Venous Leak

Venous leak is a cause of erectile dysfunction because the veins in your penis can’t hold enough blood.

To understand venous (pronounced “VEE-nuhs”) leak, it helps to understand how your body supplies blood to your penis when you have an erection. To get a hard (rigid) erection, blood must be able to fill the erection tubes of your penis and remain there. Arteries carry oxygen-rich blood to your penis, and veins take blood from your penis back to your heart.

When you get an erection, your arteries expand and blood fills two tube-like erectile tissues (corpora cavernosa) that run the length of the top of your penis. As the tissues swell, your penis becomes hard and extends away from your body. The swelling also compresses your veins, trapping or storing the blood in your penis so you can maintain an erection.

But if you have a venous leak, the blood can’t remain in the erection tubes. It “leaks” out of your penis and back toward your heart. This prevents you from maintaining an erection that’s hard enough to have sexual intercourse.

Experts aren’t sure exactly how many people have erectile dysfunction due to venous leak. But it’s common in males with certain medical conditions, including diabetes and high blood pressure. 

Healthcare providers may use other terms or phrases to describe venous leak. These include:

• Venogenic erectile dysfunction
• Veno-occlusive insufficiency
• Corporal veno-occlusive dysfunction
• Penile venous insufficiency
• Poor storage
• Venous leakage

Types

Types of venous leak include:

• Organic venous leak: This type results from conditions that affect blood storage in your erectile tissue during sexual stimulation. Such conditions typically affect your circulatory system or nervous system. Examples include high blood pressure, diabetes, smoking or an injury.
• Psychogenic venous leak: This type involves conditions that affect your thoughts, feelings or behaviors (psychogenic conditions). Examples include stress and anxiety (“performance anxiety”).

What are the symptoms of venous leak?

Common signs of venous leak include:

• Difficulty or inability to get an erection hard enough for sexual activity, including sexual intercourse and masturbation
• Difficulty or inability to maintain an erection without constant manual stimulation
• Only being able to maintain an erection during certain sexual positions
• The tip of your penis (glans) being soft when you have an erection
• Difficulty or inability to get sudden (spontaneous) erections, including while you’re sleeping (“morning wood” or spontaneous penile tumescence)
• Resistance to erectile dysfunction medications

What does it feel like?

Venous leak doesn’t cause physical pain. But it can be embarrassing or frustrating if you can’t get or maintain an erection. Venous leak doesn’t occur because you did something wrong — it just happens sometimes due to underlying medical conditions.

If you have this condition, it’s a good idea to be open with your sexual partner(s). You can also explore other ways to be intimate or physically express your feelings for each other.

Why does it happen?

Venous leak causes may include:

• High blood pressure
• Tumors around your pelvis or perineum that affect how blood flows in your arteries or veins (blood vessels)
• Injuries to a nerve that helps regulate an erection (cavernous nerve), which sometimes happen after radiation therapy or surgery to treat prostate cancer
• Peyronie’s disease
• Low testosterone
• Enlarged prostate (benign prostatic hyperplasia)
• Diabetes
• Stress, anxiety and depression
• Certain prescription medications
• Addictive substances, including nicotine, alcohol and opioids

Complications

Erectile dysfunction can cause:

• Low self-esteem
• Low self-confidence
• Decrease in sexual behavior or activity
• Relationship problems
• Infertility

How do I know if I have a venous leak?

Your healthcare provider can diagnose venous leak and determine its cause. They’ll review your medical history, ask you about symptoms and perform a physical exam. To help confirm a venous leak that’s responsible for erectile dysfunction, your provider may recommend tests, including:

• Blood tests: Your provider takes a small blood sample to measure your hormone levels and lipids.
• Psychological exam: Your provider may ask a series of questions to help diagnose depression or anxiety.
• Vasoactive injection and penile Doppler ultrasound: Your provider injects a drug that makes your penis temporarily erect. Then, they use a noninvasive imaging test to see how blood flows in and out of your penis.
• Cavernosography: Your provider uses a small needle to inject a dye into your corpora cavernosa and trace it with an X-ray.
• Cavernosometry: Your provider measures the pressure in your corpora cavernosa.

How do you fix a venous leak?

Venous leak treatments may include:

• Phosphodiesterase type 5 inhibitors (PDE-5): These are oral medications that help increase blood flow to your penis. Common PDE-5 inhibitors include sildenafil, tadalafil, vardenafil and avanafil. Depending on the medication, you may take them daily or one to two hours before sexual activity.
• Penile injections: These are medications that you inject directly into the base of your penis immediately before sexual activity. They help open up your blood vessels to increase blood flow and improve storage. Common treatments include FDA-approved medications, like alprostadil, or “off-label” compounded combinations of medications, like papaverine and phentolamine. Injections may start to work within 10 minutes.
• Vacuum erection device (penis pump) with a constriction band or ring: This is a medical device that goes over your penis and creates a vacuum effect. It draws blood into your penis, which leads to an erection. Once your penis is hard, you place a band around the base of your penis to maintain your erection. A penis pump works almost immediately. It can sometimes maintain an erection for 15 to 20 minutes.
• Penile implant: A urologist places small, inflatable cylinders into the erection tubes of your penis. This allows you to get a typical-feeling erection whenever you wish for as long as you want. You won’t need pills, needles or other external devices. You should avoid sexual activity for at least six weeks after receiving the implant to allow for healing.

Can low-intensity shock wave therapy treat venous leak?

The U.S. Food and Drug Administration (FDA) hasn’t approved low-intensity shock wave therapy (LiSWT) to treat venous leak. But initial studies show that shock wave therapy may help treat mild venous leak.

LiSWT is a noninvasive treatment that sends shock waves to your corpora cavernosa. This stimulates blood flow and creates new blood vessels. You may need several sessions before you see improvement.

What is the best treatment for venous leak?

It depends. There are many different treatments. Depending on the severity of the leak, certain treatments may work for some people, but not others. Before you start treatment, your healthcare provider will ask about your goals, review each treatment option with you and make a recommendation based on:

• Your specific condition
• Your preferences and your partner’s preferences
• Your overall health

When should I see a healthcare provider?

Talk to your healthcare provider if you’re having problems getting or maintaining an erection. This can be the first sign of a serious medical condition. They can help determine if venous leak is the cause of erectile dysfunction and recommend the best treatment.

During your appointment, you may want to ask:

• How will you determine that I have a venous leak?
• What’s causing my venous leak?
• If I don’t have a venous leak, what’s causing my erectile dysfunction?
• What treatment do you recommend?
• Should I see a sex therapist?
• Should I see a urologist?

If your provider prescribes medication to treat erectile dysfunction with venous leak and you experience a painful erection that lasts more than a few hours, go to the nearest emergency room. This may be a sign of priapism. Priapism can permanently damage your penis without prompt treatment.

Is venous leak permanent?

For many males with erectile dysfunction, it can be a permanent condition. But there are many venous leak treatment options that can help you get and maintain an erection hard enough for sexual intercourse.

Can venous leak be prevented?

You can help support erectile function by making certain lifestyle changes, including:

• Getting regular physical activity, including walking or jogging
• Maintaining a weight that’s healthy for you
• Quitting smoking
• Cutting back on or stopping drinking
• Lowering your cholesterol
• Maintaining normal blood pressure and treating any underlying medical conditions that may affect blood flow to your penis