Erectile dysfunction (ED) affects millions of men worldwide – and is still often considered a taboo topic. It is also widely misattributed to psychological factors. However, in around 60% of cases, ED has an underlying physical cause¹. Unfortunately, this is often overlooked or inadequately investigated. In particular, vascular causes require precise diagnostic clarification – not only to guide effective treatment, but also to prevent serious comorbidities.
Thus, ED is a common symptom that not only significantly impacts quality of life, but may also serve as an early indicator of cardiovascular disease. This is where modern vascular diagnostics play a key role.
Arterial vs. Venous Erectile Dysfunction: What’s the Difference?
ED can generally be classified into three categories:
- Arterial ED: Blood flow into the penis is restricted, typically due to atherosclerosis.
- Venous ED (Venous Leak): The penis fills with blood but loses it too quickly due to insufficient venous outflow control.
- Non-vascular causes: Hormonal, neurological, or psychological factors.
Proper diagnosis is essential, as treatment strategies differ significantly. Arterial ED may respond to medication or revascularization procedures, while venous ED may require surgical or interventional therapies.
Diagnostics: Why Accurate Differentiation Is Essential
In clinical practice, distinguishing between arterial and venous causes of ED can be challenging. A thorough medical history and physical examination often aren’t enough on their own.
This is where advanced vascular diagnostics come in – ideally as part of a structured vascular screening process:
- Penile Duplex Ultrasound: Offers an initial assessment of arterial inflow and venous outflow – but is highly operator-dependent.
- Vascular Screening Methods: Non-invasive, quick, and delegable.
Structured Diagnostics with a Protocol
To make this differentiation easy and reliable, SOT Medical Systems has developed a dedicated Penile Function Protocol. Using the AngE™ system, clinicians can determine the PBI (Penile-Brachial Index) – a key parameter for evaluating arterial blood supply in the genital area. Venous parameters can also be assessed using methods such as PVR (Pulse Volume Recordings) or Doppler ultrasound .
The PBI is calculated and interpreted automatically:
- PBI ≥ 0.7: Normal
- PBI 0.6–0.7: Borderline
- PBI ≤ 0.6: Suggestive of arterial insufficiency
All measurements are performed in just 1 minute, independently of blood pressure, pain-free, and can be delegated to trained clinical staff.
Scientifically Proven: Erectile Dysfunction as a Vascular Marker
As early as 2003, Montorsi et al. showed that around 50% of ED cases have a vascular origin – especially in patients with diabetes or hypertension². A more recent study by Zhou et al. (2021) confirmed that changes in pelvic arteries may be early markers for ED and cardiovascular disease³.
A systematic review by Maiorino et al. (2021) concluded that ED is often the first clinical sign of vascular endothelial dysfunction – and should therefore always trigger further vascular assessment⁴.
Conclusion: Fewer Assumptions, Better Diagnostics
ED is still too often assumed to be purely psychological – despite the strong evidence supporting vascular origins. Early differentiation between arterial and venous causes is key to targeted, effective treatment and can also indicate systemic conditions such as PAD, early-stage atherosclerosis, or coronary artery disease.
It’s critical not to view ED in isolation, but as a potential marker for broader vascular health issues. With the devices and diagnostic protocols from SOT Medical Systems, this process can be seamlessly integrated into everyday clinical practice – quickly, reliably, and efficiently.
Would you like to learn more about the Penile Function Protocol or the PBI?
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References:
¹ Ilham Mulyana et al. (2021). The Impact of Psychological Disorders on Erectile Dysfunction: A Systematic Review. Macedonian Journal of Medical Sciences. https://doi.org/10.3889/oamjms.2021.6116
² Montorsi F. et al. (2003). The association between erectile dysfunction and coronary artery disease. Journal of Sexual Medicine, 1(2), 145–153.
³ Zhou H. et al. (2021). Pelvic arterial insufficiency is associated with erectile dysfunction. The Aging Male, 24(3), 217–225.
⁴ Maiorino MI et al. (2021). Diabetes and sexual dysfunction: current perspectives. Diabetes, Metabolic Syndrome and Obesity, 14: 3301–3313. https://www.dovepress.com/diabetes-and-sexual-dysfunction-current-perspectives-peer-reviewed-fulltext-article-DMSO
