Venous leak, also called venogenic erectile dysfunction and penile venous insufficiency, is one category of vasculogenic impotence — a cause of erectile dysfunction in males. It affects all ages, being particularly awkward in young men. Much about venous leaks has not reached a consensus among the medical community, and many aspects of the condition, particularly its treatment strategies, are controversial. The prevalence of the condition is still unknown, although some sources claim it to be a common cause of erectile dysfunction. Signs and symptoms Many men with Venogenic Erectile Dysfunction start having trouble with their erections from a young age. Common complaints include a chronic soft erection insufficient for sexual intercourse, position-dependent erectile rigidity, difficulty achieving erections, difficulty maintaining erections without constant manual stimulation, loss of penile length and girth, and a soft glans of the penis during erection that is not fully engorged (also known as cold glans syndrome). Physicians often look for signs that suggest an organic cause of erectile dysfunction rather than a psycho-osmotic cause in making a diagnosis of venous leak. Such suggestive signs include (1) Erectile Dysfunction that is persistent on all occasions where an erection is required, including with a partner and without a partner during masturbation, (2) Loss of quality of morning erections, (3) Loss of quality of spontaneous erections, and (4) multi-treatment resistance to traditional erectile dysfunction medications including sildenafil and intracavernosal injection therapy. Causes Venous leak is an inability to maintain an erection in the presence of sufficient arterial blood flow through the cavernosal arteries of the penis. The defect lies in the excessive drainage of veins in the cavernosal tissue of the penis, which undermines normal erectile function. This provides extraordinary venous drainage from the corpora cavernosa of the penis despite the existence of a rigid erection and fails to adequately trap blood inside the corporeal chambers to maintain an erection of adequate strength or adequate length of time. It is still disputed as to what causes the excessive leakiness that is characteristic of the condition. However, it is mostly thought that the defect is in the connective tissue of the tunica albuginea surrounding the penile veins, most importantly, the deep dorsal vein of the penis, a pair of cavernosal veins, and two pairs of para-arterial veins between the Buck's fascia and the tunica albuginea of the penis. Recently hemodynamic studies were conducted in both fresh and defrosted human cadavers