ED for as long as I can remember, frustrated from Penile Doppler ultrasound results

[Yopej619]

Hi all, this is my first time posting here. Just a bit of background, I am 30 and I have had ED for as long as I can remember. I am only able to get erections that I would say are roughly 50-60% hard, but it requires constant manual stimulation otherwise it goes down in a few seconds. I can just about get an erection for penetration but I always worry about changing position and getting a condom etc because it will go down so easily. I also have a 50 degree downward curve which I suspect is Peyronie's though this hasn't been formally diagnosed as I will explain below. Also I never get morning, nocturnal or spontaneous erections.

I saw a urologist and he suspect a venous leak so sent me for Doppler ultrasound. To my surprise, the radiologist informed me there is no venous leak and the test show my penis is physically normal. This seriously shocked me because I had gone six months without porn and masturbation thinking this was the issue and it made no change to my erectile issue. I also don't think it's psychological because then wouldn't I still get morning erections? I'm at a loss now at what it could be because I don't see how it's not physical (particularly since the first time I went for the Doppler ultrasound the injection they gave had no effect and I had to go back for a larger dose). This larger dose didn't even give me a full erection. It made it hard yes but it still felt flaccid and definitely not a full erection. Though it did last for roughly two hours even though it was a sub par erection.

I guess what I'm worried about now is that it seems they are saying nothing is wrong which means that nothing can be done. I am reluctant to try injections because it caused me pain and didn't really give me a full erection. I will try Viagra Cialis etc but I was actually hoping to just get an implant because I'm so sick of never having had a relationship because of this problem, I just can't take it anymore and I want it to be over. Could it be possible that the doppler missed the venous leak, or maybe the radiologist didn't really know what to look for? I have an appointment with my urologist soon to discuss the results so hopefully he will find something and then we can sort it.

I'm sorry for the long post but thank you for reading. Really feeling down about this, I was actually looking forward to being diagnosed with a physical issue so they would give me the implant but now it feels like they will just say it's in my head and do nothing to help

[abhishek26]

Welcome to the forum!

First off, try to get a more clear diagnosis on the penile doppler ultrasound, potentially with an even higher dose that ought to eliminate any uncertainties with regards to arterial insufficiency or venous leakage. Also, get a comprehensive blood test done (with hormones including testosterone).

You always have the option to get an implant, but remember it is irreversible, so we want to make sure we're making the right decision. If an implant is in fact necessary, then make sure to choose the best surgeon if possible.

[Yopej619]

Welcome to the forum!

First off, try to get a more clear diagnosis on the penile doppler ultrasound, potentially with an even higher dose that ought to eliminate any uncertainties with regards to arterial insufficiency or venous leakage. Also, get a comprehensive blood test done (with hormones including testosterone).

You always have the option to get an implant, but remember it is irreversible, so we want to make sure we're making the right decision. If an implant is in fact necessary, then make sure to choose the best surgeon if possible.

Thanks for taking the time reply. I was thinking regarding the higher dose, at first I thought maybe they actually gave me too high of a dose and the increased blood flow negated the venous leak, could that be the case?

Also had a blood test and everything including test was fine, even at the higher end of normal.

One thing I forgot to mention is that I also suffer from severe premature ejaculation, not sure if it's related to the ED and there is a physical cause for that as well, but it's one of the reason I'd want the implant because it would solve both issues at once, even if I came early it would allow me to keep going. I will of course try Cialis etc as well but I don't have much hope in this working because the injections never really have me a full erection

[Lost Sheep]

(edited for focus) I was thinking regarding the higher dose, at first I thought maybe they actually gave me too high of a dose and the increased blood flow negated the venous leak, could that be the case?

Not so much negating the venous leak, but increasing arterial inflow that overwhelmed the venous outflow. A small distinction, but, I think, more descriptive. I hope you don't mind my intruding in your description.

(edited for focus) One thing I forgot to mention is that I also suffer from severe premature ejaculation (PE), not sure if it's related to the ED and there is a physical cause for that as well, but it's one of the reason I'd want the implant because it would solve both issues at once, even if I came early it would allow me to keep going. I will of course try Cialis etc as well but I don't have much hope in this working because the injections never really have me a full erection

I attributed my premature ejaculation to my E.D./Venous Leak. Here's how I envisioned it. \

In order to keep my erection, I needed continual vigorous stimulation. If I paused stimulation (to avoid ejaculation), the erection collapsed. If I continued (to maintain erection) ejaculation happened, followed by the erection's refractory collapse.

So, I think your analysis is quite correct. They are related. The VL-ED forces you to fuck in such a manner that PE is inevitable.

[Txagq8]

Basically you are me, 35 years ago.

Flat on my back, with pressure monitors on my junk, taking x ray pictures with contrast, they were telling me they weren’t seeing anything abnormal.

I started to sit up and tell the doctors I wasn’t crazy, that I knew something wasn’t working quite right. The instant I moved from flat on my back, the pressures started to drop, my pharmaceuticals induced erection started to subside. I have no idea what it did to the imaging.

It did alert the doctors to the fact that my ED was very position dependent and no, a guy can’t expect to use a precarious erection by remaining perfectly still.

So they treated me with injections, which was about the only weapon in their arsenal back then. This was around ‘86-‘87 time frame. Diagnostics and treatments are much impotoved. Still, my point is that just because venous leakage didn’t show up one time, that doesn’t mean it never happens.

You know something’s wrong. That’s a given. The doctor’s job is not to declare nothing is wrong, but instead determine what’s causing the problem and then fix it.

Maybe it’s not venous leakage. Maybe it’s arterial insufficiency. Maybe it’s central nervous system related. If you’ve got a 50 degree bend and nobody is willing to call that an issue, you need to talk to different medical people.

Just a few thoughts. As tough as it may sound, font get impatient. I have faith that they can figure you out and fix it. I’m also pretty sure the process will not be instantaneous and will be frustrating at times. That’s life with ED. It can be conquered but it’s not for the faint of heart. Strength, courage, persistence will get you where you need to be.

[Spontaneous1]

Frustration, I hear ya brother!

[Yopej619]

(edited for focus) I was thinking regarding the higher dose, at first I thought maybe they actually gave me too high of a dose and the increased blood flow negated the venous leak, could that be the case?

Not so much negating the venous leak, but increasing arterial inflow that overwhelmed the venous outflow. A small distinction, but, I think, more descriptive. I hope you don't mind my intruding in your description.

(edited for focus) One thing I forgot to mention is that I also suffer from severe premature ejaculation (PE), not sure if it's related to the ED and there is a physical cause for that as well, but it's one of the reason I'd want the implant because it would solve both issues at once, even if I came early it would allow me to keep going. I will of course try Cialis etc as well but I don't have much hope in this working because the injections never really have me a full erection

I attributed my premature ejaculation to my E.D./Venous Leak. Here's how I envisioned it. \

In order to keep my erection, I needed continual vigorous stimulation. If I paused stimulation (to avoid ejaculation), the erection collapsed. If I continued (to maintain erection) ejaculation happened, followed by the erection's refractory collapse.

So, I think your analysis is quite correct. They are related. The VL-ED forces you to fuck in such a manner that PE is inevitable.

That's interesting that you had PE and I see you have the implant. May I ask did that mean you are basically over the PE now, in terms of it doesn't really matter that you cum early because you can just keep going?

[Yopej619]

I started to sit up and tell the doctors I wasn’t crazy, that I knew something wasn’t working quite right. The instant I moved from flat on my back, the pressures started to drop, my pharmaceuticals induced erection started to subside. I have no idea what it did to the imaging.

That's interesting, do you think that because after the injection I was able to keep that same level of erection for roughly two hours, even though it was only at roughly 60%, does that mean there is no venous leak? But then I suppose I have to answer the question of why didn't I get 100% hard even on a strong dose as the doctor described it.

Anyway thank you for your words, you've given me some hope and a lot to think about.

[abhishek26]

I started to sit up and tell the doctors I wasn’t crazy, that I knew something wasn’t working quite right. The instant I moved from flat on my back, the pressures started to drop, my pharmaceuticals induced erection started to subside. I have no idea what it did to the imaging.

That's interesting, do you think that because after the injection I was able to keep that same level of erection for roughly two hours, even though it was only at roughly 60%, does that mean there is no venous leak? But then I suppose I have to answer the question of why didn't I get 100% hard even on a strong dose as the doctor described it.

Anyway thank you for your words, you've given me some hope and a lot to think about.

the dosage situation is probably due to the fact that injections induce a chemical/physical reaction in the arteries to keep them dilated, and this is quite distinct from the normal spontaneous biological reaction to induce erections. so the extent of the chemical reaction often depends on the existing amount of substrates and potential catalysts, and this may differ among individual males.

[Benjohn]

Hey, sounds like you're in the same boat as me. I'm 30, two penile doppler ultrasounds. Both came back as no venous leak. But no nighttime erections without max dose Sildenafil.

The second time I had a ultrasound they had to inject me twice to get a sufficient response. The erection lasted 5 minutes with EDEX 15. On the flip side, I've been prescribed Invicorp and even using half a dose gives me a 3 hour erection... Which is further evidence to convince me it is a venous leak.

Maybe you could try invicorp and see what your response is?