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  • Writer's pictureKen Schafer

Venous Insufficiency: It’s Not Hopeless

Updated: Sep 14, 2023


How serious is venous insufficiency? If you have erectile dysfunction and venous insufficiency is the cause or a contributing factor, it’s not good news, but it’s not hopeless, either. There are treatments and ways to mitigate the problem. Accept that it will complicate dealing with erectile dysfunction, but it’s not a reason to give up!

How I discovered I had venous insufficiency

I had ED for many years, and like many men, I took Viagra and Cialis to treat it. Eventually, the pills stopped working, and I ended up working with Dr. Rachael Ross and starting on her program. I was willing to do the work to address my ED and committed fully to following the program to the letter. My routine was extensive, and I stuck to it and included the following.

  • A strict diet prescribed by my doctor

  • Exercising 5 days a week

  • Taking prescribed supplements

  • Taking prescribed hormones

  • Performing prostate massage 3 times a week

  • Performing Kegels exercises (AKA Dick-ups) daily

  • Using the Phoenix 3 times a week

  • Pumping 5 days a week

Unfortunately, after many frustrating months of diligent effort, my ED showed no improvement. I was afraid I might not be “fixable,” and I suspected venous leakage might be the reason for my lack of progress.

To get diagnosed, I went to a urologist recommended by Dr. Rachael Ross. Unsurprisingly, the tests indicated I had a moderate level of venous insufficiency. In other words, I couldn’t keep enough blood in my penis to maintain an erection.

Getting that news was a real punch to the gut because I thought I would probably have to resort to a penile implant. However, I wanted to try everything else first and saw an implant as a last resort.

Venous insufficiency

What Is it exactly?

Venous insufficiency (also known as Venogenic Erectile Dysfunction, Veno-Occlusive Insufficiency, and Venous Leakage) is a failure to achieve or maintain adequate blood volume and retention in the penis during an erection. In other words, insufficient blood volume enters and is trapped in the penis to get or keep an erection.

Erection mechanics

To get an erection, the smooth muscles in the arteries of the penis relax, allowing them to dilate (widen). As they dilate, more blood enters the penis filling the corpus cavernosa and corpus spongiosum tissues. As those tissues fill with blood, they compress the veins of the penis, preventing blood from flowing out. So the extra blood is trapped in the penis, keeping it erect.

Diagram of Penile Tissues

Causes of Venous Insufficiency

Two primary mechanisms can contribute to venous insufficiency. One involves the arteries, which let blood into the penis, and the other is the veins which let blood out of the penis.

How arteries contribute to venous insufficiency

The smooth muscles in the arteries of the penis don’t relax enough, and the arteries don’t dilate properly, preventing an adequate volume of blood from entering the penis for an erection.

How veins contribute to venous insufficiency

The cavernosal tissues don’t provide enough pressure on the veins of the penis. This lack of pressure allows too much blood to escape, and adequate blood volume cannot be maintained.

One or both of these conditions can result in venous insufficiency. Maintaining an erection requires the arteries to let in enough blood and for the veins to be closed off enough to prevent too much blood from escaping. If one or both of these are not functioning correctly, the result is having problems getting or maintaining an erection.

Risk factors

The root causes of venous insufficiency are poorly understood, and there may be many contributing risk factors. Here are some risk factors that are suspected of contributing to venous insufficiency.

Possible contributors to venous insufficiency

  • Stress

  • Neurological problems

  • Side effects from drugs

  • Chronic diseases like diabetes

  • Lower urinary tract issues

  • Low testosterone


Venous insufficiency symptoms include the following:

  • Unable to get or maintain an erection

  • An erection that is too soft for penetration

  • Able to get an erection in some positions but not others (position-dependent erections)

  • Penis length becomes shorter

  • Penis girth becomes more narrow

Unfortunately, most of these are symptoms of erectile dysfunction generally, not just venous insufficiency. So to determine if you have venous insufficiency, you will need specific medical tests for proper diagnoses.


Is there a test for venous insufficiency? Yes, there are many tests for diagnosing venous insufficiency, and here are two commonly used tests I have experience with.

Intracavernous injection of vasoactive agents

For this test, a mix of compounds designed to cause an erection is injected into the penis. Using an injection alone is more of a screening test, and it’s not considered conclusive because the rate of false positives is relatively high.

Color duplex Doppler ultrasound with intracavernous injection

This test involves injecting the penis with trimix compound and imaging blood flow with ultrasound. This is currently the most commonly used test for venous insufficiency. This test is excellent for diagnosing problems with the arteries but not as much for concerns with veins. So, it has some limitations, but it’s a popular non-invasive test for venous insufficiency.

Other Tests for venous insufficiency

Here is a link to a literature review with an exhaustive list of tests for venous insufficiency with all their advantages and disadvantages.

Ma M, Yu B, Qin F, Yuan J. Current approaches to the diagnosis of vascular erectile dysfunction. Transl Androl Urol. 2020 Apr;9(2):709-721. doi: 10.21037/tau.2020.03.10. PMID: 32420178; PMCID: PMC7215019.


General ED treatments used for venous insufficiency

Many doctors will simply use the standard treatments for ED for men with venous insufficiency. Below is a list of some of the most common treatments for ED.

PDE5 Inhibitors

Phosphodiesterase Type 5 Inhibitors (PDE5 inhibitors) are vasodilating drugs. Viagra and Cialis are the most commonly known of these drugs, but there are others. They promote blood flow to the penis.

Penile injections

Penile injections are also called trimix injections. The injections usually, but not necessarily, consist of the 3 separate compounds injected directly into the penis to cause an erection. Doctors will vary the compounds used based on the patient. Sometimes these compounds can also be administered through the urethra rather than by injection.

Pump and cock ring

A penial pump uses negative pressure to pull blood into the penis to create an erection, and a cock ring traps the blood.

Penile implants

Penile implants are inflatable structures surgically inserted into the penis. When an erection is desired, the implants are inflated and deflated when no longer needed.

Medical treatments for venous insufficiency

I’ve had doctors tell me that there were no specific treatments for venous insufficiency. That is not true, and what is true is that the available treatments may not always be very effective. These treatments aren’t only used for venous insufficiency but are definitely used to treat it. I received acoustic wave therapy, the P-shot, and Botox injections; in my case, they significantly improved my ability to get an erection.

Acoustic wave therapy

Acoustic wave therapy uses sonic shock waves to create microtraumas in the penis to stimulate the growth of new blood vessels.

Acoustic wave therapy is also believed to increase Nitric Oxide (NO) sensitivity. Nitric Oxide is a critical compound for getting erections. If you don’t produce enough of it or are not sensitive to it, you will have problems getting an erection.


The P-Shot involves taking platelet-rich plasma from your blood and injecting it into your penis. The purpose is to promote tissue growth. It is commonly used in combination with acoustic wave therapy to help promote the development of new blood vessels.

BotoxⓇ Injections

BotoxⓇ is administered by injection and is used to relax the smooth muscles in the arteries of the penis, allowing for better blood flow into the penis.

Other interventions

Improved Health

An essential part of addressing ED is getting healthy through diet, exercise, sleep, and avoiding environmental toxins. If you have any specific health issues, you must do everything you can to address them and manage whatever medications you are taking. Whether or not your ED is caused by venous insufficiency, getting healthy will help you to get the best possible outcome.


Dieting is a complicated subject, but generally, diets similar to the Mediterranean Diet are recommended, and you want to eat lots of fruits and vegetables. In particular, you want vegetables rich in nitrates to produce the Nitrous Oxide essential for erections.

I do not recommend going vegan or vegetarian because getting enough essential fats and proteins on these diets is difficult. So, while there is no diet for venous insufficiency, addressing your diet is still important.


Exercise is another complicated subject. High-intensity interval training (HIIT) is known to help increase testosterone levels. It is essential to get your body moving, even if it’s just walking. Most exercises won’t directly address venous insufficiency, but there is one called a Kegel that does. I talk more about Kegels below.


Adequate sleep is also essential to good health, and it’s also when your body generates testosterone. So, getting sufficient sleep will often significantly increase testosterone levels and many other health benefits.

Environmental Toxins

Our environment is filled with endocrine-disrupting compounds (EDCs). Two of the most significant sources of EDCs are plastics and pesticides. So get plastics out of your kitchen, and never store or cook food in plastic. To avoid pesticides, buy organic food. If you want to learn more about EDCs, check out

Cock rings

If you have venous insufficiency, a cock ring might be a game changer. It helps to trap blood in your penis and makes it much easier to maintain an erection.

Warning on the use of cock rings!

If you use a cock ring, never use it under the influence of drugs or alcohol or when you might fall asleep while wearing it. You should never wear one for more than 30 minutes. Wearing one for over 30 minutes can damage your penis and lead to severe complications.

There are many types of cock rings. In general, you should look for a cock ring that has a quick-release mechanism. You don’t want to be in a situation where you can’t get it off. Fortunately, cock rings are generally not very expensive, so you can probably buy several types and choose the one you like.

Sexual positions and venous insufficiency

Men with venous insufficiency often find they can get an erection in some positions but not others. For most men, standing positions are better, followed by sitting positions. Reclined positions will generally give the worst results, but it’s not the same for everyone. In my case, I get the best results when reclined, followed by sitting. I can’t get or maintain an erection while standing. If your ability to obtain and maintain an erection depends on specific body positions, that indicates venous insufficiency.


Kegel exercises will help you to strengthen your pelvic floor. Strengthening your pelvic floor can improve your ability to keep blood in your penis and maintain an erection. So this exercise may directly help with venous insufficiency.

How To Do Kegel Exercises

Check out this video on Kegels.

Pelvic Floor Therapy

In some cases, men with venous insufficiency can benefit from Pelvic Floor Physical Therapy.


A venous insufficiency diagnosis probably means treating your ED will be more difficult. The effectiveness of the treatment for venous insufficiency varies greatly. Some men will get great results, while others may not. If you are not getting good results, the option of last resort is a penile implant. It’s worth trying everything else first.

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