R
robsonwho
Iron
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So the main theory with venous leak is that something in the vein (valves ?)becomes dysfunctional and that leads to more blood going out of the penis during an erection.This of course comes with difficulty maintaining an erection.
Now first i want to say that it is the job of the vein to return blood to the heart.The valves' function is to PUSH blood to the heart not keep it in a given area of the body.This is why people with thrombosed veins (with dysfunctional valves) have massive veins,most commonly found in the legs,that keep blood in the area and do not return it to the heart.If the veins were dyfunctional they would have trouble returning blood,not keeping it there.
So the physiology of the male erection is that during tumescence the penis is filled with blood,this fills the capilary beds and the cavernosal bodies that push against the tunica albuginea and the veins situated there and thus keep blood from returning to the body.So as you can see it is the cavernosal bodies and cappilary beds that determine the strength of the erection by pressing against the veins and preventing them from returning blood to the heart.You can see how in people with arterial insufficiency,heart problems and atherosclerosis this can lead to trouble filling the penis with blood,thus trouble pushing against the veins and preventing outflow.
A very important element is forgotten here,however.We talked about the vascular side of erections,we talked about the connective tissue side (tunica albuginea).We however completely forgot the muscular side of the equation.The penis is after all nearly 50% smooth muscle.
The strength of an erection relies upon all these factors.And it also is determined by one small muscle called -the ischiocavernosus.This muscle is sadly completely and unfairly forgotten when speaking about the male erection.It is the job of this muscle to press on the crura of the penis and prevent venous outflow thus maintaining tumescence.
https://www.nature.com/articles/3900730.pdf?origin=ppub - While it is widely accepted that hemodynamicchange in the corpus cavernosum is necessary for production and maintenance of erection, the mechanism of venous outflow regulation is still subject to controversy. Involvement of the ICM in the process of penile rigidity was suggested as long as a hundred years ago. Some researchers have emphasized the vascular system as a unique mechanism capable of producing outflow resistance,while others say that contraction of the ICM is necessary to attain enough outflow resistance. In animal experiments intracavernous pressure exceeded systolic blood pressure in rigid erection, but this high pressure was decreased by anesthesia of the muscles. Therefore, although the hemodynamic mechanism was essential for erection, it seems the ICM was also important. Our data showed that the contractile capacity of the ICM in ED patients is significantly lower than that of potent controls, thussupporting the involvement of the ICM in the process of erection.
Now before Viagra came out and made billions docors were trying to test whether rehabilitating the pelvic floor will have an effect on erection.The results were promising.You can see :
http://www.err.eg.net/article.asp?i...1;issue=4;spage=179;epage=186;aulast=Al-Helow-In this medical article 50% of those DIAGNOSED with venous leak recovered after pelvic floor exercises.
https://pubmed.ncbi.nlm.nih.gov/8435738/-This is another article that comes to the conclusion that after pelvic floor training 75% of the people with proven venous leak scheduled for surgery for erectile dysfunction,resolved or massively improved their condition.The 25% who did not experience this improvement either did not stick to the regimen or dropped out due to personal reasons.Sadly i can not find the full article i read a few months ago.In this abstract the information is criminally reduced.It is said that while 50%resolved another 25% had such improvement that they refused surgery.The authors also noted that the results would have been better if it was not for a large part of people dropping out.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1324914/ - This study is particularly interesting.It used kegels to treat venous leakage**(kegels are not advised if you have hard flaccid ).** With a clinical improvement of 6.74 points on the erectile function domain of the IIEF, the intervention group showed a significant improvement (P = 0.004) in erectile function compared with the control group after 3 months. The control group showed no significant increase in erectile function following lifestyle changes (P = 0.658), but a highly significant increase following intervention at 6 months (P<0.001). At 6 months, there was clinical improvement of 9.88 points on the erectile function domain of the IIEF for the intervention group and 10.94 points for men initially assigned to the control group.
After 3 months of intervention and 3 months of pelvic floor exercises, 40.0% of all participants had attained normal function, 34.5% had improved, and 25.5% failed to improve.
In this trial the median age of the participants was 59.2 years and much higher than the subjects in all the other trials.7-9,17,21 The duration and severity of erectile dysfunction were not predictors of the results of therapy in this trial. The number of participants who withdrew from the trial was a concern, although a high drop-out rate has been reported previously in this type of study18 and may reflect the embarrassment and unease suffered by this cohort of men or possibly the commitment involved in performing daily exercises. However, some of the men who withdrew from the study did so because they had achieved normal erectile function.
All participants who received the allocated intervention reported completion of their pelvic floor home exercise regime. All men were able to achieve a penile retraction and scrotal lift during training with pelvic floor muscle exercises, although, initially, this response was often difficult and slow. As muscle strength improved, this response was initiated at a faster rate. Examination of individual cases revealed the return of self-reported nocturnal erections following 1–4 weeks of pelvic floor muscle exercises and prior to regaining erectile function. The results of this trial may have been more impressive if men with severe low back pain, addiction to alcohol, cardiovascular disease, diabetes mellitus, Peyronie's disease, and bilateral orchidectomies had been excluded in the first instance.
This is all to show you that the common symptom of not being able to maintain your erction is probably caused by the tense and probably weak ischocavernosus.To all new members stop worrying about venous leakage since it is a misnomer.The problem is NOT in the vein-the vein does the job it has to do-it returns the blood back to the heart.Focus on the muscles (specifically the ischiocavernosus) around the penis by relieveing tension ( erect reverse kegels are helpful) and strengthening.
A user also send me these studies :
► Says that the IC is best trained erect
► Also says that the IC gets activated by glans pressure Interesting quotes: "Increasing the strength of a striated muscle implies a work of this muscle against a resistance. Regarding the ICM, the only resistance is the pressure in the CC. The treatment, therefore, should be carried out in full erection when the CC is filled" "The above physiological considerations suggest that coital penile rigidity dysfunction and possibly PE may be partly due to ICM atrophy and that they may be treated by rehabilitation intervention" "Therefore, coital penile rigidity is achieved according to the following sequence: coital movement → glans pressure variations → ICR triggering → ICM contractions → SS ICP → penile rigidity." (Also supported by: https://pubmed.ncbi.nlm.nih.gov/8352579/)
OUP Academic
Pelvic-Floor Muscle Rehabilitation in Erectile Dysfunction and Prem...
Background. In men, involuntary or voluntary ischiocavernosus muscle contractions after erection lead to intracavernous blood pressures far higher than the syst
PubMed
[Supra-systolic elevation of the intra-cavernous pressure secondary...)
The role of the perineal muscles in human penile erections is still controversial. The authors investigated surface electromyographic activity of the ischiocavernous muscles together with intracavernous pressure recordings during pressure stimulations of the glans penis. Successive glans stimulation …
3) The role of biofeedback in the rehabilitation of veno-occlusive erectile dysfunction https://link.springer.com/content/pdf/10.4103/1110-161X.147362.pdf
► Shows that pelvic muscle training can cure venous leak -- levator/IC and more Interesting quotes: "Pelviperineal muscles’ visual pressure biofeedback rehabilitation is effective, inexpensive, noninvasive, safe, and easily applicable in the treatment of venogenic ED" "The patient performed 10 maximal muscle contractions: each lasted for 10 s with a 5-s rest in between. The patient was able to visualize and quantify his muscle contractions. The sessions were performed three times weekly for 3 months. [They trained the] pelviperineal muscles (levator ani, external anal sphincter, ischiocavernosus muscle, bulbospongiosus muscle, superficial transverses perineal muscles, deep transverses perineal muscles, and sphincter urethrae)"
4) Longterm results in the conservative treatment of erectile dysfunction of venous etiology using an external ischiocavernosus stimulator (EIS) https://publikationen.sulb.uni-saarland.de/bitstream/20.500.11880/21378/2/GesamtDiss_Final_X3.pdf (German; but see page 6 for english abstract)
► Proves that IC training (manually or even better electrical) improves erection rigidity and duration and is even better than venous leak surgery Interesting quotes: "As evidenced by the reported results, the external ischiocavernosus stimulation is an effective conservative treatment option in erectile dysfunction of venous etiology"
Now first i want to say that it is the job of the vein to return blood to the heart.The valves' function is to PUSH blood to the heart not keep it in a given area of the body.This is why people with thrombosed veins (with dysfunctional valves) have massive veins,most commonly found in the legs,that keep blood in the area and do not return it to the heart.If the veins were dyfunctional they would have trouble returning blood,not keeping it there.
So the physiology of the male erection is that during tumescence the penis is filled with blood,this fills the capilary beds and the cavernosal bodies that push against the tunica albuginea and the veins situated there and thus keep blood from returning to the body.So as you can see it is the cavernosal bodies and cappilary beds that determine the strength of the erection by pressing against the veins and preventing them from returning blood to the heart.You can see how in people with arterial insufficiency,heart problems and atherosclerosis this can lead to trouble filling the penis with blood,thus trouble pushing against the veins and preventing outflow.
A very important element is forgotten here,however.We talked about the vascular side of erections,we talked about the connective tissue side (tunica albuginea).We however completely forgot the muscular side of the equation.The penis is after all nearly 50% smooth muscle.
The strength of an erection relies upon all these factors.And it also is determined by one small muscle called -the ischiocavernosus.This muscle is sadly completely and unfairly forgotten when speaking about the male erection.It is the job of this muscle to press on the crura of the penis and prevent venous outflow thus maintaining tumescence.
https://www.nature.com/articles/3900730.pdf?origin=ppub - While it is widely accepted that hemodynamicchange in the corpus cavernosum is necessary for production and maintenance of erection, the mechanism of venous outflow regulation is still subject to controversy. Involvement of the ICM in the process of penile rigidity was suggested as long as a hundred years ago. Some researchers have emphasized the vascular system as a unique mechanism capable of producing outflow resistance,while others say that contraction of the ICM is necessary to attain enough outflow resistance. In animal experiments intracavernous pressure exceeded systolic blood pressure in rigid erection, but this high pressure was decreased by anesthesia of the muscles. Therefore, although the hemodynamic mechanism was essential for erection, it seems the ICM was also important. Our data showed that the contractile capacity of the ICM in ED patients is significantly lower than that of potent controls, thussupporting the involvement of the ICM in the process of erection.
Now before Viagra came out and made billions docors were trying to test whether rehabilitating the pelvic floor will have an effect on erection.The results were promising.You can see :
http://www.err.eg.net/article.asp?i...1;issue=4;spage=179;epage=186;aulast=Al-Helow-In this medical article 50% of those DIAGNOSED with venous leak recovered after pelvic floor exercises.
https://pubmed.ncbi.nlm.nih.gov/8435738/-This is another article that comes to the conclusion that after pelvic floor training 75% of the people with proven venous leak scheduled for surgery for erectile dysfunction,resolved or massively improved their condition.The 25% who did not experience this improvement either did not stick to the regimen or dropped out due to personal reasons.Sadly i can not find the full article i read a few months ago.In this abstract the information is criminally reduced.It is said that while 50%resolved another 25% had such improvement that they refused surgery.The authors also noted that the results would have been better if it was not for a large part of people dropping out.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1324914/ - This study is particularly interesting.It used kegels to treat venous leakage**(kegels are not advised if you have hard flaccid ).** With a clinical improvement of 6.74 points on the erectile function domain of the IIEF, the intervention group showed a significant improvement (P = 0.004) in erectile function compared with the control group after 3 months. The control group showed no significant increase in erectile function following lifestyle changes (P = 0.658), but a highly significant increase following intervention at 6 months (P<0.001). At 6 months, there was clinical improvement of 9.88 points on the erectile function domain of the IIEF for the intervention group and 10.94 points for men initially assigned to the control group.
After 3 months of intervention and 3 months of pelvic floor exercises, 40.0% of all participants had attained normal function, 34.5% had improved, and 25.5% failed to improve.
In this trial the median age of the participants was 59.2 years and much higher than the subjects in all the other trials.7-9,17,21 The duration and severity of erectile dysfunction were not predictors of the results of therapy in this trial. The number of participants who withdrew from the trial was a concern, although a high drop-out rate has been reported previously in this type of study18 and may reflect the embarrassment and unease suffered by this cohort of men or possibly the commitment involved in performing daily exercises. However, some of the men who withdrew from the study did so because they had achieved normal erectile function.
All participants who received the allocated intervention reported completion of their pelvic floor home exercise regime. All men were able to achieve a penile retraction and scrotal lift during training with pelvic floor muscle exercises, although, initially, this response was often difficult and slow. As muscle strength improved, this response was initiated at a faster rate. Examination of individual cases revealed the return of self-reported nocturnal erections following 1–4 weeks of pelvic floor muscle exercises and prior to regaining erectile function. The results of this trial may have been more impressive if men with severe low back pain, addiction to alcohol, cardiovascular disease, diabetes mellitus, Peyronie's disease, and bilateral orchidectomies had been excluded in the first instance.
This is all to show you that the common symptom of not being able to maintain your erction is probably caused by the tense and probably weak ischocavernosus.To all new members stop worrying about venous leakage since it is a misnomer.The problem is NOT in the vein-the vein does the job it has to do-it returns the blood back to the heart.Focus on the muscles (specifically the ischiocavernosus) around the penis by relieveing tension ( erect reverse kegels are helpful) and strengthening.
A user also send me these studies :
- Pelvic-Floor Muscle Rehabilitation in Erectile Dysfunction and Premature Ejaculation https://academic.oup.com/ptj/article/94/12/1731/2741899
► Says that the IC is best trained erect
► Also says that the IC gets activated by glans pressure Interesting quotes: "Increasing the strength of a striated muscle implies a work of this muscle against a resistance. Regarding the ICM, the only resistance is the pressure in the CC. The treatment, therefore, should be carried out in full erection when the CC is filled" "The above physiological considerations suggest that coital penile rigidity dysfunction and possibly PE may be partly due to ICM atrophy and that they may be treated by rehabilitation intervention" "Therefore, coital penile rigidity is achieved according to the following sequence: coital movement → glans pressure variations → ICR triggering → ICM contractions → SS ICP → penile rigidity." (Also supported by: https://pubmed.ncbi.nlm.nih.gov/8352579/)
OUP Academic
Pelvic-Floor Muscle Rehabilitation in Erectile Dysfunction and Prem...
Background. In men, involuntary or voluntary ischiocavernosus muscle contractions after erection lead to intracavernous blood pressures far higher than the syst
PubMed
[Supra-systolic elevation of the intra-cavernous pressure secondary...)
The role of the perineal muscles in human penile erections is still controversial. The authors investigated surface electromyographic activity of the ischiocavernous muscles together with intracavernous pressure recordings during pressure stimulations of the glans penis. Successive glans stimulation …
3) The role of biofeedback in the rehabilitation of veno-occlusive erectile dysfunction https://link.springer.com/content/pdf/10.4103/1110-161X.147362.pdf
► Shows that pelvic muscle training can cure venous leak -- levator/IC and more Interesting quotes: "Pelviperineal muscles’ visual pressure biofeedback rehabilitation is effective, inexpensive, noninvasive, safe, and easily applicable in the treatment of venogenic ED" "The patient performed 10 maximal muscle contractions: each lasted for 10 s with a 5-s rest in between. The patient was able to visualize and quantify his muscle contractions. The sessions were performed three times weekly for 3 months. [They trained the] pelviperineal muscles (levator ani, external anal sphincter, ischiocavernosus muscle, bulbospongiosus muscle, superficial transverses perineal muscles, deep transverses perineal muscles, and sphincter urethrae)"
4) Longterm results in the conservative treatment of erectile dysfunction of venous etiology using an external ischiocavernosus stimulator (EIS) https://publikationen.sulb.uni-saarland.de/bitstream/20.500.11880/21378/2/GesamtDiss_Final_X3.pdf (German; but see page 6 for english abstract)
► Proves that IC training (manually or even better electrical) improves erection rigidity and duration and is even better than venous leak surgery Interesting quotes: "As evidenced by the reported results, the external ischiocavernosus stimulation is an effective conservative treatment option in erectile dysfunction of venous etiology"
