The Role of Blood Vessels in Erectile Function
Erection is penis expansion in comparison with its resting position and acquisition of mechanical hardness which is important for sexual intercourse.
- Constitution of penis. Penis consists of three longitudinal bodies, filled with porous tissues and surrounded by tiny blood vessels. Two external bodies (cavernous bodies) become firm and elastic during erection. Internal or porous body surrounds urethra and goes over penis balanus. Erected tissues which make up cavernous and porous bodies are able to be filled with blood. This is the essence of erection: blood is accumulated in cavernous and porous bodies. The last stage of erection is firmness. Penis becomes elastic and rises up and forwards.
- Blood flow and supply. Like in other body parts the blood supply of penis results from cardiac performance. Fresh blood flows through arteries to genital area. After oxygen and nutritious matters uptake by the tissues located here from arterial blood, used blood flows to venous system.
- In resting position the blood pressure in penis is low. But sexual enticement makes the blood circulation twenty-six times more intensive. In this case, it receives 4 spoons of blood per minute. At this moment blood is pumped into penis under a considerable pressure. Only in case of erection blood pressure in penis may be compared with pressure in other organs.
- Filled with blood, erected tissues begin squeeze draining veins. The latter ones shrink but are not overlapped completely. About 12 ml of blood per minute still flow through penis. In order to maintain erection on this level blood must be supplied in penis with the same speed. When the quantity of blood flowing in and out of penis levels, its size and elasticity do not change and erection continues.
- Constant unceasing erection would cause great inconvenience. Therefore, it is so constructed that in resting position it accepts little blood. Cavernous bodies get smaller and flabbier. High concentration of tiny blood vessels in this small space is possible because of their shape resembling tiny cork-screws. So, their shape is able to create a strong resistance to blood flowing through penis protecting it from erection at the wrong time.
Healthy heart-vascular system is an indispensable prerequisite of erection implementation! Any disorders making the blood flow through penis difficult have a negative impact on erection.
How Blood Vessels Conditions Affect Potency?
Since erection is resulted from filling of penis with blood, problems with blood vessels may lead to erectile dysfunction.
Let us enumerate them:
- Hardening of arteries (atherosclerosis) in penis, which can block blood supply to penis and arteries filling penis.
- Side-effects of medications acting adversely on blood vessels (for example, some diuretics or other remedies for hypertension), which may disturb the process of penis blood filling.
- Blood leakage cavernous bodies of penis through veins which carry blood from penis. This may lead to impossibility of keeping erection.
Problems with blood vessels (vascular system disorders) may hinder penis from being filled with blood or its presence in penis for sufficient time necessary to keep erection. For example, long-lasting arterial hypertension may damage blood vessels and lead to erectile dysfunction.
Vascular System Disorders
Vascular system disorder is one of the reasons of man’s sexual dysfunction. This dysfunction may result from smoking, vascular heart disease, clotting of arteries in small pelvis, circulatory system disorders.
Vascular system disorders may be indicated as the most widely spread cause of sexual dysfunction. An erection of a healthy man comes with the flow of arterial blood to penis, the outflow to veins of which is completely blocked.
In case of erectile dysfunction, the arterial blood flow weakens (erection is not fully-realized and long-lasting) or the outflow of blood through veins is too strong (in this case erection comes fast and may be very good but it disappears in a while, which hinders further sexual intercourse).
Also, hypertension sufferers and diabetics have erectile dysfunction as a result of vascular system disorders. Treatment of these people is rather difficult, since sexual dysfunction of such patients may have other causes as well.
Hypertension and Erectile Dysfunction
Hypertension is one of the reasons of erectile disorders. It occurs as a result of narrowing of penis arteries causing vasoconstriction. Hypertension is a huge stress on man’s organism in general and in vascular system in particular. Erection is blood supply to penis. Some vessels allow blood to flow to sexual organ whereas others are responsible for outflow. But hypertension affects vessels and they become less elastic. More than 45% of men suffering hypertension have problems with sexual intercourse. Sexual enticement occurs but penis becomes soft after starting coitus.
Other 55% of hypertension sufferers do not have difficulties with coitus. But this may be explained by the fact that either they lead a sedentary behavior in sexual life (i.e. sexual partner is on the top position) or position choice implies reduction of physical activity.
Nevertheless, if hypertension sufferers do not have problems with sex and erection yet, it is not guaranteed that they won’t appear in several years. One should treat hypertension since this is a heavy stress on heart and organism.
Weak potency and hypertension may be resulted from one and the same cause – plaque build-up on vessel walls.
Treatment of Impotence with Underlying Vascular Diseases
Vascular erectile dysfunction is treated according to the type and severity of the circulatory problem. Reduced arterial inflow, excessive venous outflow, diabetes-related vessel damage, and long-term hypertension may produce similar symptoms, but they do not always require the same treatment. A medical assessment may include a review of cardiovascular health, current medications, blood pressure, blood glucose, hormone levels, and other factors that influence erectile function.
Treatment usually combines management of the vascular condition with therapy directed at the erection itself. Improving blood pressure control, treating diabetes, stopping smoking, increasing physical activity, and correcting abnormal cholesterol levels may protect the blood vessels from further damage. These measures may also improve the response to erectile dysfunction medication, although established vascular injury does not always reverse completely.
1. Oral Medicines That Improve Penile Blood Flow
Phosphodiesterase type 5 inhibitors are commonly used as the first medication option for vascular erectile dysfunction. This group includes:
- sildenafil
- tadalafil
- vardenafil
- avanafil
The medicines support the natural relaxation of smooth muscle in penile arteries, allowing more blood to enter the erectile tissues during sexual stimulation. They do not create an automatic erection and do not remove arterial plaque or repair damaged vessels.
The choice of medicine depends on the expected duration of action, other medical conditions, previous response, side effects, and interacting drugs. Sildenafil and vardenafil are generally used for a shorter treatment window, while tadalafil remains active for longer and is also available in a once-daily regimen. Avanafil is another shorter-acting option used before anticipated sexual activity.
Once a clinician has determined that a PDE5 inhibitor is appropriate, the prescribed medicine may be obtained through several domestic or international dispensing channels. The main differences concern the ordering process, required clinical review, listed price, and available delivery area.
Where U.S. Patients Can Order PDE5 Medicines:
| Country | International Pharmacy or Service | Typical Listed Price | Prescription Policy | U.S. Delivery |
|---|---|---|---|---|
| Canada | Canadian Pharmacy Spot | From $0.30 per sildenafil tablet | Valid prescription required | All 50 states, usually 10–18 days |
| Israel | IsraelPharm | $39 for 8 sildenafil 50 mg tablets | Valid prescription required | Usually 7–10 business days |
| Vanuatu | Inhouse Pharmacy | $28.75 for 4 sildenafil 100 mg tablets | Prescription preferred under site policy | Free airmail, usually 10–21 days |
| New Zealand | Kiwi Drug | From $49.99 for 32 generic sildenafil 100 mg tablets | Prescription or online clinical review | International, product-dependent |
Special Precautions for PDE5 Inhibitors:
PDE5 inhibitors must not be combined with nitrates used for angina because the combination can cause a dangerous fall in blood pressure. Additional caution is necessary with alpha blockers, several antihypertensive medicines, severe hypotension, unstable cardiovascular disease, and significant liver or kidney impairment. Common adverse effects include headache, flushing, nasal congestion, indigestion, dizziness, and temporary visual changes.
2. Treatment When Oral Tablets Are Unsuitable
Oral PDE5 inhibitors are not suitable for every patient. They may provide an insufficient response, interact with another medicine, produce unacceptable side effects, or be contraindicated because of cardiovascular health. In these situations, treatment may involve medication delivered directly to the penile tissues or a mechanical device that increases and temporarily retains blood within the penis.
The main alternatives include:
- intracavernosal alprostadil injections
- intraurethral alprostadil suppositories
- topical alprostadil cream where approved and available
- vacuum erection devices with a constriction ring
Intracavernosal alprostadil is injected into one of the erectile bodies of the penis. It relaxes local smooth muscle and widens blood vessels, allowing blood to enter the erectile tissues. Because the medicine acts directly at the treatment site, it does not depend on the same signaling process required for oral PDE5 inhibitors.
The first injection is normally administered in a clinical setting. This allows the clinician to evaluate the response, establish an appropriate dose, and demonstrate how to prepare the medicine, select an injection site, alternate sides, and dispose of the needle. After proper instruction, some patients can administer the prescribed dose at home.
Intraurethral alprostadil is supplied as a small suppository or pellet that is inserted into the urinary opening with a dedicated applicator. It avoids the use of a needle, although it may be less effective than an injection and can cause urethral burning or penile discomfort.
Topical alprostadil cream is available in certain countries. It is applied to the opening at the tip of the penis according to the product instructions. Availability differs by market, and the cream should not be treated as interchangeable with injectable or intraurethral alprostadil.
A vacuum erection device provides a non-drug alternative. A plastic cylinder is placed over the penis, and a manual or battery-operated pump removes air from the cylinder. The resulting negative pressure draws blood into the erectile tissues. A constriction ring is then positioned at the base of the penis to slow venous outflow and maintain firmness after the cylinder is removed.
Comparison of Alternatives to Oral Tablets:
| Treatment Option | U.S. Clinic or Provider Example | Expected Onset | Main Consideration |
|---|---|---|---|
| Alprostadil injection | Memorial Sloan Kettering Cancer Center | Approximately 5–20 minutes | Requires dose selection and injection training |
| Intraurethral alprostadil | UCSF Health | Approximately 5–10 minutes | A test dose and instruction may be provided in the office |
| Topical alprostadil | Not currently available in the United States | Not applicable to standard U.S. treatment | Not FDA-approved for ED in the United States |
| Vacuum erection device | Cleveland Clinic | Usually works within several minutes | Device selection and technique may require clinical instruction |
Special Precautions for Local Medicines and Vacuum Devices:
Alprostadil must be used only in the prescribed amount. Increasing the dose or repeating it too soon can raise the risk of penile pain, low blood pressure, tissue scarring, and priapism. Injection sites should be alternated, and needles, syringes, pellets, and applicators must not be reused. An erection lasting four hours or longer requires emergency medical treatment. A vacuum device may cause bruising, numbness, cool skin, temporary discoloration, or reduced ejaculation. The constriction ring should remain in place for no longer than 30 minutes. Medical assessment is necessary before vacuum treatment in patients with bleeding disorders, conditions associated with priapism, or treatment with anticoagulant medicines.
3. Procedures for Severe or Persistent Vascular Erectile Dysfunction
Procedural treatment may be considered when erectile dysfunction remains severe after appropriate trials of oral medicines, local medication, and vacuum devices. The decision requires a urologic assessment and a discussion of the expected result, recovery period, surgical risks, device operation, and possible need for future revision.
The principal procedural options include:
- inflatable penile prosthesis implantation
- malleable penile prosthesis implantation
- penile arterial reconstruction for narrowly selected patients
A penile prosthesis creates mechanical rigidity inside the penis. It does not remove arterial plaque, restore natural blood circulation, or treat vascular disease elsewhere in the body. The implant is generally considered when less invasive options have not produced a satisfactory result or cannot be used.
An inflatable prosthesis usually contains two cylinders placed inside the penis, a fluid reservoir, and a pump positioned in the scrotum. Activating the pump transfers fluid into the cylinders and produces firmness. After sexual activity, the device is deflated and the penis returns to a softer state.
A malleable prosthesis consists of bendable rods placed inside the penis. The rods maintain a degree of firmness at all times and are positioned manually for sexual activity. This design has fewer mechanical components, although it does not provide the same flaccid appearance as an inflatable system.
Penile arterial reconstruction is different from prosthesis surgery. The procedure is intended to repair or bypass a localized arterial obstruction and improve natural arterial inflow. It may be considered for selected younger men whose erectile dysfunction followed a focal pelvic or perineal injury. It is generally unsuitable for widespread atherosclerosis, long-term diabetes-related vascular damage, or generalized cardiovascular disease.
Comparison of Procedural Treatment Options:
| Procedure | U.S. Clinic or Provider Example | Typical Candidate | Main Limitation |
|---|---|---|---|
| Inflatable penile prosthesis | The Men’s Clinic at UCLA Health | Persistent ED after less invasive treatments | Mechanical components may eventually require revision |
| Malleable penile prosthesis | Urology Specialty Group | Patients who prefer a simpler implant mechanism | The penis remains semi-rigid when not in use |
| Penile arterial reconstruction | NYU Langone Health | Selected younger men with traumatic arterial injury | Not suitable for generalized vascular disease |
Special Precautions for Procedural Treatment:
Penile implantation requires anesthesia and carries risks that include infection, bleeding, pain, erosion, mechanical failure, and future replacement surgery. Implant surgery should not be performed while a systemic, skin, or urinary infection is present. The procedure produces permanent changes inside the erectile tissues, so postoperative appearance, device operation, recovery, and revision risk should be discussed before surgery. Penile arterial reconstruction is appropriate for only a small group of patients with a confirmed localized arterial injury and should not be used as a general treatment for vascular erectile dysfunction caused by hypertension, diabetes, smoking, or widespread atherosclerosis.
What to Remember About Treatment
Taken together, the information above shows that vascular erectile dysfunction is closely connected with the condition of the arteries, veins, and cardiovascular system. Reduced blood flow, impaired blood retention, hypertension, diabetes, atherosclerosis, and smoking can all interfere with the normal erection process.
Treatment depends on the cause and severity of the problem. Oral medicines are commonly used first, while local medication, vacuum devices, implants, or arterial surgery may be considered when tablets are unsuitable or ineffective. The main points covered in this article can be summarized as follows:
- Healthy blood flow is essential for erection.
- Vascular disease can contribute to ED.
- PDE5 inhibitors require sexual stimulation.
- PDE5 inhibitors cannot be used with nitrates.
- Local treatments require clinical instruction.
- Vacuum rings must be removed on time.
- Surgery is reserved for selected cases.
- A four-hour erection is an emergency.
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Please note, this content is not exhaustive and may not include all aspects related to the product. Its contents do not vouch for the absolute safety, effectiveness, or appropriateness of the product for your circumstances. This information is not a replacement for personalized medical consultation, nor does it stand-in for the expertise of your health practitioner. Always engage your medical professional for a detailed understanding of this product and a comprehensive assessment of your distinct health conditions.