Discover the #1 Erectile Dysfunction cause is vascular or blood flow! Learn all about how blood flow affects your erections and ...

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The Science of Getting Hard &amp; How Blood Flow Impacts your Erections

have you ever wondered why your erections work the way they do I'm Dr Reena Malik urologist and pelvic surgeon and I'm going to cover exactly what happens in terms of blood flow when you have an erection and how issues with blood flow can cause problems in fact vascular problems are the number one cause of erectile dysfunction in men so what happens well first of all you need to understand the anatomy of the penis so the penis is made up of corpa kosa and those are the two spongy cylinders on the inside of the penis they're covered by the tuna alenia which is a firm sheath that's around those tissues which is then covered by skin interestingly the tuna is actually noted to have the strength of steel so it's actually quite quite strong now what happens during erections is first you have to understand the Baseline state of the penis at Baseline the muscles or the smooth muscles in the penis are contracted as well as the the arteries to the penis are mildly contracted and so it's got a mild oxygen state of about 30 to 40 milligram of mercury when you get aroused the nerves or the cavernous nerve terminals will release a substance called nitric oxide and that's why you'll often hear me say nitric oxide is the ignition for erections when this is released by your body the muscles relax and the arteries widen which allows blood flow to flow in this then begins to compress the veins that are around the penis that allows for the first phase of erection called the latent phase and as the penis fills the tuna alenia remember that wrapping that's as strong as steel expands and pushes against additional veins leading to the tessent phase now that's when you are pretty hard now when those veins get flattened to the maximum potential the inflow is maximal and the blood flow can't get out and the pressure can go as high as 100 mm of mercury now what this means is you are going to have the most rigid erection or the rigid erection phase now this is also a time when the isoc cavernosus muscles can have rhythmic contractions in response to this firm erection and so that's essentially the muscles that are around the penis that causes this sort of rhythmic contraction erections are much more complex than just blood flow but like I said for this video we're just going to focus on blood flow so the initial D2 Messin or the first part of losing an erection is typically when the arteries Vaso constrict or begin to get smaller so that inflow starts to reduce this then allows the veins to slowly open up and let the blood flow out and this is called the late dessant phase and so this is all normal physiology when the arteries have damage to them like things like having heart disease where you get plaques in your arteries or high blood pressure when the vessels actually become a little bit thicker making more resistance to letting blood flow through this can actually affect your penis before it affects anywhere else in the body like your heart because the arteries to the penis are significantly smaller than the arteries to the heart this obviously can make it more difficult to get an erection because the blood has to overcome this increased pressure to get into the penis now the interesting part about this is over time this can cause the amount of oxygen getting into the corpa to be lower so you're having less oxygen in those penal tissues and this over a prolonged period of time something called chronic hypoxia causes actual changes to the tissue so you're actually getting more different types of factors like TGF beta an increased production of certain types of collagen fibers which can eventually lead to fibrosis which is essentially scarring of those tissues which means that they can't expand as much and get as much blood flow into them to create the erection and even when they do get blood flow into them they don't expand as much because they're not as elastic now this is a problem because a lot of people will say that my penis is shrinking right I'm not noticing that my penis is as long as it was when I was younger sometimes that's part of just having a larger body weight if you have more body fat in the mons area or the area right above the penis your penis will appear shorter but also it can be because they're having erectile dysfunction and it continues to perpetuate and the oxygen in those tissues gets lower and lower and that's actually causing changes in the tissues this is different from Venus leak and there's a lot of discussion about arteriogenic versus Venus leak erectile dysfunction so what exactly is Venus leak Venus leak is essentially when blood flow enters the penis the veins don't get compressed well or they are unable to compress well so the blood just essentially leaks right out so you may get a good erection but it tends to go away very quickly now the most common causes of this are things like trauma maybe having something like Peron disease where you get plaque formation in the penis if you want to learn more about that check out my video on curved penises where I talked about it it can be due to priapism where you've had an erection that lasts longer than 4 hours and then you've subsequently developed some trauma or fibrosis to the area it can also be due to those oxygen changes that we talked about due to arterial dysfunction then leading to Venus leak so you can sometimes have both together and lastly it can be due to congenital vascular problems so if you have problems with your veins that you've had since you were born it can also affect the ability to get erections so TP typically what we find in particular patients who just present with Venus leak is they're never really able to get a firm enough erection to penetrate it's been that way for years and they very infrequently have nighttime or early morning erections so in some people what they'll see is that Tunica alenia has weakened or atrophied and so it doesn't compress those veins quite as well as it used to now there's nothing we have that's going to firm up that tuna albinia tissue except for generally working on lifestyle right anything you do to improve your health your nutrition with exercise that's going to help the health of your tissues all over your body including your penis now typically you can diagnose this with a penal Doppler ultrasound however penal Doppler ultrasounds are not perfect tests they are very operator dependent and they can have false positives if you're having too much anxiety on the day of your test or if you don't get the right right dose of medication and typically they require you to get a pharmacologic erection so which means that you'll get an injection with medication into the penis that's going to make you have an erection and so that in of itself can create a lot of anxiety and again like I say very operator dependent so many urologists including myself do not offer penal Doppler ultrasound because ultimately the treatment options are not different now I will say that certain things Venus leak does not respond too well so Venus leak is not going to improve with shock wve therapy it's not going to improve with PRP injections and those are certain things that are certainly talked about a lot right now as regenerative therapies but they are not shown to be beneficial in this patient population now things like medications work a little less often than these patients but sometimes they do help and so it's worth trying you can try medications like pd5 Inhibitors I've talked about seleny and tadalfil in other videos so you can learn more about them you could also use things like constriction bands or using a vacuum erection device which will then help compress those veins so that you can sustain the erection for longer alternatively you can try pharmacologic injections that you inject into the penis that can create erections that you do about 10 minutes before sex and honestly I think a lot of people get really nervous about the idea of injecting their penis rightfully so but I will tell you many of my patients have told me that it was nearly not as bad as they thought it was going to be and they love the ability to get an erection relatively quickly when they feel the need to and it's really not a huge of a pain as it sounds and then lastly there are surgeries like penal implants and sometimes in patients with Venus leak we end up going to penal implant surgery sooner because these other options don't work as well but I always encourage my patients to try as many of the other options as possible available to them before going to penal implant so they can really feel confident in their decision to have surgery I've talked again about penal implants on prior videos so check those out you may have heard about things like vascular surgeries or embolization for Venus leak however if you look at the data critically basically they do show shortterm benefit in terms of improving vascular flow and improving the ability to get and sustain erections but after about 12 months the success rate goes way down to about 25% and there of course are risks associated with these surgeries that can include numbness of the penis and other sorts of negative side effects that are certainly not worth it for a 25% success rate which is why you're going to be hardpressed to find a urologist that will offer something like that because as of yet we have not seen the evidence that these are successful in the long term now if you've had a recent trauma and you've very quickly get seen sometimes there can be benefit but this is a very small subset of people and to my knowledge there's only a handful of surgeons in the country that offer these surgeries so as always I hope you guys found this helpful um let me know what else you want to learn about in the comments below and if you want to see me as a patient check out my website www.ram Malik md.com you can make an appointment there I see patients in person in both Los Angeles as well as Newport Beach and I can see you via tele medicine if you're located in a multitude of States including New York New Jersey Maryland Texas Virginia Illinois Florida and of course California and as always I'm going to take care of yourself because you are

Dr.

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