611d7059736cb065a0568a3f_water pipe leaking

Venous Leakage: Why Won’t My Penis Stay Hard?

Dr. Joe Pazona

Nothing is more frustrating to a man than when a perfectly good erection decides to go away for seemingly no good reason. Why did this happen? You were into “it”. Your partner was looking particularly sexy. But your best bud below the belt decided to let you down. Literally.

If this has happened to you, then you probably have venous leakage. The blood flowed into the penis OK, but it also “leaked” back out before you were ready.

You might be asking yourself several questions:

  • What is venous leakage?
  • Is venous leakage curable?
  • How do you know if you have a venous leak?
  • Does Viagra work for venous leakage?


Don’t worry. At VirtuCare we got you covered. Let’s learn everything there is to know about venous leakage and talk about ways to help you get the care you deserve.

Because bros don’t let bros down. Never.

What is venous leakage?

To best understand venous leakage, it helps to first review the normal physiology and anatomy of an erection.

When your primary sex organ gets stimulated (your brain, silly goose), a signal is sent to your other sex organ (now we’re talking about your penis) to fill with blood.

The erectile chambers of the penis are called the corpora. The two main chambers are the corpora cavernosa running side-by-side on the top and sides of your penis. You also have the corpora spongiosum running on the underside with the urethra. This part connects to the glans or head of the penis.


penis diagram anatomy

The cavernosal arteries send fresh blood into the corpora cavernosa which then engorge until they compress against the tunica albuginea. The “tunica” is a hard capsule that allows for a “boner” (although there really isn’t a bone in there).

When the corpora are fully engorged, they force the deep veins of the penis to close shut, preventing blood flow from leaking out of the penis. If the corpora don’t expand/engorge fully, then these veins stay open causing venous leakage.

In other words, venous leakage is allowing blood to “leak” out of the penis faster than the blood is flowing into the penis. Thus leading to erectile dysfunction, shame and embarrassment.

What causes venous leakage?

Venous leakage is caused by a variety of factors. Let’s go through each of them briefly:

Psychologic venous leakage

Remember that your primary sex organ (again it’s your brain) is also your primary sex deterrent. If you are tired, stressed, or anxious, then your stress hormones become activated. Epinephrine (adrenaline) prevents relaxation of the spongy corporal tissues which subsequently keeps the veins of the penis open.

Open veins equals venous leakage which equals erectile dysfunction.

Don’t worry if this has happened to you. You’re not alone. Almost every man can report a time where he “lost an erection” in the middle of sex because something else was going on in between his ears.

Peyronie’s disease and venous leakage

If your penis has a new angle to the dangle, along with softer erections, then you may have something more than venous leakage. Peyronie’s disease is the development of scar tissue on the tunica of the erectile chambers. The scar tissue doesn’t allow the erectile chamber to fully stretch in this area.

As a result, the penis will now curve when erect. Another consequence of Peyronie’s disease is venous leakage. This scar tissue doesn’t allow for the closure of the deep penile veins. Thus leading to softer erections.


About 50% of men will report a traumatic sexual episode where they heard a “pop” during intercourse (usually partner on top or doggy-style). A plaque of scar tissue then develops several months later.

Other causes of venous leakage

Diabetes, previous prostate cancer treatment (surgery or radiation), and low testosterone levels have all been associated with venous leakage as well. The exact mechanism is poorly understood but the common factor is a loss of elasticity of the spongy erectile chambers (corpora) and firm capsule of the penis (tunica).

Venous leakage is a less common cause of ED compared to its counterpart: poor arterial blood flow. If venous leak is an outflow problem, then arteriogenic ED is an inflow problem. The pipes are clogged and blood can’t get into the penis.

The most common causes of arteriogenic ED are the same diseases that cause atherosclerosis or hardening of the arteries:

  • Smoking
  • Age
  • Diabetes
  • Hypertension
  • High cholesterol
  • Obesity


Since atherosclerosis is so common as we age, most men with venous leakage also have some degree of an arteriogenic cause of ED. More importantly, atherosclerosis is the most common cause of heart attacks and strokes. So if your buddy ain’t performing, make certain you have an evaluation with your primary care doctor to check out your heart and blood vessels.

How do you know if you have a venous leak?

Men with venous leakage will often complain of the following symptoms:

  • The ability to achieve an erection but difficulty maintaining an erection.
  • Chronic, “soft” erections.
  • Difficulty with penetration due to lack of rigidity.


Venous leakage also tends to present at an earlier age than arteriogenic ED in men with no obvious risk factors for atherosclerosis.

To differentiate between artery (inflow) and venous (outflow) causes of erectile dysfunction, a urologist may perform the following tests:

  • Doppler ultrasound: take pictures and measure the blood flow after injecting the penis with a medication (ouch).
  • Dynamic infusion cavernosometry/cavernosography: measure pressures and take pictures of the erectile chambers to test for venous leakage.


Testing to diagnose venous leakage is rarely performed for several reasons:

  • The tests require tools and expertise that most urologists don’t possess.
  • Most men are not excited to have needles put in their junk to tell them what they already know . . . their penis isn’t working right.
  • Regardless of the cause of ED, the treatment recommendations are the same.
  • Surgery to specifically fix venous leakage lacks long-term data and is rarely performed.

Does Viagra work for venous leakage?

Sure, it’s very possible that Viagra might work. The treatments for venous leakage remain the same as other causes of ED. In this case, it depends on the severity of the leakage. The only way to know for certain is to give the little blue pill a try.

Treatment of ED typically progresses in a stepwise fashion.

Oral medications (e.g. Viagra) for venous leakage

Viagra or sildenafil is one of the oral phosphodiesterase inhibitor medications (PDE5 inhibitors). These medications prevent the breakdown of nitrous oxide, the compound which tells the arteries of the penis to open up and send in the blood.

These medications, which also include Cialis/tadalafil, are typically the first-line therapy for venous leakage. If we can get more blood going in the penis, then the erectile chambers can force the veins closed.

When pills don’t do the trick for venous leakage, then you may need to consider . . .

Vacuum erection devices for venous leakage

Also known as the “penis pump” (not to be confused with although quite similar looking to the Swedish Made Penis Enlarger from Austin Powers), a vacuum erection device is a mechanical solution to venous leakage.

After placing your friend in the plastic cylinder, a vacuum draws all the air out of the cylinder, forcing blood into your penis. A ring is then stretched over the base of the penis. This keeps blood from leaving the leaky veins of the penis.

A vacuum erection device may not sound like fun, but plenty of men use these devices successfully. If you’re interested in learning more, then here’s an affordable vacuum erection device to consider.

Penile injections for venous leakage

I realize that whenever I use the word “injection” in the same sentence as “penis”, that I’m going to lose a percentage of the audience. But, men will do almost anything to get busy in the bedroom. Including penile injections for venous leakage.

In all honesty, the injections are not as bad as they sound. A small needle is used to inject vasodilator medications (fancy doctor term for opening blood vessels) into the shaft of the penis. Men are surprised to find out that the injections themselves usually don’t hurt.

It’s important to only perform injections under the direction of a board-certified urologist. Many “Men’s Health” clinics charge several hundred dollars for penile injections and use much TOO HIGH dosages. This leads to painful, 4-hour erections and trips to the ER.

When done correctly, penile injections for venous leakage can be safe and effective.

Surgery for venous leakage

If there’ s “leaky vein”, then why not just close it shut with surgery (venous ligation)? This makes sense however, surgery for venous leakage has not been widely adopted. The results from venous ligation surgery are not long-lasting because most men have an inflow issue as well.

If you need surgery for ED, then a penile prosthesis is the best way to go. Only used for men with no other options, this involves placing cylinders inside the erectile chambers with surgery. Most prostheses then have a pump inserted in the scrotum. When you’re ready to get busy, you squeeze the pump, forcing fluid into the cylinders, giving you an erection for as long as you would like. When you’re done, click the release valve, and squeeze all of the fluid back into it’s reservoir. Now it’s snuggle time and Netflix.

A penile prosthesis placement should ideally be performed by a high-volume urologist with expertise in this surgery. When done by the right surgeon, complication rates are relatively low.

I think I have venous leakage. What next?

Maybe it’s time to receive some 1-on-1 guidance from a board-certified urologist. Why not start with a VirtuCare telemedicine consultation. Our experts can take a detailed history to see what the next best step is for you.

If you need referral to an in-person urologist, then we can help guide you to a colleague with expertise in treating venous leakage. We have an extensive network and want you to get the best care possible.
Stop struggling with venous leakage and get help today. Click here and someone will reach out to you within 24 hours to schedule a virtual visit from home for only $89.


Dr. Joe Pazona

Dr. Joseph Pazona is the founder and President of VirtuCare, a telemedicine solution for connecting patients with physician experts.

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