From a vascular standpoint, any disease process that can affect arteries may also affect the arteries that supply the penis. Men with coronary artery disease (sometimes manifested as angina, which is a pain in the chest, with a feeling of suffocation), cerebrovascular disease (which may have caused prior stroke or transient ischemic attack), peripheral vascular disease (decreased blood flow to the legs, often associated with aches/cramps in the legs when attempting to walk for a distance), high blood pressure, and high cholesterol levels are at increased risk for erectile troubles. Men who have experienced severe pelvic or perineal trauma, such as from a motor vehicle accident causing a pelvic fracture or direct injury to the penis, are at risk for erectile dysfunction.
Radiation therapy (administration of radiation to kill cancer cells) to the pelvis for colon cancer or prostate cancer can cause damage to the blood vessels supplying the penis. Erectile dysfunction has been reported in 15% to 65% of men undergoing external-beam radiation therapy (high-energy radiation beams passed through the skin) for prostate cancer. The onset of erectile dysfunction after radiation therapy is usually not immediate; it typically occurs 2 or more years after the radiation therapy. Interstitial seed therapy for prostate cancer also affects erectile function in 25% to 60% of men who undergo it. As with external-beam radiation therapy, the effect on erectile function is usually seen a year or more after seed placement.
Smoking causes vasospasm, or tightening up of the arteries, but it also may cause atherosclerosis, or hardening of the arteries.
Venous leaks or abnormal veins may result from prior trauma and may be identified in Peyronie’s disease, a benign condition affecting the penis in middle-age men.