Arterial disease
Erectile Dysfunction — Vascular Causes
Erections are a vascular event. When medication stops working or arterial disease is suspected, a vascular assessment can show whether a treatable vascular cause exists.
Last reviewed 30 Jun 2026
Reviewed by Dr Tay Jia Sheng · Vascular, Endovascular & General Surgeon
A vascular condition, more often than not
An erection is fundamentally a blood-flow event: arteries must deliver blood into the penis, and veins must hold it there. It follows that the most common organic causes of erectile dysfunction (ED) are vascular — narrowed inflow arteries (the same atherosclerosis that affects the heart and the leg arteries) or veins that leak blood away too quickly (venous leak).
ED also matters beyond the bedroom: because the penile arteries are small, they are often the first arteries in the body to show atherosclerosis. New ED in a man over 40 can precede coronary artery disease by several years — it is a reason to check cardiovascular risk factors, not just to treat the symptom.
Who benefits from vascular assessment
- Men whose ED has not responded adequately to first-line tablets
- Men with known arterial disease, diabetes, or multiple risk factors
- Younger men with ED after pelvic or perineal trauma
- Anyone in whom the pattern suggests a vascular cause — gradual onset, reduced rigidity rather than absent desire
How it is assessed
Assessment is straightforward and non-invasive to begin with: a focused history, cardiovascular risk review, and penile duplex ultrasound, which measures arterial inflow and venous outflow directly. Where intervention is contemplated, CT or catheter angiography maps the pelvic arteries.
Treatment options
- Risk factor treatment and medical therapy — the foundation, managed alongside your physician
- Endovascular treatment — in selected men with focal narrowing of the arteries supplying the penis, angioplasty or stenting of the responsible artery aims to restore inflow; suitability depends entirely on the anatomy shown on imaging
- Referral pathways — where the cause is not vascular (hormonal, neurological, medication-related or psychological), assessment findings guide referral to the right specialist rather than more of the same tablets
When to see a doctor promptly
ED accompanied by leg pain on walking, a known aneurysm, or other signs of arterial disease warrants vascular review — and new ED in mid-life is a sensible prompt for a cardiovascular check-up even when the symptom itself is manageable.