Venous leak: why you can get an erection but not keep it

By Yosef Golowa, MD, FSIR · Published July 14, 2026 · 6 min read

Erectile dysfunction (ED) is a common condition affecting millions of men, yet it remains a sensitive topic, often shrouded in misunderstanding. Many factors can contribute to it, but one specific cause does not always get the spotlight: venous leak, also known as veno-occlusive dysfunction. If you can achieve an erection but struggle to maintain it, venous leak may be the underlying issue.

Here is what venous leak is, what it feels like, what causes it, and how a minimally invasive treatment called venous leak embolization works. If you want the treatments compared side by side, see venous leak treatment options; if your erection fades specifically when you shift position, see losing your erection when you change position.

First, what exactly is erectile dysfunction?

ED is the consistent inability to achieve or maintain an erection firm enough for satisfactory sexual performance. Occasional difficulty is not usually a cause for concern, but a persistent problem warrants investigation. ED can stem from physical factors such as heart disease, diabetes, or hormonal imbalance, from psychological ones such as stress, anxiety, or depression, or from a combination of both.

Understanding venous leak: when the trap door fails

A normal erection is a complex process involving nerves, muscles, emotions and, critically, blood flow. It happens in two stages.

1. Inflow. When you are aroused, nerve signals relax the muscles in the penis, allowing the arteries to widen and fill the spongy tissue, the corpora cavernosa, with blood.
2. Trapping, or veno-occlusion. As the penis fills and expands, it compresses the veins that normally drain blood away. This acts like a trap door, keeping the blood inside and maintaining rigidity.

Venous leak occurs when that trapping mechanism fails. The veins do not compress properly, and blood drains out of the penis too quickly. Even when blood flow into the penis is perfectly adequate, the inability to hold it there prevents a firm or lasting erection. It is like trying to inflate a tire with a hole in it: air goes in, but it escapes too fast for pressure to build.

Symptoms specific to venous leak

Symptoms overlap with other kinds of ED, but venous leak often presents in a recognizable pattern.

• Difficulty maintaining an erection. This is the hallmark. You may get an erection initially, but it softens or disappears quickly, often before or during intercourse.
• Erections that are not fully rigid. The erection may never reach maximum hardness.
• Losing the erection when you change position. Simply shifting during sex can be enough.
• A poor response to oral ED medication. Drugs such as Viagra, Cialis, and Levitra work mainly by increasing blood flow in. If the real problem is flow out, these medications may give only partial improvement, or none at all.

What causes venous leak

Several things can stop the veins working as they should.

• Age-related changes. Tissue loses elasticity over time.
• Underlying medical conditions. Diabetes, cardiovascular disease, high blood pressure, and Peyronie's disease, which is scar tissue in the penis, all affect the structure and function of the penile tissue and blood vessels.
• Nerve damage. Conditions affecting nerve signals, such as pelvic surgery, spinal cord injury, or multiple sclerosis, can interfere with the process.
• Surgery or trauma. Injury or an operation in the pelvic region can damage the relevant structures.
• Psychological factors. The problem is usually physical, but performance anxiety can make it worse.
• No identifiable cause. In some men no specific cause is found.

How venous leak is diagnosed

1. A detailed medical and sexual history, discussing the specific nature of your symptoms. The pattern matters as much as the symptom itself.
2. A physical examination, to check for underlying physical causes.
3. A penile Doppler ultrasound. This is the key test. An erection is induced, usually with an injection of medication, and ultrasound measures the speed of blood flow into and out of the penis. High outflow speeds point to a venous leak.

Traditional ED treatments, and their limits for venous leak

• Oral medication (PDE5 inhibitors). Usually the first line, but as above, often less effective when the leak is significant.
• Vacuum erection devices. A pump draws blood into the penis and a constriction ring at the base helps hold it there. Effective for some men, but cumbersome.
• Penile injections. Medication injected directly into the penis induces an erection. More effective than oral medication for some men with venous leak, but it requires self-injection each time.
• Penile implants. A surgical solution using rods or an inflatable device. Highly effective, but invasive and irreversible.

Venous leak embolization: targeting the leak directly

For men with a confirmed venous leak who have not succeeded with less invasive options, and who would rather avoid an implant, embolization offers a targeted approach.

What it is. A minimally invasive procedure performed by an interventional radiologist. Using imaging guidance, a tiny catheter is inserted into a vein and navigated to the specific veins draining blood away from the penis.

How it works. Once the leaking veins are identified, a medical-grade glue or another blocking agent is delivered through the catheter directly into them, closing the abnormal drainage pathways.

The goal. With the escape routes closed, more blood stays in the penis during arousal, allowing firmer and longer-lasting erections.

The advantages of this approach:

• Minimally invasive. No large surgical incisions.
• It targets the cause. The abnormal venous drainage is addressed directly rather than worked around.
• Outpatient. Performed in an outpatient setting, with no hospital stay.
• It preserves natural function. The aim is to restore the natural erection mechanism, unlike an implant.
• Encouraging results. Studies show significant improvement in erectile function for appropriately selected patients. Success rates vary between series, but many men experience a noticeable benefit.

Who is a good candidate

• Men whose ED is caused primarily by a venous leak confirmed on Doppler ultrasound.
• Men who have had an inadequate response to oral ED medication.
• Men looking for an alternative to more invasive options such as a penile implant.
• Men without severe arterial insufficiency, meaning poor blood flow into the penis, since embolization addresses only the outflow problem.

Take the next step

Living with ED, particularly the frustrating kind caused by a venous leak, can affect quality of life and self-esteem considerably. The encouraging part is that identifying the specific cause opens the door to a targeted treatment. Venous leak embolization is a meaningful advance, offering a minimally invasive way to restore natural erectile function for many men.

If you recognize the pattern described here, do not hesitate to seek help. A proper diagnosis is the first step toward finding the treatment that will actually work for you.

To learn more about venous leak embolization, or to find out whether you are a candidate, call our office at (212) 991-9991 or book an appointment with Dr. Golowa through this website.