Understanding Vascular Erectile Dysfunction: Causes and Treatments

Vascular erectile dysfunction (ED), also called vasculogenic erectile dysfunction, is one of the most common reasons men experience ongoing erection problems. To understand why it happens, it helps to know one simple fact: a firm erection depends on healthy blood flow. If blood cannot enter the penis properly, or if it drains out too quickly, maintaining an erection becomes difficult.

This form of erectile dysfunction is closely tied to the health of your blood vessels and cardiovascular system. In many cases, it reflects what is happening in the heart and arteries in the body. 

In this article, we’ll break down what vascular erectile dysfunction is, why it occurs, vascular erectile dysfunction symptoms, the difference between the types of vascular ED, like arteriogenic erectile dysfunction and venogenic erectile dysfunction, how doctors diagnose it, and the most effective vasculogenic erectile dysfunction treatment options available in India.

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What Is Vasculogenic Erectile Dysfunction?

Doctors broadly divide erectile dysfunction into two categories: organic ED and psychogenic ED. Vascular erectile dysfunction is a type of organic ED. In this type, reasons for erectile dysfunction include diseases affecting the blood vessels that interfere with normal erections. Because vascular problems are so common, vascular ED accounts for nearly three-quarters of physical erectile dysfunction cases.[1]

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So, what is the main cause of erectile dysfunction of this type? To understand this, let’s briefly look into how normal erections happen:

• When a man experiences sexual arousal, signals from the brain cause the blood vessels called arteries in the penis to widen.
• Blood rushes through these arteries into the erectile tissues of the penis (corpus cavernosum/ corpora cavernosa).
• At the same time, the veins in the penis narrow to trap blood inside until sexual activity is over. This is how the penis stays firm and what we call “an erection.”

When this finely balanced system breaks down due to vascular disease, erections become weak, short-lived, or difficult to achieve. Vascular disease can affect the blood vessels in the body, be it arteries or veins. This directly affects the quality of erections because healthy erections depend on healthy blood flow.

Next, let’s look at the different types of vascular ED.

Types of Vasculogenic Erectile Dysfunction

There are two main types of vascular ED:

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1. Arteriogenic Erectile Dysfunction:

Arteriogenic ED (also called arteriogenic impotence) occurs when not enough blood enters the penis due to damaged arteries.

This usually happens due to narrowing or blockage of arteries, often from:

• Atherosclerotic cardiovascular disease
• Coronary artery disease
• Peripheral artery disease
• Long-standing high blood pressure
• High cholesterol
• Type 2 diabetes

Because penile arteries are smaller than those in the heart, arteriogenic erectile dysfunction can appear years before heart disease symptoms. We will look at this connection in detail later.

2. Venogenic Erectile Dysfunction

Venogenic ED, commonly known as venous leakage/ venous leak, occurs when blood enters the penis normally but escapes too quickly, and the penis loses its firmness before sexual activity is complete.

Men with venous leakage may achieve an erection but lose it rapidly during sexual activity or notice inconsistent firmness during it. Usually, venogenic ED is linked to age-related changes like decreased elasticity of the veins and weakening of the erectile tissues, but it can also occur due to vascular disease, conditions like diabetes, as well as lifestyle habits like smoking.

How Does Vascular Erectile Dysfunction Develop?

Certain health conditions and habits raise the risk of vascular erectile dysfunction.[2][3][4] These are called risk factors because they increase the likelihood of vascular ED developing[5][6][7]:

• Poorly controlled blood pressure
• High cholesterol
• Type 2 diabetes and high blood sugar
• Smoking or chewing tobacco (tobacco use)
• Excessive alcohol use
• Obesity (high Body Mass Index)
• Sedentary lifestyle
• Lack of cardio (cardiovascular exercise)
• Aging
• Certain prescription drugs
• Chronic stress
• Unhealthy lifestyle choices like eating highly processed foods
• Low testosterone (in some cases)

Symptoms of Vascular Erectile Dysfunction

Vascular erectile dysfunction symptoms include:

• Difficulty getting an erection despite arousal
• Erections that don’t stay firm during sexual intercourse
• Softer or weaker erections than before
• Fewer morning erections
• Gradual decline in sex drive

Because vascular ED reflects broader circulation problems, some men also experience:

• Cold hands or feet
• Fatigue
• Shortness of breath with mild activity
• Chest tightness or palpitations

It can also be important to learn how heart disease and ED are connected:

How are Vascular ED and Heart Disease Related?

The same processes that damage heart arteries also affect penile arteries. Conditions like heart disease, cardiovascular disease, and coronary heart disease reduce blood vessel flexibility and function.

Studies from institutions such as the Mayo Clinic[8]and the National Institutes of Health[9] emphasize that erectile dysfunction can be an early marker for future cardiovascular events, including heart attack and stroke.

Hence, if you’re experiencing symptoms of vascular ED, it’s not just about sexual performance. These symptoms may be your body’s way of signaling an underlying circulation or heart-related issue.

We see many patients where erectile dysfunction is the first sign of undetected heart disease. Don’t ignore it.

How Doctors Diagnose Vascular ED

The diagnosis of vascular ED focuses on identifying blood flow problems.

Evaluation may include:

• Detailed medical and sexual history
• Physical exam
• Blood tests for cholesterol, glucose, testosterone, and hormone levels
• Duplex Doppler ultrasound or color duplex Doppler ultrasound to assess blood flow
• Doppler spectrum analysis to evaluate arterial inflow and venous outflow

In complex cases, advanced vascular imaging studies may be used:

• Penile angiography or computed tomography angiography
• Magnetic resonance imaging or magnetic resonance arteriography
• Magnetic resonance angiography
• Ultrasound elastography, shear wave elastography, or virtual endoscopy

Vasculogenic Erectile Dysfunction Treatment

The good news is that vascular erectile dysfunction is often treatable, especially when identified early. Treatment may focus on improving overall vascular health or on addressing the specific type of vascular ED responsible for the erection difficulties.

Treatment for vasculogenic erectile dysfunction focuses on one core goal: improving blood flow into the penis and helping it stay there long enough for a firm erection. This can be done by various methods:

First-Line Treatment:

1. Oral Medications

ED Medications called PDE5 inhibitors are usually first-line therapy. These prescription medications improve blood flow by relaxing penile blood vessels and supporting normal blood vessel function.

The most common medications used are sildenafil, tadalafil, vardenafil, and avanafil. They work best when vascular damage is mild to moderate and sexual stimulation is present.

2. Lifestyle Changes

Because vasculogenic ED often reflects underlying vascular disease, improving overall vascular health is essential. Lifestyle measures can significantly improve both erectile and heart health:

• Regular physical activity, such as brisk walking, cycling, or swimming, to keep blood vessels flexible
• Yoga and pranayama, including practices like Surya Namaskar, and deep breathing, which may support circulation and reduce stress
• A heart-healthy diet, focusing on fruits, vegetables, whole grains, pulses, nuts, seeds, and healthy fats like mustard oil or olive oil
• Reducing excess salt, sugar, and fried foods to help control blood pressure, blood sugar, and cholesterol
• Maintaining a healthy weight, especially around the waist
• Quitting tobacco and limiting alcohol, as both damage blood vessels over time
• Adequate sleep and stress management, which influence blood vessel tone and hormone balance

For some men, these changes alone can noticeably improve erections over time.

A Note on Natural Remedies:

Some Indian dietary supplements and traditional remedies, such as ashwagandha, shilajit, and safed musli, are often promoted for sexual health. While some may support overall wellness, they should not be seen as a standalone treatment for vascular erectile dysfunction.

Supplements should be used only after discussing them with a doctor.

Therapies for Non-Responders

When oral medications are ineffective, several non-surgical options are available.

1. Penile Injections

For men who do not respond to pills, penile injections, or intra-cavernous injection therapy delivers medication directly into the erectile tissue to produce a reliable erection. They act locally and can produce reliable erections even when blood flow problems are more severe.

2. Vacuum Erection Devices (VEDs)

Vacuum devices use negative pressure to draw blood into the penis. These devices are safe and effective for many men.

3. Intraurethral Suppositories (MUSE)

This method involves placing medication into the urethra to stimulate blood flow. While less invasive than injections, the effectiveness can vary.

4. Low-Intensity Shockwave Therapy (Li-SWT)

Shockwave therapy aims to stimulate new blood vessel growth, a process called neovascularization. It may improve blood flow in men with mild to moderate vasculogenic ED, though results can vary and research is ongoing.

Surgical Options

Surgery is generally reserved for men who do not respond to other treatments.

1. Penile Prosthesis (Implant)

For severe, treatment-resistant cases, penile implants offer a reliable and long-term solution. Modern implants are discreet, effective, and associated with high satisfaction rates.

Arteriogenic Erectile Dysfunction Treatment:

Arteriogenic erectile dysfunction happens when not enough blood can flow into the penis because the arteries supplying it are narrowed or blocked. Hence, the treatment focuses on opening up these blood vessels.

Apart from the options mentioned above, additional options include:

1. Angioplasty and Stenting

These are minimally invasive procedures used in select cases of arteriogenic erectile dysfunction. In angioplasty, a small balloon is guided into a narrowed penile artery and gently inflated to improve blood flow through the artery. [10] In other cases, a stent may be placed to help keep the artery open over time.

2. Penile Revascularization Surgery

This procedure redirects blood flow from healthier arteries to damaged ones, improving penile circulation. It is typically considered only in younger men with isolated arterial injury.[11]

3. Drug-Coated Balloons

These balloons deliver medication directly to the artery wall during angioplasty, helping reduce inflammation and lower the risk of the artery narrowing again. Because these approaches are still evolving, they are used selectively and only after a careful vascular assessment by a specialist.[12]

Venogenic Erectile Dysfunction Treatment

In venogenic ed, since the problem lies in blood retention rather than blood inflow, treatment focuses on improving the penis’s ability to trap blood and keep it in the penis for long enough.

Apart from the options mentioned, specific treatment for venous leak includes:

1. Venous Leak Embolization

During embolization, a doctor uses imaging guidance to locate and block the damaged veins responsible for rapid blood drainage, so that the blood can stay trapped inside the penis for longer. It is usually considered only when simpler treatments, like medications or devices, have not worked.[13]

2. Crural Ligation

This surgical procedure involves tying off problematic veins to reduce premature blood outflow. It is used selectively and only in carefully chosen cases. [14]

Each vascular erectile dysfunction treatment will be personalized, based on age, health status, and underlying cause. 

Comparing Treatement Options In India:

The table below shows approximate cost ranges for different vascular erectile dysfunction treatments in India. These are indicative ranges meant to help with planning and comparison, not exact prices:

Note: Costs vary by city, what’s included in the package, and separate diagnosis expenses.

When to See a Doctor

Occasional erection problems are normal and can happen due to stress, tiredness, or alcohol, but when they become frequent, it’s usually a sign of an underlying issue that needs attention.

Seek medical help if you notice any of the following:

• Erections that are consistently weak or short-lived
• Reduced sexual desire or fewer morning erections
• Pain, curvature, or changes in the shape of your penis during erection
• Numbness, tingling, or coldness in your legs, feet, or hands
• Other symptoms like chest pain, fatigue, or shortness of breath

Conclusion

Vascular erectile dysfunction is one of the most common and treatable causes of erection problems. It occurs when blood flow to the penis is reduced or when blood does not stay trapped long enough for a firm erection. Because the same factors that affect erections also affect heart health, ED should never be ignored.

Seeking medical guidance early can uncover hidden health issues, improve sexual function, and protect long-term heart health. Taking care of your blood vessels means taking care of your erections, too.

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