Position-Dependent Erectile Dysfunction: What to Know

Have you ever lost your hard-on when switching sex positions? You’re making your way from doggy to the helicopter when, suddenly, your rotor fails. Welcome to position-dependent erectile dysfunction (or PDED).

There are many reasons you might experience PDED. But it often involves blood vessel issues like venous leakage. This disorder makes blood flow out of your penis too quickly during sex.

Keep reading to find out what causes venous leakage and what you can do to improve your erections.

Erectile dysfunction (ED) is one of the most common sexual dysfunctions. It affects around 30 million men in the U.S. and is more likely to happen the older you get (though guys of any age can have ED).

Men with ED have difficulty getting or keeping erections firm enough to have satisfying sex. If you have position-dependent erectile dysfunction, it means your erection quality changes with certain sex positions.

A venous leakage can cause PDED because certain positions can exacerbate pre-existing blood flow issues. When this happens, it’s called venogenic erectile dysfunction.

Apologies for all the clinical terms — we’ll break down what all this means below.

Venous leakage happens when the veins in your penis can’t store enough blood to maintain an erection. It affects around one to two percent of men under 25 and 10 to 20 percent over 60.

When an erection works as it should, blood pools in your corpora cavernosa — that’s the spongy part of your penis. It stays that way until you ejaculate.

A venous leak causes blood to drain (or leak) back into your body’s general circulation before you’re done.

Some research suggests venous leakage occurs when penis tissues lose collagen, making them less elastic. Less elasticity means less ability to trap blood and keep an erection. And like ED, collagen loss becomes more common with age.

Sometimes, people are born with blood vessel issues that cause abnormal blood flow. Other times, these problems develop over time due to medical conditions or injuries.

Venous leakage causes that may lead to position-dependent erectile dysfunction can include:

• Congenital abnormalities

• Medical conditions

• Injuries

Keep reading to learn more.

Congenital Abnormalities

A continental abnormality (sometimes called a birth defect) is a condition that develops in the womb, before birth. Some folks are born with a condition affecting the connection between their arteries and veins, causing abnormal blood flow and pressure. It’s called arteriovenous malformation.

In one case report of PDED, a man with this condition could only have sex while fully standing. Certain sex positions made him lose his erection due to changes in abdominal pressure.

Some men are also born with a venous leak (or veno-occlusive dysfunction). This disease results in lifelong ED and typically occurs in younger patients. 

Medical Conditions

If you have a high risk for conditions like diabetes mellitus or cardiovascular disease, you may also be at risk for ED. These medical conditions affect the blood vessels and can contribute to venous leakage.

Diabetes can damage nerves in the penis, and hypertension (high blood pressure) can cause a loss of smooth muscle cells in the penis, impacting blood flow.

Injuries

Traumatic injuries to the penis can also cause venous leakage and PDED.

Repeated injury to the penis during sex or other vigorous activities can lead to Peyronie’s disease. This is when built-up scar tissue creates a curve or another change in the shape of your penis.

Some research shows there’s a connection between Peyronie’s disease and ED due to abnormal blood flow.

You could have PDED if you struggle to get an erection in certain sex positions. However, there’s not enough evidence to confirm some positions work better than others.

Your healthcare provider might order specialized tests to figure out if you have a venous leak. They may also use a Doppler ultrasound or an MRI (magnetic resonance imaging) to monitor your erection in different positions.

But first, your provider will likely do a thorough medical assessment of erectile dysfunction to assess the severity of your symptoms.

This is to rule out psychogenic causes, meaning a condition has a psychological origin, like performance anxiety. Your ED could also be due to hormonal imbalances or medication side effects.

Some signs you may have abnormal penile blood flow:

• You’ve never been able to obtain a fully erect penis, suggesting a congenital venous leak or abnormality.

• You’ve experienced a penis injury in the past.

• You can get an erection, but it doesn’t last long enough to reach ejaculation or satisfy your partner.

• You lose your erection when you switch to different sex positions.

• You have weak morning erections (morning wood) or none at all.

• Your libido (sex drive) is unaffected.

How is it treated? Keep scrolling for answers.

Position-dependent erectile dysfunction treatment options for PDED range from prescription medication and injections to more invasive procedures that address the organic causes of ED, like surgery.

Your healthcare provider might also suggest treating PDED symptoms with unique devices like penile pumps.

Oral ED Medication

The first-line treatment for erectile dysfunction is typically prescription medication like phosphodiesterase type 5 inhibitors (or PDE5 inhibitors for short). These drugs improve blood flow to the penis by widening blood vessels.

Popular oral medications for ED include:

• Viagra^® (or its generic version, sildenafil)

• Cialis^® (and generic tadalafil)

• Stendra^® (avanafil)

• Chewable ED meds

These medications might help those with PDED. But know that some men with severe vascular disease may not respond to these prescription drugs.

Penile Injections

Another ED treatment option is alprostadil, an FDA-approved intracavernosal injection (meaning it’s injected into the penis). Like PDE5 inhibitors, alprostadil widens blood vessels to increase blood flow to the penis.

Other injections include BiMix^®, TriMix^®, and QuadMix^®, which combine alprostadil, phentolamine, papaverine, and atropine.

If injections aren’t your thing, alprostadil is also available as a suppository to insert directly into the urethra (that’s the tube urine and semen come out of).

Surgery

Surgeries for venous leakage don’t have the best track record for long-term success. But if you don’t respond to ED medication, your healthcare provider may suggest vein ligation surgery. To redirect blood flow to the penis, they’ll make an incision at the base of the penis to block particular veins.

Other outpatient procedures are available for redirecting blood flow but are less invasive. For instance, your provider might use heat or radiofrequency energy to block specific blood vessels. Or they may inject medications through a catheter for the same purpose.

While the above procedures can be successful for some men, their success is usually temporary.

Generally speaking, penile implant surgery is a last-ditch treatment option. It involves surgically placing rods inside the penis to support erections.

Other ED Treatment Options

Though penile pumps and vacuum devices won’t necessarily correct a venous leak, they can help improve erectile function. These devices use suction to draw blood into the penis, making it easier to get and maintain an erection.

Another gadget you may want to try is a cock ring. It can help slow blood flow out of the penis while providing extra stimulation for you and your partner.

If you only lose your erection in certain positions, we’ll state the obvious: Avoid them. 

But if your ED is caused by a venous leak, the best thing you can do is follow a healthy lifestyle while you and your medical provider discuss treatment options.

This can help you prevent diseases that worsen venous leakage, like diabetes and cardiovascular disease.

Lifestyle habits to help prevent position-dependent ED include:

• Following a well-balanced diet full of nutritious foods

• Exercising regularly

• Maintaining a healthy weight

• Finding healthy ways to manage stress levels

• Cutting back on alcohol

• Avoiding smoking

If you need help making any of these changes, don’t be afraid to consult a healthcare professional, meet with a nutritionist, or reach out to loved ones for support.

We know you want to impress your partner with acrobatic skills in the bedroom, but you may want to switch things up if your moves cause you to lose your erection.

You can also see a urologist or another healthcare provider to check if a venous leak is causing your ED.

Here’s what to remember about position-dependent ED:

• The underlying causes of position-dependent erectile dysfunction vary. However, the most common reason is venous leakage, when blood escapes from penile tissues too quickly.

• You can be born with a venous leak or develop it over time. Congenital abnormalities, medical conditions like diabetes, and traumatic injuries can all cause venous leakage.

• Position-dependent erectile dysfunction treatment is available. From ED medication to more invasive penile implant surgery, a range of treatments can help.

Ready to make the next move to tackle ED and improve your sex life? Consult a healthcare provider online to find the best ED treatment for your needs.