Venous leak and ED: What every man needs to know

Everything is going your way, but when it’s showtime, you’re found unable to perform? It happens to the best of us, but when it becomes a familiar pattern, you could be dealing with erectile dysfunction.

According to the Royal Australian College of General Practitioners (RACGP), it’s the most common form of sexual dysfunction alongside premature ejaculation [1]. You’re not alone, and it’s an issue that impacts 322 million men globally [2].

The problem is figuring out why you’ve got this problem and what you can do about it. Today, we’ll focus on venous leakage, what causes it, and what you can do about it.

What is a venous leak?

Let’s get back to the basics of penile venous anatomy. Erections aren’t magic. They’re a harmony of the circulatory system, the nervous system, and the brain.

When you’re aroused, nerve signals activate and release nitric oxide. This causes the muscles in your penile arteries to relax, which brings blood into the corpora cavernosa. The deep dorsal vein and other penile veins responsible for draining blood are then compressed, trapping blood and giving you an erection [3].

During arousal, nerve signals activate the parasympathetic nervous system, releasing nitric oxide (NO). NO causes smooth muscles in the penile arteries and erectile tissue to relax, increasing blood flow into the corpora cavernosa. Simultaneously, the veins that drain blood are compressed, trapping the blood and causing the penis to become rigid and engorged. 

A venous leak, penile venous insufficiency, or Venogenic Erectile Dysfunction (VED), is when your cavernosal arteries don’t bring enough blood into your penile arteries when you’re aroused, resulting in soft erections, or even nothing at all. That’s why venous leaks are a form of erectile dysfunction. Around 80% of men with vasculogenic impotence were found to not be able to hold blood within the penis, which is why venous leaks are so prominent in sexual dysfunction [4].

How common are penile venous leaks in men?

We know that around 23% to 27% of Aussie men suffer from erectile dysfunction, but the truth is, we don’t know how many cases are caused by venous leaks [5].

The reason is that studies tend to focus on erectile dysfunction as a whole, rather than on venous leaks specifically. And just like a lack of normal erectile function, it’s widely acknowledged that many men never come forward out of embarrassment, which is why any numbers we have are likely undercounts.

Of the studies we do have, estimates vary wildly. For example, one study estimated that in 89% of organic erectile dysfunction cases, venous leaks were to blame [6]. Other studies place the number far lower.

How does venous leak affect men’s sexual health? 

Venous leaks impact male sexual health because they result in VED, which is characterised by the inability of the penile veins to trap blood effectively [7]. It means you’ll suffer from problems getting and maintaining erections.

You already know that this can stop you from enjoying the sex life you want. Regardless of age, it’s a crushing blow to quality of life and damages your self-confidence. Luckily, it’s a known condition and it can be diagnosed and treated.

What are the signs and symptoms of a venous leak?

Venous leaks have some clear signs that should convince you to set up an appointment with your GP. Here’s a breakdown of the most common symptoms [8]:

• Problems achieving an erection
• Difficulty maintaining an erection
• Soft erections
• Inconsistent erections
• Quick loss of erection
• Poor response to sex medications
• Lack of spontaneous erections

What causes a venous leak?

Diagnosing a venous leak is one thing, but determining its cause is quite another. Generally, there can be a range of reasons why it happens, including [9]:

• Aging – Like erectile dysfunction generally, the chances of getting a venous leak grow with age due to the natural changes in the penile tissues.
• Medical Conditions – Certain medical conditions linked to damage to the nerves and blood vessels may also increase the likelihood of this condition
• Trauma – Any form of trauma could also damage the blood vessels and connective tissues, such as pelvic injuries, prostate surgery, and penile fractures.
• Hormonal Imbalances – Low testosterone levels have been linked to venous leaks in some cases.
• Psychological Factors – Sometimes, it could be all in your head. Stress, anxiety, depression, and other mental health issues have been linked to venous leaks and erectile dysfunction.
• Medications – Any prescription medications you’re taking could contribute to venous leaks and erectile dysfunction.

How is venous leak diagnosed?

Venous leaks can be diagnosed in any number of ways. When you’re at your GP, you’ll usually be given a clinical evaluation, consisting of a review of your medical history and a physical examination. Any issues like varicose or bulging veins can give medical professionals an idea of whether you’re suffering from venous leakage.

Other tests a professional might order include [10]:

• Ultrasounds
• Magnetic Resonance Imaging (MRI)
• Cavernosography
• Nocturnal Penile Tumescence (NPT) tests
• Blood tests

On a side note, if you’re younger, beware that a study did find that younger adults had a higher chance of being misdiagnosed with venous leaks when using penile ultrasounds [11]. That’s why your doctor might use more than one diagnostic tool to get a complete picture of what’s going on.

What treatment options are available?

Treatments generally depend on the cause of your venous leak. For example, if it’s believed that a mental health disorder might be the main cause, you might be asked to attend sex therapy with a registered therapist. More commonly, physical issues are treated with physical treatments.

Some examples of what that could look like include:

• Medications – Some medicines can boost the flow of blood to the penis. In mild cases, putting you on a course of medications could be all that’s needed to restore a full and healthy sex life.
• Penile Injection Therapy – In this case, medication is injected directly into your penis. The medication forces the blood vessels to dilate, allowing blood to rush in and give you an erection.
• Vacuum Erectile Devices – A vacuum erectile device is a type of device that creates a vacuum around the penis. It then allows blood to be pulled into your penis to create an erection.
• Embolisation – Embolisation is a minimally invasive treatment that blocks the veins responsible for causing the leakage. This means that you won’t have the issue of blood not being trapped inside your penis anymore.
• Penile Implants – An invasive penile venous surgery, like a penile implant, is considered the option of last resort. When other treatments haven’t given you the results you expected, a penile implant can be used instead.

The right treatment for you depends on your circumstances. Listen to your doctor and follow their advice. Other options your GP might suggest include Pilot’s ED treatment package. Generally, it’s about finding out what works for you because everyone is different.

Can exercise or lifestyle changes cure penile venous leakage?

Exercise and proper diet can’t cure a venous leak because it’s a structural issue. That doesn’t mean there are no benefits to transforming your lifestyle to make it easier to manage your condition and lessen its symptoms, though.

Anything that reduces the pressure on your veins, reduces inflammation in the lower body, or improves blood circulation will be a big plus for your sex life. Some of the changes you can make today include:

• Exercising at least 30 minutes a week.
• Going on a diet to maintain a healthy weight and support your vascular health.
• Avoid prolonged sitting to promote blood flow.
• Wearing compression stockings to support efficient blood flow.
• Quitting smoking to avoid damaging your blood vessels.

None of these things is an alternative to medical treatment from a professional if you’ve already been diagnosed with a venous leak. However, improving your health can support you in reclaiming your sex life and getting your self-confidence back.

Living with venous leak and erectile dysfunction: What men should know

Living with any form of male erectile dysfunction is frustrating and challenging for even the best men. The first thing to remember is that it’s remarkably common. Millions of men around the world are going through the same thing as you. The second thing to bear in mind is that venous leaks aren’t a threat to your health and are treatable. 

Honest and open communication is the mantra for living with a venous leak. Talk to your partner about what you’re going through and proactively approach your GP. It might feel embarrassing, but the sooner you can air it out, the sooner you can stop worrying about what’s wrong and start thinking about solutions.

More solutions to restore proper penile venous drainage are available than ever before, ranging from medications and sex therapy to non-invasive and invasive surgeries. Treating erectile dysfunction is more straightforward than ever before to help you get your sex life back.

When to see a doctor about penile erection problems

The simple rule of thumb is that you should see a doctor about erectile problems if you’re distressed by them. If the issue is happening more than 25% of the time and you’re unable to enjoy a healthy sex life, it’s time to make an appointment with your GP.

The sooner you’re diagnosed. The sooner you can start taking positive steps toward a better sex life.

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