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I had a very uncomfortable experience yesterday morning which may relate specifically to me and should not be looked at as anything more. Having said that, I had my first intracavernosal injection of 20mcg of Caverject (Alprostadil) in my uro's office (not my surgeon). Prior to this day, and prior to my Robot Assisted Laproscopic Prostatectomy (RALP) six weeks ago, I believed that I had a venous leak which was the "cause" of my pre-surgery ED. It turns out that until very recently, I had no idea that men were supposed to have multiple noctural erections every night. I do not recall having any as an adult. As there is some thought that the purpose of these nightime erections is to protect penile tissue using the "use it or lose it" argument, I guess I've been on the losing end of that argument. I was using 100 mg Viagra for the better part of the last decade and it ceased to aid me in my efforts about three years ago. Even using a VED device with a ring has been problematic because of this venous leakage.

So at my uro's office I wanted to get some useful data on whether I had a venous leak. From Dr Mullhall's writing, it seemed if you could get and hold an erection with the injection then you did not have venous leakage. On the other hand, if you had the erection while standing but lost it when you lay down, you probably had venous leakage. Yes, there is duplex doppler ultrasound for diagnosis but even those are problematic as to accuracy.

So I got the injection. I new of the potential for pain/discomfort from the Prostaglandin (Alprostadil) but what I experienced was a hard erection with incredible pain that brought tears to my eyes and caused me to bend over in a crouch. But strangely, when I lay flat on my back, both the erection and pain subsided. When I stood up again, everything returned. This went on for two hours before I could comfortably walk out.

My uro (not my RALP surgeon) was surprised. He said that if the pain was specificly due to the prostaglandin then it probably would not have subsided when I lay down on my back. He surmised that maybe the pain was due to the opening of arteries and veins in my penis that have not been subject to such a firm erection for what could be several years. Is that really possible? I have had erections but not this strong.

Now his thought was news to me. We both agreed that my losing the erection upon lying down was probably confirmation that I did have this venous leak and that unless I was interested in sex while standing with the help of gravity, the venous leakage would make sex lying down VERY problematic.

Any thoughts to share?

Clan,

If you read far and wide on this site you will probably see more than a few stories that are like yours.. really good ache from PGE-1 .. hard when standing .. softens when on your back.

I thought than with Venous Leak it wouldn't work not matter what position you were in -- it just would not get erect -- but maybe not. I am sure there are all levels of leakage too from small to complete, so that might account for such variations.

On the excruciating ache you experienced, it may indeed be from your Lil Clan not being used to a super hard erection and the expansion of tissues and arteries and veins that accompany it. You would experience the same excruciating ache if you started using a VED Pump and tried pumping to a similar hard level -- it would be almost impossible to stand it at first but after days and weeks you'd get used to it/and into 'shape'.

The best way to condition for such erections in a controlled manner is by using a VED Pump. You really should have been pumping from a few weeks after your surgery but not all Uros believe it is necessary. You will find that when you use a Pump you will get some of the same high level of achiness -- I even get a little now after 4+ years of pumping, but just have a little ache due to PGE-1 injections. So think about some penile conditioning using a pump. A $100 encore or other version in that price range will do the trick. Or even a cheap sex shop pump might do -- some people swear that' those are fine (but so many variations to choose -- there are less variations with the more expensive ones).

So think about that to get your dick into fighting shape. Pumping also helps some with extra permanent girth if you might need some extra. Who doesn't?

J