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I am 45 year , generally healthy straight male. Did notice erectinons getting softer in last few years.
Started 10mg Cialis..intially worked well...now not so much. Have done 18 sessions of shockwave starting May 2018 with a company in Toronto, initial response was pretty good..slowly seems to have tapered off.

Last six months my ED got serious..penetration while standing is becoming difficult.Went to a clinic in Toronto..tried few different IC injections...didn't get a decent erection.

Saw an Urologist..he prescribed MUSE.. tried 500 and 1000 dosage..not any significant improvement.
I do get morning erections everyday.Also masturbation and blowjobs and handjobs by females work normal.

Had a telephonic consultation with Morganstern Urilogy..the gentlemen on phone was really supportive and knowledgeable. Went to great detail about my possible reasons.Sounds like I might have a venous leakage. Blood flow tests are planned next and some blood work before the visit.

Reading through the posts here..I am also suspecting venous leaks.

Would appreciate if experienced members here can share what are the treatment options if venous leak is indeed detected.

Thank you in advance.

I had a Venous Leak for years. I could only get hard when laying still on my back. I woke up nearly every day with morning wood. Sex was difficult because movement caused my dick to go soft. My urologist/surgeon told me any direct treatment for VL is unreliable. If surgery to repair the leak appears to work at first, it rarely lasts. He suggested a Penile Implant. Although I trust my doctor, I thought it was smart to get a second opinion. That doctor told me the same thing.

Thanks.

What would you say the cons of penile implant.

After years of having ED I do not find anything negative about my implant. Obviously I would prefer if I could get a rock hard erection for great sex whenever I wanted it, but that had not happened in a very long time.

I have some venous leakage, too. Looking back at my life, I could almost never maintain an erection when lying on my back, especially if I moved during intercourse. This was in my 20's. Now, I'm 71.

ED pills worked for most of 10 years starting in my 50's, but age takes its toll and now, ED pills do not provide reliable, lasting erections by themselves.

I've moved on to Trimix injections. They work well, almost too well, even at low dosages. Used in conjunction with Viagra, I get serious erections. My wife has no complaints.

Captain1117 wrote:I am 45 year , generally healthy straight male. Did notice erectinons getting softer in last few......

To the original poster:

It sounds like you are plowing thru all the treatment options as you steadily search for the cause to your cure.

I’ve had VL for as long as I’ve had erections. When I first learned to masturbate, I found that I had to hold the area by base of penis compressed with left hand while stroking with right or it wouldn’t stay hard. When I first became sexually active I never lasted long enough to allow VL and ED to rear their ugly heads. It was after marriage, and focus on lovemaking rather than drive by slam bang sex that I found out what I experienced wasn’t normal.

Remember, this was back in the 70s and 80s. If the only erect cock you’ve ever seen is your own, then whatever it does seems normal.

Not sure why anyone still prescribes Muse. It’s good for irritating the urethra and that’s about it. But depending on how bad the VL is, how well your arterial flow compensates for the leaks, and your body’s reaction to pills, shots, or pills plus shots....it might be possible to dodge an implant for a while.

I got mine (implant) yesterday. It was the court of last resort, so to speak. Had pills or shots worked better I might not have crossed this bridge, as it is a one way street. Long way to go before I put this baby into service but I will get there. As surgeries go it wasn’t too bad but it’s definitely more invasive than a vasectomy or a hangnail.

I’m unfamiliar with your Canadian medical care but on the south side of the border, it is beneficial to discuss ED snd VL and possible implants with several doctors. Not all urologists are cutting edge in terms of penis malfunction, they’d rather do kidney stones or prolapsed bladders. It’s like looking for the right woman to marry. You’ve got to date s few before you decide.

TX

Great line here!

"Not all urologists are cutting edge in terms of penis malfunction, they’d rather do kidney stones or prolapsed bladders. It’s like looking for the right woman to marry. You’ve got to date s few before you decide."

Congratulations on overcoming VL! in the New Year...Hope you have a speedy recovery!

FL

Captain,
My Peyronie's / ED starting showing up in my 30's, and has gotten progressively worse over the years. When Viagra came along, it worked well, for a while and became less and less effective. It was leaving me with only a partial erection, headaches and stuffy nose. FINALLY found a Uro who is trying to help. He gave me an injection to prompt an erection (or in my case a chubby) and performed a Doppler Ultrasound which no other Uro even mentioned as needed. He diagnosed me with a "very severe" veinous leak. He recommended Trimix injections, saying they would overcome the leak, at least temporarily, but would also lose effectiveness if my leak continues to worsen, which he thinks will happen. A strong dose at a fairly high volume is giving me a rock hard erection, which lasts around 2-2.5 hours. This is only a bridge solution for my ED until everything comes together in the spring of next year for my implant. Other than ED drugs, as explained to me, there is no treatment for our veinous leaks. The only permanent solution, at least in my case, is the implant. Just a brief snapshot of my journey through what can be a really depressing situation. Good luck!
Steve

Thanks to each one of you and wishing you all a happy new year.

After discussing in the forum and reviewing my last three/four sexual encounter..here is what I am gathering.I am bit perplexed with the different results I observed. Trying to understand my root cause of ED and mental condition during these data collection experiments.

1.There are two females with whom I usually have video call sex. The more frequent one lives in asia. The way it unfolds it that we video call and first I talk to her and she plays with her own body on my instructions and I immediately get a good erection while sitting on my bed. After few minutes she orgasms from her own finger play and then she wants to see me orgasm..a this point I walk to my shower and then masturbate for around 5 minutes. All along I do not experience any loss in erection. The latest session was yesterday. The only help I have is Cialis..daily. With this person I do not experience any performance anxiety and its fun overall.

2. I was on first date with a chubby asian woman , from Tinder ,in Toronto last week. She was sex starved and mentioned that to me openly.After some foreplay I gave her an orgasm with oral. This usually helps me to ensure I don not have to make them orgasm through penetration. After few minutes I did penetrate her..noticed standing(my preferred method) was less effective for me. Sex lasted for few minutes and then we fell asleep. Morning I usually get erections..so started arousing her.She was receptive and had good satisfying penetration and sex(lying down) position for 4-5 minutes. I did use the MUSE 1000 before night sex..didn't see any perceptible change.The only help I have is Cialis..daily. Felt anxious before penetration, and was thinking of not trying to come too soon, ED +PE anxiety.

3. Another Indian female I have been talking for some time..pretty chubby and she mentioned she hasn't dated anyone for long. Not very attractive though easygoing and fun person. We were at my place and worked around 20 minutes to give her an orgasm, but didn't succeed...she mentioned she doesn't usually get one. She was also very tight and I could insert one finger after lot of lube and patience. When I tried penetration after 30 minutes of oral, fingers etc..I realized my penis wasn't hard enough and she was fat and it was difficult to reach and tight to penetrate. I decided instead for her to give me oral...while I was lying in bed. She did a great job and I had intense and satisfying orgasm..I remember my penis was doing the "jumping" motion after climaxing. Morning again I tried to penetrate for a bit but decided a handjob was better under current circumstances. She again did a good job and I came in few minutes. Was very happy during the day from these two orgasms..though never managed to penetrate. She told me she has'nt felt this good in a long time..though she never orgasmed during our night.The only help I have is Cialis..daily. Since no penetration, anxiety was low.

4.Yesterday evening I was with another online dating female, asian 33 in great shape. She was shy initially but came pretty fast with just finger stimulation in my couch. Thereafter we moved to bedroom and I tried only lying position(in case my VL had to do something with standing). I penetrated her in missionary..didn't feel a strong erection but workable.The only help I have is Cialis..daily. She liked deep thrusting and that usually causes me to come sooner that I would like. Felt anxious before penetration, and was thinking of not trying to come too soon, ED+PE anxiety. Lasted 3-4 minutes, she was happy though. Dropped her home afterwards.

Some observations and questions:

1. I have erections every morning and can have sex(not as good as i would like) once at night and again in morning..so I assume my refraction period isn't that bad. Would it be accurate to say I have a decently functioning penis and an implant may not be right at this point?

2. When I am having video call masturbation with the lady in asia ..I have great erection, never gets soft and lasts longer, in lying down and standing.Is my ED in person related to anxiety of performance or coming soon? Since in video call I have no anxiety of her coming..am I possibly not anxious at all? If its VL then with her why dont I lose erection?

3. I have started High intensity workout thrice a week(to improve blood flow), continuing strength training three days a week. Added L arginine and L citruline supplements to increase NO2 in blood. When I workout with weights..pretty good vein popping on my arms and veins visible in chest and legs. I have to lose around 10lb of fat to get to visible abs but the ED+PE kind of affects my motivation.

4. I was with a long term partner for almost two years. I used Promescent spray those days along with Cialis. I did lose sensation right after promescent application, but maintained erection to penetrate and could go on for 30-40 minutes..till the sensation returned and erection got stronger again and would orgasm around 40 minutes mark. She was amazed at my stamina(didnt know about promescent) and would ask me sometime if I was really 42 years.I remember I was proud of my performance and didnt feel anxious since I knew I could impress her. She used to come once/twice before penetration(she was easy to climax and pretty horny) and during these 30-40 minutes she would come again once or twice. So overall the sex was great with help from Cialis and delay spray combined.After painful breakup with her..I haven't used promescent since. Should I start using it again combined with Cialis and MUSE and see if PE anxiety is causing my ED.

The one thing I havent tried is rings for holding the blood in. I saw a ring called giddy..is that any better than others to keep the veins closed.
Any inputs will be helpful.

Cock rings can be great for most men, my vl was so bad they did not work well for me. I would say yes to the spray, you may want to try less spray for a shorter amount of sex.