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I just asked a question on here, want to get your opinion. Several months ago i hit my crotch area on a tank of a motorbike going very slowly to abrupt stop. it hurt for 20 min, there was no bruising or swelling and i was able to get a full erection within the hour.  a few weeks after that i had successful intercourse a few times, then a random loss of an erection during sex. i've since had good sex many times since hitting the area with a random loss of an erection during sex only a couple times out of many. never lost an erection with masturbation.

a month after hitting the area, after a night of heavy masturbation/sexual activity i developed superficial vein thrombosis. i went to a urologist and he said it was not related to hitting the area. he told me to take baby aspirin and that it shouldnt' effect erection function.  it's been a few months since both things and i've had sex many times. i'm just wondering how big of an injury could cause any damage or venous leak? I asked a few other doctors and they seem to think it would have to be penile or pelvic fracture with severe bruising or swelling.

i've had erections that have lasted several min without touching them. i've also had nocturnal and morning erections but not every morning. another doctor said if you had venous leak it would be a consistent issue and you wouldn't be able to maintain hard erections with masturbation. like i said there was no brusing or swelling and i got a full erection afterwards. i had good sex after with a random loss of an erection with sex only a couple times out of many many.  

one doctor said you can still have night time erections with venous leak and another said you can't. What is your take on all this.

Answer
Ken, first, let me explain the mechanism of venous leak to you.  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.  It is not often due to injury & certainly not from the type of trauma you described.   With a venous leak, 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”.  

The 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.

It is not unusual for symptoms from a venous leak to be intermittent.  Therefore, the presence of some normal erections does not necessarily rule out this disorder.  Conversely, the presence of ED does not mean one has a venous leak as this is only one of many causes for erectile dysfunction.  There is nothing in your history, however, to suggest that you have a venous leak.  Good luck.

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Arthur Goldstein, M.D.

Expertise

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.

Experience

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.

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

Education/Credentials
College degree - BS Medical degree - MD Master of Science - MS

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