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interactions between the central nervous system, the arterial and venous systems and the axis hypothalamus-pituitary-gonadal. The main source of blood supply of the penis is through the internal pudenda artery, a branch of the internal iliac artery. The pudendal artery becomes the common penile artery, which is divided into three branches-dorsal, bulbourethral and cavernosal. For a proper assessment, we recommend to follow these requirements: space with appropriate privacy, provide a detailed explanation to the patient, obtain informed consent, use of B-mode, Color Doppler and spectral analysis display, intracavernous injection of vasoactive drugs (i.e. Alprostadil), serial arterial velocity measurements, 5-10-15-20-30 min. It is necessary to document the five hemodynamic phases and measure the systolic and diastolic velocities in the cavernosal arteries. The normal peak systolic velocity (PSV) is equal or greater than 30 cm/s and the end diastolic velocity (EDV) is equal or less than 5 cm in the cavernosal arteries. The dorsal vein of penis has vmax less than 5 cm/s. Men with arteriogenic ED demonstrate PSV , 25 cm/s, with 100 % sensitivity and 95 % specificity. Venoocclusive dysfunction shows PSV 25 cm/s or greater with a persistent EDV.5 cm/s, with a sensitivity of 90 % and specificity of 56 %, in the setting of venous leak. Ultrasound is a valid method of assessing for arterial insufficiency and venoocclusive dysfunction.