottom\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.336538461538462%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.336538461538462%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.9326923076923075%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.413461538461538%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.451923076923077%\" valign=\"bottom\"\u003e\n \u003cp\u003e99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.413461538461538%\" valign=\"bottom\"\u003e\n \u003cp\u003e57.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.60576923076923%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"18.509615384615383%\" valign=\"bottom\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.336538461538462%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.336538461538462%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.9326923076923075%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"8.413461538461538%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.451923076923077%\" valign=\"bottom\"\u003e\n \u003cp\u003e72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.413461538461538%\" valign=\"bottom\"\u003e\n \u003cp\u003e42.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\n \n\u003c/p\u003e\n\u003cp\u003eTable-2: Comparison between all cigarette users and control group\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"491\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.53061224489796%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.408163265306122%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003eCigarette (+) (n=100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.408163265306122%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003eCigarette (-) (n=71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.040816326530612%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.612244897959183%\" valign=\"bottom\"\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.463414634146343%\" valign=\"bottom\"\u003e\n \u003cp\u003eFSFI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.365853658536585%\" valign=\"bottom\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.121951219512194%\" valign=\"bottom\"\u003e\n \u003cp\u003eStd. Deviation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.365853658536585%\" valign=\"bottom\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.121951219512194%\" valign=\"bottom\"\u003e\n \u003cp\u003eStd. Deviation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.991869918699187%\" valign=\"bottom\"\u003e\n \u003cp\u003et\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.56910569105691%\" valign=\"bottom\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.463414634146343%\" valign=\"top\"\u003e\n \u003cp\u003eDesire\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.365853658536585%\" valign=\"top\"\u003e\n \u003cp\u003e3,634\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.121951219512194%\" valign=\"top\"\u003e\n \u003cp\u003e1,5209\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.365853658536585%\" valign=\"top\"\u003e\n \u003cp\u003e4,044\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.121951219512194%\" valign=\"top\"\u003e\n \u003cp\u003e1,4055\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.991869918699187%\" valign=\"top\"\u003e\n \u003cp\u003e1.325\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.56910569105691%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.071\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.463414634146343%\" valign=\"top\"\u003e\n \u003cp\u003eArousal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.365853658536585%\" valign=\"top\"\u003e\n \u003cp\u003e2,700\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.121951219512194%\" valign=\"top\"\u003e\n \u003cp\u003e1,6634\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.365853658536585%\" valign=\"top\"\u003e\n \u003cp\u003e3,450\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.121951219512194%\" valign=\"top\"\u003e\n \u003cp\u003e1,3007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.991869918699187%\" valign=\"top\"\u003e\n \u003cp\u003e2.469\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.56910569105691%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.463414634146343%\" valign=\"top\"\u003e\n \u003cp\u003eLubrication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.365853658536585%\" valign=\"top\"\u003e\n \u003cp\u003e3,583\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.121951219512194%\" valign=\"top\"\u003e\n \u003cp\u003e2,4287\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.365853658536585%\" valign=\"top\"\u003e\n \u003cp\u003e4,614\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.121951219512194%\" valign=\"top\"\u003e\n \u003cp\u003e1,7497\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.991869918699187%\" valign=\"top\"\u003e\n \u003cp\u003e2.595\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.56910569105691%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.463414634146343%\" valign=\"top\"\u003e\n \u003cp\u003eOrgasm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.365853658536585%\" valign=\"top\"\u003e\n \u003cp\u003e3,132\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.121951219512194%\" valign=\"top\"\u003e\n \u003cp\u003e2,3509\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.365853658536585%\" valign=\"top\"\u003e\n \u003cp\u003e4,552\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.121951219512194%\" valign=\"top\"\u003e\n \u003cp\u003e1,7668\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.991869918699187%\" valign=\"top\"\u003e\n \u003cp\u003e3.830\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.56910569105691%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.463414634146343%\" valign=\"top\"\u003e\n \u003cp\u003eSatisfaction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.365853658536585%\" valign=\"top\"\u003e\n \u003cp\u003e3,313\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.121951219512194%\" valign=\"top\"\u003e\n \u003cp\u003e2,5453\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.365853658536585%\" valign=\"top\"\u003e\n \u003cp\u003e4,528\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.121951219512194%\" valign=\"top\"\u003e\n \u003cp\u003e1,7550\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.991869918699187%\" valign=\"top\"\u003e\n \u003cp\u003e3.142\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.56910569105691%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.463414634146343%\" valign=\"top\"\u003e\n \u003cp\u003ePain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.365853658536585%\" valign=\"top\"\u003e\n \u003cp\u003e3,392\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.121951219512194%\" valign=\"top\"\u003e\n \u003cp\u003e2,6592\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.365853658536585%\" valign=\"top\"\u003e\n \u003cp\u003e4,784\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.121951219512194%\" valign=\"top\"\u003e\n \u003cp\u003e1,9546\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.991869918699187%\" valign=\"top\"\u003e\n \u003cp\u003e3.638\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.56910569105691%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.463414634146343%\" valign=\"top\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.365853658536585%\" valign=\"top\"\u003e\n \u003cp\u003e19,754\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.121951219512194%\" valign=\"top\"\u003e\n \u003cp\u003e11,7918\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.365853658536585%\" valign=\"top\"\u003e\n \u003cp\u003e25,972\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.121951219512194%\" valign=\"top\"\u003e\n \u003cp\u003e8,7901\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.991869918699187%\" valign=\"top\"\u003e\n \u003cp\u003e3.303\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.56910569105691%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eIndependent sample t-test was used\u003c/p\u003e\n\u003cp\u003eTable-3: Comparison between control group, cigarette, and e-cigarette groups\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"628\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.535031847133759%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"24.522292993630572%\" colspan=\"2\"\u003e\n \u003cp\u003eNo cigarette\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.840764331210192%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003eCigarette\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.11464968152866%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003ee-cigarette\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.987261146496815%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.535031847133759%\" valign=\"bottom\"\u003e\n \u003cp\u003eFSFI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.872611464968152%\" valign=\"bottom\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.64968152866242%\" valign=\"bottom\"\u003e\n \u003cp\u003eStd. Deviation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.9171974522293%\" valign=\"bottom\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.92356687898089%\" valign=\"bottom\"\u003e\n \u003cp\u003eStd. Deviation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.439490445859873%\" valign=\"bottom\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.67515923566879%\" valign=\"bottom\"\u003e\n \u003cp\u003eStd. 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\u003ctd width=\"10.987261146496815%\" valign=\"top\"\u003e\n \u003cp\u003e0,060\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.535031847133759%\" valign=\"top\"\u003e\n \u003cp\u003eArousal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.872611464968152%\" valign=\"top\"\u003e\n \u003cp\u003e3,568\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.64968152866242%\" valign=\"top\"\u003e\n \u003cp\u003e1,2091\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.9171974522293%\" valign=\"top\"\u003e\n \u003cp\u003e2,700\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.92356687898089%\" valign=\"top\"\u003e\n \u003cp\u003e1,6634\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.439490445859873%\" valign=\"top\"\u003e\n \u003cp\u003e3,300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.67515923566879%\" valign=\"top\"\u003e\n \u003cp\u003e1,4086\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.987261146496815%\" valign=\"top\"\u003e\n \u003cp\u003e0,003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.535031847133759%\" valign=\"top\"\u003e\n \u003cp\u003eLubrication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.872611464968152%\" valign=\"top\"\u003e\n \u003cp\u003e4,854\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.64968152866242%\" valign=\"top\"\u003e\n \u003cp\u003e1,6522\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.9171974522293%\" valign=\"top\"\u003e\n \u003cp\u003e3,583\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.92356687898089%\" valign=\"top\"\u003e\n \u003cp\u003e2,4287\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.439490445859873%\" valign=\"top\"\u003e\n \u003cp\u003e4,309\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.67515923566879%\" valign=\"top\"\u003e\n \u003cp\u003e1,8404\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.987261146496815%\" valign=\"top\"\u003e\n \u003cp\u003e0,003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.535031847133759%\" valign=\"top\"\u003e\n \u003cp\u003eOrgasm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.872611464968152%\" valign=\"top\"\u003e\n \u003cp\u003e4,700\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.64968152866242%\" valign=\"top\"\u003e\n \u003cp\u003e1,6059\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.9171974522293%\" valign=\"top\"\u003e\n \u003cp\u003e3,132\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.92356687898089%\" valign=\"top\"\u003e\n \u003cp\u003e2,3509\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.439490445859873%\" valign=\"top\"\u003e\n \u003cp\u003e4,364\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.67515923566879%\" valign=\"top\"\u003e\n \u003cp\u003e1,9554\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.987261146496815%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026lt;0,001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.535031847133759%\" valign=\"top\"\u003e\n \u003cp\u003eSatisfaction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.872611464968152%\" valign=\"top\"\u003e\n \u003cp\u003e4,657\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.64968152866242%\" valign=\"top\"\u003e\n \u003cp\u003e1,7097\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.9171974522293%\" valign=\"top\"\u003e\n \u003cp\u003e3,313\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.92356687898089%\" valign=\"top\"\u003e\n \u003cp\u003e2,5453\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.439490445859873%\" valign=\"top\"\u003e\n \u003cp\u003e4,364\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.67515923566879%\" valign=\"top\"\u003e\n \u003cp\u003e1,8174\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.987261146496815%\" valign=\"top\"\u003e\n \u003cp\u003e0,001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.535031847133759%\" valign=\"top\"\u003e\n \u003cp\u003ePain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.872611464968152%\" valign=\"top\"\u003e\n \u003cp\u003e5,086\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.64968152866242%\" valign=\"top\"\u003e\n \u003cp\u003e1,7153\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.9171974522293%\" valign=\"top\"\u003e\n \u003cp\u003e3,392\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.92356687898089%\" valign=\"top\"\u003e\n \u003cp\u003e2,6592\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.439490445859873%\" valign=\"top\"\u003e\n \u003cp\u003e4,400\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.67515923566879%\" valign=\"top\"\u003e\n \u003cp\u003e2,1824\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.987261146496815%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026lt;0,001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.535031847133759%\" valign=\"top\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.872611464968152%\" valign=\"top\"\u003e\n \u003cp\u003e27,107\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.64968152866242%\" valign=\"top\"\u003e\n \u003cp\u003e8,0964\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.9171974522293%\" valign=\"top\"\u003e\n \u003cp\u003e19,754\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.92356687898089%\" valign=\"top\"\u003e\n \u003cp\u003e11,7918\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.439490445859873%\" valign=\"top\"\u003e\n \u003cp\u003e24,527\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.67515923566879%\" valign=\"top\"\u003e\n \u003cp\u003e9,4991\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.987261146496815%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026lt;0,001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"cigarette, e-cigarette, female sexual function, orgasm, satisfaction","lastPublishedDoi":"10.21203/rs.3.rs-4153907/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4153907/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eAim\u003c/b\u003e\u003c/p\u003e \u003cp\u003eWhile the effect of tobacco use on female sexual functions is known, the effect of electronic cigarettes on female sexual functions is unknown. The aim of this study is to investigate whether electronic cigarette use influences female sexual functions.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethod\u003c/b\u003e\u003c/p\u003e \u003cp\u003eFemale patients over the age of 18 who applied to the Chest Diseases Polyclinic between July and August 2023 were included in the study. Patients were divided into 3 groups according to smoking status. Patients who consume tobacco products, patients who consume electronic cigarettes, and patients who do not smoke. Participants filled out the Female Sexual Function Scale (FSFI), which consists of 19 questions. Participants' sexual function scores were compared between groups. Female Sexual Dysfunction (FSD) rates were evaluated between groups.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eA total of 171 women participated in the study. The mean age of the participants was 34.25\u0026thinsp;\u0026plusmn;\u0026thinsp;7.51 (19\u0026ndash;58). Participants who smoked were divided into two groups: tobacco smokers (n\u0026thinsp;=\u0026thinsp;56) and electronic cigarette users (n\u0026thinsp;=\u0026thinsp;44). 71 participants who did not smoke constituted the control group. A total of 72 patients (42.1%) were found to have FSD. When the electronic cigarette group and the control group were compared, the FSFI-orgasm, satisfaction, pain and total FSFI scores of the participants in the e-cigarette group were found to be lower than the control group (p\u0026thinsp;=\u0026thinsp;0.005 for orgasm, p\u0026thinsp;=\u0026thinsp;0.029 for satisfaction, p\u0026thinsp;=\u0026thinsp;0.046 for pain and Total p\u0026thinsp;=\u0026thinsp;0.040 for FSFI). More FSD was observed in the cigarette group and e-cigarette group than in the control group (26.8% for the control group, 48.2% for the cigarette group, 47.7% for the e-cigarette; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e \u003cp\u003eFSD can be seen in women who use e-cigarettes as frequently as in women who smoke regular cigarettes, and FSD is seen at a higher rate than in women who do not smoke.\u003c/p\u003e","manuscriptTitle":"The Effect of Electronic Cigarette Use on Female Sexual Functions","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-28 16:10:24","doi":"10.21203/rs.3.rs-4153907/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3e9398e2-cf35-4640-9c9a-72e13887a6cf","owner":[],"postedDate":"March 28th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":29875546,"name":"Health sciences/Risk factors"},{"id":29875547,"name":"Health sciences/Pathogenesis/Inflammation"}],"tags":[],"updatedAt":"2025-07-14T12:10:36+00:00","versionOfRecord":[],"versionCreatedAt":"2024-03-28 16:10:24","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4153907","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4153907","identity":"rs-4153907","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}