Arteriogenic: This form of impotence is when the arteries that supply the penis with blood can’t deliver sufficient blood to cause or sustain an erection. There are some patients who are susceptible to narrowing of the arteries, including the elderly, diabetics and people with high blood pressure, although some patients suffering from an injury to the genital area may also suffer from blocked arteries leading to the penis. The last is very common in the young. The types of injuries that can cause impotence problems include major incidences, as in a fractured pelvis or pubic bone, or from minor incidences, as in with bicycle riding that can crease friction which could lead to clots forming, or thrombus, within the artery to the penis. Clots such as these are capable of continuing to grow until they block the penis’ blood supply altogether.

Recently, it’s been recognized that signs of erectile dysfunction in men can serve as a warning for future cardiovascular diseases, such as heart attack or stroke. Diseases of arteries affect the smaller arteries (penis) before they affect the larger ones (coronaries of the heart and carotids of the brain). This should be a strong argument for the benefit of having erectile dysfunction diagnosed and treated early, as medical specialists can then help to detect any early warning signs of other problems developing, such as diabetes, high blood pressure and others.

In a case study, College student S.V.S., 23, became totally impotent following a vehicular accident in which he sustained a fracture of the pelvis and a rupture of the urethra. This involved hospitalisation for nearly a month and an operation. Prior to the accident, the patient reported a normal sex life with his fiance. When he went back to the doctors who treated the primary problem, he was told that his was a purely psychological problem and that everything would be all right in a couple of months. After a year with no improvement, the patient was seeking to end his engagement. An article in a magazine brought him to an andrologist. Investigation using a phalloarteriogram revealed an artery leading to the penis was blocked. The patient was finally cured with a microsurgical bypass operation – a penile revascularization procedure.

Arteriogenic impotence resulting from injuries is very common but often unsuspected because of ignorance of the causative conditions. In fact, some of these patients may be wrongfully sent to orthopedic or urology wards for treatment. Unfortunately the impotence problem is often not discovered until after the more noticeable wounds or injuries have recovered. Ironically, it is most often discovered by the patient himself and not by the doctor.

Venogenic: This is a condition whereby blood leaks from the penis and stops a hard erection forming. In an unaffected male with an erection the veins will shut off blood flow almost totally so that no blood can escape back out of the penis. This allows blood to accumulate in the sinusoids of the penis, thus raising pressure and allowing for the development of rigidity or hardness.

Venogenic impotence is extremely common. It is said to account for as much as 30-70 percent of all impotence. Men that are affected from birth are said to have primary venogenic impotence. These men have most likely never attained a hard erection in their lives. Others develop venogenic impotence suddenly after years of normal sexuality (secondary).

Neurogenic: The nerve pathways leading to the penis are extremely complex. A proper conduction of impulses along these is basic for the initiation and maintenance of an erection. It is these nerves that activate the arteries and the veins and alter the dynamics of blood flow within them.

Many things can go wrong with the nerve supply to the penis. Injuries to the back, especially if they involve the vertebral column and the spinal cord can cause impotence.

There are other nerves that can be affected by other injuries, such as pelvic or perineal trauma. A wide variety of operations performed for other conditions can cause incidental injury to the nerves of the penis and cause impotence. Those surgeries can include rectum, prostate, urethra, spine, urinary bladder and more.