Venous leak


A few years ago my penis was bent the wrong way during sexual activity. It was not painful, but I heard a small pop sound and noticed that although my penis was full it was pointing down, not straight out as a penis full of blood should, so I knew something was wrong. I was still able to get erections after this incident, but the erections were not as hard as they used to be, and if I stopped stimulating myself in the middle of masturbation (i.e., before orgasm/ejaculation) the erection would vanish very rapidly (within about 20 seconds), whereas it used to last much longer (perhaps a few minutes) and subside more gradually.

I thought that my penis might heal on its own, so I waited several months before seeking treatment. After several months with no improvement I saw a urologist. He did not know what the problem was, but he gave me some Cialis (although I didn’t give the pills a serious try for various reasons). I then did some Internet research and learned about venous leaks, which seemed to be the problem I was having–my penis had trouble holding blood in once it got there. I saw a second urologist who said that a venous leak may indeed be the problem I had, but I don’t think he had the diagnostic equipment in his office to confirm that. He gave me some Viagra and, on a second visit, Levitra or Cialis. These pills sometimes helped my erections, but when they did so they also gave me headaches. To avoid the headaches I decided to try penile injections, and for this I went to a third urologist. The dosage of the injection he gave me must have been too low, however, because the erection was very weak. I then went to a fourth urologist who showed me how to inject myself and gave me a prescription for a stronger dosage. I injected 15ml of a Trimix solution at home and got a very good erection although the erection took too long (a few hours) to fully subside after orgasm/ejaculation. Reducing the injection amount to about 7ml helped the erection subside in a more reasonable time.

This fourth urologist also had the ultrasound equipment in his office to examine my penis and verify whether I had a venous leak. But he did not perform the ultrasound exam himself; his nurse did. When the urologist analyzed the video of the exam that the nurse performed, he did not see anything physically wrong with my penis and said my problem was not a venous leak. He suggested that my problem might be psychological. The suggestion was highly implausible to me, however, because all my problems started right after my unfortunate bending incident, and I knew that I had no psychological issues. I told him as much and he said that maybe I should see Dr. Goldstein, one of the world’s leading experts on erectile dysfunction, who could confirm whether or not my problem was a physical one.

So I made an appointment to see Dr. Goldstein at his San Diego office. He said he wanted to do the ultrasound exam on me again, but he wanted to do it himself; he didn’t want a nurse to do it because sometimes they don’t do it correctly, and he proved to me that he was right about that. Dr. G did the ultrasound exam, and I could see on the monitor that I had scarred tissue inside the base of my penis, where the traumatic bend occurred. He explained to me (and gave me a copy of his book, which helped me understand) that some of the smooth-muscle tissue in the penis, which is supposed to relax during an erection and allow more blood to flow into the penis, had been replaced by scar tissue, which cannot relax and allow more blood in. In an erect penis the inflow blood vessels compress the tiny outflow blood vessels (“subtunical venules”) so that the blood cannot escape, but to the extent that the smooth-muscle tissue is replaced by scar tissue, that mechanism breaks down and the blood escapes–and then one has a “venous leak” problem.

In a way, the problem is like trying to keep a leaky bucket full of water. There are two solutions: You can either (1) find a way to plug the holes or (2) just keep pouring in water so that the inflow keeps compensating for the outflow. Unfortunately, there is no easy way (short of surgery) to do (1). Strategy (2) is therefore what Dr. G has recommended to me as a first way of managing the problem. To increase the inflow I am trying Viagra. I am currently experimenting with the dosage amounts to find what will give me a good erection without also giving me a headache. (Injections are also a way to increase the inflow, but they only affect the shaft, “corpus cavernosa,” not the glans, for which creams are available, and the whole process of injecting is more cumbersome than simply taking a pill, so I am trying pills before I resort to anything else.)
In the past several months I have experienced another problem, in addition to the venous leak, and that is a cold glans in the flaccid state. Whereas before the bending incident I often had erections throughout the day (for example, when I see a pretty girl), now I hardly ever have erections (unless I am actually manually stimulating myself–and even with manual stimulation it is much harder to get an erection than it used to be). In general, I think fewer erections and decreased regular bloodflow to my penis is what has caused my cold glans/penis. To deal with the cold glans Dr. G prescribed “Flomax” in addition to the Viagra. I’m still experimenting with these medications to find out how effective they can be in dealing with this problem.

In summary, I am still experimenting to find a good solution to my problems, but I have at least made some progress. Thanks to Dr. G, I now have a solid diagnosis, and thanks to his book, his helpful conversation, and my own research and thinking about the issue, I now have a better understanding of my problem and what the presently available strategies are for dealing with it. Hopefully presenting my journey here will be helpful to others who are dealing with similar issues. And if you have any tips for me, please let me know! Thanks!



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