Rather, the associated arterial stenosis found in patients with hypertension is thought to be the cause of the erectile dysfunction. In patients with hypertension, it is not the increased blood pressure itself that contributes to erectile dysfunction. A recent study reported that in one series of impotent men about 45 percent had a history of hypertension. High blood pressure (hypertension) is another established risk factor for arteriosclerosis.

The extra lipid builds up in the wall of the artery and eventually causes a significant degree of blockage. Patients with hyperlipidemia, or marked elevation of lipid (fat) levels in the blood, have a definite well-described risk for arteriosclerosis. Diabetic men, as well as older men, have an increased amount of scarring or fibrosis within the walls of the arteries to the penis. Diabetic men can have impotence secondary to both effects on the nerve supply to the penis, as well as the vascular supply. This is usually seen in young patients, in their twenties, who have sustained blunt pelvic trauma such as a past pelvic fracture. Occasionally, we find a patient who has a focal isolated blockage of one of the arteries carrying blood to the penis. Some individuals with erectile dysfunction also have a history of poor blood circulation to their feet and legs, resulting from arterial occlusive disease. Frequently, impotent men also have a history of coronary artery occlusive disease with or without a history of prior heart attacks. The majority of patients who have erectile dysfunction as a result of reduced arterial blood flow will also have more generalized cardiovascular problems throughout the body. These venous leak-type problems can often be surgically corrected. Such patients may report relatively normal initiation of an erection, but within a few seconds or up to a minute or so lose the erection without ejaculation.

Often, this problem is seen in relatively young patients who have experienced erectile dysfunction over their entire life. Some men may develop large venous channels that are never quite fully occluded as the arterial blood flows into the penis during the beginning phase of erection. Failure of the mechanism that clamps down on the veins that drain blood from the penis has been proposed as one of the more common causes of vasculogenic impotence.