Venous leak syndrome (VLS) affects all men. In time, every man gets it. Yet no one talks about it. Fortunately, for most men, there is an easy, non-pill solution.

Men with this condition get it up, but can’t keep it up as easily and as long as they could in their youth. In short, VLS is blood leaking from the penis’ veins. By age 70, men may be able to get just as “rock hard” as a 20-year-old. But with aging, the smooth muscles that constrict the veins weaken and the small veins get stiffer. This is also why, as we age, our feet and hands swell more easily than when we were young, like when we sit for a long time. While we can strengthen our skeletal muscles with exercises, working out our smooth muscles means having sex frequently. Good cardiac help and avoiding erection-interfering medications are also important. An erection pill can get more blood into the penis by opening up the arteries. But if men have VLS, how much blood will stay there and for how long to keep them hard?

Venous leak syndrome often leads to a loss of confidence as the condition worsens. In some cases, it can lead to depression and other emotional or relationship issues. In addition to the psychological effects, in severe cases, VLS can lead to physical complications such as loss of penile length and girth due to fibrosis in the penis caused by chronic insufficient filling of the penis overnight and during sex.

Early diagnosis of VLS can help reverse the long-term effects associated with the condition. Men who are concerned about VLS should see a specialist—usually a urologist—who will obtain a comprehensive medical history, ED questionnaires, a physical exam, and order a series of screening blood tests. Several tests can be used to diagnose VLS, including:

Penile duplex ultrasound: This test uses ultrasound waves to assess the penile tissue and blood flow in the penis with and without an erection. This test can identify the extent of venous leak.

A proven wearable device: A wearable can be used at home under real-life situations to measure the firmness and duration of erections. These erection rings do not require an office visit or any uncomfortable and embarrassing procedures in a doctor’s office. It can be used at home, in privacy, and under natural conditions. The Bluetooth-enabled phone app for these rings generates data that can then be shared with doctors.

Treatment for aging men with VLS can include:

1. Erection rings to constrain the venous outflow from the penis. Rings that also simultaneously block the arterial inflow should be avoided, as they can only be worn for 20 to 30 minutes. These have been demonstrated by research to be safe for up to 10 hours of use in thousands of uses.

2. Lifestyle changes: Weight loss, regular exercise, and smoking cessation can help improve blood flow and reduce the risk of developing venous leak syndrome.

3. Medications: Oral medications such as phosphodiesterase type 5 (PDE5) inhibitors (e.g., sildenafil, tadalafil, vardenafil) can help improve blood flow to the penis, but they are less effective at keeping it there.

4. Surgery: In some cases, surgery may be necessary to repair or correct any underlying structural issues that are contributing to the venous leak.

5. Penile prosthesis: A penile prosthesis is a device that is surgically implanted into the penis. The prosthesis can be inflated and deflated to create an erection and can be helpful for those who have not responded to other treatments.

It is important to note that the choice of treatment will depend on the underlying cause of the VLS and the individual’s preferences and general health. A health care provider will work with the patient to determine the best course of treatment.

Preventing VLS

The most important step that can be taken to help prevent the development of VLS in aging men is managing underlying medical conditions such as high blood pressure and diabetes. Men who are at risk for VLS should be aware of the symptoms and seek medical attention if they experience any symptoms.

It is important to note that VLS can be caused by a variety of factors and it is not always possible to prevent the development of the condition. However, taking steps to maintain a healthy lifestyle, tracking the firmness and duration of erections, and managing underlying medical conditions can reduce the risk of developing venous leak syndrome. It is important to speak with a health care professional for a proper diagnosis and to determine the best course of treatment.

Elliot Justin is an emergency physician.