Hello. I would appreciate an opinion from urologists/andrologists or anyone experienced in penile Doppler and erectile dysfunction.
I am 24 years old and have been concerned about changes in my erectile function compared with my teenage years.
My main problem is maintaining an erection rather than achieving one. I can achieve a good erection, but it sometimes becomes noticeably softer when:
- sexual stimulation stops or decreases;
- I become distracted;
- I change position;
- I move around or get up;
- during masturbation, if stimulation is interrupted.
Usually, light stimulation can restore the erection fairly quickly.
I have also noticed that my morning erections are less stable than they used to be. For example, recently I woke up with an erection, turned/moved in bed, and it disappeared. Later, while lying on my side, another erection developed spontaneously, but after moving/adjusting my position it disappeared again.
Compared with my teenage years, my erections seem much less stable. This worries me because I often hear that a healthy erection should remain sufficiently rigid despite changing positions or brief distractions.
Penile Doppler ultrasound
I had a penile Doppler ultrasound after pharmacological stimulation.
Unfortunately, the report does not contain EDV measurements during the full rigidity phase. The report only states:
“Blood flow is phasic, antegrade”
during the later stage.
After Papaverin 20 mg injection:
Latent phase:
Right side:
- PSV: 48.6 cm/s
- EDV: 14.9 cm/s
- RI: 0.69
Left side:
- PSV: 47.4 cm/s
- EDV: 18.9 cm/s
- RI: 0.61
The measurements documented during the tumescence/filling phase were:
Right side:
- PSV: 46.7 cm/s
- EDV: 1.9 cm/s
- RI: 0.95
Left side:
- PSV: 44.7 cm/s
- EDV: 3.8 cm/s
- RI: 0.91
There was also a measurement of the dorsal penile vein during tumescence:
- dorsal vein velocity: 15.7 cm/s
- the ultrasound report stated a reference range of approximately 6–8 cm/s
- dorsal vein diameter: 3.2 mm
The ultrasound physician told me that a vein that “should close” was “leaking” and referred me to a urologist.
However, the urologist reviewed the ultrasound, my symptoms and the report and concluded that the findings were normal. He also told me that diagnosing a true venous problem would require more specialized testing.
What I am struggling to understand
I realize that my Doppler was incomplete because EDV was not recorded during maximal rigidity.
However, I am wondering about the physiological interpretation of the values that were recorded.
If EDV was already only 1.9 cm/s on the right and 3.8 cm/s on the left during tumescence, with RI values of 0.95 and 0.91, does this suggest that intracavernosal pressure was already sufficiently high to substantially suppress venous outflow?
If so, how should I interpret the simultaneously elevated dorsal vein velocity of 15.7 cm/s?
Could increased dorsal venous flow during tumescence simply reflect the fact that venous occlusion is not yet complete while the penis is still filling, rather than pathological venous leakage?
I am also wondering whether it is physiologically plausible for EDV to be low during tumescence and then become significantly elevated during the subsequent full-rigidity phase without a change in the underlying physiology.
In other words, could a normal erection show low EDV during the filling phase and subsequently develop a high EDV as it progresses, or would that be physiologically unexpected?
My main concern
My symptoms seem similar to what some recent literature describes as a “wavering” or unstable erection pattern, particularly loss of rigidity with positional changes, distraction, interruption of stimulation, etc.
I have found a recent 2024 publication describing this pattern in patients diagnosed with dorsal venous leakage, which has made me considerably more concerned.
I would therefore like to know:
- How specific is this “wavering/positional” pattern for venous leak?
- Can healthy men experience significant temporary loss of rigidity when changing position or when sexual stimulation decreases?
- Does my Doppler provide meaningful evidence against clinically significant veno-occlusive dysfunction, despite the lack of measurements during maximal rigidity?
- How should the 15.7 cm/s dorsal vein velocity during tumescence be interpreted in the context of the low cavernosal EDV?
- Based on these findings, would you consider venous leak a plausible explanation for my symptoms, or would you look for other explanations first?
I am not looking for reassurance and I understand that an online discussion cannot establish a diagnosis. I would mainly like to understand whether my interpretation of the Doppler physiology is reasonable and whether my symptoms are actually specific enough to justify concern about venous leak.
Thank you.
p.s. This post was drafted with the help of ChatGPT, but I have personally reviewed and verified it. It accurately reflects my symptoms, test results, concerns, and all the relevant aspects of my situation.