Of 135 patients who underwent penile angiography at our institution, impotence was related to noniatrogenic trauma in 16. Impotence developed immediately following an isolated traumatic event in 14 patients, and months or years after repeated blunt perineal trauma in 2. Invasive vascular assessment facilitated diagnosis in all patients. Although the mechanism of trauma varied greatly, most patients had vasculogenic (arteriogenic or venogenic) impotence. Complete vascular assessment required selective magnification pharmacoarteriography in multiple projections, pharmacocavernosography, and pharmacocavernosometry. Therapeutic choices were based largely on the angiographic findings, and included venous ligation, arterial bypass or angioplasty, self-injection of papaverine, or insertion of a prosthesis.