The pathophysiologic basis for impotence, as related to possible vascular surgical procedures, is briefly discussed. In order to better classify criteria for selection and results of surgery, various relevant terms are defined. In the authors experience, conventional procedures for venous ligation have restored potency in only about 20% of cases. An additional 60% respond when given supplemental papaverine therapy. A new surgical procedure for venous ligation, which allows access to the cavernosal veins, has produced very promising results in a small pilot series. Arterial reconstruction has been effective in about 80% of a highly selected group of patients with arteriogenic impotence.