27 year-old pump injury - any advice much appreciated!

[Fed1981]

I am a 27 year-old Doctor in UK who has suffered what seems to be severe injury from a medical grade VED I was prescribed by a Consultant back in December. My erections were very good at this point (although could be affected by stress/anxiety at times) but he felt he could feel some narrowing at the base even though he never confirmed any plaque or fibrosis on scan. Therefore he prescribed cialis 5mg once a day a night and advised using a VED once a day for 10 minutes to help stretch out the narrowing and firmness at the base.

The way in which he advised using the pump was:
- pump up to the max size you can tolerate; some discomfort is ok but never pain
- hold at max for no longer than 2 seconds then release vacuum
- start the process again and aim to cycle through 10 full erections (or however many fit in to the 10 minute session)
- 3 pumps every 10 seconds, no faster than this
- check for bruising/petechiae

Now checking this forum it seems like what he had advised me was incorrect, and in fact too aggressive. I followed his advice in that I never held at max erection for longer than 1-2 seconds, I felt a slight discomfort/stretching sensation but I wouldn't say I ever felt pain, my sessions never went over 10 minutes, I never had superficial bruising/petechiae, I never pumped more than 3x/10 seconds.

Just for more information, I was using the Somaerect device from Augusta Medical Devices which is a medical grade VED and therefore does not have a vacuum gauge. He never mentioned anything about vacuum levels, and both him and the pump technicians assured me it was completely safe with no scope for damaging yourself.

Interestingly, I used the pump alongside cialis 5mg for around 2 and a half weeks in December/January and everything seemed fine and I was having some of the best erections I can ever remember. Therefore, I stopped using the pump at that point and carried on. It was only when the Consultant called me for a follow-up in April that he advised I should still be using the pump daily until I saw him in clinic again. Therefore, I went back to the pump for 8 days over a 10 day period at the end of April and it was then that I noticed my EQ suddenly plummet. I was living with my girlfriend at that time and having sex several times a day so I don't know if that was potentially the issue compared to the pump use in Dec/Jan when I was not sexually active. Maybe it was too much in conjunction with the pump.

The symptoms since that use in April have been:
- some soreness R-side of shaft after stopping use of the pump (this resolved relatively quickly in just a few days)
- no spontaneous erections - I was getting these all the time before, at times even from just seeing my girlfriend or holding her hand
- No nocturnal/morning erections generally, and if I do get them, 50% of normal and very short-lived
- contracted, tense flaccid which feels hard
- cold glans. Poorly engorged glans and corpus spongiosum with erections
- very difficult to get erection even alone - takes 1-2 minutes of stimulation to even get to something resembling erection and I have to be sitting or lying down - no chance if standing up
- erections feel less rigid and more unstable at the base
- seem to have lost girth when erect
- lose erection within 10-20 seconds without constant stimulation
- small brown pin-prick mark on left side of glans

My questions are really:
- has anyone experienced similar, and if so, what can be done to try and recover?
- I don't understand why 2 and a half weeks of pumping in Dec/Jan caused no issues but 8 days in April has led to this? What would the mechanism of pump damage even be as I never had any bruising, petechiae, pain or significant oedema?
- I have been taking cialis 5mg daily, l-citrulline 1500mg, ginger 500mg, vitamin E 400 IU, vitamin D 1000 IU and muira puama 500mg but not much has improved - in fact I would say things are getting worse
- I have been looking at proteolytic enzyme supplements such as serrapetidase and nattokinase to try and break down scar tissue/fibrosis as I am worried this is what I may have
- I have an appointment with a private urologist on Monday 3rd August and hopefully will be able to get a scan (previous urologist I saw in July just told me it was all psychological and there is no way the pump could have caused damage)

Thanks, I appreciate any help that can be suggested!

[bldoink]

Hard Flaccid might be something you should look into: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7271516/

Paul, the site administrator appears to be very knowledgeable on that topic. You should message him.

[dtwarren1942]

I am not a medical professional, but Based on my ten years of pumping, I say your doc gave you bad advice. A medical grade pump is inappropriate for penile therapy. A medical grade pump is intended for generating and maintaining an erection with a tight constriction band.

He was probably recommending pulse pumping, the process your dick goes through at night during REM sleep - night wood. It forces Oxygenated blood into you penis to rejuvenate the penis tissues. In this regard, you need a pump system with a vacuum gauge. Pump up to 5 hg for two minutes and then reduce the vacuum to 2 hg for 30 seconds, repeat four or five times

Without a vacuum gauge, pump up until you feel slight discomfort and then back off slightly.

[LuisFernandez]

It doesn't seem like you misused the VED. The somaerect is used for therapy by Peyronie's sufferers with good outcomes. The only thing is that it is not recommended to pump to 100%. But for only a few seconds i don't see a big deal.

Theoretically it is possible to get ED from traction and VED. I've experienced it with traction. The thing is that the penis is like a bicycle tire. If you stretch the outer tube, you're not stretching the inner tube (the muscle) and will develop a venous leak.

You can get a venous leak diagnosed with an induced erection and an ultra sound when done by an expert urologist.

If you don't have ED or Peyronie's i don't see any point in using a VED. If you stop for a few days you might see your erections return.

Good luck.

[Simbarn]

I am a 27 year-old Doctor in UK who has suffered what seems to be severe injury from a medical grade VED I was prescribed by a Consultant back in December. My erections were very good at this point (although could be affected by stress/anxiety at times) but he felt he could feel some narrowing at the base even though he never confirmed any plaque or fibrosis on scan. Therefore he prescribed cialis 5mg once a day a night and advised using a VED once a day for 10 minutes to help stretch out the narrowing and firmness at the base.

This is an odd and interesting case of ED.
Sorry to hear you having these problems.

Was the initial reason you went to the consultant/specialist for anxiety and stress related ED?
If your erections were working well it does seem like overkill to prescribe what they did IMO.

The chronic Cialis would have most likely been quite sufficient.

Sounds like you may have just had slightly overactive adrenergic activity in your penis in the beginning. Some guys are IMO more susceptible to this and are therefore more likely to experience ED from performance anxiety and certain medications or illicit drugs.
This sympathetic activity in the penis can increase too as we age, making it more difficult for this cohort of men to maintain an erection in middle age.

As your symptoms happened so quickly after a short period of relatively intense sexual activity and combined use of the pump, could it be possible that the issue may be neurological?
You could be correct, you may have just subjected your penis to too much stress and possibly a1-receptor expression has increased to keep the penis in a flaccid state, or a nerve has been temporarily affected.
There could also be a strong psychogenic component as this usually develops quickly if ED develops for any other reason, and you already had stress related ED, which would make this even more likely.
Given time and rest, your penis may recover by itself.

Two symptoms you mentioned were interesting to me:
“contracted, tense flaccid which feels hard”
“very difficult to get erection even alone - takes 1-2 minutes of stimulation to even get to something resembling erection and I have to be sitting or lying down - no chance if standing up”
Both of the above could suggest excessive norepinephrine activity in the erectile tissues. This can be worse when standing as the body is in a more “stressed state”, sympathetic activity is heightened. The excessive time needed to get an erection may be because the NO pathway is having trouble overcoming the adrenergic pathway.
A pelvic floor issue as others have mentioned would also be worth investigating.

If it was vascular damage in such a short period of time, one would think that the tunica albuginea would need to be damaged, compromising the ability of the veins directly underneath (venous plexus and or emissary veins) being able to make a seal. However, would this not be discernible by examining the penis? As a doctor you may know more about this.

If it were me, I would continue with the chronic low dose Cialis to help prevent ischemia and hypoxia in the penile tissues whilst nocturnal erections are not occurring as well as they did beforehand. The more I research about erectile dysfunction, keeping oxygen saturation occurring with nightly erections appears to be so important.

You have mentioned fibrosis and scar tissue, would this take more time to develop and therefore the onset of symptoms would be more gradual than the sudden dysfunction you experienced?

Please do keep us informed as to what the specialists find, as this is unusual.

[Fed1981]

I am a 27 year-old Doctor in UK who has suffered what seems to be severe injury from a medical grade VED I was prescribed by a Consultant back in December. My erections were very good at this point (although could be affected by stress/anxiety at times) but he felt he could feel some narrowing at the base even though he never confirmed any plaque or fibrosis on scan. Therefore he prescribed cialis 5mg once a day a night and advised using a VED once a day for 10 minutes to help stretch out the narrowing and firmness at the base.

This is an odd and interesting case of ED.
Sorry to hear you having these problems.

Was the initial reason you went to the consultant/specialist for anxiety and stress related ED?
If your erections were working well it does seem like overkill to prescribe what they did IMO.

The chronic Cialis would have most likely been quite sufficient.

Sounds like you may have just had slightly overactive adrenergic activity in your penis in the beginning. Some guys are IMO more susceptible to this and are therefore more likely to experience ED from performance anxiety and certain medications or illicit drugs.
This sympathetic activity in the penis can increase too as we age, making it more difficult for this cohort of men to maintain an erection in middle age.

As your symptoms happened so quickly after a short period of relatively intense sexual activity and combined use of the pump, could it be possible that the issue may be neurological?
You could be correct, you may have just subjected your penis to too much stress and possibly a1-receptor expression has increased to keep the penis in a flaccid state, or a nerve has been temporarily affected.
There could also be a strong psychogenic component as this usually develops quickly if ED develops for any other reason, and you already had stress related ED, which would make this even more likely.
Given time and rest, your penis may recover by itself.

Two symptoms you mentioned were interesting to me:
“contracted, tense flaccid which feels hard”
“very difficult to get erection even alone - takes 1-2 minutes of stimulation to even get to something resembling erection and I have to be sitting or lying down - no chance if standing up”
Both of the above could suggest excessive norepinephrine activity in the erectile tissues. This can be worse when standing as the body is in a more “stressed state”, sympathetic activity is heightened. The excessive time needed to get an erection may be because the NO pathway is having trouble overcoming the adrenergic pathway.
A pelvic floor issue as others have mentioned would also be worth investigating.

If it was vascular damage in such a short period of time, one would think that the tunica albuginea would need to be damaged, compromising the ability of the veins directly underneath (venous plexus and or emissary veins) being able to make a seal. However, would this not be discernible by examining the penis? As a doctor you may know more about this.

If it were me, I would continue with the chronic low dose Cialis to help prevent ischemia and hypoxia in the penile tissues whilst nocturnal erections are not occurring as well as they did beforehand. The more I research about erectile dysfunction, keeping oxygen saturation occurring with nightly erections appears to be so important.

You have mentioned fibrosis and scar tissue, would this take more time to develop and therefore the onset of symptoms would be more gradual than the sudden dysfunction you experienced?

Please do keep us informed as to what the specialists find, as this is unusual.

Hi Simbarn,

Thanks for the really detailed, comprehensive reply! Is there any chance I could message you privately to ask a few more questions and get your opinion on things?

Best wishes,

Fed1981

[Frank Talk Admin]

You did not hurt yourself. The pumping was fine. The pump had nothing, or very little to do with what is going on.
You have a case of Pelvic floor dysfunction AKA Chronic Pelvic Pain syndrome AKA Hard Flaccid as BLDoink said.

It is easily treated. Stop the panic, it is only making it worse. It is related to anxiety. nothing is wrong with your penis. Please just go to www.pelvicrehab.com and find a pelvic floor physical therapist near you. Stop listening to everyone. Stop that panic. Take a breath. You will be fine.

GO NOW and call the PT. no arguing, asking, searching, worrying. Stop it now and call them.
Paul

[Fed1981]

The other unusual factor to mention is that I have seen 3 top urologists in the field of Andrology and they have all stated they have treated thousands of men with VED devices and never seen permanent injury or decreased erectile quality. Understandably they have seen non-response, but never deterioration from the pump in the short term.

I am tending toward believing them in this sense as they were very open to listening to my story and ideas, and being a medical colleague of theirs (actually working in the same hospital as one of them), I feel they had my best interests at heart and wouldn’t make such statements were they not to be true. If that is the case, and they haven’t seen permanent injury/fibrosis/damage or decreased erectile quality, then I wonder what has happened in my case. I don’t think I completely abused the pump in any way but maybe did pump up to the max for short periods of 1-2 seconds - that’s the only thing I can think I did wrong and only because that is what I was advised by the original urologist!

Any ideas?

[Jolum87]

Hi Fed

I feel your pain. I too injury myself doing something stupid. After seeing multiple urologist/radiologist and countless other specialist and test it was determined that a main blood vessel/artery sending blood to the penis had died.

I had all the same issues as you. If you problem is like mine it will continue to deteriorate and most if not all of the penis tissue will be gone.
My best suggestion just to leave it and pray. The more you try to fit it the worse it will get.

Sorry for the bad news

[Fed1981]

Hi Fed

I feel your pain. I too injury myself doing something stupid. After seeing multiple urologist/radiologist and countless other specialist and test it was determined that a main blood vessel/artery sending blood to the penis had died.

I had all the same issues as you. If you problem is like mine it will continue to deteriorate and most if not all of the penis tissue will be gone.
My best suggestion just to leave it and pray. The more you try to fit it the worse it will get.

Sorry for the bad news

Hi Jolum87, thanks for the reply.

What did you do to injure yourself? Also, how did they confirm that a blood vessel/artery had died and what did you do to cause that?

Do you mean the more you try to "fix" it the worse it will get?

Thanks