ED, PE And Venous Leakage
There are recurrent themes on this forum; one is ‘Does maturbation hinder gains?’: a poster asks again this very old (and beated to death) question and suddenly many other similar posts pop up; another one could be ‘Girth gains hinder length gains?’, just to make another example. A more serious, recurrent topic, is venous leakage. Since when Willy Wonka started posting again, I am having many private messages of people suddenly worried that they could have undiagnosed venous leakage, caused or not by PE; I’m sure I’m not the sole vet receiving posts like that.
So I think it could be useful to start a short reference thread on this subject. First point to make clear: venous leakage is often used as a general synonimous of ED; to be more rough, when Docs can’t find any other culprit for ED, they start speaking of venous leakage; venous leakage is somewhat an ad hoc hypothesis, like aehter - since They can’t make another convincing hypothesis, they think there has to exists something called ‘venous leakage’ which impairs erections. But let’s walk straight.
Causes of ED
‘There are many classification systems for the causes of ED. The easiest is to categorize the causes as physical, psychological, neurological, vascular and other. Reduced blood flow to the penis and nerve damage is the most common causes of erectile dysfunction. Underlying causes include the following: vascular disease, diabetes, drugs, hormone imbalance, neurological causes, pelvic trauma in surgery, Peyronies disease, and venous leak.
Vascular Disease: Vascular disease is the predominant cause of erection problems. Low blood flow in and around the heart may cause a cardiac infarct, the same problem in the brain may cause a stroke, and in the penis it causes erection problems.
Diabetes: Diabetes is a major cause of erection problem. Between 35 and 50% of men with diabetes experience erectile dysfunction and 50% of all diabetic men become impotent after age 50. The disease can damage blood vessels and nerve tissues. Both may have an effect on erection. High levels of blood sugar associated with diabetes often damage small blood vessels and nerves throughout the body, which can impair nerve impulses and blood flow necessary for erection.
Other: Drugs and vices, like drinking alcohol or smoking, may damage the nerves and blood supply needed for normal erection. There are over 200 prescription drugs that may cause or contribute to impotence, including drugs for high blood pressure, heart medication, antidepressants, tranquilizers and sedatives.
Hormonal Imbalance: Testosterone deficiency can result in a loss of libido (sexual desire) and a loss of erection. Low testosterone account for 1% of ED. High production of prolactin and high or low thyroid hormone levels (hyperthyroidism or hypothyroidism, may add to a low testosterone production and thus, cause a lower libido. Hormonal imbalances can also occur as a result of kidney or liver disease.
Neurological Causes: Multiple sclerosis, Parkinson’s disease, and spinal cord injuries are among those that may lead to loss of potency. Spinal cord and brain injuries can cause impotence because they interrupt the transfer of nerve impulses from the brain to the penis.
Pelvic Trauma in Surgery: Surgery of the colon, prostate, bladder, or rectum, may damage the nerves and blood vessels involved in erection.
Peyronie’s Disease: Peyronie’s disease is an inflammatory condition that causes scarring of the erectile tissue. ……………..
. The cause of Peyronie’s disease is unknown, although trauma to the penis has been implicated. This curvature can be so severe that it prevents intercourse.
Psychological Causes: Though the physical reasons for ED are many, once a man has difficulty with erections, psychological factors often become a factor. Men who experience a sudden loss of erectile capability often have a psychological origin to their condition.
I think the above is clear enough, but to put things even more in perspective:
’Exploding Common Myths about Erectile Dysfunction.
Performance Anxiety is a Rare Cause of Erectile Dysfunction.This is just not so. Performance anxiety is in fact the single commonest cause of all erectile dysfunction in younger men and indeed plays some role in all erection difficulties.
All Erectile Dysfunction requires Prescription Medication to fix it. Nothing could be further from the truth. Most erectile dysfunction in younger men does not call for a pharmaceutical solution at all. Indeed such an approach may be entirely inappropriate and bring about a dependency that never addresses the underlying cause. In older men too medication may not always be indicated though in this group it can be extremely effective.
Venous Leak is a common cause of Erectile Dysfunction. This is absolute nonsense. Venous leak is very uncommon, is often used as the diagnosis of last resort and may be grasped by the desperate to avoid having to face up to performance anxiety.
Performance Anxiety is a Form of Weakness and is the man’s own fault. This, in my view, is the very worst myth of them all. This myth stops and diverts a man from accepting performance anxiety as the underlying cause of his problem. These diversions can be extremely expensive and unhelpful. They can lead to costly investigations, misdiagnosis and delays to resolution. Performance anxiety is not as sign of weakness nor is the mans own fault. It is something that can be perpetuated from a single event where a negative thinking pattern develops that can be challenging to shift.’
Ok, do we have a bit more clear picture now? I hope so. Let’s look specifically to venous leakage, what it is? More often than not, you could get an answer like this:
‘What Is a Venous Leak?
If the veins in the penis cannot prevent blood from leaving the penis during an erection, an erection cannot be maintained. This condition is known as a venous leak. Venous leakage may occur with vascular disease, but it also can occur as a result of poor muscle relaxation of the penis…..’
So, as the name imply, venous leakage is a problem linked with the vein in itself. This is not anymore believed to be true, according to most recent research.
Several studies have shown that, leaving apart other specific factors above reported (vascular disease, diabetes etc.), when veins fail to trap blood, mantaining the erection, the problem is likely not in the veins themselves; here you are one of those studies:
On the pathogenesis of penile venous leakage: role of the tunica
, Ismail Shafik1
, Olfat El Sibai2
and Ali A Shafik1
Background: Etiology of venogenic erectile dysfunction is not exactly known. Various pathologic
processes were accused but none proved entirely satisfactory. These include presence of large
venous channels draining corpora cavernosa, Peyronie’s disease, diabetes and structural alterations
in fibroblastic components of trabeculae and cavernous smooth muscles. We investigated
hypothesis that tunica albuginea atrophy with a resulting subluxation and redundancy effects venous
leakage during erection.
Methods: 18 patients (mean age 33.6 ± 2.8 SD years) with venogenic erectile dysfunction and 17
volunteers for control (mean age 31.7 ± 2.2 SD years) were studied. Intracorporal pressure was
recorded in all subjects; tunica albuginea biopsies were taken from 18 patients and 9 controls and
stained with hematoxylin and eosin and Masson’s trichrome stains.
Results: In flaccid phase intracorporal pressure recorded a mean of 11.8 ± 0.8 cm H2O for control
subjects and for patients of 5.2 ± 0.6 cm, while during induced erection recorded 98.4 ± 6.2 and
5.9 ± 0.7 cmH2O, respectively. Microscopically, tunica albuginea of controls consisted of circularlyoriented collagen impregnated with elastic fibers. Tunica albuginea of patients showed degenerative
and atrophic changes of collagen fibers; elastic fibers were scarce or absent.
Conclusion: Study has shown that during erection intracorporal pressure of patients with
venogenic erectile dysfunction was significantly lower than that of controls. Tunica albuginea
collagen fibers exhibited degenerative and atrophic changes which presumably lead to tunica
albuginea subluxation and floppiness. These tunica albuginea changes seem to explain cause of
lowered intracorporal pressure which apparently results from loss of tunica albuginea venoocclusive mechanism. Causes of tunica albuginea atrophic changes and subluxation need to be studied.
(The whole study is attached to this post, since it’s in the free domain).
So, in the very rare cases when venous leakage is the culprit, the issue is not in the vein but in tunica albuginea (and/or smooth muscle tissue). That's why venous ligation is unlikely to solve the problem:
‘If you indeed have a primary severe venous leak, then surgical correction is rarely effective long term. Look into some of the research by Dr. Tom Lue who pioneered surgery for venous leak only to virtually abandon it because of lack of permanent cures.’
So, how can we cure it? If the issue is that tunica albuginea and/or smooth muscle are atrophied and have lost strenght and elasticity, what can be done? One of the simplest guess would be: mechanical stimulus to reactivate atrophied and weakened tissues, isn’t that true? You go to the gym to get back strength and elasticity in your muscle and bones, maybe that could work for your penis too. That’s what enlightened urologists do suggests, actually:
‘The venous leak issue has nothing to do with overall health. The best treatments are the following:
External vacuum system. While you feel this is too embarrassing or intimidating, recognize that this is a very safe and effective way of controlling the venous leak problem without surgery and providing a reasonably good result for most patients. Potential partners worth keeping will not reject this type of a remedy.
Combination therapy where we use Viagra plus MUSE or the injection together with a tension ring borrowed from the vacuum devices. This uses blood flow enhancers to generate the increased blood flow necessary for the erection together with the tension ring that substitutes for the missing venous control. A bit expensive, but may be worth a try….’
‘…Organic ED responds well to vacuum erection device (VED) therapy, especially among men with a suboptimal response to intracavernosal pharmacotherapy…’
‘…..Organic impotence as a whole responds well to this type of therapy [ 58], with age presenting no barrier, as the elderly can expect equivalent results [ 59]. If efficacy in certain groups is examined, satisfactory erections range from almost 100% in men impotent after radical prostatectomy [ 40, 60], to ≈70% where diabetes is deemed to be the root cause [ 43, 61, 62].
In arteriopaths, the success is reputed to be ≈90% [ 40, 41] and where the main problem is venous leak, ≈70% [ 42, 63, 64] are satisfied with the results. In our experience it is rare to find those who have such severe arterial disease that they should be denied a trial with the VCD and further, it has been suggested that as venous leakage becomes more severe, so any increased efficacy of the VCD over pharmacotherapy or intracavernosal injections becomes more pronounced [ 65]. This may be related to the recent evidence that there is a variable contribution from venous back-flow [ 37] as opposed to the initially proposed effect of a pure increase in arterial inflow [ 66]….’
Uhm…mechanical stress, vacuum devices… does it sounds like….PE?
Take At Home
1) If you think you have venous leakage, you are 99% wrong;
2) if you fear you have permanently broken your penis, probably your penis is not working for psychological reasons;
3) if you really have venous leakage, the best remedy for it could be cautious and progressive PE.
Disclaimer: I’m not an urologyst, so don’t take my words for granted (neither the words of anybody else, for that matter, but that’s just me), check my sources, do more deep searches and make up you brain. This thread is just for a quick reference.
Last edited by marinera : 01-22-2013 at .