Objective: The purpose of this study was to evaluate the inflow and outflow communications of the cavernous arteries to the extra cavernous arteries and their association with erectile dysfunction. Materials and methods: An observational, analytical, cross-sectional study was conducted which included 63 patients complaining of erectile dysfunction that had been referred from the urology and andrology services for a penile color Doppler study with a pharmacological test. Severity was classified in accordance with the erection phases evaluated by a Doppler ultrasound and its clinical correlation. Results: There were 63 patients, 22–83 years of age, having variable degrees of erectile dysfunction that were analyzed. In 59 patients (93.6%) some arterial communication was seen. Regardless of the collateral artery involved, we found that with each collateral passing through the tunica albuginea and showing outflow from the cavernous arteries the severity of erectile dysfunction was worsened. prevalence ratio of 1.33 (95% confidence interval 1.13–1.56, value of p=0.001). Conclusions: The helicine arteries seem to participate in the phases of erection and detumescence, and dysfunction of their flow mechanism may be the first step in erectile dysfunction. Hence the importance of exploring new vascular factors that might affect the erectile mechanism and thus propose new lines of treatment. Level of evidence: