Vasculogenic Erectile Dysfunction, or erectile dysfunction from the vascular system, is the group of conditions met most often in men who have a problem of erection, and usually does not arise from psychological factors alone, but reflects changes in the vascular system that nourishes the genital organ and holds the blood in it.

This article explains Vasculogenic ED in clinical terms, from the true mechanisms of the state, the difference between narrowed arteries and venous leak, the risk factors met often, and the approach to in-depth diagnosis, through to the choices in care at PYONG MEN, which the doctor may consider choosing after an assessment specific to the individual.

What is Vasculogenic ED?

The mechanism of erection of the male organ relies on the working in harmony of two systems, namely the system of blood coming in (Arterial Inflow), which makes the arteries dilate in order to pump blood into the spongy shaft, and the system of holding the blood (Venous Occlusion), which compresses the veins so that the blood does not flow back.

When one system or the other works abnormally, the consequence is the state of Vasculogenic ED, which can be divided into two main mechanisms that may arise together.

Narrowed arteries (Arteriogenic ED)

This arises from chronic inflammation, the accumulation of fatty plaque, or a state of the wall of the blood vessels degenerating (Endothelial Dysfunction), resulting in the blood that goes to nourish the spongy shaft being insufficient in quantity. Those who have this state usually feel that erection begins with more difficulty, or that they cannot become fully erect as they once could.

Venous leak (Venogenic ED / Venous Leak)

This arises from the structure of the spongy shaft or the muscles of the pelvic floor losing their elasticity, so that they cannot hold the blood long enough and the blood leaks back out rapidly. The consequence is that the genital organ can become erect at first, but gradually becomes softer during sexual intercourse.

In many men, the symptom of incomplete erection may arise from both mechanisms together. Detailed examination and assessment is therefore important, in order to help identify the cause precisely.

The risk factors that should be considered

Vasculogenic ED is directly linked to the health of the blood vessels overall. The factors met together with it often are

Diabetes
High blood pressure
High blood lipids
Smoking over the long term
A state of central obesity and accumulated abdominal fat
Not exercising and accumulated stress

This is therefore the reason why Vasculogenic ED is usually called an "advance warning signal" of the health of the vascular system throughout the body.

The signals that may indicate the state of Vasculogenic ED

The loss of erection in the morning (Loss of Morning Wood)
Difficulty in beginning to become erect, taking longer and not being complete
Becoming soft rapidly during sexual intercourse
Having the metabolic risk factors mentioned above
The response to PDE5 inhibitors decreasing compared with the early period

The examination and diagnosis at PYONG MEN

Diagnosing the state of Vasculogenic ED requires examination that can see the working of the vascular system directly.

Penile Color Doppler Ultrasonography (PCDU) is the examination popularly used as the standard in assessing Vasculogenic ED, using high-frequency sound waves to measure the speed of the circulation of blood, both the rhythm of blood coming in (Peak Systolic Velocity – PSV) and the rhythm of blood going out (End-Diastolic Velocity – EDV), in order to identify whether it is a problem from narrowed arteries, from venous leak, or from both together
Comprehensive Endocrine & Metabolic Panel: examining the level of the hormones, the sugar, and the lipids, in order to assess the state of inflammation of the blood vessels throughout the body
Assessment of the muscles of the pelvic floor: in order to examine the tightness and the strength of the muscles that have a role in holding the blood

All the results of the examination will be analysed together before the approach to care is considered.

The approaches to care that may be considered after the assessment

The approaches to caring for Vasculogenic ED at PYONG MEN are considered according to the cause and the severity in each individual. In general the length of time in care is about 2–3 months, so that the process of creating blood vessels and restoring the tissue has a suitable period.

High-Precision Focused Shockwave Therapy (f-ESWT): firing focused shock waves of low energy deep down to the spongy shaft and the pelvic floor, in order to support the release of Vascular Endothelial Growth Factor (VEGF), which is connected with the creation of new capillaries and the restoration of the lining of the wall of the blood vessels
Superdose Activated Purified Growth Factor: a procedure of injecting a biological substance extracted at high concentration into the spongy shaft at a particular point, in order to support the repair of the tissue and reduce the state of oxidative stress
Transrectal QMR (Quantum Molecular Resonance): sending waves of a specific frequency through the anus, in order to support the repair of the cells in the prostate gland and the deep structures of the reproductive system, without using heat
Advanced Pelvic Neuro-Vascular Protocol (PMS): the use of electromagnetic technology in order to support the working of the muscles of the pelvic floor in holding the blood, which suits cases where venous leak is an accompanying factor

The concept of the plans of care, Plan A / B / C

The plans of care for Vasculogenic ED at PYONG MEN are designed according to the severity of the state found on examination.

Plan A (Best) for those whose vascular system has degenerated to a great degree, directed at integrated care covering several technologies
Plan B (High Standard) for those at a middle level, emphasising technology that stimulates the creation of blood vessels together with preliminary biological restoration
Plan C (Essential) for those at an early stage who still respond well to medicine, but want care at the root cause

The budget of each Plan is at a different level: Plan A is assessed preliminarily at 200,000–250,000 baht, Plan B at 100,000–130,000 baht, and Plan C at 45,000–65,000 baht. Considering the choice of Plan depends on the cause found on examination and on the doctor's assessment, not on the budget alone. All the prices are a preliminary assessment and may be adjusted according to the plan of care specific to the individual.

The concept in care at PYONG MEN

PYONG MEN looks at Vasculogenic ED as a reflection of the health of the blood vessels overall, not as a single symptom. The care therefore emphasises assessing the true cause, planning care specific to the individual, and following up the result by expert physicians throughout the process.

In brief

Vasculogenic ED is erectile dysfunction that has its root cause in the vascular system
It is divided into two main mechanisms, namely narrowed arteries and venous leak, which may arise together
The risk factors met often are diabetes, blood pressure, high blood lipids, and smoking
The standard diagnosis is Penile Doppler Ultrasonography (PCDU)
The approach to care at PYONG MEN is designed specifically for the individual and considered only after assessment

FAQ

Q: How does Vasculogenic ED differ from general ED? A: Vasculogenic ED is the kind that has its root cause in the vascular system in particular, while other kinds of ED may be connected with hormones, the nervous system, or psychological factors. Assessment helps distinguish the kind.

Q: How is it examined to see whether it is Vasculogenic ED? A: The standard examination is Penile Color Doppler Ultrasonography (PCDU), which measures the speed of the circulation of blood in the genital organ, together with metabolic blood tests.

Q: If it is Vasculogenic ED, is surgery necessary? A: In many cases it is not necessary. Technologies such as Focused Shockwave or Growth Factor may be considered as approaches, depending on the result of the assessment.

Q: After treatment, can it recur? A: Since Vasculogenic ED is related to the health of the blood vessels overall, controlling the risk factors, such as diabetes, blood pressure, and the behaviour of smoking, still has an important role in long-term care.Q: Does it take a long time? A: The length of time in care in general is about 2–3 months, depending on the cause and the response of each individual.

If you suspect that you may have the state of Vasculogenic ED, beginning with a Penile Doppler Ultrasound will help the doctor assess the cause systematically. Make an appointment for a consultation to have a PCDU examination and an assessment of the cause specific to the individual with PYONG MEN.