Vascular problems of arterial and/or venous origin are often found as the cause of erectile dysfunction. Clinical examination alone is insufficient and must followed up by a number of non or minimally invasive tests in order to confirm the etiology. Such testing should include: Doppler measurements or, better, duplex sonography, nocturnal penile plethysmography, psychological status, clinical biochemistry and intracavernous injection of vasoactive drugs. Occasionally, it may be necessary to complete these tests by more invasive examinations: pharmacoarteriography and/or pharmacocavernosography. Several novel therapeutic approaches have been developed in recent years and have given rise to encouraging improvements.