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Urology/Venous leak?


QUESTION: I'm afraid that I have venous leakage. If I sit down or lie down I can keep an erection at least 5 minutes (I haven't counted any further) but I need to stimulate my penis 'cause its hard for me to be aroused that long just by watching porn etc. Its not so easy when I'm standing even if I stimulate aka. try to test if I can keep an erection. I can masturbate to orgasm in any case with a hard penis but this only takes 1-3minutes.
  So does this sound that I might have venous leakage? Or is there just something wrong with my libido? Is it possible that I might have venous leakage but it doesn't show because I can masturbate to orgasm fairly quicly.. in another words could it be possible that I have an venous leak about 5-10 minutes after I get an erection but I haven't been able to experience this? Or have I misunderstood venous leakage completely?

ANSWER: Jason, It does onto sound to me like you have a venous leak.  I don't know if you have previously read information I have written on this problem, so will will attach my "macro" now and comment at the end of it.

The penis is composed of three cylindrical bodies called corpora. The single corpus spongiosum  contains the urinary canal (urethra) and the paired corpora cavernosa are the erectile bodies.  The latter each contain an artery that supplies blood and they are surrounded by an elastic membrane.  The corpora cavernosa contain vascular spaces that have the ability to expand with the inflow of arterial blood.  The act of  having an erection is dependent on many factors.  In its most basic form, however, sexual arousal (touch, thought, dreams, etc.) stimulate the nervous system to send information to the penis.  This causes the vascular resistance in the corpora to decrease allowing arterial  blood to flow in much easier.  Simultaneously, the outer elastic membrane stretches to accommodate the increased blood in the penis and an erection occurs.  While arterial blood is flowing into the penis, the veins of the penis tend to let the blood escape back into the circulation.  Normally, the pressure inside the corpora increases to a critical level, the corpora swells and passively compresses the veins, thus shutting off the outflow temporarily.  However, abnormal venous drainage can be present either congenitally or develop spontaneously over time.  In such a case, the blood may flow out of the penis too fast during attempted erection resulting in no or only partial tumescence.  This is  called a “venous leak”.  

A venous leak can be identified by performing a penile duplex color ultrasound or by a special x-ray of the the penis called a corpous cavernosogram.  The latter is an invasive test and not usually performed unless one is considering surgical repair.  Although the later is an option, the success rate is disappointing.  The simplest therapy is to use a thick expandable device called a confidence ring.  These come in various diameters and strengths.  They help to compress the veins but do not affect the arterial inflow.  The ring is stretched and placed over the erect penis to it’s base just before attempting sex.  They should not be left on for more than 30 minutes because of potential comprise of blood flow.  Another option, is the use of medication to allow blood to more easily flow into the corpora.  These agents are oral medications in the class of PDE5 inhibitors  (ie Viagra, Levitra, and Cialis), penile injections (ie Edex, Caverject), and urethral suppositories (Muse).  They may be successful alone or combined with a confidence ring.

That being said, I do not think that you actually have a sexual problem.  Many men are not able to achieve and/or  maintain a good erection just from watching porn, so this is not at all unusual.  The average man will ejaculate in 2-5 minutes with sexual activity (masturbation or intercourse) so this is normal in you as well.  Most men find it easier to get an erection either in the prone or standing positions because blood flows into the penis more easily in these positions because of gravity.  However, trying to masturbate standing is awkward and this in itself can make it more difficult to get erections.  

The bottom line is, from what you have told me, I do not think you have a venous leak or other types of sexual problems.  Good luck.

---------- FOLLOW-UP ----------

QUESTION: Is venous leak related to libido in anyway? I mean I fear all the time that I have a venous leak but problem is mainly that I sometimes cant get aroused enough to even get an erection or keep the arousal when I'm first aroused, it's like I get turned off very quickly, I think the stoppong of arousal might mean that I start to panic will my dick keep up? This has become a big problem for me because I tend to think that all the time, and sometimes I even fear to start masturbating because I fear that my dick don't stay up.  Other days I'm aroused somewhat and other days not at all. I have understood that venous leakage will happen if you have still have a very high libido and if you're very aroused?


Jason, there is NO relationship between libido and venous leak. There are many causes of a decreased libido or sex drive.  It varies greatly from person to person and in some men, a low drive is normal for them.   One cause is  hormonal imbalance (the most common being a deficiency of testosterone or over production of a pituitary hormone called prolactin).  Also, if a man ejaculates too frequently, the prostate gland may become inflamed.  This may cause him to have difficulty with erections and perhaps to be less “horny”.   If this individual avoids sexual arousal and ejaculation for 7-10 days and the problem resolves, the cause was sexual activity that exceeded the tolerance of his prostate gland.  Other etiologies include anemia, chronic fatigue syndrome, diabetes, and just about any debilitating illness.   Certain medications may also lower the libido.  There are a number of men who have decreased libido on a purely emotional basis, such as might occur in anxiety, depression, bipolar disorder, etc.  Initially, one should go to their family physician for a routine history and physical examination and appropriate screening blood tests.  The latter might include a complete blood count, metabolic chemistry screen, a serum prolactin level and serum free and total testosterone levels.  If these are normal, I would suggest you consult with a urologist for evaluation of your erectile problems.

If all the above proves to be normal, my suspicion is that you suffer from "performance anxiety".  Every man occasionally has difficulty obtaining or maintaining erections.  There are many possible reasons for this such as too frequent sex (or ejaculation), prostatitis (inflammation of the prostate gland), fatigue, drugs, alcohol, emotional causes, etc.  When it happens out of the blue for the first time, it is not uncommon to have the event in the back of your mind when you try to have sex in the future.  If this thought interferes with your function, the disorder is called "performance anxiety".  It is one of the emotional causes of impotence and quite common.   Although drugs such as Viagra, Levitra and Cialis are not specific for such problems, I have used them in these situations.  I have found that the use of 1/2-1  50 mgm tablet of Viagra works very well. Often it  is not necessary to use the drug again.  Just having it available for those problem situations seems to bolster one's confidence enough so that it is not needed.  These medications do have certain contraindications and side effects.  Therefore, they should only be prescribed by a physician familiar with your medical history.  If the problem persists or still worries you, the best course of action is to discuss the anxiety with a sex therapist.  Good luck!


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Arthur Goldstein, M.D.


Problems or questions related to the field of urology; ie urinary stone disease, urinary cancers (kidney, bladder, prostate, testis, etc.), urinary infections, etc. I no longer answer questions related to erection problems or male sexual dysfunction.


I am retired from the active practice of urology. My 34 years was totally in the clinical field and involved the entire gamut of genitourinary problems, with special interest in endourology.

American Medical Association, American Urological Association, American College of Surgeons

College degree - BS Medical degree - MD Master of Science - MS

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