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Old 09-19-2009, 10:30 AM   #1
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Venous Leak - A result of poor smooth muscle relaxation?

Hi All

Am new to this forum and want to reach out to others out there with venous leaks in the hope of finding a solution to this problem. I am 32, otherwise healthy male (aren't we all?). Doctors have diagnosed me with a mild venous leak after a penile doppler test which I took earlier this week.

Details of report

(Papavarine Bimix, Sustained peak velocities of over 40cm/sec in both caversnosal arteries, Mild diastolic flow seen at 30 mins in both arteries, Mild diastolic venous runoff (venous leakage)

Mild as it might be called, it has caused enough problems to deny me a functional sex life.

What's probably different in my case, unlike most of you, is that I'm gay. I would say that being gay has lent me a more intimate understanding of the male anatomy than what most straight guys will ever have. Having been with guys across races, ages, physical types and habits, I have a sure idea of how a functioning penis should work, including physiologies, degrees of hardness, refractory time etc. My benchmarks and comparisons, thus, are pretty fair and realistic. Sleep, diet, and other peripheral issues (that I was focusing on a few years back) have very little bearing on a man's ability to have an erection and keep it.

For the sake of brevity and simplifying what the problem is, I'll just break down the process of erection, as a precursor to my question.

There are two components to an erection.

- The first, of course, is blood flow in to the penis. Nitric oxide stimulates production of cyclic GMP, a chemical that relaxes the smooth muscles in the penis. This allows blood to flow into the tiny pool-like cavernous sinuses, flooding the penis.

- The second is holding of the blood. Veins surrounding the chambers are squeezed almost completely shut by this pressure.

- The veins are unable to drain blood out of the penis and so the penis becomes rigid and erect.

- Venous leak occurs when the veins in the penis cannot prevent blood from leaving the penis during an erection. If the smooth muscle is not relaxed enough, it cannot pinch the veins, thus draining blood.

So my question is:

From my understanding of the topic, there is no physical 'leak' in the veins. The actual culprit is the penile smooth muscle that has not been able expand enough in order to compress the veins. This results in a leak and loss of erection with the resultant outflow.

Is this the ONLY reason a leak happens or is there any other reason as well? Most websites also say 'vascular problems' can cause Venous leaks - what exactly does that mean? How does one find out if there is a vascular disorder and how does it cause a 'leak'

If there is enough blood reaching the penis, wouldn't that mean that everything up to that point is working fine? Does that not exclude vascular disorder then?

If so, isn't there enough justification to treat the smooth muscle rather than the veins themselves? If there is, perchance, a way to enhance smooth muscle relaxation (besides the use of viagra and other synthetic means), wouldn't that warrant serious investigation?

I have met several urologists and doctors over the years. Not all, but most of them are apathetic to a patient's condition - that's my personal experience. I believe that they are a similar breed, wherever they may be. Yes, they'll perk up at the prospect of surgery and wherever there's something they can gain from. I'd rather do some homework on my own, and stay informed. If I'm erring, at least it's on the side of caution.

Sorry about the long rant....seems like I'm venting more than asking my question. Would greatly appreciate if some enlightened one can shed some more light on this. Any venous leak experts/ones with similar diagnosis? Thanks for reading!

 
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Old 09-20-2009, 09:26 PM   #2
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Re: Venous Leak - A result of poor smooth muscle relaxation?

Hey excalibur,

I'm 22 and have a "venous leak" myself and from all of the research I've done (A LOT), it seems to me that "venous leak" isn't actually a condition as much as it is a blanket term that doctors apply when describing the condition of men who are unable to maintain an erection (Who have good arterial flow).

I've never come across any data (there isn't any), that scientifically links so-called malfunctioning veins to the loss of an erection. The only basis for the diagnosis of venous leak is pretty much that it, 'seems to be the common-sense explanation.'

However, if it were the genuine cause of erection loss in men with healthy arterial flow then procedures like venous ligation would actually work. They don't.

If you are unfamiliar, venous ligation is an 'experimental' (HMOs don't like to pay for it) procedure in which veins in the penis are closed off by a variety of methods, ranging from use of tissue glue, cauterization, and general removal. Neither method or combination of methods seems to yield measurably higher success rates.

It's performed infrequently, but over the years there have been enough studies to draw some conclusions from it, chiefly that long term success rates are at about a dismal 10%, so it seems unlikely that 'leaky veins' could be the cause. More likely it is a distruption or anomaly of metabolic pathways not yet(ever?) understood.

As an aside: I'm not sure about your theory regarding incomplete filling of the cavernosal structures, as I am fully able to get a rock hard 10/10 erection for about 10-12 seconds(Sometimes even 30!) before my inevitable disappointment.

And yes, I had doppler examination and was diagnosed as having "venous leak," by a well-respected urologist specializing in sexual dysfunction.

Last edited by Ethan54; 09-20-2009 at 09:30 PM.

 
Old 09-21-2009, 01:00 AM   #3
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Re: Venous Leak - A result of poor smooth muscle relaxation?

Hi Ethan

Thanks for writing in. I did consult my urologist about venous ligation surgery. He advised me against it citing the dismal success rates. The principal reason why it does not work is that once the offending vein is ligated, in time collateral vein pathways form, which become leak sites. This is what my urologist explained. So even in the best case scenario, it is only a matter of time before the leaks resume.

About your ability to get a rock hard 10/10 erection for about 10-12 seconds (Sometimes even 30!). Could it be that your smooth muscle relaxation is optimal for the 10-30 second range and then drops, leading to the venous leak?

From whatever I have been reading, it just seems that a venous leak is more of a side effect or an outcome of something else that has malfunctioned. Ligation surgery seems to me is a classic case of treating the symptom rather than the cause.

 
Old 09-21-2009, 05:46 PM   #4
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Re: Venous Leak - A result of poor smooth muscle relaxation?

Quote:
Originally Posted by excalibur09 View Post

... Sleep, diet, and other peripheral issues (that I was focusing on a few years back) have very little bearing on a man's ability to have an erection and keep it.
...
Hmm, I am not sure if I agree with this. Especially after a certain age, forty or fifty, these things (plus physical exercise and relative lack of stress) are vital for a man to have and keep his erection. He must above all avoid atherosclerosis, poor blood circulation, and iatrogenicity (too much medicine). How can he ever do so if he has not a healthy lifestyle?

 
Old 09-22-2009, 12:48 AM   #5
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Re: Venous Leak - A result of poor smooth muscle relaxation?

Quote:
Originally Posted by pendulum View Post
Hmm, I am not sure if I agree with this. Especially after a certain age, forty or fifty, these things (plus physical exercise and relative lack of stress) are vital for a man to have and keep his erection. He must above all avoid atherosclerosis, poor blood circulation, and iatrogenicity (too much medicine). How can he ever do so if he has not a healthy lifestyle?
I think he was referring to things that he'd tried himself and decided couldn't be responsible. And I agree. Even with an unimaginably bad diet and regular binge drinking/smoking no one should encounter acute ED in their early 30s.

 
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Old 09-22-2009, 12:52 AM   #6
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Re: Venous Leak - A result of poor smooth muscle relaxation?

I couldn't agree more that it's just a treatment of symptoms, and a poor one at that.

I'm amazed at how little is known. Is there absolutely anybody studying this? I thought ED was big business...

 
Old 09-22-2009, 06:37 AM   #7
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Re: Venous Leak - A result of poor smooth muscle relaxation?

Quote:
Originally Posted by Ethan54 View Post
I think he was referring to things that he'd tried himself and decided couldn't be responsible. And I agree. Even with an unimaginably bad diet and regular binge drinking/smoking no one should encounter acute ED in their early 30s.
I am confused . You mean to say you agree with Excalibur, not with me?

Ok.

Yet, we often hear on these Boards from young males with ED. That's why I think modern eating habits, lifestyle and stress are major causes for ED and infertility as well. In the long run, it doesn't much matter how old or young you are. In the past, when people ate in a healthier way and lived a less stressful life, such cases were probably more infrequent.

 
Old 09-22-2009, 03:16 PM   #8
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Re: Venous Leak - A result of poor smooth muscle relaxation?

Quote:
Originally Posted by pendulum View Post
I am confused . You mean to say you agree with Excalibur, not with me?

Ok.

Yet, we often hear on these Boards from young males with ED. That's why I think modern eating habits, lifestyle and stress are major causes for ED and infertility as well. In the long run, it doesn't much matter how old or young you are. In the past, when people ate in a healthier way and lived a less stressful life, such cases were probably more infrequent.
I think that that's really only speculation fueled by our modern perceptions of , "The good ol' days," there isn't any statistical or anecdotal evidence to prove whether or not ED was more or less prevalent in the past.

 
Old 09-23-2009, 01:50 AM   #9
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Re: Venous Leak - A result of poor smooth muscle relaxation?

Quote:
Originally Posted by Ethan54 View Post
I think that that's really only speculation fueled by our modern perceptions of , "The good ol' days," there isn't any statistical or anecdotal evidence to prove whether or not ED was more or less prevalent in the past.
Yes, you could be right: "the good old days" is much of a myth. Yet, there remains a couple of things we keep trying to bring back from the past: food was purer and there was less stress, or if anything it was of a different kind.

 
Old 09-23-2009, 07:01 PM   #10
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Re: Venous Leak - A result of poor smooth muscle relaxation?

Quote:
Originally Posted by pendulum View Post
Yes, you could be right: "the good old days" is much of a myth. Yet, there remains a couple of things we keep trying to bring back from the past: food was purer and there was less stress, or if anything it was of a different kind.
You are definitely right about the food. My guesses as to the cause of my ED are pretty much 1.Genetic 2.Chemicals from food/water etc. There are just so many unnatural additives and compounds in food now that even if you are aware of them you still can't avoid them because they are in EVERYTHING.

Even organic food is unsafe because despite what a lot of people think they are not actually pesticide free, they are just free of MANUFACTURED pesticides. They could even be worse because the "natural" pesticides are so weak compared to their engineered equivalents that they have to use 10X as much!

Last edited by Ethan54; 09-23-2009 at 07:03 PM.

 
Old 09-24-2009, 10:04 AM   #11
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Re: Venous Leak - A result of poor smooth muscle relaxation?

Hi

That organic food was unsafe is really news to me. I guess I have to educate myself better in terms of organic foods. All I know is that they are always more expensive, lol.

Ethan, may I ask you how old you are? You seem to be a well-informed and sensible person.

I am not sure to what extent ED is genetic. I know that in my case I have become (slightly) more potent with my increasing age, if you see what I mean, although my refractory time is now longer, of course. This is because I have now a much healthier lifestyle than before when I was younger. I smoked and didn't know anything about nutrition.

 
Old 09-25-2009, 12:05 AM   #12
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Re: Venous Leak - A result of poor smooth muscle relaxation?

Hi Ethan/Pendulum

Believe me, I've been with guys who could not manage 2 square meals a day, ate the worst food possible, but had no problems in the sack. I've also been with men in their 60s as well and a majority of them (80-90%) do not have problems getting or maintaining an erection, all without chemicals. I have pretty much seen the whole spectrum and in the light of my experience, I do not consider diet/nutrition to be a very important factor - it is a factor, no doubt, but not a crucial one.

A penis, in most circumstances, behaves like any other part of your body like your hand or leg. Only seriously debilitating factors would affect it.

I find young men suffering from ED going on ridiculous diets, drinking L-Arginine, eating ridiculous amounts of zinc, fish oil and exotic herbs from all over the world....Hell, I've done that myself - but to no avail. I believe these things can help somewhat only when your ED is psychogenic and that too not severely psychogenic (that would necessitate medication).

It is an old school outlook on ED puts premium on nutrition and lifestyle. These are no doubt important factors, as I said before, but no amount of 'perfecting' these will over-ride organic problems that most people with serious ED have.

 
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