PIED or venous leak?

Hello,

I am a 23 year old, healthy and fit male. I've been experiencing ED since the beginning of this year. I'm able to get an erection, but it rapidly goes down with no stimulation. Had a doppler ultrasound done at a local clinic and these were the findings:

Appropriate physiologic erectile response Trimex. Cavernosal arterial diameters normal. Expected Trimix induced decrease in flow resistance followed by expected increase in flow resistance. Cavernosal artery peak systolic velocities within normal limits with the exception of borderline transient decrease on left at 15 minutes which may have been technical variation.

According to this report, there are no indications of any penile abnormality (i.e. venous leak). But to this day, I'm still unable to maintain an erection. Concerning morning wood, I never wake up with a full erection. When I wake up, it's typically in a state similar to that after you lost an erection (it's filled with some blood, but not rock hard). I've seen multiple urologists about this issue, and they have all told me that this report indicates "good" news for me, and that my issue is psychogenic. I was given the Cialis treatment, but that has shown minimal improvement in my EQ.

Is it possible that my symptoms are due to PIED or extreme anxiety? With porn, there is also need for constant stimulation to maintain my erection.

I'm at a point now where I think the doppler results are incorrect and I do have a physical problem. Any words of advice on this issue? I'm going to try going masturbation-free for a solid month or 2 to see if that helps anything.

Thank you.

Did you try a Hard 90 yet? do you have a libido?

I also don't get morning wood.

Try not to fall into the trap of venous leak worry. I did too for a while and it fucked me up.

Thanks for the response man. I'm really convinced I have a leak though. When I get erect, I can see my penis losing blood right when stimulation is stopped. Lose solid hardon within 5-10 seconds. Did all day researching the validity of Doppler ultrasound results, and that honestly made me more worried.

Sorry, didn't see your questions. I'm not sure what hard 90 is. My libido is maybe good once a week when I get really horny after no masturbation.

If they say you're okay, you should be fine. I would try a hard mode 90 abstaining from PMO and then get back to us. Do you get penis shrinkage?

Thank you for the encouragement. It really means a lot to me. Recently got put on a new depression med and it's making me as emotional as a girl PMS'ing, haha. Combined with this fear of VL, it's really killing my mood for the day.

I've tried those no PMO things, but I always end up giving in and masturbating with porn. I'm telling myself now, though, that this "reboot" is really my only hope at this point.

Side note: my doctor wants me to cycle through a daily dose of cialis for a month, thinking that will clear my ED. He's just my GP (not a uro). Do you think this is advisable at this time?

Yes I've been there.

I wouldn't reboot until I know i don't have VL. Why torture myself If i got an incurable disease, right?

I had doppler ultrasound which returned normal too. Still it did not calm me down entirely and I had to find reassurances everywhere that my problem is not physical.
I think those test are pretty accurate when detecting that you DON"T have VL. It's results could strongly indicate VL and only then Cavernosography should be conducted to determine if leak exist and if it does to find it's location.

For months I was worried that my erections won't last longer than 30 seconds(had like 5 seconds when I was still watching porn and it required constant strong stroking) without touch (I even counted seconds, not a good idea, got me really paranoid), but when I finally had one or two erections lasting longer(months later) I realized I could maintain them longer, but still I would get paranoid (and still am, psychoterapy is needed in my case) sometimes and my doubts would return again, on and on and on - vicious circle. So now it seems sometimes I can, sometimes I can't, really depends on my mood, state of mind and how turned on I am. And if I think about my dick staying hard then I ALWAYS loose it fast, took me 7 months to get longer lasting erection, and when it did it felt great.

Your case is actually suggestive of strong anxiety and possible PIED.

Also VL is extremely rare and it seems to happen only after some kind trauma to the Penis or congenital. The problem is that news about VL spread around the internet few years ago and started some kind of a phobia. Everybody seem to think they have VL when most likely they don't.
And in your case you actually HAD tests ruling it out. Most of those guys never had any. I think you should stop worrying about it.

Keep on with your reboot, and don't give up on it, there is nothing to loose really

Thanks for the response, ojacek. I had my Doppler results read by 2 uro's, and they both said everything looked good. The uro I trust the most said my end-diastolic velocity was 0, indicating that blood was not leaving my penis when I have an erection. She also said she was "110% sure" things would go back to normal for me. I just find this hard to believe since the symptoms seem to completely mimic those of a leak, and it's been going on for a long time.

Yes, symptoms mimic those of venous leak got me crazy too. You don't have it. To my knowledge EDV <5cm/sec is good so I wouldn't worry about VL. Have you had some blood work done etc (captain obvious )?

I think you definitely need to give reboot a shot. I rarely have morning wood too and I used to not have them at all until recently. I don't remember what was happening while watching porn or shortly after quitting, but I definitely remember some time later I was regularly waking up in the middle of the night with erection, and if did not I would get paranoid. I guess I was sleeping past through them. And even to this day I sometimes wake up in the morning with this as you called it "state similar to after erection".

I am at the beginning of nofap now. Think that is what I need to reboot properly.
But for me I am not sure if I still have PIED or really strong anxiety caused by worrying about VL. What I know is - with time  my erections are sometimes good, and interestingly enough they also correlate with my good state of mind. When i tried to "test" myself it would always produce bad results and I was even more upset and worried.
I know it's hard. Maybe go to psychiatrist and be open about everything (porn, VL worries etc.). They might help you finding the root of your problems - if not with erections than with your mental state. I am starting therapy next month. Also don't expect that you erections will heal overnight, they won't. It needs time and proper mindset.

Get a night stamp or something after few weeks of quitting porn and see if it breaks .

I am really with you on this one. I was in very similar situation, and I know how you feel. I guess we are both prone to self diagnosis and internet is filled with misleading information. I would trust doctors more then myself in terms of diagnosis. After all those are people that spent years studying, learning, gaining experience etc.

ojacek, I held a semi-erection around someone for a while. Is this a good sign that things work and this is most likely PIED and not a VL? It was constant visual stimulation being around an individual, but it was a semi-erection so idk. Not intimate at all. No physical contact to the penis was involved at all.

Otherwise, my penis is normally shrunk and I have no libido.

scorpion1386 said:

ojacek, I held a semi-erection around someone for a while. Is this a good sign that things work and this is most likely PIED and not a VL? It was constant visual stimulation being around an individual, but it was a semi-erection so idk. Not intimate at all. No physical contact to the penis was involved at all.

Otherwise, my penis is normally shrunk and I have no libido.

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Never had this but I've heard it is called a flatline and it has nothing to do with organic problems. If you worry go to urologist and check yourself up for peace of mind.

EDIT. I think those talks about VL aren't a good motivator for people trying to reboot. They can be really daunting and scary and might lead to some hysteria.

get into a serious flatine then see how it goes. complete lack of visual stimuli for 21 days and check your progress. youll see some results, post back when you have!
FAPPY

I actually didn't get into my flatline normally. It happened after a prone masturbation and then the flatline occured like 2-3 days after that prone masturbation session. A urologist and my primary care physician say I'm okay physically.

How do people get into flatlines this way? I haven't seen anything about this. I feel alone. Help?

Woke up in the middle of the night with a 40-50% boner. Not full, but I guess it's better than nothing. The thing that has me nervous about my Doppler is the "borderline transient variation" in the dictation. I know it says it could be a technical variation, but that still has me nervous considering my symptoms are stilll going on. After my Doppler, I held an 80% erection for 2 hours. It started to become a little painful, so I called the doc and was instructed to put ice on it. That experience makes it seem like my veins were closing adequately, but who knows.

One question I have about the medication used for the Doppler.. If Trimix is a treatment method for guys diagnosed with ED, why is it used to check for ED? Would a guy with venous leak have a good response to Trimix since it's a treatment method?

goldpeak93 said:

Woke up in the middle of the night with a 40-50% boner. Not full, but I guess it's better than nothing. The thing that has me nervous about my Doppler is the "borderline transient variation" in the dictation. I know it says it could be a technical variation, but that still has me nervous considering my symptoms are stilll going on. After my Doppler, I held an 80% erection for 2 hours. It started to become a little painful, so I called the doc and was instructed to put ice on it. That experience makes it seem like my veins were closing adequately, but who knows.

One question I have about the medication used for the Doppler.. If Trimix is a treatment method for guys diagnosed with ED, why is it used to check for ED? Would a guy with venous leak have a good response to Trimix since it's a treatment method?

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What does that mean? Huh?

You're lucky you get boners, at least. I never get spontaneous ones anymore. I don't have a libido either. I hope this is indication of a PIED condition. Anyone know for certain?

Sounds like my blood flow fell to a borderline level for a short period of time. My erection seemed to get a little harder every couple minutes though, so I'm hoping it was just a fluctuation with the machine.

You should call your urologist and ask her about it.

If I am not mistaken Borderline transient variation means that PSV is between 25 and 30 cm/sec and if below that it is clear that there is arterial insufficiency (not mistaken with VL, it means that blood is not moving fast enough to induce erection not that it is escaping the penis).

I had similar reading at some point for this. I called my uro about it and he told my that it is not indicative of arterial insufficiency because PSV is changing during erection and it can even get close to 0 at some point. I had also reading that it went close to 61cm/sec at some point. And that is, it seems fluctuations of the reading.

Again it is not venous leak, you would have EDV above 5 cm/s and bad RI(resistive index) ratio not PSV. Also you can have excellent inflow but pretty bad outflow(VL) which is not diagnosed in your case. Cavernosography is performed usually if Doppler has shown signs of VL or some other arterial/vascular anomalies, and it is a definitive exam to confirm or discard doppler's diagnosis and find leaky veins.

Trimix is used for guys with VL and it helps them that's for sure but often even that is not helping. Sometimes they are using constriction bands along with it in more severe cases or even opt for implant. My erection after injection was painful too and also lasted for about 2 hours.
It is used for doppler because it is necessary to check blood flow during erection. And yes in bad or even moderate cases of VL it won't cause an erection or it will deflate pretty quickly because outflow is so bad, which would itself promote the idea of VL significantly even without proper readings.

BTW. When I was feeling really bad I can remember I had not nocturnal erections or had been waking up with 30% erection. Imagine how much it helped when I was experiencing this ... I was leak OMG. I have a leak...

I know you are in pretty bad state of mind, if you are feeling really anxious right now appoint another test and get over it. It is your mental health we are talking about! Insist on it or get this exam done in another clinic.

I'm going to call the uro tomorrow and request the actual numbers I got on the test. I'm not sure the numerical results will make me feel much better though. My doc only injected about 1/4 of the Trimex medication, and he would administer more if he thought it necessary. While the achieved erection with that small dose of medicine didn't produce a rock-hard boner, it was apparently sufficient enough for the testing procedure. Therefore, I would guess that my PSV wouldn't be as high as it could be with a larger does of medication. I'm no doc so I could easily be wrong, but that's just my guess.

Yes call her, and stop guessing anything until tomorrow it won't help. Crossing my fingers.

ojacek said:

Yes, symptoms mimic those of venous leak got me crazy too. You don't have it. To my knowledge EDV <5cm/sec is good so I wouldn't worry about VL. Have you had some blood work done etc (captain obvious )?

I think you definitely need to give reboot a shot. I rarely have morning wood too and I used to not have them at all until recently. I don't remember what was happening while watching porn or shortly after quitting, but I definitely remember some time later I was regularly waking up in the middle of the night with erection, and if did not I would get paranoid. I guess I was sleeping past through them. And even to this day I sometimes wake up in the morning with this as you called it "state similar to after erection".

I am at the beginning of nofap now. Think that is what I need to reboot properly.
But for me I am not sure if I still have PIED or really strong anxiety caused by worrying about VL. What I know is - with time  my erections are sometimes good, and interestingly enough they also correlate with my good state of mind. When i tried to "test" myself it would always produce bad results and I was even more upset and worried.
I know it's hard. Maybe go to psychiatrist and be open about everything (porn, VL worries etc.). They might help you finding the root of your problems - if not with erections than with your mental state. I am starting therapy next month. Also don't expect that you erections will heal overnight, they won't. It needs time and proper mindset.

Get a night stamp or something after few weeks of quitting porn and see if it breaks .

I am really with you on this one. I was in very similar situation, and I know how you feel. I guess we are both prone to self diagnosis and internet is filled with misleading information. I would trust doctors more then myself in terms of diagnosis. After all those are people that spent years studying, learning, gaining experience etc.

Click to expand...

Be careful with psychiatrist and over all stay away from SSRI (google PSSD)