Diseased Penis

[Old Guy]

The point I'm making is that if you are planning to get an implant someday and you are using medicines to help your erections, don't wait. The longer you wait the more diseased your penis becomes and the worse your operation will be. There are many problems that might arise from a more diseased penis that you would never face with a less diseased one. Fibrosis, scarring, plaque and penile shrinkage all make your IPP operation much harder and less effective. If any of you are now experiencing these things, I'm talking to you. Your penis is also talking to you. Are you listening?

Yes. Not sure why there is a couple who don't agree. Putting drugs in your system that no one knows yet if there will be long term side effects seems more dangerous than a surgery. Yes, it's an expensive surgery if you don't have insurance coverage. And yes, insurance might make you try the band aid fixes first before they cough up the bucks. And yes, it's irreversible but if you don't have natural erections is there any difference if it has to be removed? No.
But if it's broke, you fix it. If you blow out a knee, are you going to hobble around for years until you can't walk? No.

[DougAnd]

Now that's what I'm talking about. Right on brother!

[noot1991]

The point I'm making is that if you are planning to get an implant someday and you are using medicines to help your erections, don't wait. The longer you wait the more diseased your penis becomes and the worse your operation will be. There are many problems that might arise from a more diseased penis that you would never face with a less diseased one. Fibrosis, scarring, plaque and penile shrinkage all make your IPP operation much harder and less effective. If any of you are now experiencing these things, I'm talking to you. Your penis is also talking to you. Are you listening?

Yes. Not sure why there is a couple who don't agree. Putting drugs in your system that no one knows yet if there will be long term side effects seems more dangerous than a surgery. Yes, it's an expensive surgery if you don't have insurance coverage. And yes, insurance might make you try the band aid fixes first before they cough up the bucks. And yes, it's irreversible but if you don't have natural erections is there any difference if it has to be removed? No.
But if it's broke, you fix it. If you blow out a knee, are you going to hobble around for years until you can't walk? No.

I agree that if I were 50+ (or even 40+) years old, I would have no second thoughts about going with an implant. At that age, almost half of the male population is dealing with *some* form of ED anyway, and an implant is certainly a good long-term solution for the remainder of your sexually active lifetime (requiring perhaps only 1 or 2 revisions). No need to hope for better treatments coming out during your lifetime. More importantly, the diagnosis and prognosis of ED is often much clearer at that age: if you had a prostatectomy, you know your erections are going to disappear; if you had lifelong hypertension, diabetes or some other vascular/neurogenic disease, you know that your arteries are getting clogged up and/or blood flow is compromised. You are absolutely certain that physical elements are causing your ED and will only get worse over time, so it's up to you to decide if you want to live like that or solve it. Literally nothing to lose (assuming you can afford it) going for an implant.

The decision becomes much harder when you are facing these issues in your 20s / 30s though. Implants will probably require multiple revisions, which could cost a lot of money and/or may cause physical complications (most notoriously, an infection, which could completely ruin your entire sexual future). So it's far from an ideal solution; one that you only want to go for if you are absolutely certain that nothing else will help you in the future. And unless you are diabetic and/or have some other less common disease, the cause of the ED may be unclear. The most common diagnosis amongst otherwise healthy young men is "venous leak", but most people fail to understand (unfortunately, even some doctors) that tests for VL are completely unreliable, and may show a VL simply due to psychological factors (e.g., anxiety). Psychological ED is the most common cause of ED for young men, and in this case going for a physical solution with an implant, while still a solution of course, may not be the best one.

My own situation as an example (young man, turning 28 next week): I remember that even as a teen, I'd sometimes lose erections during masturbation. I don't recall having much (if any?) morning wood in my early 20s. My last relationship (from 22-27), on top of all that I was so nervous in the beginning that I couldn't get it up the first few times we tried to have sex. Luckily, Cialis helped, and after using it for a few months, my anxiety around ED completely disappeared. I then noticed that I could often manage without it (despite having sex every day), although my PE may have masked the issues as I rarely had to maintain an erection longer than 5mins. I then only started taking the Cialis on weekends/special occasions where I wanted to be guaranteed not to fail. ED was mostly no longer on my mind, a wonderful feeling! Unfortunately, the relationship had other issues, and we broke up a few months ago. Since then, I'm again worried: no morning wood, issues getting it up even for masturbation, ... . Initially thought it was just due to post-breakup depression, but after a few months decided to have a Doppler test anyway to rule out physical issues. The injection (apparently, 15mcg PGE1) didn't do anything for me at all. Got diagnosed with venous leak. Started 5mg daily tadalafil, which "mostly works": I get morning wood most of the time (though it usually goes away quickly) and successfully had intercourse a few times since then, but the effectiveness seems to have already dropped over time.

I feel that my case is a mix of physical and psychological ED, keeping me from immediately jumping to an implant (considering the downsides and the fact it's irreversible). On the other hand, I'm sort of avoiding sex right now, and when it does happen my worries about "keeping it up" prevent me from really enjoying it as much as I should.

[jersey58]

I agree with the OP. Got implanted at 60 after 10 years of tri-mix injections caused peyronie's. Tri-mix did not always work and there was no spontaneity. Had ED since my mid-30s due to venous leak. Knowing what I know now, I would have gotten implanted 20 years ago. Life would have been much better with the implant. Happy I have it now, works great and never fails.

[noot1991]

Got diagnosed with venous leak. Started 5mg daily tadalafil, which "mostly works": I get morning wood most of the time (though it usually goes away quickly) and successfully had intercourse a few times since then, but the effectiveness seems to have already dropped over time.

I feel that my case is a mix of physical and psychological ED, keeping me from immediately jumping to an implant (considering the downsides and the fact it's irreversible). On the other hand, I'm sort of avoiding sex right now, and when it does happen my worries about "keeping it up" prevent me from really enjoying it as much as I should.

I don't understand how you can have venous leak, and the injection did nothing, but you say Tadalafil mostly works. I would think guys would progress from pills to injections. I agree that you shouldn't rush into such delicate surgery at your age and with any possibility at all the ED is psychogenic. I think guys need to stop thinking of their penis as something that should be like an iron rod. It's almost like people don't want to be a real live human anymore.

The explanation I got for the injection not working: I was probably too anxious when they did the test (being uncomfortable with the needle etc.). Anxiety releases adrenaline in your body, which prevents the smooth muscle tissue in your penis from relaxing and therefore makes its veno-occlusive mechanism fail. According to a more knowledgable urologist I visited after that test, it is known that often 2-3 times the usual necessary dosage is required to overcome the needle / "white coat" anxiety, especially in younger men. The problem then is that overdoing it could cause a priapism, which they really want to avoid even more of course.

Also, venous leak is not a disease, it's an observation. An observation that too much blood is flowing out of the penis too quickly. The underlying reasons can range from psychological factors (e.g., anxiety) to hormonal issues (low T), weak pelvic floor muscles, congenital vascular defects, ... In my case, the doctor believes it is mostly a psychological issue, since I can still respond to 5mg tadalafil when on my own, which as you say is a much weaker dosage than pretty much any injection.

This is also one of the reasons why I put little faith in a Doppler test to diagnose VL: it doesn't really measure your "real" erection quality. On the one hand, your erection is artificially boosted using an injection; on the other hand, it is negatively impacted by the lack of arousal and the presence of anxiety. And in case of a VL, the Doppler also has no way of indicating what the underlying cause would be. Nor does its outcome make any difference in how the ED should be treated.

[frwmw1]

Nocturnal erections are under-rated and misunderstood.

They actually exist to keep the penis healthy as far as I'm aware.

Yet this is never explained to young boys, and really it should be.
They are as vital as menstruation.

I wish there was more research on nocturnal erections and ED disease in terms of fibrosis and what the OP describes.

I still occasionally, in certain positions, get hard nocturnal erections, but most of them are soft.
I have had no size loss.

I do wonder if nocturnal erections should be discussed and explained more.

[DougAnd]

The most common diagnosis amongst otherwise healthy young men is "venous leak", but most people fail to understand (unfortunately, even some doctors) that tests for VL are completely unreliable, and may show a VL simply due to psychological factors (e.g., anxiety). Psychological ED is the most common cause of ED for young men, and in this case going for a physical solution with an implant, while still a solution of course, may not be the best one.

Noot, I disagree that the Doppler test is not reliable. Nearly everyone has some VL, but 3 or more on one or both sides is ED. I had 6 on both sides and was impotent for 2 years prior. They injected me for the VL test and like you nothing happened. The veins that restrict blood from flowing back out were too badly damaged. So let's suppose your car tire is fine for weeks then comes up flat. Would you think that it was psychological? I doubt it. Eventually when it stayed flat you'd get it fixed. For 30 years my wife and I assumed that my problem was psychological and that she didn't turn me on anymore. That is a devastating assumption for any couple. But I knew my nocturnal erections had failed and I never got morning wood. Then even masturbation failed. I had to learn how to masturbate while fully flaccid. That's when I took the VL test. I'm not saying that all the things you mentioned have no affect. But I am saying that if you have venous leakage disease then none of those really matter. That's like blaming cold weather on your flat tire when you have a nail in it.

[Fourtytwo00]

Doppler Ultrasound as basically any ultrasound diagnostic is operator dependent. It's not objective like an X ray for a broken bone or a MR scan. So it's not so black and white. Reading FT I've got the impression it's easier to get a Venous Leak diagnosis in the USA maybe for a practical reason: you just need it if you want your insurance paying for the surgery. The same holds true for a surgeon who doesn't want his business being limited to "out of pocket only" clients. In many countries insurers simply don't pay for pre-existing conditions or erectile dysfunction unless it's a consequence of something else like injury, peirone, etc. Where ED isn't an insurable event and the only option are going out of pocket or apply to a national healthcare system this kind of "market" for VL diagnosis "doppler certified" especially in younger patients (< 40/50yo) seem reduced. At least this is my blog / social media experience.

Btw imho chronic PDE5 before bedtime to preserve penile tumescence even if not enough for intercourse is a sensible advice for anyone who doesn't feel ready for the big jump.

[DougAnd]

Fourty,
I don't doubt that the prognosis is somewhat arbitrary. For example what level is considered abnormal. Online it is 3 on one side but I had 6 on both sides and even though I was completely impotent my doc didn't seemed to be concerned, like it might get better or something. But the science is not arbitrary. I'm not saying that on a very good day I would never have tested better. No doubt like blood pressure etc the body changes. But I am saying that with 6 on both sides it was game over.