Do I have venous leak when PDE5i work?

[Pierre]

I would like to ask about your views concerning venous leak.

About half a year ago, I noticed I could get hard, but lost the erection within seconds when I stopped manually stimulating. When I use PDE5i, however, I have no problem maintaining my erection.

I have done some exercising which improved my ability to maintain erections even when not using PDE5i. I also get NTE and morning wood, however they are only at about 80-90% and the latter fades after 2-3mins (practically when I move to the toilet). When I masturbate I can hold an erection without touching and using NO PDE5i for about 30 seconds.

Last week, however, I was making out with my girlfriend (myself with no pants ) on the couch and I had a strong erection for about 7-8 minutes...without touching (before we moved to the bedroom).

Note that for 2 weeks now I am on low-dose Tadalafil (5mg) which I take before bedtime.

My question is kind of the following: Given the above evidence is it less likely that I suffer from venous leak? Some tell me being able to maintain erections very easily with PDE5 almost rules out VL.

However, could it not be the case that higher blood inflow due to PDE5i compensates for the relatively high outflow due to VL? Are PDE5i effective for VL?  

 

[Hawk]

Higher blood inflow compensates for venous outflow in healthy males with no venous leak.  

Your words:
I can get an erection without PDE5 inhibitors.
exercising improved my ability to maintain erections even when not using PDE5i
I get NTE and morning wood

Venous leak does not come and go.  If the inflow outruns the outflow to produce an erection and you lose it because of no stimulation, that means the lack of stimulation reduces the level of inflow.  It does not cause your veins to start leaking.

Does this mean you cannot have some slight venous leak? Probably not. That could be possible, but how puzzling over that mystery help you in any way?  What would you do differently?  How would you react to find out:

1. you have insufficient inflow
or
2. You have slightly increased outflow.

It becomes a distinction without a difference.?

[porterrobinson]

so venes do not trap 100% of the blood, they let some of it flow out of the penis back into the body. if the arousal changes and thus the arterial inflow is lower than the outflow you lose the erection despite having no venous leak? and isnt venous leak degined as a diastolic velosity of greater than 5?

does this also mean venous leak is really not just someone who get get an erecrion but not keep it but instead someone who has a hard time getting it in the first place because of the increased outflow? doesnt this depend on the cause of the leak? like some men have leakage due to a less elastic fibrotic tunica albuginea that cant suppress the venes on the side, others have actual morphological changes to their smooth muscle content, fibrosis in the actual erectile tissue of the corpus Cavernosum and thats the reason for their leak

i have these questions myself as i have the same problem as OP

[Hawk]

If you have a venous leak you can not get a rock-hard erection for any period of time.  How could you?  

[Pierre]

Hawk, Thanks a lot.

So you are saying there is a possibility I am losing my erection quickly simply because arousal isn't high enough - i.e., it does not have to be necessarily venous leak? This would be consistent with my low arousal level as compared to the times when maintaining wasn't a problem really.

In other words, I could amerliorate the situation by getting inflow levels back to normal, which may have been well higher. This could help me maintain my erections despite a possible higher outflow?

 

porterrobinson, can you maintain erections with PDE5i?  

[Hawk]

If it were me, the first experiment I would conduct is to stop masturbation for at the very least 1 month to see if my intensity of desire/erections increased.

I would also have a thorough physical because Erectile Dysfunction can be a sign of diabetes, Parkinson's, heart disease, and more.  Don't just assume anything at 30 years old.  

You can also experiment with a cockring which should work great IF you can gain an erection to start the process.  There are many types, including adjustable loops and metal horseshoe-shaped adjustable ones.  Both of those work well.

[Pierre]

Thanks again, Hawk.

I stopped masturbating 3 months ago. Strangely, I do not develop the urge I used to. Previously, when I haven't masturbated for a week or so, I would get super horny. That isn't the case. I am much less horny. T levels are in the mid range, but I suffered from a burnout.

Also strangely, once intercourse starts, I can maintain erections much easier, e.g. when switching positions. The problem is the beginning of the act.

[Hawk]

Please do not misread the tone of what I am about to say.  I am not scolding you or being disrespectful.

If your libido is gone then there should be little confusion as to why your erections are not optimal.  I am puzzled why you would even suspect venous leak when a far more obvious cause is in plain view.  

Did you have free and total testosterone checked? I suppose you could just have a low sex drive but I would have a full hormone work-up preferably with an endocrinologist.

[Pierre]

Hawk, thanks a lot. Certainly not misreading what you're saying.

Yes, I had blood work done: Free Testosterone and Testosterone in the 90th percentile of the range, so quite high. Prolactin and Cortisol high, but still within the range.

I am wondering what this means:

• My subjective feeling of libido is low - as I said, I don't really feel the urge even when stopping masturbating for a week or two (I haven't masturbated for 2 months now, only having sex with my partner). How can this be when T levels are rather high?
• Is it still possible to have psychogenic Erectile Dysfunction if Prolactine and Cortisole are within the normal range?

Doesn't all of this suggest that there is a physical problem leading to Erectile Dysfunction, e.g. venous leak?

The doctor doesn't think that I have a leak, but he did suggest that he could inject Caverject and check inflow and outflow.

One other question:

• If PDE5 inhibitors allow me to maintain an erection, is it likely that Caverject will, too?

[Hawk]

The venous leak has zero connection to libido.  But it is obvious that low libido affects erection.  The world's MOST PERFECT penis will not increase libido.

I don't think this can be puzzled over to come up with a speculated diagnosis on a forum.  I think you need to rule out issues with a good endocrinologist.  

[Pierre]

Hawk, I see this point and will go to an endocrinologist.

But what's on view with my uro's suggestion to make a Doppler with caverject? Can it create an erection with no libido (or no arousal, which I won't have in his practice)?

Is the doppler using injections a definite test on venous leak?

[Hawk]

Since all preliminary evidence points away from venous leak, I would search for other causes first.  If all comes back well, then I guess I would do a test for venous leak, understanding that it will only be effective IF you are injected with one or a combination of injectable erection drugs.  

Is a test for venous leak reliable?  I think they are, but who is to say?  Tests for plaque probably only have a 70% reliability, but I have not known men to have 5 tests for venous leak with different results.