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In Egypt, where nearly 40 percent of adult men smoke, the latest national antismoking campaign has had an unexpected result: a surge in demand for images of deformed fetuses.

Male smokers, wary of a new package warning that employs a photo of a limp cigarette to relate the link between smoking and impotence, are demanding packs with the older pictorial warning, one that links smoking to birth defects.

“Nobody wants the new packs,” said Mohammed Saad, a kiosk owner in the sprawling Cairo slum of Imbaba. “They’re afraid women will see the picture of the flaccid cigarette and think that men who smoke are ‘incapacitated.’ ”

Since August 2008, Egypt’s Health Ministry has required all cigarette producers and importers to print a designated image on their products that highlights the effects of smoking. The packet warning is circulated for six months, then a new image is introduced.

Earlier images included a dying man in an oxygen mask, a coughing child and a cross-section of a pregnant woman’s womb with the caption, “Smoking causes fetal deformities.” The new packet warning that rolled out late last month comprises a photo of a wilting cigarette with a caption that reads, “Long-term smoking may affect marital relations.”

Egyptians are quick to pick up on the nuance. “My wife is screaming at me to throw my cigarettes away,” minibus driver Tamir Hassan said. “I’m 100 percent healthy, but we don’t have any children yet, and she’s worried about what people will think.”

The packet warnings are part of a World Health Organization-monitored tobacco-control program that complements antismoking legislation passed in June 2007. While the “limp butt” photo has been printed on cigarette packets in more than a dozen countries, this is the first time it has appeared in the Middle East.

Hassan argues that the image, with its phallic suggestions, offends the sensibilities of conservative Egyptian society. “Everyone knows smoking is harmful to your health,” he said. “So why do they need to put this obscene picture on packages where mothers, sisters and children will see them?”

Fatima al-Awa, the regional adviser of the WHO’s Tobacco Free Initiative, said the image was selected based on the results of field tests that demonstrated its effectiveness.

“Many people have spoken against the health warning that Egypt now has on packs, but this is the first time in the region that cigarettes have been linked directly with impotence and fertility,” she said.

A national survey conducted in 2009 revealed that nearly 40 percent of adult male Egyptians smoke cigarettes or the ubiquitous shisha water pipe. Doctors cite high rates of smoking-related diseases such as hypertension, emphysema and lung cancer.

Male smokers, however, appear less concerned about death, which is perceived as inevitable anyway, than the link between tobacco use and impotence. Studies have found that smoking is a leading cause of erectile dysfunction because it constricts veins, reducing blood flow.

“The relationship between smoking and impotence has been known for a long time,” said Mustafa Kamal Mohammed, a professor of public health at Ain Shams University. “Some clinical observations suggest that around 40 percent of males above the age of 40 suffer some form of erectile dysfunction or impotence. When youth see this fact they may be forced to reconsider smoking.”

Health officials explain that Egypt’s packet warnings employ shocking imagery to reinforce their messages and transcend the country’s high illiteracy rate, estimated at 26 percent. “Pictorial health warnings have proven to be the most successful approach all over the world, together with taxation and demand-side measures,” al-Awa said.

But embarrassed Egyptian smokers are finding ways to hide the controversial impotence warning.

One kiosk owner reported a run on cheap cardboard packet covers with cheery photos or illustrations that cover the limp butt image. Another said smokers were refilling their older packs and discarding the new ones. Both confirmed that cigarette sales are as firm as ever.

Hassan said he hides his cigarette packs now, but has not reduced the amount he smokes. “I’ll be healthy and strong until I’m an old man,” he said, defiantly waving a lit cigarette. “And if that fails, there’s always Viagra.” DPA