ANSWER IN BRIEF
A venous leak, also called cavernovenous leakage, can cause erections that are difficult to maintain because blood leaves the erectile tissues too quickly. Diagnosis should not rely on symptoms alone: it requires a clinical assessment and, in selected patients, pharmacologically stimulated penile Doppler ultrasound and caverno-CT. Treatment depends on the confirmed cause and the patient’s individual situation.
WHAT IS A VENOUS LEAK?
An erection depends on two coordinated vascular mechanisms: sufficient arterial blood must enter the penis, and the venous outflow must be reduced so that this blood is retained within the corpora cavernosa.
When the veno-occlusive mechanism does not function adequately, blood drains too rapidly. Erections may then be insufficiently firm, unstable or short-lived. This is known as cavernovenous leakage.
WHAT SYMPTOMS MAY SUGGEST CAVERNOVENOUS LEAKAGE?
• Difficulty maintaining an erection despite adequate desire and stimulation.
• An erection that loses firmness rapidly.
• Limited or inconsistent response to PDE5 inhibitors such as sildenafil or tadalafil.
• Persistent erectile difficulties in a younger man without obvious cardiovascular risk factors.
These symptoms are not specific. Psychological, hormonal, neurological, arterial, metabolic and medication-related factors may coexist. A medical diagnosis is therefore essential.
HOW IS A VENOUS LEAK DIAGNOSED?
The assessment begins with a detailed medical and sexual history, examination and appropriate laboratory testing. When a vascular cause is suspected, a structured erectile dysfunction evaluation is required:
https://www.drallaire.com/erectile-dysfunction
Pharmacologically stimulated penile Doppler ultrasound
Penile Doppler ultrasound evaluates arterial inflow and venous parameters after pharmacological stimulation. Technique and interpretation matter because an incomplete pharmacological response can produce false-positive results.
Pharmacologically stimulated caverno-CT
In selected patients with a well-supported suspicion of cavernovenous leakage, caverno-CT can provide a detailed anatomical map of the venous drainage. This information may be useful when an intervention is being considered.
WHAT TREATMENTS MAY BE CONSIDERED?
Treatment must be individualized. Depending on the cause and severity, options may include risk-factor management, medication, intracavernous injections, psychosexual support when appropriate, vacuum devices, vascular procedures or penile prosthesis.
Overview of erectile dysfunction treatments:
https://www.drallaire.com/erectile-dysfunction-treatments
For carefully selected patients with drug-resistant erectile dysfunction and objectively documented cavernovenous leakage, Professor Éric Allaire has evaluated a combined approach using venous ligation and endovascular embolization during the same procedure. The rationale is anatomical: some abnormal venous pathways are more accessible endovascularly and others surgically.
WHAT DOES THE PUBLISHED EVIDENCE SHOW?
In a 2021 prospective series of 45 patients, the combined protocol was associated with a primary success rate of 73.3% and a secondary success rate of 82.2% after additional treatment, at a mean follow-up of approximately 14 months.
A 2025 study of 171 selected patients reported a composite success rate of 80.2% after combined ligation and embolization. These results concern defined clinical cohorts. They do not constitute a guarantee of individual success and require careful patient selection and follow-up.
SCIENTIFIC REFERENCES
• Allaire E et al. Ligation and Embolization in One Procedure for Cavernovenous Leakage in 171 Patients with Drug-Resistant Erectile Dysfunction. Annals of Vascular Surgery. 2025;121:664–672.
DOI: https://doi.org/10.1016/j.avsg.2025.08.025
• Allaire E et al. Erectile Dysfunction Resistant to Medical Treatment Caused by Cavernovenous Leakage. European Journal of Vascular and Endovascular Surgery. 2021;61(3):510–517.
PubMed: https://pubmed.ncbi.nlm.nih.gov/33067110/
• Sussman H et al. Ultrasonography after pharmacological stimulation of erection for the diagnosis and therapeutic follow-up of erectile dysfunction due to cavernovenous leakage. Journal de Médecine Vasculaire. 2020;45(1):3–12.
PubMed: https://pubmed.ncbi.nlm.nih.gov/32057324/
Scientific publications of Professor Éric Allaire:
https://www.drallaire.com/scientific-publications
WHEN SHOULD YOU SEEK SPECIALIST ADVICE?
Persistent erectile dysfunction, worsening symptoms or an inadequate response to medication warrants medical assessment. Erectile dysfunction may also be associated with cardiovascular or metabolic disease and should not be dismissed as an inevitable consequence of age or as purely psychological.
Request a confidential consultation:
https://www.drallaire.com/contact
Medical content: Professor Éric Allaire, vascular and endovascular surgeon, Clinique de Genolier.
Last medically updated: 18 September 2026.
