Quick answer
A "good-quality" erection is firm enough and lasts long enough for satisfactory intercourse. When this is repeatedly no longer the case, it is called erectile dysfunction, a common problem whose cause (vascular, hormonal, psychological) must be sought before treatment.
📖 What does a good-quality erection mean?
A "good-quality" erection is one that is sufficiently firm and sufficiently lasting to allow satisfactory sexual intercourse. When this is repeatedly no longer the case, it is called erectile dysfunction, a common problem whose cause is not always what one imagines.
This is the most important point of this page: there is no single treatment for erectile dysfunction, because there is no single cause. The right treatment depends entirely on the right diagnosis. Proposing a treatment before the real cause has been identified means running the risk of treating blindly.
🔍 The different causes of erectile dysfunction
A good-quality erection depends on a precise balance between arterial inflow, venous blockage, nerve and hormonal integrity, and the psychological context. An imbalance at any of these levels may be responsible:
| Origin | Mechanism | Is embolization treatment relevant? |
|---|---|---|
| Venous | Penile venous leak: blood escapes from the corpora cavernosa | Yes - this is the only indication for embolization |
| Arterial | Insufficient blood supply (atherosclerosis, often linked to cardiovascular risk factors) | No - different management |
| Hormonal | Testosterone deficiency in particular | No - endocrine work-up and specific treatment |
| Neurological | Diabetes, pelvic surgery, neurological disease | No - specialist management |
| Psychogenic | Performance anxiety, stress, relationship context | No - sexological or psychological support |
| Mixed | Combination of several mechanisms (common after age 50) | Depends on the respective contribution of each cause on work-up |
It is precisely because these causes often coexist that a superficial work-up may wrongly point towards embolization, or conversely miss a genuine venous leak in a patient who could have benefited.
⚠️ The key point: patient selection
Embolization only works in patients who genuinely have a penile venous leak, confirmed by imaging. This is not a technical detail: it is the condition for success. A patient whose erectile dysfunction has another cause will gain no benefit from embolization, whatever the quality of the technical procedure.
This is why this management can only be carried out seriously by an expert team with access to the full diagnostic platform: hormonal work-up, validated questionnaires, pharmaco-induced penile Doppler ultrasound, and cavernous CT. Without this complete work-up, it is impossible to know with certainty whether a patient is really a candidate for embolization, and offering the procedure without that certainty is not honest practice.
🧪 What does the full diagnostic work-up involve?
At Cochin AP-HP, before any treatment decision, the work-up includes:
- History and clinical examination: cardiovascular history, diabetes, current treatments, psychological context
- Validated questionnaire (IIEF): objectively quantifies the severity of the problem
- Hormonal work-up: testosterone measurement in particular, to rule out an endocrine cause
- Pharmaco-induced penile Doppler ultrasound: after intracavernous injection, separately assesses arterial flow and venous drainage
- Cavernous CT (if a venous leak is suspected): confirms the diagnosis and precisely locates the vein or veins involved, essential for planning an embolization
Only at the end of this full work-up, in consultation between urologist, andrologist and interventional radiologist, can the decision to refer for embolization, or for another form of management, be made reliably.
📊 Honest results, not promises
In correctly selected patients with a confirmed venous leak, embolization improves erections in 60 to 75% of cases in the medium term. This figure also means that:
- Improvement is not 100% guaranteed, even in the best candidates
- Some patients will need additional treatment (drugs, injections) even after embolization
- The result depends directly on the rigour of the upstream selection, hence the importance of the full work-up rather than a hasty decision
Any communication presenting embolization as a guaranteed or universal solution to erectile dysfunction would not be honest towards patients.
🔀 If it is not a venous leak, what are the options?
The diagnostic work-up directs you towards the management suited to the real cause identified:
💊 Drug treatments
PDE5 inhibitors (first-line in most causes)
💉 Intracavernous injections
When oral treatments have failed or are contraindicated
⚕️ Hormonal management
When testosterone deficiency is confirmed on work-up
🧠 Sexological support
When a psychogenic component is identified, alone or in combination
🩹 Vacuum devices
A non-invasive alternative in certain situations
🔧 Penile implant
As a last resort, when other options have failed
Venous leak embolization, detailed on our dedicated page, is just one option among these possibilities: the right option for the right cause, identified by the right work-up.
❓ Frequently asked questions
Where should I start if I have erectile dysfunction?
Can I ask directly for an embolization?
Is a prescription needed to book a consultation?
🔗 See also
✓ Why this page is trustworthy
Written by the Interventional Radiology team at Cochin Hospital AP-HP, Université Paris Cité. Medically reviewed by an interventional radiologist of the department. Last updated: July 2026.