Using strict selection criteria, peripheral microsurgical revascularization was performed in 23 of 180 patients with erectile dysfunction (seen between February 1987 and December 1988). Average age of the 23 men was 51.8 (44-59) years. In 14 patients, the epigastric artery was transposed end-to-side to a side-to-side anastomosis between the dorsal artery and vein of the penis, while in two a piece of inferior epigastric vein was interposed. In the other seven patients an end-to-side anastomosis was constructed between the inferior epigastric artery and the deep dorsal vein of the penis. After three months, 19 of 20 patients who were followed-up had regular intercourse without intracavernous administration of drugs, after six months 15 of 17, after one year 11 of 14. In two patients irreversible thromboses of the anastomoses occurred when anticoagulant administration, required postoperatively, had been discontinued. The results indicate that with careful selection microsurgical treatment can achieve good results.