Venous Leak: Cause or Symptom?

[defiant]

Hello everyone! I'm hoping I can gain some valuable insight from you all, perhaps some much-needed support and advice.

I will try to be succinct but there is a fair amount to tell.

When I was approximately 22 or 23 I was with a lovely girl. I am from London. We met at university. I cannot be entirely certain but I do recall losing my erection when I was with her after a night out and it affecting me, psychologically, quite badly. 'Oh no, why did that happen?' 'I was terrible' 'Will it work next time?'. Luckily it was temporary however I had now become an observer of my own performance, not someone who merely sits back and enjoys the ride.

Over the subsequent years, as anxiety about the situation and ability increased, so too did my increased inability to maintain an erection. Therefore, I can trace a direct correlation between awareness and anxiety surrounding my 'problem' and a diminishing ability to stay hard.

Fast forward to 2011, I'm now 27. I seek a urology review from a reputable NHS hospital in London. At this point I am still performing admirably without PDE5s with my long-term girlfriend. But I am ever-aware of my performance. I 'know' in my mind something ain't right. I have the consultation, a Doppler ultrasound is performed and lo and behold I am diagnosed with a 'Minor Venous Leak as cause for ED'. Options are discussed with me, Cialis, surgery and its pitfalls, the lot. By this point, it is real. My mind is bombarded. 'Sh*t! There IS something wrong with me' But why? How did this happen? I'm young, I'm fit! I haven't been smashed in the privates. How?!' A positive inflow is recorded but also a positive outflow, indicative of venous leak.

Eventually I split with that particular girlfriend and lost the 'comfort zone' of the one you know. Thus introducing the prospect of having to perform. By now I'm really anxious. So on my next encounter with a woman, I take the Cialis to be sure. I perform like a rock star with indefinite ability. But now I have developed a dependence on the pills. 'Oh no, I have to take the pills to be sure I will perform well!' They work, so I take them. Since then and to this day I have slept with over 20 women and have performed fantastically with them, many of them citing me as the best sex of their lives. I know that sounds arrogant and they may be lying but it's been good. All with the use of Cialis. Very rarely without.

Unconvinced by the NHS and their somewhat basic diagnosis and options, I sought a second opinion with a sexual medicine specialist in the elite row or Harley Street private practices. Told them my story, they did the same test. This time, differently.

I was told to massage in the agent once it was injected. And I actually stimulated myself during the test. At first I was worried this was breaking fair test conditions but apparently this is meant to be a 'maximal stimulation test' and I was told that if they could have put 10 scantily clad women in there to massage me it would actually be desirable. The results were the exact opposite of the NHS test. HUGE inflow, in the 120s PSV and negative outflow. Thus, no isolated or generalised venous leak found. No abnormalities detected. But how?! Why?!

I was told by the specialist that venous leak is a term thrown around too much. That it is merely a way to describe the natural detumescence of the penis, (in the absence of localised leaks). That it is more often a SYMPTOM OF SOMETHING ELSE, NOT THE CAUSE. In this case he highlighted, a single episode of loss leading to profound and cumulative psychogenic ED.

And there is no denying just how critical the mental element is. It truly is a mind body process. If you're even slightly thinking about performing as opposed to focussing on just having amazing sex, it will hinder you. Stress inhibits erection. The fight or flight response will kick in; you will release adrenaline and all the other parasympathetic nervous system hormones which CONTRADICT erection. So you may very well have physical ethology but the psychological element will deeply compound things. In some cases, as my specialist hypothesised, it will be the soul cause.

Yet, with this in mind. I'm still torn. I have not experienced regular morning erections for a long time. Do we all get them? Is this an exact predictor? No, but it's a darn good one. I have to constantly stimulate myself to stay hard when masturbating, (without pills obviously). Standing erections are a myth to me. So I have to question, can my psychogenic ED really be THIS BAD?! THIS profound? THIS deadly. I just don't know.

Therefore I will seek a third opinion with the London Andrology clinic who use the sclerotherapy technique to treat VL. This has mixed reviews. Mostly negative ones posted by users. But does this prove its efficacy or lack thereof? No. As the people most likely to write about it are those with negative outcomes. I will likely have the Doppler again and a cavernosonogram. This is apparently the gold standard in truly detecting a leak.

So with everything I have said, no morning wood, great response with cialis, a mind that is so powerful I should be a Jedi, two completely conflicting diagnoses, what do I believe? Who do I believe?

Venous leak: cause or symptom?

It's driving me to despair.

Thank you community!