Venous Leak – What is it and Why do I have it?
Erectile dysfunction (ED) can arise from various causes, and one less commonly discussed but significant factor is venous leak, also known as veno-occlusive dysfunction. This can impact men of any age, but more likely to impact young, otherwise healthy men.
Generally, it Is important to understand how blood flow contributes to an erection during sexual activity. With any sexual stimulation, your body sends signals to divert more blood to the penis through a collection of arteries. This blood moves through the penis and then exits through a collection of veins. The balances shift with arousal to the point that you have more blood or pressure in the penis and less out-flow through the veins, to the point that the outflow should cease completely with a normal erection. Only then will you be able to get the pressures necessary for a full, complete erection. In men with venous leak, the outflow does not cease; a portion of the blood continues to leak out. This is because the valves within the veins are faulty. An analogy that I use is inflating a tire and then subsequently placing a large nail in the tire. Air will continue to leak out and may be positional, but the pressure will drop over time. Similarly, men with venous leak, may be able to get a reasonable erection, but it does not last as long or is positional (erection quickly goes away with changes in body positioning).
Several factors can contribute to venous leak, but most commonly you may be born this way or have a hereditary predisposition to venous insufficiency throughout all the veins in your body. These men are also more prone to having or developing varicose veins in their legs or varicoceles in the scrotum. Other risk factors may be natural aging, pelvic injuries or surgeries, or even psychosocial stressors (where releases in the stress hormones can cause the valves to incompletely close). The diagnosis of venous leak requires a medical history, examination, and ancillary tests. Typically, the gold standard for diagnosis is a penile color doppler duplex ultrasound, where the blood flow in and out of the penis can be measured with a chemical stimulation.
The challenging part about venous leak ED is that there are not many reliable treatment options that specifically target the underlying problem. Most men go through treatments similar to those with a predominantly artery problem or mixed problem (pills, injections, etc.) with varying success. The only treatments that help with venous leak directly are external constriction loop/ring and a penile implant. An external ring or loop can put some extra pressure on those faulty valves, but it is not as precise as you would need. A penile implant essentially bypasses the blood flow issue altogether. A reliable erection can be obtained with an implant because it relies on the movement of fluid in a closed circuit within your body. Surprisingly a penile implant is the gold standard for men with venous leak who have failed other conservative measures.
Many patients will inquire about dorsal vein ligation or embolization, essentially blocking the outflow through the veins in the penis. Although this has been studied for many years, the results are mixed and these treatments are very unlikely to be successful. There are also unique risks and horror stories from my own patients that have undergone these procedures with other providers. Therefore, I almost never recommend these types of procedures to my patients.
It is important to remember that every patient is different, and finding the right treatment approach may require a combination of therapies and close collaboration with your Urologist. Many men who have struggled with venous leak ED may be a candidate for a penile implant. Some of my most grateful patients are those who have struggled with venous leak ED since adolescence that are able to restore their confidence. Contact me to schedule a consultation today!
